RxPinoy Net

It was another busy day during my fellowship at UC Irvine, filled with trips to the operating room, research work and conference meetings. We were particularly busy that day because of several deadlines. We had multi-talented personnel who seemed to be inexhaustible in their efforts, working day and night. The enthusiasm that we shared as members of the minimally invasive urology program stemmed mainly from the leadership of our chairman RVC, who is both an innovator and inventor—the perfect example of the modern “surgeon scientist.”

Recently our team submitted various abstracts to the upcoming congress of the Society of Laparoendoscopic Surgeons, the unified society of various specialties who perform minimally invasive surgical procedures. I have been tasked to analyze and compare our experience with robotic and laparoscopic-assisted radical cystectomy for the treatment of bladder cancer. This was a huge project, being the first to prospectively study the differences between two minimally invasive approaches to bladder cancer.

Doc Joben (second from right) and colleagues during the 2007 conference of the Society of Laparoscopic Surgeons, held in San Francisco, CA.

I devoted a lot of time to this project and looked at several aspects of the study population, making certain all the details were accurate and up to date, beginning with patient demographics and treatment outcome. My mentors supervised these submissions as well, overseeing the design and content. Abstracts submitted to these scientific meeting were reviewed extensively by several experts prior to acceptance and could therefore be denied presentation if they were considered irrelevant or flawed in design. For this reason, one has to be critical with one’s work before actual submission.

It was on this one busy day that I received an email from the SLS stating that my abstract entitled “Comparative Analysis of Robotic and Laparoscopic-Assisted Radical Cystectomy with Ileal Conduit for Bladder Cancer” had been chosen the “Best Urology Scientific Paper” of the Conference. It was a great day! My mentors were very proud.

I could not contain my joy and immediately informed my family members and friends back home. My parents were extremely overjoyed and traveled to the United States to attend the conference in San Francisco, where I received this award. I think they were the happiest parents on that day. My Filipino colleagues also extended their greetings and expressed their immense delight.

Doc Joben and family during the conference.

Indeed I was very happy to represent UC Irvine during this conference but more so, I also felt the pride of being able to represent the Philippines. I knew we have many talented people all over the world in the medical field that bring honor to our country. I was so glad for having contributed to that in a small way, knowing fully well that I am not alone in this venture and that many of our Filipino friends are jubilant with my “success.”

When Pacquiao won against Hatton recently and became the undisputed pound-for-pound king in world boxing, the entire Filipino people rejoiced. This was because we were able to identify with his success and felt the joy of being able to conquer a part of the world, lifting our self-esteem and respect.

These are the things that continue to inspire me as I continue my fellowship training abroad: the incessant call to live up to the demands of the medical profession, rising up to the occasion and being proactive in the pursuit of excellence.

By j.abraham. Posted 11:22 pm, Mon, 01-Jun-2009 | Tags: guest blogger, oncology, urology | Category: Dr. Joben Abraham | 673Commentshttp://www.rxpinoy.net/2009/06/reflections-of-a-third-world-surgeon-in-a-first-world-nation-part-5/Reflections+of+a+Third+World+Surgeon+in+a+First+World+Nation%2C+Part+5%2C+by+Dr.+Joben+Abraham2009-06-01+15%3A22%3A56j.abraham

What are the other names for Coronary Angioplasty?

• Percutaneous coronary intervention (PCI)
• Percutaneous transluminal coronary angioplasty (PTCA)
• Balloon angioplasty
• Coronary artery angioplasty

For whom is angioplasty suitable?

Coronary Angioplasty may be performed on patients with one or more of the following conditions:

• Significant blockage (or stenosis) of one or more coronary arteries causing angina or chest pain that is not controlled with medications, and/or angina or chest pain that disrupts daily activities, that occurs at rest (i.e., without exercise or exertion), or that recurs after a heart attack
• Acute myocardial infarction or a heart attack

How is the procedure performed?

The procedure starts with the insertion of a vascular access, usually performed at the femoral artery that is located at the groin area. Under x-ray guidance, a long, J-tipped guidewire is threaded along the artery, and eventually through the aorta with the tip of the wire positioned at the ascending portion of the aorta. A guide catheter (approximately 2.0 – 3.5 mm in diameter) is then passed along the guidewire with the tip of the catheter positioned at the opening (or ostium) of the coronary artery. Through this guide catheter, a 0.014-inch guidewire is inserted and, under fluoroscopic guidance, positioned and passed across the diseased segment with the distal tip of the wire positioned at the distal segment of the coronary artery. A balloon-tipped catheter is then passed along the guidewire and positoned at the area of narrowing. Once adequately positioned, the balloon is inflated and the coronary artery is dilated. In most cases, a stent is inserted and positioned at the diseased segment of the coronary artery.

How long does an angioplasty take?

The procedure may take from 45 minutes to as long as 3-5 hours to perform, and usually depend on the clinical situation, the technical difficulty of the case and the number of balloon catheters and stents necessary.

Will I need to stay in the hospital after the procedure?

Following coronary angioplasty, the patient is usually admitted for 24 to 48 hours to an intensive are unit (ICU) or coronary care unit (CCU) for recovery and monitoring purposes.

Is the procedure painful?

Percutaneous coronary intervention or PCI is usually performed after skin and subcutaneous infiltration with local anesthesia at the area of vascular access (usually the right groin). It may cause some minor discomfort over the area where the vascular access is inserted. During an angioplasty, it is most of the time expected that a patient may experience some chest discomfort while the balloon is being inflated at the area of the coronary artery lesion; this typically stops as soon as the balloon is deflated. For comfort and relaxation, mild sedation is almost routinely given.

How is a patient prepared for the procedure?

Laboratory tests for kidney function, bleeding parameters and baseline complete blood count (CBC) are usually performed prior to the procedure. Your Interventional Cardiologist shall instruct you regarding the medications that you need to continue or stop prior the procedure. A patient is also placed on a fasting state (i.e., nothing by mouth) for at least 4 to 6 hours before the procedure.

What is the success rate of coronary angioplasty?

Angiographic success rates (90 to 95 percent) are now higher in today’s era of new technology, which includes stents and contemporary therapies. Improvement in success rates has also been accompanied by decline in periprocedural myocardial infarction and the need for emergency coronary artery bypass graft surgery.

What are the risks associated with procedure?

Angioplasty is a common medical procedure. Major complications are rare and occur in about 1 to 2 percent. The risks of angioplasty include bleeding from the blood vessel where the catheter (small flexible tube) was inserted, damage to the blood vessel from the catheter, infection and allergic reaction to dye given during the angioplasty. Other less-common complications include heart attack, need for emergency open-heart surgery during the procedure, stroke and death. The risk of complications is higher in women, people ages 75 and older and in persons with diabetes mellitus.

By molave. Posted 11:45 am, Wed, 06-May-2009 | Tags: cardiology, heart disease, interventional cardiology, patient education | Category: Dr. Dizon Paterno Jr., Health of Adults (18 up), Health of Seniors, The Cardiovascular & Circulatory System | 663Commentshttp://www.rxpinoy.net/2009/05/essential-facts-on-coronary-angioplasty-by-dr-paterno-dizon-jr/Essential+Facts+on+Coronary+Angioplasty+by+Dr.+Paterno+Dizon%2C+Jr.2009-05-06+03%3A45%3A52molave

I never thought living in a foreign country would be easy. One day, while walking home from the medical center, I was struck by an indescribable loneliness. It was getting dark, and the cold California weather, which I was never used to, gave me the shivers. Worst of all, my wife had already gone back to the Philippines after “tucking me in” for the first few weeks of my fellowship.

I raced back to my apartment, and then drove to my cousin’s place, about 30 miles away. Back home, that would be approximately three times the distance from Makati to Alabang, and would have been a long trip through Metro Manila traffic. In the U.S. however, at 60-70 mph, it took only 30 minutes. At that point, all I wanted was to see a familiar face, laugh and speak in our native language. Because even though my English is okay, speaking it constantly had turned it into a tongue twister.

As soon as I arrived, my cousins and my aunt met me with warm hugs and smiles. They served me adobo, my favorite meal, easing my anxiety and cheering me up. I shared with them my unexplained lonesomeness, stating how it almost made me cry. My cousins were very consoling. They described experiencing similar sentiments in the past when they, too, were starting their lives in this part of the globe.

Periodic visits to my family members refueled me during my fellowship. I spent time with my relatives whenever possible. I was so glad to have so many of them in the U.S.: about a dozen families. I imagined that most Filipinos have them too.

This was a particularly challenging aspect of my training, being far from friends and family. But I knew I had to be strong, and with a clear purpose in my mind, I had to continue my work without letting it affect me. I began to understand the difficulty of our OFWs, who sacrifice a lot of themselves abroad for the sake of a better future for their families. I too, was a certified “Overseas Filipino Worker.”

I was so glad that the internet has made it possible for me to communicate more often with my loved ones back home. Emails and video conferences were very helpful.

Left to right: Dr. Joben Abraham from the Philippines and colleagues Dr. Vitor Oliveira from Portugal and Dr. Leslie Deane from Barbados enjoy a break in the middle of a busy day.

As the days passed, I met new friends: people from diverse ethnic roots who came to study and work here. Some of them were migrants at their young age together with their parents, while others had come for training purposes only.

Because of its prestige as one of the US Best Hospitals, the medical center attracted people from all over the world: to name a few, China, Korea, Japan, Bangladesh, Brazil, Portugal, Barbados, Egypt, Iran and India.

In the beginning, interaction with these people was not that easy because of unique cultural and religious differences. People also have varying temperaments and backgrounds and therefore, mutual respect is an essential part of social dealings.

Even if we Filipinos belonged to one of the largest English speaking countries in the world, spoken English in America can also be quite different. For instance, a person may respond with “I don’t care.” It does not mean he is being rude, but only suggests that he does not have a different view.

I think one of the coolest aspects of this fellowship was being able to work with some of the most talented people the world has to offer. I also learned to appreciate their traditions; and what makes them unique from others. Ultimately, this experience leads to lasting bonds of friendship, enabling me to realize that the world was bigger than my own little space back home… It made me grow and mature as a person.

By j.abraham. Posted 11:39 am, Wed, 29-Apr-2009 | Tags: guest blogger, oncology, urology | Category: Dr. Joben Abraham | 649Commentshttp://www.rxpinoy.net/2009/04/reflections-of-a-third-world-surgeon-in-a-first-world-nation-part-4/Reflections+of+a+Third+World+Surgeon+in+a+First+World+Nation%2C+Part+4%2C+by+Dr.+Joben+Abraham2009-04-29+03%3A39%3A36j.abraham

One of the advantages of training in the United States is the accessibility of modern diagnostic and imaging techniques. Instruments used for these techniques are not always available in a third world nation like the Philippines. Even if they were, their use entails prohibitive costs to a community where health care expenses are usually “out-of-pocket.”

A simple example is the extensive use of CT scans. Here in the United States, standard imaging techniques like the intravenous pyelogram (IVP) have been replaced by CT scans because scans are more highly sensitive and specific. When looking for pathologies of the urinary tract, for example, CT scans allow the physician to diagnose other extra-genito-urinary causes of  abdominal pain or hematuria (blood in the urine), which may otherwise be missed by IVP.

Back home in the Philippines, a physician would not always readily order a CT when confronted with a patient of a similar symptom. Instead, he would rely more on his “clinical” ability to diagnose a patient, such as a detailed history and physical examination in order to make an intelligent guess. While an astute physician may lead to a correct diagnosis, an inexperienced one may linger on an erroneous one.

On the other hand, second guessing could be eliminated easily with the CT. In the U.S., in fact, a physician who omits a CT in a patient with abdominal pain may be accused of practicing a substandard level of care.

Who then is the “greater” physician: the one who clinches the diagnoses with clinical acumen, or the one who liberally uses modern imaging to arrive at an accurate diagnoses? Ultimately, the patient’s risk is at hand. Time is essential to the diagnosis and treatment of serious illnesses. If a delay in the diagnosis occurs, a delay in therapy subsequently follows.

And then again, if one chooses to go for an inferior and cheaper IVP, one may or may not arrive at a true diagnosis. And so long as there is some shred of doubt (a diagnostic dilemma), a CT may be ordered too, leading to added costs (and further delay).

Another example is the use of D-dimer, a blood test that allows one to predict the probability of a pulmonary embolism (clots in the veins of the lungs), which is usually a fatal condition. This test, when done in combination with a ventilation/perfusion scan and a CT angiogram, increases the chance of diagnosis of a pulmonary embolism. Once again, these tests are not always available in even some of the most modern hospitals in Manila.

In other words, some disease conditions may be missed just because of the unavailability of these diagnostic tools, which, although expensive, may actually mean life or death for a patient…

Dr. Abraham with the da Vinci machine discussed in part 2 of this series

In conjunction with this concept, we are able to perform many minimally invasive procedures of the urinary tract through the help of modern imaging. An indispensable tool in percutaneous or retrograde access surgery is fluoroscopic imaging, or “real-time” x-rays being taken while instruments are passed to access the urinary tract, either through natural orifices or small incisions.

Combining these techniques with rigid or flexible endoscopes attached to cameras, we can now remove or excise diseased organs. A glaring example is staghorn calculi (urinary stones which conform to the shape of the kidney’s internal architecture—parang sungay ng usá) which are traditionally treated with open surgery. Modern surgical techniques have developed to help us remove these stones without opening up the patient’s abdomen or flank.

We also use CT fluroroscopy for percutaneous needle cryoablation (a method which uses subzero temperatures to freeze and ablate tumors) of suspected malignancies of the kidney. This allows real-time CT guidance during needle insertion.

In the Center, we conduct training courses in Endourology for both local and foreign physicians. In one of these sessions, I heard a visitor ask RVC this question, (after seeing a live demo of complete percutaneous stone clearance), “When do you ever consider open stone surgery?” The simple answer: “We don’t.”

In the Philippines, open surgery is still a viable first option to many. In fact, percutaneous stone removal is not popular at all. What has gained quite an attention is Extracorporeal Shock Wave Lithotripsy (ESWL), which is a non-surgical approach to stone disintegration. ESWL is however limited when there is huge stone bulk or when the renal collecting system is markedly obstructed.

What I have found to be very effective is a combination of percutaneous ultrasonic disintegration (the stone is pulverized from an incision above) and retrograde laser lithotripsy (a stone which is inaccessible from the antegrade route could be visualized and pulverized from the ureter below, e.g., a middle pole stone).

There are other situations where modern technology may actually be beneficial to the patient. For example, a patient may complain of “inability to urinate” or “lack of urine output,” a situation which is particularly challenging to the clinician. One should distinguish absence of urine or inability to empty a distended bladder.

The easiest way would be to insert a catheter into the bladder in order to drain it. Sometimes however, situations may arise such as difficult catheterization, or a flabby abdomen which makes assessment of bladder distention quite challenging.

Another way to differentiate this is with an ultrasound which may show the empty or distended bladder or obstructed kidneys. An ultrasonic bladder scan also allows the nurses to determine at bedside, if the bladder is empty or full.

Percutaneous bladder drainage is still being performed in a blind fashion in the Philippines. In the U.S., this procedure is done with ultrasonographic guidance, providing real-time imaging as the catheter enters the bladder, thereby allowing safe and accurate placement and minimizing injury to other organs.

There are more examples similar to these. Ultimately, having access to the most sophisticated tools for diagnosis and treatment has allowed me to understand the magnitude of modern medicine’s effect on the simplest and most complex diseases, as well as its impact on patient survival and quality of life.

By j.abraham. Posted 11:30 am, Wed, 15-Apr-2009 | Tags: guest blogger, oncology, urology | Category: Dr. Joben Abraham | 619Commentshttp://www.rxpinoy.net/2009/04/reflections-of-a-third-world-surgeon-in-a-first-world-nation-part-3/Reflections+of+a+Third+World+Surgeon+in+a+First+World+Nation%2C+Part+3%2C+by+Dr.+Joben+Abraham2009-04-15+03%3A30%3A20j.abraham

I had mixed emotions. On the one hand, I longed for more training. But on the other hand, it was difficult to leave behind a practice just as it was starting to grow. Taking a few steps back to become a resident/fellow once again is tough, considering that I had already been a consultant for about five years. But this was a choice I had already made. My father offered his full support. He is a urologist, too, and has always served as my inspiration since I was a child.

I informed my patients of this unexpected turn of events. Many of them felt very happy for me. Others, however, were deeply saddened that I was leaving, One even cried when she heard the news, and this struck me deeply. I advised them that this was for their benefit as well. After all, one year of training will be over sooner than one could imagine.

I had visited the United States before as a tourist and focused mainly on leisure. This time, I had a more serious purpose, and yet I still arrived with the eagerness of a child, wanting to explore the world and learn new things.

I found a studio apartment with only the bare necessities, but it was close to the hospital—about 0.8 miles, or a good 15 to 20 minutes of brisk walking. Barely a week after settling in, I started work.

I came to work very early, at 6:30 AM, and stayed late almost daily, in order to maximize my time at the hospital, especially because I was uncertain of what the expectations were of me.

The goals of this fellowship focused mainly on learning minimally invasive urological techniques, which included familiarity with video-endoscopes, both rigid and flexible types, and adjunctive devices that may be used to access and treat various urinary tract diseases, whether retrogradely through the bladder, or percutaneously through the kidney (via the flank), or laparoscopically (through the abdomen).

Endourologic techniques were developed more than 20 years ago and are now the procedures of choice for stone disease and malignancies of the urinary tract. Unfortunately, it has not gained popular support in the Philippines, for a variety of reasons. For one, unfamiliarity with the technique has created reluctance among our local urologists to incorporate them into their practice. Secondly, the logistical support that is required to perform these techniques add significantly to the surgical expense. Residents are also inclined to believe that learning the “open” surgical approach was preferred, even mandatory.

In the U.S., in contrast, I observed that open surgery has become a last option, RVC referred to it as a “historical reference.” This struck me hard. I grew up in an environment where open surgery was considered a primary viable option.

I had emailed a friend of mine back home, who had said that it would be difficult for me to apply the techniques I would be learning to the Philippine setting. For him, my fellowship was an expensive learning experience with limited applications locally. His outlook saddened me but my motivation remained high. I recalled the main reason I went for training, which was to give my patients the quality care they deserve.

It is amazing how India, which is considered one of the most impoverished country in the world, has one of the most modern urological services available. Several physicians take extensive training in the United States and come back to India to upgrade their practice.

I asked myself “Why should we promote minimally invasive techniques in a third world nation when its cost is very limiting?” While it is true that it may be more expensive than open surgery, recovery from this type of procedure is fast, because it offers a more gentle approach to the human body. Cost efficiency, therefore, is seen in the long term because of less analgesic requirements and less man-hours lost from work. Comfort is higher and patients feel good about themselves because their body image is less altered.

One clear example of this is the concept of “same-day-admission” or SDA. This means that preoperative work-up is done prior to the patient’s arrival at the O.R. suite, and being admitted the day before surgery becomes unnecessary. Instead, patients are operated on the day of their arrival, and admitted after their operation.

The following morning, if the patient’s vital signs are stable without evident blood loss requiring transfusion, they are fed and discharged later during the day. Hospital stay is therefore equivalent to about 23 hours or less. That is truly amazing! The advantages include lower incidence of hospital-acquired infections, faster recovery, and an early return to work.

Our hospital has a huge skills training facility, fully equipped with all the instruments and devices used in the operating room. We “practice” with these devices in the laboratory in order to understand how they are used, thus acquainting us with the intricacies of the instrument, and enhancing our ability to perform in the operating room.

One such situation refers to the use of something called the da Vinci robot, a breakthrough in medical innovation intended to make laparoscopic surgery more operator-friendly. With the help of joysticks in a console box, the operator can improve the precision by which he moves laparoscopic instruments within the body. This is because of the three-dimensional image quality and multiple degrees of freedom, which this technology offers.

Technology meets medicine! This is a clear example of how far-advanced the urological surgery has developed in this part of the world.

Although it is tempting to look at it as a toy, the da Vinci is not that easy to use.. One needs to practice with this expensive plaything in order to use in on a human being. For this reason, we had two da Vinci’s in the skills facility being used to train other surgeons through educational courses under our “mini-residency training program.” I served as instructor in many of these courses, and this allowed me to learn while teaching others.

More than the skills acquisition though, I consider my entire training experience as a “cultural revolution,” a change of attitude towards health care. My mentor used to say that “the enemy of good is… better,” and that “good is not good enough.” To me this always meant aspiring for perfection in surgery, minimizing errors and maximizing patient safety.

By j.abraham. Posted 10:19 pm, Tue, 17-Mar-2009 | Tags: guest blogger, oncology, urology | Category: Dr. Joben Abraham | 610Commentshttp://www.rxpinoy.net/2009/03/reflections-of-a-third-world-surgeon-in-a-first-world-nation-part-2/Reflections+of+a+Third+World+Surgeon+in+a+First+World+Nation%2C+Part+2%2C+by+Dr.+Joben+Abraham2009-03-17+14%3A19%3A12j.abraham

I am a Filipino doctor currently training in the United States: a third world surgeon in a first world nation. I practiced in the Philippines for a few years after my residency training in urology. Before I left for the U.S., my clinical practice had just started to blossom. There I was, a young vibrant surgeon in a specialty hospital where people go for treatment of the most serious medical and surgical diseases of the urinary tract. It was haven for a urologist starting his career.

In those few years, I had accumulated a long list of patients, my faithful followers. This was because as soon as one patient got well, he would entrust to me the care of many other family members and friends. And with the extended nature of the Filipino family, this led to a chain reaction. Out of these referrals my patient database expanded to include people throughout the land, from the farthest places in northern Luzon to the southernmost regions of Mindanao. I became a “frequent flyer” in the operating room, and it was part of my regular routine to be in the O.R. It did make sense, because all surgeons feel an unquenchable longing to “fix” a patient’s body parts.

I also worked in one of the most prestigious university hospitals in the country, the same institution where I had my medical education. It took a while before I started teaching. The opportunity came when I was offered a faculty position in 2004. It was something I had always dreamt of. And therefore after much reflection, I decided to take the job. I guess I had always had the knack for teaching.

Some people envied my clinical practice and my lifestyle, I never meant it to be that way. Having come from a family of doctors, all I ever wanted was to be a good physician with a healing hand. I distinctively recalled how my mother would remind me to always put the patient’s condition first and my compensation last.

In fact one day she remarked, “Anak, I know that you have a very active clinical practice, but what have you been doing for the poor?”

Wow! I honestly never really thought about it. As soon as I finished residency and became a specialist, I was a newly married guy who was broke, with financial means that could barely support a family. So it was incumbent at that time to seek financial security. Service to the poor was the last thing on my mind back then.

Then, one day at the clinic, I felt a certain void. Reflections on my current situation led me to believe I was not giving my patients the ideal treatment they deserved. Sure, patients were getting well and recovering. However, some of them were internet-savvy and asked me about modern surgical techniques…

By then, minimally invasive surgery has developed and is creating an impact to the rest of the world. Urologic surgery was being performed through the aid of video endoscopes that allowed one to image the internal anatomy of the human body. In contrast to traditional open surgery, small incisions were used to offer a more gentle approach to surgical treatment, allowing more rapid recovery and return to work and better cosmetic acceptability.

I had always wanted to train in the United States. Having listened to updates from experts in local and international conferences, I yearned to cross the other side of the globe and be immersed in the medical practice there. It was not beyond reach, after having passed all the requirements for training, the so-called “USMLE.” All I needed to do was apply.

I recalled having applied previously to a urological oncology fellowship (cancer surgery) in 1998. I was fortunate to be offered a position at the University of Miami Jackson Memorial Hospital in 2000. It was a dream come true. Unfortunately, it did not materialize due to certain visa restrictions. In other words, I ended up not leaving… and was a little sad.

This time, my enthusiasm was again enkindled. I applied to several American institutions for a minimally invasive surgical fellowship. It really didn’t matter to me where I would end up, for as long as a program would accept me. I was invited for interviews—one of the most exciting things I had ever done. I traveled eagerly to the US at my own expense, took advantage of an international meeting to meet with the different program directors. I put my best foot forward, wore my best suit, had a haircut and practiced my best English… it was an experience I cherished the most.

When the results came back. I was sadly not matched anywhere. But wait… the email said that I could re-apply because a “scramble” had to be made. Certain programs had vacancies, which needed to be filled in. I was advised to email these institutions if I was still interested.

I definitely was, so I wrote to one who however, turned me down instantly… and then to another, whose program director was considered the leader in minimally invasive urology in the world, RVC. To my mind, there was a slim chance I would get accepted for I was an unknown from a distant country. Nevertheless, I sent him my CV anyway, and sent him a well-intentioned letter. Surprisingly, he became interested and asked more details about myself.

RVC expressed his appreciation of my good intentions, and his willingness to take me as his fellow in 2006 if the match acceptance committee agreed with his recommendations. He wrote this magnificent endorsement letter, which sounded like he had known me for such a long time! I became very optimistic and kept my fingers crossed.

After several weeks, I received an email confirming my acceptance as a fellow in endourology, having been granted the Endourology International Fellowship Scholarship Award! Oh my! Was this for real? It was March of 2006. My program was to start in July…

An exciting new path had laid itself in front of me, and I couldn’t wait to get started.

By j.abraham. Posted 11:12 pm, Sun, 01-Mar-2009 | Tags: guest blogger, oncology, urology | Category: Dr. Joben Abraham | 601Commentshttp://www.rxpinoy.net/2009/03/reflections-of-a-third-world-surgeon-part-1/Reflections+of+a+Third+World+Surgeon+in+a+First+World+Nation%2C+Part+1%2C+by+Dr.+Joben+Abraham2009-03-01+15%3A12%3A57j.abraham

Pardon me for not posting lately. Below is a story I published on Trusera, which tells part of the reason for my silence.

By molave. Posted 12:55 pm, Sun, 22-Feb-2009 | Tags: Amvasc, blood pressure, Combizar, heart disease, hypertension, personal, Provasc, Ziac | Category: Drug or Medication, Health of Men | 597Commentshttp://www.rxpinoy.net/2009/02/a-change-in-blood-pressure-medication/A+change+in+blood+pressure+medication2009-02-22+04%3A55%3A20molave

Ang Doctors On Line ay isang publice service radio show na nagtatalakay tungkol sa kalusugan. Mapapakinggan ito bawat araw mula lunes hanggang biyernes alas 8:30 hanggang alas 9:30 ng umaga, over DZAS 702 AM band sa inyong mga radyo. Tuwing Miyerkules ang RxPinoy ay nagbibigay ng isang eksperto upang magtalakay tungkol sa napiling paksa ayon sa specialty ng doctor. Ang host ng programa ay si Lyn Garcia, at ito ay isang produksyon ng Far East Broadcasting Company.

Sa ibaba ay listahan sa buwan ng Mayo 2008 ng mga eksperto na nagbahagi ng kanilang kaalaman tungkol sa kalusugan.

By Derek. Posted 10:31 am, Wed, 18-Feb-2009 | Tags: acupuncture, dementia, menopause, pediatrics, pneumococcal vaccination, radio show | Category: About RxPinoy Net, Body Systems | 591Commentshttp://www.rxpinoy.net/2009/02/doctors-on-line-radio-past-episodes-2008-05/Doctors+On-Line+Radio%3A+Past+Episodes+2008-052009-02-18+02%3A31%3A05Derek

Uploaded to Flickr by rosamay

Several months ago, our help desk fielded an inquiry from a mother seeking a pediatric dentist based in Pampanga. The young woman wanted to make sure her four-year old, who needed dental work, would not be traumatized by his first dental check-up.

Since we did not personally know a dentist of this type in Pampanga, all we could suggest was that she either travel to Manila, or ask around at a city closer to her, such as Angeles.  

We actually get a fair number of inquiries about specialists working in the province. Unfortunately, many of our health professionals–for understandable reasons–practice in cities like Metro Manila, Metro Cebu, and other major urban centers. This leaves the majority of our kababayans in small towns still unable to access the health care they need, even in this day and age.

Sad, isn’t it?

With so many Pinoys abroad sending money home to families in hometowns all over the Philippines, one would think that the purchasing power of provincial Filipinos might already have risen, if only a little. Maybe the time has come for better products and services, including health care, to be more available to them.

I guess the time hasn’t come yet, after all.

By molave. Posted 7:24 am, Fri, 13-Feb-2009 | Tags: province | Category: The Practice of Health Care | 583Commentshttp://www.rxpinoy.net/2009/02/medical-and-dental-specialists-in-the-barangays-of-our-many-provinces/Medical+and+dental+specialists+in+the+barangays+of+our+many+provinces2009-02-12+23%3A24%3A17molave