All of 57 years: A synopsis

c. Nov 11, 2012

Soon, I will be all of 57 years.

The signs are here:
PHYSICALLY - the law of gravity for sagging skin;

Leaving the office one rainy day...
An anticipation of
days to come:-"leaving"
(retirement, that is : D)
for new ventures- exciting times!

OUTDOORS - deference as I fall in line- "mauna po kayo, 'Nay"; ("nanay", is Filipino word for mother);  on purchase of hypertension medicine,"senior citizen card Ma'am?"
FAMILY -  enjoying long drives with hubby in silence- no words needed; children asking, "why do you know that song, Ma? Is this a remake then?"; weekly conversations with spritely 90 year old mother;
FRIENDS - more fb groups of past school years; uploaded photos with browned edges - authentic, not edited nor photoshopped;
MIND- more minutes spent trying to remember passwords, attenuated, sharpness gone which is sometimes irritating, sometimes a good thing; o_O
CAREER - signs like walking through the university hallways and meeting no one I can address as Sir or Ma'am, but instead, people who greet me "Hi, Ma'am";

These are just a few of my favorite things now!

And in all these, I praise the Lord Jesus, for His great brush strokes of retaining the love, beauty and peace in this canvas of life, despite the difficult and dark times. Necessarily, the lessons were many times painful, but He bore them all for me.

May all of us experience His Love in this life.

Arthritis meeting in Amman, Jordan.

The APLAR (Asia Pacific League of Associations for Rheumatology) 2012 is on - previously scheduled in Damascus, Syria, it is pushing through in Amman, Jordan.

Many had been adamant in coming, in my case, mainly due to the extended Arab Spring phenomenon, just several hundred kilometers away, and the fact that geographically, Jordan is wedged between Israel and Iran. But in the airport I met several friends from other countries and  represented in the mix were attendees from Korea, Japan, Indonesia,  Malaysia, China, and some from western countries AND the trainees slinging poster canisters. It was a comforting sight.

Today will be the first day of meeting and I am hopeful that this Middle East meeting will still give us a good "harvest".

Some notes on the bus trip to the hotel: searing hot sun, immense expanse of red brown land, with sparse dots of palms, olive grooves, one camel herd, and one sheep and goat herd - as quick as my neck can turn. It's fantastic, given other countries that I have visited had trees and plants, asserting themselves between buildings - here it is a desert expanse, breath -taking for a first-timer. One cannot but praise God for His creation. We are in the Dead Sea - where the convention center is located, and it is 384 meters below sea level!

The "chick" - ever heard of Chikungunya fever (and associated arthritis)?

        This article is being written with a real time possibility that chikungunya fever is on the rise in Manila. It is a virus, the CHICV, that is also acquired from a mosquito bite (same mosquito as the dengue -  Aedes aegypti  and some other species). 

        This viral infection has also been described as the "neglected" infection since its course is more benign and has not hugged the lime light of public health concerns,  as say, dengue. There has been NO reported deaths from it since its first isolation in Tanzania in 1953, but the arthritis associated with it can be debilitating. The term chikungunya is from a Bantu (African) language, which means to "fold up." This is thought to refer to the patient's stooped posture due to joint pains and generalized body aches. This fever is unique since it makes its appearances in many African, Southeast Asian and even temperate countries like Italy, where it had been reported, then disappears for decades at length, then is back.

       Again, i reiterate that its course is benign.

       There is a possibility that in the Philippines where dengue is endemic, fever and rash and general body aches associated with most viral infections could miss the "chick." Since its course is benign, identification of this fever can spare many a hospitals' resources on intravenous fluids which is the main supportive treatment for dengue at this current time. Still, any infection for that matter needs increased fluid intake, and if it's the "chick", drinking water may suffice. If there is headache and vomiting, then intravenous fluids become necessary.

       Your internist, infectious disease specialist and your rheumatologist can help. Please seek any of these specialists. Testing can be done if the illness is 7 days or less in the NIH of UP Manila,  and if more than 7 days, testing is in RITM in Alabang.

Ref:
1. Alladi Mohan, DHN Kiran, I Chiranjeevi Manohar, and D Prabath Kumar. Epidemiology, clinical manifestations, and diagnosis of Chickungunya fever: Lessons learned from the re-emerging epidemic. J Dermatol. 2010 Jan-Mrch; 55(1): 54-63. doi: 10.4103/0019-5154.60355
PMCID: PMC2856377
2. Dieudonné Nkoghe, Roland Fabrice Kassa, Mélanie Caron, Gilda Grard, Illich Mombo, Branly Bikié,Christophe Paupy,Pierre Becquart, Ulrich Bisvigou, and Eric Maurice Leroy. Clinical Forms of Chikungunya in Gabon, 2010. Negl Trop Dis. 2012 February; 6(2): e1517.

Published online 2012 February 14doi:  10.1371/journal.pntd.0001517

 PMCID: PMC3279511

with permission from my daughter who came down with fever, arthritis and rash, and is being tested for the "chick"

      Updates are upcoming, and we are collecting data on this interesting cause of arthritis.

Calisthenics: when was the last time you did it?

        The Merriam -Webster dictionary defines the word as systematic, rhythmic bodily exercises performed usually without apparatus.

        Fifty years ago, I recall my Grade 1 teacher, Ms. Rose Cabaron, (any current information about her is most welcome) leading us out of the classroom in a bee line, to bring us out to the sunny, grassy school quadrangle, for our regular calisthenics. She would have an empty can and a wooden stick to drum up counts 1 - 8, then 8 -1, for the head roll up, side, down, side and up again; for arms forward, upward, sideward, down, repeat, till you are down to count 1 again. Then while arms are in sideward position, we twist to the right and left, and the tin drum goes tang, tang, tang, tang 1- 8, 8-1. Then we should march in place, "feet high up" - she would holler, and the tin drum goes, tang, tang, tang. This was repeated several times, and when we were all sweaty and in all probability, smelly- she would then herd us back to the classroom for the rest of the lessons. (Thanks Ms. Cabaron!)

      Why talk about calisthenics after 50 years? It crosses my mind now why children in elementary grades had to go through such boring routine, when they should be jumping, running, climbing and even falling at that age.

      

       This is because calisthenics is the easiest exercise routine that can be done by ALL people, age 5 -95, with arthritis or not - as in, by all.  

      It can be done in the bedroom, on waking up, even while still seated at the edge of the bed (for those with knee or hip arthritis who have pain on standing), in the bathroom before dipping the "tabo" or opening the shower. It can be done by the busy mom who needs to fix kids for school before sun rise, for the business man who is averse to the gym, by the gym buff who knows that the body needs rest from heavy gym routines, and even by the teenager who is busy with, whatever- school, iPads, fb, etc. The stay at home moms can do this before doing the laundry, cooking, potato couching and even after!

       Calisthenics are essentially range of motion exercises, and for the uninitiated, heaviness and pain may be experienced as the limbs are moved. The muscles of the arms, legs and buttocks provide the natural resistance or weight. When done slowly -no jerky motion, please, the pain eases over a few weeks and the repetitions can then be increased.

       I used to attend a nice non air-conditioned gym, where I really sweated it out. But now, with less time and the distance of the place, I reverted to calisthenics. This way, I spend less, and has no more reason at all not to do the basic body maintenance required as we age. 

       This is an invitation to do calisthenics, add on the hula-hula for the hips, and any innovations you feel will move as many muscles there are in you. Just do it slow and deliberate, and feel the stretch (and pain) and enjoy the relaxing feeling after. Don't forget a good tall glass of 

WATER with it!

     

If you have arthritis, who you gonna call?

           Call the Rheumtatologist, the "lesser known" bone and joint doctor in the neighborhood.

          And if there is none, it is because the field is quite new, interest in the field is low, training centers are few or non-existent in many areas, and - this is a personal observation- arthritis as a disease is not as dramatic or life-threatening as, say, a heart attack, a stroke and diseases of the lungs, liver and kidney.

          In fact, in a 2nd year medical class, I asked for a show of hands for the question " is the joint an organ or not"? There was a handful, tentative yes answers. This is not surprising, and while the first year course on human anatomy surely carries this fact -  that an organ is a group of tissues serving a function -  it seems more tangible to hold the cadaver heart, lung or kidney and say, "this is an organ".

          In 2004, the Section of Rheumatology, Department of Medicine, University of the Philippines College of Medicine embarked on an academic program aimed at presenting rheumatology to medical students and training residents in Internal Medicine in a one day symposium consisting of diagnostic and treatment updates of common rheumatic diseases in the ambulatory, as well as, in -hospital settings. We called this now yearly symposium, The Dr. Lourdes Manahan Lectures in Rheumatology (LMLR) in honor of the first rheumatologist of the country. Dr. Lourdes Manahan attended all first 7 symposia  (in her wheelchair), and just after the 7th year, she passed on. 

          The 8th and 9th LMLR featured foreign academic collaborators from the University of Melbourne - Prof. Keith Lim and Dr. Lawrence Clemens, and this year, on the 9th LMLR, we had Prof. Tsutomu Takeuchi of Keio University of Tokyo, Japan.

          The University of the Philippines, as the state university, is mandated to provide health services for the Filipinos, and we have graduated more than 50 rheumatologists, presently serving in hospitals in all the big Philippine islands of Luzon, Visayas, and Mindanao.

           Now, the challenge is to retain trainees who will stay to be faculty of the university, bring new knowledge about rheumatology as it affects the Filipino and pursue honest to goodness research of rheumatic diseases. To date, our own bright graduates have checked out our program as a specialty to take, with 4 of them currently undergoing training with us. I would like to believe that the LMLR has partly achieved its goal. Dr. Manahan's legacy is strong and will sustain the next generations of doctors of the country to expand this field.

           Dr. Lourdes Manahan was a pioneer, a teacher, mentor and researcher. Her life continues on in us who have decided to follow in her footsteps.

Of Vitamin D, sun exposure and falls

      June 27, 2012 was a a tiring day, having arrived in Seoul, Korea after a midnight flight for a 2- day meeting. Sleepy and trying to get a bath and some sleep after, I slipped and fell in the bathroom, hitting the left side of my face against the tub, which opened a 1 cm gash just at the side of the left eyelid. In ten days, July 7, 2012, after celebrating my Mama's birthday, I fell down the stone steps of our boulevard in Dipolog City and landed on my buttocks and right side of the face.

     Series of falls like these, in a post-menopausal 56 year old female should alert one to the possibility of a significant decrease in the bulk of Type 2 skeletal muscles, which are the fast acting, quick response muscle groups - especially those in the thighs. Type 1 muscles are retained and give the bulk of our body, arms and legs as we grow older, but  are slower  in responding to changes in position and balance.

From: Microsoft clip art

      Type 2 muscle fibers are known to be maintained by many factors, among these - Vitamin D. One can have his/her blood Vitamin D levels checked and take a daily dose of Vitamin D per your doctor's prescription.

     Sun exposure activates skin Vitamin D and supplies us with ample levels to maintain our muscles, especially Type 2, and improve calcium absorption from our food - when we are younger. But as we age, this is not as efficient.

      Still for the young and not so young out there, have a 15 minute noontime sun exposure daily (if the sun is out) for your Vitamin D. Sorry, it's not the early morning sun as previously thought.

                                          Careful.....

In celebration of life: Gifts for my 90 year old Mama

I have been away for a long time from my blogger's seat. This long August weekend certainly should be THE time to write some.

July 6, 2012 was the 90th day of my Mama. After some illness last April-May that increased her pain in the back, we were able to strike a good balance of pain relievers safely and so, on July 7, 2012, we honored her with a thanksgiving celebration in Valdia Resort, Sicayab, Dipolog City. My sister Nellie Crawford and her family were there, my family too - Ed, Tin and Grace and the celebration was attended by close relatives and friends who helped make it a success.

Here are some details: a 4- tier cake, banner with her photos and video loops of photos during her work days as an educator, with my deceased Papa, and her travels abroad - all contributed by her nieces and nephews. Many were called by the emcee, a niece - Cheche, to give some messages. One could hear several lines repeated - she cared for us, she taught us to pray, she told outrageous stories, she is a strong woman, intelligent, patient and helped some nephews in their schooling. Tio Vicente, my Papa's youngest brod made a quaint speech on the seasons of life
: ) There were Mama's cousins too, and their children were represented!

Dr. Val and Lydia Tiu, owners of the resort, came and we certainly were honored by their presence.

At the end of the day, Mama had a blast opening her gifts, and sure enough, gifts reveal the child in all of us! Look at her opening her gifts!

She is a most wonderful gift from God, given a long and full life. Praise the Lord!