Sunday, November 6, 2011

SGV Fun Run

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My youngest sister invited me to join a fun run organised by her employer, SGV. For this year, this is the 2nd "fun run" we joined together. The run happened in the grounds of SM MOA but it was a rainy start. I thought the run was going to be suspended but the organisers decided to push through. Thankfully, the rains stopped before the race started.

The roads were damp, the air was cold, and it was cloudy. Thank goodness, or else I'd be looking hard for a sunscreen. With new, comfy running shoes (ahem!), it was a good day for running. Not to mention, it was a long weekend. So I didn't mind the muscle sores that will happen after.

My sister ran ahead of me, but I didn't care. I alternated my jogging with walking and occasional brisk walking. Nevertheless, I crossed the finish line and she was waiting for me. I asked her if our gap was long. She said it was less than 5 minutes. After a few drinks, we headed back to our car and went home.

I'm not a fitness buff but I'm glad to run again. I just wish I had the luxury of time to run more often.

Sunday, October 16, 2011

Preparing for the Written Diplomate Exams

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For the past several months, one of my batchmates and I have frequently discussed if we're going to take the Diplomate exams of the Philippine Academy of Family Physicians this year, or postpone it for next year. We've debated countless times the pros and cons of taking it this year. We usually end our discussions uncertain, anxious, no definite answer.

Last month, I received a letter from the Academy telling me that I am eligible to take the examinations. I was torn - take it this year or next year. I know my preparation is not going to be enough, and I will be relying on my stocked knowledge (if there was, or was it "stucked"). A deadline was set and my batchmate seemed eager to do it. I had no choice, I went with the flow. I was like a robot when I went to the office of the academy somewhere near Buendia, Makati City, to pay for the fees (written & oral). I told myself "Bahala na si Lord if I'm making the right decision."

Before I knew it, it was the end of September and I haven't opened any single reference book in Family Medicine. I didn't know where to start! I had two weeks to study/review but I was not determined, had no drive. My almost-daily trips to Starbucks Coffee to review (similar to what I did when I reviewed for the local licensure exams) became my sort-of security blanket. Most of the times I was drained. I watched movies, window shopped, strolled around the malls, even got my hair rebonded, and slept more hours than my usual. 

Then the dreaded day came - the day of our written exams. I surrendered everything to the Lord. With the few stuff I reviewed, I hoped & prayed that I could remember them all.  

Monday, August 15, 2011

RIP, Grandma Regina P. Lopez

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July 27, 2011
Around 1pm

While having lunch with my youngest sister somewhere in Pasig, I got a call from my younger sister informing me of an unusual situation back at home. She was called firsthand via mobile phone by our helpers that our grandmother was found unresponsive in her bed. I told her to bring her to the nearest hospital immediately and we will follow them. At that time, my parents were also somewhere else but they were also informed about the situation. 1 hour later, I arrived at the hospital. Our grandma was being attended to by the emergency physicians on-duty. Being a physician myself, I told them about her past medical history - diabetic for more than 15 years, controlled, not on any insulin therapy nor oral hypoglycemic agents, had stroke around 2003 with left-sided residual weakness, had upper gastro-intestinal bleeding due to aspirin intake, transfused with 2 (I think) bags of packed red blood cells, admitted at another private hospital last year due to complicated urinary tract infection. The ER physician also told me his working impressions - another episode of stroke, possibility of heart attack (NSTEMI/non-ST Elevation Myocardial Infarction), Pneumonia in the elderly. I saw my grandma intubated, but with stable vital signs, yet still unresponsive and a high capillary blood glucose level. I was also told that she must be admitted at the intensive care unit/ICU but I didn't give my consent. Instead, I told them I had to wait for my mom & will ask her. I doubt she'll agree with it. Moments later, my parents arrived and they went to the Admitting section to get a room. Not surprised, my mom didn't consent for my grandma to stay at the ICU. She opted to hire a private bedside nurse instead. 3 hours later after arriving, we finally settled in 1 of the private rooms in the hospital. And we hoped, prayed for her recovery.


July 28, 2011 to August 3, 2011

I always visited her at the hospital on my way home from work. There were moments that she was "going down" and I had a feeling that we will not be able to bring her back home alive. My mom decided to bring her home to her original home town, even if it meant travelling by ambulance for many hours. My mom's relatives arranged for my grandma's transportation and transfer of hospital. On her last night at the hospital in Manila, I realised that probably it was the last time I'll see her alive. She was transferred after midnight. She was accompanied by my parents and another relative on the maternal side.


August 4, 2011
AM

When I woke up for work, my dad left me messages on my mobile phone, giving me updates about their travel and grandma's condition. It seemed that she was "stable" during the entire travel. They finally arrived at another hospital by 9am. They were attended to, immediately brought inside a room. I thought everything was going to be okay.

12noon

I got a text message again from dad. The content was what I dreaded for - grandma joined our Creator. I was stunned, distracted from work. I informed our friends, other relatives about it. Details regarding the wake and interment followed suit.

She was 86 years old.


I went home (with my youngest sister) to Ilocos night before her interment. When we arrived early morning, everyone was in frenzy and we were extremely busy. No time to catch up for some sleep. Mass was at 8am, followed by the procession to the cemetery, the burial rites, and finally lunch at her place. We headed to the beach for awhile at high noon for a ceremonial "cleansing" and letting go. Of course, we had to put lots of sunscreens on ourselves. Then back again at the house for bathing.

(My younger sister stayed behind in Manila because she was reviewing for the Physicians' Licensure Examinations. Thankfully, the results turned out to be great.)

The activities didn't stop there. Since we had guests from Manila, we toured them in Vigan, ate empanadas, bought lots of souvenirs. By night, I was so tired. Since I was also headed back home, I decided to sleep in the bus. I was in Ilocos for less than 24hours.

Tomorrow is her supposed to be 87th birthday. We will still celebrate it, like she's still alive.

We will celebrate her "40 days death anniversary" on 13 September 2011. I'm not sure if I was going to Ilocos because of work. But I'll try to file for a 2-day leave.

Thursday, July 14, 2011

Jitters

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For the past few months, I've constantly re-vamped my work - I've been going on/off in different clinics, various schedules almost everyone is confused regarding my work schedule. They've always asked me "My bago ka na namang clinic?" I know they're confused. Me too.

Like before, I'm going through another series of changes starting next week. Today (as of this writing) is my last day here at Tokyo Healthlink in Makati. After less than 4 months of being their part-time Family Physician (from a reliever promoted to a regular physician just in the middle of June), I resigned one week ago due to personal, professional, and financial reasons.

My mother company, Health Delivery Systems Inc. recently has tied up with Philippine Long Distance Telephone Co. (PLDT) to be the third party outsource to man their different clinics in select branches. HDSI has recruited lots of specialist physicians, nurses to be assigned in different branches. I was offered this job & accepted the offer. In exchange, I had to leave Tokyo Healthlink.

Yesterday, we had our orientation regarding their electronic record system. Their system is very different, more complex in comparison to what we have in Health First. During the entire orientation, one thing was in my mind "Nosebleed ito!". There were more tabs to click, but with few available characters, more complicated steps. I got more & more confused because they have a system uniquely their own. Immediately I became worried, nervous about my performance on the first few weeks. Adapting to their system will take some time (but not too long, hopefully). Being the first doctor to "start the ball rolling" every tuesdays, punctuality is the top priority. I have to brace myself for a more toxic workload than in Health First.

After the orientation, I had many reasons to go back to HDSI Office. I signed my contract with PLDT, tried which size of long coat fits me for use at PLDT and anywhere else that is a client of HDSI (like in my case, at DMPI and Health First clinic itself), posed for a 1x1 picture & specimen signatures for our IDs at PLDT, filled an application form for an HDSI privilege card. I thought "Finally! They're starting to treat me like one of them" since I'm starting to get privileges.

However, this journey was not smooth-sailing. I went into argument with one of their HR personnel several times before; I almost thought of refusing this job completely. Since this is the beginning, taking an absence, looking for relievers is not being considered for now. I made some sacrifices, I postponed some personal matters. It was hard for me to accept at first & after crying through it, I thought that this job is the priority & it will be for my best.

But really, as early as now, I'm having jitters when I think of tuesday next week. Waah! Goodluck to me (& to all of us as well).

Sunday, July 10, 2011

Advanced Cardiac Life Support (ACLS) Training

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After successfully passing the BLS training, I can now proceed with the Advanced Cardiac Life Support (ACLS) training. During those 1 1/2 days, we were handled by 3 different ER physicians, and 1 anesthesiologist. Comparing to BLS, this is more difficult, more nerve-wracking, more stressful - more different algorithms to learn, more ECG tracings to identify, more drugs to give.

Prior to class, we were instructed to visit the website of AHA to read their supplementary discussions regarding ECG interpretation and pharmacology. They will not be discussed in class. Furthermore, we were also instructed to answer a pre-course evaluation, print the results, and submit it to class.

The class was already divided into two groups, alphabetically.


Day 1, July 7, 2011
2 to5:30 pm 

More videos were shown and we still had practice sessions regarding Rescue Breathing, BLS Surveys. No surprise, there were practical exams regarding them, but they were all a "piece of cake" (since we just had our BLS hours ago). Unfortunately since we started late, we also finished later than planned. Plus, we weren't able to discuss Acute Coronary Syndromes (ACS) as scheduled because we ran out of time. Prior to dismissal, we were all instructed to read our books, study the checklists (found at the appendix section) in preparation for the Megacode the following day.

I did try to read but I was distracted by something else, and it's not related to ACLS.


Day 2, July 8, 2011
8am to 7pm

I arrived at the place 30 minutes earlier. Everyone was talking about the Megacode, saying that they're unprepared because they just slept the entire night, they can't wait for the day to finish, blah blah blah. When we entered our classroom at quarter to 8, we saw that the mannequins, cardiac monitor, other equipment were ready. Gulp! It was going to be a loooonnggg day.

We met 2 different physicians - another ER physician and an anesthesiologist. One of them began to worry about our schedule since we failed to discuss ACS the previous day. Like a domino effect, the succeeding topics were adjusted as well. All of us bore the consequences - the discussions regarding the algorithms were fast, next thing we knew we were being tested individually as team leaders (but it wasn't graded). We were being criticised, corrected, reminded constantly.

My preparation for the course paid off - since most of our decisions, orders are based on correct ECG interpretations, I was able to go through the practice session well (when I was the team leader twice - cardiac arrest algorithm & arrhythmia algorithm). My groupmates had a hard time reading the ECG tracings that they kept on looking at me for answers or clues on what the tracing is. Ironically, some of them were physicians.

Thankfully, we had time "to put it all together" as a review before we went into the dreaded Megacode. We were given time for CR break, last few minutes to read our manuals. Then, it started.

My case was ok, but I had some flaws - my case was again Stable Tachycardia. I should've been lucky to get the same case twice but I screwed up. My instinct told me to do vagal maneuvers [when the QRS complex of the tracing went from regular-wide (I already gave adenosine 6mg) to regular-narrow] but I listened to my groupmate's whisper, telling me to give adenosine 12mg & I ended up doing that. Wrong! One cardinal rule - always follow your instinct. The other one was a SVT that was pulseless. I told the facilitator it was Pulseless VT and following the algorithm, I ordered for a shock. I was wrong again! It was PEA. I learned about my mistakes afterwards. I was able to see my paper and the remarks were high. Well, not bad but I'm not happy either because I felt I had an easier case, compared to the others. I had no excuse for messing up.

After the megacode, we weren't done yet. We still had the written exam to take. The rule was to obtain a score of at least 42 (or 84%) out of 50. Otherwise, you'll have to undergo remediation with 1 of the facilitators. I was the first to finish and I got exactly 42. Whew! It was more difficult than the BLS exam, because it asked questions all the way from the previous day's topics & it involved cases. Among 12, only 3 students (myself included) didn't had to go through remediation. We graduated from the course ahead of the others, claimed our IDs and certificates, and left the place; while the others have to wait more, go through remediation before they can get their IDs and certificates (if the facilitator is satisfied). I observed that if most of my classmates were prepared for this, we would've gone home earlier.

Once again, we were told to answer a course evaluation for the ACLS. Just like yesterday, I gave the course high remarks.

With regards to the current AHA guidelines, they are more simpler, easier to understand. There are major, major changes and it will take awhile for those changes to sink in & be actually applied. I just hope that everyone, physicians and non-physicians alike, will be able to apply it & be able to save lives.      

Basic Life Support (BLS) training

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I underwent a basic life support (BLS) training last thursday at Global CE of America in Sta. Ana, Manila. This is my 3rd BLS training course, but my 1st training that is AHA (American Heart Association)-accredited. It's more expensive than my previous trainings but it's worth every penny.

Actually, I enrolled into 2 courses - BLS, and Advanced Cardiac Life Support (ACLS). Of course, you need to pass the BLS before progressing to the ACLS. During my enrollment, I paid half of the course fees and received the books for advanced reading. I started to prepare a week earlier, and read the BLS manual in just 1 day. Preparing for the ACLS was longer because I also had to review certain ECG tracings and pharmacologic drugs. We were instructed to arrive at class on-time since there are so many topics to discuss in such a limited time. Still, some students arrived late. Oh well... Old habits die hard.


Day 1, July 7, 2011
8am to 1pm


Our BLS instructor, a dermatologist by profession, started on time. After a brief "getting to know you" & laying down of the house rules, we proceeded to watching the videos followed by practice sessions with the mannequins. No lectures were done. The videos simply reiterated what was written on our textbooks, and it also serves as a review. Since AHA regards as all as professionals, they treat us as adult learners. No spoon-feeding. Personally, it's better that way because you're after the skill, the correct manner of doing it. Each part of the BLS algorithm was discussed & shown clearly - starting from 1-rescuer, we started with chest compressions then mouth-to-mask breathing, then 2-rescuer now with the incorporation of an automated external defibrillator (AED) & the correct way of switching roles. It was followed by the child BLS (which was faster) and finally the infant BLS. Like in the adult BLS, the steps are almost the same except for the manner of doing chest compressions, and the ratio of compression-ventilation when there are 2 rescuers. The video also showed how to relieve patients from choking - both in the adult and infant.

Of course, we are evaluated by 2 ways - a practical exam and a written exam. If you've read the book & watched the videos closely, the written exam will just be a "piece of cake". The practical exam is easy too. If you watched the videos closely and took the practice sessions seriously, then it will not be a big problem. You can be criticised by your instructors but they will be just few or minor pointers for further improvement.

In return, we also evaluated the course, the instructors, the place. I had no complains and I gave them high remarks in all aspects. I didn't put on any comments, and I couldn't think of other suggestions for improvement. I was completely satisfied & happy for what I came for.

In the end, I got my ID and certificate. Their valid for 2 years.

I was asked by the Operations Manager if I want to be a BLS instructor with them. I said sure (since being a BLS instructor is a "plus" factor not only for my resume but for practice as well. Oh yeah, source of additional income. Haha!). This seems promising for me. :)  

Friday, July 1, 2011

Busted Tail Lights

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My green Honda car (1997 model) has gone through many repairs and replacements in the past years. Just like people who age, gradually its parts have succumbed to wear and tear. Well, I don't know which is more cost-efficient - summing up the expenses of the repairs or buying a new car instead. Hey, where's the promise of giving me a new car when I pass my medical boards?

I've recently noticed that the tail lights were still left open after I've turned off the engine. It's noticeable during the night, but not in the day. Before leaving the car, I've always checked if the tail lights are still open. I don't want the battery to be drained empty. Besides, it was just replaced 1 month ago.

My fear came true when around lunch time, after my clinic work in Pasig, the engine didn't fire. Every time I turn on the ignition, all I heard was "click!". Thankfully, I was parked in a secure place thus I felt confident leaving the car, to look for a mechanic and/or nearest motor shop. I was directed by a tricycle driver to a motorshop along Pioneer St. The mechanic went to my car, brought a spare battery, and some cables to do a "series". We got to the parking lot thru his motorcycle (yeah, I rode at the back of his motorcycle - my first time). The mechanic connected my battery with another one, and after one click, the engine roared to life. Then, I drove the car back to the shop and have it checked. Turns out the battery current is still adequate (not emptied as I initially thought). I mentioned to him regarding the tail lights and he hypothesized that the electricity could be grounded. No other repair was done. On my way to my other clinic in Paranaque & when I went home, I didn't encounter any problems.

I already told this to my dad. He'll have it fixed next week.

I thought "Bumili na kasi ng bago. Palitan na iyan".
 
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