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Monthly Archives: August 2014

Those Painful Teenage Years

In my work, I accidentally encounter problematic teens when they get admitted under my service as the consultant on duty. I would like to share these two stories that I have come across with. Let us not judge them too quickly until we have finally come to the bottom of their stories.

Teen Y was a 15 year old female who was brought to the hospital for attempted suicide; she drank a silver cleaner. We were glad she did not have any caustic injuries down her alimentary tract or else I would have been so stressed. I kept her for observation but while in the ward, I was not able to talk to her in depth. She always covered herself in blanket. She was always with a friend; the mother or parents never took watch.

I asked the mother to pay me a visit at the clinic as she is always busy with their retail store and I could not meet her by chance when I do my rounds. She revealed that her daughter was born out of wedlock during her younger years. She is now married to another man who accepted the elder daughter like his own. However due to conflicts with her, the daughter gets to live with the grandmother sometimes. Just before the suicide attempt, she was trying to call her daughter. Apparently her daughter was not taking her call, which made her mad. When her daughter arrived, she reprimanded her. While the daughter was trying to explain why she wasn’t able to get the call, the mother refused to listen. She raised her voice instead and had told the daughter that she is disrespectful and has no sense of indebtedness.

I discharged the patient after more than 24 hours observation and told her to follow-up at the clinic after a week. I was glad she came over with the mother. So I asked the mother that I needed to talk to the daughter alone, while she waits outside. I asked her what made her mother get mad at her to the point she had thought of committing suicide.

She said she was at home but on the next door building, manning the store. Then her phone’s battery got drained. She left the phone at the first floor and went upstairs. That was when the mother was calling. She had no way of knowing her mother calling. So when she saw her mother later, she was surprised why she was being reprimanded. She tried to explain that her phone died, but her mother kept on ranting. She got so desperate because deep inside her she knew she did nothing and yet here she is being wrongfully accused. She went back to the next door store, saw the silver cleaner and drank it.

I called the mother and talked to them both. I had to explain things, let the mother know that sometimes she also needs to listen to her daughter and if she thinks the daughter becomes disrespectful as she talks to her, then she can point it out in a non-authoritative manner. Meanwhile, I also told the daughter to listen to her mother as I was sure the mother only want good things to happen to her, and that she might not repeat whatever mistakes her mother had done during her younger years.

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A 17-year old female came to the labor room with cervix fully dilated. History reveals she is 28 weeks pregnant. She came to the hospital with an 18 year old cousin. There was no time to transfer the mother to the delivery room as when the baby was at the treatment room, the head was already crowning. Baby was born vaginally and had to be brought immediately to the neonatal ICU. Baby was stabilized and initial x-ray didn’t show respiratory distress syndrome. But knowing that the mother was not given antenatal steroids, I was anticipating that eventually the baby will deteriorate respiratory wise in the next hours. I was not present at the labor room during the delivery but my resident was so I had been giving my instructions via phone call. He did a great job.

Baby had vomited repeatedly even if we only give minimal enteral feeding once. I had requested for x-ray to be repeated. On evaluation of the film, true enough, respiratory distress progressed. We needed surfactant to be administered so I asked what was the financial status of the patient (we don’t have surfactant in the hospital but it can be bought from a nearby pharmacy). I was told that the teen mom is unsupported, apparently she was disowned, and the boyfriend does not support her either.

I went to interview the teen mom after I did my rounds. She was from the south who was sent to the metropolis to stay with a male cousin, first-cousin, the reason why, I failed to ask. While being in Manila, the cousin would make her drink until she passes out. The next day, the girl would notice that her vulva feels sore. This had happened several times according to her, until she got pregnant. She never reported it, but she let her cousin know that she got pregnant. She then came over to the highlands. Her granny, who has end-stage renal disease came to learn about her condition. (But she could not support also this hospitalization as she is just dependent on her son for her dialysis expenses.) Teen mom only had one prenatal visit before the delivery. While I was interviewing her, my voice broke and said, “so, this is rape.”

I got to do something. I told the OB in-charge to notify the Women and Child Protection Unit, even if the crime was not committed locally. Meanwhile I wanted the baby to be transferred to another hospital where they can give surfactant for free. But we cannot make major decisions as the mom is a minor, and the cousin cannot sign for the consents. As I was about to leave the hospital I was glad I met a relative of legal age who took the role as the guardian of both the teen mom and the baby. Baby was transferred within few hours.

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Posted by on August 28, 2014 in Adolescents

 

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The Prize of My Sacrifices

My life has been an open book, especially after that dreaded meet and greet with Death and his scythe. I have allowed it to be, so people would be aware of their lifestyles; and make them learn from my example on how they are going to live their lives towards health.

Few months after that emergency bypass operation, I was never able to control the main culprit that made me this “known” to my colleagues. I was already in quadruple drug therapy for my lipids (ruosovastatin, ezetimibe, fenofibrate, EPA+DHA). I got back to working out two months after my surgery. I had been watching my food intake, avoiding red meat and only preferring vegetable and white meat. Aside from that, I also have problem with my heart beat rhythm hence I was maintained on amiodarone. Eleven months after the surgery, finally I saw light. Total cholesterol and triglycerides went to normal levels, although LDL (bad cholesterol) was still high for a patient who underwent a bypass operation. I was then advised to have another follow-up visit after the holidays to check the effect of christmas celebrations.

Not only did my laboratory result became abnormal and back to pre-operation level, I gained weight. The light I saw few months ago was just a glimmer. On investigation, my thyroid hormones suggested hypothyroidism leading to hypometabolism, which now explains my weight gain and abnormal lipid levels. These were the result of my anti-arrhythmic amiodarone. We had to drastically revise my medications. I had to take thyroid hormone supplementation, change amiodarone to beta-blocker bisoprolol, increase the dose of ruosovastatin and increased my workout. At first I was still having palpitations and skip beats with bisoprolol and thus dose was increased. I was supposed to undergo holter monitoring in case my arrhythmia would persist.

At 18 months after the surgery, getting depressed with all the elevations of my lipids, weight gain, I decided to make a drastic change in my diet. I dropped meat and went quasi-vegetarian (having chicken or fish once a week). It was a very difficult lifestyle change as I easily get hungry, forcing me to have a lot of snacks, sometimes taking pastries (which I should also be avoiding; not that I have high blood sugar, but then simple sugars have been identified as one culprit in causing chronic inflammation of the blood vessels trapping cholesterols and forming a plaque, even if your cholesterol level is not necessarily high). Being a residency training officer of the department of Pediatrics at SLU-HSH, I decided to quit the post while maintaining the post as head of breastfeeding committee and neonatal services unit of the same hospital.

Then having been a Zumba enthusiast, I went on training and earned my license to be an instructor. Having kept this diet, exercise and religious medication, I had my follow-up on my 20th month after the surgery. Sacrifice and effort finally paid off. My total cholesterol was now down to 156.96mg/dL (from a previous of 423 the first time I found out I had elevated levels to 212 prior to my cardiac arrest). Low density lipoprotein (LDL) was now down to 92 mg/dL, and my triglyceride was still maintained below 200mg/dL at 105.32. My liver enzyme was very slightly elevated and thyroid hormone was within acceptable normal limits, bordering hypothyroid. I lost two kilograms, I can now wear my old pants and I feel a little more confident than the previous months. Because of these, my cardiologist decided to discontinue my thyroid hormone supplementation, decrease my dose of ezetimibe and lower my ruosovastatin from 40 mg to 20 mg.

Whether these changes were due to my more frequent exercise or diet restriction, or lesser stress from work, it doesn’t matter; it also means that I will have to maintain these statuses so as to keep my lipids in check. I thought I could already have the clearance to eat lechon, sigh… Well, better this than have another heart attack soon. The sacrifices paid off.

Next goal: a sculpted body? I dare myself.

 
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Posted by on August 17, 2014 in Personal

 

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