The Department of Health (DOH) has recently advised the public to take precautions against heat stroke because of expected high heat indexes this summer. What is heat index? What is heatstroke and how can we prevent it?

Heat index is the temperature people feel as opposed to the temperature measured by instruments. It is a value that combines air temperature and relative humidity. When relative humidity is high, which is often the case in the Philippines, the heat index is significantly much higher than the air temperature.

We normally cool ourselves by sweating. Heat is removed from our body when sweat evaporates from our skin. High relative humidity reduces the evaporation rate of sweat resulting in a lower rate of heat removal from our body. Thus, for us in the Philippines, where relatively humidity often exceeds 70 percent or higher, a room temperature of only 32 °C can have a heat index of 41 °C  or higher.


a heat index between 41 and 54 degrees, which will be commonplace in the Philippines this summer, is dangerous and likely to cause cramps, exhaustion, and even heat stroke after continuous activity. Temperatures across the country have been rising since early March and, to date, the heat index has gone above 41 degrees several times. Thus, the Department of Health (DOH) has raised the red flag on heat stroke and has urged the public to take precautionary measures to prevent the condition. Especially susceptible to heat stroke are the senior citizens because their temperature-regulating mechanisms do not function very well anymore, those who are working outdoors, and commuters in VEHICLES THAT DO NOT HAVE AIR-CONDITIONING UNITS.


Heat stroke is the worst form of a continuum of heat disorders that include heat syncope, heat cramps, and heat exhaustion.

Heat syncope is typified by transient loss of consciousness while heat cramps are characterized by muscle spasms. In both, the skin is moist, the pulse is weak, and the person may complain of dizziness, lightheadedness, or headache. People with heat syncope or cramps should be placed in a cool environment and given lots of fluids.

Heat exhaustion, on the other hand, is characterized by slight to moderate fever, increased pulse rate, moist skin, thirst, anxiousness, and sometimes, incoherence and disorientation. Heat exhaustion can progress to heat stroke, a life-threatening emergency that is marked by a very high body temperature (41oC or higher). People suffering from heat exhaustion or stroke should be brought to the hospital. First aid measures include cooling of the skin by spraying with water or by applying cold compresses or ice packs.

Heat stroke


To prevent heat stroke, avoid or protect yourself from the sun, do not overexert, and keep yourself hydrated.

  • Avoid the sun between 10 a.m. and 2 p.m. when it is hottest. Confine your outdoor activities to the early morning and late afternoon hours. Likewise, avoid being under sun for long stretches.
  • “Slip a shirt and slap a hat.” Clothing and hats offer the best protection against the sun. Wear loose, cool, and light colored clothing, and change clothes when sweating profusely.
  • Apply sunscreen cream liberally when you go out in the sun.
  • Take fluids liberally. When exposed to the sun, drink two to four glasses of fluids (water is best) per hour. Don’t drink alcohol, coffee, or beverages that contain large amounts of sugar—these actually cause you to lose more body fluid. Also, avoid very cold drinks, because they can cause stomach cramps. If you sweat too much, sports beverages could be taken instead of plain water.
  • Avoid strenuous exercises during daylight hours. Perform them after sundown.

Incidentally, never leave children or animals in parked cars. The sun can make car interiors unbearably hot.

source: Manila Bulletin

The do’s and don’ts of liposuction

If you can change any body part, what would you choose? It is common to hear both men and women say that they would love to have a smaller waist, thinner thighs, or slender arms, stat! It is no wonder then, that when liposuction came into the picture not so long ago (in the ’80s!), it became very popular and controversial because a slimmer body—without diet or exercise—suddenly became possible! And in this age of selfies, likes, and followers, liposuction procedures may be on the rise now more than ever. Not everyone, however, is sold on liposuction for various reasons, and that is okay. Every surgery has its own risks, so it is every patient’s right to be informed of these do’s and don’ts before doing anything to their bodies.

Liposuction has had vast improvements in procedure, safety, and results from when it was first introduced. It now offers more than just fat reduction, such as body contouring or reshaping. It has also evolved into many forms through the years, like ultrasound-assisted liposuction (UAL), power-assisted liposuction (PAL), laser-assisted liposuction (LAL), and vaser-assisted liposuction (VAL). The precautions discussed in this article are mostly for suction-assisted lipoplasty (SAL) or liposuction.

DON’T: Think that liposuction is for weight loss. Wait, what? Contrary to popular belief, liposuction is not a weight loss procedure. Its aim is to remove unwanted or stubborn fat in target areas for a better, firmer shape. If you are overweight or obese, you should still exercise and eat right until you achieve a healthy weight. If then there are still a few areas where undesirable fat is prominent, then you can go for lipo.

DO: Know your doctor. The patient should be comfortable with the physician who will perform the procedure. It is of utmost importance that you know the clinic and the physician that you will entrust this procedure to. The clinic or hospital must hold a license and certification to operate, and the physician is a board-certified and trained plastic or cosmetic surgeon.

DON’T: Keep your allergies a secret. The physician must perform a detailed physical examination on the patient during the initial consultation, and a detailed medical history will also be required. During this time, full cooperation of the patient is needed to address any concern/s, such as tobacco use, allergies, history of diabetes, heart and/or lung problems, considerable weight loss, surgery, list of medications (including herbal and over-the-counter medications), among others. If the patient is at risk with any of these, a medical clearance from a cardiologist or internist is needed to continue. Medications taken must be stopped at least two weeks prior to surgery, and smoking must be discontinued a full month before. For patients who just gave birth, it is advised to wait a full year after giving birth before undergoing liposuction. Furthermore, six major areas are to be checked for possible liposuction patients: Assymetry, contour deformities, skin tone and quality, cellulite, myofascial support, and zones of adherence (Farkas et al, 2011, p. 2753). Height, weight, and Body Mass Index (BMI) are also recorded, and complete full body photos are taken to file.

DO: Ask. Ask a LOT. During consultation, the one thing you can do is  ask and ask some more. It is at this time that all the questions and expectations of the patient must be addressed by the physician. The procedure must also be discussed fully, including all the possible risks and complications involved, duration of procedure, as well as post-operative care, including downtime and side effects such as bleeding, pain, contour irregularities, and infection, among others, so that the patient can make a proper assessment if he or she will go on with the procedure, by which a consent between the patient and physician is signed.

DON’T: Assume multiple surgeries at a time are okay. They’re not. This is where the limitations of liposuction are. According to Narins (2003), the majority of deaths related to liposuction are due to too much liposuction done at a time or combining liposuction with other procedures. Though rare, the major cause of death with liposuction is pulmonary thromboembolism (when there is blood clot in the lungs) that happens usually with the use of general anesthesia or IV sedation and performing multiple surgeries with it. There are other types of anesthesia that are safer than general anesthesia, but your physician should know which is better for your needs and discuss these with you. Furthermore, the gap between procedures must be between three to four weeks or more, depending on the patient and the procedure done.

DO: Maintain a healthy lifestyle to keep the shape.  Liposuction will not keep the weight off, only exercise and the right diet will. Swelling and other side effects may occur post-surgery, so you may only start exercising with the advice of your physician. The full effect of liposuction will not appear until months after, so it is also important to maintain your doctor’s appointments so they can monitor your progress.

Through the years, liposuction has helped thousands reshape their bodies and boost their self-confidence in the process, but always take note of the risks that come with it. Sometimes we get so caught up with media and society’s standards that we will do whatever we can to get what we want, and sometimes, at the expense of our health. It is indeed hard to maintain a positive body image in a world full of Photoshop and Instagram filters, but remember that above it all, a good support system and a healthier lifestyle can make you appreciate your flaws and love your body, fats and all!

source: Manila Bulletin


An overweight diabetic patient, whom we advised to do moderate to high-intensity exercises at least four times a week to lose weight, sent me an urgent e-mail last week concerning an article he read in this paper, stating that intense physical activity like marathon running may cause kidney injury.

The article was based on a study done by researchers at Yale University.

Being diabetic for more than 10 years, our patient already has a mild kidney problem (diabetic nephropathy) and he was worried it might be aggravated by the moderate to high-intensity exercise regimen we prescribed for him.

I immediately tried to get a complete text of the study, which was published in the March 28 issue of the American Journal of Kidney Disease. It was conducted by a group of researchers headed by Dr. Chirag Parikh at the Department of Medicine in Yale. The main author of the study is Sherry Mansour, a young doctor of osteopathic medicine.

They’re involved in the translational research program of the university—meaning, they engage in research that aims to “translate” findings of their research on relevant medical problems and public health issues into medical practice and meaningful health outcomes.

For this study, the group was concerned about any possible effects on the body of marathon running, since more than a million people worldwide are participating in this activity regularly. The subjects in the study are from the participants of the Hartford Marathon, which consists of a full 26.2-mile (42-km) marathon, and a 13.1-mile (21-km) half marathon.

Specifically, the researchers looked at kidney function by measuring blood levels of serum creatinine, which is supposed to reflect the waste products of the body’s metabolism, and other blood and urine indicators of kidney injury.

Proper context

Eight out of 10 marathoners showed indicators of kidney injury which were just transient, and cleared after 48 hours. This was described as marathon-induced acute kidney injury, and the findings raise the question: Does this also apply to other repeated strenuous activity over time, which was what our patient was worried about?

We have to put things in the proper context.

First, moderate- to high-intensity exercise, which we commonly recommend to our overweight patients and even to lean patients who want to maintain their cardiovascular fitness, can never approximate the degree of intense physical stress from a 42k or even a 21k marathon. It’s nowhere close to it.

In the study, the increase in serum creatinine only indicates that the body’s metabolism was put in high gear; hence, there was an increase in the level of waste products  which would take the kidneys a little more time to clear. It’s like after New Year’s Eve—you see more debris the following day, which may take a couple of days or longer to clean up, but after that, everything goes back to normal. Unless one participates in a 21k or 42k marathon daily, this should not be a problem.

Second, with proper preventive measures, especially adequate hydration—which should ideally replace not only the water lost, but also the electrolytes and minerals that are lost with the profuse sweating—this should not be a problem. With dehydration, which may happen even with ordinary exercise, the kidneys will have a difficult time cleaning up all the waste products in it.

Feeling thirsty is a compensatory mechanism to prevent dehydration. For as long as one feels thirsty, it means he or she is on the dehydrated side and more fluids should be taken. Ideally, when exercising, one should not wait to get thirsty.

A good advice is to drink about 15 to 20 ounces of water one to two hours before working out or exercising, and to drink another eight ounces 15 minutes before. During exercise, one should sip water every 15 minutes, especially if the weather makes one sweat buckets.

Lastly, although this is a well-designed study, one cannot draw any definitive conclusions from it. At most, one can consider it an initial pilot study which should be validated by a more extensive and more stringently designed research. There were only 22 subjects in the study, and the study duration was only two days.

Even the authors admit the study’s limitations and propose a more extensive study of longer duration, so we can really find out the long-term effects of intense activity not only on marathon runners, but in other athletes exposed to rigorous physical exertion.

Meanwhile, let’s all go back to the gym and not worry about the findings of this recent study.

Summer is here and I bet you are excited to go on another memorable trip with your loved ones this year. But of course, we wish to have only happy memories. Here are some tips to help ensure that you and your family stay healthy and worry-free throughout your trip.

  1. Be well hydrated. Dehydration wreaks havoc in your immune system as well as energy levels. When you travel, you are more exposed to harmful microorganisms. Time differences, lack of quality sleep, especially during long haul flights, lugging around luggage, and waiting for hours cause fatigue, which will be intensified with dehydration. Make sure you drink water before departure and bring an empty water bottle along with you, which you can request to be refilled by flight attendants. You can keep yourself well hydrated throughout the flight without having the need to constantly bug the crew for a cup of water. The only downside to this is that you may frequent the lavatory, but this is one inconvenience you should be willing to overlook in exchange for an energy-filled and infection-free vacation.
  2. Bring snacks. When you are on tour that lasts for hours, it is uncertain whether or not shops or vending machines are available for refreshments. Aside from carrying your water bottle, bring crackers, dried fruits, nuts, granola bars, or homemade trailmix, which you must have prepared before going on your trip. You can also visit a local grocery store to replenish your stash in the middle or toward the end of your trip. It would also be a good way to try out local snack items.
  3. Bring prescription medications and supplements. If you have a medical condition, it is but prudent to have medications more than what you need. It pays to have extra meds in case of flight delays and travel extensions. You should also have over-the-counter meds for diarrhea, allergy, cough, colds, fever, headache, indigestion, and hyperacidity just in case. The same principle applies to supplements. We are not 100 percent in control of what foods will be served to us on a trip. It is a challenge to consume well balanced meals to meet nutritional requirements, thus the need for supplementation. Consult your physician and dietitian regarding nutritional supplementation.
  4. Sanitize regularly. Wash your hands with soap and water or use hand sanitizer and wet tissues to prevent cross contamination of microorganisms. It’s better to be a germ freak than contract infections due to dirty hands and surfaces. This tip will also prevent you from getting zits, which is often caused by touching one’s face with dirty hands. You wouldn’t want to have zits all over your face while posing for that Instagram-worthy shot now, would you?
  5. Get travel insurance. This is one thing you should pray you never have to use but this is also one thing you will be thankful for once the need arises. Allot some budget for travel insurance because having a medical emergency abroad as well as the cost it entails are downright scary.

    source: Manila Bulletin

An extensive American study, published in the journal Breast Cancer Research, has found that fine particles from air pollution may increase breast density in women, a well-established risk factor for breast cancer.

New American research, based on nearly 280,000 women screened between 2001 and 2009, found that those living in areas with high levels of fine particles from air pollution had a 20 percent greater risk of having dense breasts, a major risk factor for breast cancer.

Breast density, measured by mammography, reflects the relative amounts of tissue types in the breast. Dense breasts contain a higher percentage of fibroglandular tissue which can obscure mammography and make it difficult to identify abnormalities like tumors.

Breasts with higher density levels contain less fatty tissue and more connective and glandular tissue. High breast density is associated with a four-to-six-fold greater risk of breast cancer.

The researchers found that every one unit increase in fine particle concentration (PM2.5) increased a woman’s chance of having dense breasts by 4 percent.

Moreover, women with less dense breasts were 12 percent less likely to have been exposed to high concentrations of fine particles.

The impact of air pollution on breast density could be explained by the presence of pollutants contained in fine particles and their disruptive effects on hormones, suggest the authors.

On the other hand, the study showed that exposure to ozone reduced women’s chances of having dense breasts. In fact, every one unit increase in ozone concentration was associated with a 3 percent lower chance of having dense breasts. The researchers aren’t able to explain this surprising phenomenon at this stage of their research.