GALLSTONES

It was so sad that my cousin who took good care of me during the time of my open heart operation was the one who is in the center of another ordeal in our family. My cousin is only 21 yrs. Old and it was so surprising that he was diagnosed with gallstones according to his doctor “gallstones are very rare in males.” It is also very depressing on his part because 3 days from now his review for nursing board exam will start.

If only diagnosed earlier maybe the operation is not needed anymore like what happened to my grandmother on my mother side. She was diagnosed to have gallstones but she did not undergo operation. Her doctor told her that her gallstones were smalls and suggested that instead of operation she may undergo first with oral therapy. And through the Oral Therapy that her doctor suggested to her the gallstones in her body were flashed out.

THE FOLLOWING ARE THE STEPS FOR ORAL THERAPY
(The Oral Therapy that my grandmother underwent that flushed out the gallstones from her body.)

1. Drink Mott’s Apple Juice for five consecutive days

2. After drinking Mott’s apple juice for five consecutive days take Milk of Magnesia ( the # of tablets of milk of magnesia depends on the wt. and age of the patient) my grandmother took 8 tablets together.

3. Then drink the Homemade Purgative Recipe.

HOMEMADE PURGATIVE RECIPE:

4 ounce of Olive oil
4 ounce of Pure lemon juice

After taking Milk of Magnesia drink 4 ounce of Olive Oil followedby 4 ounce of pure lemon juice (this steps may sound and taste grossy but you have to endure the taste of it ). Expectedly by completing the steps, the gallstones will be flushed out following bowel movement.

EARLY SYMPTOMS OF GALLSTONES

Pain in the right upper abdomen
Back pain
Yellowish eyes and skin ( Jaundice)

DIAGNOSTIC TEST

Computerized tomography (CT) scan
Cholescintigraphy (HIDA scan)
Endoscopic retrograde cholangiopancreatography (ERCP)
Blood tests

TREATMENT

Cholecystectomy (gallbladder removal)
Oral dissolution therapy
Contact dissolution therapy

ROLE OF CLINICAL PHARMACIST

In my last post my topic is all about Drug interaction and how it affects patient’s condition. This post is continuation of my last post which is all about drug interaction. In my last post I did emphasize the role of the doctor in drug interaction and how it affects patient’s condition. I also stated some tips on how to prevent and stop the abusive practice of some doctors. Here I am emphasizing the role of Clinical Pharmacist in Drug interaction. A Clinical pharmacy is the branch of Pharmacy where pharmacists provide patient care that optimizes the use of medication and promotes health, wellness, and disease prevention. Clinical pharmacists often collaborate with Physicians and other healthcare professionals. Clinical pharmacists are experts in the therapeutic use of medications. They routinely provide medication therapy evaluations and recommendations to patients and other health care professionals. Clinical pharmacists are a primary source of scientifically valid information and advice regarding the safe, appropriate, and cost-effective use of medications.

In our country you can only count by your fingers the hospital that has Clinical Pharmacist because of financial reason. There are many hospitals who can’t afford to pay for a Clinical Pharmacist, this is the reason why no one checks on the drugs prescribe by the doctors in the hospital. This is the reason why there are many patients who stayed long in hospital because no one checks on the kind of drugs they are taking and instead of being cured.

Not having a Clinical Pharmacist in a hospital is a reason why there are many abusive doctors who prescribe not only expensive but wrong medicine. Doctor’s are very confident that they can’t be busted of their abusive action because there are no clinical pharmacists who will check their prescription.

It is sad that most of the hospital in our country give the job of a clinical pharmacist to the nurses who have many patients to attend on. Hospitals are doing this in order to save money because if they hired a clinical pharmacist it means they will save more money for their salary. But the problem is that the patient’s welfare is being sacrifice.

I think that the best way to solve this is for the government to interfere. They should pass a bill that would require every hospital to have a clinical pharmacist in this way the abusive action of doctors might be minimize or stop.

IF THERE'S A CURE, THERE'S A KILL

Harmful drug interaction is one of the reasoned why patient stayed in the hospital. As a second year student of pharmacy I have a little background of how drugs react in our body and how it works. I’ve learned that there are drugs that could cure and relieves your pain but will also trigger another disease. Example of these are pain relievers this drug could relieve your pain but too much intake of these could cause ULCER in the stomach and intestine. That’s why I remember that after my open heart surgery my doctors limit my intake of pain relievers and they also gave me LOSEC.
Losec is a drug that counteracts the reaction of pain relievers so that you will not develop ulcer. It does not hinder the action of the pain reliever but it gives protection to the digestive system so that it will not suffer to the effect of pain reliever.

There are also drugs that could cure kidney and heart disease but could cause liver disease. We know that the liver is the filtering organ of the body and it secretes bile that help in digesting food, alcohol, drugs, chemicals and other substance. As we take too much chemicals and drugs in our body the liver repeatedly secrets bile in order to digest the chemicals but this repeated secretion of bile can be tiring for the liver and this may lead to liver diseases. It is important that doctors know how to interact and deal with side effects of the drug they prescribe.

Being a patient is not easy especially if you have financial problem and the worst if you choose wrong hospital and doctor who does not give quality care to their patient. There are hospitals and doctor’s who are only after their patient’s money. There are doctor’s who cure their patient but will give another disease so that the patient will stay long in the hospital and keep on coming back. There are also incident where the doctor give expensive drugs even if there are generic drug available and the worst there are doctor’s who do not only give wrong diagnosis but also prescribed wrong medicine.

I think the best way to stop this cruel practice is through education. It is important to educate people at least they have a little background on how drugs interact and how to prevent the abusive act of doctors. I also suggest that people should keep on reading medical magazines and books so that they are updated on health and science. In this way
They will not be ignorant and easily abuse by medical personnel.

Another way is to have a CLINICAL PHARMACIST in every hospital so that there is someone who is checking whether the doctor’s prescription is correct or not. I could tell the difference between a hospital having a clinical pharmacist and a hospital who do not have one because I myself has experienced being hospitalized. I was admitted to a hospital that has clinical pharmacist and I quickly recovered because there were no complication but when my cousin was admitted to a hospital that don not have clinical pharmacist he did not immediately recovered from it because of the wrong diagnosis and because of the drugs (pain reliever) that they gave to him he develop intestinal ulcer and his condition worsen but thank god he was transferred to another hospital and got better.

MY COUSIN'S ORDEAL

We were surprised when my cousin was diagnosed of having Gallstones because my cousin is only 21 years old and we know that Gallstones are prone to 4F. 4F means Fat Female who is fertile and over forty years old. My cousin is male and even though he is fertile but he is only 21 yrs. Old. That’s why we got very confused on why and how come he developed Gallstones. Even his doctors got very confused especially with he’s ultrasound and Ct scan result. According to his ultrasound it was positive that he has Gallstones but according to his CT scan it is not stones but Ascaris. The doctor’s can’t arrive a correct diagnosis that’s why my cousin’s schedule for operation was cancelled many times. His doctor decided to observe first my cousin’s condition and give him purgative and pain reliever for his pain. When the pain subsided and my cousin’s condition got better they decided to discharge him from the hospital. Even though he felt better his color was not change. His eyes and skin were still yellow in color.

Few days after his discharge my cousin seeks for second opinion and their new doctor suggested that he should undergo cholecystectomy in order to know what’s really inside.

After the operation the doctor told us that it was really Gallstones and it is not Ascaris. The doctor showed to us the six stones that they got from his pancreatic duct and gallbladder. The doctor explained that the stones may appear Ascaris on the CT scan because there were six stones in line in the pancreatic duct and it will really look an Ascaris on the CT scan.

After the operation my cousin’s health got better and better and we thought that it was the end of his ordeal but 3 weeks after he was discharge from the hospital my cousin started to vomit and discharge blood. Our family got very shocked and so nervous of what’s going with him. He undergoes blood transfusion in order to replace the blood that he loss but nothing change. His doctor ordered for endoscopy and they found out that he had an ulcer.


We suspected that my cousin got ulcer from the first hospital that he went on because of the different pain relievers and all the fasting that he underwent to that hospital maybe that trigger his ulcer. We know that pain relievers has side effects and it so sad that his doctors were not able to prevent and foreseen this. But anyway past is past the damage has done and we can’t bring back the past and for us what is important is that my cousin survive his ordeal.
We just hope that someday all hospital will have Clinical Pharmacist who will check all the drugs that the doctors had prescribe so that the incident that happened to my cousin will not happen to other patient.

SWIMMING IS GOD FOR THE HEALTH

After the Summer Olympics in Beijing many children wants to be Michael Phelps. As we all know Michael Phelps is the first person who won 8 Golds in single Olympics. Many children hope that they will achieve what Michael Phelps had achieved.

There are lot’s of benefits that children may get in enrolling Swimming Class aside from they learned how to swim they are also spending there time on a useful and enjoyable way. But the best benefit that they can get is that SWIMMING is GOOD for the HEALTH. According to my Cardiologist “Swimming is the Best Exercise for People who have Scoliosis and Heart Diseases.

When you swim all your body parts are in action your head, Arm, legs and hips are moving that’s why all muscles and bones are well coordinated and developed uniformly. In swimming children are taught to maintain good body posture that’s why swimming is also a very good exercise for people who have Scoliosis or to people who are prone to have Scoliosis.

For people who have heart diseases Swimming is also very good exercise for their heart because when they swim their heart beat and rhythm increases which makes their heart more stronger.

ASD: ATRIAL SEPTAL DEFFECT

What is ASD?

According to my doctor ASD means Atrial Septal Deffect it is also called "Hole in Heart". It is a defect of the atria for atrial and defect of the septa for septal. Atria is a chamber of the heart which receives the blood as it returns to the heart while the septa or septum is the dividing wall between the left side and right side of the heart.If there is atrial septal defect there will be an abnormal blood circulation the problem is that the oxygenated blood may leak to the left side of the blood and may return to the lungs and this would displace the blood that needs oxygen.The hole in the heart must be covered so that there will be no leaking and there will be a proper blood circulation. Atrial Septal defect will also damage the Lungs because of inefficient blood flow to the lungs this may result to increase lung pressure. If there is too much pressure on the lungs, the lungs might collapse and this would cause death.

What are the symptoms of ASD?

As for me, I didn't suffer any symptoms of ASD except for back pains.
But here are some symptoms of ASD according to my doctors:

• shortness of breath


• cyanosis ( blue skin, fingernails and lips)


• easily fatigue


• faint


• back pains

What are the possible diagnostic test to know you have ASD?

Well the possible diagnostic test for ASD are Chest X-Ray, Ultrasound and TEE ( Transesophageal echocardiogram).

MY ECSTATIC ORDEAL :ATRIAL SEPTAL DEFFECT

I write this because I want to share my ordeal with Atrial Septal Defect. I also want to help and share some information to people who are also suffering from this kind of heart disease.

I remember when I was just a child that I am so active, playful, alive and has full of energy. My favorite game at that time was Cats and Dogs it is a game where the dogs runs after the cat so basically the game involves running but I never had a problem with that because I'm a good runner. I also remember that I was a consistent honor student and very active in participating with school activities. Based on that you could probably say that I have a normal and happy childhood and I was just another normal kid but then your wrong because I maybe active and energetic but my physical condition was so pitiful. I could still picture out my physical condition at that time, I was so skinny, short, less hair (but not like cancer patient) and big dull eyes. I remember that some of my classmates would call me names like "skeleton". I was hurting then but I am a fighter I would call them names also so we end up fighting. But what was more painful for me was the things that my parent's friends said and asked to me, they will say and ask "Why are so skinny are you not eating well?", "You look like your not eating" and "You got everything but why do you look malnourished". For me their comments were the most hurtful one because even they say things like that there's nothing I can do but to respect them because they are my elders not like when my classmates tease me because I can tease them back. My condition at that time was more hurtful to my parents because I am there only child and they had given me everything but still there's nothing they can do about my situation. I have everything, complete nutrition, enough rest, complete vitamins and monthly check-up in fact I have 2 pediatrician but still my condition does not change. All laboratory tests were done but they were all normal. The only two important things that were not done were X-ray and ultrasound because my doctors did not suspect that I have a heart disease because my heartbeat was normal and I maybe pale but not cyanotic and I'm very active so who would suspect that I have a heart disease. Maybe if we have done chest X-ray at that time maybe my ASD was detected earlier but past is past. Because my doctors did not found any unusual findings, we decided to stop asking questions because it was also tiring on my part and we think that maybe it's in the genes because my mother was also thin when she was young.

We never try to seek any medical findings again until when I was 16 yrs. old. What happened was, I was about to enter college and one of the requirement for enrollment was to submit a chest X-ray and there we found out that I have a suspected cardiovascular disease. We went to a cardiologist and he said that we need to perform 2D-echo ultrasound so that he could clearly see what's going on inside my heart and so we performed the procedure but my doctor was so surprised because he did not found any unusual condition with my heart according to him he was looking for a hole in my heart because my x-ray result suggested that I may have hole in my heart but to his surprised he could not see anything. My cardiologist suggested another procedure called TEE (Transesophageal Echocardiogram) this procedure is more accurate than ultrasound.

We did not performed the TEE because I thought that there's nothing wrong with myself because I never experienced any symptoms of this disease so I thought I was fine and that time I was already contented with my body because ever since I have my menstrual period my body structure changes a lot from skinny to fatter sexy lady and even though I'm shorter for the average height for my age I did not care because for me my shortness is the reason of my cuteness....and also we never performed the TEE because I was already accepted in the university and I was too busy preparing for the opening of classes and all I wanted to do is to focused on my studies nothing more. I finished my four year course without suffering any symptoms of my ordeal.

Until last year when I started to have severe back pains. I always complain this to my mother that's why every Sunday we have therapy session in our house . My therapist got curious and started asking me questions so I told her that before I was diagnose to have cardiovascular disease but there was no specific findings of what kind of cardiovascular disease it is.My therapist told me that it is better that I will seek for medical opinions to make it sure because she was suspecting that my heart disease was the one causing my back pains. I followed her advice because I thought it was the right time to answer the question of the past.

We went to my cardiologist again and this time we performed the TEE. At first I was so scared maybe because my cardiologist did not explained well to me the procedure so I got shocked that I have to be IV and it was my first time to be IV. Later, when I saw the fear in my parents eyes I felt that I have to be brave for their sake. Through the TEE my doctor dropped the bomb he confirmed to us that I have ASD ( Atrial Septal Defect) and my cardiologist continue to dropped bombs he told us that the only way to cover the hole in my heart is through Open Heart Surgery.He also added that it is important to cover the hole because if it will not be covered it will cause pulmonary hypertension and too much pressure on the lungs might cause the lungs to collapse. I just laugh without thinking the seriousness of my disease, how can I possibly undergo open heart surgery when in simple procedure like TEE I got scared already so what more for Open Heart Surgery.At that time we were not satisfied with the findings of my doctor that's why we seek for a second opinion.

We hear from my aunt that my 2nd degree cousin was diagnose with PDA (Patent Ductus arteriosus) and she underwent Cardiac Catherization and now she is doing well. We contacted the doctor of my cousin and we performed TEE again and he has the same findings with my first Doctor but the good news was that Cardiac Catherization was applicable to my case and he added that I have 80% success rate with Cardiac Catherization.

Last April 2008 I was scheduled for Cardiac Catherization. I have 5 doctors on my team 2 Cardiologist, 1 pulmonologist, 1 anesthesiologist and 1 expert doctor on TEE. I'm a little bit scared but I was so hopeful that the procedure will be successful. The time has come, I spent 4 hours in the Cath Lab and after 4 hours I was brought back to my room. When I woke up I was so curious that not even one of my doctors came to me and explain what happened so I asked the nurse where are my doctors and they replied "Ma'am they are talking to your family" then I asked my nurse if the procedure was successful and they replied "Ma'am just wait for your doctors to explain what happened then at that time I begun to suspect that the the procedure failed.And, my suspect became reality when my mother told me that the procedure failed because they can't attached the amplatzer on the whole because there is a certain part that was so thin that the amplatzer can't be attached and if they forced to attached it the amplatzer would really fall and that's more dangerous because it would cause blockage in my heart and it will put my life in a life and death situation so there's nothing they can do but to pull out the amplatzer.

Later after my mother told me the bad news,my attending physician came to my room and told me the situation of my heart he explain to me why the procedure failed he told me that aside from ASD my heart is abnormally positioned that's why they have difficulty in attaching the amplatzer. He also said that my heart occupies a bigger part on the right side than the usual. He told me that there is no other way to cover the whole but through open heart surgery and we need to do it as soon as possible because the hole in my heart is growing bigger and bigger and the pressure in my lungs is increasing that there's a big possibility that it would reach to a point that even surgery can do nothing. He also added that it was the best time to have an open heart surgery because I'm still young (24 yrs.old) so my body can easily recover and he also said that all my other vital organs like kidneys, lungs and liver were in good condition that's why he gave me 99 % assurance that the procedure will be successful. But at that time I'm losing my trust in him because during the Cardiac Catherization he gave me 80% success rate and 80% was so high but still the procedure failed. I don't know what to do at the time so I told my family and doctor to gave me some time to think about it and some time to recover from my previous failed procedure.

All my life I never felt so confused until that time. Before I always feel lucky and love by God because I always have everything but now I feel so unlucky. I asked God why me I'm so young , I have a bright future ahead of me and then in one moment I need to have an Open Heart Surgery for me to live a longer life . I can't understand how my life changes in a moment. But later I realize that why should I complained this is just a very light ordeal compare to other like those children who have cancer there's so young but unfortunately they have incurable diseases. Then, I realized that all these years my life was been a miracle because I never suffered the extreme effect of ASD. I felt so lucky and thankful to God because even though I have this disease in me, I did live a normal life.Another realization hit me, this time I realize why I'm so confused and scared it's because I never gave my whole trust to the ALMIGHTY GOD but instead I put it in the hands of my doctors. Then, I remember what my doctor said to me he said "We are not the one who will heal you but someone up there". I realized that nothing is impossible with him and everything will be alright as long as you trust him. God is good. He is always there for me and I know that he will never forsake me at this time of my ordeal.I know God will guide me through out this ordeal. My fears and doubts were all vanished they were all replaced with determination and strong faith with God.

I made my decision, I told my parent's and doctor that I'm ready for Open Heart Surgery and I'm not scared anymore because I trust the lord and for me it's "THY WILL BE DONE".

We did my open heart surgery last May 8,2008 and with God's grace I survive my ordeal. My doctors were so happy because the operation went smoothly and they were so surprised that my vital signs were so stable that right after the operation they don't need to connect me to the ventilator. Then they told me nothing is impossible to God's power.

I'm so thankful to my family, doctors,nurses, friends, classmates and teachers who prayed for me and never leave by my side...

Through this ordeal I met so many people and learned so many things not only in medical aspect but most especially I learned so many lessons in life that made me stronger and better person. And also through this ordeal my family became more closer and stronger. But the most important lesson I learned from this ordeal is to realized that God is so powerful and kind that if you ask something to him he will give it to you as long as it is good for you. Nothing is impossible with God's power just gave your trust to him and everything will be alright.

Comparison bet. Cardiac Catherization and Open Heart Surgery

Cardiac Catherization

• small scars
• no blood transfussion
• lower success rate
• lesser risk
• faster recovery
• more expensive

Open Heart Surgery

• Big scar
• with blood transfussion
• higher success rate
• more risky
• slow recovery
• less expensive

My Open Heart Surgery Experienced

• We prepare for a blood in the blood bank
  


• I was admitted in the hospital
  


• I submit to different test like urine test, blood test, electrolyte blood tests and many more tests. Many blood tests compare to cardiac catherization.
  


• The night before my operation I underwent fasting
  


• The night before my operation I got acquainted with my nurses. The nurse in charge in the operating room, recovery room and ICU went to my room and orient me and one the nurse was so kind and tour me to the operating, recovery and ICU rooms. My surgeon also came that night and orient me of me of what will happened the following day.
  


• I woke up early and take a bath
  


• I took Valium for sedation
  


• The nurses brought me to the operating room. When I was in the operating room my anesthetiologist greeted me and they started to put devices on me these were the vitals signs monitoring devices.
  


• When I woke up I was in the recovery room and there were so many gadgets and devices that was connect on me. i have 3 IV's on my neck , 2 IV's on my left arm and 1 on my right arm. I have tubes in my abdomen part it is for blood darinage ( if the blood comes out from it is more than the normal amount it means that there is a leak on th operation and you will be re-open to repair the cause). I also have catheter and different monitoring devices were attached on my body.
  


• After staying at least 8 hours in the recovery room I was brought to the ICU (intensive Care Unit) then there I stayed for 3 days. I have to stand first and walke a little before they brought me to regular room
  


• After 3 days, finally they brought me back to my regular room.
  


• I stayed more day in the hospital and I underwent different blood tests
  


• When everything is okay we went home.
  


• I continue my rest at home
  


• There were no maintenance drug that was given to me.

MY CARDIAC CATHERIZATION EXPERIENCE

• I was admitted in the hospital


• I was with heplock


• Submit to different tests like blood test and urine test


• Fasting ( no food, water and everything)


• I was IV


• I took valium (sedative) and benadryl ( anti-histamine)


• They took me to the cath lab


• My anesthesiologist started to inject the general anesthesia and there's nothing more that I could remember .


• When I woke up I was with catheter, IV, Oxygen and 2 heavy sand bag on my groin to stop the bleeding on my groin.


• I have 2 very small wounds on my groin and very big hematoma on my groin.


• The recovery is so quick 24 hours after the procedure I could stand and slowly walked.


• My doctor came and explained what happened.


• Went home

TEE: Transesophageal Echocardiogram

What is TEE?

TEE is Transesophageal echocardiogram it is a diagnostic test for heart diseases. it is more accurate than the ultrasound because it is directly inside and near to your heart that's why it can capture a closer view of your heart.It is also use during Cardiac Catherization and Open Heart Surgery for monitoring what's going on inside.

My TEE Experienced

Here are the following steps I experienced during TEE

• Fasting (no food and water for 8 hours)


• I change my clothes to hospital dress


• I was IV (intravenously) this is for sedation it is where the doctor injected the sedative to make me groggy.


• Lots of devices were attached to my chest, feet and arms. These devices were for my vital signs monitoring.


• The nurse sprayed Lidocaine on my throat. Lidocaine is a local anesthesia.


• I wear the oxygen


• When the anesthesia fully affect the doctor begun to insert a very long tube through my mouth which passed through my esophagus then the doctor begun to study my heart through the monitor.


• I keep on vomiting while the tube was inside my esophagus but it is normal.
  After studying and capturing the scenes inside my heart the doctor slowly pull out the tube
  I rest for a while.


• The nurses started to detached all the devices.


• When the effect of the anesthesia subsided my doctor started to explained to us.
  I fixed myself then go home.