People who exercise regularly are less likely to get flu – 2018 – ROJoson / RO Joson

Last January 1, 2018, I was about to make a blog announcing my observation and experience that I did not get a flu for two straight years as a result of my daily exercises which I started 2 years ago.  Three years ago and earlier, I usually got flu at least once a year.

I decided to hold my blog and see what will happen to me during the next few days as my wife and daughter were down with severe flu starting January 1, 2018.  My wife had severe coughs, fever, headache and body malaise for about 2 weeks starting January 1, 2018.  My daughter had coughs, headache, and body malaise for about a week.

I tried isolating myself from them but not totally.  I was observing myself.  January 4, 2018, I felt a little sore throat.  I thought that would be the start of my flu.  However, it lasted only one night.  I continued to do my daily walking and flexing and stretching exercises during this time.

On January 8, 2018, my sore throat came back followed by malaise.  I still did my daily exercise but diminished it in intensity (from 3 km to 2 km, from 30 counts to 25 counts). On January 9, 2018 – Tuesday – Quiapo Day (good I canceled my clinic session and operation), I was already having productive cough, runny nose and body malaise.  I decided not to do exercises anymore. I also did not do exercises on January 10, 2018.  However, I noticed cessation of colds and decrease in intensity of my cough and body malaise.  On January 11, 2018, I went to work – operation at 7 am and clinics from 10 am to 1 pm.  I resumed my walking and stretching and flexing exercises but still diminished in intensity.  It was only on January 12, 2018, when I felt I had fully recovered that I brought back my walking exercise to 3 km and stretching and flexing counts to 30.

There you are – a total of 2 to 3 days down from flu after being infected by my wife and daughter but with mild symptoms. I am happy to reaffirm what I said in March 20, 2017 –

People who exercise regularly are less likely to get upper respiratory tract infections

I wrote this blog on March 20, 2017.  I like to extend it to flu.

People who exercise regularly are less likely to get flu.

People who exercise regularly are less likely to get upper respiratory tract infections and flu or if they do, the symptoms are less severe.

Pls. read my blog of March 20, 2017.

Here is an excerpt from Webmd (2017) – Exercise and the Common Cold

https://www.webmd.com/cold-and-flu/cold-guide/exercise-when-you-have-cold#1

If you’re looking for a safe way to prevent colds, regular exercise may be the ticket. And you don’t have to run a marathon, either. Moderate activity is all you need.

Exercise improves your overall fitness, which can help boost your immune system — the body’s defense against infections.

Some studies show that “moderate intensity” exercise may cut down the number of colds you get. That type of activity includes things like a 20- to 30-minute walk every day, going to the gym every other day, or biking with your kids a few times a week.

In one study in the American Journal of Medicine, women who walked for a half-hour every day for 1 year had half the number of colds as those who didn’t exercise. Researchers found that regular walking may lead to a higher number of white blood cells, which fight infections.

In another study, researchers found that in 65-year-olds who did regular exercise, the number of T-cells — a specific type of white blood cell — was as high as those of people in their 30s.

 

ROJ@18jan16

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If you’ve thought about breast cancer …

If you’ve thought about breast cancer …

A Breast Self-Examination Brochure

Reynaldo O. Joson, MD

Circa 1985

Breast cancer is the most common type of cancers that afflicts Filipino women.

It is killing many Filipino women because these cancers are usually discovered late and they are usually treated late.

At present, no one knows exactly what causes breast cancers.  So there is little anyone can do to prevent it.

But it is known that breast cancer is most treatable and curable when the tumor is small.

So, your best chance against breast cancer is to discover it early while it is still small and have it treated as early as possible.

The best and the most practical, and the most economical way of detecting breast cancer rests in a health habit called breast self-examination (BSE).

You examine your own breasts regularly at least once a month, so that you become familiar with the usual appearance and feel of your breasts.  Familiarity makes it easier to notice any change in the breasts from one month to another.  Early discovery of a change from what is “normal” is the main idea behind BSE.

If you are menstruating regularly, the best time to do BSE is one week after your period ends.  This is when your breasts are least likely to be tender or swollen.

If you no longer menstruate, pick a day, such as the first day of the month, to remind yourself it is time to do BSE.

You can do your BSE while you are taking a bath or at anytime at your convenience.

If you find something unusual or abnormal, consult a breast specialist for an examination.

Most breast lumps are not serious, but all should come to the doctor’s attention for an expert opinion after appropriate examination.  Only a physician can make sure of the diagnosis.  So see him right away and give yourself a peace of mind.

If it’s cancer, chances are you have discovered it early.  With early treatment, this can save your life.

Breast self-examination (BSE):

A breast check

  • so simple
  • costs nothing
  • yet so important
  • and life-saving!

Keep up this important health habit for the rest of your life.
Reynaldo O. Joson, MD

ROJ@18jan15



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ROJoson as a Primary Physician

Today, January 13, 2018, a physician-patient, in her mid-60s, asked me point-blank: “Rey, can you be my primary physician?”  I was taken aback when she suddenly asked me this question.  One, I know she knows that I am a surgeon.  Second, I was wondering what she meant by “primary physician.”

Primary physician as I know it is the main physician of a patient for whatever health problem he / she may have.

I googled it tonight (January 13, 2018).  I cannot find a good definition of primary physician.  What I saw were mostly definitions on “primary care physician.”

Free Dictionary defines it as “a physician, such as a general practitioner or internist, chosen by an individual to serve as his or her health-care professional and capable of handling a variety of health-related problems, of keeping a medical history and medical records on the individual, and of referring the person to specialist as needed.”

When I asked my physician-patient what exactly did she mean “I will be her primary physician,” she answered me just like Free Dictionary defines a primary care physician, except that I am surgeon.  I asked why me as I am not a formal general practitioner or internist?  She said she is comfortable with my mindset as a physician and as a person.  Specifically, she said we have the same wavelength; we are aligned in term of mindset.  Furthermore, she said, I already have her medical history and medical records.  In addition she said she has full trust and confidence in me.  She has been consulting me for more than 20 years.  Aside from her, she would bring all the members of her family to me, daughters, nieces, and maids.  Actually, I was de facto a family physician to her family.

She said I could refer her or any of her family members to other specialists as needed.  But, I will be the first and main physician.   She added she will put up an advance directive soon and will discuss this with me.   She wanted me to be the “implementor.”

We parted ways with my agreeing to be her primary physician or primary care physician.

ROJoson as a primary physician?  A primary physician for a single patient?  A primary physician for a family?  Why not?

As the primary physician and if the medical condition is within my expertise, patient and family should trust my ROJoson’s Way –

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As the primary physician and if the medical condition is not within my expertise, I will refer but I have to make sure value-based health services and patient experience are being rendered by the referred physicians.

I will have to orchestrate the medical management if there are multiple specialists involved and make sure value-based health services and patient experience are being rendered by all physicians.

As a primary physician, I will have to meet the expectations of my patient but tempered with a shared agreement between my patient and myself .  This should include the advance directive.

From hereon (starting January 13, 2018), I resolve to develop a program ROJoson as the Primary Physician.  This will complement the program ROJoson as the Holistic Physician-Surgeon.


ROJ@18jan13

 

 

 

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Telemedicine includes physician’s telephone conversations with a patient

Recently, I called up two patients by phone while they are admitted in the hospital since I could not make rounds.

Patient one – post-mastectomy patient whom I operated a day before I called her up by phone and told her she could go home the following day.  I visited her 6 hours after the operation. On the following day, I called her up by phone as she was preparing to go home.  I asked her how she was, gave further instructions, and answered her queries.

I think this telephone conversation constitutes telemedicine.

Patient two – post-exploratory laparotomy and adhesiolysis for intestinal obstruction, 3rd day postop, still confined in hospital, recovering.  On the 3rd day postop, since I could not go to the hospital (my surgical residents were taking care of her too), I called her up by phone to ask her how she was that day and if she passed out flatus already.  She said not yet.  We agreed not to remove the nasogastric tube yet.  She wanted an abdominal binder to which I agreed.  We agreed that she should ambulate more.  We also agreed on plans for the next few days.  I told her I could not make a hospital visit on that day.  She said it was alright.  She said my calling and talking to her by phone could substitute for the hospital visit.

I think this telephone conversation constitutes telemedicine. 

My TPOR (Thoughts, Perceptions, Opinions, and Recommendations):

Telemedicine includes physician’s telephone conversations with a patient and his / her relatives as long as the conversations are on the topic or matter on the management of the patient.

To extend it further, telemedicine includes physician’s conversations with a patient and his / her relatives using cellphones, email and social media as well as long as the conversations are on matters on the management of the patient.

ROJ@18jan7

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Breast Cancer Survivor Maria Buella – 26 Years in Remission

Today, I was surprised to see a former patient of yesteryears.   She had not seen me for a long time.  She came all the way from Samar to have a check-up with me for her swollen leg.

Then, Maria Buella, now 68 years old, told and thank me for what I did in 1992.    I did a modified radical mastectomy for her breast cancer in the Philippine General Hospital in September 30, 1992 (she cannot forget the date – I don’t have her records anymore).  She was 43 years old then.  She did not receive any additional treatment after her operation.  She is now 26 years in remission.  We both thank God for this long remission.  (Published with permission from patient and daughter.)

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ROJ@18jan4

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Psoriasis and Cancers

There are reports saying that patients with psoriasis have increased risk for other cancers.

https://www.healthline.com/health/psoriasis-cancer#2

I have a patient (BA) who is now in the 80s who has breast cancer in 1998 before the appearance of her psoriasis and who went on to develop another breast cancer in 2011 (on the opposite side) and then basal cell carcinoma in 2017 (skin cancer on the trunk).  A wide excision of the skin cancer was done after no response to topical steroid medication for 2 months.  Because of black color, I initially suspected melanoma. However, histopath showed basal cell carcinoma.

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For the skin cancer, it is said:

“Research does suggest that the use of ultraviolet light therapy to help heal psoriasis patches may increase the odds of developing squamous cell carcinoma—especially in patients who have at least 250 ultraviolet light therapy treatments.”

https://www.healthline.com/health/psoriasis-cancer#2

ROJoson’s medical plan for the patient:

Will closely monitor development for other skin cancer as well as other cancers.


ROJ@17dec24

 

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Classification of Wounds – Guides to Antibiotic Prophylaxis

Wound 1 – Clean wound: An uninfected operative wound in which no inflammation is encountered and the respiratory, alimentary, genital, or uninfected urinary tracts are not entered. In addition, clean wounds are primarily closed and, if necessary, drained with closed drainage. Operative incisional wounds that follow nonpenetrating (blunt) trauma
should be included in this category if they meet the criteria.

Clean uninfected operative wound: Clean wounds are primarily closed and if necessary, drained with closed drainage.

Wound 2 – Clean-contaminated: Operative wounds in which the respiratory, alimentary, genital, or urinary tracts are entered under controlled conditions and without unusual
contamination. Specifically, operations involving the biliary tract, appendix, vagina,
and oropharynx are included in this category, provided no evidence of infection or
major break in technique is encountered.

Wound 3 – Contaminated: Open, fresh, accidental wounds. In addition, operations with major breaks in sterile technique (e.g., open cardiac massage) or gross spillage from the
gastrointestinal tract, and incisions in which acute, nonpurulent inflammation is
encountered including necrotic tissue without evidence of purulent drainage (e.g., dry
gangrene) are included in this category.

Wound 4 – Dirty or infected: Includes old traumatic wounds with retained devitalized tissue and those that involve existing clinical infection or perforated viscera. This definition suggests that the organisms causing postoperative infection were present in the operative field before the operation.

Source: Procedure-associated Module SSI, CDC, January 2016



As a rule, clean wounds and uninfected operative wound do NOT need antibiotic prophylaxis.

Wound 1 – Clean wound: An uninfected operative wound in which no inflammation is encountered and the respiratory, alimentary, genital, or uninfected urinary tracts are not entered. In addition, clean wounds are primarily closed and, if necessary, drained with closed drainage. Operative incisional wounds that follow nonpenetrating (blunt) trauma

should be included in this category if they meet the criteria.

Clean uninfected operative wound: Clean wounds are primarily closed and if necessary, drained with closed drainage.



As a rule, antibiotics are indicated for contaminated and dirty or infected wounds.



Antibiotics may or may not be given for clean-contaminated wounds depending on the degree of contamination and the potential for infection.


ROJ@17dec23

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