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  • Bone MD blogging back in The Orthopedic Logbook

    After that scary Mt. Dulang-Dulang to Mt. Kitanglad traverse trek I joined 4 days ago (watch out for an upcoming post about this trek on my mountaineering blog, Talakudong Mountaineer at http://tacurongmountaineers.blogspot.com) , It’s nice to be back here, in the “comforts’ of my logbook. Dangling helplessly on those cliffs with just your bare hands holding on to a jutting tree root, I was praying I’m just blogging instead!

    The orthopod Bone MD on top of Mount Dulang-Dulang, the first stop of a 3 day D2-to K2 Traverse Climb he joined in Bukidnon

    But I couldn’t resist this scenic view on top of Mt. Dulang. I hope this is worth the risks of the grueling traverse and the unfinished tasks I left here in TBR and Logbook.

  • The Blog Rounds First Ed at The Orthopedic Logbook : History of Medicine in the Philippines Made Ridiculous Hilarious!

    “Before the diagnosis, there is diagnostics. Before the diagnostics, there is the physical examination. But before anything else, there is the history”.

    This algorithm is the universally accepted and scientific method of diagnosing a disease in the medical world. One process may be concurrent with the other, but the whole algorithm is useless without knowledge of each one of these processes . More importantly to treat an ailment, you have to know the history of that ailment and the person afflicted with it.

    History taking by far, is often a neglected part of this clinical evaluation process. Time constraints maybe, but sometimes, disasters could be avoided by just going back to the history of the patient.

    In this week’s Blog Rounds, we go back in Philippine history, take a peek at some of the most interesting (often hilarious) health related trivia, diagnose a problem and offer some treatment pundits that mean something more than fill our stomach with gas while laughing about it. Our case?! Philippines medical history made ridiculously hilarious!

    And keeping with the scientific rigidity we doctors hate to love, I, Bone MD, being the lucky moderator, will stick to that protocol and blog about it more hilarious than factual of course, but minus the edema and witch hunt! So throw off that white blazer, hang those stets, give that scalpel to your resident, grab some pizza, open those PCs, sit back and relax . Let’s fire off with the “cases” presented by our MD blogging colleagues!

    Case No. 1: The Tragically Comic Cholera Epidemic of the Philippines
    Blogger In Charge: Prudence MD

    History: The worst epidemic in the history of Philippines was said to be the 1902-1904 Cholera Epidemic. Worst, in all aspects. Read the full article by Prudence here.

    Physical Exam: Classic Cholera, yeah…by the hundreds of thousands of Filipinos! They’re dehydrating to death! Check their huts too and the dead bodies. (Their infected too?!!!)
    Diagnostics: It’s the pooh Uncle Sam, bloody pooh in the Pasig River
    Diagnosis: Cholera in epidemic proportions, from water source; but spread cannot be controlled expeditiously by our health authorities.
    Treatment: Burn their huts, burn dead bodies , burn cholera with fire! Or throw them off Pasig River!!!Let’s infect fishes!
    Comments: “If you don’t know whats killing your patient, might as well treat every possible diagnosis in your patient” Hence the “shotgun approach” of treating a disease. And yes if everything fails, burn them. Quite interesting though, this outbreak demystified the all knowing liberators we had before! Fire treatment?What gives?

    Case No. 2: Cause of Death
    Blogger In Charge: Merry Cherry

    History: Ever wondered how Philippine presidents die?Or why they died?More importantly, aren’t you interested why some presidents don’t die early when they’re supposed to?? Merry Cherry enumerates the cause of death of presidents , that might be of interest to the National Epidemiology Center of the Philippines, DOH, DOTC, Department of Agriculture and Philippine Congress (where pork is regulated, literally) and the Presidential Security Group. It may also interest the revolutionary strategist, the coup plotters and the TRAPOs aiming for the most powerful (and lucrative) seat in the land.
    Physical Exam: I guess this is confidential, unless the president’s physicians share these data. Or if the PSG will allow us their charts. Part of EO 464 I believe
    Diagnostics: You can ask all the Presidents and presidents- to-be to undergo stress tests, or stress 2D Echo. Pass a bill that will ban all politicians from taking any pork barrels and see which among them will have a heart attack. Ask for the services of an orthopod to open up any congressmen and see if their heart (if any) is fat laden. I believe some are harder than calcar. Don’t ask for PPD or sputum smear. If the president is negative, he is not Filipino.
    Diagnosis: Dead Presidents; COD: As Described.
    Treatment and Recommendations:If you’re into the political solutions for our health concern, take a look at how these presidents die. Perhaps our Department of Justice and health epidemiologists should not be worried. Cardiac and cerebrovascular disease ranks as the top two killers of presidents- not coup de etat, revolutions nor assassinations! These may have to be included in the security protocols of the PSG. No pork (barrels) for any congressmen or even for presidents!

    Case No. 3: The Filipina Doctor Coming in Full Circle
    Blogger In Charge: Dr. ClaireBear: In the Middle of Nowhere


    History:     Dr. Clairebear narrates the colorful and often heroic women in medicine, from the Baybaylans of the pre hispanic era to the present modern day Filipina doctors standing equal or even better than their male colleagues.
    Physical Exam: Gender differences not significant! The fact that the patriarchal society relegates them to the household and kitchen doesn’t mean they couldn’t and will not excel as healers.
    Diagnosis: Filipina Doctors coming in full circle-Long, arduous battle against a patriarchal colonial system.
    Comments: The babaylans– “seer, healer, community worker” of the pre-hispanic period were central to the healing of an ailing community. The role of women as healers in the Philippines has unfortunately been suppressed by the splurge of patriarchal colonizers of this country previously. The long and ardous battle is not against the opposite gender. It’s the pervading patriarchal colonial mentality that engulfs not only the medical world but also the entire nation.

    Case No. 4. P.D.A. (Public Display of Anesthesia)
    Blogger In Charge: Doc Ness @Random Ness


    History:     Doc Ness tells us the horrific history of anesthesia and how it came about silencing these howls. Or at least, tame them. The Filipino version of these “anesthetic” is virtually inexpensive and often mind boggling.
    Physical Examination:     Doc Ness, said, ” before, they die anyway. Why bother?”
    Diagnostics:     “Try a more volatile or a stronger gas. Let’s see who’s going to feel the pain while asleep” Try vocal anesthesia.
    Impression:     “If there is pain, gas him and hope he’d wake up after!”
    Comments:     While the howling success of PDA heralded painless surgeries worldwide, Philippines has our own brand of gas anesthetic, one that helps us survive the pains of living in an ailing healthcare system. No, not that gas pioneered in the chambers of the Nazi concentration camps. Jolly and ever humorous citizens of this country, we laugh-till-we-fart at the craziness of things going on around us, even if it slapped alarming trends in our health care system. Doc Ness calls it LA or “laway anesthesia” and believed this will ease pains of those who cannot afford the anesthetic even if the anesthesiologist is free! Or the words of politicians when they promise a treatment to a Juan in pain?Where did we get this trait? Cats and dogs lick their wounds to ease pain and heal it! I’m not sure this what Doc Ness is referring to.

    Case No. 5 : Sleep and Chocos
    Blogger In Charge:     Doc Hey: An eye doctor i the third world country


    History:     The classic story of unsung heroes in the medical field-less glamorous, often ill compensated physicians trying to cut their living while doing service to their countrymen. Doc Hey recants how she goes through her normal (20/20?) opthalmologic life, balancing her precious time with her family and the ever busy medical life.It graphically depicted some reasons for the continuing extinction of MDs in the provinces.
    Physical Exam: May actually be a physical fitness feat rather than a physical exam. Or Sleep disorder in the making. For example, trying to sleep inside a car on your way to your son’s school. Doc Hey that early?Or maybe running around and racing stairways for OPD consults?
    Diagnostics: Don’t ever try what Dr. Rizal (an opthalmologist) did as a diagnostic procedure in his time. He knew our country were run by rotten eggs at that time. He tried to prove this by being killed in Luneta.
    Impression: Not all in history of Philippine medicine is misery. The fact is, most stories are heroic. Undaunted by the meager income and technological retrogression, the men and women of medicine survive each day with a smile on their face, seeing patients recovered and comforted. For Doc Hey even chocolates and cards are just bonuses.

    Summary of Findings: The history of medicine in the Philippines, is undoubtedly, one of the more interesting and sometimes annoying time
    lines this world has ever witnessed. Dumb as some of this historical events maybe but we Filipinos laugh even in the worst of our lives. Our qualities as healers- empathy, kawang-gawa, meticulousness and loving care to name a few, remained the very reason why we are truly loved as healers in this world!

    Epilogue:
    So, that’s all about this first edition of The Blog Rounds. I hope you find some interesting tidbits that painted smiles in your face.I would like to mention some contributors who submitted articles, but was not include in this edition because of technicalities in the guidelines. I will definitely forward your articles to future hosts when the theme is already apt for your articles.

    I call on the other blogger MDs (Bubbleman, Doc Ian, Pinay Megamom, Dak, Tetel) who promised to join TBR but have not submitted their posts yet, for one reason or another. Submit them. And for those who are interested to join, please do so and read the updates and guidelines in my blog The Orthopedic Logbook.

    Due credits is also given to the owner of the pictures used in this posts!

    The next T.B.R. will be up on Tuesday next week and will be hosted by Prudence MD.

    Thank you all!

  • The Blog Rounds Introductory blog rounds by the The Orthopedic Logbook

    Not getting enough of medical “edema” rounds and blogging dissertations? Then come join us! The Blog Rounds First Edition will be up tomorrow, here in The Orthopedic Logbook.

    The Blog Rounds is a weekly compilation of the best posts in Philippines medical blogosphere, written by physicians or medically inclined bloggers, talks about almost everything that interests us, medical or otherwise.

    Who may join? Who are the physicians cum blogger participating in it now? Well, having the nerve of “stalking” these excellent blogger MDs, let me introduce the “team” with their interesting posts about the project.

    “Cutttiiiing!!!”

    Bone MD is much relieved birthing the project. Tongue tied and always left off the discussions (what EMR???) of similar medical blog carnivals abroad, he pondered on the idea of a locally focused medical-surgical ground rounds.

    “Our unique experiences and the healthcare environment seem to be different in some way from that experienced by our foreign counterparts”…-Bone MD, The Blog Rounds: Blogging our way through medicine and beyond.

    But, he can’t even start a scratch without the real medical bloggers themselves. So he stalked each and everyone of them and harassed their blogs with plugs and comment cartwheels to gain their attention and coerce them joining the rounds. It paid well. Or at least based on the reactions and comments here.

    There were indeed physician bloggers waiting to jump in the idea but because of toxic clinic schedules and hospital duties, couldn’t sneak off the real edema rounds and hit the keyboards of their online patients, which is blogging of course. Yes, I hate it but it’s slowly creeping into my nerves.

    Take Prudence MD for example, a well known medical blogger both locally and internationally. She has had moments of fame contributing to and hosting Grand Rounds. Despite having been used to exchanging barbs on experiences by other more advanced health bloggers abroad, she sees the need and excitement of a locally focused, medical blog rounds.

    “By reading up their stories, I find useful advice and even funny anecdotes worth remembering. The medical practitioners and those who’re in the health care business in those countries are utilizing to the most extent the power of blogging. So, wouldn’t it be equally fun and useful to be also doing that here in our country, concentrating on the local medical and health care bloggers?” –Prudence MD, Finally A Filipino Medical Ground Rounds


    Doc Cherry‘    s experience is quite interesting, having been part of the heroic DTBB program and was actually blogging her way through medicine in the boondocks (and hanging bridges?). And while she’s often “isolated” with her most beloved patients in the “barrios” you can feel her excitement and interest in meeting everyone else MD bloggin’ here.

    The amazing thing is there are MDs that I have never met personally but got to know them through blogging like Em Dy and her famous Pulse and Dr. Claire’s Chronicles from the Middle of Nowhere. I am excited to meet them in person, just like everyone else I meet in the blogosphere.-Merry Cherry, MD: Blog Carnival

    If interest enslaves your urge for medical blogging, visit Doc Hey’s blog, an eye doctor in the third world country like the Philippines. Not only does she flaunts the simplicity of living as an MD in the third world( and an ophthalmologist at that) she often hides under the microscope of her down to earth blogging- in the local vernacular! and produce an even more interesting stories you can relate upon.

    “I’m just a simple eye doctor from the provincial islands. What difference would my presence be? –Doc Hey: The Blog Rounds

    No doc. We are not more senior (I feel the word junior is an understatement) than you are, age or otherwise. You already made a difference in the third world you’r
    e living. Ours, we are just starting.

    And starting a living as a physician may not be as simple as it seems. The business of medicine even in such third world country as we are in, is all too complex for a newbie physician to handle. But as a business? What the heck? To cut for living shares his thoughts and discoveries amidst his non-existent, undervalued and often salamat dok! professional practice, here in The Blog Rounds.

    “Our unique form of service as physicians makes the defining principles even grayed and controversial. That’s why sharing ideas and learning from fellow physicians is a must to gain a wider perspective on issues in the business of medicine. And where is the best way to share or learn from each other?”-Bone MD: To cut for living shares the “business of medicine” in the Blog Rounds.

    Doc Claire rather demystifies the medical professions’ godly image and shares them in The Blog Rounds. That while bloggers “medical” posts and articles often caught her attention, a lot of non medical blogging by MDs shouts the humanity of fellow physicians. Read this.

    I think that The Blog Rounds is a great way of fostering a community spirit among Pinoy doctors on-line – wherever they may be. There is much we can learn from each other that we cannot learn from our books or our practice; and, in the same way, each of us, regardless of where we are on our journey, has much to teach. –In the Middle of Nowhere: Proudly Pinoy BloggerMD/span>

    And it’s cool- if we hear Doc Ness‘ rants. Doc Ness is cool as any anesthesiologist should be even if she claims to be a baby blogger. But her “coolness” will not be limited to the OR or her blog now. She is going to share it with us, in TBR–cool Ness style.

    I wanted it to be more of a right-brain thing, you know… write from the cuff, not much thinking, much like dishwashing… just write spontaneously, without much planning, whatever comes out on the computer, let it be.- Random Ness: Something is a brewing

    There were other blogger MD who promised to keep The Blog Rounds brewing with their posts and hosting schedules. That though they were stuck in their interesting non medical expeditions (Doc Ian‘s blogger layout problem, Bubbleman‘s Can’t touch this brain for a while, Pinay Megamom‘s Bayombong trip, Daks exams or Tetel‘s dying to join message?), their blogging is all part of the TBR for now. Or at least when they have their blog introductions done.

    Other MD or medical bloggers and everyone else who can write about medicine and issues related to it, who are interested , please don’t hesitate to join , email me kokegulper[at]yahoo[dot]com,or any of the blogger already in the carnival, introduce yourself briefly, your blog and yes, subscribe to The Blog Rounds.

    The first edition of TBR will be up tomorrow at The Orthopedic Logbook, 7AM PST.

  • Orthopedic Logbook re-examines patient when he is in doubt!

    “I think it’s Septic Arthritis.”

    Twenty six years old male farmer with a history of fall from level ground, landing on his buttocks, able to stand up and walk immediately after without pain. The next day he felt excruciating pain in his swollen left hip, was unable to move his L thigh nor ambulate. He was brought to a bone setter who “massage” his L thigh but patient wasn’t relieved of the pain at all. In severe pain and febrile the next day, he was brought to the hospital immediately.

    “It looks like septic arthritis to me.”

    He was referred to a surgeon instead, who took x-rays and showed a less than 5% compression deformity of L5 . His differential count showed leucocytosis with lymphocytic predominance. He was started on Cefuroxime IV and pain meds. Four days after patient still has fever spikes and increasing trend of leucocytosis with lymphocytic predominance. Unable to move his swollen L hip and thigh he was referred to me.

    “I’m leaning towards reactive synovitis or septic hip here, bacterial or otherwise”.

    Short of doing formal arthrocentesis, I asked for an ultrasound of the hip-looking for water filled masses or pus filled joint. There was none according to radiologist. The white cell count is still increasing with lymphocytic predominance. I started the patient on Metronidazole and re -examined the patient carefully. He was afebrile for 2 days and noted an improvement in L hip range of motion. But there was still L hip pain and is unable to walk. The white cell count is still increasing. Lymphocytosis?Mature lymphocytes? Let’s call in an internist (we don’t have infectious disease specialist here nor a hema-oncologist)! See if it’s a possible lymphoproliferative thing!

    “I still think its septic arthritis, but I have no hard evidence yet”

    Instead, the IM gave more pain relievers and suggested patient be seen by a neurologist for a radiculopathy 2 herniated disc. The neurologist agrees triumphantly and advised more pain meds and bed rest. Sighed. Febrile, 26/male with L hip pain and elevated white cell count? Radiculopathy? I re-examined the patient. I courteously asked the patient if they can afford a CT scan of the hip and then asked the Radiologist to make the cuts up to the lumbar area and “peek” at possible herniated disc.

    “I’m still convinced this is septic arthritis L hip”.

    “No lumbar disc herniation nor radiculopathy. The L hip and anterior musculature is enlarged and fluid filled much more than the right. No fractures. Septic Arthritis highly considered”. Double sighed. Tomorrow I have to open up this patient’s hip joint, drain it’s pus, wash it carefully and apply traction. I gave enough time for guess making here.

    So when In doubt, go back and re-examine your patient!

  • The Blog Rounds First Edition at The Orthopedic Logbook:Call for Submission of articles.

    The Orthopedic Logbook will host the first edition of “The Blog Rounds“, a weekly compilation of the best posts , medical and otherwise, from the Philippine medical blogosphere. Thanks to the pioneering Filipino MD bloggers who willingly joined the project and will soon host TBR in their blogs!

    The Blog Rounds!

    Like what Doc Tess felt, my heart’s “thump” is audible from the write ups I made for TBR. But the first ed will also be one of the hardest edition to produce because of the grand expectations attached to it. Choosing a theme as an icebreaker for the chilled Philippine medical blogosphere is a though one to make!

    For TBR’s first edition I’ve chosen a theme related to the history of medicine in the Philippines, with a twist of humor of course that will make the readers (and us) say something something like “uh, I didn’t know that!” I’m putting an edition punch line and title,

    “History of Medicine in the Philippines Made Ridiculously Hilarious!

    Caution though, that the article should be factual (more commonly anecdotal?) and not fabricated nor twisted. It should nevertheless funny and interesting and may pertain to an icon, an institution, heroes or any event in the history of medicine in the Philippines. An example would be the hilarious investigation into the true cause of Apolinario Mabini’s paralysis.

    “Did you know that the body of the “Brains of Katipunan” has to be exhumed and examined by a panel of competent orthopods, just to disproved an allegation he was paralyzed because of a sexually transmitted disease?”

    I now put the challenge unto the blogger contributors to read about our history, find some fascinating facts about medicine, create a post about it and submit it to TBR via my email or you can submit this to the official submission site (which will also forward the permalinks and to your posts, to the host’s inbox), here. For those who haven’t read the “rules”, The Blog Rounds submission guidelines are posted here. Schedules for upcoming editions, hosts and publication dates are are regularly updated here.

    And to those MD bloggers (and anyone else interested) who haven’t written their introductory post yet, please do so. It will be the official ticket of your entry to the BEST OF PHILIPPINE MEDICAL BLOGOSPHERE.