All About Dry-Weight In Hemo-Dialysis: Rewind

     Estimating the dry-weight (this is the lowest possible weight of a dialysis patient after dialysis where the patient has normal blood pressure and most of excess body fluid is taken out) is hard sometimes because the patient is afraid that he/she might exceed below the actual dry weight and suffer very painful cramps, temporary hearing loss and low blood pressure. On the other hand, not reaching the dry weight after dialysis means retention of extra body fluid that may result to Edema or swelling of the legs and water is stored in the abdomen. Twice, I have experienced that situation when I lost my appetite and not being aware that excess body fluid is stored in my abdomen and my legs and I am way above my actual dry weight. If you experienced this, the right thing to do is not to abruptly take out the excess body fluid in one dialysis session but to slowly take it out one dialysis session after another dialysis session until your legs are not anymore swelling and your stomach is not feeling too heavy. You do this by lowering your estimated dry weight by 300 ml. in one dialysis session, then 500 ml. on the next dialysis session and so on until you begin to feel that your legs is about to cramp or you are about to experience temporary hearing loss. Do not eat salty food as this may cause fluid retention and excess body fluid is harder to take out. It is not necessary to reach your actual dry weight but you should always try to go near it after every dialysis sessions.

     I have experienced that if I am at or near my actual dry weight, my appetite for food is increasing and the result is I get fat and I have to re-adjust my estimated dry weight until I have a big and heavy stomach and my legs begin to swell and I lose my appetite. This means that I am again way above my actual dry weight and I need to lose weight by not eating too much carbohydrate like rice, bread and pastries. I eat small amount of meat and chicken, lots of fish and some vegetables that are high in Vitamins and fiber. I drink less than one liter of water per day. My experience is that if I drink a lot of water, I have observed that I do not feel well during dialysis because my heart is stressed while the excess fluid is being taken out of my body. If I drink only the allowed amount of water, I feel well during dialysis and I can still take out more water below my estimated dry weight until I go near again to my actual dry weight.

     My advice to my fellow dialysis patients: always try to stick on the dos and don’ts of dialysis as I have written in one of my articles in my blog. It is very tempting to exceed the allowed amount of food and water for dialysis patients; but I tell you, the corresponding discomfort or pain during dialysis is not worth the satisfaction you felt when you ate excess amount of food and water. I am reiterating again that we (dialysis patients) should eat to live not live to eat. If you want a longer life in dialysis, you must exercise a strong will to resist the temptation to over eat and drink. You can do it!

Life of a Dialysis Patient (Part 3)

Part Three:

    

     I will reach my sixth year on dialysis on September 29 this year. Having dialysis is part experience and more on learning the various technical aspects of dialysis. This is important since I cannot always rely on the doctors and nurses because they can commit lapses sometimes because of their work load. It is I who can tell what I feel and from experiences, research and insights I can prevent mistakes from happening again. Like the estimation of my dry weight (this is the lowest weight I can possibly obtain after dialysis where my vital signs are normal and any excess water from my body is taken out). I have learned to observe during dialysis if the amount of water taken out of my body is already enough and I could instruct the nurse to lower my fluid goal or stop the drawing of water from my body. I know the frequency of injecting Erythropoietin (for maintaining the amount of blood Hemoglobin) based on my latest Serum Hemoglobin test. I know that I should take Calcium Carbonate tablet or Sevelamer tablet (phosphate binders; serum phosphorus level tend to rise in dialysis patients) either before, during or right after meals and not to be taken more than thirty minutes after eating because the phosphorus in my meal is already getting absorbed and taking phosphate binder at this stage is already late. Based on what I feel and the condition of my body, I could instruct the nurse to either lower or increase the rate of my blood flow on the dialyzer.

     I have said that the doctor and nurses could commit a wrong diagnosis or decision sometimes. Like what happened to me on December, 2015. I had a persistent cough with no fever that time and the doctor listened to my lungs and said that she heard something in my left lung. She advised me to have a chest x-ray and the result was I have Pneumonia in my left lung and she gave me strong anti-biotic and after two weeks, my cough did not stop. The medicine she prescribed me made me lose my appetite and I have difficulty sleeping. Again, another doctor from the hospital gave me more strong anti-biotic and this has worsened my condition and one night I have difficulty breathing and my phlegm has a streak of blood in it. I had my dialysis immediately but I was not relieved of my difficulty in breathing so the nurses advised me to be admitted to a private hospital. I rode an ambulance to the Holy Name Hospital without an oxygen tank and this worsen my condition. Upon reaching the Emergency Room I was given oxygen and my condition has improved. The next day our Nephrologist in GCGMH ordered that I be dialyzed again and was repeated again the next day and after that I rested for one day and I was dialyzed again the next day. At the fourth day, my Pulmonologist visited me with our Nephrologist and heart doctor. 

     The findings was I have had fluid overload resulting to Pulmonary Edema and there is water surrounding my heart. My Pulmonologist diagnosed me before my admission that I have no Pneumonia but have water in my lungs. Taking those anti-biotic for Pneumonia had aggravated my condition. On the fifth day I was discharged from the HNU Hospital and continued with my regular dialysis afterwards. I had fluid overload because I lost my appetite and I cannot sleep when I took those anti-biotic. I was supposed to decrease in weight but I maintained my original dry weight which is not anymore correct because I lost some weight. I was supposed to have adjusted my dry weight to a much lower value. So my conclusion, doctors’ diagnosis is not correct sometimes.

     After that hospital experience, I became cautious with my dry weight. I see to it that the excess water in my body (since I have end-stage kidney disease and my urine output is very minimal) is taken away by the dialysis machine. I have to control or limit drinking too much water. I realized that I have a congestive heart failure at that time because I kept coughing so my heart doctor prescribed me with Isosorbide Mono-Nitrate (ISMN). My condition improved but I am still coughing because I have Allergic Rhinitis which I treat with Levo-citirizine and Monteleukast. My knowledge on Hemo-dialysis is not yet complete. I am still wondering what is the reaction of Calcium Carbonate and Phosphorus in the digestive tract. Calcium carbonate is a Phosphate binder that binds with Phosphorus in what I have eaten and the Phosphorus is not absorbed in my blood stream and excreted with the stool. I take a Phosphate binder like Calcium Carbonate and Sevelamer Carbonate if my Inorganic Phosphorus in my blood is high. Excess phosphorus in the body is dangerous for dialysis patients because Phosphorus binds with Calcium in the blood and form Calcium Phosphate crystals which are deposited in the skin and extremities including the heart and eyes. This causes the skin to itch and crack with constant scratching that could lead to an infection called Cellulitis and when left untreated can cause Sepsis (infection in the blood) infection that could lead to death. Calcium Phosphate are also deposited in joints that causes pain, when deposited in excess in the heart muscles can cause heart failure and death. When deposited in the eyes this result to rupture of small blood vessels in the eye causing red eyes. Excess deposits of Calcium Phosphate in muscles, tissues and joints cause muscular and skeletal pain, stroke or death. Monthly monitoring of my Calcium and Phosphate level in my blood is very important since they indicate whether my Calcium is normal or below or above normal. This aid me whether to increase or decrease my Calcium Carbonate dosage. Taking too much Calcium Carbonate is not good because Calcium could cause Calcification in the joints and muscles.

     I have yet to learn more about Hemo-dialysis so I can impart my learning and insights to my co-dialysis patients for them to learn what to avoid and prevent aggravation of their condition. I am sure that doctors and nurses could also learn from our experiences so that mis-diagnosis can be avoided that could compromise the health of the patients. With this, it is hoped that longevity of patients and the quality of service to dialysis patients could be improved. 

   

Life of a Dialysis Patient (Part Two)

      As months and years pass by, I saw the need for the dialysis patients and their watchers to have an association to have their rights and privileges protected; and aid them in sourcing funds for dialysis. I saw that their PHILHEALTH Dialysis package was not maximized since the hospital is charging high cost of maintenance and operating expenses as well as medical supplies. I also noticed that the 45 dialysis sessions per year package of PHILHEALTH before was not enough since at the start of the fourth quarter of the year, most of the patients were already out of funds from PCSO and the PDAF of congressmen and thereby forced to raise funds from other sources (personal or financial help from kind hearted relatives). Other un-fortunate patients with no fund sources chose to skip from their dialysis sessions. Instead of two dialysis sessions per week, they make it to only one or none at all for the week. I also observed that the Hemo-dialyis Staff of the hospital were not behaving like professionals since they are rowdy (keep chatting and noisy while on duty), less work load and seem superior to their patients (you can hear comments like: “Do not compare us to private dialysis centers because this is a government hospital. What do you expect of us?”). Sometimes they imply, especially the technicians, that something will happen if we go against them. As if their salaries and benefits are low but the truth is, they are the highest paid nurses and technicians in the province since they are employed with the Regional Hospital. Aside from salaries, they also have a commission on the total professional fees of PHILHEALTH collected for a certain period (every regular employee of the hospital receives a portion of the total value [of all the patients of the hospital] of professional fee of P300.00 per patient).

       So I decided to form a core group from dialysis patients and watchers and we made a resolution that we will establish the: Bohol Association of Hemo-dialysis Patients and Watchers (BOASHEPAWA). We had a general assembly of members and I was elected Chairman of the Board of Trustees. Putting up an association among dialysis patients and watchers is difficult since some of them were burned or frustrated from the past organizations they have joined. They are also reluctant to pay the membership fee of P100 and Annual Fee of P100. How can our association perform its duties if we have no initial fund for operating expenses? Others are simply ignorant of what is an association. 

     We prepared the required documents for registration with the Securities and Exchange Commission (SEC) to make our association have a legal personality to solicit funds and to participate in other programs and projects of the government. Preparing the documents was very difficult because you have to approach every signatory and asked them of their full name and complete address and I have to go back and forth to the SEC Provincial office for revision and additional requirements. My wife and I took the time for the documents to be notarized. After a visit to our daughters in Manila, me and my wife had the chance to go to the SEC head Office to submit our registration requirements.  This is the time when I still have water in my lungs and I have to gasp for air in order to breath after a long climb and walk on the over pass. Despite the hardships we encountered, BOASHEPAWA was finally registered with the SEC on May 9, 2013 with Registration No: CN201326623.

       Running an association among dialysis patients and watchers is difficult since our members are having dialysis and they are weak and prone to infections and other hazards like eating foods that may aggravate their condition. Hospitalization or death among our officers and members cannot be avoided. This hampers the attendance to our meetings thereby delaying our decision and policy making process. Others cannot attend simply because they live far from the city and they have to spend for the transportation expense while others are busy with their personal activities because we have to time our meetings during Saturdays when our members are finished with their dialysis. These problems were aggravated by the efforts of the HDU staff to malign the image of our association to other dialysis patients.

       Before, our members have to solicit dialysis funds from the Philippine Charity Sweepstakes Office (PCSO). They have no office in Bohol so the patients were forced to make a trip from Bohol to Manila just to get PCSO financial assistance of P20,000.00. This puts the dialysis patient on a high risk since he/she has to endure the hardship of long travel and to have patience while bearing the burden of joining on a long line of people waiting for their names to be called while processing their documents. So we at BOASHEPAWA made a Board Resolution to request the PCSO to put up a provincial office at Tagbilaran City, Bohol. Fortunately, our provincial Governor acted favorably on our request and made the appropriate coordination with PCSO. After a few months, the PCSO has put up their provincial office in Bohol and the dialysis patients were freed from the burden of going to Manila to get financial assistance.

       We also saw the need for additional dialysis sessions under the PHILHEALTH Dialysis Package. So instead of then on-going policy of only 45 dialysis sessions per year, we at BOSHEPAWA, submitted to the PHILHEALTH our Board Resolution requesting them to increase the dialysis package from 45 dialysis sessions per year to 90 dialysis sessions per year. We sought the intercession of our Governor and Congressman and after a few years, PHILHEALTH has approved our request and the dialysis patients are now enjoying 90 dialysis sessions per year within the PHILHEALTH Dialysis package.

       BOASHEPAWA has also been coordinating with various National/Government agencies like the DSWD and the Provincial Government for programs and projects that may be beneficial to our association. BOASHEPAWA has submitted a Board Resolution asking the National Government for financial assistance obtained from a portion of taxes collected from cigarettes and liquors. As a result, with the effort of the past and new administration, the financial assistance from Congressmen in the form of PDAF is now directly channeled to the Regional Hospitals and the dialysis patients are now enjoying these benefits through the Medical Assistance Program (MAP) for medicines, laboratory tests and dialysis sessions. Once our dialysis sessions under the PHILHEALTH Dialysis Package of 90 sessions per year are depleted, we need 96 dialysis sessions for patients having dialysis twice a week and 144 dialysis sessions for those having dialysis thrice a week, we charge our excess dialysis sessions to the MAP. 

      From funds solicited from good-natured owners of business establishments in Tagbilaran City, we have set-up a fund for the family of our members who have died at P1,000.00 per member. Basically, we have no more problem with our dialysis. We also arranged for meetings with the Executive Committee of the Regional Hospital which is the GCGMH for possible review of current Policies and Guidelines concerning the dialysis patients to incorporate possible amendments and to generate new, appropriate and flexible ones that will benefit our members. Now, we can say that the quality of service of the Hemo-Dialysis Staff has improved greatly although our dialysis facility still needs improvement but being addressed by the Top Management of the hospital. New buildings are being constructed to hopefully house our new first class dialysis center.

                                                                                                               (to be continued)

       

Life of a Dialysis Patient

      Life is a journey; it may take you anywhere to start a new adventure and a family of loved ones. As in any adventure, you will follow your dream, you will experience joy and sadness, success and failures; and yet you must stand for what you believe no matter what adversity you may encounter as you continue with your journey in life. Push on till your heart say you have reached the end.

     

 Before, when I hear about or see person(s) having dialysis I feel pity at the same time fearful with regret because they say that dialysis can be afforded only by the rich since one session cost five to six thousand pesos; and done one to two times per week depending on the damage of the kidneys. Not to mention the pain the patient has to go through and the long dialysis session of four hours. When my doctor in Cebu Doctors Hospital told me that sooner or later I will undergo dialysis, I began to worry about the financial burden it would bring to my family and the thought that I am not fit for dialysis and will only suffer while in dialysis. I began to be frustrated for a while but realized later that I should not worry because it is up to the will of the Lord if I could overcome my fear of dialysis; and live a new life having a mission to share to others my experiences while in dialysis for other dialysis patients to learn ways in coping up with their disease. Also, my mission may include other healthy people to be aware about the importance of their kidneys and learn ways to protect their kidneys from damage by avoiding unhealthy practices. That was five years and six months ago, I started having dialysis on September 29, 2011, and with the grace of the Lord I am still healthy in mind although not quite healthy in body but coping well.

       The first month of my dialysis sessions was entrusted to the doctors, nurses and technicians of the Hemo-Dialysis Unit (HDU) of the Gov. Celestino Gallares Memorial Hospital (GCGMH). I did not know much about dialysis then and all I can do is obey what I am told. One time, while on dialysis I experienced Hypo-tension or very low blood pressure. I had cold sweat, blurring of vision and almost passed out. This also happened in some dialysis sessions and I had darkening of my finger nails due to lack of oxygen brought about by my very low blood pressure. Now, with months and years of continuous Google search I finally found out that my tendency to have hypo-tension is due to my low sodium level in my blood, we have a monthly laboratory tests of our blood consisting of Sodium, Potassium, Phosphorus, Calcium, Blood Uric Acid, Blood Urea Nitrogen (nitrogenous waste in the blood), Complete Blood Count (CBC) to determine the level of Hemoglobin, Red Blood Cell (RBC), White Blood Cell(WBC) and possible sign of infection, Creatinine (how much blood waste) and Albumin (help in stabilizing fluid volume; lack of it will cause Edema or swelling of legs, arms and abdomen). My low sodium in the blood before was due to lack of salt in my diet (bland or not salty). I have found out that with low sodium in the blood of a dialysis patient, he/she will be prone to low blood pressure and cramping while having dialysis which is aggravated by too much drawing of fluid or water from his/her body by the dialysis machine. In my case, now I know how to set the right volume of water to be drawn from my body based on my dry weight (this is my optimum obtainable weight after dialysis where my blood pressure is normal). If I set a low water volume way above my dry weight, less water is drawn resulting to swelling of my legs and arms or stomach since my urine output is already very low. This means that I have to set just enough water to be drawn from my body. I will also know if I have set too much water volume because I feel uneasy and my toes seems very dry and they are twitching so I will tell the nurse to decrease my set goal before I experience Hypo-tension. On the other hand, high sodium level in the blood while in dialysis cause high blood pressure because the arteries and veins are constricted and the heart should exert more effort to pump the blood. 

     Before, I used to experience high blood pressure and I had Pneumonia (lung infection) in my left lung. I have to take strong anti-biotic that made me more sick and I cannot sleep well. Six hundred ml. (that was the findings of the Radiologist in my ultrasound) of water have accumulated in my left lung. I have difficulty in breathing and I have to sleep with two pillows in my back since I cannot lay flat on my back. My doctor said that I should not eat salty food. Thankfully I was given Catapres (Clonidine), medicine for high blood pressure, and my blood pressure went back to normal and there is no more water in my lungs. That experience has taught me to wear a face mask while in the dialysis room or in places where there are many people and not to eat salty foods because it can cause high blood pressure, Edema and heart disease. 

     When I had my first dialysis session in Capitol Dialysis Center in Quezon City, once in a while we take a vacation in our house in Quezon City to visit our daughters, I have seen that the doctor and nurse will adjust the sodium level in the dialysis machine (determine how much sodium to be released during dialysis) depending on the condition of the patient. In one of my dialysis sessions, I have experienced cramps and my blood sodium is low, the doctor then instructed the nurse to increase the sodium level of the dialysis machine to compensate for my low blood sodium. This is not practiced in GCGMH in Tagbilaran City, Bohol. The doctors are playing safe because the nurse or technician might set the sodium level of the machine too high or too low to the detriment of the patient. There is no regular doctor (whole day basis) on duty inside the HDU and cannot supervise the nurses and technicians; unlike in Capitol Dialysis Center, they have a doctor inside the dialysis room the whole day.

                                                                                                            (to be continued)

Life After "Armageddon".

Prelude:

       It is not my intention to scare anybody. I should be writing about positive things that would uplift our hope about the future; but the truth is loud and clear, our environment is at the brink of breakdown and we should do something about it before it is too late. This is my way of creating awareness about the condition we are all in and find ways however simple or small to protect our environment and conserve the natural resources we still have. Being aware about the gloomy future and not doing anything and continuing with our lavish and happy go lucky lifestyle with the notion that "We will all die, why not make the most of it by partying, eating, drinking and buying the things we want while we can?" will only make matters worse. This is our mother Earth and we should do our part in making her clean and habitable for our children and the next generations to come.

The Present Day:

       It is safe to say that most people today are oblivious of what will happen to them in the near future. They are caught in their daily routine to work and earn money to buy food and things that are necessary to survive daily. Some buy things that are not necessary but for the sake of its aesthetic value and buy things as an effect of mind conditioning and selling techniques of: TV commercials, billboards, magazines, newspapers even beauty pageants, fashion shows, concerts and boxing bouts. All of us want to build our houses and buy new clothes and shoes. We look into the future on the basis of improving our skill to acquire more material wealth that most people consider as success. We can say that this is happening in a global scale and enhanced by digital boom of the internet and other forms of media.

     Businesses flourish due to production and consumerism because there is an ever increasing demand and some even create demands for goods that have less appeal to consumers through controversy and other unscrupulous marketing strategies. What is important to these big corporate conglomerates are cost of production and profits with the motivation of greed. “Greed is good” they say.

       Everybody is tied to politics and the economic and financial system that are rooted in greed and callousness as long as they satisfy their personal interests to the detriment of the people. Government spending is viewed as economically sound since it improves the Gross Domestic Product (GDP) even if it is already hurting the environment through exploitation of natural resources.

    Technology is making progress in every aspect of human life whether it is for the cure of diseases, amenities and comfortable living or for the destruction of human life like bullets and bombs for warfare.

     Yes, despite all the dangers and benefits that the world can offer, we can say that we are still all part of these conditions – that everything on earth is inter-connected.

The Inter-connectivity of All:

       Tinker on one aspect of humanity and everything is affected. For example, raise the price of fuel or gasoline and the price of goods will also increase and the purchasing power of the people will decrease unless there is an increase in their salary. Transportation fare, electricity and water rates all increase to the burden of the citizens. Even tuition fees are affected by this increase in price because oil or fuel is a prime commodity that we cannot live without. Much more if it is the availability of food that is affected in a global scale. No economic measures could alleviate its catastrophic effect on the lives of people.

        Oil and coal are all carbon based and when burned to provide energy to cars and factories or generate electric power to light and energize machines and appliances in our homes it also emits carbon dioxide to the atmosphere where it accumulates in large amounts enough to cause global warming that have profound disastrous effects to our environment in which we live.

What is being done?

     To avoid this impending catastrophe, Super Power nations are into biological research and development of space travel. An option is to send people in the moon or other planet(s) or space lab to save the human race for possible extinction due to Nuclear Warfare and virus/bacteria pandemics. Scientists are into genetic engineering with the purpose of creating super beings that could survive radioactivity, hunger and resistant to harmful viruses and bacteria. Scientists are also developing super medicines that could cure infectious and deadly diseases. They are also into cloning of individuals whether human or animals whose organs can be harvested and transplanted into humans with diseased kidney, heart, lungs, etc. They will make slave robots for: industries, exploration, home and warfare. The question is will they be ahead or will they beat the deadline of what will happen soon?

The Inevitable Consequence:

     It cannot be disputed anymore that we are now living in a dangerous era where all the signs of Climate Change is happening all around us. Due to the increase in earth temperature due to air pollution, the polar icebergs and mountain ice caps are melting resulting to increase in sea level and subsequent flooding of low lying areas. Seas are warming resulting to the altering of weather conditions creating the El Nino and La Nina Phenomenon causing long period of droughts and existence of strong typhoons and snow blizzards. This also results to warming of the seas that affect ocean currents that have disastrous effects on planktons, corals and algae on major rivers and seas. With less available nutrients, the population of fish is decreasing coupled with the illegal/overfishing practices of fishermen to meet the demand of people consuming fish has resulted to less fish catch and they have to go out further to sea exposing them to more dangers. Less fish catch means higher prices of fish in local and foreign markets creating a “domino” effect on the lives of people. Small village fishermen have less source of protein and they become malnourished and prone to different diseases and mortality. To avoid this, member of their family start their exodus to big cities hoping they could find jobs and provide sustenance to their families left behind in the provinces. Major cities become over-populated which will result to more crimes, robberies and killings.

     Agriculture is also very much affected by global warming since the regularity of rainfall in the area is affected. Long period of droughts results to the decimation of crops and livestock causing exodus of farmers to big cities and other fertile areas. On the other hand, too much rainfall and strong winds will cause flooding and devastation to the farmers livelihood. There is also a problem of salt infiltration and acidification of soil brought about by too much application of chemical soil fertilizers that will result to “locking” of soil minerals and nutrients. Plants will not be able to absorb these nutrients and minerals and would have stunted growth and contain not enough nutrients for animal and human sustenance. Due to droughts, the salinity of soil surrounded by seawater will slowly increase making them un-productive. Soil Erosion and siltation of seas have negative effect on shallow water corals.

     It is projected that 30 to 50 years from now, the availability of potable water will become scarce. The source of non-renewable resources such as oil and fuel would probably been depleted and the power needs of nations will be put in a critical level unless the renewable sources of power are fully developed such as solar and wind energy.

     With less food in the markets, people living in the provinces and cities will have a hard time earning money to buy fish, meat, vegetables and water whose prices would have increased dramatically due to Climate Change. There will be chaos and disorder resulting to looting and lawlessness. The Law of Nature which states that: “Only the strong of species will survive” will always hold true. Anarchy will prevail in the streets and no one is safe even from their houses. Offices and factories will shut down and many people will be jobless.

    Countries will be in grave competition with other countries resulting to invasion and wars that will result to a World War that will force the Super Powers such as USA, China, Russia, Korea, Iran to aim and execute firing orders of their nuclear arms to each other that will result to global destruction. This is the so called “Armageddon” which is the final battle of good and evil.

The Aftermath:

     No one really knows if the human race will survive the nuclear war. For sure some animals and plants will survive and they will dominate the earth. Each Super Power nation has built strong bunkers for their presidents and families and their staff. It is for sure that they could survive many days and even months inside those protective bunkers with enough food and water but for how long? Assuming they have survived and successfully went through the radioactive stage by “means” of scientific wonders and the world has naturally healed itself and plants and animals have grown back, this is the time when a new world will be born. The good will still triumph over evil. Only a few people have survived and there will be less competition for food, water and shelter. Order will again be restored to start a new beginning!

     Just like in a colony of bacteria, there will be time of nourishment and population development, but there will also come a time of over-population and pollution resulting to death of many and their population will decrease. The few strong ones that have survived will then start populating again to repeat the cycle of life!

Soulmates: Seven Years And Onward.

    Looking back, I was able to watch my eldest daughter Yanie grow up from childhood to adulthood. She bloomed into a lady who is soft spoken, kind hearted, trust easily, friendly and fragile looking. She is very particular with her looks so that she will look beautiful all day. No wonder at a young age she had already a boyfriend but broke up with him after a while. Then she met Joel who courted her and became her boyfriend for more than seven years. They spent their time playing computer games (Joel has a degree in Computer Science) and talking about anything that would come to their mind. Joel is the more mature type and the second to the eldest among his siblings. He asserts his points with superiority but knows how to reciprocate affection while Yanie would understand what he says and feels. So came the day when they decided that they are really meant for each other and planned to get married. They managed to go through the planning and raising of the required funds and got married on May 27, 2016 at Christ The King Parish in Green Meadows.

     Yanie was very lovely in her wedding gown as she walked along the aisle of the church. She looked so happy and fulfilled all throughout the wedding and reception which went smoothly. Yanie and I became emotional for a moment when we performed the father and daughter dance. My message to my daughter is to consider each day of their married life as a day of discovering their good and bad traits; but they should always focus on the positive ones and accept their limitations and weaknesses so that their relationship will become stronger. They should put our Lord God at the center of their relationship and they should always lift up their problems to Him for enlightenment and courage as they tackle their adversities in life. Lastly, they should always love their children for in them the bond of a family will become stronger.

     It is amazing to note that such relationship exists. Two souls with a promise to understand each other through thick and thin, in sickness and in health -- only in death do they part! 

One Bout of "Pneumonia"

One Bout of “Pneumonia”

A

Viewpoint on Quality of Service

And

Private vs. Government Management

        It all started in September, 2015 when I had a persistent cough which I thought was only an allergic cough which persisted for weeks. I am a dialysis patient at the Regional Hospital of  Gov. Celestino  Gallares (GCGMH) for four years  now and I had one bout of Pneumonia since last 2012. I had no fever and my body is functioning normally aside from my cough so the doctor assigned at the Hemo-Dialysis Unit (HDU) finally decided to conduct a thorough listening on my lungs and said that she heard something on my left lung and prescribed me with an anti-biotic which I deliberately took as prescribed. My condition did not improve and the other HDU doctor (the former doctor was reassigned) conducted another thorough listening on my lungs and again said that my left lung is “noisy” and suggested that I should have chest X-Ray. As an obedient patient, I had a chest X-Ray on October, 2015 at the Ramiro Hospital. The result said that I had pneumonia at my left lung and my right lung is “clear”. The HDU doctor was informed and she prescribed me with more potent anti-biotic to treat the infection. I trusted the doctor more since her diagnosis is “right”, but I told her that I do not feel anything in my left lung, instead I feel something in my right lung and I also have pain at the right side of my back. The HDU doctor replied “how do you know?” I was taken aback by her authority and decided not to reply back. I could have told her that I feel that my sputum is coming from the right lung and I feel that my right lung is sore. After taking the prescribed anti-biotic, my condition improved a little bit but I still have a persistent cough so the HDU doctor advised me again to have a chest X-Ray so that she will know if she will prescribe me with a broad spectrum anti-biotic. So I had again a chest X-Ray on November, 2015 at the Ramiro Hospital and the result said that I still have Pneumonia of my left lung but it is improving and my right lung is “clear”. This time my wife and I decided to consult our Pulmonary Specialist who is also our family friend. We showed the X-Ray plate and the result and upon examining the plate, he said that I have no infection on my left lung but my right lung showed some cloudiness. He said further that probably what the radiologist saw in the left lung as pneumonia is actually a “thickening” of tissues as a result of my last bout of pneumonia in 2012.  We were amazed by his findings and realized that all the time the HDU doctors have been treating my left lung which have no infection and it finally turned out that it was my right lung which need to be treated. What is most amazing is the result of the two successive  X-Rays which showed that my right lung is “clear” and have no infection. The radiologist and the HDU doctors simply failed to see the true condition of my right lung which the Pulmonologist easily saw. How come that this has happened? After having laboratory tests of my blood, our pulmonary doctor friend concluded that I have no more infection and prescribed me with anti-allergy tablets. If I did not consult a specialist, I could have been prescribed with more potent anti-biotic  which could have affected my liver. I also concluded that the patient is more sensitive of his condition and the doctors could also be mistaken with their diagnosis.

         The question now is: who should have an “eagle” eye in reading the X-Ray plate, is it the Radiologist or the Pulmonologist? It should be the Radiologist since he has specialized in reading X-Ray plates while the Pulmonologist has specialized in diseases of the lungs. I could only surmise that due to the busy schedule of the Radiologist, he is quick to decide that the interstitial infiltrates which he saw in my left lung is Pneumonia and the rest of the lung fields are “clear” and he decided to stop to carefully scrutinize the cloudiness in my right lung. He could have concluded that anyway the patient will be treated with antibiotics which will affect the left and right lung. I cannot blame the Radiologist because he does not know my medical history, but he should have been more careful with his X-Ray readings because these could result to incorrect diagnosis that could endanger the patient’s life. In my case, what if I had no lung infection and it was only an allergy; and because of incorrect diagnosis I was treated with strong antibiotics that could have affected my liver. I am a dialysis patient and it is my liver that takes care in eliminating toxins from my body. If my liver is damaged, I would die because dialysis alone is not enough to keep me alive. No wonder, even doctors in Tagbilaran City are more confident to have their medical check-ups in Cebu City rather than in Tagbilaran City to avoid incorrect diagnosis.

        It is here, that quality of service plays a vital role in medical institutions. The medical personnel are dealing with their patient’s life and they should be fully qualified or re-qualified through further trainings to perform their tasks. This is the modern world and what is applicable in the past may not be applicable today and nurses, doctors and radiologists are sent to seminars to update their skills and knowledge to be more competent in doing their duty. Of course, dedication to duty is also important. Combining all these factors, I am sure these medical personnel can sleep soundly without being bothered by their conscience.

       The Top Management also plays a vital role in keeping their medical personnel to perform in their maximum proficiency because management is all about planning, leading, organizing and control. Be loose in one of these tasks or focusing only in some will affect the performance of the organization. Not sending medical personnel to trainings and seminars will cause stagnation of their knowledge that will result to poor performance and incorrect diagnosis that will result to aggravation of the condition of the patient and the worst, it could also mean death.

       I cannot stop comparing private management of hospitals to government hospitals because I am a patient myself and I regularly enter hospitals for treatment. Top Management of private hospitals is strict in the implementation of duties of their personnel. One complain from a patient or patients means reprimand, suspension and in worst cases even dismissal of the personnel involved, while in government hospitals, lapses of medical personnel are tolerated and you would be lucky if they get a reprimand from their supervisors and Top Management. That is why the quality of service of government medical personnel is not at par with their private counterparts. Why is this so? In my opinion, government medical personnel are regular, casual or consultants. The regulars are always protecting their position so they can have a good retirement with their lump sum and monthly pensions. For this, they should have a political rapport with their co-employees. So if a patient complains, the Supervisor or even the Chief of Hospital is very careful not to put their staff in bad light because of this political bond with each other.

      My Kudos goes to the Top Management of Gov. Celestino Gallares Memorial Hospital (GCGMH) where I am a dialysis patient. Finally, the Top Management has decided to apply for ISO (International Organization for Standardization) accreditation to upgrade the level of service that will hopefully make the hospital one of the best in the Region. This act is more appropriate to remove the stigma that government service is equal to poor service because of the wrong notion that government personnel have low salaries and should only perform according to what they are receiving. I can dream of that one day when government medical personnel are proud of their institution and they can face their patients with politeness and say: “You are most welcome sir/madam to our hospital which can provide you with quality service” and not to utterly say to patients: “If you are not satisfied with our service then go to private hospitals. This is a government hospital, what do you expect from us?”