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On Unwanted Pregnancy
Wednesday, June 27, 2007
My first patient this morning is a female in her 20's. She does not appear to be sick but she looks really worried. She asked for a pregnancy test and I readily complied. After a few minutes, the result was in and I told her it was positive. "Oh my God! It can't be true!", she exclaimed."Doctor, I can really feel that I'm pregnant. But I have another problem", she continued. "I don't want to have this baby. Can you do one more thing for me?"

This situation is not new to me. At that point I already knew what she has in mind. She wanted her baby aborted. I told her that I don't do the procedure, and that as a doctor my duty is to protect and preserve life."Please doctor, help me!", she pleaded again and again. She was behaving like a child asking for something from her mom. I firmly said "NO" then I started giving her a lecture on what she should have done if she doesn't want to be pregnant. I then continued with what she is now supposed to do to take care of her pregnancy. She was quiet. I know her mind is drifting somewhere else.

Before I ended my advise I noticed tears rolling down from her eyes. I said sorry for not doing what she wanted me to do. I also told her that I can help her if she decides to go on with her pregnancy. She was silent, paid her bill, and left my clinic.

Countless of young ladies come to different clinics for abortion. Most of them come alone, some come with their husband, others with their parents. Yes, you read it right - the parents.

What kind of parents are they, you might ask. Instead of guiding their child on the right decision, they are even the first to tolerate bad ways. But in most cases it is even the parents who are persistent on their child to undergo abortion. A friend doctor often offer adoption of the baby right after the delivery just so they will push through with the pregnancy.

A friend told me that in Italy mothers prime their daughters on pregnancy when they reach pubertal age. By the time the daughter starts to entertain suitors, her mother supplies her with contraceptive pills. Although this is one way to prevent unwanted pregnancy, its as if the mother is tolerating her daughter to have sex at an early age, which is not good.

Maybe it is lack of knowledge, lack of proper guidance from parents, not having a sense of belonging, or just plain curiosity that drives these ladies to do these things.

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posted by Amelyn R. Rafael,MD @ 7:33 PM   5 comments
What an Experience!
Sunday, June 24, 2007
Yesterday was my first day to teach Anatomy and Physiology in the College of Nursing. Although I've been teaching for nine years in the College of Medicine in LNU, I felt that yesterday was somewhat different. It was a day of firsts: it was our first meeting (Ana-Physio), my first time in the College of Nursing, my first time in a new school, first time to be exposed to nursing students, and my first time to teach for the whole day! It was 8:00AM to 5:00PM class and my gosh it was really tiring!

The day begun with me arriving an hour earlier. I wanted to talk to the Dean but I was informed that she might not come because it was Saturday. So I proceeded to the rooms in the third floor where the nursing students are. Not knowing that there are 2 sections for the same subject, I entered the first room. I have already introduced myself, finished collecting the class cards, and have already started with the lecture when somebody knocked on the door. Oh, it was the Dean in the College! She informed me that I was in the wrong room.

I hastily collected my things and said goodbye to the class. The students we're saddened when they realized that it was a nurse who will handle them. They said that they have wanted a doctor to teach the subject to them and that the reason why they failed was because their former teacher was not knowledgeable with the subject. It was then that I learned that the class which I will handle is a group repeaters, shifters, and transferee s.

When I reached my class, I did the same thing again. When I was already giving my lecture, the class was silent. They didn't want to participate with the discussion and bowed down their heads when asked. What a day to start. To think that most of them are repeaters!

I simplified my approach. I started with the basics of Anatomy just for me to know how deep their knowledge was. Still they cannot answer. What complicated the problem was that some students are taking only the lecture part, for some only the laboratory part, and only a few are taking both. I was shocked!

Anatomy- Physiology is one subject in Nursing and it is composed of the lecture and laboratory parts. What the students learn in the lecture part is applied in the laboratory (practical part). And this means that we cannot separate the two.

I talked again to the Dean. She firmly told me that that's the way it is in their school and that there's nothing I can do. I just wonder how these students will learn their basics with this kind of set-up.

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posted by Amelyn R. Rafael,MD @ 1:52 PM   2 comments
Is She a Good Tutor?
Thursday, June 21, 2007
When I was a child, my mom, who was then a nurse in the Rural Health unit of our town, was my tutor. Every afternoon after her work, we (me and my sister) will gather together in our study table for her to help us with our lessons and assignments. This was always the situation during our preschool and grade school years until we studied in Manila and had to do everything on our own.

This is also what I do with my kids ( 1 in prep and 1 in grade 4). But since oftentimes I'm in the medical school in most afternoons to teach and I arrive home in the evening, I don't tutor them everyday. I spend the whole day of Sunday with them helping them with their assignments, reading in advance, playing with them or preparing snacks during our breaks. It has been this way since Raymund, now in grade 4, started schooling.

As a school physician working in several schools, I noticed that tutoring the kids is not anymore the work of most moms. Maybe it's because most mothers work full-time nowadays that there is no more time left for them to tutor their kids. And this is now the job of teacher-tutors who are mostly teachers accepting tutorial jobs during their breaks or after school hours. In some cases, they are full-time tutors in tutorial institutions.

I see nothing wrong with this set-up though it is important for parents to choose very well the tutors that they give to their child. Every child has a different need. The tutor should be able to identify the child's particular need with regards to his studies and she must able to address it. It is not enough that the tutor just helps the child with his assignments leaving the area where the child is having difficulty unaddressed. A tutor can only perform her job well if she knows where to focus. With the right focus, long hours of study is not needed.

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posted by Amelyn R. Rafael,MD @ 3:19 PM   2 comments
Exercise Motivation
Tuesday, June 19, 2007
Coming from families of hypertensive diabetics, my husband and I make it an effort to shun away these diseases from our systems through the cheapest way we know possible - exercise. That's why my husband and my eldest son enrolled in Garciano Kilat Serrada. This decision is not only for learning self-defense but also because it is a form of exercise.

My own form of exercise is different from that of my family. I do it at home ( in our own gym) utilizing different kinds of CDs ( aerobics, tae-bo, pilates, weight lifting) that I collected over the years. I make it a point to have a variety of exercise from day to day making my muscles respond better and faster. It could be more on the upper body one day, then more on the lower body the next day, then maybe a combination with emphasis on abdominals the following day. Whatever it is, I make it a point to cover all body parts for the entire week. On days when my husband and son cannot make it to Kilat Serrada, they join me at home thus making it a fun-filled activity.

As doctors, we want to make our patients make exercise a part of their daily routine. We feel that through exercise we can lessen the incidence, if not arrest the progression, of the common killer diseases nowadays. And I tell you that motivating them is really the most difficult part. They constantly find excuses just to be able to put it off. Among the common excuses are: not having enough time, no money to enroll in a gym and/or to buy exercise materials like dumbbells, exercise mat, etc.

We start off by just asking them to try even just for two months, at least 3x a week with about 15 minutes per session. We believe that after two months of religious exercise, the change in their health and physical appearance can already manifest. We ask them to do it during their free time while watching the TV. Yes, some patients drop out from exercise. The more health-conscious ones do continue especially after noticing improvements. They are then able to gradually increase the time-duration and frequency of their work outs.

Exercise need not be expensive. It can be done in the comfort of your own home and the materials needed can be improvised. You can do with plastic bottle containers filled with sand if no dumbbells are available, for instance.

Exercise sets no age-limit. My own mom still exercises for an hour 5x a week. And she is still very strong. Of course with the right kind of diet.

Exercise is the key to be able to enjoy life to the fullest. Try it then commit it to life. It is the most that you can do to your body.


posted by Amelyn R. Rafael,MD @ 4:59 PM   2 comments
Understanding Diabetes (Part II)
Sunday, June 17, 2007
How does one know that he has diabetes? What are the symptoms? The most common early symptoms are excessive hunger, excessive thirst, and frequent urination. The diabetic person always feels hungry even with regular meals because the glucose cannot enter the cell so that the cell sends signals to the brain of being hungry. The thirst on the other hand is due to loss of fluid inside the cell because water moves from an area of lower concentration (cell) to an area of higher concentration ( blood vessel). Frequent drinking then results to frequent urination.

The other symptoms like the numbness in hands and/or feet, and change of vision appear later in the condition when the nerves had already been affected. Aside from these, there is weight loss, fatigue, slow healing or non-healing wounds, very dry skin, and more infections than usual. Most of these can be explained by the absence of energy and build-up of glucose in the blood vessels.

What can be done? Control the weight by having a meal plan. It is also good to have regular exercise at least 3 to 4 times a week with at least 15 minutes per session. This will help lose the excess weight or maintain an ideal one. It also increases the body's sensitivity to medications.

For individuals who are: obese, with positive family history, lack exercise, with prior history of gestational diabetes (women only), please don't wait for symptoms to appear before seeking consult. It maybe too late. Act now and have your blood sugar evaluated.

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posted by Amelyn R. Rafael,MD @ 7:16 PM   2 comments
Lucky with My Hubby!
Is it easy to be a dad? I think it's not. Working everyday to provide for the family, thinking always for the betterment of the family, getting up early to bring the kids to school, and making time for the family inspite of the busy schedule... that's my husband, the father of my two sons! He is a father, doctor, driver, body guard, plumber, electrician, houseboy...all rolled into one.

We we're classmates in the medical school. Being seatmates and groupmates (our family names both start with the letter R) in every project, ward work, and assignment, we became close and ended up with each other.

When we we're just starting up with our family life, I found out that he can cook and a very good one indeed! He can also wash clothes and iron them ( he do these when we don't have maids). When Raymund arrived, he was also a good baby sitter! I can count on him at night to prepare the baby's milk or to cradle him and put him to sleep. He is so caring that he watches over the baby the whole night when he's sick. As the kids' grew older, he became their best friend. He always make time to play with them. In fact, he turns down appointments if they interfere with his playtime with them.
As a husband? He is the best for me. He is understanding, very supportive and his love is overflowing. Saying "sorry" is one of his virtues. I may not have the best in life but I'm lucky enough to have the best husband in the world!

To my husband and all the fathers out there...Happy Father's Day!

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posted by Amelyn R. Rafael,MD @ 6:08 PM   0 comments
Understanding Diabetes (Part I)
Thursday, June 14, 2007
What is type 2 diabetes, what causes it, and why does it affect many individuals nowadays? Everywhere we go, it's very common and the number is increasing everyday.

Normally, insulin which is produced by the beta cells of the pancreas, bind to insulin receptors located on the cells of the body. This causes the opening of portals to allow glucose to enter the cell. It is inside the cell where glucose is converted to energy.

Where does glucose come from? It came from carbohydrates, the food that we eat. After a meal, sugars and starches are converted to glucose and is brought in the blood stream, others stored in the liver. This is the reason why our level of blood sugar increase after a meal.

What happens in diabetes? In diabetes, the pancreas produces little or no insulin at all. It also causes the body to lose its ability to respond normally to insulin. We call this insulin resistance. When insulin resistance takes over, glucose will have difficulty entering the cell thereby decreasing the production of energy. This results in accumulation of glucose in the blood vessels which can destroy the different body organs.

What can we do? This will be tackled in the next post of Understanding Diabetes.


posted by Amelyn R. Rafael,MD @ 7:21 AM   0 comments
Will I Greet Him on Father's Day?
Father's Day is celebrated every 3rd Sunday of June. It is during this day when we pay tribute to our fathers for all the good things they have done to us. While this year's Father's Day is fast approaching, one question keep on popping on my mind: Will I greet my own father on that special day?

He lives with his other family (his other wife and their adopted son) for some years now. We rarely see each other though he stays two towns away from us. Our means of communication is either through telephone calls or text messages. I last received a text message from him on my birthday (June 6) just to greet me. No more no less. He never asks anything about his grandsons, or on how we are doing, much more about my mom who lives with me and my family.

My relationship with him is erratic. I guess because we live in the same province where it is impossible not to see him with his other family. Maybe because I still love him not only because he is my father but because I had wonderful memories with him when I was still growing up. Maybe because I idolized him so much when I was still a child. Maybe because....

He is closer to my elder sister who stays in Manila. Oftentimes he would call her and sometimes visits her in her house and stays with her for a few days. It is from my sister that I learn most of the latest happenings about him. Maybe because she is more open-minded. I don't know. All I know is that I feel pain whenever I think of him. This is the reason why I never greeted him on any special occasion.

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posted by Amelyn R. Rafael,MD @ 7:16 AM   4 comments
Feeling dizzy?
Tuesday, June 12, 2007

Most of us, if not all of us, already experienced being dizzy at one point in our lives. Most of the time,what we do is to keep still and lie down with our eyes close. Though avoidance of any movement lessens or spares us with the symptom, this also causes us to miss the chance for cure in the natural way. This means that by not controlling our movement, by just doing what we regularly do everyday, may hasten our trip towards cure.

Dizziness is a very diverse symptom. It can be a symptom of something mild or it can be of something grave. At any rate, dizziness should be given importance and should never be ignored. Whenever dizziness is felt, consult to a physician is needed.

Here are some exercises that you can do when suffering from dizziness. I took it from a flyer given by Solvay Pharma Philippines. Consult first your doctor before performing any of the following:

I. On a bed without a pillow:
1. Sit upright on the bed with your feet also in the bed and look forwards.
2. From position 1, lay back briskly.
3. Look upwards while on your back.
4. Turn head and body briskly to your left side.
5. While on position 4 look forwards.
6. Turn head and body to your right side.
7. While on position 6 look forwards.
8. Turn briskly and lie on your back.
Stay for 30 seconds to 1 minute in each position.

II. Standing:
1. Stand upright and look forwards.
2. Spin once to the left with your left heel.
3. Stand upright and look forwards.
4. Spin once to the right with your right foot.

The above exercises can be performed at least once a day.

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posted by Amelyn R. Rafael,MD @ 3:43 PM   3 comments
We Are a Family of Black Belts
Monday, June 11, 2007
My husband and my elder son, Raymund, got promoted recently from just plain black belts to 2nd Dan and 1st Dan black belts respectively. This is in the discipline called Garciano Kilat Serrada. Kilat Serrada is not a kind of sport but purely self-defense. Here, a student learns empty hand fighting, use of chaku, penjak, and arnis as defense, knife-fighting and how to defend yourself at gun-point.

You might be wondering why the need to learn self-defense? In this day and age, more and more people get hold-upped, injured or worst killed in the streets any time of the day. Meeting situations where they could have protected themselves end up in a bad way just because of not knowing what to do.Knowing something about self-defense can change the outcome of events and may even save lives.

One day, as Raymund grows older, he will find his own place under the sun and will be away from us. Knowing that he can protect himself gives us peace of mind.

I was the photographer during that day. I also got videos of some of their demonstrations. Here is a sample of them. I hope you enjoy watching.


posted by Amelyn R. Rafael,MD @ 3:08 PM   0 comments
Ralph and his Allergic Rhinitis
Tuesday, June 05, 2007
I woke up this morning and saw Ralph, my younger son, suffering from allergic rhinitis again. It's difficult when he is under this condition. He becomes irritable because of the frequent sneezing, nasal itching, headache, and the nasal obstruction causing the difficulty in breathing. Maybe its because of the rainy season. Ralph is really that sensitive. Even a little change in the environment will trigger his symptoms.

I worry a lot everytime he has his attack. He cannot tolerate the nasal itching that he would wipe his nose every now and then. He would incessantly do the "allergic salute" which causes his nose to redden and worse bleed. I hope it won't be as frequent as before during the previous school year wherein it has affected his grades. I was expecting then that his attacks will come more frequent during summer time. But it did not.

A week before we had our vacation in Catanduanes, I was able to attend a lecture on allergies sponsored by UCB. In that lecture I learned that it is better to give the antihistamines for allergic rhinitis daily for at least 6 months. This will provide rest to the constant inflammation in the lower airway. This will also lessen attacks. Giving antihistamines during the attack is not anymore beneficial according to the lecturer. It's already late for it to arrest the attack.

Since allergy and allergy-related conditions (asthma, eczema, rhinitis, chronic sinusitis, atopic dermatitis, drug sensitivity, and food allergy) are hereditary, Ralph got his condition from me. Yes, I also have allergic rhinitis and mine also worsened when the rainy season started.

Most of the time people with rhinitis also have asthma. And Ralph also have asthma just like my grandfather. His last attack was 2 years ago. I just hope that he won't have it again especially now that school is about to open.
posted by Amelyn R. Rafael,MD @ 10:29 AM   6 comments
On Going Back to School
Sunday, June 03, 2007
It's back to school once again. For most schools it will be tomorrow, June 4, but in my kids' school (La Marea Academy in Dagupan City) it will be next week, June 13. Since La Marea always start the school year late, we also end it late.

Yes, it is really hard for the young ones to go back to school after a very enjoyable summer vacation. My 2 sons who are incoming Grade IV and Preparatory pupils feel a little bitin when school opening is mentioned. So that as early as possible I'm trying my best to bring back their biorhythm by convincing them to go to bed early so that they can get up early the next day. Doing some neurobic exercises everyday until "the day" is part of our routine for the remaining one week. This is to wake up their neurons making them more alert and ready for school.

One night before my 5-year old son went to bed, I asked him some Math questions. He was initially shocked and he told me that he already forgot how to perform the operation being asked. I told him it's okay and that we will do something about it next time. The following day after he had his breakfast it was he who approached me and asked me to review him. I can say that right now he is ready again for school.

My 9-year old son who is always first in his class for the past years is more than ready I think. He had equipped himself with the link system, the number-shape and the number-rhyme systems, etc. Being an MTAP (Math Teachers Association of the Philippines) contestant yearly, I hope he will do his best again this time. Good luck, kids!
posted by Amelyn R. Rafael,MD @ 10:53 AM   0 comments
About Me

Name: Amelyn R. Rafael,MD
Home: San Fabian, Pangasinan, Philippines
About Me: Family Physician, and Associate Professor (Clinical Anatomy and Medical Physiology)
See my complete profile
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