Filipino women, that includes myself, are very fond of going to beauty parlors to get our nails cleaned. We call it manicure for the  fingernails, and pedicure for the toenails. The process entails pushing the surface of the nail plate backwards into the cuticle. Then the cuticle is trimmed before applying the nail polish for a final finish. Sounds simple and easy and the nails really look beautiful. But very few women know that one skin disease called onychomycosis is commonly transmitted in this manner.

Onychomycosis is fungal infection of the nails. It is usually caused by Trichophyton rubrum. It starts with pitting of the nails. Then gradually, the infected nail changes color from yellow to black. And as the condition progresses, the nail plate separates from the nail bed. The underside of the nail plate can also be invaded causing elevation of the nail plate away from the nail bed. The condition is bad aesthetically. And women with the condition resort to applying nail polish to cover up the bad-looking nail.

How does one gets the infection? One very common way is through the use of dirty manicure-pedicure sets ( pusher, cuticle cutter, file, brush, nail cutter). Let’s take the case of my patient Lisa (not her real name). She had her toenails cleaned for the first time five months ago. Several days after the procedure, the skin surrounding five of her toes became very itchy. The skin became rough and then gradually the nails became pitted and changed color. She sought consult because of the itch. Maybe the manicurist’s tools were not cleaned at all. She used them from one customer to another without cleaning them and one of her previous customers may have the condition. Thus, unknowingly spreading the condition from one customer to another.

So, next time you plan to have your nails cleaned, ask for a clean set of tools or you might want to bring your own set.

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There was one time when I prescribed mefenamic acid suspension to a six-year-old. After sending off the patient, the mother came back telling me to compute again because the lady in the drug store told her that her child will die because of overdosage. I got furious of course. I told her to tell the lady to come to my clinic and I would gladly explain to her how dosages of medicines for children are computed. The mother refused to bring her. I wrote her a letter instead explaining how the dosage of the said medication is computed. I also explained to the mother in detail how I arrived in the dosage. I just don’t know if she followed the dosage written in the prescription. Well, I cannot blame her after hearing the comment from the drug store.

Just the other day, my son Ralph got sick. I asked my house helper to buy the medicine in Mercury drug. When the lady in the drug store (the new Mercury drug in Mangaldan, Pangasinan) read the prescription, she told my maid that there is overdosage. My maid commented that the parents of the boy who is going to drink the medicine are doctors, and that she doesn’t have to worry because the parents love their son too much to cause him into trouble. To make the story short, it turned out that the medicine written in the prescription was not available to them. She was making comments of overdosage because she wants to change the prescription to another drug which is available.

The drug I am referring to which I prescribed to my son was Cefixime. It used to be computed as 1-3mg/KBW/dose. But lately, recent studies show that there is a need to increase dosage to 8mg/KBW/dose. With Ralph, I only computed 5mg/KBW/dose. How could that lady in the Mercury drug say that there is overdosage?

The problem with pharmacists or ladies manning drug stores in general is that they only know the dosaging of medicines by basing it on the age of the patient. Please be informed, you people. There are only a set of medicines on which dosages can be based on the age of the child. These are called drugs with empirical dose. And these include cough and colds preparation ONLY. The rest are computed based on weight and the number of times they are given in a day.

So, if you have two 5-year-old boys. One is overweight meaning his weight is beyond the normal range of his age. The other boy cannot be given the same dosage as this overweight boy because that would mean overdosage.

I hope these people in the drug stores would stop commenting about overdosage. Know first the range of dosage of each kind of drug (that compels a lot of memorizing!), learn how to compute, ask the weight of the child and NOT the age, then comment if there really is overdosage. Doctors certainly know more of that aspect as we regularly attend updates and conventions regarding these things. It would be best if these people just do what is expected of them and stop acting as if they know everything and as if they are better off than doctors. And PLEASE stop changing prescriptions.

As soon as our stomach fills with solid food, contractions start which marks the start of digestion. Some of us, and that includes me, down it with water even with just a few tablespoons of food. It is just too difficult for me to continue eating without drinking water every now and then, allowing me to consume around three to five glassful of water during the entire mealtime. The end result is a bloated feeling with a heavy stomach which disappears only after two to three hours.

The practice is bad because it causes the protein in the food to be partially digested or not at all. The voluminous water intake prevents the pepsinogen to be converted to pepsin which is responsible for digestion of protein.

I am not saying that drinking water is entirely prohibited. Small sips are allowed. And drinking to the max is best for the digestive system only after two hours.

Now, some people cannot wait that long. So, to enhance or augment digestion, a tea or coffee will help after meals. Alcoholic drinks, wine, also help. That is the main reason why Italians down their food mostly with red wine or any alcoholic beverage.

Do people really benefit from such missions? Maybe yes with the dental part and the circumcision. But I have my reservations with regards to the medical part.

Take the case of the mission sponsored by the PCSO. The only available medicines were amoxicillin, paracetamol, mefenamic acid, and metoprolol. There is a very high level of resistance of Filipinos to amoxicillin. When a patient suffering from chronic cough and colds with on and off fever comes along and that patient will only be given amoxicillin without a cough and cold preparation, that person will surely not recuperate. If the doctor gives amoxicillin together with a prescription for cough and colds, there would be complains. More so if everything is given in prescription form.

What if a patient is suffering from dizziness, a very common complaint of geriatrics? What will be the choice of medicine from the list? Or a case of diarrhea? Or abdominal pain, which oftentimes is acidic in nature?

If only PCSO sent the money to the local government and allowed them to choose and purchase the appropriate medicines (with supervision of course!), then it could have been better.

Most patients who come to our clinic are commonly misinformed about the vaccine. They think that a single injection is enough, and that it is given at any age as long as a woman is still sexually active. This post is aimed at providing clarifications to all these.

First of all, the vaccine is designed to target women who are 9 to 25 years of age. Since it is only for prevention, it does not aim to treat individuals who are already exposed to the virus, or those who have abnormal Pap smear results. Which means to say that not everyone can have it. Otherwise the money invested will only go to waste as the vaccine is quite expensive.

Secondly, it is not only given once. It is given at three injections, at 0, 1, and 6 months interval. And it will not prevent occurrence of UTIs (urinary tract infection) and cystitis as what some women I’ve talk seem to believe.

And lastly, there are only two international drug companies who manufacture the drugs – Merck and GSK (Glaxo Smithkline). There are some vaccines being sold at certain areas which are very low-priced. Since fake medicine still abound here in the Philippines, take precautions before subjecting yourself to such. It is best that you’re getting your money’s worth than be fooled by people with selfish motives. Know also if its really safe to take. You might as well read some adverse reactions before finally deciding on whether to have it or not.

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One activity that is a common practice during the summer is free circumcision. Millions of Filipinos take advantage of this annual event because recipients earn lots of savings from it. What with the cost of medical procedures nowadays, topped with oral medications to take after the procedure.

But the question that should be playing in the minds of parents is whether this procedure, free at that, is safe to the boys receiving them. Being in a place (usually in a basketball court, baranggay hall, or any spacious open area) which is far from being sanitized, this boys line up hoping to be finished as soon as possible. There is literally no room for the medical apparatus from being fully sterilized. And this causes the transmission of various blood-transmissible diseases, one of them, and perhaps the most common, is hepatitis.

I have actually came across two siblings who have been diagnosed to have Hepatitis B after a routine medical physical examination in the Nursing course. They have not undergone any blood transfusion, or any medical procedure that would lead to acquisition of the disease, except for circumcision done during a medical mission in their place. It was a shocking experience for the siblings and for their parents as well.

The brothers blamed their father for it, for initiating the idea of undergoing the procedure just because it is free. But the condition is already there. The best thing to do is to prevent others from going through the same thing. As the doctors do their best to maintain sanitation in a poorly sanitized environment, people at the receiving end should be knowledgeable.

If you are familiar with diabetes, or has a family member who is diabetic, you probably are familiar with the drug metformin. It is a first-line drug in the treatment of diabetes. It is usually taken at 1000 to 1500mg daily.

In a meta-analysis published in the American Journal of Medicine 2008, it has been found that the drug metformin can delay the onset of diabetes in patients who are at risk over a three-year period. This means that the drug can be taken too by pre-diabetic individuals or IGT (Impaired Glucose Tolerance) individuals.

Nothing still beats regular exercise and lifestyle modification in the prevention of diabetes. But this is something we can turn to in order to ease the fear of having this condition.

If you want to read more about diabetes, you can read it here, here, and here in my other blog.
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Summer is really in our midst. And going out of the house when the sun is up hurts not only the eyes but most especially the skin. Using a cap, or an umbrella and eyeglasses are just not enough to protect our body from the glaring heat of the sun. It is important to use or apply sunblock to our skin to prevent damage to this biggest organ in our body.

What sunblock to use? Choose the ones which offer broad spectrum protection, with titanium oxide and zinc oxide as active ingredients. They block both UVA and UVB rays. Choose carefully especially if you have sensitive skin. One with SPF (sun protection factor) 15 will do but if your skin burns fast, one with SPF 30 is better. Apply at least 20 minutes before sun exposure, then re-apply every after two hours.

If sun exposure can be avoided, better do so between 10:00 AM and 3:00 PM. The noontime heat causes the most damage to the skin. And we must avoid chronic sun exposure because it can lead to frightening and deforming skin cancers like melanoma, basal cell carcinoma, and squamous cell carcinoma.

Beat the heat, enjoy summertime, but don’t forget to take care of your skin.
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I had been on aerobics and weight lifting for nearly eight uninterrupted years now. And my regimen has given me acceptable results and enough boost of confidence. Though I am not gaining additional weight, my body got accustomed to my 5-day-a-week work-out such that my weight plateaued. And no matter how hard I exercised, I noticed no change in weight for several months. This made me try other exercise regimens to test my body.

I tried Pilates once. But the different movements made it impossible for me to follow because of my back problem. And so I tried yoga. I was against yoga initially, thinking that it would not even help burn calories. But contrary to what I believed, yoga helped me a lot in lossing the stored fat that I had been painstakingly trying to remove with my previous exercise regimen. The different poses made me sweat a lot and I had a difficult time following every move. But with time I got accustomed to it. My body even became more flexible.

Together with yoga, I also tried kickboxing. There is a lot of cardio moves in this one. And one session will make you huff and puff if you are not used to jogging for several minutes. The movements takes some time of getting used to. But everything is all worth it.

So, my advice? Choose the exercise that you will enjoy. And if you are into any kind of exercise regimen and your body starts to plateau, don’t ever hesitate to try other kinds of exercise to test your strength and waken up those muscles. Our body can get accustom to anything we do everyday and a little change will do them good. If changing is not your choice, then increase the amount of weights to increase your level of fitness. Any which way, sticking to the same routine everyday for some time will not give good results.