Temporomandibular Joint Dysfunction: The Agitated Jaw


Millions encounter this condition each year and chances are at some point, you have, too. And daily, explains V. Glenn Orion, this particular joint is agitated an estimated 2,000 times as you chew, talk, or yawn. On top of these jaw-dropping statistics is that, if untreated, it could have serious ramifications on your overall health.

IF you’ve woken up with inexplicable pain in your neck, ringing in your ears, and a toothache despite finding no new cavities during your last dentist visit, then you could likely be one of the million others suffering from temporomandibular joint dysfunction.

Also known as TMD, its symptoms are vastly diverse, both in nature and severity. TMD occurs as a result of problems with the jaw, specifically the temporo-mandibular joint, and surrounding facial muscles responsible for moving the jaw during actions such as chewing or talking. Ideally, you should be able to experience its full range of motion  for instance yawning  without any pain or discomfort.

The temporomandibular joint acts like a hinge that connects the lower jaw or mandible to the temporal bone of the skull, which is immediately in front of the ear on each side of your head. Muscles attached to and surrounding the jaw joint control the position and movement of the jaw. The temporomandibular joint combines a hinge action (up and down) with sliding motions (side to side). The parts of the bones that interact in the joint are covered with cartilage and are separated by a small shock-absorbing disk, which keeps the movement smooth.

The cause of TMD is not clearly defined but dentists believe injury to the temporomandibular joint or jaw, grinding or clenching of the teeth, or improperly aligned teeth or bite are the main contributors. Grinding or clenching the teeth, especially, puts extra stress on the jaw.

Other causes listed by dentists include:

-Dislocation of the soft cushion or disc between the ball and socket

-Presence of osteoarthritis or rheumatoid arthritis in the jaw joint

-The joint is damaged by a blow or other impact

-The muscles that stabilize the joint become fatigued from overwork, which can happen if you habitually clench or grind your teeth

Stress factor

Stress is another factor, adds Dr. Agnes Claros, a DMD who specializes in Comprehensive Aesthetic Restorative Dentistry. Grinding can also be related to stress, especially clenching. When you’re really anxious or tense about something, or even furious, it has something to do with stress, too. Many don’t realize the debilitating effects grinding and clenching have on the teeth and jaw such that its subconscious practice continues as a daily habit.

Diagnosing TMD can be tricky because it often mimics symptoms of other conditions. Patients may disregard headaches or facial pain as independent of TMJ issues. Only when they are involved in an accident or experience trauma to the side of the face do they identify a specific event to the TMD experienced later on.

Further research reveals that TMD may be related to fibromyalgia, a chronic musculoskeletal pain and fatigue disorder that causes pain in the muscles, ligaments and tendons, according to a report in the March/April 2003 issue of General Dentistry, the clinical, peer-reviewed journal of the Academy of General Dentistry (AGD).

Both TMD and fibromyalgia produce similar painful symptoms in the muscles of the neck, shoulders, back, face and head. Dizziness and sleep disturbances are also symptoms both conditions share.We’ve found that many patients suffering with TMD problems also suffer later in life from fibromyalgia, says Thomas Sollecito, DMD and lead author of the report. Typically thought of as unrelated, this potential connection is being further explored.

Many people wake with a headache each morning or have tension and pain in the muscles on the back of their neck, while others can’t open their mouths very wide without pain. Some people continually break teeth that are not weakened by decay and others exhibit excessive wear on their teeth. When some patients come in, says Dr. Claros, sometimes we don’t even need them to tell us their problem because the condition of their teeth is already apparent. I’ll think to myself, Oh, grinder ito ah.

The most common symptoms are migraine-like headaches, which seem to come from behind the eyes or the side of the head just above the ears. The pain has been described to often radiate down into the shoulders or upper back. Another type of headache associated with TMJ dysfunction may occur in the area of the cheekbones, resembling a sinus headache.

Women experience TMD more than men and the age bracket is usually between 20 and 40 years. Dr. Claros explains further, Children have mixed-dentition where their grinding and clenching of the teeth is normal because of the difference in the height of baby teeth in the arch. For adults, as we grow older, we get cavities, wear braces or dentures, have crowns and caps put in  all these contribute to the imbalance that we acquire over time. As we live with that imbalance in our mouth, the temporomandibular joint also reacts to that imbalance.

Symptoms

More common and likely to come in waves are popping sensations or clicking sounds in the jaw when chewing or yawning. Here are a few more symptoms dentists consider to indicate the onset of TMD:

-Pain or tenderness in the jaw

-Aching pain in and around the ear

-Limited ability to open the mouth very wide

-Difficulty chewing or discomfort while chewing

-Aching facial pain or tired feeling in the face

-Locking of the jaw joint, making it difficult to open or close the mouth

-Uncomfortable bite, as if the upper and lower teeth are not fitting together properly

-Swelling on the side of the face

Better understanding of the factors leading to TMD as well as to the sites involved has led to considerable refinement in the treatment of this condition. That’s what comprehensive dentistry is all about, comments Dr. Claros who took her postgraduate studies at The Pankey Institute located in Florida. You start with one tooth, then you look at the entire structure that is around the teeth. So the gums, the bones, and how they come together and where they are located on the arch, upper and lower joints, how the TMJ makes them come together, and how the muscles relate with all of that  that’s why there’s a field of TMD specialists.

Initial therapy is directed at relief of the painful muscle spasm and involves use of heat, massage, and muscle relaxing therapy. Self-care practices could include applying ice or cold packs, avoiding crunchy or chewy foods, and taking over-the-counter anti-inflammatory drugs to relieve muscle pain and swelling. For many patients one or two weeks of such treatment is sufficient to eliminate the symptoms.

For those with tooth grinding or clenching habits the dentist may sometimes construct a plastic appliance that separates the teeth and makes such activity more difficult, if not impossible. We aim to either stop it, minimize it, or protect the teeth as the person grinds, says Dr. Claros. It’s not so much treating the grinding, but protecting the teeth from the damages caused by grinding. This appliance is particularly helpful for individuals who grind their teeth while sleeping and therefore cannot consciously control the habit.

In rare occasions, your dentist may recommend minor adjustments to the biting surfaces of the teeth, using crowns, bridges, or braces to adjust one’s bite. Even more rarely is surgery suggested to adjust or replace the joint. However, the National Institute of Dental and Craniofacial Research of the NIH advises against it, citing that There have been no long-term studies to test the safety and effectiveness of these procedures.

Injury plays a role in some TMJ problems, but for many people, symptoms seem to start without obvious reason. The good news is that for most people, pain in this area is not a signal of a serious problem. Generally, discomfort is occasional and temporary and will go away with little or no treatment. Even if symptoms persist, most patients still do not need aggressive types of treatment.

Still, it helps to know if you’ve bitten off more than you could chew.

Chiropractic Medicine: The Odd One in Medicine


V. Glenn Orion files this interesting report on the progress chiropractic medicine has made over the last 11 decades, from the time it used to be considered by medical bodies as an unscientific cult, to recent times when even the International Olympic Committee has cited it as a cost-effective management of neuromusculoskeletal problems. Well-respected chiropractic specialist Dr. Martin Camara provides the answers to Glenns long list of questions on this relatively low-key specialty of cracking bones to achieve a healthy skeletal alignment.


THERE’S one in every family. That odd-looking second-cousin you see across the function hall at family reunions. You can’t figure out how he could possibly be related to you but you know your aunt and uncle love him the only way parents can. He doesn’t pose a threat, yet you have to prove that you’re superior to him at all costs, especially during the last leg of the annual potato sack race where it all comes down to the two of you. Still, there’s nothing quite like an underdog.

In a similar vein, such is the case of chiropractic medicine considered for a while as an odd method of healing neuromusculosketal disorders.

The story begins in the late 1890s in the Midwest region of the United States during the era of heroic medicine. It was at this time when medicine  the regular medicine, the MDs believed that diseases were blood-born, relates Dr. Martin Camara, chiropractic specialist and director of clinics for Intercare Healthcare Systems, Inc.Which meant, if you got sick, the solution was to puncture a vein or an artery to bleed the bad blood out of it.

At that time, according to Dr. Camara, they would use leeches to remove some blood from the patient.They didn’t know, like everybody knows now, that you need blood to maintain life, says Dr. Camara. Because of the inappropriateness of this mode of treatment, people were dying from it.

D.D. Palmer and later his son, B.J. Palmer, founded chiropractic after the development of osteopathy by Andrew Taylor Still, who revived an old European tradition of bone-setting. The proper term for it actually is chiropractic, clarifies Dr. Camara. So this was the era were MDs were bleeding people to death, and chiropractors were cracking peoples backs.

Because of better results, the people then preferred the chiropractors because they and their relatives were getting better and dying less than those who subjected themselves to the bleeding form of medicine. The medical profession didn’t like us, because we were taking their patients, Dr. Camara continues. So, we (chiropractors) were thrown in jail for the illegal practice of medicine. And the only reason were still here is because patients would support us, rally around us basically to keep chiropractors around.

Dark Ages in medicine

If there were ever an equivalent to the Dark Ages in the history of medicine, this would be it. Health professionals at the time completely discounted the contributions by chiropractors even having the American Medical Association (AMA) call their practice an unscientific cult. Chester Wilk along with four other chiropractors refused to sit idly by. He appealed the 1981 decision all the way to the Seventh Circuit of the United States Court of Appeals to win the case against the AMAs blatant violation of antitrust laws.

The fallout has been felt ever since. Then, medicine was forced to work with chiropractic, although they didn’t want to, notes Dr. Camara, who is also the chairman of the Philippine Board of Chiropractic. The relationship was antagonistic, so when you see remnants of older doctors in their versions of chiropractic, it’s because of the mindset that was institutionalized by the medical profession all over, from that generation.

That was a very interesting time in healthcare development, recounts Dr. Camara. There were three medical professions then: the doctor of medicine or MD, the doctor of osteopathy or DO, and the doctor of chiropractic or DC. The three professions were considered separate and distinct from one another. Over the years, osteopathy became incorporated into the medical degree. One now rarely hears about osteopathy unless they’re in Europe and its an older person. There are very few osteopathic schools. Chiropractic survived and it’s been in practice in many different countries, says Dr. Camara.

Indeed, chiropractic practice is well established in the United States, Canada, and Australia. In some countries like Denmark, the chiropractic school is a part of the large universities, and it is sometimes harder to get into the chiropractic program than it is to get into the medical program. In countries like Denmark, chiropractic is also very well integrated into the regular healthcare that’s available to all its people. In fact, all a chiropractor has to do is open an office if he plans on setting up a private practice because public perception is good, referral paths are good. Whoever pioneered chiropractic in Denmark did a fantastic job, says Dr. Camara.

But for many who still see chiropractic measures as glorified hilot, misconceptions abound. Going to the chiropractor is like going to an architect, asserts Dr. Camara, a consultant for this field at the Department of Health. We look at structure, load, and function. If your structure is properly aligned, it should function well. And functioning well means that one should be able to run without pain, go to the office, bend over to pick up something, carry ones children. It shouldn’t have to alter your body mechanics because you’re avoiding pain or discomfort, Dr. Camara explains.In our world view  Im very specific because the chiropractic profession looks at it this way  just like an orthopedist looks at it from a surgical perspective, we look at it from a different perspective, from the architects point of view.

Difference in approach

There is a marked difference in the approach of chiropractics and other bone specialists, according to Dr. Camara. A physiatrist or rehab doctors main therapeutic approach is generally to coordinate with a physical therapist and to give medications. He expounds further: Their solution is pharmaceutical, so if you have pain theyll give you painkillers, if you have inflammation, they’ll give you anti-inflammatory medications, etc. An orthopedist, is trained to look for conditions that may require orthopedic surgery. So, if you have a completely torn ligament that’s ruptured, that needs to be orthopedically surgically reattached, he would be the best to do that. Of course they are trained as surgeons, so their primary emphasis is surgical correction. Now, chiropractic is basically a natural, drug-less, non-surgical option or alternative for people suffering from these types of conditions. We can do whatever tests, order x-rays, come up with probably the same working diagnosis as the other physicians. The difference lies in our approach.

Contrary to popular belief that chiropractors can only treat back problems, chiropractic actually takes a holistic medical approach focused on keeping all of the bodys skeletal structures in alignment to encourage optimal functionality. To explain his point, Dr. Camara compares the human body to tires, which when misaligned, wear out unevenly. The same thing happens to the body. For the most common type of arthritis, which is degenerative osteoarthritis, chiropractors are trained to correct the structure so the skeletal joints don’t wear out. So if you’re in pain, we can get rid of the pain, if you have an imbalance, were trained to look at muscle imbalances so we can strengthen the weaker side so we can align it properly, says Dr. Camara.

Chiropractors also can manage patients with so-called pinched nerves as in sciatica or carpal tunnel syndrome. Again, the principle of alignment of structure is applied. Sometimes, by aligning the neck or the lower back, you can get rid of the pinched nerve that is traveling down the arm or the leg, he explains. So skeletal problems with nerve compression symptoms can be resolved by chiropractic treatment, which also has beneficial effects on the muscles, their articulations; and on the nerves, relieving the compression and allowing the whole body to function better.

 

Getting the recognition they deserve

Today, health professionals and chiropractors have a much improved relationship, and chiropractors are getting the recognition they deserve. In the 2008 Summer Olympics in Beijing and 2010 Winter Olympics in Vancouver, chiropractors were included for the first time in the polyclinic. I’ve been working with the Philippine Olympic team since 2004 in Turino, recounts Dr. Camara who sits as the co-chair for the Medical Commission of the Philippine Olympic Committee, but never inside the polyclinic. The polyclinic is set up by the International Olympic Committee to service all of the needs of the athletes during the games. So now, even Olympic athletes can benefit from the chiropractic touch.

But perhaps the biggest milestone chiropractic medicine has achieved was in 2005 when the World Health Organization (WHO) set an official guideline for chiropractic. It said, One of the benefits of chiropractic, may be that it offers potential for cost-effective management of neuromusculoskeletal disorders.

So now, when a doctor comes up to Dr. Camara and says, You know what, I don’t believe in what you’re doing, Dr. Camara would politely reply, Well, you may have a difference of opinion, but why don’t you take it up with the World Health Organization because they seem to disagree. Indeed, chiropractic medicine has come a long way.

For more information, or to contact Dr. Martin Camara, please visit http://www.intercare-centers.com.

Comprehensive Dental Examination: Portal to the Big Picture


The eyes are the windows to the soul as the mouth is the portal to the body since manifestations in the oral cavity often come with systemic diseases. A visit to your friendly dentist might be able to provide you with answers and explanations on the different changes in your body through a comprehensive dental examination. Ana Carmela G. Ledesma details the importance of this procedure, as she hints that the benign-looking mouth sore may just be the tip of the iceberg.

UNASSUMING as a gentle tooth fairy, a dentist may have stereotypically projected the image over the years as that professional who just fills, extracts, and cleanses the teeth. Unknown to many, dentists can also detect and diagnose a disease or condition by means of a comprehensive dental examination.

It is actually the dental examination. There’s no such thing as a dental examination, [because] when you do dental examination it must be comprehensive, emphasizes Dr. Leo Gerald de Castro, a consultant in dentistry and implantology and past president of the Philippine Dental Association. We start from medical questionnaires where you rule out any contradicting medical condition and then you proceed to the dental [procedure]. It starts with the history of the existing condition such as the chief complaint, to start with, and from that we determine if it is medical or dental in nature, he adds.

At the Asian Center for Dental Specialties (ACDS) patients may subject themselves to an extensive oral assessment, which includes a dental x-ray, oral history evaluation, and cleaning, at an affordable cost of Php 1,800 to Php 2,000.

Ideally all dentists should perform a comprehensive dental examination, most especially during the first visit as it’s part of the protocol, says Dr. Gina Sicangco-Gamboa, endodontics specialist at the ACDS. I’m going to address your chief complaint but I’m not going to stop there. I’m going to give you a full review of your oral condition and your health condition because we owe that to you.

Bird’s eye view

Since the mouth, considered as the body’s portal, is where almost all particles such as air, food, and even germs and bacteria liberally enter and exit, it can also provide a bird’s eye view of the bigger picture taking place inside your body. Albeit the clue-like manifestations your mouth can provide, it can give you and your doctor the head’s up you both need. It may even save your life.

In a sizable number of instances, the oral clues are the first and sometimes the only evidence of a disturbed state, says Emanuel Cheraskin, M.D., D.M.D in his dissertation Oral Manifestations of the Systemic Diseases published in the Journal of the National Medical Association. Among the classic examples are the Koplik’s spots in the buccal mucosa which precede, by about 24 or so hours, the eruption of measles.

All cancers may have oral manifestations. And a simple mouth sore may just be the tip of the cancer’s iceberg as most cancers would manifest oral lesions, explains Dr. De Castro. Another manifestation is the growth of the teeth. Take for example the inconspicuous case of a set of crooked teeth. It may seem usual that teeth get crooked in time but because you have underwent a comprehensive dental examination, your dentist may find out that there is a bone-eating tumor that is pushing the teeth away, thus its crookedness, Dr. De Castro adds.

But there are also cases wherein the oral condition triggers the systemic disease of a person or that oral reflections follow rather than precede or parallel, evidence in other parts of the body, says Dr. De Castro and Dr. Cheraskin.

Early in the 2000s, studies have shown that the mouth and the heart are connected. People who have gum disease (periodontal disease) were twice as likely possible to also have coronary artery disease, along with other heart-related health conditions.

If the patient has a chronic periodontitis or gingivitis and poor oral hygiene, he might suffer from high blood pressure. The reason why the patient is prone to heart problems is because of the condition of the oral cavity, propo-ses Dr. De Castro.

Case report

Dr. Cheraskin explains that the oral cavity is vital for diagnosis as the oral cavity contains derivatives of all of the primary germinal layers and the mouth includes tissues not demonstrable anywhere else in man.

One of his published case reports highlights the interconnection between manifestations in the oral cavity and more serious underlying diseases. The case report brings this important point into focus:

This is the story of an elderly gentleman who presents himself in the clinic with a chief complaint of soreness and tenderness in the floor of the mouth. Oral as well as physical examination is essentially negative except for tenderness in the sublingual space in the general area of the distribution of Wharton’s duct. A lateral jaw roentgenogram confirmed the original tentative diagnosis of sialolithiasis a salivary stone in Wharton’s duct as shown by the discrete, roentgenolucent shadow. However, additional skull (and other roentgenograms indicated that this patient was probably suffering from something much different from sialolithiasis. Biopsy confirmed the suspicion of cysticercosis.

Cysticercosis is a parasitic infection caused by the pork tapeworm Taenia solium. Early diagnosis is important since it can affect the brain and spinal cord (neurocysticercosis) and can cause seizures. Hence, it is a major cause of acquired epilepsy.

This case is not isolated. Many systemic diseases can manifest in the oral cavity, and can wave the red flag alerting the dentist to a more serious underlying problem. A close collaboration with the patient’s family physician can help diagnose the underlying problem and lead to an early and appropriate intervention.

A comprehensive dental examination can indeed be one of the most cost-effective, and perhaps life-saving procedures one can undergo.

Shattering the Pill-for-Every-Ill Myth


Indeed, antibiotics are wonder drugs. But Dr. Elvie Victonette B. Razon- Gonzalez takes a closer look if we are maximizing them, or abusing them.

ANTIBIOTICS are wonder drugs that, since their inception, have magically cured diseases once considered by humans as curse to humanity, such as plague, leprosy, and syphilis. Gone are the days when half of the population can easily be eradicated by the lightning swiftness of a spreading disease caused by dreaded bacterial organisms. Today, antibiotics have become strong and potent weapons by doctors in their fight against malady such that no organism can be considered insusceptible.

Like most things good and beneficial, however, antibiotics are prone to be abused in different ways by different people, from key players from the pharmaceutical industry to practicing physicians and even hapless patients themselves. Antibiotics are one, if not the best-selling drugs in the market today, perhaps owing to the fact that their dramatic and fast therapeutic effects are easily apparent to everyone; hence, the notion that, in general, they are the pill for every ill. Almost everyone has had an experience with antibiotics, most of whom are guilty of having self-medicated unabashedly. In our country, amoxicillin is inarguably the most popular and most abused antibiotic. Aside from its cheap cost, it is the most easily accessible and available antibiotic in different health centers, even in far-flung areas. I vividly remember a patient I encountered in our community immersion before who pricks an amoxicillin capsule with a needle and pours its content in open wounds. Even people who reside in urban areas are guilty of irrational antibiotic use. A friend of mine admittedly self-medicates with antibiotics left and right at the slightest elevation of body temperature or any abominable symptom, thinking that whatever she or her son has, will resolve instantaneously with antibiotic use.

Doctors, even the most experienced ones, are not immune to committing mistakes, either, especially in prescribing antibiotics. In medical school, we are taught that antibiotics should be used rationally, keeping in mind the right indication, dose, administration, duration, and safety. But years pass by since medical school, patients come and go; unfortunately, some of us inevitably forget about the basics of the so-called rational drug use. From my limited experience and keen observation from being an internist, here are the most common mistakes committed by doctors in antibiotic use.

Antibiotic overkill: Using more potent antibiotics when simpler and less expensive ones will do

In the age of multidrug resistance in the community and hospital setting, it is quite tempting for doctors to prescribe newer and more potent antibiotics to their patients even when the bacteria they’re dealing with can easily be eradicated by antibiotics considered to be in the lower end. Not only will patients suffer ultimately with this kind of practice because of the unreasonably exorbitant cost of such antibiotics, the practice of using strong antibiotics carelessly can lead to resistance by various microorganisms, later necessitating the invention of more potent antibiotics. Quite sooner than expected, it becomes a tenacious vicious cycle. The most dreaded, inexorable complication is that we will be left with nothing in our armamentarium against infectious diseases later on because of the lack of antibiotics that would work effectively. We would be pushed to the wall, defenseless and regretful. Every doctor should be made aware of this inevitable consequence of haphazard practice to circumvent multidrug-resistant diseases of pandemic proportions.

Incorrect drug dosing and timing

Antibiotics require the right amount of concentration in the blood and the correct timing of administration. Some drugs are considered to be concentration dependent such as beta-lactams (e.g., amoxicillin and cefuroxime), while some are time dependent such as fluoroquinolones (e.g., ciprofloxacin and levofloxacin). The importance of knowing the therapeutic concentration and time to peak of an antibiotic cannot be overemphasized. This is why patients need to consult their doctors first before taking any form of antibiotics. Self-medication and polypharmacy are strongly discouraged. In return, doctors are expected to know the correct pharmacodynamics and pharmacokinetics of every drug they prescribe. Since pharmacology is one of the main subjects taught in medical school, every doctors are expected to imbibe the lessons in their head and, lest their memory fail them, they must take the initiative to consult their textbooks, medical literature, and practice guidelines to lead them toward the right antibiotic, route, dose, timing, and duration.

Wrong antibiotic choice

For every infectious disease, there are myriad of options with regards to the antibiotic of choice, especially with the increasing number of antibiotics available today, becoming mere commodities in the marketplace. With the passage of the Cheaper Medicine Act, doctors are left with more options now that price is not an issue and there’s a conscious effort to abolish disparities in the realm of healthcare and social welfare. This wide array of choices can all lead to confusion if the doctor does not seek clarity. Thus, it is of paramount necessity for doctors to be abreast with present recommendations and guidelines by consensus or expert opinion with regards to antibiotics. It becomes his or her responsibility as a physician to his or her patients. One must avoid getting stuck in the past, with all things obsolete and pass. Medicine is such a dynamic world that doctors are expected to keep up with the waves of change rather than being drowned by the old and useless data and washed slowly ashore.

Forgetting to educate patients

I believe that patient education plays a vital role in treating patients. Patients need to be instructed properly before sending them home or at the end of a clinic visit. This involves speaking in simple language and audible voice for the patient to understand the doctor’s instructions. Doctors should encourage patients to ask questions after instructing them to avoid any confusion at home. This also means writing prescriptions legibly for the patients to avoid any inadvertent mistakes. Doctors should consciously try to make their handwriting easy for the patients to understand even when they are in a hurry. Before, the term compliance was used to encourage patients to follow doctors instructions. This is now replaced by a more appropriate term, adherence, which suggests mutual decision of both doctor and patient to stick to the treatment plan. It connotes active participation by the patient in his or her relationship with his or her physician, which becomes more of a partnership rather than leadership.

Forgetting to warn patients on the adverse drug effects, both expected and idiosyncratic

All drugs have adverse drug effects, which can be the sequelae of their natural mechanism of action or entirely idiosyncratic, which means that it can be completely unexpected. An example of the former is when an antihistamine, which is used for allergic reactions like rashes and angioedema, causes sedation. Thus, every patient should be forewarned against driving or doing heavy physical work soon after taking the drug. An example of an idiosyncratic reaction is when a drug such as co-trimoxazole can suddenly induce catastrophic skin eruptions such as Stevens Johnson syndrome or erythema mutiforme. By letting patients understand the possible side effects of drugs, medical lawsuits and other doctor patient relationship conflicts can be preempted.

Prescribing an antibiotic when it is not needed or not prescribing one when it is needed

Although bacterial infections comprise a lot of infectious diseases, viral infections are still the most common. Antibiotic administration is often unnecessary with viral diseases because they resolve spontaneously. On the other hand, bacterial infections necessitate antibiotics. Physicians must be cognizant when a patient is septic, when a bacterial infection is present in the bloodstream. Although the symptoms can easily be recognized by most physicians, some patients, especially the elderly and the immunocompromised, can be completely asymptomatic and the only clue is an elevated white blood cell count or profound weakness. Physicians must be astute enough to institute antibiotics especially when the disease can easily be reversed by the right antibiotics.

Neglected No More


Have we given proper attention to neglected tropical diseases, asks Framelia V. Anonas.

THE sight is familiar, especially in population-dense areas. Small children running barefoot, their dirty hands dipping into a pack of chips then popping the crunchies into their mouths, and finally relishing the last traces of the flavor by running their small tongues all over their palms. You look at their bulging bellies and shudder at the thought of how many parasites could be calling their small bodies home.

A study led by the Department of Health found that among children aged 1271 months old, there was a cumulative prevalence rate of 66 percent of soil-transmitted helminthiasis.

Meanwhile, hospitals noted the rise in elephantiasis cases after the onslaught of typhoons Ondoy and Pepeng. Men and women trooped to the hospitals, their body parts bulging due to infections they caught in the floodwaters. A study by the University of the Philippines National Institutes of Health estimates 645,232 cases of elephantiasis in the Philippines today.

There’s the cheese.

To call a group of diseases, including helminthiasis and elephantiasis, as neglected while over 1 billion people suffer from them worldwide is an enigma. In fact, here at home, these infections afflict some 500,000 Filipinos while 10 million more are actually at risk, according to Dr. Remigio M. Olveda, director of the Research Institute for Tropical Medicine.

Apparently, neglected as a definition comes from the relatively measly financial support of governments in addressing them despite the damage they cause to people. Moreover, these neglected tropical diseases mostly affect people who are marginalized and forgotten by the society, so they are left to suffer in silence.

What are the neglected tropical diseases?

Neglected tropical diseases (NTD) are 14 chronic tropical infections; namely buruli ulcer, leishmaniasis, Chagas disease, leprosy, cholera/epidemic diarrheal diseases, lymphatic filariasis, dengue/dengue hemorrhagic fever, onchocerciasis, dracunculiasis (guinea-worm disease), schistosomiasis, endemic treponematoses (yaws, pinta, endemic syphilis, etc.), soil-transmitted helminthiasis, trachoma, and human African trypanosomiasis.

These diseases are diverse and cause severe disability or even death. They also bring economic burden on the government. According to experts, NTDs impede child growth and development and harm pregnant women.

In many cases, people who suffer from NTDs are usually shunned by people, including their families. People with NTDs often cannot work productively, so it is economically disadvantageous to them and their families.

Children affected by NTDs can experience both physical and mental effects, says Dr. Olveda. Moreover, there are areas where intestinal parasites overlap, so children are infected not only by one kind of infection. Such condition increases the burden of the disease, especially to children, he adds.

At the core, NTDs are diseases of the poor. According to the World Health Organization, people afflicted with NTDs worldwide are those who live on less than $1 a day (Php46). That the afflicted are left as social outcasts and do not receive adequate government attention is simply a double burden to them.

NTDs in the Philippines

In the country, schistosomiasis is endemic in Central Visayas, Mindanao, and in southern part of Luzon such as Mindoro, informs Dr. Olveda. There are also cases of intestinal helminthes, such as ascaris, hookworm, trichuris, tapeworm, and others, but one of the most common NTDs in the country is onchocerciasis.

The prevalence rate of intestinal helminths among children ranged from 48 to 93 percent, with Bicol having the highest prevalence rate, a DOH study showed.

Several years back, other diseases such as malaria and tuberculosis were considered neglected, but not anymore,  reveals Olveda. Programs that address these diseases are now well funded.

Meanwhile, the National Filariasis Elimination Program reports that filariasis, discovered to be endemic in the country some 90 years ago by foreign workers, has caused Php197,163,848.46 in annual losses due to lost work days and decreased productivity. Moreover, up to 23 million Filipinos are at risk of getting infected with filariasis.

Some 76 percent of the filariasis endemic areas in the Philippines belong to fourth to sixth class types of municipalities, statistics show.

Neglecting the neglected

NTDs are usually associated with poverty, yet the control of these diseases remains excluded in the priority list of funding agencies in both the government and private sectors.

One reason for such neglect is the fact that these diseases [usually] don’t cause obvious illness [unless it is too late], informs Dr. Olveda. Moreover, they are also not among the top 10 diseases that cause severe morbidity and in the countries where they can be found.

Dr. Olveda reveals that a few years back, tuberculosis and malaria were the most prevalent tropical diseases in the country, although these also occur in temperate countries. But because NTDs are associated with poverty; they are more common in underdeveloped countries,  Dr. Olveda explains. Industrialization and economic development have caused the dwindling of NTD cases in Western economies.

Neglected but not unimportant

NTDs may be neglected by governments but they cannot forever turn a blind eye on these diseases. NTDs do impact the society in a huge way.

The best way to understand the impact of NTDs is to measure the years of healthy life lost from these diseases due to illness, disability, and premature death. A common tool in measuring healthy life years lost is a time-based measure named DALY (Disability Adjusted Life Year). DALY combines years of life lost due to premature mortality and years of life lost due to time lived in states of less than full health.

In computing the DALY, experts use a complex formula that takes into account several factors, such as age and severity of disability, and length of disability. A 30-year-old man bedridden for 10 days, for example, would have greater loss than a school child suffering from the same disease.

Stop the neglect

Controlling NTDs will have a direct impact on alleviating poverty and could even strengthen some components of health systems in the poorest areas. Governments should realize that controlling NTDs requires increased investments and fortified health information systems.

In practical terms, early case detection and appropriate case management would be best. However, this requires skilled personnel and, sometimes, complicated treatments that reflect a strong health system. Another method to address NTDs is to deploy safe single-dose medicines which make for simple and very effective treatment.

According to Dr. Olveda, the Department of Health does have a budget to combat NTDs. He, however, admits that the amount is not as large compared with allocations for tuberculosis and malaria, but they help. Some pharmaceutical companies also donate several millions of pesos to fight NTDs.

In the United States, President Barack Obama’s proposed budget for NTDs in 2011 is a big jump from $65 million this year to $155 million. The USAID too has just embarked on a 5-year NTD control program that raised some $100 million for a 5-year NTD control program. USAID concentrated on five of the 14 WHO-identified NTDs, with a working annual budget of $65 million in 2010.

Treating NTDs: A spectrum of approaches

Budget notwithstanding, Dr. Olveda assures that NTDs can be eradicated through a combination of approaches.  Drugs alone are not enough. These are not 100 percent effective to treat these diseases,  he said.

Many of these diseases are transmitted from animals, which is particularly problematic in the rural areas where people are highly exposed, he explains. Even if the infected are treated, they can still be reinfected.

Dr. Olveda cites farmers, for example, who are always exposed to the soil which carry organisms that cause some of the NTDs. But when they use mechanized farming, their vulnerabilities decrease.

We really need development, in terms of economics, sociocultural services, and others, says Dr.  Olveda, for the country to be able to fight NTDs. We also need to educate our people, improve agricultural practices, enhance irrigation of farm lands, handle domestic animals better, and others.

There are already many drugs available that can effectively treat NTDs. But the problem lies in sustaining treatment, according to Dr. Olveda. Peoples exposure to these diseases should be minimized too in order to bring down the number of cases, he adds.

Also, some treatments take several rounds but people stop having treatments once they feel better. Others simply cannot afford the extra expense.

Those are just some of the problems that need to be threshed out. As soon as these are properly addressed, Dr. Olveda ensures that NTDs can be eradicated, just as small pox and polio were.

The problem of NTDs can be addressed by coming up with a sustainable program, says Dr. Olveda. This means that this program will be able to continue on and on, even without much support from the national government.

Children’s Best Shot


Sherma E. Benosa takes a close look at the Philippine expanded program on immunization.

IMMUNIZATION, or the administration of vaccines to give an individual immunity to vaccine-preventable diseases (VPD), is an important and cost-effective health investment. It effectively prevents the outbreak of VPDs and, thus, lowering rates of suffering, disability, and even death caused by these diseases.

An important World Health Organization initiative geared toward disease prevention is the Expanded Program on Immunization (EPI), established in 1974, with the objective of vaccinating children throughout the world. The program makes vaccines available to these children to be administered following standard schedules designed and established by the international health body. The original vaccines available included Bacillus Calmette-Gu rin (BCG), diphtheria-tetanus-pertussis (DPT), oral polio vaccine (OPV), and measles. Through time, as knowledge of the immunologic factors of disease increased, new vaccines were developed and included in the program. Among such new vaccines is the hepatitis B vaccine (HB).

The main goal of the program is to make every child fully immunized. A child is fully immunized if he has received his BCG1, DPT 1, DPT 2, DPT 3, OPV 1, OPV 2, OPV 3, HB 1, HB 2, HB 3, and measles vaccines before he reaches the age of 12 months.

At the local front

Since the start of the EPI in the Philippines in 1979, the government has aggressively procured vaccines to be given and administered to every Filipino child for free following the standard schedule set by the WHO. To ensure the quality of its vaccines, the government uses the procurement system of the UNICEF and follows the standards of transport and storage of the WHO.

Since the start of the program, the Philippines has achieved comparatively high levels of immunization against PVDs. In 1989, the program achieved universal coverage and peaked in 1997, with an all-time high of 90 percent coverage of fully immunized children.

These initial achievements, however, were not sustained. In a 2010 report prepared by Dr. Howard Sobel, WHO Philippines EPI Medical Officer, he noted that beginning 2000, the program suffered national stockouts and drastically decreased vaccination coverage and that in 2003, the coverage declined to a low of 55 percent.

A partnership between the Department of Health and the WHO beginning in 2002 paved improvements and record-high achievements in the implementation of the program. The program achieved the following from 2003 to 2008:

Measles

According to Dr. Sobel, the program recorded an all-time low of measles cases following the 2004 Ligtas Tigdas campaign. The campaign achieved 96 percent decrease in measles cases, so that from 2004 to 2006, an estimated 6,000 deaths per year were prevented.

Dr. Joyce Ducusin, EPI Programme Manager of the DOH National Center for Disease Prevention and Control added that the program, which targeted children 9 months to below 8 years of age, was able to reduce measles morbidity by 98 percent and mortality by 99 percent.

I personally got to witness San Lazaro Hospital in 2004 with 10,000 cases every year. Every room of the ward for measles was overflowing to three children to a bed. It was a very sad place to be. I watched deaths happen every day. Then, between February and April, I watched [the outbreak] progressively shut down. By April, that ward was completely empty [of patients]. That’s one of my evidence that the campaign was successful, shared Dr. Sobel.

We tested suspect cases for measles and we found that of the many hundred cases, none was positive between mid 2004 and late 2006. What’s more, after the campaign, the D3 strain of measles disappeared from the face of the earth, he added.

Polio

According to Dr. Ducusin, the Philippines, together with other countries in the Western Pacific, was certified polio-free following a nationwide polio vaccination campaign and surveillance conducted by the DOH. The surveillance involved looking for symptoms of polio in children younger than 15 years.

Neonatal tetanus

Neonatal tetanus decreased by eight-fold between 2003 and 2008. Moreover, the countrys unique approach to the maternal and neonatal tetanus elimination risk assessment has been recognized and duplicated in the Asia Pacific region.

In January 2007, no births were receiving a dose of neonatal tetanus vaccine within 24 hours of birth. Within 2 years, the big hospitals, and 3 years, all hospitals achieved [more than] 70 percent of births receiving a dose with 24 hours,  he shared.

Hepatitis B

Coverage for hepatitis B improved from 40 percent in 2003 to 80 percent in 2006. Hospital birth dose likewise improved from zero to 70 percent in 2 years.

In 1984, we were only procuring 40 percent of the needs of the country for hepatitis B due to lack of fund. The plan was to buy 10 percent more every year until we get 100 percent of our hepatitis B vaccines, but it did not happen until 2005,  shared Dr. Ducusin.

Fully immunized child

The years 2003 to 2008 recorded the highest coverage historically.  FIC coverage improved by 10 percent, from 70 percent for many years to a record high of 80 percent in 2006, shared Dr. Sobel. Child protected at birth against tetanus likewise increased by 13 percent from 62 to 75 percent,  he added.

In addition to these milestones, the Philippines likewise added Haemophilus influenzae type B vaccine into the program, and the program managed to restore effective vaccine procurement and management, and greatly improved supervisory, data, and surveillance systems.

Measles outbreak of 2010

Six years after the Philippines recorded an all-time high in vaccinating infants against measles, an outbreak was reported in March of this year. Dr. Sobel explains that the outbreak is due to the fact that while their success rates had been high, there is still a small percentage of children that they were not able to reach, and that small percentage could translate to over 2 million children over 3-4 years.

As of this writing, local government units have started a response to the outbreak. According to Dr. Ducusin, local government units have started immunizing children 6 months up to 59 months as well as children 7 years up to 15 years of age. In the NCR, [the vaccination] is already region-wide. There are areas in the country that have done the vaccination city-wide and province-wide,  she added.

Directions of the EPI

While the DOH and the WHO are happy with what they have achieved thus far with regards to their EPI efforts, they are not riding high on their successes, knowing that their work is a continuous, never-ending challenge. They continuously monitor the country for outbreaks, and are actively planning and implementing immunization campaigns to ensure that Filipino children receive maximum protection against VPDs. Among the ongoing and future campaigns for the program include:

-Inclusion of measles, mumps, and rubella (MMR) vaccine to the menu of vaccines being provided. The MMR vaccine is to be administered to children 12-15 months old.

- Procurement and administration of pentavalent (five-in-one) vaccines. Thus far, the country has already procured 30 percent of the countrys needs. These will be distributed to priority areas in the country.

-Elimination of neonatal tetanus.

- Screening in preschools and grade schools.

This coming school year, screening will be held in preschools and grade schools, where all children entering preschools and grade school will be screened for vaccination. If they find that a child is not yet immunized, they will recommend to parents to coordinate with the local government for administration of needed vaccines. We appeal to parents to keep their childrens immunization records, said Dr. Sobel.

Appeal to parents and health workers

Besides the WHO, the DOH, and international health organizations that have been involved in the immunization campaigns through funding and other kinds of support, another partner plays an important role in the immunization program: parents and health workers. Parents need to realize the importance of the program in ensuring that their children are protected against PVDs, while health workers need to fully realize why such campaigns must be executed with the highest degree of efficiency and coverage.

The children need to have their vaccines on schedule because we want to give the children protection at the earliest possible time. A lot of health workers and parents, however, don’t give the vaccines on schedule. Sometimes they even split the doses, which is not good because if they do that, the childs protection is considerably lowered, Dr. Sobel shared. I’d like to appeal to parents to have their children vaccinated on schedule and if not, they must have their children catch up with the vaccination. Catching up with schedules is not ideal but it’s the next best thing they can do, he added.

Dr. Ducusin directed her appeal to the health workers to reach the chronically unreached children.

They also appealed to local health centers to keep a good inventory of their stocks and to stock up before their stocks reach critical levels. We have to realize that we must do it and do it right, Dr. Sobel added.

Sex in the City


Henrylito D. Tacio takes another look at HIV/AIDS, and how the Philippines is coping in terms of preventing this disease.

WILLIAM was only 18 when he went to Manila to study in one of the countrys most prestigious schools. The parents of this Davaoeo wanted him to be a lawyer. William was an outstanding student during his first year. But after meeting some friends, everything changed.

His friends brought William to a pub one evening. There, the young man was introduced to a beautiful guest relation officer. And the rest, as they say, is history. Since then, William was picking up girls here and there.

Lately, however, he started suffering from a chronic cough that lasted for more than a month. He also experienced itching in several parts of his body, aside from having swollen lymph. William decided to see a doctor and told him his problem. After hearing his woes, the doctor asked William about his sexual lifestyle.

Quite surprised at the question, the young man told his story just the same. After conducting several blood tests on William, he was asked to return a week later.

I am sorry to tell you this, William, the doctor told him when he returned, but you are positive of HIV.

William felt all the energy drained from him. I don’t know where I got this disease  his voice trails off as he recalls his past sex conquests. Maybe from one of those girls I picked up. Or maybe

Surveying HIV

Pasay, where William had been picking up girls, is one of the cities where HIV serosurveillance (HSS) is conducted. The primary purpose of serosurveillance is to track the spread of HIV infection in highly vulnerable groups so that appropriate public health intervention can be instituted.

Surveillance sites were chosen to the degree of urbanization, presence of known commercial sex trade, and geographical representatives. Aside from Pasay, the other HSS in the country are Quezon, Angeles, Baguio, Cebu, Iloilo, Cagayan de Oro, Davao, General Santos, and Zamboanga.

By the end of 2007, the Philippines has 8,200 people living with HIV/AIDS, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS). Twenty-seven percent of HIV cases in the country occurred among women (ages 15-49). Some 200 Filipinos died as a result of AIDS.

AIDS is a disease caused by a deficiency in the body’s immune system. It is a syndrome because there are a range of different symptoms which are not always found in each case, explains Dr. John Hubley, author of The AIDS Handbook. It is acquired because AIDS is an infectious disease caused by a virus which is spread from person to person through a variety of routes. This makes it different from immune deficiency from other causes such as treatment with anticancer drugs or immune system suppressing drugs given to persons receiving transplant operations.

The origin of HIV and AIDS is still a mystery. There have been many theories but none so far have been proven. During the early stages of the AIDS epidemic, the flimsiest evidence was used to blame AIDS on certain groups, countries, or animals. Kenneth Kaunda, former president of Zambia, urged: It is not important to know where it came from but rather where it is going!

You can catch it if you

HIV is present in all body fluids of an infected person but is concentrated in blood, semen, and vaginal fluids. Virtually, it is present in all body tissues and organs including the brain and spinal cord. It can be found in tears, saliva, and breast milk although these last three are not considered significant routes of infection.

In fact, you can’t get HIV/AIDS from kissing. A protein in human saliva keeps HIV from infecting white blood cells, informs The Merck Manual of Medical Information. The protein attaches itself to white blood cells and protects them from infection.

And if ever you get HIV through kissing, you need to imbibe 32 liters of an infected person’s saliva, according to Health Action Information Network. That would be enough saliva to fill up the gasoline tank of six-by-six truck. And the transfer should happen in one kissing session! HAIN said.

Medical experts say HIV is relatively fragile and can be easily killed by household disinfectants. But once it is inside the human body, there is no way a person can eliminate the dreaded virus.

HIV progressively weakens the body’s immune defense system until it is no longer able to fight off infections, many of which are normally harmless, said Dr. Dominic Garcia who, at the time when this author interviewed him, was the program officer of the AIDS Society of the Philippines. When the immune system is severely damaged by HIV, several opportunistic infections are present at once.

Opportunistic infections or indicator diseases affecting people with HIV include tuberculosis, Kaposi’s sarcoma (a tumor primarily affecting the skin), pneumonia, herpes, shingles, and weight loss. Death is not caused directly by HIV, but by one or more infections.

How does HIV work? The AIDS Information Unit of the Department of Health explains: When HIV enters your body, your body tries to kill the virus with the use of antibodies. This process from the moment you are infected until the moment antibodies appear in your blood takes an average of 6 weeks but may take as long as 1 year.

The DOH information sheet said HIV antibodies do not kill the AIDS virus. The antibodies and HIV remain in the bloodstream of a person until the rest of his or her life. Only a special blood test can detect whether a person is HIV positive.

According to Dr. Garcia, HIV is a retrovirus or a slow virus.  Unlike flu, which already gives you the symptoms the following day after acquiring it, HIV can show no symptoms for several years. Possibly as short as 3 years or as long as 12 years,  he points out.

A DOH report cited sexual intercourse as the leading mode of transmission in the Philippines. Vaginal intercourse is the usual route of transmission. Anal intercourse is also a route of transmission, especially among men who have sex with other men.

A single sexual encounter can be sufficient to transmit HIV, Dr. Hubley wrote. Although the risk from an individual sexual act may be low, the more times a person has sex, the greater the likelihood that transmission will take place. Women appear to be more at risk than men from heterosexual sex. The transmission of HIV from man to woman is believed to take place more easily than from woman to man.

Health experts say condom use is an effective way of stopping the spread of HIV. But Pangasinan Archbishop Paciano Aniceto, chairman of the Catholic Bishops Conference of the Philippines Commission on Family and Life, said promoting the use of condoms was dangerous and ineffective.

The prelate said the most effective way to prevent the spread of the virus was to have a change in sexual behavior. The idea of safe sex, he said, lulls men and women into complacency, thinking that using condoms would protect them from the disease. Instead, the Catholic Church encourages men and women to live morally upright lives, and to practice marital fidelity and chastity within and outside marriage.

For William, life goes on. I know just how difficult it is to cope with being HIV positive,  he says. I feel the pain, the burden. The tendency is to be depressed, and depression weakens the immune system, which is what the AIDS virus attacks. A positive attitude helps.

In the Eyes of a Renowned Filipino Global Expert


First TOYM awardee on global and maritime health Dr. Don Eliseo Prisno III sat down with Jenny Lynne Aguilar to share his views and vision not only in every seafarers health but in the welfare of every Filipino.

First off, what pushed you to become a doctor?

Initially, it was a choice between a lawyer and a doctor but having witnessed my grandparents neighbors in Samar and Leyte die because they don’t have any access to health services, I was moved to pursue medicine in the University of the Philippines.

Knowing that your mother single-handedly raised you, how did you manage to finance your medical school?

My mother literally [worked] 24 hours and would accumulate as much overtime work that she can so that she could upkeep our simple family lifestyle. We never had any vacations or lavish parties; when I perform well, I will reward myself with a McDonald’s meal and was extremely happy with that.

Why did you choose to become a researcher-scientist rather than a clinician?

With my experience being in the vulnerable and marginalized sector, I appreciated the research work in my bachelor’s degree in psychology and the research intensive work that I have in the Social Development Research at De La Salle University. I think there are still many things to be understood about human life and the circumstances that surround [us].

Had you decided to be a clinician, what would your specialization be and why?

If I were a clinician, I would have specialized in emergency medicine. I have an interest in disasters and emergencies which are really fields of public health. This interest is again part of my personally which like quick problem solving endeavors fast-paced and challenging.

Do you find the field of research medicine in the Philippines wanting?

We have to develop a research culture similar to that in the United States, Germany, the United Kingdom, and Japan, and our research program should focus on developing an economy that is grounded in knowledge. We should also provide substantial support for research appreciation. [The Philippines] is the 12th largest in the world in terms of population. We are highly literate. Yet there is still something wrong with our research environment. We don’t go far into the next level.

Why seafarers health?

While I was working on my masters thesis, I stumbled upon the large number of seafarers living with HIV and I find it more interesting that the Philippines had the most number of global seafarers yet no Filipino [researcher] conducts research on them. Maritime health research is already well established in other countries so I thought it would be a good research area. Aside from research, I also assisted health programs for seafarers.

Has it been fulfilling so far?

The work has been very fulfilling since I am now considered as an expert in the field of maritime health, corporate responsibility, global health, occupational health, and other related fields. My study influenced the international standards on medical fitness of seafarers and it also lead to the establishment of programs of which one is led by the United Nations. Hopefully the intensive health promotion has increased the use of condoms and prevented the transmission of HIV.

What are your achievements as research scientist that made you deserve the TOYM award and your other international awards as well?

Awards and recognitions are not really my intention when I conduct research; my main goal is to understand what I am studying. Awards are simply a bonus to one’s work. They are not the end goals. What makes my work get recognized is because they find it trailblazing. According to the TOYM Screening Committee, the work I did was totally different and unique. In fact, I opened categories in TOYM, which are maritime health and global health.

What it is like to be a Philippine-trained physician who is now being cited and recognized by foreign award-giving bodies?

I owe my training to the Philippines so it is but rightful that I should start improving the health of the marginalized groups in [this] country. I had the chance of being a dual Dutch-Filipino citizen but I put it on hold. I keep my Philippine passport. I would love to make an impact in the health policy of the country.

Having the privilege to work with foreign medical professionals, what characteristic of a Filipino doctor do you think gives us a cut above the rest?

We are always a jolly bunch wherever the Filipinos are. We are also known to be hard working even beyond the hours of duty. This is not only true with doctors but [with] nurses as well. Normally, we always take on the challenge of following any requests or commands without too much question. Filipino healthcare workers also have good interpersonal skills with their patients. They are known to be more caring.

Is There Sex Life After Cancer?


Is intimacy still possible after beating the big C? Framelia V. Anonas discovered that that the answer to this question is yes.

BEING told you have cancer takes a lot of emotional toll. The handful of medical examinations and treatment that follows means even more physical and even financial drain. Suddenly, all of your attention is focused on the disease. Everything else takes the backseat.

After being confronted with many changes and finally accepting them, you are ready to move on. Once again, you want to be at the peak of your health and lead a normal life, pursuing your usual interests-including your interest in sex.

Take heart, this is a very normal stage. Welcome back.

However, this will not mean “back to normal” because, in most cases, it is not. Before you hoist the green flag, there are some important points you have to consider.

Changes in sex life

There is usually no reason why you should not have sex when you have cancer, unless the cancer affects the genital area. However, be prepared for some changes. According to the U.S.-based National Cancer Institute, many cancer patients may experience changes in sex life after cancer treatment. These changes may be short-term or long-term, depending on the kind of cancer that a patient has. The most important thing right now is to prepare for such changes in your sex life.

Performance

One major change that may confront you is your inability to perform just as you did before. This is especially true to patients whose treatments caused changes in their reproductive organs. For example, some men may no longer be able to hold it up after treatment for prostate cancer, cancer of the penis, or cancer of the testes. Some who are successful may be met with weak or dry orgasms.

Some women may experience difficulty, or even pain, during the sexual act. This may be caused by cancer treatments. Some women even report losing sensation in their genital area, according to the National Cancer Institute.

Diminished sex drive

Intimacy may already feel strange as you may have struggle with your body image after cancer treatment. Thinking of your body with clothes off may even cause stress. Most cancer patients and survivors likewise feel less attractive and worry about getting hurt during the act. These kinds of fears pull your sex drive down.

Dr. Tranquilino Elicano Jr., former head of the Department of Health’s National Cancer Control Center, says that women who have cancer of the uterus and underwent surgical removal with radiation treatment may have diminished sex drive. Some women have lessened vaginal lubrication while others have vaginal stenosis, both contributing to decreased interest in sex.

Weird sensations

Women undergo odd sensations when they stop getting their periods. They can get hot flashes, dryness or tightness in the vagina, and other problems, all of which affect their desire to have sex.

Why changes happen

These weird changes happen, often due to cancer treatment’s effect on your body. Surgery, chemotherapy, radiation, and medications all made changes to your system. Emotional issues such as anxiety, depression, feelings of guilt about how you got cancer, changes in body image after surgery, and stress affect your body’s readiness to perform.

Related problems

Wrong notions

Some patients are afraid to have intimate relationship because they are afraid that sex could cause physical injuries. Even after they recover from cancer, patients still worry that having sex will cause the cancer to go back. This may be irrational, but some people think that cancer may be contagious or sexually transmitted, so they are afraid to do it with their loved ones who have the disease.

Such thoughts and wrong notions can make a relationship come to a standstill. Couples need to be open at this point and seek the doctor’s advice to dispel any fears or uncertainties.

Infertility

Receiving cancer treatments makes some patients unable to have children. Dr. Elicano, meanwhile, advises women patients to avoid getting pregnant if they are receiving radiation treatment because it will have adverse effects to the fetus.

Communicating with partner

Cancer is one of the storms that you and your partner have weathered. It is important at this point to stay connected by being open with each other. The National Cancer Institute advises that you and your partner have to talk openly about your sex life and what changes may happen. Be open about your concerns, beliefs, feelings, and what would make you feel better.

Openness with each other would prevent problems in the future, would make both of you positive, and would allow your partner to have a better view of your feelings. Focus on your partner’s feelings too and ask questions to understand your partner’s concerns better. Make sure to convey that your partner’s views matter to you.

Being single

If you are single, it is normal to feel worried about how other people will accept you. Others fear rejection so they moderate their social life and stick only with people they are most comfortable with. Quite a number are pressured by family and friends to go out more often and meet more people.

According to the National Cancer Institute, in situations like this, you may focus more on activities that you enjoy, such as enrolling in a class (cooking, dancing, etc.) or joining a club. Don’t let cancer hinder you from dating or meeting other people. Make every date a learning process; it does not have to be perfect. Rejection from other people does not mean you have failed. Dates that don’t work out are normal, with or without cancer.

Seek professional help

Your doctors, nurses, and medical social workers have a big part in helping you cope with your new condition, according to Dr. Elicano. They can very well provide you clear and detailed information about sexual functions to help you and your partner. Their pragmatic advice on coping strategies can help you have a semblance of normalcy in your new experience. Most beneficial would be advice from medical experts specializing in psychosexual medicine or from sex or relationship therapists.

Professional organizations such as the Philippine Cancer Society have medical practitioners, counselors, and support groups who can likewise assist you in your medical and counseling needs.

A patient’s experience

Cymbeline Villamin, 54, a writer, was diagnosed with invasive ductal carcinoma (breast cancer) in November 2008. The news naturally made her feel depressed, to the point that she refused any kind of intimacy with her husband. She holed up in a shell, but, fortunately, her husband Eli remained supportive and understanding.

Well into her radiotherapy sessions, Cymbeline discovered that she developed an emotional attachment to one of her radiotherapists. This she realized when she reached home after her last radiotherapy session. It was strange, but she actually felt heartbroken when she realized she would not be seeing him anymore.

Her husband noticed her strange behavior and, being open with each other, she finally got to telling him what was bothering her. She was surprised when he suggested that she visit the guy in the medical center and “and give your radtech a hug and a kiss so you can have closure and move on.”

She cried when she realized her folly, but her husband assured her that it was alright. He even explained to her what was happening-that she, having gone through chemotherapy, mastectomy, and radiation plus a 30-day Linac treatment, was at a very vulnerable stage.

Because she was physically weakened and depressed with her condition, Cymbeline realized that her radtech’s attention meant so much to her. His caring ways, even the way he touched her and sang to her during treatments, filled some kind of need inside her. “Walang kamalay-malay ‘yung radtech, he was just being kind to me,” she thought.

But the kind words from her husband and the deep understanding he showed her for a long time put her back to her senses. “My husband and I finally resumed our intimacy 3 days after my last radiotherapy session in December 2009,” she shares.

She did not mention if she did go back to hug the radtech guy goodbye before returning to her husband’s waiting arms. But Cymbeline’s story proves that cancer patients are indeed vulnerable to affection and that they can still make love with their partners, despite going through severe physical and emotional pains.

Cymbeline admits that because she and her husband are already well into their 50s, they only have “a few but quality encounters”. She documented her healing journey in an 80-page book Precious in His Eyes in which she wrote the line: “I will lose this breast/tomorrow/at 3 p.m./but I will not die.” Her experience clearly proves that, indeed, there is life (including sex life) after cancer.

Enjoy!

Unlike Cymbeline who first withdrew herself then slowly went back to normalcy, many cancer patients were actually able to maintain their libido. In developed countries, women who underwent lumpectomy were reported to have maintained high levels of libido and sexual satisfaction, according to Dr. Elicano.

At this point, your body has got you through treatments’ be proud of it. Be positive, focus on things that make you feel attractive and confident. In case you can no longer have the kind of intimacy you used to have, you and your partner can always hug, kiss, and cuddle. Feel free to explore and find new ways to enjoy your time of intimacy with your partner.

Big Brother is Watching You…Sleep!


Text and photos by Ma. Teresa C. Dumana

TAKE a tour into St. Luke’s Medical Center’s Comprehensive Sleep Disorders Center, and get to know the mechanics behind observing the pattern of our behavior, heart rate, and brain activity while we sleep.

The “technical booth” is where the technician observes the sleeping patient using that huge computer. It is here that they check on the heart rate, or any signs of twitching.


A technician views a patient’s recording. He then passes the readings to the doctors who would analyze these data for their conclusion and corresponding treatments.


A hodgepodge of equipment which are connected to the patient’s leg, chest, and head to record the needed data.