Stop Stressing. Start Living

“Worry and stress affects the circulation, the musculoskeletal system, the glands, the whole nervous system, and profoundly affects heart action”- Charles W. Mayo, M.D 

      Today’s lifestyle may be described as the rat race. Stressful. Competitive. Tiring.  Always on the go.  I may be in the same boat, just like the rest of humanity.

     But I’d like to remember the time when life was a bit simpler, more relaxed. 

 

       Single man. No house bills and tuition fees to pay.  No investment decisions to make. 

     No internet blogging like this. (That time wasn’t during an ancient, pre-historic era.)

       As you know, I have 3 children.  One day I had zero.  The next day, I had 3.  

       No, I don’t have 3 wives that gave birth on the same day.  But it’s just like in a blink of an eye, I had 3 children, three energetic, highly active children (who cry and fight each other just like any children).  

     And sometimes I can’t believe I’ll be turning 37 years old this year, with my hairline receding.  (I have big problems, you see).

      Hey, don’t get me wrong.  37 years old is still young. Honestly, not too long ago, I used to think that forty was ancient. Pre-historic. Jurassic. Yet this year, I will be a mere 3 years from that age. Haha! Although when I talk to one of my patients, he calls me young doctor. He calls everyone young. That’s because he is 95 years old.

      But I wonder then.  What can we all do to deal with stress, and perhaps delay the aging process?  Is it possible to do this?

     Recently, I had a husband and wife patient.  The husband was the patient, who was complaining of several painful areas in his body. He seems to look much older than his wife of same age. After I talked to them and thoroughly examined him, I asked the husband to step out of the clinic for a while so I can talk to the wife privately.  

     I said to the wife. “Your husband is just too stressed for now.  You are giving him too much stress. The painful areas are a combination of physical and emotional stress.  What you need to do is offer him a relaxing environment.  Treat him like a king.  You know, breakfast in bed, daily massage, etc.”

      The wife nodded, thanked me and went out of the room. I overheard their conversation outside. 

 

    “Honey, what did the doctor say?  What’s wrong with me?” asked the husband.

      The wife responded “He told me you are going to die. That there is no treatment for your disease. It is hopeless!”

    Ok.  Ok. This is a joke. I heard this somewhere. =)

     But the point is, stress can really create pain in your body and will let you deteriorate and age faster.  

    Stress management is important to prevent premature aging and aching. Several studies have shown STRESS as one major factor that influences our health. 

     Not diet, not exercise, not how much we sleep. 

     So why is emotional stress one of the most significant challenges to our health? 

     First of all, stress serves an important purpose in certain situations in life. It is needed for survival in emergency situations, such as when the house is on fire, or you meet a wild lion in the streets of EDSA =). The danger is in experiencing stress on a chronic, repeated basis, just what the husband patient I described above, was experiencing.

    Our body will eventually find it difficult to defend itself against the damage that emotional stress creates over time. And this is exactly what many of us are suffering from in today’s rat race.

    So what can we do to effectively manage emotional stress in our lives and prevent them from creating significant health problems? 

     I am not really an expert on this but seeing patients with chronic pain from too much stress made me do some research about this.  The following are recommended to deal with stress.

1.      Relax and take deep breaths regularly.

     Doing so can regulate our body system. This will promote relaxation and good digestion.  Blood pressure and endocrine enzymes will be at normal levels.

2.   Exercise

      As I’ve said in previous posts, find an exercise that you like and move your body.  It's a well established fact that regular exercise is one of the best habits you can do that will help you avoid stress and stay emotionally healthy. 

     It doesn't matter what kind of exercise you do. For me, just walking and stretching may be good enough. Doing push-ups form time to time also helps me. In fact, I can do 10 push-ups easily.  One day, I wanted to impress my wife.  I tried 30 push-ups. Unfortunately, after 25, she had to carry me to bed. Hehe

      What's important is to be active and use your joints and muscles on a regular basis. 

3.   Spend some quiet time every day in prayer or meditation

       This has been proven to facilitate a relaxation response in your body that can decrease blood pressure, decrease pulse rate, and improve blood circulation. 

4. Be honest about yourself

      Know thyself is a wise saying in virtually every culture of our world. Striving to know yourself and what you are truly feeling is essential to prevent unpleasant emotions from creating emotional stress. 

      One of the methods I have learned to increase your awareness of what you are truly feeling is blogging. It’s simple: no censorship, no possibility of another set of eyes reading your thoughts, just pure flow of thoughts from your mind and heart onto your computer screen. And you don’t force anyone to read your posts. Blogging can be extremely beneficial to your emotional health. 

    And don’t take yourself so seriously, no one else does!

5. Talk to happy and positive people

     Sometimes, this is difficult, especially if your family members and close friends are always negative-thinking.  Just try to spend less time with negative people.

6. Laugh and say thank you more often

      Self-explanatory

Take Home Message

   Don't make the mistake that many health conscious people today make and fret over the percentages of carbs, protein, fat, raw food and cooked food in their diet, while neglecting the emotional stressors in life.

     Yes, eating fresh, nutritious foods, exercise and rest is good for your health. 

      But doing all of these while feeling emotionally balanced and at peace is even better. 

       Live a wonderful, stress-free life!

Makati Med's Symposium on the Treatment of Osteoarthritis

Last Saturday, I had another speaking engagement, this time at the Makati Medical Center- Department of Orthopedics’ Annual Orthopedic Symposium. The theme of the morning session was about the current trends in treatment of osteoarthritis, but not including joint replacement.  The focus was on the alternative management to joint replacement of patients with such conditions.  The theme was very relevant in my practice that’s why I readily agreed to be a speaker. 

As in the last Philippine Hip and Knee Society Convention, I was truly honored and privileged to have spoken before my esteemed colleagues because the audience was mostly orthopedic consultants, residents and medical students. I’d like to extend my gratitude to the Department for inviting me to be one of the speakers and share my knowledge. At the same time, it was also an opportunity for me to continuously update my knowledge by learning from other speakers’ experience. 

         Preparing lectures for orthopedic conferences is both stressful and energizing for me.  Stressful because there is so much pressure involved in researching and preparing a scholarly lecture before former mentors and colleagues in the profession.  I had to write and re-write my manuscript and think of all the possible post-lecture questions they will throw at me.  At the same time energizing, because it is an opportunity to shine and show your former mentors what you have learned during fellowship training. 

       The opening remarks were from the Makati Med Department of Orthopedics Chairman Dr. Liberato Leagogo who acknowledged the challenges of managing osteoarthritis, especially in the young and active patients. All the speakers, in my opinion, had well-prepared lectures that generated active participation among the audience. We even had the opportunity to learn from a foreign speaker from Singapore who was specializing in cartilage regeneration techniques.

      My lecture on the use of osteotomy (a surgical procedure that re-aligns a malaligned knee to prevent the progression of osteoarthritis, went well,  I thought. Thanks to my friend & colleague Dr. Marc Castro who provided me with some pictures I used in my presentation. The following are some of the pictures taken during the symposium.

Dr. Tony Rivera dishing out his usual fiery questions

         The afternoon session was devoted to presentation of researches in orthopedics which was personally sponsored by my mentor, Dr. Ramon Gustilo of Minnesota, USA. I wasn’t able to finish the afternoon sessions, though, due to clinic schedules. Dr. Gustilo himself gave a talk on the success and failures of total hip replacement patients.  Having done at least 10,000 hip and knee surgeries and has trained countless orthopedic surgeons, including me, throughout the world, his opinion and experience definitely are well-valued.

With my mentor, Dr. Ramon Gustilo

         There is so much more I want to talk about, but I just don't have the time right now. Hopefully, during the course of the next few days, I'll be able to share that with you.

           In the meantime, I just like to express this take home message:

     Doctors should invest in educating themselves, so that we remain up-to- date with the latest medical advances. This will help us provide state of the art medical care for our patients.  Attending conferences and actively participating is one way to do it.

        Orthopedic surgery is a very dynamic field.  Researches and studies are continuously being undertaken so what we might have learned a few years ago may not be the best option for our patients now.  However, I do acknowledge the fact that change does not mean improvement.  Long-term studies are usually needed to prove the effectiveness of  new procedures, especially if they are more expensive.

Everything You Know about Osteoporosis is Wrong

I read somewhere that being a senior citizen has its cool advantages.

Here they are.

o   In a hostage situation, terrorists and bank robbers are likely to release you first. (Especially if you try acting having  difficulty breathing).

o   People call at 9:00pm and ask, “I’m sorry, did I wake you up?”

o   You have a party at home and the neighbours won’t even know you’re having a party. Because it is so quiet.

o   Your secrets are safe with your friends because they won’t remember them.

o   And finally, you enjoy 20% discounts in restaurants, drugstores, and if you live here in Quezon City, free movies on Mondays of the week. (I have an aunt who tells me she has watched every single movie shown. I bet even The Exorcist, the Grudge and all versions of Friday the 13th.)

However, aging is also associated with health concerns such as hypertension, diabetes, ulcers, etc, and osteoporosis may seem not so worrisome. But is it not really?

So, that brings us to the orthopedic topic of this post: osteoporosis. First, let us define osteoporosis. It is the thinning of the bones that cause them to lose strength and become fragile. It is associated with aging, affects women more than men, and progresses more rapidly after menopause.  Osteoporosis, similar to hypertension, is sometimes called the "silent disease," and most people don't know they have osteoporosis until it has progressed — often to the point of fracture, usually in the hip, wrist or spine. Even when undiagnosed osteoporosis results in a spinal fracture, the pain is frequently dismissed as general back pain. This lack of awareness, even among doctors, can lead to serious illness, deformity, even death.

       The following are some things that are regarded about osteoporosis but evidence show they are untrue.

Wrong Number 1 - Since osteoporosis is associated with aging, we cannot prevent it.

Aging per se, cannot be prevented.  No matter how many noselifts, tummy tucks or breast augmentations you undergo, it will not stop you from aging. Osteoporosis, on the other hand, while associated with aging, is both preventable and curable, if caught in time.  Problem is, there is not enough awareness of the opportunities for prevention and treatment of osteoporosis, and too many people—mostly women over the age of 50—suffer significant illness, deformity and sometimes even death from this condition.  People, even the family doctor, are not well-informed about this, and dismiss it as just part of the normal process of aging.  .

Wrong Number 2 – Osteoporosis is not that common, so why bother

        It is a fairly well-known fact that osteoporosis is one of the most common conditions in the US. Approximately 8 million women and 2 million men suffer from this disease. Another 34 million have low bone mass and are thus at increased risk for osteoporosis. Some key statistics include:   

 * Approximately 1.5 million people suffer from an osteoporotic fracture each year. An estimated 700,000 of them experience vertebral compression fractures (spinal fractures).

    * From age 50 on, one in every two women and one in four men will sustain some type of osteoporosis-related fracture.

    * An average of 24% of hip fracture patients aged 50 and over die in the year following their fracture.

Wrong Number 3 – It is not good to exercise when you have osteoporosis or else, you might break your bones.

        Weight bearing exercise (which refers to activity that one performs while on their feet that works the bones and muscles against gravity) and muscle contraction combined have been shown to effectively increase bone density in the spine. It is recommended that an individual perform 30 minutes of aerobic exercise 3 to 4 times weekly to increase bone mass. Besides, exercise promotes the general well-being of individuals. Remember in my previous post, I told you to find an exercise you enjoy and try to incorporate that in your daily activities, with your-loved one, for added incentive.

        A note of caution: for people with osteoporosis, care must be taken when exercising. Activities that require twisting of the spine or bending forward from the waist (such as sit-ups or toe touches) may be dangerous. Individuals already diagnosed with osteoporosis should discuss their exercise program with their physician to avoid fractures.

When your elderly parents develop fractures due to osteoporosis, it may really be devastating, not only to them, but to you as well. The cost of treatment by way of surgery may be prohibitive to most Filipinos, especially if you don’t have any medical insurance.  Not only that, the stress of caring for a depressed elderly can put a toll on you, too, emotionally. Remember that as people age, they tend to become more sensitive, easily agitated and depressed from their sudden loss of independence and mobility.

As of now, clearly, prevention is the best solution.  Don’t take osteoporosis for granted.  People who dismiss that osteoporosis is just part of the normal aging process and do nothing about it, are clearly missing the whole point. 

 If you're concerned about your bone health and would like to prevent osteoporosis, consult your doctor, preferably orthopedic surgeon. He or she may recommend a bone density test. The results will help your doctor gauge your bone density and determine your rate of bone loss. Recently, in my clinic in Katipunan, Quezon City, we had a free osteoporosis screening to our patients. We hope to do this more regularly. Unless you have yourself checked, you will never know if you have osteoporosis or not.

Friends, realize that there are more health care options available for you in this time and age. Take time to study them.  Weigh the benefits versus the risks of each option. Don’t settle for “patch up care and band-aid solutions”. Make up your own mind without being pressured or harassed.  Ultimately, it is you or your family member who is going to suffer if you insist on solution rather than focusing on prevention.

More tips to bone up your bone health in future posts……………

READY… STEADY… SURGERY

Things you need to know about preparing for surgery

        I'm back. So you missed me.  Not as much as I missed writing on my blog though.  For the past few weeks, the Philippine Hip and Knee Society (PHKS) convention has been foremost in my activities, being part of the Organizing Committee and of the team of speakers.  There is so much pressure involved in researching and preparing a scholarly lecture before former mentors and colleagues in the profession.  I had to pay attention to every detail, write and re-write my manuscript and think of all the possible post-lecture questions they will throw at me.  

      But on the other hand, it was an honor and privilege to speak before my esteemed colleagues.  I’d like to extend my gratitude to Dr. Greg Azores, the incumbent President of the PHKS, and Dr. Paul San Pedro, my mentor at the Philippine Orthopedic Center, for inviting me to join the society and share my knowledge as one of the speakers.

Photos courtesy of Dr. Iggy Agbayani

         Now, since the topic of my lecture there was how to evaluate and prepare patients undergoing total joint replacement, I realized that some points of that lecture might interest you, especially patients considering surgery.

        You may be trying to avoid surgery at all costs, but there are times when surgery becomes a necessity. So let me illustrate the pre-operative procedures for most surgical patients.  

         Here’s the story of one of my patients.

        My patient had a knee condition that had gone from bad to worse.  Initially, I diagnosed her with knee osteoarthritis about 2 years ago.  She could hardly walk then and was already confined to a wheelchair.  I informed her that whereas we would be trying other modes of treatment at that time (medicines, pain control, and therapy) she would eventually need to undergo total knee replacement in the future.  Physicians use the phrase “lost to follow up” when patients stop coming for regular consultations.  So after a few consultations, perhaps due to lessened pain and discomfort, this patient was eventually lost to follow up.  

       Last week, lo and behold, my lost patient was found… on my patient list for the day.  Her pain returned and had gotten worse.  After some knee injections for pain control, her family told me that, while they understand the need for surgery, they were buying a little more time because of the expenses involved.  “Yes, of course. No problem,” I told them.  I made a careful evaluation of her knee again, including the hips and spine.  Repeat xrays confirmed worsening of the condition. 

       After a few weeks, they called my clinic to inform me that the effect of the injections had waned and their family decided to have their mother operated on for a total knee replacement.

Pre-op and Clearance  

    First, we discussed, in general terms, what to expect during hospitalization, the length of confinement, the recovery period, etc. Then we decided on the exact date of surgery.  

     The patient needed to get blood exams, a chest xray and an electrocardiogram (ECG) test.  Dental check-up and urine test was also advised.  The possibility of blood transfusion was discussed with the patient and so they agreed to find blood donors. 

       They were seen by a medical colleague known as an internist (a doctor who specializes in Internal Medicine) a few times before surgery with the understanding that he will be giving the “medical clearance” to undergo surgery.  Her general medical condition and allergies were documented. These procedures needed to be done since we wanted the patient to be at the peak of health during surgery and to determine if, in consideration of her age and medical problems, she can still tolerate the procedure safely.  The medications she was taking were also reviewed, and the meds that can affect bleeding during surgery, like aspirin, were stopped.

       This assessment gave us the opportunity to weigh the benefits versus the risks of undergoing total knee replacement.  She was eventually cleared to undergo surgery by the internist.

The Day before surgery

        They arrived at the hospital in the afternoon, the day before the scheduled surgery, carrying with them the admitting orders I gave them, as well as the xray plates taken at the clinic.  It is important to bring the xrays as we need the plates during surgery to make certain measurements. 

         At the admitting section, they filled out some paperwork and were soon going through all the prep questions:  “Your name please?" "Date of birth?" "When are you having the surgery done?"  "Which knee?"  These were all noted in the patient's hospital chart.

         Before being taken to the third floor room reserved for them,  they told me the thing that took extra time was getting the IV line in.  According the son, this was no surprise to them, as many times in the past, this was a challenge for nurses. A second nurse eventually came and managed to get the line in at the first try.  She was ready to go to the room.

         Nighttime came and another important member of the surgical team, the anesthesiologist, came to their room.  After a pleasant exchange of “hi's and hello's”, the anesthesiologist explained the different types of anesthesia to the family, with their corresponding risks and benefits.  They eventually agreed that regional anesthesia (a type of anesthesia where only the lower part of the body is anesthetized, and the patient is sedated), would be used. Consent was signed in the presence of the relatives.  The patient was reminded not to eat and drink anything past midnight.

The Day of the Surgery

      The OR nurse came in their hospital room at around 6 in the morning (surgery scheduled at 7 AM) and said it was time for hugs & kisses.  The eldest daughter told her mother she would see her later in the recovery room and went straight to the hospital chapel.  Her son-in-law arrived and figured it was time for some snack while they had a chance.  

  

        Antibiotics were injected through her IV line prior to the patient being put into sleep. She eventually underwent total knee replacement surgery.  During surgery, no untoward incident happened.  After about two (2) hours, the patient was wheeled to the recovery room.

       In my patient’s own words “The experience was simple. The fear was only in the beginning. The joy you’ll feel when you awake from surgery, and realize you’re on your way to being healed is amazing!!!”

Surgery is risky, but it is a calculated risk.   

“The surgeon does the calculating, the patient takes the risk!”

         Not all surgeries are successful.  Not all surgeries proceed without complications or difficulties for the surgeon.  With total joint replacement, however, there is a very high rate of success.  Literature puts it at 98%.  But a vital part to this success is, for the surgeon, proper preparation and planning.  Proper evaluation and preparation helps us weigh the benefits versus the risks of the surgery, and clear up some doubts with the patient. 

       For the patient, following pre-op guidelines, and knowing what to expect before and during surgery, can make a big difference in your recovery and success.  A well-informed and motivated patient makes a difference.

Nighttime Nuisance

        Recently, I saw a stunningly gorgeous lady, in sexy lingerie.  She was at the stairs of our house, signaling me to go up.  Curiously, I followed her, up to our 3^rd floor. Then, this Angel Locsin look-alike continued going up to our 4^th floor. There was a problem, though.  Our house didn’t have a 4^th floor. But I followed her anyway. When I got there, boy, I was mesmerized with what I saw. Sexy, beautiful ladies I don’t know walking around, talking in some language I thought spoken only in the second Moon of planet Mars. Then, this beautiful lady I saw earlier moved towards me, about to hug me when…………………………...... I woke up!  Arrrggg! I woke up!   

       Darn. It dawned on me that I was only dreaming.   I was awakened because my wife woke me up because she felt severe muscle cramps in her leg.

       “Aww. Come on, Mama. Your leg cramp is such a kill joy. What I was witnessing was better than any erotic movie, I thought”.  Hehe. Well, after I massaged and stretched her affected leg, the cramps went away and she went back to deep slumber as if nothing happened. Unfortunately, I never got to finish the dream I was having =(. 

       Have you ever experienced the same thing?  No, not the same dream, but being awakened by severe leg cramps?

So, that brings us to the orthopedic topic of this post. Leg cramps.  

What is leg cramps?

      A leg cramp means a sudden, severe pain usually at the back muscle of the leg we call calf muscles. It is caused by a sudden involuntary contraction of these muscles.   

        It may occur when you are sleeping just like what happened to my wife. If not given the necessary attention, it can become a distressing problem which can disturb our regular sleep. 

What causes nighttime leg cramps?

      During cramps, your muscle contracts and doesn’t relax.  It may occur more often on people who don’t stretch enough or improperly stretch.  The following are risk factors for leg cramps:

1.      Prolonged flexion of foot - The nighttime leg cramps can be caused by prolonged and unopposed foot flexion while in bed. In the regular sleep position, the muscles of the feet and back of the legs are shortened because the foot is pointing slightly away from you. In addition, if you point your foot like a ballerina when you stretch, contraction of an already shortened leg muscle may occur and further cause the muscle to go into spasm.

2.      Electrolye imbalance - You can have nighttime leg cramps with heavy sweating from prolonged exertion. Muscle cramps happen more frequently during hot weather because we lose fluids when we’re hot and sweaty. We also lose electrolytes—especially potassium and magnesium.  These nutrients are needed to prevent muscle spasms.

3.      Certain Medications – Consumption of diuretic drugs, calcium channel blockers, can also cause nocturnal leg cramps. 

4.    Certain medical conditions – This includes later stages of pregnancy, untreated hypothyroidism, hypoglycemia, those undergoing hemodialysis, and excess alcohol intake.

However, these are just the probable causes, and a definite cause of leg cramps while sleeping at night still has to be verified.

What to do

        I wish I could tell people that all you had to do is this and that and miraculously your cramps will be a thing of the past. Problem is, no one even knows for sure what causes cramps.  But here are some accepted ways to prevent leg cramps.

1. Stretching exercises- 

      Making  regular stretching  a habit is a good start for preventing leg cramps.  Focus on exercising the calf muscle while doing the stretching exercises. Stretch your calf muscles by pointing your foot towards you. You may try to do some routine stretching before bedtime. Try this out for a week or so, you would most probably see the difference.

2. Appropriate sleeping posture-

      Well, of course, if you’re sleeping you won’t be aware of your posture. But a change in your sleep posture can prevent leg cramps. Try keeping a pillow under your calf before you sleep, if you are lying on your back. Letting the feet hangover the edge of the bed is another way to relax that muscle and avoid leg cramps at night while sleeping.

3. Get properly hydrated - 

         As mentioned, loss of fluids and essential nutrients could be a cause of cramps. So make sure you drink lots of water and juices.  Avoid dehydration!

Daily activities that might help prevent night leg cramps include:

• Maintain  correct posture of your feet. Remember my discussion about high heels?  If not, browse through the previous posts and learn again.
• If you have no plans of being a ballerina, avoid the temptation of pointing your toe! (Unless you use your toes to signal directions to people). 

4. Gently and carefully massage your calf muscles every now and then

5. Take a warm water bath before going to bed – 

          I know that for some of you, you don’t like taking a bath. It’s like water torture.  And for some hardline environmentalists, they want to conserve water so bathing is absolutely unnecessary for them.     Kidding aside, taking a warm water bath may relax your cramped and tired muscles. If you’re too lazy or sleepy to take a bath at night, then you may just use a warm pack and apply it around your affected muscles.

Summary

       Leg cramps can really be a painful nuisance, especially for nighttime leg cramps. Theories of its cause include improper position of feet, dehydration, electrolyte imbalance, certain medical conditions and medicines. Make sure you do calf stretching exercises, maintain proper position of your feet, and be properly hydrated. Gently massaging your calf muscles and applying warm compress may help in relaxing the cramped muscle. 

        If you have a muscle cramp that lasts for more than a couple of days, see your orthopedic surgeon. You may have a muscle tear, blood clots, nerve damage, or some other more serious problem that will prevent you from having and finishing the same dream that I had. =)