Wala lang, perpective pics kunwari, using a digicam, the legatoscope, and CT plates of a guy with hydroceph…

Just received my first paycheck as a “Medical Officer III,” employed by the Republic of the Philippines-University of the Philippines-Philippine General Hospital. And now that the customary treat for the more senior residents and the required contribution for bills at home are already done/paid, it’s time to contemplate what to do with the rest of what the government has decided to compensate for my (rather amateur) services as a physician. Do I:

 [  ] buy a laptop I can use to make the 7 mortality presentations I need to finish by the end of the month? (correction, 7 and running, since Feb is not yet over)… I’m eyeing the white ultraportable eeePC:

[  ] buy a dual-SIM phone I can use to call my family and friends (Globe) and co-residents (Sun), without the hassle of having 2 bulky phones in my blazer pocket? The stylish myPhone Slyder is at the top of my list:

[  ] buy the latest edition of Adams’ Principles of Neurology? So that I won’t fail the next exam? (or else, Sunday duty ang katapat).

[  ] buy a new Littman branded stethoscope? I lost mine in the Pay wards last month, and I’m now using a cheap imitation (works great, by the way, so this item is at the bottom of my things-to-buy).

Or, I could be really childish and buy something totally unrelated to work… like my own Playstation!

It’s shopping time!!!

I hate to say it, I hate to admit it… but this blog is probably dying. More specifically — and very ironically – it’s suffering from brain death. It still exists physically (aha, but whether internet space is physical is one other question to dissect), it still has visitors (paambon-ambon, hehe), it still is a blog in the most skeletal definition of what a blog is… but really, there’s no new activity, no recent creative output, and the electrical impulses signaling excitement have long since left it. GCS 3.

Side note, the CT Scan in PGH is still non-functional (for about 1 month now), so if you’re going to have a stroke, drop by Mediscan first to have your scan done before heading to the PGH ER for admission. It will save you (and me) from a lot of hassle later on. Thanks.

My social life recently has been limited to visiting patients, interaction with the friendlier consultants (I try to hide from the scary ones), and playing PSP (actually an alone-activity, but at this point, any respite from hospital work would qualify as socialization). Of the three, it is obviously the last that I enjoy the most. Especially since I rediscovered that the PSP reincarnated one of my favorite Playstation games of all time… PaRappa the Rapper! In this video PaRappa is being taught by Instructor Mooselini to drive and rap at the same time (my personal favorite, Stage 2):

Excerpts from the wiki entry for PaRappa the Rapper (sorry, tamad):

Released in the mid 1990s, it was one of the first rhythm video games of its time. While the gameplay is simplistic on a certain level, the game is remembered for its unique graphic design, its quirky soundtrack, and its bizarre plot. The game is named after its protagonist, PaRappa, a rapping dog, with the motto “I gotta believe!”…

Considered revolutionary in its day, PaRappa the Rapper is fundamentally similar to the classic 1980s game Simon, in which the player is required to repeat a sequence of sounds and light. PaRappa the Rapper demands that the player not only get the sequence correct but also the timing of the sequence. The game provides small portions of spoken vocals that are triggered when the appropriate buttons are pressed. Pressing the buttons in the correct order, with the correct timing, provides an intelligible imitation of rap, while pressing the buttons in an incorrect order or with lousy timing rewards the player with nothing more than unintelligible garbage…

The player takes on the role of PaRappa, a paper-thin rapping dog. He is trying to win the heart of a flower-like girl named Sunny Funny. He is aided by his friends Katy Kat (an enthusiastic cat) and PJ Berri (a fat teddy bear DJ with a huge appetite). Also vying for Sunny Funny’s attention is PaRappa’s arch rival Joe Chin, a rich, narcissistic dog…

To impress Sunny Funny, PaRappa learns to fight at a kung-fu dojo, takes a driver’s education course to get his license, learns the art of flea-market training to raise money for a new car, bakes a seafood cake, uses the bathroom, and finally, performs a hip hop song on stage at a party…

Oha! Check out the super cool official website for videos, pics, fan art, and lots of PaRappa stuff!!! Ka-addict to, promise!

Starting today, I’ll be posting interesting stuff related to my chosen specialty (Neurosciences) that I find on the net in a series I’ll call neuroyloy in aloyloy. This serves two purposes: 1. to promote Neuro as an alternative to boring old residency programs (calling all medical interns out there still deciding where to go after the Boards… join us in Neuro na lang!); and 2. to prevent this blog from CODING (ie, flat-line) while I am in first year (ie, while I am the slave of all slaves in the department, at the bottom of the totem pole, jingle lang ang pahinga). So, even when I’m too busy with hospital work or too tired to post, you, dear loyal readers (yes, the 3 or 4 of you) will have something to aloyloy about.

The first of this series is a very interesting article from The Guardian about what I think is one of the most complex diseases known to man, epilepsy. I remember that there were many instances in the past when, while I was in Church, or at a dine-in, or even while I was lounging at the beach (yes! true story!), a PWE (Person-with-Epilepsy) near me suddenly seized. All these events I took to mean that I really belong to Neuro. Here’s the article, pasted without permission from The Guardian’s website (I cite Fair Use):

Earthquakes may hold clues for treatment of epilepsy
Alok Jha, science correspondent
The Guardian, Thursday January 10 2008

Earthquake-prediction techniques could help develop a way to forecast epileptic seizures, according to research which found striking similarities between the electrical activity in the brain before and during seizures and seismological data around earthquakes.

Both are usually preceded by small, barely detectable tremors and, as with an earthquake, the longer it has been since a seizure, the longer it will be until the next one. According to scientists, these shared features mean that the patterns are not random and could even be governed by similar mathematical rules.

Epilepsy comprises a set of conditions which disrupt the electrical activity in the brain and the main symptoms are recurrent, unprovoked seizures. It is one of the most common long-term neurological disorders, affecting 456,000 people in the UK and around 50 million worldwide.

The condition can often be controlled by drugs that damp down the brain’s electrical activity, although surgery to remove the affected part of the brain is sometimes used in the most hard-to-treat cases.

Seizures often start suddenly in a region of the brain and can then spread to engulf the organ. An earthquake also appears as a sudden, potentially damaging vibration focused around a relatively well-defined point. The researchers said both seizures and earthquakes could be thought of as “relaxation events”, in which accumulated energy is suddenly dissipated.

In their study researchers led by neurologist Ivan Osorio from the University of Kansas showed the frequency of both earthquakes and epileptic seizures could be described by “power laws”, which can often explain the frequency of events that, on the surface, seem random. In earthquake prediction power laws link the size of an individual quake with the time that passes between quakes of that size.

Osorio suggested that the similarities between electrical activity in the brain and seismic activity could bring prediction and prevention of seizures a step closer. “This suggests a novel research direction for the prediction of seizures based on the notion that seizures beget seizures,” he wrote in a paper uploaded to the Arxiv website, where scientists swap research findings before they undergo peer-review.

Matthew Walker of the experimental epilepsy group at University College London told New Scientist magazine that the research was an “attractive concept”, adding that “a good predictive method could revolutionise people’s lives”. But he cautioned that the Kansas team had yet to show that its method worked in practice.

Aloysius Domingo, MD
A> Neuro first-year resident
Chronic fatigue syndrome

Admitting Orders
January 1, 2008

> Admit to Ward 5 under PGH Adult Neurology service
> Secure consent for admission and for 4 whole years (and possibly more) of toxicity
> Diet: diet as tolerated but mostly PGH canteen food or fastfood
> IVF: none for now, will insert once with dengue secondary to callroom mosquito bites
> Monitor NeuroVSq3days (ie, everytime mag-postduty), WOF decrease in sensorium
> Monitor I&O qshift and record, refer if already urinating coffee
> Diagnostics: [ ] CXR-PA upright — baseline, in case mag-pulmo eff 2dary to PTB
                      [ ] plain cranial CT Scan STAT – R/O first-duty stroke
> Therapeutics: start ChartRounds 25mg tab 1 tab PO bid x forever
                               ServiceRounds 100mg cap 1 cap PO q3days x forever
                               ConsultantRounds 1 amp IV qweekly, WOF hypersensitivity rxn
                               OPD neb 1 neb twice a week
> May give diazepam 1 amp IV PRN for frank seizures during rounds
> Self to ensure meds are given, else will be kicked out of program
> Limit social life
> Refer to Psych for evaluation and co-management
> WOF hypertension (when in Charity Svc), WOF pedal edema (when in Pay Svc)
> Close watch please, for standby intubation
> Inform family and friends once admitted, because they might think he disappeared
> Refer PRN

RIZAL, MD
Lic No 000001

Yesterday was Rizal Day; today is new year’s eve; and tomorrow is my first day as a resident physician at the Philippine General Hospital.

So many have inquired about this choice of mine, to stay in the Philippines, and to undergo residency training here.

There is no doubt that there are more financially-rewarding opportunities abroad. There is also no doubt that the programs in first-world countries are more modern, and represent best practice. All in all, there is no question that career-wise, migration and specialization in a hospital in the developed world is the more logical choice. No wonder there is the phenomenon of health professional migration: currently, the push and pull factors balance out logically in the direction of travel and training abroad.

The caveat here is, what is logical is not always what is most rational, especially under very dire circumstances. The dictum after all is Omnia Supra Ratio, “Reason Above All,” not “Logic Supersedes Everything.”

I refuse to pass judgement on those who choose to go; to each his own. I am sure they have very important reasons why they are opting out of the Philippine health system. I have no right to judge, because I myself am not sure that I will be staying until the very end. Right now though, considering all the considerations there are, I just can’t leave this country behind… even if it means a less comfortable life, even if it means slower professional progress, even if it means refusing the logical choice of going abroad to train.

I bet Rizal also faced a similar dilemma in his time. As a wealthy ilustrado, he had the capacity to study and to work abroad (he actually did). As a citizen of the world, he also had the opportunity to forever leave the country and be comfortable and safe. But he always came back. He wrote about life in the Philippines (dire then, dire now) and he emphatized with those he left behind. He went back to share to his countrymen the things he learned abroad. He eventually got killed for his patriotism (slash hard-headedness).

If there was one thing that stuck from the address given by Rizal historian Ambeth Ocampo when he spoke to our graduating class last April, it’s this: Rizal was not a very good doctor during his time; he actually mismanaged and even killed a lot of his patients… yet we call him Hero.

(Photo above: Notebooks I will use for residency! Standard Best Buy record books bought from National Bookstore, with the labels replaced by stickers from Team Manila… The Sunday Inquirer Metro headline was very apt: “… looking for a few good men”)

2008 is just around the corner and it’s about that time of the year again for me to get a new planner (quite a requirement for a semi-OC person like me). Last year and the year before and the year “before-before” (hi to my Comm I/II Prof, Ma’am Gavino of UPM at this point, who finds the distinctly Filipino phrase “before-before” weird), I used Starbucks planners. It was quite easy to get them then; I was still a med student and the stickers overflowed with each exam that went my way (at worst, there could be 4 exams in a week). This year though, the stickers were more difficult to complete (reason 1: unemployed state, reason 2: no more exams, reason 3: tachycardia), so I had to find an alternative, especially since by 7AM of January 1, 2008, it’ll be all systems go for a full year of toxic work c/o the PGH Department of Neurosciences for me (gawd!). Good thing I found the Jollibee planner. As it turns out with my critical appraisal (which follows), it seems that the Jollibee planner is not just a decent alternative, it’s even a better datebook than the one from Starbucks!

Cover
One doesn’t judge a book by its cover… planners exempted:

Starbucks: Made of soft, dark brown leather (if you are to believe the barista I talked to, it’s real leather made of cow hide), the cover is actually too soft such that if you put it inside your bag, the edges can be folded causing the leather to be creased. Additionally, think of the environmental cost: the cover is made of cow hide (poor Moo!) plus it’s probably tanned using toxin-containing, water-polluting dyes. Plus points for the cool, preppy strap though.

Jollibee: made of pressed cardboard (thus probably recycled and eco-friendly), it’s fold- and crease-resistant, and it appears very sturdy (it will probably last the whole year with minimal wear and tear signs). The cover design is an artistically-done abstract full of reds (very Jollibee, very aloyloy), and there is a nice collage of Jollibee images on the inside.

Winner: Jollibee!

Binding
Binding is very important (lest you want the pages to scatter by August 2008 — lucky pa naman dapat ang 8/8/08). Comparing Starbucks planners through the years, I think the best was their 2006 version (?) which had a simple black cover and bookbound pages.

Starbucks: ring-bound.
Jollibee: bookbound.
Winner: Jollibee!!!

Planner Pages
Judging from look and feel, the two planners have similar paper/material. Differences with respect to planner pages are:

Starbucks: Limited space for weekends (half of what is alloted for notes during the weekdays… does this imply that Starbucks-planner users have more busy workday skeds?). There is a “Notes” page at the end of each monthly section.

Jollibee: Equal space alloted for each day of the week (for a more balanced life daw). There are 3-5 “Thoughts” pages at the end of each monthly section. Plus, each weekly spread has a notes area somewhere on the spread. Thus, the format is great for daily (ie, what to do for the day), weekly (ie, projects due sometime during the week), and monthly planning (ie, monthly budget). The December section has 7 notes pages… perfect for making Christmas wishlists/giftlists (hehe, kakatapos pa lang ng Pasko, yun na kaagad iniisip ko)!

Winner: Jollibee pa rin!

Freebies
I will admit that one the major come-ons for the previous versions of the Starbucks planner were the freebies that came along with the datebooks. There were years when the planners came with either gift certificates, or stickers, or coupons, etc. Let’s see what’s in store for us this year:

Starbucks: an unsharpened pencil.

Jollibee: There’s a full sheet of coupons that Jollibee fans like myself can use for the whole year. Save 10 pesos on a Chickenjoy meal in January, or get two Chickenjoys for just 100 pesos in Feb… Get pancakes and fries for just 40 pesos in March, and get a FREE Choco Sundae in March! The list goes on and on! One whole year of Jollibee fun!

Winner: Jollibee syempre!

In Celebration of…

Starbucks: 10 years of Starbucks in the Philippines.
Jollibee: 30 years of Jollibee! Yay!
Winner: Jollibee!

Charity

Starbucks: For every planner redeemed, Starbucks donates a certain amount to SparkHope, a UNICEF program that promotes early childhood development in the Philippines.

Jollibee planner: Every planner comes with a raffle ticket; 10 winners will win 30,000 pesos each! This amount can be donated of course to charitable institutions, or better yet, to my NGO project for early childhood development!

And the overall champion is (all together now):

J (J!) O (O!) double L (double L!) I (I!) B (B!) double E (double E!)… It’s Jollibee!!!

(Poking fun at my friend Manggy’s blog today)

The traditional Filipino christmas celebration involves the preparation and partaking of what is usually a large, lipid-laden, stroke-inviting Noche Buena feast during Christmas Eve (I’ve heard stories of dogs suffering from strokes after begging for scraps at the Noche Buena table!). And while the actual event (ie, eating time) is a very happy time for everyone, the activities some hours prior are usually toxic and stressful. Grocery lines start snaking and become kilometers long, taxis become rare commodities, pots and pans have to be brought down from places you didn’t know existed… all this culminating in a mad dash of cooking/preparing the usual suspects (in our family, they’re spaghetti, ham, and fruit salad).

So this year, our family decided to be practical (read: lazy) and instead of tiring ourselves with hectic cooking, we spent the 24th doing our last-minute shopping; then we just had our Christmas dinner outside (we also had loads of Friday’s Fun taking pics).

Still, Christmas didn’t seem complete without at least a semblance of a potluck meal. Hence, upon arrival at home, I prepared my very own contribution for our Noche Buena Dessert: Strawberries and Cream. The recipe follows (no, it’s not from Jamie’s Kitchen; he wouldn’t dare make a dish this complex):

1. Whip some cream, add some condensed milk.
2. Chuck in chopped strawberries.
3. Enjoy!

It’s delicious with Bailey’s. Merry Christmas to one and all!!!

Russia’s enigmatic President AND Prime Minister, modern-day Tsar and overall CEO of the Kremlin Vladimir Putin bests celebrity environmentalist Al Gore and crowd favorite JK Rowling to take this year’s Time Person of the Year recognition.

Photo credit: Platon for Time

The banner story reads:

“… When this intense and brooding KGB agent took over as President of Russia in 2000, he found a country on the verge of becoming a failed state. With dauntless persistence, a sharp vision of what Russia should become and a sense that he embodied the spirit of Mother Russia, Putin has put his country back on the map…“

“… It is ultimately about leadership—bold, earth-changing leadership. Putin is not a boy scout. He is not a democrat in any way that the West would define it. He is not a paragon of free speech. He stands, above all, for stability—stability before freedom, stability before choice, stability in a country that has hardly seen it for a hundred years…“

So what differentiates Putin from our very own human rights-abuser, GMA? Why does he have a popularity rating of 70% while GMA gets another failing mark in the latest survey? (one of many, many bagsaks/lagpaks on her report card, as the PCIJ reports).

“… In his eight years as President, he has guided his nation through a remarkable transformation…” (Note: Gloria is almost 8 years in power now as well). “… A basket case in the 1990s, Russia’s economy has grown an average of 7% a year for the past five years. The country has paid off a foreign debt that once neared $200 billion. Russia’s rich have gotten richer, often obscenely so. But the poor are doing better too: workers’ salaries have more than doubled since 2003…“

Apparently, when people are comfortable, it’s easier to forget human rights abuses, corruption and authoritarianism… And that’s the missing link to your equation, Ma’am Gloria.

Read Person of the Year 2007.