What the doctor needs to know

You are not feeling ok.  You are not sure what you have or what needs to be done, so you decide to see a doctor.

Photo credit: http://phodyr.deviantart.com/art/11th-Doctor-vs-the-Daleks-209807302

The doctor, like an investigator, or fishing expert needs to know some things in order to form an impression.  These are the usual questions we ask:

What are the symptoms?  There is usually a reason why a person sees a doctor.  Whether it’s a headache, tummy ache, pain, weakness, do let us know so we know what to look for.  Describe the symptoms — for example, if your tummy hurts we’d like to know where exactly and how you would describe the pain.

Of course, there is also the possibility that you just want to make sure everything’s working ok even if you do not feel anything untoward.  That’s also ok, just tell us.

When did the symptoms start?  Did the symptoms start just yesterday?  Or did it start months ago?  A headache that occurred just yesterday may signal something different from a headache that’s been around for weeks.  It would also be helpful to note if there were any prior incidents that would have contributed.  For example, a tummy ache that occurred after eating in a certain restaurant or eye pain after welding.  Any accompanying symptoms too.  For example, tummy ache only, or accompanied by vomiting?  These information are relevant.

What was done to address the symptoms?  Were they effective?  For example, when you had the headache, did you take Paracetamol or another analgesic?  Did the headache go away?  Did you see another doctor before coming to see me?  What was  prescribed?  If you know that you are going to have trouble remembering the medications, bring the prescription and or the medications themselves.

Your medical history — any history of surgeries, accidents, chronic health concerns, maintenance medications?

Your family history?  Many health concerns have a genetic predisposition.  For example, you are at higher risk for hypertension if people in your family have this.

Your personal history?  What’s your current occupation?  Do you smoke or drink?  These could tell us what conditions you are more at risk for.  For example, if you work as a welder and you do not wear eye protection, the stinging pain that you may experiencing may be welder’s keratitis.  We certainly would not think of that condition for somebody who has never done welding or stood close to somebody welding in his life.

Oh, and if the doctor asks you about sex — please don’t get offended.  We are not judging here — it’s not our place.  We just want to rule in or rule out problems that may occur with sex, like a sexually transmitted infection, for instance. So, please don’t hide these stuff from us.

Current medications?  This would give us clues as to your condition.  Do be honest and tell us if you have followed the doctor’s instructions to the letter.  We can then gauge if the treatment has been truly effective or not.  Bring your prescription or samples of your meds if you will have trouble remembering their names.  If you are seeing an ophthalmologist, it helps to bring your current spectacles.

Of course, the doctor needs to do physical examination to arrive at a working impression.  If you had given enough information and clues, there’s a better chance that the doctor would know what to look for and consequently arrive at a more accurate diagnosis so that we would be able to help with your current situation.

2013 is here!

Again, the Philippines welcomed the New Year with a flurry of noisy firecrackers!  We were fortunate to have a great view of a fireworks display from our window, hence we, the kids especially, were able to enjoy the view without exposing ourselves to the smoke and to the danger of being too near explosive materials.

I haven’t read the news but I’m sure this day will have the sad news of someone incurring firecracker injuries.  Being a first hand witness to some horrific injuries that were completely avoidable, I wouldn’t want anybody in my family to be added to the stats.

Now, the other problem of indulging — it’s pretty difficult NOT to eat a lot during the round of parties.  The start of the new year should be the end of that!

Oh, we have a giveaway over at my other blog, to celebrate new beginnings.  I do invite you to join.  Here’s the link: http://www.ethanmama.com/2013/01/a-giveaway-for-the-new-year/

May you have a year to remember this 2013!  May good fortune and good health be yours :)

Labs on wheels

Doctors, midwives, and other health care workers doing the heroic job of serving the far flung barrios know how difficult and yes, sometimes frustrating it is to be where they are.  Not only is there a dearth of funds for proper and complete medical care, it’s also difficult to have ancillary and diagnostic procedures done.  Most needed procedures are deferred because the barrio does not have the required equipment to do the diagnostics.  Most patients are referred to the cities where there is generally more facilities.  However going to the city requires money for fare. Most people do not have any health insurance – and do not know they can check quite easily to see if they qualify for a European health insurance card here. More importantly, some patients just cannot travel long distance, hence the doctor is forced to treat empirically.

Although many laboratories now offer home services, most often these are limited to procedures like blood works wherein the only real service done at home is the drawing of the blood and the specimen is sent to the laboratory for analysis.  But of course this could be done only for households that are not too far from the laboratory.

Since the government has initiated the doctors-to-the-barrios, I wonder if they would consider also mobile laboratories and mobile imaging devices (like xrays and ultrasounds) to serve the more far flung parts of the Philippines.  These would somehow make it easier for both the doctors and the other health workers.  While it’s possible to treat without having to order ancillary procedures, there are times that we doctors need more information to make a better assessment on the patient’s condition and what else, if possible, we can do to remedy the situation.

The challenge of public health is for government to make health care accessible to people everywhere in the country.  Door to door vaccination is a great step, but there should be continuous efforts to bring health care closer to the people.

FAQs about Glaucoma

It’s World Glaucoma Week!  This is established to mainly raise awareness of this disease.

Glaucoma is a disease of the eye that is largely mysterious to the general population, even if it is the second leading cause of blindness in the world.

FAQs about glaucoma:

What is glaucoma?

Quote from http://emedicine.medscape.com/article/1206147-overview:

“The definition of glaucoma has changed drastically since its introduction around the time of Hippocrates (approximately 400 BC). The word glaucoma came from the ancient Greek word glaucosis, meaning clouded or blue-green hue, most likely describing a patient having corneal edema or rapid evolution of a cataract precipitated by chronic elevated pressure. Over the years, extensive refinement of the concept of glaucoma has continued, accelerating, especially in the last 100 years, to the present date.

Glaucoma is currently defined as a disturbance of the structural or functional integrity of the optic nerve that causes characteristic atrophic changes in the optic nerve, which may also lead to specific visual field defects over time. This disturbance usually can be arrested or diminished by adequate lowering of intraocular pressure (IOP).”

Glaucoma is a disease

How do I know if I have glaucoma?  What are the signs and symptoms of glaucoma?

Unfortunately, in most cases of glaucoma, the patient does not feel anything at all!  Visual loss usually starts from the periphery (from the sides) so the person usually does not feel that he is already losing vision until the loss is large enough that he starts bumping into things.

However, some patients may experience sudden, severe eye pain, headache, sudden blurred vision, nausea, vomiting, seeing rainbows around lights (iridiscent vision).  This usually happens if the onset of the glaucoma is sudden (acute).

My doctor says that I am a glaucoma suspect and has requested for some tests.  What does this mean?

This means that your doctor probably thinks your optic nerve’s appearance looks suspicious and/or your intraocular pressure is elevated.  However, you will need to undergo other tests in order to establish if glaucoma is, indeed present.  These tests may include automated perimetry (to check your peripheral vision), optical coherence tomography (to check your retinal nerve fiber layer), gonioscopy (to check your angles — your drainage system), disc photos (photos of your optic nerve), etc.  The doctor will determine which tests you need.

Normal vision.This image is in the public domain because it contains materials that originally came from the National Institutes of Health (http://www.nih.gov/)


A scene as it might be viewed by a person with glaucoma. This image is in the public domain because it contains materials that originally came from the National Institutes of Health (http://www.nih.gov/)

My doctor says that I have glaucoma.  But I feel fine and my vision is great.  Can I just take the medications when I feel something?

Glaucoma is often called “the thief in the night”.  That’s because you begin to lose vision even when you don’t feel it, as the visual loss begins from the periphery going to the center (see photos above).  By the time the visual loss is perceived, the damage has already been made.  Unfortunately, damage to the optic nerve is considered irreversible.  Hence it is important that maintenance eyedrops be put on a regular basis to slow down the progression of the disease.  Check this link out to view how the visual loss progresses.

I believe my doctor!  I am putting drops in my eyes for glaucoma.  He told me to go back for a follow up.  But I am very busy.  Can I just go back when I need to?

Follow-ups are VERY important in glaucoma.  During the follow up, your doctor will determine if the treatment is still working as planned so that any necessary changes may be made if it is not.

I used up the bottle of eyedrop that the doctor prescribed.  I am not yet scheduled to go back for follow up.  Do I stop the meds or do I continue?

Continue your medications.  The eyedrops are considered “lifetime” medications.  Unless your doctor tells you to stop, DON’T.

My doctor says that I need laser for my glaucoma.  What is this?  Will this improve my grade?

Depending on the type of glaucoma, your doctor may be referring to a laser iridectomy, a trabeculoplasty, an iridoplasty or a cycloablative procedure.  None of these are the same as LASIK, which is the most popular laser procedure designed to free you from the use of glasses.

The laser procedures used for glaucoma are designed to help lower the intraocular pressure (or IOP, the pressure inside the eye) because it has been proven that lowering the IOP slows down the progression of visual loss.

My doctor says that I will need surgery for my glaucoma.  Will this surgery improve my vision?

If your surgery is a simple filtering surgery (trabeculectomy), we don’t really expect any visual improvement.  If the surgery is a surgery combined with cataract, your vision will likely improve because your concomitant cataract has been removed.

I saw my doctor because I found that my vision is getting blurred.  I was told that I have glaucoma and was treated for a few months already.  When will my vision get better?  I don’t really see any improvement?

Unfortunately, treatment for glaucoma is designed to preserve the remaining vision.  Any vision that was previously lost due to the glaucoma is considered irreversible.  That is why it is important to catch the disease early, when any visual loss will be mild and not very noticeable to the patient.

I was told that I may have glaucoma.  How it that possible?  I am quite young.  I though only old people get the disease?

While glaucoma is most common for the elderly age group, it does occur to anybody of any age group.  Even babies and children may have glaucoma (congenital or developmental) although this is not very common.

I hope through this article, I have done a small part in educating the public about glaucoma.  Do feel free to ask me about this disease. :)

Basic Contact Lens Care

Photo: “January 8 - 15, 2011” by Victor Martinez, c/o Flickr. Some Rights Reserved

Although I’m also do online selling on the side, one thing I don’t sell is contact lenses.  That’s because I am well aware of the risks of contact lenses.

Let me qualify that.  I think contact lenses are a great invention, especially for people with high error of refraction.  However, many people who use contact lenses DO NOT know how to manage them.

What’s worse is that there are now people who wear cosmetic contact lenses without bothering to understand how to take care of it.

Some of the things you have to do when you are a contact lens wearer are pretty easy.

  • Don’t share contact lenses.  There are some people — especially those who do not have any error of refraction but simply wear contact lenses to change the color of their eyes– who share their contact lenses with friends in order to save.  This is not like a T-shirt or a blouse that you can lend to other people.  Treat contact lenses like you would treat your intimate wear.  It’s only for the use of one person.  Otherwise, you risk infections.
  • Don’t go to bed with your contact lenses on.  While there are newer contact lenses which are very oxygen permeable AND comfortable, so much so that it doesn’t hurt when you sleep with them, it’s still not a good idea to actually go to bed with them.  Most infections that we see involve people sleeping with their contact lenses on.  So, to be on the side of safety, do remove your contact lenses before you retire for the night and disinfect them well before putting them on in the morning.
  • Have a pair of glasses as backup.  I’m pretty surprised when my patients say that they do not wear glasses and do not even have a backup since they started wearing contact lenses.  What if they lost their contact lenses?  Or for some reason, they can’t wear their contact lenses?  Especially if the vision without correction is really bad.
  • Use your lubricant.  There’s a reason why it’s included in the starter kit.  Contact lens users are prone to dryness, resulting to occasional redness or stinging sensation.

Other tips:

  • After taking out your contact lens from the container that it’s been soaking in, throw away the solution that’s in the container and dry the container.  At the end of the day, you can use the container again with a fresh batch of solution.  Do not reuse the solution, as much as possible.  That’s because the solution may already be contaminated with microbes that may cause problems on your eyes.
  • Try to store your contact lens, the containers and the solution in your bedroom or somewhere else cleaner than the bathroom.  The bathroom is a source of microbes which might infect your contact lenses and accessories.
  • If you get eye irritation or infection, stop using your contact lenses and have yourself checked so that the proper management can be instituted promptly.  This is where your backup eyeglasses will come in handy.
  • Take “contact lens holidays” once in a while. :)
  • Buy your contact lenses from reputable retailers.  Especially those who can teach you to handle them properly.

So there!  Contact lenses are not really bad.  People just need to take care of them (and their eyes) more.  It’s sad that most complications that we get are actually preventable if only proper care were instituted.

Fake meds seized in Pangasinan

We see them everywhere — fakes.  Pirated DVDs, fake designer bags, fancy jewelry.  People buy these mainly because of the price.  Of course, they are cheaper than the original, but of course they lack something — clarity, durability — depends on the item actually.

But one of the worst things that you could fake is medicine.  Because medicines are there to save lives, and fake medicine won’t.  Thank goodness the government has caught some people involved in selling fake medicines:  http://www.abs-cbnnews.com/video/nation/regions/03/08/12/nbi-agents-seize-fake-meds-pangasinan

That’s why I usually buy medicine at reputable drugstores.  That’s because I’m sure the meds I buy are genuine.  And while there are generic meds, I always advise patients to check out the company.  If it’s some fly by night company that nobody has ever heard of, I couldn’t be sure of the quality.

Same goes for owners of drugstores.  It’s best to deal with the supplier or distributor of the meds.  If somebody offers meds at cheaper than direct prices, something may be wrong here.

Saving on medicine is sometimes necessary, but do draw a line somewhere.  If the price for a branded med is too good to be true, it probably is.

Tax Season

I see quite a few accountants in my clinic lately, many of them complaining of symptoms that could be attibuted to eye fatigue secondary to the nature of their work — computers, paperwork and figures.

That’s because the deadline of the filing of the income tax is next month, April 15 to be exact.  Our friendly accountants, especially if they have a lot of clients, are already busily trying to beat that deadline, some of them won’t even be able to enjoy the much anticipated Holy Week break.

Fellow doctors (note to self), do mark that on your calendars, and make sure to submit all info ASAP so your accountant can help you finish it on time.

Missing posts

http://www.joeymd.com/2010/05/12/modern-tools-for-assisted-mobility/ — found in google cache







Modern tools for assisted mobility

The Philippines is not exactly handicap-friendly. While we may have parking spaces for handicapped, we hardly have any other facilities to make mobility easier for people who need assistance in mobility. Forget about getting into the LRT/MRT/Megatren if you need a wheelchair or crutches. Sure there are elevators, but once you get to your desired floor, it would be difficult to get into the train itself. And even then, you need assistance from another person. Ditto buses. Taxis or private cars are the way to go, but even then, it’s not easy.

At home, we don’t usually plan for something unexpected like losing the use of a leg or getting a stroke. Not to mention that we try to maximize the lot area that we have by building vertically. That’s why when we encounter problems later on that would necessitate assisted mobility, we are at a loss on what to do.

I’ve come across a site that offers home elevators. While this may sound like overkill to some people, let me assure you that if you are in the situation of needing it, you’d be thankful there’s this option. I mean, good for people who only need to navigate one floor of living space but what if your home consists of several floors. Vertical buildings, remember?

Another option, especially for those homes who do not have space for the aforementioned home elevator but has an existing staircase are stairlifts. These contraptions are fitted onto the banister of the stairs and may help with people who have difficulty going up, especially if assistance is not always available.

Granted, this type of lift is not for people who need the wheelchair to get around all the time. In such cases, the wheel chair lifts seem to be more useful. It is certainly more versatile, as it can be used both indoors and outdoors. The manufacturer also claims that the cost is comparable to putting a ramp.

While I’m guessing that a cost of these are likely out of the reach of the ordinary Pinoy, it’s comforting to know that now there are options, and that there’s a chance for people with some difficulties in mobility may be able to muster a bit of independent living, even if it’s just in their own homes. But if you or a loved one are having an extra hard time getting around then consider checking out an assisted living community where you can always have someone there to help you. Here are some assisted living community designs found here.