#BiteSeries: A Complete Guide to San Lazaro Hospital Animal Bite Center

Note: This article will be written in Taglish. Doktora Undone believes she can better expound her points if the medium is Taglish. Add to that, she hopes to demolish the heavily flawed superstitious belief about Rabies and the things related thereof by writing in the “language of the masses”. And unless otherwise specified, all parentheses are her annotations and do not necessarily reflect the views and opinions of the hospital staffs.

If any case that there shall be a conflict between what is written here and what your doctor has told you, please listen to the latter. NO QUESTIONS ASKED.

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Hello, mga ka-hombre! 🙂

Kakauwi ko lang galing ng San Lazaro, ‘yung pampublikong ospital du’n sa Tayuman. As usual, pabugso-bugso na naman ‘yung sakit ng ulo ko (PS 6-7/10). Nu’ng Sabado pa talaga naka-iskedyul ‘yung pangatlong tarak ko, kaya lang na-late ako ng gising kaya ngayon nalang. Sayang hindi ko tuloy nakita ‘yung mga klasmeyts ko. Wala na rin akong balita kay Tatay Nestor. Iyon na nga, Lunes Santo kaya napakaraming tao. At gurl, ang inettt! Nauurat na ‘yung mga gwardiya du’n dahil bukod sa napakainit na nga e hindi pa matapos-tapos sa katatanong ang mga pasyente kung paano ang proseso, kahit nakapaskil naman sa dingding, hindi lang talaga nagbabasa.

Kaya eto na, isusulat ko na. Ako nalang talaga! Mawalang-galang na po sa Kagawaran ng Pangkalusugan at San Lazaro Hospital, bakit ‘di man lang kayo mag-update ng website kung papaano ba ang proseso? E helloooo!!! Social Media era na po tayo. Panahon pa po kasi ni kopong-kopong ‘yung istayl niyong whiteboard at pentel pen. Kulang na kulang po kayo sa public information campaign! *end of rant*

How to get to San Lazaro Hospital

Map to San Lazaro Hospital courtesy of Google Map.

If you’re coming from Fairview or Commonwealth area:

1. Take a bus, UV or jeepney bound to Quiapo or Buendia. Basically, anything that will pass along UST will do.
2. Get down at Lacson Avenue. Transfer to a jeepney bound to SM San Lazaro.
3. Walk along Tayuman St. passing by the Espiritu Santo Parochial School until you reach LRT Tayuman Station.
4. Cross the road and walk along Rizal Avenue. There you’ll pass by the buildings of DOH and JRMMC. (Those are big buildings and are hard to miss.)
5. Make a right turn at Quiricada St. until you see the sign that says “San Lazaro Hospital”.

If you’re coming from CaMaNaVa (North of Manila) area:

1. From Roosevelt station, take an LRT Line 1 and get down at Tayuman Station.
2. Walk along Rizal Avenue and make a right turn at Quiricada St. until you see the sign that says “San Lazaro Hospital”.

(Para sa mga taga-Manila o Antipolo area, I honestly don’t know how you’ll get here. But just get down at LRT Tayuman Station and you’ll get by.)

San Lazaro Hospital Out-Patient Department

San Lazaro Hospital is a referral facility for infectious/communicable diseases. OPD, particularly, is situated at the right-most area. Head to the triage near the entrance, there you will be asked several questions and fill-up forms re: the animal bite and be given a number corresponding to your # in line. After which, you’ll have to pay Php 50 at the cashier for the hospital card and wait for your name to be called. They usually start calling names around 7:30-8AM. But on Mondays, it starts around 8AM (or a bit later) secondary to their flag ceremony.

One thing about public hospitals is that you ALWAYS have to be early, unless you’re planning on staying there the whole day.  Personally, I was in line at 6AM, #34th and finished at around 2:30PM. The first visit always takes the longest hours since you have to do a series of interviews. Follow-up checkups are easier and usually takes 1-2 hours depending on the influx of patients. Also, OPD tend to be crowded on Mondays and Saturdays. And when I say crowded, it’s REALLY crowded.

To sum it up, below is SIMPLIFIED procedure:

1. Get a number at the triage. Fill up forms. Pay Php 50 at the cashier for the hospital card. (Follow-up patients need not to pay. You’ll only pay ONCE. And that is on your FIRST VISIT.)
2. Wait for your name to be called at the waiting area. (Mainit, I swear. If you have a battery-operated pocket fan, be sure to bring it as it’ll save you from the distress.)
3. Once called, you’ll be interviewed by a clerk (I suppose). After which, you’ll have to go inside the OPD to be interviewed again by a doctor. There you will be given prescription. (I will expound the possible prescriptions below.)
4. After buying your meds at the hospital’s pharmacy, head to the injection area to get inoculated.
5. And voila! You’re done! Easy-peasy, right? But the  buying and sharing of meds are where things get a bit complicated.

OPD Schedule and SLH ER

On Mondays to Fridays, OPD is open from 8AM until 3PM. As far as I’m aware, you can start getting number at the triage as early as 6AM. Again, it pays to be early. However on Saturdays, OPD is only open from 8AM-11AM, and closed on Sundays and official holidays. For the few unlucky ones who have been bitten on Sundays, official holidays or after clinic hours, you will given utmost attention at San Lazaro ER if you fall on the ff categories:

• Children ages 0-2 y/o
• 60 and above
• If the offending animal died
• If the offending animal is a stray and therefore cannot be observed
• If patient was bitten on dangerous areas (thorax up, including upper extremities)
• (+) multiple and deep wounds
• PWD

Say you fall on any of above category, here’s the catch: YOU WILL HAVE TO PAY A COLOSSAL AMOUNT!!! When my dog bit my neighbor’s kid last December 2016 at around 3PM, we rushed the kid to SLH the same day and was told that I needed to pay five thousand for the post-bite prophylaxis. And that only covers the first cycle. Que horror!

I can’t help but ask: where does this leave the poor, the ones who had it rough all these years, the ones who barely survive on a single meal, the beggars and the homeless? What happens then if they fall on any of the above categories and has no means to pay for the insurmountable bills?

And the answer comes right along: they’d be dismissed. 😦

Hangdami! (Credits to: thefrequentvoyager.blogspot.com)

SLH-OPD Animal Bite Tips

• Wear facial mask at ALL TIMES. I cannot emphasize more on the need to wear facial mask at all times, most specially if the patient is a kid. In SLH, you will press flesh with people of different colors, statuses and medical histories. Keep in mind that SLH caters to INFECTIOUS/COMMUNICABLE diseases hence the need to observe proper protection. Facial masks can be bought outside the hospital (near the entrance) for Php 5.
• Bring alcohol. Like most public hospitals I know, SLH isn’t exactly clean. Same goes to its public CR. It’s a good thing that I always carry with me alcohol and wet wipes. Hindi po ako maarte pero iba pa rin ang nag-iingat. Health is wealth, ika nga.
• Bring something to keep you occupied. Some complained that the procedures are chaotic. Personally, I didn’t find the procedures chaotic at all, albeit tiring and painful. Only that there were lots and lots of waiting. My first visit took the longest waiting hours but I had Dennis Lehane’s Shutter Island which made the waiting somewhat bearable.
• Buy insulin syringe outside the hospital. Mas mura. Inside, it sells for about Php 12.50 / syringe. Sa labas, mabibili mo lang ng Php 5-10. Ingat ka lang kasi baka gamit na. Hahaha. Mercury Drugs sells this in bulk, usually by 10, costs Php 100. There is a Mercury Drug in Bambang St. ‘yung isa naman sa may bandang JRMMC.

Credits to: http://www.thefrequentvoyager.blogspot.com

Anti-Rabies Prophylaxis: Prices, Diskarte and Paawa

Eto na ‘yung nakakaiyak na parte: ang bayaran. Alam mo ‘yun? Nasaktan ka na nga, sasaktan ka naman ulit? Hahaha alangya! Anyway, below is the usual post-bite regimen:

Purified Chick Embryo Cell (PCEC). Eto ‘yung tinatawag nilang anti-rabies vaccine. I honestly have no idea how a purified (I wonder if it’s sterilized?) chick cell can kill rabies virus? Hahaha, that I leave to the experts. Another anti-rabies vac that they prescribe is called Purified Vero Cell Rabies Vaccine (PVRV). I don’t know the difference between the two but the nurse that I asked told me it’s just different brands. Ergo if you’ve been bitten, you are prescribed either with PCEC or PVRV. (Mine was PCEC. Rationale unknown.) For PCEC, they will ask you to find three other patients to share the vaccine with (1 vial= 4 patients). I shared mine with a carpenter, a vendor and a sexy mistress from Navotas (for realzZz). PCEC can be bought at the SLH Pharmacy for Php 1,170/vial, will be shared by 4, so that’s Php 292.50/patient. Hmm bearable naman— if you have a job that pays. Note however that they do not allow selling 1 vial to a single patient only. Perhaps it has something to do with the storage.

Kapag can’t afford ka naman at gusto mong mailibre nalang ‘yung PCEC, you have the option to make pila at the Medical Social Service located at the 2nd floor. It’s a rather long line so be extremely patient and kind. There you will be interviewed re: your occupation and your parents’. If you qualify, they will stamp the back of your hospital card indicating that your PCEC vaccine/s is/are free. Tip: if you plan on getting your PCEC free, have someone fall in line for you at social service while you wait for your name to be called.

Segue: May kwento ako. Kasi ano, nu’ng pangalawang follow-up ko, sabi sakin hindi daw ako pagbibilhan sa Pharmacy ng PCEC kapag walang tatak ‘yung hospital card ko. Hence I made pila pa at social service!!! Buti nalang kaunti pa lang ‘yung tao nu’n sa pila! We were 30 in line, I think. Aba’t sabi na naman ng katabi ko sa pila, “Baka hindi ka tatakan kasi mukha ka namang may pera.” Helloooo!!! Wala po akong pera! Naisip ko pwedeng pa lang mailibre with a little white lie. I mean, why pay for something you can get for free? And so I sat there, quietly, ever so quiet yet shaking (I’m bad with lying. I shake and stutter.), formulating the lie in my head.

Walang akong trabaho.

Walang trabaho ang tatay ko. Nasa probinsiya.

Walang trabaho ang nanay ko. Nasa probinsiya.

Pagdating ko sa loob, tinanong na ko, “May trabaho ka ba? Anu’ng trabaho mo?” Ha!  As expected! I’ve rehearsed my answer in my head several times! Victory! “Wala po.” *puppy eyes*

“Anong trabaho ng tatay mo?” – wala po nasa probinsiya. Ah, easy peasy! Did not even break a sweat!

“Anong trabaho ng nanay mo?” Toinks!!! Para akong nag-zone out at bigla akong kinabahan sa mga pinag-gagawa ko (perhaps ’twas the heavens telling that I shouldn’t lie, churi talaga) at ang bigla kong nasabi, “Nagtitinda po.”

“Nagtitinda ng?” Holy crap, why do you keep asking questions?! Will I be put into jail because I lied to get a free PCEC? Will my pictures be posted on the walls?! Mugshots?! I panicked na. I didn’t know what to answer but I want my PCEC free! I glanced at my seatmate hoping to find answers, and saw that he was wearing a dilapidated pair of tsinelas. So I turned my gaze at the woman interviewing me, let out a little pout and said, “Nagtitinda po ng tsinelas.”

And then voila! My 2nd dose of PCEC was free!!! *evil laugh* (To be fair, I’m really jobless but my parents aren’t. But I was the one shouldering the entire expenses so their jobs are irrelevant. Haha. Excuses.)

I’m pretty sure I’ve derailed quite significantly  to what this article is about. Haha going back…

Equine Rabies Immunoglobulin (ERIG). This was probably the most expensive on the regimen and costs Php 1, 190 / vial (5mL).  Dosage depends on the weight of the patient. For example, at 60kg, I needed 3 vials. That’s a whopping Php 3,570!!! I guessed this partially explained the headaches and fever I had the following day. (Kidding aside, according to CDC, 10-15% of patients experience fever, headaches and nausea after getting inoculated. Perfectly normal. Daw. Sabi ng CDC.)

If anatomically possible, ERIG will be injected around the bite wound. BUT, mine was at my lower lips! Man, I was terrified! I kid you not! I took comfort at the thought, that maybe, just maybe, ERIG will be like  a lip filler and then I’ll end up having Kylie Jenner’s lips!!! Not bad, eh? But the nurse injected mine at my Quads. Fart. Ang sakit, bes! Ang sakit sakit!!! Muntik ko ng hawiin ‘yung kamay ng nurse! After that, my legs felt heavy and sore, even surpassed the sore I usually have after hours of treks. Fortunately though, ERIG will be only be given once. If out of stock sa SLH Pharmacy, wala kang choice kundi bumili sa labas. Sa Mercury Drugs along Bambang St., mabibili po ito ng Php 1,320/vial (5mL).

Oo nga pala. Nakalimutan kong banggitin na bago i-tarak ‘yung ERIG e kailangan mo munang magpa-skin test, to see if you’re allergic to it. So basically, skin test > wait 30 minutes > if (-), ita-tarak na ‘yung ERIG. Pray that the heavens allow your skin test to be negative otherwise you’d have to be injected with Human Rabies Immunoglobin (HRIG) instead and that sh*t costs a whopping Php 4,100 per vial!!! Mabuti sana kung isang vial lang! E paano kung more than two?! Nganga! Bigti kana, friend! (Please verify. A nurse told me that ERIG isn’t necessary as long as the offending animal is happy and healthy.)

Para malibre ang ERIG: magpapatak ng INDIGENOUS sa BARANGAY niyo. Tapos dalhin mo sa Social service. Bibigyan ka nila ng letter tapos ‘yun ang ipepresent mo sa Pharmacy. Voila! Libre na ERIG mo.

Anti-Tetanus Serum (ATS). Very cheap. Costs Php 78/shot. Kelangan ng skin test bago i-tarak. I don’t know what happens next if positive. (Mercury Drug’s price: Php 100)

Tetanus Toxoid. Cheap din. Costs Php 55/shot. (Mercury Drug’s price: Php 119)

Antibiotic. I was prescribed with Clindamycin, I think. There is a syrup for kids who still have trouble with taking tablet medicines, so need not worry. Sa follow-up checkups, PCEC nalang ang ita-tarak. At least for me. I don’t know if it’s the same for everyone.

In conclusion

Mag-mahal ka pa rin, kahit paulit-ulit kang masaktan. Charot. I mean mag-mahal ng hayop— as in dogs and cats and monkeys and exes. Hahaha joke. Pagod na po ako. I had an extremely exhausting day. To anyone who might be in need of this, I hoped this helped even for a bit. Now let me sleep in bliss.

*enter Liza Loeb’s Stay*

(will proofread this later)

UPDATE: There are food restrictions while you’re on the anti-rabies regimen. Bawal kumain ng malansa (chicken, itlog, seafoods, patis, etc) at bawal uminom ng alak (ehem, mga tomador diyan). Mine coincided with Holy week so I couldn’t eat meat. I do not believe in such profound belief, but I was on a holy week vacation with my lola so you know how it went. I ate a lot of seafoods. I ended up with pantal pantal all over my upper extremities  at talagang makati, bes! 

#BiteSeries: San Lazaro Hospital’s ABC

Actual bite wound 3 days after the incident.

Last week, I wrote about how I have been accidentally bitten on my lower lip by my pet dog. And how I failed to get my post-bite prophylaxis right away, because (1) I have certain commitments that day; (2) I have been bitten around four in the afternoon and bite centers are closed already; and (3) I simply cannot afford to pay for the non-government subsidized shots which would cost me roughly around five thousand.

For equanimity’s sake, I just want to reiterate that if you have been bitten or scratched by an animal, be it a pet or not, DROP everything you do and RUN to the NEAREST bite center!!! RABIES is “100%” FATAL but is HIGHLY PREVENTABLE.

Anyway hemingways, my account is as follows:

March 30^th, 2017. Lower lip got bitten. I immediately washed the wound with soap and running water for ~15 minutes and applied Povidone Iodine (or simply Betadine) over the area.

March 31^st, 2017. Woke up late and decided not to head to the Bite Center.  Went to my cousin’s birthday party instead and ate to my heart’s content. Note however, that immediate medical attention is warranted. Rabies is scary. It accounts to over 200 deaths per year locally. In fact, there are only SEVEN recorded cases worldwide known to have successfully recovered from Rabies. Nakakatakot, ‘di ba? 

April 1^st , 2017. Left home around 4AM and arrived at the QC City Hall Animal Bite Center 10 minutes later. The whole place was unlit and no one was around, hence I opted to get breakfast at Mcdonald’s Philcoa and just return after. I got back around 5:30 AM and still with no people except for a guard who’s stationed nearby. I was told that the center pala is closed during weekends. Fart.

I was about to leave when kuya guard tried to make a small talk.

“Saan ka ba kinagat? Delikado kasi kapag sa ulo.” I pointed out my lower lip and watched his expression changed from warm to somewhat mortified. Guessed he’d seen the worst.

“Hindi ka naman takot sa tubig? Naglalaway?” I signed no as I was letting out a little laugh. For some reason, I found his questions rather ridiculous despite him being right.

“Ganu’n kasi ‘yun eh. Basahin mo diyan o.” He pointed out to the big banner of Rabies signs and symptoms hung on the center’s front wall. I flashed a faint smile and told him that I needed to go.

At home, I immediately took my on-the-go bag and off I flew to San Lazaro Hospital. Call me OA or whatever, but I was praying the Prayer of Salvation in case things go south. (Actually, ayoko na nga sanang pumunta kasi baka hindi na rin ako ma-accommodate dahil late na. Kaya lang natatakot na ako eh. Baka mapurnada ang pagdo-doktor ko. Better safe than sorry. Haha.)

San Lazaro Hospital Animal Bite Center

When I got there, there were hundreds of patients already lined up. It was a good thing that they have separate lane for follow-up and new patients. I thought I’d finish quite early since I’m 39th in line for the new patients, but boy I have never been so wrong. I registered around 6:30AM and ended up waiting until 11AM for my name to be called! Add to that were the parents who kept complaining about the anarchic process. Personally, I didn’t find the process anarchic at all, but there were lots and lots of waiting. Hours upon hours. I find it reasonable because they are accommodating hundreds of patients everyday.

To cut the story short, I was able to get my shots after running around here and there. And I met a few friends whom I like to call my classmates (hahaha). We shared stories of how we got bitten, how some deliberately ignored the bite and how some managed to sneak out from their daily jobs just to get shots. But the monumental event happened just as I was about to leave. One of my classmates, Tatay Nestor (not his real name), who was bitten on his (R) posterolateral leg by his neighbor’s chow-chow suddenly had a seizure near the Pharmacy.

Locked-jaw.

Sialorrhea.

Stiff.

Where tatay was sitting when he had a seizure.

Everything happened too fast, too fast that everything became a blur of  unrecognizable images and all I knew was that I was staring, not too close but not afar. I was jolted out of my delusion when I heard the screams of his terrified wife begging for help. And before I do anything stupid (again), hospital staffs arrived and rushed Tatay Nestor to the ER.

Then, I found myself walking toward the exit and prayed he’d still be alive.

Life can be full of surprises, don’t you think?

#BiteSeries: The Day I got Bitten

Pixie, my 3 year old American Bully.

Pets— cute, fluffy, and tamed as they may be— they’re still animals. Further proves that, even if you love someone so much, still they can hurt you. #hugot

Last Thursday, Pixie, my 3 year-old American Bully, accidentally hit my lower lip with her canine tooth. To be fair, it was not her fault. I positioned my head too close to hers that when she suddenly jumped, her tooth caught my lip. My youngest cousin, saw how I instinctively pulled my head away from my dog but I quickly hid my lips between my hands so as not to cause a commotion. I then ran to the bathroom, locked the door and inspected the wound.  And although she didn’t bite, the impact was strong enough to puncture my lower lip.

This was not the first time I’ve dealt with bite wounds, so I knew what should be done. I immediately washed the bite wound with soap and running water for a good fifteen minutes and applied Povidone Iodine.

Actual bite wound

The first thought that came into my mind was the inconvenience that’s ahead. I’ve been through that when my dog bit my neighbor’s kids last August and December 2016 (yup, twice!), and I refused to go through all those inconveniences again. Add to that was the massive cost of post-bite prophylaxis that loomed over me. But hell, I had no choice lest I wanna take my chances with Rabies.

***

Ideally, if you have been bitten in dangerous areas, that is from the neck above (or if the animal that bit you is a stray and therefore cannot be observed), YOU SHOULD SEEK IMMEDIATE MEDICAL ATTENTION. Rabies is a potentially life-threatening virus and should NOT be taken lightly.

BUT, I got bitten around 4PM on March 30th, and Animal Bite Centers are usually closed na. Fart.

In the spirit of fairness, public hospitals, particularly San Lazaro Hospital, will still accommodate you— if you have five thousand— that is according to the nurse on duty, as the usual cost of Rabies post-bite prophylaxis (not government subsidized) will more or less be around five thousand. Eye-opener #1, you can’t be bitten during wee hours if you are poor and don’t have five thousand. Que horror!

I do not have freaking five thousand with me and I still have to do my sister’s makeup for her graduation ball that day. So I took comfort at the thought that my dog just had her Rabisin shot last Feb. 26, 2017, never socialized with other dogs (in fact, she never went anywhere close to other animals other than my lola’s Shitzu;  vacc also updated), ate only what I fed her and left everything into His hands.

Preparing the makeups for my sister’s grad ball.

I finished my ulirang ate duties around 9PM that night and planned to go to Quezon City Hall Animal Bite Center the next day to get my free shots. Unfortunately, I woke up pretty late the next day (March 31st) and was told that they only accommodate around 100-150 patients/day. The only option left for me was to head to a private clinic/hospital to get my shots but are too expensive. For instance, when we suspected that our youngest got bitten by a rodent, we had to pay Php ~1300 for her anti-Tetanus shot at a private hospital.

I couldn’t afford it because (1) I never told anyone so I had to shoulder the entire expenses myself (I am so not eating this month); (2) I refused to bother my parents for another bills to pay; (3) they may never allow my best friend to get out her cage again.

So instead of entertaining the thoughts that I may possibly die of Rabies (again, Rabies shouldn’t be taken lightly), I opted to attend my cousin’s humble birthday party and ate to my heart’s content.

Fortunately on April 1st, I finally had my shots. Yey. But that should be tomorrow’s blog post.

Two Missed Calls

12NN. Call log: 2 missed calls.

“Tulog ako kanina nu’ng tumawag ka.”

“Kumusta?”

“Maayos naman.”

“Galit ka ba?” (About to reply when another msg was sent…)

“Tulog na ko.”

Why do people think it’s okay to leave a conversation hanging?! It is so annoying knowing that some people couldn’t care less. That, after all the brouhaha, still some sees you as no more than a spare tire, a mere entertainment when they’re bored or a person to talk to when they’re not busy. 

I refuse to be someone else’s spare tire. 

I AM SO OVER THIS.

My Ghost Encounter

Randomly googled image. Credits to owner/s.

I had a ghost encounter the other day, I think.

As you all know, I have been staying at home for almost a year now. To answer your questions as to why, please refer to my previews blog posts. Anyway, I just want to disclose that I do not have paranormal abilities whatsoever, nor am I affiliated to people who possess such. Moreover, I have yet to see ghosts in the past, but I think, at very least, I am able to hear them (Or maybe, they’re allowing me to hear them? I don’t know.) Although, I do not consider the me-hearing-them as a paranormal ability because it happens so rarely and only when I am at home. So, this particular incident happened on 03/20/2017 around one in the afternoon. Note, however, that this was not the first time I heard “them”.

March 20, 2017, 1PM

I was home alone when I decided to squeeze in some much need prophylactic nap. I turned off the lights and found my way to our couch. Not even five minutes into my sleep when I heard panting in the background. ’twas as if someone had just finished an ironman 70.3 and was deliberately trying to catch his breath.

“Haaaa! Haaaa! Haaaa!”

I kept my eyes closed and tried to ignore the noise. But the panting got louder and louder. This time it was as if his mouth was only an inch away from my left ear.

“Haaaa! Haaaa! Haaaa!”

I opened my eyes, scanned the darkness that looms in the room but saw no one. “Ano kaya ‘yun?“, I thought to myself. It couldn’t have been a person since I am alone in the house and I don’t remember ever panting while asleep. Could it be those pesky rats or the roaches, again? But “it” cannot possibly pant, or can it? Was I delusional?

I quickly got up from the couch and turned on all the lights never to return back to my nap again.

*****

Kwento ng lola ko, dati daw talahiban ‘yung lugar namin at pinagtatapunan daw ng mga sinalvage. Matagal ng may nagpaparamdam sa bahay namin. Sa awa ng Diyos, hindi naman sila nagpapakita pero maririnig mo sila. Paminsan naglalakad-lakad. Siguro nagpapaalala lang na hindi kami nag-iisa.

Ikaw, anong kwentong kababalaghan mo?

A Day In The Hospital

Mar 18, 2017, 4AM. Ohai! Just woke up, checked my blog’s daily stat and I realized that I just I hit an all-time low: ZERO VIEWS! From 63 views per day to a staggering ZERO. Hahaha kenchubilibdat?! To anyone who might be reading this, my apologies for the lack of updates in the past few days. I haven’t really had the energy to write because I ran out of coffee the other day, and my brain had pretty much self-destructed. Plus, I think millenials aren’t into blogs anymore? Halos majority ata VLOGS na ang gusto. They prefer to watch things on the screen rather than read about it. Anway, I’m REALLY hungry na. I’m starting to see things… and hear things haha. What used to be a sweet singing and chirping of my little stomach minions had turned into a LOUD growling (RawRRRrrRrR!!!). Churi talaga!

Paano ba naman kasi ang huling kain ko pa e ‘yung lunch kong Lauriat kahapon sa Chowking. Buti nalang talaga madami ‘yun!

Snapped this photo yesterday while passing on a footbridge near LCP. Buti nalang hindi na-snatched ‘yung kemruh ko. Ang ganda, ‘no? Parang hindi sa Pilipinas. Parang “Pilipinas meets San Francisco, California”, ‘di ba? So byutipul!

Opkors, this wouldn’t be possible without my killer photography skills. Charot.

Pata 200/kl. Dobol ded!!!

Yesterday had been a busy, tiring day. Sinamahan ko kahapon ‘yung lola ko sa LCP para sa monthly checkup niya. As usual, commute lang kami. Huhu kailangan ko na talaga mag-aral mag-drive para pag aalis kami ng lola ko, makikihiram nalang ako ng kotse ng kuya ko o kaya ng tatay ko.

Pag dating namin sa ospital, ang haba na ng pila! Daming pasyente. Nag-antay ako ng mahigit dalawang oras hanggang sa matapos ‘yung lola ko. Sa sobrang bored ko, mine-memorize ko nalang ‘yung pangalan ng mga doktor sa bawat kwarto sa Doctor’s Clinic. Yung peyborit ko si Marie Charisma L. Dela Trinidad, MD. Siguro charming talaga siya sa personal. Hu knows?!

Tapos tumawid kami papuntang National Kidney para bumili ng Insulin niya. At dahil medyo may kalayuan sa LCP, naihian ng lola ko ‘yung pants niya. So, we made punas-punas pa at the CR. Ah, the things you do for the people you love.

Sa NKTI kami bumili kasi mas mura daw ‘yung gamot du’n sabi ni doktora. Subsidized ata ng Government. True enough, 190+ lang ‘yung isang vial ng Insulin. Akala ko naman chismis lang. 5 na binili namin para meseye. Oo nga pala, ang ganda ng cafeteria ng NKTI. Gusto ko kumain du’n! Kahit nu’ng bata pa ako, gandang-ganda na ko sa mga pantry ng ospital. Tapos ang daming doktor na nakaputi. May magaganda, may gwapo. *insert kileg*

And we capped the day with Chowking’s Lauriat. Ang daming nakain ng lola ko. Halos siya rin nakaubos nu’ng large halo-halo na inorder ko. Paano ba ‘yan? Hanggang dito nalang muna. Gutom na talaga ako. Kain na muna me.

*enter my papa’s daily dose of sermon wew!*

Be Careful What You Wish For

 

Randomly googled image to put emphasis on what I have to say. If this is offensive, please let me know. (credits to owners)

For days, I incessantly debated against myself on whether I should write about this. A part of me wanted to tell the whole story as it is. On the contrary, the other part of me wanted to fall silent and just move on with my life, for fear that others might perceive this as a grave attempt to aggrandize myself. P****** lang. Three days after and yet, I am still jaded as of this writing, and the last thing I wanna do is deal with any social media turmoil that could possibly erupt hereof. But for the sake of MY EQUANIMITY and PUBLIC INFORMATION, I am exterminating my reservations re: the matter and telling it all. My account is as follows:

March 12, 2017, 10AM: Event of a lifetime

Big brother’s last birthday as a bachelor.

The family and I attended a joint birthday party held in a resort somewhere in Imus, Cavite. Prior to this, my father and I were sorta having a discussion because of  my defiance to come along.  I am not a social butterfly, so my refusal was given whenever opportunity presents itself. Add to that, I was determined to finish the tagalized medical book I was writing that same day and I couldn’t afford any distraction— no matter how grandiose and festive that was.

 In the end though, I succumbed to my father’s requisition.

We left home around at 8AM and arrived at Roselanie’s resort past 10AM. The place was serene, so much so that I regretted not bringing any swimwear. The catering service, however, was a flunk by itself. Granted that the foods were exquisite, but to have the guests wait around from 10AM until 1PM for something that SHOULD’VE BEEN PREPARED all along, was unacceptable to say the least. Although I will not go further into that, as I will completely adrift to what this entry is about.

Turned out, ’twas a good thing that I had not eaten ANYTHING the night before and the morning of the event. I saved my calories enough to feast!

“Breakfast” for the champions!

The delay was worth it, after all.

March 12, 2017, 1PM

As shown above, I had a massive lunch that day which caused me to feel drowsy. I had not slept the night before, and so I fell asleep quite easy as soon as I hit the bed in one the rented rooms at the resort. Despite the scorching hot weather, I managed to sneak in a solid 2-hour sleep.

March 12, 2017, ~3PM: The unexpected happened

This is where everything started to go downhill.

In the middle of my deep sleep, I suddenly woke up. The suffocating atmosphere of the room prompted me to go outside. I headed toward the veranda (see picture below) and stood there while I watched my cousins playfully teasing each other in the pool. Then all of a sudden, people started rushing to a nearby pavilion (see picture below). I knew something was wrong. I then started scanning the surrounding to know what it was, until I saw my uncle sprinted like a lightning bolt and grabbed a 4-year old boy out from the adults’ pool.

The boy had drowned. And NOBODY KNEW HOW LONG.

Adult pool. I assumed it’s around 4-5ft. The boy, however, is barely 3ft tall.

Randomly googled image. Credits to owners.

P*cha naman, why me?!

I rushed to the scene. And as soon as I got there, I had to step back, lest I do anything stupid.

“Ikki, Kaya mo ‘ba?“, my balik bayan cousin asked. For a moment, his question bewildered me. Then it hit me. He was asking if I knew how to do CPR!!! Of course, he knew (and everyone else in that place) that I am a pre-medical student! If anyone else can do it, I would be it.

I stared at him blankly before I give him my unintelligent reply, “Hindi, kuya.” H-how can I say yes when all I have with me was mere book knowledge?! W-why should I say yes?! I haven’t done any of this! W-What if I ended up in jail for this?! My mind was playing tricks on me. Fearful. Always fearful.

At this point on, the scene was very chaotic, that even the word chaotic itself was an understatement. There were people screaming loudly, “Tisoy! Tisoy!”, adults were panicking, afraid to do anything,  and on top of that was a dazed mother hysterically crying her lungs out. I knew I needed to do something. Time was running out and I had to act fast. So with no real life experience but the lessons I learned from my 5-year in pre-med and the tons of Grey’s Anatomy episodes I had religiously watched over the years, I put my best foot forward. I quickly recalled all the things I learned from the past and took over the emergency response. Fearlessly.

It is now or never, I told myself

“Hayaan niyo na kay Ikki ‘yan!”, my uncle instructed the others to move away from the kid. My mind was clear. My hands weren’t shaking. I knew what I needed to do. Everything else in the background became a blur. My focus, directed to the boy, and to him only.

“How long has he been under?” No response.

I was not getting any response from the boy either. Pulse, negative Breathing, negative. Color, bluish. Tone, stiff. Stomach, bloated. Sh*t! The kid had been underwater for too long.  And as if the scene was not horrendous enough, there was water coming out of his ears, nose and eyes. The scenes in movies were protagonists look oh-so-beautiful even when drowned? Those were all BS. In reality, you have to be ready for EVERYTHING that the human body can possibly throw at you, that for sure was not emphasized in school.

I cleared the airway. Lifted his chin. Administered rescue breathes. Began CPR.

1001…

1002…

1003…

Still no pulse. Chest, not rising. I continued with chest compression, while instructing the others to prepare for the car.  I admit though, that at this point, I didn’t think he’d survive. “He’s too far gone”, I told myself.  While at it, I resorted to the best weapon I have, something that transcends even the most skillful doctors combined, I began praying. “Lord, this is not up to me. This is up to you. Please heed my prayers. Even one last time.”

All of a sudden, I had this surge of hope, that maybe, he’ll make it, even if ’twas against all odds.

YOU ARE NOT DYING. NOT ON MY WATCH.

1004…

1005…

1006…

After what seemed like forever, he gasped. He seemed to be exhibiting signs of life. I checked for his vitals. Pulse, faint but otherwise palpable. Chest, rising. I knew better, the fight wasn’t over yet. I cuddled him as we quickly drove to the nearest hospital. None of us knew the way to the nearest hospital, so we had to stop midway and ask for directions. The kid, on the other hand, was unstable. His VS were fluctuating. His mom, hysterical.

“Mahal na mahal ‘yan ng papa niya.“

“Anak, gising kana. Please. Please.“

“Anak, ‘wag kang matulog. Hinde… hinde…“

“Iniwan ko lang siya saglit. Katatapos lang namin mag-picture.“

“Anak, please. ‘Wag kang matulog.“

Lord, please. Not today. Not on my watch.

I wasn’t ready to lose. NO, NOT THIS TIME. So, I began tilting the boy head down, squeezing him, tapping his back, hoping that he would soon vomit whatever water he  had ingested.  Then again, after what seemed like forever, he vomited, lots and lots, and began mumbling words I couldn’t comprehend.

“Paki check ang bunganga. Paki siguradong walang nakabara.” I couldn’t see his mouth because I was holding him upside down, so I had his mom do it for me.

Deliberately, he faintly opened his eyes to gaze at his mom. Still lethargic, but otherwise responsive. At last, the critical part was over. I heaved a gigantic sigh of relief. When we arrived at the ER, the nurses and doctors on call were attentive to our needs. They began administering oxygen through a nasal canula, which irritated Genesis. I knew everything was going to be okay when the he finally screamed,

“P*tang-ina!”, and a nearby patient bursted out in laughter.

Haaay. Close call. Had I slept more that day, it would’ve been too late for Genesis. Buti nalang. When I got home that night, I locked myself inside my room and cried myself to sleep.

*****

Thank you father for a life well-saved. All glory belongs to you, and you alone.

Dearest Genesis,

Live up to your name. Live a new beginning. Fly high. Be brave. Paint beautiful portraits. Capture every moment. Have an awesome life. Soar high on mountains even if it scares you, because only then you will know that you had lived a full life .

I hope to meet a fine, young man should our paths cross again in the future.

Love,

Anna

These pictures do not give justice on how much the kid had puked.

After the storm, he gamely posed for a picture! Carrying him was his mom.

Now, you wonder why the title?

Because once upon a time, I asked  for life to surprise me. And oh boy, how it did! At siniguro niyang ’twas a surprise of lifetime! Just when I thought my life couldn’t spiral any further, then this happened. A validation that perhaps my existence wasn’t so bad after all.

*insert cue music*

🎶 Be careful what you wish for… because you might just get it all… you might just get it all. 🎶

Letters and Words

Temporary lang. My apologies kung walang konek hahaha.

I wrote this minutes after I sent him my message.

“Why do you waste your time writing? Don’t you have MORE important things to do?” He had put emphasis on more.

“What a rather insensitive question”, I thought. Truth be told, I almost threw a fit. I am surprised he had the temerity to ask, that he sees writing as a good-for-nothing avocation, a flavor of the month, a thorn in the bush. Not wanting to start a fight and put our relationship in jeopardy, I composed myself and waited a few minutes before I give him my answer. 

“I write to keep my sanity at bay,” I responded plainly. I initially thought of stopping here since people only understand from their level of perception, but to do so will not render justice to writing. I had to present corroborating “evidences”.

So to you sir:

I write because it is something I am good at. And as people like you often find yourselves lost in flashbacks and extended metaphors for interminable hours, I could easily write a review of  the most intricate American novel. And maybe it isn’t the best, but who cares? 

I write because it allows me to see things in a different light, to see things beyond the superficial— the dark blue sky as  it slowly gets painted with the faintest tinge of orange and yellow, the stillness of the world at dawn, the humming of the little birds as they sing a song ever so lovely, or the fragrance of a blooming flower on a Sunday morning. 

I write because it excites my senses, it makes me feel alive. That after an exhausting chaotic day, I get to be human again. It gives me an opportunity to pause for awhile and unload my pent up frustrations over things that refuse to go my way.

I write because it takes me to all sorts of places that exist only in the minds of those who wander. Sadly though, those are the places you will never land.

I write because just a like somber prisoner imprisoned in a  sunless, forgotten oubliette, writing frees me from the prison that is my own anger and resentment.

Lastly, I write for the sheer beauty of it. 

And so what if the only thing I get out of this is a one-bedroom wooden house with a thatched roof made of palm frond? Still I know I’d be happy.

And so what if I don’t get anything at all? Still I know I’d be happy.

And maybe writing will not earn me a place in heaven, but at least I know that even if I die, I will remain,

Free.

Indefinite.

Interminable.

Immortal.

To all my friends who might be reading this, if you read this past 9AM, please don’t bother calling me or texting me. I might be asleep pa e. I finished this article past 4AM na. I really to get a life na, ‘no? Sheez! And just in case you ask, I am not trading my steth for a virtual pen. Contrary to the popular belief, you are allowed to love two things or more at once. Hahaha. And oh, did I mention that this conversation took place in my mind only? Yup, it did. 

 

Living the Bum Life

Note: I will proofread this later. It’s already past 8AM, and I’ve been awake all night. I’m tired na. Let me sleep in bliss. Engkyu! 

Embedded under the red sleeping bag. Mt. Maranat, circa 2016.

I did it again.

I practically slept the whole day (again). Now I’m starting to think, that if there ever was a competition for people who can sleep the most — then without a doubt — I will emerge as the overall victor. AWUUU!!! AWUUU!!!

2011. Summer. Everyone was off doing their own thing: galavanting around the globe, reading thick school books, filling in their boss’s daily dose of coffee, you name it. I, on the other hand, was embedded under the warm and fuzzy blanket. (See, I told you. I’m a professional sleeper.)

It must be said though, that even if I had slept the whole day, I had a productive a night. A not-so-rare occurrence for a night owl like I am. 

Now why productive when all I did was sleep the whole day, you ask? Well, let me give you a quick rundown as to why:

I read articles

Yes, you read it right. I read articles— fifteen notoriously long articles to be specific (no kidding). I thought I’d never voice out my opinion re: the Cirque du Freak that is the Philippines Government on this blog, but I can’t help it. Everything is so chaotic, and I can’t find the right words to express my utter disgust to the bureaucracy and to every political prostitutes and opportunists of this country. And at the rate things are going, I only have this to say, “To hell with them all.”

I blogged a bit

After writing the uber-long medical article last night, I told myself that it’s okay if I skip a day or two from writing. But then I found out that I’m running low on caffeine, and it simply wouldn’t suffice for the days to come. And my brain refuses to function without it. Meaning: no caffeine, no blog. 

And so, I figured I should keep writing while supplies last. 

Yes, those are my socks on the desk and I make no apologies for it. Hehehe.

I learned a few words

My friends know that I am a logophile. In fact, I have a little notebook at home where I write down words, phrases and sentences that appeal to me. Words are like collection for me. The more I know, the happier I get. 

Today I learned quite a few interesting ones, but that should be tomorrow’s blog post.

Credits to Pinterest

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To all the ladies who might be reading this right now: Happy International Women’s day!

• I wish you all genuine laughter and the chance to let it ring loud and splendid;
• I wish you all moments that shall take your breath away; and
• I wish you all lots and lots coffees without side effects.

With that said, I now leave you with a quote from none other than the Iron Lady of Asia,

“This is goodbye. I shall not importune you any longer. I shall now fade into the night like Batman.” (M. Santiago, 2016)

Initiator vs. Synergistic: A Clarification On the Role of Supraspinatus Muscle

A few days days ago, I published six articles that are medically irrelevant. Now allow me to transition to the scientific aspect of this blog. But before we begin, I shall say, that I am not a know-it-all. I am a nobody who happens to have a fondness for teaching — even with the little I know. 

On that note, let’s begin! *enter the propeysyunal me*

---

Whether you are a pre-medical or a medical student, chances are, you have already read of the obscure role of the supraspinatus muscle in terms of shoulder function. Let I, Doktora Undone,  shed some light on the topic that raised a thousand eyebrows.

Let’s begin by defining the suprasinatus muscle:

The supraspinatus (plural supraspinati, from Latin supraspinatus) is a relatively small muscle of the upper back that runs from the supraspinatous fossa superior portion of the scapula (shoulder blade) to the greater tubercle of the humerus. It is one of the four rotator cuff muscles and also abducts the arm at the shoulder. The spine of the scapula separates the supraspinatus muscle from the infraspinatus muscle, which originates below the spine. [1]

Malabo ba, ‘teh? Basta ang sinasabi lang sa taas e ‘yung anatomical description ni supra. Now, let’s cut the chase and get down to business: what then is its REAL function?

CLARIFICATION ON THE ROLE OF SUPRASPINATUS IN SHOULDER FUNCTION

Clinical Anatomy by Regions,by Snell, 9th Ed., pg. 360

It is for a fact that professors base their lectures using different references, thus resulting to varying information. Personally, I can no longer put a finger on how much I have sat and listened to contrasting lectures re: its function— which is why I had to make this article in the first place. Some said it acts as an initiator for shoulder abduction, while others have said that is synergistic with deltoid. Perplexed as I was, I did a little digging which led to my discovery of several Easter eggs. The references are as follows:

BRUNNSTROM, 6th Ed: Initiator (pg. 197)

“In normal abduction, the supraspinatus initiates motion. However, in the persons with supraspinatus paralysis or debilitating injury, the deltoid is able to abduct the humerus throughout the range of motion if the other other functioning rotator cuff muscles are able to counteract the deltoid’s translatory force. Even though deltoid-only abduction occurs, it is produced with less than normal strength.”

To better explain the description above, I will be writing in my native language.

TAMBAY TRANSLATION:

1. Kung ang pinag-uusapan ay normal shoulder abduction, si supraspinatus muscle po ay INITIATOR. 
2. Pero kung PARALISADO si supra, magte-take over si DELTOID bilang shoulder abductor sa buong ROM (0-180°).
3. Ngunit ‘yun po ay mangyayari lamang kung NORMAL o walang diperensiya ang iba pang bahagi ng rotator cuff muscles. Ibig sabihin ay okay ang ITS muscles.  (see note below on point #3)
4. At kahit posible ang deltoid-only abduction, MAS MAHINA ito kumpara sa kung okay o wala diperensiya ang supraspinatus.

On point #3:  Ang pinag-uusapan po dito ay ‘yung tinatawag na translatory forces. Mahaba pong diskusyon ito. Kailangan mong aralin ‘yung translatory forces ng SITS muscles (supraspinatus, infraspinatus, teres minor at subscapularis) para maintindihan mo kung bakit kinakailangang normal ang mga ito para mangyari ang deltoid-only abduction. Gets pa ba? Text niyo ako kapag hindi na ah.

Susubukan kong i-explain  ito in details sa ibang blog post. Pero kung gusto mo nang palitan si Jollibee sa pagiging bida e mabuti pang aralin mo na si Norkins, 5th ed., pg 263. Ayan na ha. Binigay ko na ‘yung page. Magbabasa ka nalang.

NORKIN, 5th Ed: Initiator (pg. 263)

“The supraspinatus muscle is considered an abductor of the humerus. Like the deltoid muscle, it functions in all planes of elevation of the humerus. Its role, according to MacConaill and Basmajian, is quantitative rather than specialized. The pattern of activity of the supraspinatus is essentially the same as that found in the deltoid. The moment arm of supraspinatus is fairly constant throughout the ROM and is larger than that of the deltoid for the first 60° of shoulder abduction. When the deltoid is paralyzed, the supraspinatus alone can bring the arm through most, if not all, of the glenohumeral range, but the motion will be weaker.”

TAMBAY TRANSLATION:

1. Ha?! Ano daw?!
2. Ang dami niyang sinabi pero ang tinutumbok niya talaga e INITIATOR pa rin ang function ni supraspinatus muscle.
3. Opposite scenario naman ang binigay niya dito. Imbis na supraspinatus ang paralisado (katulad nang ibinigay ni Brunnstrom sa taas), si deltoid naman ang paralisado dito. Essentially, ang sinasabi niya e kaya ring mag-abduct ni supraspinatus sa buong SH ABD ROM if deltoid is paralyze, pero WEAK lang din.
4. May kinaliman pa rin sa translatory forces dito. Explain ko sa ibang post pag sinipag ako.

SNELL, 9th Ed: Initiator (pg. 360)

Woah! Ang daming words! Ang intense!

To sum it up, Snell basically said supraspinatus acts as initiator. In case of its paralysis, shoulder abduction is still possible provided that the arm be assisted in the first 15° of abduction. Thereafter, the deltoid takes over to a right angle, or simply 90° abduction.

Now, here lies the problem: both Brunnstrom and Norkin said that deltoid can take over as the shoulder abductor in case of supraspinatus paralysis. But here comes Snell saying that deltoid can take over up until 90° of shoulder abduction ONLY. 

‘Yung totoo?! Anong problema niyong tatlo?! Suntukan nalang kaya tayo?!

The answer lies in the study of translatory forces of the rotator cuff muscles. Yet again. I will discuss this should my schedule allow. Tuuhhhrayyy.

At this point, you should now be seeing it as an integrated function of the shoulder complex. In other words, you have to “look at the forest and not just the trees.” 

Did I make myself clear? Well, at least I hope, I did.

Now most professors will stop after giving you these references, but since I’m not like the others, I’ll give you more… for free. 

This part is where it gets exciting as I will be challenging everything you think you know.

---

GRAY’S ANATOMY, 40th Ed: Synergistic with Deltoid

“The conventional view is that supraspinatus initiates abduction of the shoulder and assists deltoid in abduction thereafter. However, there is evidence that both supraspinatus and deltoid are involved throughout the range of abduction, including initiation of the movement. As part of the rotator cuff, supraspinatus helps to stabilize the head of the humerus in the glenoid fossa during movements of the glenohumeral joint. With the arm dependent, even when moderately loaded, supraspinatus and tension in the upper capsule prevent downward displacement of the humerus.”

TAMBAY TRANSLATION:

1. Una sa lahat, walang  akong page number na binigay sa taas kasi Vishal ang version ng Gray’s Anatomy na meron ako. Baka may pdf version kayo. Pahingi naman. Pretty please?
2. Anyway, ang sabi ng kapitbahay na si Gray ay synergistic daw si supra with the deltoid. Ibig sabihin, si supraspinatus ay hindi nag-tatrabahong mag-isa bilang isang shoulder abduction initiator. Nag-tutulungan silang parehas ni deltoid throughout the entire motion. Gets pa ba?

 LIPPERT, 5th Ed: Synergistic with Deltoid (pg. 138)

Read the supraspinatus part at the leftmost.

TAMBAY TRANSLATION:

1. Supraspinatus is active throughout abduction. Still synergistic with deltoid. Self-explanatory.
2. Kung PT ka at reviewee ka dati sa Gold Rank, eto po ‘yung reference na ginamit ni sir ken– yung nagturo mismo ng UE ortho conditions. He didn’t mention it though, but I figured since he used the exact same words.

GOOGLE SCHOLAR: Synergistic with Deltoid

It is imperative to note however, that the research above had been published way back 1986, meaning it could be obsolete nowadays.Why did I use such old research, you ask? This is because I failed to find anything that’s more recent than this. The rest are dated 1940s.

With that said, let us now recap everything that’s been written here so far:

1. Brunnstrom, 6th Ed: Initiator (pg. 197)
2. Norkin, 5th Ed: Initiator (pg. 263)
3. Snell, 9th Ed: Initiator (pg. 360)
4. Gray’s Anatomy, 40th Ed: Synergistic with Deltoid
5. Lippert, 5th Ed: Synergistic with Deltoid (pg. 138)
6. Google Scholar, 1986: Synergistic with Deltoid

There you go. That’s a three on three.

Now, who has the monopoly to truth? I will leave you with the analysis.