Whenever we admit a patient, it is imperative to get a baseline of getting their history that includes their lifestyle. We always ask our patient about their smoking and drinking habits. There were some who have been smoking all their lives and just have recently quit some are still puffing their black and milds as if there is no tomorrow. Being a smoker before, I know that it is really hard to turn one’s back to the addicting puffing habit.

I have learned recently that there is a new diet in the US that is a hit among the brides.
It is called the K-E diet in which the patient eats through a nasogastric feeding tube. The nasogastric tube is usually used in the hospital setting or at times at home when patients cannot eat o ntheir own. A tiny yet long tube is inserted in the nostril passing through the esophagus down to the stomach. In our hospital, the osterized feeding is computed based on the kilo calorie requirement of the patient. Feeding is given through the NGT every four hours round the clock .
In K-E diet, a portable bag containing the feeding. It gives constant slow drip of protein and fat, mixed with water, which contains zero carbohydrates and totals 800 calories a day.
The patients will be carrying the bag like purse for 10 days. The Diet is totally hunger free but according to Dr. Oliver Di Pietro of Bay Harbor Islands, Fla, have main side effects that include It is a hunger-free, effective way of dieting,” Di Pietro said.
The newest diet craze is picking up in the US and costs $1,500 for the 10-day plan.
So are you up for it?

A health practitioner needs to be abreast with the trends in health science. More and more patients are becoming curious or obsessed with their health that they google their health-related issues side-by-side with consultation with medical professionals. It is alarming though that some information that these people get are not based on studies. Getting subscriptions from good reviews such as progene review are good investments so you could be assured that what you are getting are actual facts and not hearsay.

In our institution which is a cardiac center, it is not unusual to come across non-cardiac cases. While we prioritize patients with heart condition, our doors are still open to other patients. We try to cater to any medical-surgical cases that may come our way but only to some extent. This is the reason why we are overflowing with pay and service patients. You could read more here about the services one could get at our institution.

This is a case of a 41-year-old male who came in for right atrial mass excision.
During his annual physical exam there was a noted mass in the right atrium of his heart and was advised to undergo surgery.
According to adam.com: A myxoma is a benign tumor in the heart. Right atrial myxomas occur less frequently than left atrial myxomas. Treatment is necessary to avoid metastasis and the formation of clots. In addition, untreated growth of the tumor can obstruct blood flow through the heart. Myxomas are curable with surgical removal.
During the endorsement from the Surgical ICU I was told that the patient’s case was taunted as one in a million as the most common site for myxoma is the left atrium. Checking on line at MedlinePlus, it says that about 75% of myxomas occur in the left atrium of the heart, usually beginning in the wall that divides the two upper chambers of the heart. The rest are in the right atrium. Right atrial myxomas are sometimes associated with tricuspid stenosis and atrial fibrillation.
Myxomas are more common in women. About 10% of myxomas are passed down through families (inherited). Such tumors are called familial myxomas. They tend to occur in more than one part of the heart at a time, and often cause symptoms at a younger age than other myxomas.
He presented with no symptoms as right atrial myxomas rarely produce symptoms until they have grown to be at least 13 cm (about 5 inches) wide. Common symptoms of such as disease are the following:
• Breathing difficulty when lying flat
• Breathing difficulty when asleep
• Chest pain or tightness
• Dizziness
• Fainting
• Sensation of feeling your heart beat (palpitations)
• Shortness of breath with activity

The operation which was done on his second hospitalization day was successful. Also, the biopsy performed on the excised mass turned out to be benign and non-cancerous. He continued to have normal vital signs and he was discharged the day before his birthday.

This is a case of 56 year-old-female who was diagnosed to have diabetes mellitus for 38 years. Her uncontrolled diabetes has taken its toll on his other systems such as the urinary and cardiac systems. She has just underwent Coronary Artery Bypass Graft to treat her 3-vessel disease. Before that, she was diagnosed to have Chronic Kidney Disease secondary to Nephropathy and has not been urinating normally for years (anuric). She has been created with arteriovenous fistula (AVF) on her left antecubital area for hemodialysis about 1 ½ months ago. Right now she is on peritoneal dialysis for three years with her own dialyzer machine. Her caregiver is doing the peritoneal dialysis for her with the order she got directly from her nephrologist.
So what is the difference between peritoneal dialysis (PD) and hemodialysis (HD)?
Dialysis is the process of removing waste products and water from the bloodstream. Necessary elements include a semipermeable membrane, dialysate solution, and a surgically created access. Blood is separated from dialysate solution by a semipermeable membrane. Because the dialysate solution contains physiologic amounts of electrolytes and buffers, exposure to blood across the membrane allows diffusion to begin. Solutes dissolved in the blood, such as blood urea nitrogen (BUN) and creatinine, cross the membrane from an area of greater to an area of lesser concentration. Osmosis is the other process at work, whereby water moves across the membrane into the dialysate, which by virtue of its composition has a lesser concentration of water molecules. (Levy, Morgan, & Brown, 2001). Both HD and PD rely on these basic principles of osmosis and diffusion.
During hemodialysis, the blood is pumped into a machine to be filtered and then returned to the body. On the other hand, PD process include the infusion time, dwelling time and the drain time.
In PD, a soft tube called a catheter is used to fill the abdomen with a cleansing liquid called dialysis solution. The walls of the abdominal cavity are lined with a membrane called the peritoneum, which allows waste products and extra fluid to pass from the blood into the dialysis solution. The solution contains a sugar called dextrose that will pull wastes and extra fluid into the abdominal cavity. These wastes and fluid then leave the body when the dialysis solution is drained. The used solution, containing wastes and extra fluid, is then thrown away. The process of draining and filling is called an exchange and takes about 30 to 40 minutes. The period the dialysis solution is in the abdomen is called the dwell time. A typical schedule calls for four exchanges a day, each with a dwell time of 4 to 6 hours. Different types of PD have different schedules of daily exchanges.
Patients who are ambulatory, work, want independence, live a distance from the nearest dialysis unit, like to travel, and like to participate in their care are apt to choose PD. Often, patients who are severely limited in mobility or who live in a nursing home will opt for PD because someone else is available to perform the therapy. Medical reasons to use PD include failed vascular accesses and severely compromised cardiac function.
A particular advantage of PD is that because of its continuous nature, potassium is not nearly as restricted in the diet as it is on HD, nor is fluid. In fact, it is not uncommon to find hypokalemia and dehydration in certain PD patients.
In HD, a nurse or a technician cares for the patient during treatment. The PD patient performs self-care, with the support and encouragement of the PD team. (Source: Findarticles.com)
One of the biggest adjustments you must make when you start hemodialysis treatments is following a strict schedule. Most patients go to a clinic-a dialysis center-three times a week for 3 to 5 or more hours each visit.
One important step before starting hemodialysis is preparing a vascular access, a site on your body from which your blood is removed and returned. A vascular access should be prepared weeks or months before you start dialysis. It will allow easier and more efficient removal and replacement of your blood with fewer complications. (Source: National Kidney & Urologic Diseases Information Clearinghouse (NKUDIC))
In a nutshell, the PD can be performed anywhere by a person who was taught to perform it while HD is done in dialysis centers performed by a dialysis nurse or any trainged healthcare personnel.

This is a case of a 45-year old female who was referred by another hospital on her island with chief complaint of body weakness and pain while urinating or dysuria.
She was diagnosed with cervical cancer stage IIA with vaginal extension in a local hospital on her island. PAP smear in May 2010 showed HGSIL/CIS or High grade squamous intraepithelial lesion, or HGSIL for short, is a medical term given to a category of cervical dysplasia detected through a Pap smear. Cervical dysplasia is mild to severe abnormal changes that can occur in the lining of the cervix. Her biopsy then showed poorly differentiated squamous cell carcinoma.
A Pap smear is a test used to detect cervical cancer or abnormal changes in the cervical cell. It is done by taking sample of cells by the use of a small spatula.The cells are then placed in a tube with a preservative, or placed on a slide and sent to laboratory to tests.
If HGSIL is found through a Pap smear, a colposcopy is then done to confirm results. A colposcopy is an in-office procedure that allows a doctor to examine the cervix more in-depth. It is done by using a colposcope, a lighted microscope that magnifies the cervix.
Since we do not have that type of equipment, the patient procedure was done in another hospital.

During the colposcopy, the doctor may also do a cervical biopsy, the removal of small pieces of cervical tissue. The tissue samples are then sent to a lab for further examination.
Due to lack of resources in her place then, colposcopy was never performed. The OB –Gyne to whom she was referred to immediately requested for such.

A colposcopy is performed in the doctor’s office and normally takes less than an hour to perform. Results are available within two weeks, depending on the lab the doctor uses.
It was actually my first encounter with the OB-Gyne from another hospital and I was really impressed by his ability to show genuine concern with the patient who hardly understand English and took her time discussing the matter with the patient’s niece. I have learned from him that the patient’s condition is not actually cervical cancer but as he termed “pre-cancer”.
Although there are other procedures done to destroy the abnormal tissue formation that cause the vaginal extension, he chose to have the patient on Cryotherapy.
Cryotherapy is a technique used to destroy abnormal tissue by freezing it. It is also called crysosurgery. Since our hospital cater to operable clean cases, the patient had to be brought again to another hospital where the OB-Gyne could perform the surgery.
Cryosurgery is method of treatment used for cervical dysplasia, or abnormal cells on the cervix. It may also be performed in very early staged cervical cancer. If left untreated, these abnormal cells may develop into cervical cancer. Cryosurgery is also called cryotherapy. Cryosurgery kills pre-cancerous and cancerous cells by freezing them.
During cryosurgery, a doctor will insert a speculum into the vagina. A probe is inserted into the vagina that releases a gas that freezes the abnormal cells. It is left in for three minutes until ice crystals form on the cells. The process may be repeated after waiting for an additional three minutes. (Source: about.com)
It only took her half a day in that hospital and she was brought in our hospital again and she was already able to ambulate.
According to the doctor, she might have blood-tinged discharges that will go away after a couple of days.
The patient has been discharged and was then advised to come to an OB-Gyne in her place for follow up check up.
Also, it is important that every woman should get vaccinated to prevent cervical cancer.
It is just amazing how God sends his angels to heal those who are sick.

I once saw it on a local reality TV. Pepe Smith’s kids were desperate to take him off the cigarette smoking habit that caused him serious lung disease. His daughters have thought of buying him e cigarette that mimics a real cigarette minus the deadly nicotine and smoke. Smith found it weird at first but in the end he got the hang of it and swore by it. There are really cool inventions that are perfect substitutes for some stuff.

It is a very long weekend and what is the best way to spend it during this rainy times? Curl up in bed while hopping on from channel to another. Glad that cable service remains uninterrupted.
Filling myself with Hollywood buzz,I stumbled upon ET Weekend’s take on Hollywood weight wars. From Oprah’s yoyo diet, to Kirstie Alley’s dance diets. Each of the stars has really worked their way to achieving a health bod that is like finding the best weight loss pills that work for you.

One has undergone transradial coronary angiography that revealed one-vessel disease of the left anterior descending artery (diagonal). As he was sent back to his room, the management to his disease was discussed.
The order says possible FFR (fractional flow reserve/transradial PCI or percutaneous coronary intervention.
According to ptca.org Fractional Flow Reserve, or FFR, is a guide wire-based procedure that can accurately measure blood pressure and flow through a specific part of the coronary artery. FFR is done through a standard diagnostic catheter at the time of a coronary angiogram (a.k.a. cardiac catheterization). The measurement of Fractional Flow Reserve has been shown useful in assessing whether or not to perform angioplasty or stenting on “intermediate” blockages.
Stenting is one of the interventions considered to open up a narrowed vessel to increase the blood flow that goes in and out of the heart.
The first instinct or consideration made is to stent a block that is more than 50% to give in the “oculo-stenotic reflex but if FFR is done, blood flow in the affected vessel could be determined and will further call for a more sound decision of whether or not to stent the vessel.
A stent would cost around P80,000 – P100,000 and additional fee for the FFR would not as expensive as that .
The special guide wire crosses the lesion and is able to measure the flow and pressure of the blood. Results are displayed on a special monitor (left) along with the “FFR value”. Studies have shown that an FFR value less than 0.75 or 0.80 corresponds to inducible ischemia, and most likely will require interventional treatment. Blockages that score above this threshold can be safely and adequately treated by medical therapy without the need for angioplasty. (ptca.org)
This has been existing along with the discovery of angiogplasty but due to size in circumference that will fit in a vessel it has somehow virtually died. Recent innovations though gave birth to devices that uses smaller Dopplers which does not need any balloons.
As mentioned, it is usually done during the coronary angiogram but for some reason, the interventionist has reserved it to be done after it and before considering transradial PCI.
I was the charge nurse one night and in my rounds I mentioned to the patient the preparation for the procedure including the needed downpayment. Although he is under an insurance company, he said that they are still to decide if they will be going for the procedure. That is what I endorsed to the incoming charge nurse and the next day that I came in, the patient has been discharged.
I hope that he made a very wise decision as his condition needs special attention.