Measles Infection Timeline

Measles Infection Timeline

Incubation Period: After exposure to an infected person, it will take about 10 to 12 days for the disease to develop within the exposed person.

Prodromal Phase: The disease is heralded by appearance of the 3 Cs (cough (brassy in character), conjunctivitis (makes the person photo-sensitive/avoid bright light source), coryza/colds, and fever

Exanthem Phase: on the 3rd to 4th day of fever, rashes start to appear from the head (face, nasal bridge, nape) then spread downwards (cephalo-caudal fashion)

Convalescence: When rashes reach the lower extremities, fever disappears, and then desquamation takes place also from head downwards

The person is communicable between 4 days before and 4 days after appearance of the rash.

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Posted by on January 11, 2014 in Uncategorized


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Have American Parents Got It All Backwards? – Christine Gross-Loh



(Disclaimer: This article is originally not mine; it is a re-blog from Christine Gross-Loh’s The Blog posted May 7, 2013 –

The eager new mom offering her insouciant toddler an array of carefully-arranged healthy snacks from an ice cube tray?

That was me.

The always-on-top-of-her-child’s-play parent intervening during play dates at the first sign of discord?

That was me too.

We hold some basic truths as self-evident when it comes to good parenting. Our job is to keep our children safe, enable them to fulfill their potential and make sure they’re healthy and happy and thriving.

The parent I used to be and the parent I am now both have the same goal: to raise self-reliant, self-assured, successful children. But 12 years of parenting, over five years of living on and off in Japan, two years of research, investigative trips to Europe and Asia and dozens of interviews with psychologists, child development experts, sociologists, educators, administrators and parents in Japan, Korea, China, Finland, Germany, Sweden, France, Spain, Brazil and elsewhere have taught me that though parents around the world have the same goals, American parents like me (despite our very best intentions) have gotten it all backwards.


We need to let 3-year-olds climb trees and 5-year-olds use knives.

Imagine my surprise when I came across a kindergartener in the German forest whittling away on a stick with a penknife. His teacher, Wolfgang, lightheartedly dismissed my concern: “No one’s ever lost a finger!”

Similarly, Brittany, an American mom, was stunned when she moved her young family to Sweden and saw 3- and 4-year-olds with no adult supervision bicycling down the street, climbing the roofs of playhouses and scaling tall trees with no adult supervision. The first time she saw a 3-year-old high up in a tree at preschool, she started searching for the teacher to let her know. Then she saw another parent stop and chat with one of the little tree occupants, completely unfazed. It was clear that no one but Brittany was concerned.

“I think of myself as an open-minded parent,” she confided to me, “and yet here I was, wanting to tell a child to come down from a tree.”

Why it’s better: Ellen Hansen Sandseter, a Norwegian researcher at Queen Maud University in Norway, has found in her research that the relaxed approach to risk-taking and safety actually keeps our children safer by honing their judgment about what they’re capable of. Children are drawn to the things we parents fear: high places, water, wandering far away, dangerous sharp tools. Our instinct is to keep them safe by childproofing their lives. But “the most important safety protection you can give a child,” Sandseter explained when we talked, “is to let them take… risks.”

Consider the facts to back up her assertion: Sweden, where children are given this kind of ample freedom to explore (while at the same time benefitting from comprehensive laws that protect their rights and safety), has the lowest rates of child injury in the world.

Children can go hungry from time-to-time.

In Korea, eating is taught to children as a life skill and as in most cultures, children are taught it is important to wait out their hunger until it is time for the whole family to sit down together and eat. Koreans do not believe it’s healthy to graze or eat alone, and they don’t tend to excuse bad behavior (like I do) by blaming it on low blood sugar. Instead, children are taught that food is best enjoyed as a shared experience. All children eat the same things that adults do, just like they do in most countries in the world with robust food cultures. (Ever wonder why ethnic restaurants don’t have kids’ menus?). The result? Korean children are incredible eaters. They sit down to tables filled with vegetables of all sorts, broiled fish, meats, spicy pickled cabbage and healthy grains and soups at every meal.

Why it’s better: In stark contrast to our growing child overweight/obesity levels, South Koreans enjoy the lowest obesity rates in the developed world. A closely similar-by-body index country in the world is Japan, where parents have a similar approach to food.

Instead of keeping children satisfied, we need to fuel their feelings of frustration.

The French, as well as many others, believe that routinely giving your child a chance to feel frustration gives him a chance to practice the art of waiting and developing self-control. Gilles, a French father of two young boys, told me that frustrating kids is good for them because it teaches them the value of delaying gratification and not always expecting (or worse, demanding) that their needs be met right now.

Why it’s better: Studies show that children who exhibit self-control and the ability to delay gratification enjoy greater future success. Anecdotally, we know that children who don’t think they’re the center of the universe are a pleasure to be around. Alice Sedar, Ph.D., a former journalist for Le Figaro and a professor of French Culture at Northeastern University, agrees. “Living in a group is a skill,” she declares, and it’s one that the French assiduously cultivate in their kids.

Children should spend less time in school.

Children in Finland go outside to play frequently all day long. “How can you teach when the children are going outside every 45 minutes?” a recent American Fulbright grant recipient in Finland, who was astonished by how little time the Finns were spending in school, inquired curiously of a teacher at one of the schools she visited. The teacher in turn was astonished by the question. “I could not teach unless the children went outside every 45 minutes!”

The Finnish model of education includes a late start to academics (children do not begin any formal academics until they are 7 years old), frequent breaks for outdoor time, shorter school hours and more variety of classes than in the US. Equity, not high achievement, is the guiding principle of the Finnish education system.

While we in America preach the mantra of early intervention, shave time off recess to teach more formal academics and cut funding to non-academic subjects like art and music, Finnish educators emphasize that learning art, music, home economics and life skills is essential.

Why it’s better: American school children score in the middle of the heap on international measures of achievement, especially in science and mathematics. Finnish children, with their truncated time in school, frequently rank among the best in the world.

Thou shalt spoil thy baby.

Tomo, a 10-year-old boy in our neighborhood in Japan, was incredibly independent. He had walked to school on his own since he was 6 years old, just like all Japanese 6-year-olds do. He always took meticulous care of his belongings when he came to visit us, arranging his shoes just so when he took them off, and he taught my son how to ride the city bus. Tomo was so helpful and responsible that when he’d come over for dinner, he offered to run out to fetch ingredients I needed, helped make the salad and stir-fried noodles. Yet every night this competent, self-reliant child went home, took his bath and fell asleep next to his aunt, who was helping raise him.

In Japan, where co-sleeping with babies and kids is common, people are incredulous that there are countries where parents routinely put their newborns to sleep in a separate room. The Japanese respond to their babies immediately and hold them constantly.

While we think of this as spoiling, the Japanese think that when babies get their needs met and are loved unconditionally as infants, they more easily become independent and self-assured as they grow.

Why it’s better: Meret Keller, a professor at UC Irvine, agrees that there is an intriguing connection between co sleeping and independent behavior. “Many people throw the word “independence” around without thinking conceptually about what it actually means,” she explained.

We’re anxious for our babies to become independent and hurry them along, starting with independent sleep, but Keller’s research has found that co-sleeping children later became more independent and self-reliant than solitary sleepers, dressing themselves or working out problems with their playmates on their own.

Children need to feel obligated.

In America, as our kids become adolescents, we believe it’s time to start letting them go and giving them their freedom. We want to help them be out in the world more and we don’t want to burden them with family responsibilities. In China, parents do the opposite: the older children get, the more parents remind them of their obligations.

Eva Pomerantz of the University of Illinois at Urbana Champaign has found through multiple studies that in China, the cultural ideal of not letting adolescents go but of reminding them of their responsibility to the family and the expectation that their hard work in school is one way to pay back a little for all they have received, helps their motivation and their achievement.

Even more surprising: She’s found that the same holds for Western students here in the US: adolescents who feel responsible to their families tend to do better in school.

The lesson for us: if you want to help your adolescent do well in school make them feel obligated.

I parent differently than I used to. I’m still an American mom — we struggle with all-day snacking, and the kids could use more practice being patient. But 3-year-old Anna stands on a stool next to me in the kitchen using a knife to cut apples. I am not even in earshot when 6-year-old Mia scales as high in the beech in our yard as she feels comfortable. And I trust now that my boys (Daniel, 10, and Benjamin, 12) learn as much out of school as they do in the classroom.

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Posted by on January 5, 2014 in Uncategorized


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Thank You


My own heart during my bypass operation

I wish to extend my sincerest gratitude to all of you who were the instruments of God that I be given another new purposeful life. I wish someday I will be able to repay you all for your kindness…

These are the people who I personally call my own #TeamBuhay (TeamLife)

Cardiovascular surgeons: Dr. Aleta, Dr. J. Bautista, Dr. R Hojilla
Cardiologists: Dr. S. Black, Dr. J. Calibuso, Dr. H. Helenne Brown
Pulmonologists: Dr. Ruel Revilla, Dr. Jovy Nigos, Dr. Kareem Mejia Eustaquio
Anesthesiologists: Dr. Juffey S. Tabingan Dr. L. Revilla, Dr. Florentino
Neurologist: Dr. Dudds Fangonilo
Gastroenterologist: Dr. William Antonio
Nephrologist: Dr. Vivian Untalan
Endocrinologist: Dr. Raymond Oribio
Infectious Disease: Dr. Rhoda Lynn Orallo-Fajardo
Physiatrist (Rehabilitation Medicine): Dr. Judah Leo Capistrano

and the NDCH Resident physicians – Dr. Venus, Dr. Von, Dr. Novie, Dr. Jen, Dr.Rainville, (forgive me if I missed someone) 

OR AND ICU: Regene Flora, Maura Maggudayao, Pauline Alzona, Michelle Ariz
Nicolette Batenga, Moby Burayag, Kenneth Cosi, Aljan Jay Mendoza, Miles (who guards my secret after shaving me and inserting my IFC LOL), Chief Nurse Sr. Cora (who strictly implemented the visitation restrictions and for that wonderful salads she always prepared for me when I was already on full diet). 

NDCH Administration: Sr. Adelina Javellana, who facilitated the my team of cardiovascular surgeons who was supposed to be on their way back to Manila and whose birthday celebration I interrupted with my tragedy

PCDH Emergency Staff: (my apologies for not gathering your names) who were the first line and bore the stress during my resuscitation

Dr. Efren Balanag for the first blows of breathe

Dr. Cristy Marrero, for intubating me

Dr. Arlene Baguilat for facilitating my transfer from PCDH to NDCH

For the other people that were as well instrumental for my survival, without your help I wont be able to make it:

SLU Pediatric Residents: Dr. R. Arca, Dr. Jeh del Rosario, Dr. Resie Casem, Dr. A. Aragon, Dr. Ivy Ausa, Dr. Terence Fang – for facilitating blood units and blood donors for my emergency surgery

My blood donors: Dr Giovanni Balangay, Dr Delvyne Agsalud, Dr Karol Villanueva, Dr David Dumaup, Dr Philip Parilla, Mr Arca — husband of one of my Pedia resident Dr Rowena Arca

To my residency batchmates who stood by me like my brother and sister – Dr. Tolits Domingo and Dr. Myra Estrada

My “mother” during my residency Dr. Gomez, who kept comforting my biologic mother.


SPECIAL THANKS also goes out to:

My Pediatrician colleagues in the entire Baguio Community, actually the BBMS

The Philippine Pediatric Society – Northern Luzon Chapter

Dr. Benjie Co and Bob James Carreon

My USTH Family

The Philippine Society of Newborn Medicine

Cong Mark and Kimi Cojuangco who sent their staff to check on my condition and offering help

My twitter gangster family who have been in my defense while being attacked by a certain @ConcernedAntiRH, labelling me an abortionist #7 at the time I was struggling and fighting for my life

Sen Pia Cayetano for the thoughtful gift

my Facebook friends and others who joined the prayer brigade for my survival and recovery

my gym friends Ms Rina, Rose, Grace, Dindin, Guion, Kylie, Ate Len, Rhoda, Fred, Jun, Erick, Aldrin, Atty Jeff

My mother Maria, my father John, my brother Lawrence, and my sisters Vanessa and Candice, my nephews Laurent Jan and Viktor Rami, and cousin Raquel.

(I may have forgotten some people who were crucial to my survival and recovery, please do forgive me. I think my short term memory has been somewhat affected)

And above all, the Lord Almighty for the second chance to live life purposefully anew.

A BIG BIG THANKS to all of you. 

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Posted by on December 31, 2013 in Uncategorized


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The Teacher: Underpaid Professionals


Teachers are one of the most underpaid professionals in the country, literally underpaid. Why so?

For a full time teacher, he/she is only paid for his/her work from 8 am to 5 pm in a day, giving lectures to his/her students. Just that, no overtime pay at all. But is the teacher’s work only confined within that 8am to 5pm time slot? Definitely not. In fact, majority of his/her work is outside of that paid time, an overtime. 

What constitutes the teacher’s overtime works? 

1. He/She prepares the lecture, and in doing so, must research several resource materials for a good content of each lecture. He/She should keep himself/herself updated as well so that his lectures are in keeping with the changing times. Each lecture entails creation of instructional design – the objectives, contents, the sources, learning activities/teaching strategies, and methods of evaluation. (For the elementary teachers, this would be their lesson plans). Teachers should be careful and make sure that everything he/she utters in front of his/her students are factual. Whatever the teacher says is considered gospel truth by his/her students and is sometimes upheld by the students over what is said by parents at home. The preparations are very taxing, and you only deliver it for an hour. It is therefor insulting when the students do not listen, do not enter classes and attend to the lectures, or when the student just asks a copy of the lecture so he/she doesn’t have to listen to its delivery. How much time did the poor and lowly teacher devote for this? 

2. When a teacher construct test questions, he/she has to always consider the MPL – minimum passing level. This pertains to the degree of the difficulty of the question being asked. This is based on the probability that a minimally competent student will be able to answer the question correctly. When you set the MPL at 65, this means that at least 65% of the students will be able to answer correctly this particular question. And that should always be considered for every question that the teacher drafts. Secondly, the teacher should make sure that each question should be answerable for a maximum time of 1 minute. Therefore, when an examination period lasts for 2 hours, it means that the teacher should maximally ask 120 questions only. How long does it take to make a quality question thus? That would entail a minimum of 5 minutes (that is, basing from personal experience). It takes more time for the teacher to construct the question that the time it will take the students to answer it. 

3. Of course, those test papers need to be corrected as well, recorded, and grades computed. While some teachers device a way to make correcting test papers conveniently, it still entails time to do so. The advent of technology has as well allowed teachers to easily compute grades. Otherwise, manual computation would entail more time to do such.

Teachers do not only need to lecture, prepare test questions, compute grade. At school, they are also disciplinarian, second mother/father to their students while away from home, influencers and molders of our children. And so much more.

They are encouraged as well to undergo postgraduate studies. This allows the teachers to be adept with the facts they teach their students, improve or enhance their teaching skills, etc. There is of course an advantage to that, and few of those include promotion to the next level, better salary, better credentials and an expert, authority in his/her field.

Our teachers do sacrifice a great deal beyond what is paid by their salary. But despite that, their sheer dedication to their profession keeps them striving so that our children may be able to learn well; and everyone of us had been taught by a teacher. They are indeed the unsung heroes, often paid tribute only by mere words. They deserve more than their pay, or citations. They deserve our lifetime respect.

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Posted by on December 24, 2013 in Uncategorized


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Neonatal emergencies really make pediatricians and neonatologists high-strung as this event in the baby’s life significantly affects his future. One of those emergencies is a problem with baby’s blood sugar, whether it is elevation or depletion. Either way will produce a grave sequela if not immediately corrected.

The cut off value whether to consider the blood sugar low or high is quite controversial. Hyperglycemia (elevation of blood sugar) may be considered when the reading is above 120 mg/dL; but others may use higher cut off value. In one study, the ceiling value was 140 mg/dL. That study mentioned that any blood sugar elevation above 140mg/dL within the first week of the baby’s life is highly associated with infant mortality. (Of course, this elevation is not a product of medical and nursing error). But the study does not state whether higher value means greater risk of dying and vice versa. In my limited practice, I have noticed that this study finding is true in almost all cases, except for one. Elevation of blood sugar may mean hormonal imbalance, but most commonly an infectious process.

Hypoglycemia (low blood sugar) also has controversial cut off value. Some use 50 mg/dL, others use 40 mg/dL and another article uses operational cut off value at 36mg/dL.  As with hyperglycemia, hypoglycemia as well has unwanted sequela. Baby can either be asymptomatic or have life-threatening nervous system or cardiopulmonary disturbances. Some of the symptoms include lethargy, cyanosis (bluish discoloration), apnea (cessation of breathing), jitteriness/seizures, congestive heart failure, or hypothermia. Clinical manifestations of hypoglycemia with the activation of autonomic nervous system include anxiety and tremulousness, diaphoresis (sweating), tachycardia, palor, hunger, nausea and vomiting. When the central nervous system is depleted of blood sugar (hypoglycorrhachia) it may manifest with the following

  • Headache
  • Mental confusion, staring, behavioral changes, difficulty concentrating
  • Visual disturbances (eg, decreased acuity, diplopia)
  • Dysarthria
  • Seizures
  • Ataxia, somnolence, coma
  • Stroke (hemiplegia, aphasia), paresthesias, dizziness, amnesia, decerebrate or decorticate posturing


During fetal life, glucose is a very significant fuel for development, especially that of the brain. If glucose level is maintained adequate, it brings about normal levels of the substance insulin-like growth II (IGF-2). The latter, IGF-2, promotes increase in the number of neurons, also increase in dendritic-axonal arborizations, which thus means faster transfer of neuronic impulse. Depletion then of the brain of blood sugar brings about the opposite, and may thus lead to a patient with cognitive-impairment. Babies who had intrauterine growth restrictions (IUGR) during pregnancy are often the victims of this.

Hypoglycemia may be caused by a lot of factors. It may be due to lack of supply and storage in the liver (eg, prematures, IUGRs); may be caused by excessive consumption during stressful conditions (eg, sepsis, asphyxia) or maybe due to excessive insulin production (infants of diabetic mothers, large for gestational age).

Once my patient, your baby, is detected to have a low blood sugar reading, you now understand why I get so hyped to have it corrected at once. I do not only want your baby not to have seizures… I don’t want your baby to grow up CLUELESS.

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Posted by on July 3, 2013 in neonates


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In The Nick Of Time



A first time mother was well into the third trimester of her pregnancy. She never got sick, currently with no pregnancy-induced illness like hypertension or diabetes. She was regular on her prenatal visits, compliant. Unremarkable.

During the wee hours in the morning, she began to feel some abdominal cramps. She thought it was hunger pangs, so she had something eaten. However, after few minutes, in contrast to the relief she was expecting, the abdominal cramps continued, intermittently.

She then went to consult her OB-Gyne and have the problem assessed. On internal exam, her cervix was already 1.5 cm dilated. Her abdominal contractions were intermittent. What was unusual was that she was screaming as if in in severe pain, which was incongruent to the degree of the abdominal contraction she was experiencing. She was thus advised admission.

Upon arrival at the emergency room, it was noted that the abdomen was a little harder than the usual premature contractions, with her screaming still as if in severe pain. A tracing taken from the abdomen to assess the contractions of the uterus and heart beat of the baby (cardiotocography, CTG) showed abnormal uterine contractions and variable fetal heart rate pattern. Quick thinking by the OB-Gyne lead to the consideration of impending abruptio placenta (premature detachment of placenta from the uterine wall).

Normally, the baby gets delivered first, before placenta separates from the uterus. When the placenta prematurely detaches from the uterine wall, ahead of the delivery of the baby, this can lead to exsanguination (massive hemorrhage). On the maternal part, she can have anemia, or worse, hypovolemic shock, due to the blood loss. On the fetal side, since the placenta (which serves as the baby’s siphon for blood from the mother, delivering nutrients and oxygen supply to the baby) prematurely detached, baby can also have hypovolemia, anemia and shock. And since baby gets deprived of oxygen, baby is in a similar situation to that who is drowning or strangulated, resulting to asphyxia, and worse, death. It is then crucial that this condition (abruptio placenta) be diagnosed and managed very early on to prevent the occurrence of such adverse effects on both the mother and the baby.

Mother had to undergo emergency cesarean section. While the obstetrician was doing her job, I went to peek on the complete blood count of the mother. It showed that the mother was already having anemia. This means that she was losing significant amount of blood. (This could then explain why the uterus was unusually hard, and her unusual screaming, characteristic of one in severe pain.) On opening up of the uterus, there was a huge blood clot between the uterine wall and placenta, with about 30-40% of the placenta detached from the uterus.

When baby came out one minute after opening of the uterus, baby had difficulty of initiating his first breaths. I had to stimulate and provide bag-mask ventilation until baby began to cry. We did uninterrupted skin-to-skin contact for that chance to acquire maternal bacterial flora that will eventually help protect baby from infections. As soon as baby began to grunt (which began at about 10 minutes after skin-to-skin), we took him to the NICU for care.

When the result of the complete blood count of the baby came in, it showed that per 100 of white blood cells (WBC), 45 of which were nucleated red blood cells (NRBC). RBCs are produced in the bone marrow. While still undergoing development, the immature forms are still nucleated. Once they mature and before they are released to the peripheral circulation, the nucleus is extruded. This now allows the RBC to be pliable in the peripheral circulation, with an increased carrying capacity for oxygen. If however, in cases where baby becomes deprived of oxygen such as in massive bleeding as was the case for this baby, immature RBCs, the nucleated ones, are then thrown out into the peripheral circulation, in an attempt to increase the oxygen-carrying capacity of the RBCs — to protect the brain, heart and adrenal glands from the devastating effect of hypoxemia and hypoxia.

The urgency of the cesarean delivery has just saved the mother from massive hemorrhage and the baby from being asphyxiated. A few minutes of delay perhaps would have resulted otherwise… In the nick of time.

IMAGINE this happening to a mother, who is living in a far-flung area, with no access to obstetrics care; where hospital is 2-days travel away; where there are no barangay health workers that can be called, or even if there are, but no nearby health care facilities… would we have saved the mother? the baby? How many perinatal deaths would have to occur before the reproductive law be enacted? Do we need to have a national dumping site of dead mothers and babies (similar to that of the “Killing Fields” of Cambodia), which our leaders will personally inspect, or perhaps do a skull count, before they believe there is a need for the immediate enactment of the reproductive law? Well, one senator wanted to have maternal death certificates as an evidence before he could believe high perinatal mortality is happening.

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Posted by on June 17, 2013 in Pregnancy, Prematurity, RHBill


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Bits and Pieces


While it is true that fat jokes are at the most offensive, this is what I think about it.

IF a person is fat because he/she suffers from medical conditions (endocrine-metabolic problems), or is taking medication/s that makes him/her fat as a consequence, psychological causes like depression, then making a joke out of his/her fatness would be outright offensive; he/she did not acquire his/her fatness INTENTIONALLY

However, if the person became fat because of his/her lack of discipline and irresponsibility towards his/her own body, and his/her attention was called to it, and still intentionally keep on doing things that brought about his/her, or aggravate his/her dysmorphology, then he/she has no right to be offended if ever generic fat jokes are cracked. Fat jokes at the expense of one person though, remains offensive.



Finally, Charice Pempengco, the diminutive singer with a big and magnificent voice, publicly admitted her real sexual preference on television yesterday. However, what was sad with her announcement was that, she had to APOLOGIZE! People lauded her, while others remained critical. She is proud of her being, she said. She is unsure how people will accept her, but has foreseen that some of her fans may leave her camp after this public admittance. There was nothing wrong about her being a lesbian, and she should not apologize for being one, not even to her mother or brother. It was not a choice for her to make, it was her being.

What statement I liked that supporters were saying was that “talent has no gender.”

I echo the sentiments of others who said they look forward to the day when living who you are should not require public announcement; people who are gay should not feel obliged to divulge about themselves publicly and that they be accepted without hostility.



Michael Douglas has admitted that it was oral sex that brought about his oral cancer, and not anything else. It was caused by human papilloma virus. This virus is acquired through direct skin-to-skin contact – whether sexually or otherwise. This virus as well causes ano-rectal cancer for those who practice unprotected anal sex.

This again highlights the importance of men and women having the human papilloma virus vaccine as the virus do not only cause oral, anal and genital warts; and oro-pharyngeal, rectal and cervical among women. It also causes the same in men, gay or not.

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Posted by on June 3, 2013 in Personal


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