The thousands crossroads we face in our daily lives. Who makes these crossroads? Who serves us the options? Why do we have to face it? What makes us choose the road less traveled? How do we feel about our decisions now? Are we happy about it?
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At A Crossroad: The Blog Rounds 3rd ed is up at In the Middle of Nowhere
(The original picture in this post is owned by Kenny Gulley, entitled The Storms of Life, was removed upon the owners request, depicts a man at a “crossroad”)These are some of the questions physicians have dissected, researched and the answers, blogged in The Blog Rounds 3rd ed. Themed “At a crossroad“, the third edition of The Blog Rounds is up at Doc Claire‘s blog In the Middle of Nowhere. In this edition, you will see a growing community of Filipino doctors who blogged about their personal and medical life! What they wrote, will actually fill my whole week of reading and pondering!I am very thankful Doc Claire accepted and run a well thought of third edition of TBR. I am very much excited also of the growing number of Filipino MD blogger who joined TBR! My hat’s off to all of you!The Blog Rounds is a weekly compilation of the best in Philippine’s medical blogosphere, written by physician bloggers (or the medically inclined bloggers) and hosted on a participating blogger’s weblog. Archives and edition schedules ( plus the host blogger) are listed here. The next edition of TBR will be up this Tuesday, April 8,2008 7am PST and will be hosted by Doc Tess of An Eye Doctor in a Third World Country. For physicians and medically inclined bloggers interested in joining this blog carnival, please contact me through my email kokegulper[at]yahoo[dot]com or any of the participating TBR bloggers. Guidelines and updates are posted here in my website, The Orthopedic Logbook. -
No where to go but up!
(I wrote this article while savoring the brutality of starting a practice and endless whining of a slow start.)
My struggle has always been between filling up my empty stomach or satisfying my impoverished brain. To the millions of hungry Filipinos like me, this our “class struggle”-an unarmed, non-violent but similarly aggressive perspective of seeing past our choices of everyday life.
To a proletarian who have gone to the bottom lowest of the pits, the best assurance one can get whenever you start a career or something is an old adage that says “you can go nowhere but up” or something to that effect. Like a messianic prophecy, I fanatically held on to this belief since high school days . The capitalist notion of incentive-driven success vis a vis hard work is as ironic as it is baffling to everyone in this “stomach” struggle. Yet, I survived half of my lifetime living in such altruistic ironies that neither my myopic deconstruction of choices nor the risky jumps I made could explain the extraordinary luck I had ending up being a physician.
The dream of donning a white blazer and treating a patient is as fascinating as it is exciting. I am so entwined with that dream I forgot I have neither the financial capabilities nor the intellectual giftedness needed to attain such lofty dreams. I went into this profession simply because I wanted to prove to myself (and to my less encouraging social caste) what everyone in my bunghole has failed to do before me- don the white blazer with the least expense I can- financially and intellectually that is. Everyone think it was suicide in the making. I thought I have nothing to loose. I don’t have anything to loose anyway.
That dream however grew into a vision, thanks to my alma mater. I practically crawled and bled to finish top of the line education for a career not everyone in my caste will experience- not even in their dreams. Fifteen years of Hippocratic studying did wizen my outlook about this noble profession. But it also shattered some idyllic notions I once have about doctors’ blissful life. More importantly, it brought my bourgeois upbringing to its knees and gave me the awakening of my comfortable life. My mission is never confined to the personal and financial self gratification kind of success. Because if it is that myopic, I could have never gotten this far.I have all the necessary ingredients for a successful medical practice. Ingredients that when “cooked” rightfully, would lead me into the much coveted goal in life that is termed success. Such “ingredients” are big words indeed, taught in bold letters, eaten in gastronomic amounts and digested in herculean way. It’s funny after that word found its way into the neurons of my brain, I have been deluded of a blissful life outside the academe, akin to the Renaissance Man. Little did I know about the truth that lay ahead in real medical life that is called “the Practice“
Starting an upstream professional career is never an easy thing for the not so typical surgeon wannabe like me. I neither possess the inherited practice most other surgeons nor the coffers to buy a new one. Most people believe though, that having trained in one of the best medical schools in the country prepared me for one of the most formidable foe of the real life physician practice- an empty stomach.Of course being out of the academe and starting your own practice has its exciting advantages. The thought of having to take control of one’s time and spend it according to what you want is exhilarating. I can spend more time with what I want most, or with my loved ones I neglected when I was still studying. Gone are the Sundays where you have to read and prepare for pre-ops instead of having to eat dinner with family. I see non emergency patients on a scheduled time I myself created. Most of all, I have time to take care of my body while taking care of patients as well. I can eat full meals in a day and exercise regularly to maintain a sound and fit body. It is ironic that while we take care of patients 24/7 in a hospital, I lost tract of my own health in the process.
I am into the practice of my profession for just barely two months, and it’s neither the blissful stride I once dreamed nor the catastrophic frustration I’m so afraid of before. Somewhere in between these extremes is the horrible spectrum of uncertainty where my minute practice existence resides. I wish my practice was as dramatic as the scenes in ER and Grey’s Anatomy or as wacky as unnerving as House’s one liner ass kicking. Nonetheless, the uncertainty gave me ample excuse to whine and be cynical about everything I get my hands on. Blame it on inexperience surgeon wannabe that is me. Everyone says that staring a career is shitty enough to make or break your soul. My soul has undergone so many breaks it neither can feel any shattering this practice has to offer nor enough time to recover form constant battery of changing lucks past choices.
I bet it’s easier to just look at it as the paradigms of opposites. The definitions of success (and failure) in ones’ professional practice defined by simplistic phrases like-great clinic practice, successful surgeries, acknowledged researches, magnanimous services to patients and yes, professional fees enough to buy what we need. In essence, the very opposite of such adjectives and superlatives defines failure . Of course almost everyone believes that such simple dichotomous definitions don’t exist in reality. The theory of relativity seems to apply even in the psychology of success.
So it seems. But that, I have yet to uncover.
(Photo credits: All photos were taken from Deviant ART, my favorite repository of artistic shots.)
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Call for articles and updates on The Blog Rounds
Even the real edema rounds “rest” during holy week! So is The Blog Rounds! But now that the Lenten- blogging holiday is over, TBR will resume making rounds!
The Third edition of TBR will be hosted by Doc Claire‘s Chronicles from the Middle of Nowhere. Call for articles and entries is up here. Please visit Doc Claire’s blog for the edition’s theme and additional guidelines.I’d like to congratulate Prudence MD (for hosting TBR) and the blogger contributors ( Doc Tes, Doc Ness, Pinay Megamom, Joey MD) for the very interesting Second Ed of TBR. We’re glad Pinay Megamom and Joey MD joined TBR already. Doc Tess and Doc Ness, saludo ako sa inyo! You both blog ala naturelle!
For those unaware yet, The Blog Rounds is a weekly compilation of the best in Philippine’s medical blogosphere, written by physician bloggers (or the medically inclined bloggers) and hosted on a participating blogger’s weblog. Archives and edition schedules ( plus the host blogger) are listed here. The next edition of TBR will be up this Tuesday, April 1,2008 7am PST.
Physicians and medically inclined bloggers interested in joining this blog carnival, please contact me through my email kokegulper[at]yahoo[dot]com or any of the participating TBR bloggers. Guidelines and updates are posted here in my website, The Orthopedic Logbook.
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The Orthopedic Logbook on Physical Fitness and Conditioning for Mountaineers
The author with a few trekking pilgrims to Mt. Apo, post for a group picture while at camp at the highlands of Makalangit, New Israel. This camp is considered station 10 of the long, arduous station of the cross climb towards Mt. Zion-just north of Mt. ApoThe “holy week” is of special interest to outdoor pilgrims like me not only because of an important Christian tradition it celebrates, but also because of the long vacation time it offers. It give us trekking saints longer time to troop to our mecca hit those peaks again! I am one of those outdoor buffs who spent the last two successive Lenten season on top of those mountain ranges.
Ironically, no matter how low profile I keep on what my real job is, I often get questions related to it and mountaineering, a hobby I soon enjoyed.“How do you physically prepare for this climb Dokie? Is there a way for us to prevent injuries and muscle soreness during and after climbs? Why do some people pass out of exhaustion or get headaches at high altitudes?”
These are the common questions fired at me, by my climbing buddies and often by newfound trekking friends.
Oftentimes asked about questions related to his job and his hobby, like in this picture, a post climb socials, the author sometimes grapples for answers he wished taught in med school and training.Sometimes, I wish I have a tape player with me, so I could replay my answers to these questions. Because of these recurring questions, I have been inkling to write about the medical aspects of mountaineering. Specifically, I would like to start off with physical fitness and conditioning based on what I know and experienced, both as an orthopedic surgeon and an aspiring mountaineer.
The author after a extremely cold night on top of Mt. Dulang-Dulang, in a recently concluded double major, double strenuous traverse climbA word of caution though. As much as I want to claim bragging rights of being a mountaineer, I am still a novice in this sport. That I am an expert sport physician and wilderness doctor is also too capricious a title. But I have developed a fitness program for myself, trekked a few mountains (read my other blog, Talakudong Mountaineer), endured some accidents and injuries from climbing but was able to go back to work as an orthopedic surgeon again. That in itself perhaps led me to study and learn more from my experiences and share it with anyone willing to learn and try it themselves.
The author, after a river trekking (Penek Busay, Digos) accident last September 2007, sustaining bilateral 2 inches gaping cut on both his knees.Physical fitness and conditioning for mountaineering is a complex topic to discuss, often involving the ideas of a multi specialty training team but basically anchored on sound scientific, medical principles that is fine tuned by personal experiences. My fitness regimen was a product of reading, experiences of me and others I know, of trial and errors, of accidents and injuries I got whenever I hit the peaks or outdoors. I realized though that such experience and knowhow is of no use if not shared or taught to newbies willing to learn, and to experienced climbers avoiding accidents to happen while at their beloved sport.
Before we go further, I highly recommend that any serious climber should seek advise from their physicians before embarking on this task or scaling any mountains. In developing a fitness training program for your mountaineering expeditions, I also suggest the guidance of a certified fitness instructor. I understand that these two person may not be available in certain areas for certain people either for monetary reasons or lack of specifically trained personnel. But these are essential persons if you want to have a fun and less strenuous, less accident prone climbs. There’s no doubt about that. Ultimately, I (and this blog) hold no responsibility for whatever will happen to you, on training and on your climbs, whether you’ll follow my advise or not. That is entirely a personal
risk you have to take.Personally, I always make it a point to know my current fitness status and goals before I embark on a training program or climb. There are numerous factors that can affect the fitness capacity of any person scaling a mountain, be it the weather, difficult trails, steep inclines and the altitude itself to name a few. To be able to face these unforeseen factors squarely and hurdle them, you have to be fit enough to adapt and survive. Aside from your basic mountaineering skills and survival tactics, this is where a fitness program and physical conditioning is all too important and beneficial.
Chris and Lemuel, the author’s climbing buddies while maneuvering a 20 meters slippery 90 degrees steep descent, holding only to jutting root parts and mostly dangling helplessly with no footholds. This is an extreme, “hard core” trail we manage to pass during our late traverse climb in Bukidnon.A good fitness program for mountaineers consist of two major groups of exercises, the cardiovascular (aerobic) and motor (anaerobic) fitness exercises. Cardiovascular fitness is measured by your aerobic capacity to take in and use oxygen. In most instances, this is a function of pumping blood (and oxygen) into the muscle system with the help of lungs. A motor fitness program consists of exercises to enhance strength, endurance, power, balance, agility and flexibility. With better cardiovascular capacity and good motor fitness, the third component of fitness training for climbing, which is acclimatization, will be a little less painstaking.
The author, on top of one of Mt. Apo’s peaks, terribly out of shape but happy. He promised to develop a better physical fitness and conditioning for himself next climb. (Aguilar 2007)For purposes of discussion, I’d be using the goals I set for climbing Mt. Apo (which I climbed on a Maundy Thursday last year) and the fitness program I tried to implement. Mt. Apo is the Philippines’ highest peak (2,954 MASL) and also have one of the coldest open air temperature nigh time. Considered as a Level 3 (strenuous, major) climb, the “trip” to the peak consist 3-5 days of passing through wet, tropical rain forest, with some objective hazards, rope maneuvering, and walking for at least 6-8 hours a day on mostly steep slopes of up to 80 degrees. Mt. Apo is a popular destination for newbies and experienced climbers alike not only because of the bragging rights conquering the highest peak but also of the beauty that lies within that solemn mountain.
Here are my specific goals I set before I embarked climbing Mt. Apo last year:
- To be able to carry a 40 litre backpack (NF Flight Series) , for 6-8 hours a day, for 4-5 days.
- To be able to recover from climbing exhaustion for 8-12 hours sleep on a cold (0-5 degrees) night.
- To be able to ascent to the peak on summit assault day on usually 60-80 degrees slope and back.
My fitness program and physical conditioning starts well before the climb date usually at a minimum of one month. But effective training is noticeable after least 3 months, studies have shown. I usually go on interval climbs to train for another major climb though. And this might explain why I get conditioned even if my fitness program only start at least a month on some climbs. And the exercise I do are often, close simulation of climbing.Simulation and training climbs conducted by the author’s group, TAMAC, often on hills and benign trails like this one going to Lake Maughan in Tiboli South Cotabato is needed to augment climb conditioningThe first few weeks is centered on getting myself into the routine of exercises, emphasizing discipline but at the same time, carefully observing myself for overenthusiasm injuries. Using a timed fitness program, I vary and progress my exercises depending on my month to month progress. It is usually a regimented but often flexible program that suits my work days and schedules.
There are many cardiovascular exercise you can do that may be available to you in your location. I chose exercises I can do easily in my place, like running, stairs climbing, biking or swimming. These exercises not only increases cardiovascular capacity, it also increases strength and endurance for climbing. Here are other benefits of cardiovascular exercise.
Some general guidelines for aerobic training:
- Aerobic training should be monitored by your heart rate or pulse rate, which should be 65%-80% of maximum heart rate. Maximum heart rate is computed by subtracting your age from 220. This should be your training heart rate.
- Training each day should be at least 30 minutes to one hour to be effective. A longer period of training time each day, on special locations and equipments is needed if your going for lengthier climbs.
- The frequency of training should be regimented but flexible. I train 2-3 times per week and daily near the climb date and watch myself for over use injuries. Rest is very much recommended between training weeks.
When I developed discipline for training routines, I advance my cardiovascular training using interval training. Interval training includes upsurges in exercise intensity during an elevated heart rate and is very strenuous. Interval training when used over long period of times, increases the capacity of heart to pump blood even on emergencies and unexpected hazardous treks. Here are my examples.- On running, I start with a thirty minute moderate intensity pace then increase this pace 3 times for ten minutes then go back to moderate intensity. I repeat this every 20 minutes.
- Track or oval running includes running one round on moderate pace then sprinting 100 yards then one round again on moderate intensity.
I use stretching, weights and calisthenics to develop my motor fitness. I have yet to develop an effective program with weights as I have at the moment very limited access to a fitness instructor, but I’m working on light weights (15kg) of 2 sets consisting of 20 reps each. Then I rest for 60 sec between sets. Stretching, calisthenics, abdominal and back strengthening exercises can be done daily.
I also concentrate training on my lower extremity (thigh and leg muscles) and my upper torso, usually the back and stomach as this will help me carry my backpack. Strength motor training of upper and lower body should be done twice a week
Warming up and cooling down is an important part of my fitness program. I warm up 10 minutes before any exercise, with jogging or skipping ropes and bring my heart rate to my training range.
I do static stretching for 10-15 minutes before and after my fitness program workout. Stretching reduces muscular tension and prevents soreness after workouts and climbs. Any static stretching exercise should be held for 30 seconds.
Weight training should be focused on correct form and technique to develop the essential large muscles first, like the shoulder, triceps, biceps, quads and calf muscles. Leg curls, calf raises and squats strengthen the lower body and extremities while some exercises should be aimed in developing the chest, shoulders of the torso. For abdominal exercise, cross training the abdomen is beneficial. I highly suggest you seek advise from your fitness instructor regarding these strength training exercises and the correct techniques needed to do it.
I do one leg stand for my static balance exercise. This consist of standing on one leg holding the other leg’s foot then squatting and then returning to the standing one leg position. I do this two sets with 12 reps each.
I benefit much from badminton for my dynamic balance exercise, since I do this as a sport also. Aside from dynamic balance, I also gained some sort of cardiovascular strength from badminton, although this is just on the subjective point of view.
For most of my training regimens and physical conditioning, I try to keep a training record of my fitness program, more for discipline and assessing my improvements. I am certainly motivated and getting enthusiastic every time I see an improvement in my fitness status.
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The Blog Rounds Second Edition; Internet and Philippine Medicine hosted by Prudence MD
The second edition of The Blog Rounds is up at Prudence MD. This week’s theme focuses on the impact of internet on medicine here in the Philippines. Read the whole edition here.
(Cartoon grabbed from Prudence’s Blog)
The Blog Rounds is a weekly compilation of the best in Philippine’s medical blogosphere, written by physician bloggers (or the medically inclined blogger) and hosted on a participating physician blogger’s weblog.TBR archives and edition schedules are listed here. The next edition of TBR will be up next Tuesday 7am PST and will be hosted by Doc Cherry on Merry Cherry. Call for submission of articles will be announced by the host blogger soon.
Physicians and medically inclined bloggers interested in joining this blog carnival, please contact me through my email kokegulper[at]yahoo[dot]com or any of the participating TBR blogger. Guidelines and updates are posted here in my website, The Orthopedic Logbook.








