Chest pain that is not a heart attack

Angina pectoris or chest pain is an ominous symptom which is caused by heart muscles not receiving enough oxygen for its work of "perpetual" pumping. This great mass of muscle actually gets its oxygen from blood brought by arteries that crisscross it. Yes, though the heart contains and pumps blood, it has its special delivery system of  oxygen-laden blood from small arteries springing right at the base of the aorta, that big artery that receives blood as it is pumped out of the heart to supply the rest of the body.

But what about chest pain that is not at all related to an oxygen-starved heart?

There are other causes of chest pain and among the most common is arthritis of the breast bone to rib joint or the costochondral joint. Costochondritis can be mistaken for a heart attack in many occasions and can cause unnecessary laboratory examinations intended to check the heart to be ordered.  ECGs are routine and can be superfluous in this condition. How then can costochondritis be discerned?

from: Google images, mayoclinic.com

There are ways to differentiate costochondritis from a heart attack. First is to suspect it when the pain is movement-related (twisting the torso, for instance) and happens to occur in a young individual, especially females. A specific kind of costochondritis,  Tietze's syndrome, affects females in their 20's and involves the 2nd left rib to breastbone joint, so that the pain it produces is right smack where pain of heart attacks is felt - mid chest. Second, the pain is lancinating and quite severe, but is usually not associated with cold sweats and the "sense of impending doom", which occurs with the chest pain of heart attacks. More so, save for the pain and the rapid heart rate it can produce, costochondritis is not related with serious breathing difficulty and blood pressure problems, as seen quite commonly during heart attacks.  Costochondritis cause pain in the affected chest on pressure over the area, while this does not occur in heart attacks, where the pain is deep and persistent.

It is however, prudent to relate matters like these to family histories of heart attacks or ailments, as well as, lifestyle risk factors like smoking, sleep deprivation, dietary excesses and diabetes. Despite age, a person with chest pain will warrant a thorough check when the above conditions are present.

from Goodle images

The other common cause of chest pain that happens not to be a heart attack is the viral infection Herpes zoster, when it erupts along the spinal nerve of the nipple line. Chest pain is usually more superficial than deep, also severe, and then in about 2 weeks, chicken pox-like eruptions appear over the affected part of the chest. That would clinch the diagnosis, but in the early phase, the pain can be so distressing and cause the patient to be worked up for a heart problem. It is advised that superficial gnawing pain with unusually sensitive skin in localized areas of the chest warrants observation and monitoring for the appearance of skin lesions. Early treatment is necessary to shorten the course of the rash and the disease in general.

Do you have chest pain? In addition to heart attacks, think joints and skin conditions!

Aurora's Fingers

If you are one who awakens at dawn to feel around for your first 3 fingers, you could well have carpal tunnel syndrome or CTS, a malady I have had for the past 3 years and which I fondly call aurora's fingers (did Aurora, goddess of dawn, have it?). 

photo from Google images

Carpal tunnel syndrome is a disturbing hand disease that causes sensation of pins and needles, and numbness of the first 3 fingers (start with the thumb) and half of the ring finger, especially at dawn (aurora). During the first months, the symtoms can be fleeting, a few dawn awakenings due to numbness, and relieved by shaking the hands. Later, these symptoms become more intense, prolonged and associated with weakness of the thumb and index finger grip, or the pincer grip. Each dawn becomes a misery as sleep and the pins and needles vie for the few more minutes of slumber till morning sun.

There are many possible causes including inheritance, age, work-related causes,  as those seen in jack-hammer operators and long distance drivers and other events that cause pressure inside the carpal tunnel, (where the nerve that gives sensation and strength to the 3 1/2 fingers is lodged), to rise and create the nerve pinch. Perhaps for me, it's stick driving, and the vibration of  the wheel during the frequent long drives I do daily.

Rest from repetitive or wrist-intensive hand activities is paramount for relief during the early days of the disease and  a CTS splint can be helpful, but only for a time. Nerve-pain relieving drugs, and injections into the carpal tunnel are also known to relieve the pain. Don't wait though, for the pincer grip to be compromised to the point of being "clumsy", frequently dropping utencils and hand-held stuff.  Decreasing the carpal tunnel pressure by surgery can be a permanent cure.

For those with the inherited trait, prevention may not work, but those who don't have the symptoms yet might have to avoid some activities (operating jack-hammers, vibrating equipment, etc.) 

Common and disturbing as it is, it is far from life threatening and many an elderly chap or lady have lived with the aurora fingers, albeit, with misgivings. 

Is arthritis fatal?

As a big group of diseases, lumped as one in common knowledge as "rheumatism" -  no, arthritis do not kill. Surely, it can mame and relegate the arthritic to a life of pain, but in the lay mind's mind, nobody dies of arthritis.

However, there are arthritides that can cost a life. Mostly, these are the untreated, undiagnosed  ones, albeit, rare, still, a fact that one should be vigilant about. The key to avoiding the fatal effects of some rheumatic diseases is early diagnosis and treatment.

Here is a short list of serious types of rheumatic diseases that may directly cause death if left untreated for long:
1. Uncontrolled/untreated lupus
     nephritis or kidney inflammation
     lupus lung hemorrhage
     lupus blood disorders
     lupus brain inflammation
2. Lung and brain hemorrhage of Bechet's syndrome
3. Vasculitis or inflammation of blood vessels especially those in the heart, lungs and brain
4. Blood clots in the lungs in hypercoagulable conditions like APS (antiphospholipid antibody syndrome), and catastrophic APS when many other organs of the body are involved
5. Progressive systemic sclerosis (generalized form of Scleroderma) and  CREST syndrome with their associated pulmonary hypertension

List of complications of arthritis and/or treatment that have proven fatal in the long run:
1. kidney disease of gout
2. Stomach and intestinal bleeding due to unsupervised intake of pain medicines
3. Kidney disease from unsupervised intake of pain medicines
4. Presence of other diseases in the arthritic individual, like diabetes, infections anywhere in the body, heart failure, liver disease, high blood pressure
5. Intake of alternative medicines that can have kidney and liver side effects

It is therefore prudent advise to see a rheumatologist early in a disease with symptoms of joint swelling and pain. 

Some like it hot!

Have you noticed how achy joints get stiff on a cold morning?

This is a major dilemma for many arthritis patients who plan to travel to a colder country. You see, in most parts of the Philippines, a cold December or January means a 25 degrees centigrade and summer is easily a 37. And for many of my patients, at 25 C, the joints complain!

This observation is common and hypotheses abound as to why the so-called "gelling phenomenon" of arthritic joints happen. It is said that the lesser motion during sleep may cause inflammatory elements to remain in the joint areas and cause more tightness and consequently, pain, as the patient starts to move on awakening. Pain on the other hand, is chronic in most of the arthritides, and chronic pain can make an individual sensitive even to a slight touch, temperature/weather change or anything at all, that ordinarily should not cause pain. This is called allodynia, a close equivalent to lowered pain threshold. So, we happily "blame it all on the weather".

The association of cold and achy joints is very strong for some patients and yet, in my experience, as soon as these patients from the tropics get to the colder countries, many if not all, report back that their arthritis has not intensified, or even, that the pain had gone altogether. 

The explanation? Your guess is as good as mine. I do tell my patients who worry about such trips to temperate countries to go and enjoy their visit, because, the weather may not matter after all. Still, the standard advise to get that extra warm mitten or socks, just in case, is still to be given, just in case.

Tendonitis, a sequel

In posting "On fire and frozen...", saying no thank you is many times, not an option. And you are right, after 3 trips in 2 months, lugging baggages around, my left bicipital tendons gave. It is different reading it in books, and having it for real. But this just shows that rheumatism respects no one, and certainly, makes sure that all would experience one form or another of this painful malady in his/her  lifetime.

The good thing about having bicipital tendonitis is that I now actually feel what the patient tells me he feels. That is a good thing, and gives a human side to an otherwise automatic reaction by a doctor to a patient's cry. Suddenly, the pain is lancinating, gnawing, with the patient in real distress - according to MY shoulder!

Being a rheumatologist gives you a plethora of interventions to choose from. What did I choose? A self-made bicipital splint made of an adhesive plaster and tying it around the arm nearest the shoulder,  where it hurts. In addition, an NSAID liniment.

Principle? Fix or splint from too much distending motion, the insertion of the bicipital tendon.
Is it working now? I would like to think so. I'm in the airport yet again lugging my carry on baggage, using a lighter shoulder bag, and carrying both with my right hand and shoulder, and hoping that the right shoulder does not give.

Principle? Rest as much as can be afforded the poor tendons.

Updates forthcoming. In the meantime, smile and get on with life which does not tarry with pain.

On fire and frozen - tendonitis, anyone?

The shoulder is the most movable joint of the body. Anatomically, this joint is where a shallow socket which is the glenoid fossa of the scapula (wings), meets the ball, which is the head of the humerus or arm bone. Despite this unique arrangement, shoulder joints are kept aligned and intact because of a very competent and strong supporting capsule, criss crossed by tendons to make a surrounding, circumferential cuff called the rotator cuff.

There are 4 of these tendons, and one other tendon just outside the capsule that can cause trouble - tendon of the biceps muscles, with its 2 heads, the short and the long head. These tendons are lodged in a groove along the front of the arm bone, but as how biceps go, we can twist and over exert during lifting, and so we can "over-pull" the tendon. The resulting pain can be exquisite, and each motion of reaching out to the lower back to scratch an itch becomes impossible.

Bicipital tendonitis is quite a common occurrence, and with rest, the biceps tendon quiets down. But some "pulled" tendons don't. The pain smolders and like embers, can be fanned into a full blown conflagration, and rightly so -  continued work or gym-related lifting, pulling and other daily activities, just cannot be avoided. Increasing pain keeps you to move the shoulder less and less.  A week or 2 of decreased shoulder motion gets the rest of the rotator cuff tendons stiff. They later "freeze" to cause the "frozen shoulder".

Biceps tendon  on fire and shoulder cuff frozen - bad combination. It spells sleepless nights, gnawing shoulder pain, painful limitation of activities that in the past you could do without thinking. And for a working and active individual, this is catastrophe, indeed!

What else do we need to know about tendons?

Tendons are  found where there are muscles. They insert muscles to bone, thereby moving the skeleton as muscles move. But there is a catch - they are not well supplied with blood, and this makes healing slow.

Rest is best, with guided physical treatment, using deep and superficial heat or sometimes cold. Please avoid massage during the painful phase, it will only prolong the healing process. Exercises are introduced slowly and designed to allow slow but sure recovery of motion. Some cases count years, with residual limitation on stretching out of arms, but full recovery is possible.

Pain medicines? Not fully helpful. Treatment is applied over the area that hurts, and this can include anti-inflammatory liniments and steroid injection. The latter can effectively remove pain fast, but the recovery of motion takes the slow and long way.

And so, tendonitis anyone? I'd say, no thanks.

Photos from Google images of rotator cuff tendonitis.

Arthritis and mood disorders

Practicing rheumatology is hearing the word pain  - patient in and patient out, on every clinic day, making the practice a class all its own. The rheumatologist sees that pain is handled in as many ways as there are individuals with arthritis. On some occasions, patients react to pain violently enough to create a "transference" of sorts that causes many a rheumatologist to find the last patient's pain already in his own joint.

While pain is the most important protective mechanism of all of animal kingdom, pain lasting longer than 6 weeks or so becomes a "disease". Arbitrarily, 6 is not a magic number, but denotes chronicity and a duration where many processes in the nervous system have been activated to transform the pain complaint into the "pain disease".

I invite you to recall the last time you had a headache. Normally, headaches make a person moody, withdrawn and quiet. Some would try to sleep it off, but not before taking the favorite pain pill for relief. Even then, knowing that this pain would go away does not keep bad mood at bay. Invariably, all sorts of pain, the quick ones like stubbing the toe, or the headaches you can sleep off, can spoil a well meaning day.

Pain of arthritis is a different story. It can be of varying intensity, with gout pain possibly occupying top spot, followed by the pain of ankylosing spondylitis and reactive arthritis. Add to that duration- arthritis pain can be "forever". But wait till a rheumatoid arthritis patient comes in in tears, wanting never to wake up, and you know that this is a different kind of pain. It is as if dying is relief and the only hope. But a patient with arthritis who wants to die is pathetic. Many arthritides mame but do not kill.

We recently held a symposium on mood disorders in the arthritides. This was prompted by our paper which uncovered that about 40% of our lupus patients have anxiety/ depression. This is a high rate and is disturbing, since mood disorders can affect the way patients view the illness, but more important, accept treatment. Likewise, treatment for different forms of mood disorders is available and can spell the difference between a difficult-to-treat patient and the rest of them. Putting principles learned from this symposium, let me cite a case.

Mr D. was admitted yet again for a bout of gout affecting this time, as many as 6 joints. He is bad case of chronic tophaceous gout, with crops of urate deposits, 5X6 cm masses over the hands, elbows, knees and ankles. Dehydrated and irritable, he would only take the medications he was familiar with but had poorly complied. Suggestions to bring in a physical therapist and to call another doctor for his other problems were met with a flat no. Arthritis improved over the next 7 days, but by the 10th day, he still refused to budge from bed due to pain. Finally, I decided to  give an antidepressant. He was smiling the following day (!) and was moving his lower extremities, finally sitting up and dangling legs on the 12th day. He consented to calling the second doctor to check his other problems. It could not have been just the arthritis treatment - the overall recovery was amazingly fast. While anecdotal, it validated what I long wanted to do- treat the patient and not just the arthritis.

One sees the importance of recognizing mood disorders that accompany medical problems that cause prolonged pain. Additional treatment for such disorders may actually make sending a happier patient home easier.

Of Gout and men

     Gout is known as the "disease of kings", as it is wont to affect high profile statesmen, intellectuals, athletes, artists and actors, and practically anybody's who's who. It is also said to be the "king of diseases", in the intensity of pain and disability which are its hallmarks.

      Looking at the following persons plagued by the gout, one might hypothetically ask how the world would have been, had these men not have the gout.
(from: 8 famous people with gout, http://www.health.com/health/gallery/0,,20451892_9,00.html?)

       King Henry VIII, Benjamin Franklin, Samuel Johnson are among the best documented pre-20th century cases of the gout.  





It is said that King Henry VIII was infamous for both his head-chopping spree, and his gout malady. Without the gout, would his queens have kept their heads?

Benjamin Franklin, inventor and statesman, who was famous for  drafting the Declaration of Independence of the United States of America, was infamous for the absences he made during the drafting due to the gout. The Declaration of Independence is one of the world's greatest document, complete in content and intent, but as an inventor, could he have made other great inventions?

British author and poet, a top man of letters, seemed to have a mild form of gout, 'which never climbed above the ankles". He probably also had Tourette's syndrome. Would he have written greater works and expanded his Irene or Vanity of Human Wishes ?








Gout affects such illustrious names, so that if you have the gout, surely, you are in good company.

Come home to Haiku Home

Just in March of the year 2012, I was introduced to Haiku, (re-introduced perhaps) by a cousin who had nothing better to do while recuperating from illness, but to write her experiences in 5-7-5 graphic scenes that got me hooked. How soon she recovered is a testimony of how art therapy can work wonders!

As a medical professional in my almost-retirable years, I sought the "comfort" activities of my younger years, like playing the piano. It all went well for 3 years with one recital to my belt -  a general class recital with small children, and I was last number to play in the program. On my 4th year however, as my piano teacher patiently prepared the simpler of  Debussy's, a bad carpal tunnel syndrome struck, first my right dominant hand, then the left, (like the rheumatism knew exactly who to afflict). Having treated many patients with the malady, I could hear myself say, "rest for the hands and fingers from avoidable activities is first line treatment, otherwise, you will either receive an injection to the wrist or get the part opened up".

Haikus came as a welcome respite. Yes, I still have to write or type the poems, but this art form is less finger intensive in terms of force and repetitive motion. Soon, my cousin and I exchanged haikus daily through SMS, writing them down at the same time on notebooks. Friends started to join in, too. 

I told a friend that to write haiku is to breath, a brief moment with almost no thought taken,  just short punctuations of observations about nature, experiences, so short that the only imagination allowed is that of the reader's. The poet pens thoughts down in 5-7-5 cadence,  with no burden to explain, leaving the scene to someone else.

 

We now invite you to +Haiku Home . Come one, come all haiku-ers!

Ethnic preponderance of some important joint diseases

Behcet's Syndrome - Turkish, Mediterranean and Arab, Japanese
               Behcet's syndrome affects both men and women almost equally and manifests with painful mouth and genital ulcers, eye inflammation, arthritis and in severe forms, can involve the heart, brain and lungs.
     



Osteoarthritis - most ethnic groups worldwide
               Osteoarthritis is the most common joint disease of persons above 40 years of age. It affects  the joints of the fingers and knees but is most debilitating when in the knees and  hips, causing pain on walking. Osteoarthritis of the hips is reported more among Scandinavians/Europeans and less among Asians.




Gout - Polynesian, Chinese, Southeast Asian, Caucasians
               Gout is a severe, recurrent inflammation of one or more joints, most often in men. It is associated with high blood uric acid levels. It is reported to be related to lifestyle and obesity especially among Caucasians. Among Asians, gout is known to be due to problems in the elimination of uric acid by the kidneys. Uric acid deposits can cause masses to grow over joints and soft tissues in many parts of the body.




 Rheumatoid Arthritis - worldwide but probably more diagnosed among Caucasians

                Rheumatoid arthritis affects more women than men and affects more joints -  shoulders, elbows, wrists, hands, knees, ankles and feet and severely restricts most daily activity due to pain and stiffness, and later,  joint deformities. More severe forms can affect the lungs, eyes, heart and blood.

Lupus - Latin Americans, American Blacks, Southeast Asian
                Systemic lupus erythematosus or lupus is a form of arthritis that affects more women than men, and is also systemic, affecting the kidneys, skin, blood and joints simultaneously or appearing in a progression. Severe forms can also affect the brain, lung and heart. Severe disease are reported more among colored people.






Spondyloarthropathies including psoriatic arthritis, inflammatory bowel disease - Scandinavians, European ethnicity, Chinese
               This is a group of arthritides that affects the spine in younger individuals, causing back stiffness, hip pain and can also be associated with eye disease that can cause blindness in some cases. It can come with inflammation of the bowels causing repeated diarrhea,  inflammation of the skin and with the scaly rash of psoriasis.
             

This list is short and focuses on diseases that can affect many body organs and also cause severe disability due to pain, joint deformity and organ damage. The need to see a rheumatologist is emphasized, seeing that many of these arthritides affect many organs of the body and requires special forms of treatment.


All photos by Google Images

2012

2012 saw past December 21,  it is an old year now, with the remaining 10 days in a frenzy build-up for the next dated new year, 2013.


2012 saw in this Blogger 19 blogs -  from Thoughts on the new year to short expositions about osteoarthritis, gout, rheumatoid arthritis,  alternative medicine, back pain, sleep and inflammation, meetings in Jordan, and thoughts on aging.







                   




2012 saw Chikungunya fever outbreak in the Philippines and in my home, the "break bone" fever becoming real break bone (fracture) of my daughter with the Chikungunya arthritis severe enough to cause her to fall one day.

2012  saw my mother turn 90, outlasting friends (and perhaps foes alike), continuing to serve as auditor of the local association of senior citizens, getting crankier as her sharp mind blunts away and her quick body ever slower.


2012 meted out a personal warning, with two falls, only 10 days apart, for me to be more careful.




2012 saw a protracted Arab spring in Syria (dragging through summer, autumn and winter of 2011 and 2012) and the possibility that Damascus, the longest living city which has not been sacked or destroyed through all waves of empires it rode, may actually lay flat in ruins, desolate; and elsewhere in the Middle East, wars and rumors of wars.

2012 saw Europe do balancing acts for the teetering economies within, London's success as host of the Olympic games, a royal wedding; America re-electing Obama and hoping to survive the "fiscal cliff" and the burden of a wave of gun-related violence that killed innocents; Latin America preparing for another World Cup; African countries holding fast despite its cauldron of famine and share of wars; the "awakened" giant of Asia asserting its numbers, and the hermit kingdom handing power over  - nuclear at that, to a young progeny.

2012 saw earthquakes everywhere, storms, tornadoes and floods of "strange" dimensions.

Then I smile as 2012 saw hope - Aung San Suu Kyi, ever poised, with flowers in her hair, finally fly and take to wings. This phenomenon has shown how transformation is possible in unexpected places, like the rigid, inflexible mold of a military junta. A generation of leaders pass, the new generation decides to change for the greater good and for their own sakes.



The world will continue till its set time so 2012 is able to fold in its arms the bits of history it has collected. It will then add them to the Library of Man that contains what has been known since the beginning of time.

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!

Of Robot Mornings and 24/7 pain...

Morning experiences vary - you can have a jolt, or a lazy, dragging type, maybe a hangover headache, or the best...a pleasant refreshed feeling where bird tweets are musical and ethereal.These feelings wane off as the day goes, taken over by the concerns of the day.

Mornings for people with rheumatoid arthritis  is decidedly different. The joints of the hands, wrists, elbows, shoulders, knees, ankles and feet are painful and stiff - getting up is slow and robot-like. Being young to middle age and female does not help. Mornings are about being up and going -  for kids getting ready for school, for that new job assignment, that trip, the upcoming dinner with the boyfriend... the works. Many can be mislabeled as acting out or lazy. This is the age when life is at its peak, productively and reproductively!

photo from Microsoft clip art

Add to this the fact that the pain stays for the rest of the day and on to the tomorrows. What do we do when we have a headache or toothache or even other forms of arthritis? We take a pain pill and expect the pain to go. With rheumatoid arthritis, its a 24/7 proposition of pain and stiffness, which improves a bit with movement and activity, but comes back especially after resting.

Rheumatoid arthritis patients can avoid both the emotional and physical ravages of the illnes, through proper treatment. A rheumatologist should be the health care provider to consult. Check out one near you!

In the Philippines, check out: www.philippinerheumatology.org

  

Thoughts on aging... A tribute to Mama

My mama is hitting 90 in 2 months and 5 days!

She:
         maintains:   a facebook account (with a little help  with typing from great grandkids),
                             the real "techy" great grandma
         says:           "my thoughts are clear, my memory, a bit slow..."
         complains: "my back, knees and legs are so painful on waking up, and..." (lumbar spondylosis)
         does:           "...without my routine morning stretching exercises, I can't rise from bed" 
         has:             hypertension, too
         eats:            whatever she likes, but notes not really feeling hungry, just vague fullness : /
         hollers:        at the dog
         sleeps:        odd hours, but sleeps well
         hates:          street urchins that steal her mangos or throw stones
         serves:        as auditor (active) of the Senior Citizens group of our baranggay
         observes:    that she seems not to fear death, because Jesus is in her heart
         loves:          her children (2), grandchildren (6) and great grandchildren (6)
       
She is TRANQUILINA D. ZORRILLA-GONZALES  (shown here clowning with a red ballpen holder that doubles as toy spectacles :D!)