October 2003 Vol. 3 Issue 12

An Internet Newsletter publication for all CIM Alumni and friends.

    Clem S. Estrera, Jr., M.D.
          Editor

    Ma. Belen Rosales, M.D.
        Associate Editor

     Ray Castillejo, M.D.
    Binisaya Section Editor

Newsletter Contributors:

Clem S. Estrera, Jr.
    Class 1972

Ma. Belen F. Rosales
     Class 1970

Hector Vamenta
    Class 1972

Narciso Tapia, M.D.
    Class 2001

Anny Misa-Hefti
   Switzerland

NOTE: Due to the turn of event, the continuation of the article Letting Go is put on hold.

Editor's Column

"I think these difficult times have helped me understood better than before how infinitely  rich and beautiful life is in every way and that so many things that one goes around worrying about are of no importance whatsoever." – Isak Dinesen

Flirting with Isabel

Clem S. Estrera, Jr. CIM 1972

Thoughts to ponder
    How many of us believe that there is a divine plan unfolding in our lives and find comfort in that when an unwelcome event happens? How many of us assume that every natural disaster is simply God’s way of reminding us that in this world, there are situations that are not for humans to dispute, or outcomes that are not for humans to refute, so that our fear would be replaced with faith and tragedy becomes easier to deal with? How many of us are cultivating a willingness to accept that all things happen for a reason, in order to give us the strength we need to make the best of every situation and disappointment? I, for one, don’t believe in a divine plan, but I have cultivated some willingness to accept that there are things that happen for a reason.

     I don’t know about you but I consider devastating hurricane like Isabel as Nature’s way of clearing the air, and bringing the world fresh and clean to every one’s attention once more. Mother Nature wants to remind us that with the exception of perhaps some organisms, every living thing needs clean and fresh air. It makes me feel a lot better to think along this line during hard times. It motivates me to make the best of the bad situation. The dark nights Isabel brought were simply to be endured, waited out in order for us to understand once again that events both pleasant and unpleasant would come to pass and that tough times never last. And that the properties like cars and houses Isabel destroyed are only things, and the lives it took remind us that our life can come to an end anytime, any place, anywhere.

A misguided confidence
    When hurricane Isabel was forecast to arrive here in Central Virginia on Thursday, September 18, during the day the sky was clear and the weather was calm and cool. It was hard to believe that a catastrophe was about to happen in the night. I guess it was what is called “calm before the storm.” I reported to work like it was business as usual. After our rounds that morning, my boss asked me whether I plan to sleep in the hospital during the night because everyone was planning to. He was concerned that since the patients from the state facility in Eastern Virginia were evacuated to our facility, we should stay during the night in case of emergency. If we chose to stay home, we might not be able to come to the hospital for emergency if the storm gets bad.

     I was not really concerned about the hurricane, for having experienced typhoons in Camotes, I was confident that it would not be that bad. I did not even bother to make some preparation even for a night or two, let alone weeks in the aftermath although my wife had bought a couple of lamps and a bottle of lamp oil. She also replaced the batteries of our flashlights with new ones. After all, this is America where businesses won’t tolerate any delay in services from whatever cause. I’ve found out later that my confidence was terribly misguided. Indeed what I’ve found later made me promise myself never to flirt, let alone fool around with any hurricane particularly the ones having a lady’s name.

     At lunchtime, I went home and picked up things for overnight camping in my office like a sleeping bag, pajama, etc. The weather remained calm and the wind was nothing more than a pleasant breeze although it started to rain, just a shower, not a downpour. At around 6:00 P.M., I realized that I forgot my toothbrush and my special natural non-allergenic shampoo. Also, I didn’t have anything to eat. Every one was prepared except me. When the weather person in TV said that Isabel would arrive at our place between 8:00 P.M – 10:00 P.M., I immediately ordered pizza. I figured out that since I wanted to go home anyway to pick up few things I needed for the night, I might as well pick up the pizza on my way back. When I got outside, the wind had already picked up strength and the rain was heavy, but the deteriorating weather condition did not stop me from going out, let alone shake my confidence.

The flirt
    About 20 minutes after I left the hospital and about a mile to our house, down the road I saw a pick-up truck that appeared to be floating with its hazard lights on. It was stuck because the road was flooded. Since I did not see any sign of anyone in the truck that may need help, I turned around to drive back to the hospital, for the wind was getting stronger and the weather was fast deteriorating. I was getting worried, no longer hungry and so I did not bother with the pizza. Immediately after I’ve turned around, I had the hunch that I needed to step on the gas pedal hard and accelerate. I had never accelerated on a wet road before but this time I did.

     A moment or two later, the street and traffic lights flickered and went out and I could hear the wind whistling, shaking my vehicle and making the driving rough. The road was almost invisible because the rain was pouring and pelting on my vehicle’s windshield like being in a carwash. Just then the leaves of the trees started to rattle loud and noisy as if gravels were being poured on the side of the street by a dump truck. This was followed by loud cracking and crashing noises. They happened so fast and were frightening. Even inside the closed vehicle, the noises and the darkness were eerie like death was on its way. My heart started pounding and my hands were in cold sweat although I was not about to be swept on the verge of panic yet. I did not look back, but I knew those cracking and crashing noises were trees breaking and falling. Indeed they were because in the morning, the road was closed and I could see those trees littered all over the road blocking it. I was not able to come home until later that day.

Risk without reward
     Although I only encountered the initial strength of Isabel like a sort of warning of what was about to come and I was already inside the hospital when the main force came, it was a harrowing experience. The wind was already a lot stronger than any of the typhoons I had experienced in Camotes, and more dangerous because of the so many trees. The wind stripped the trees of its leaves and small branches, and blew them away. Some of them pelted on my windshield.  I was glad that I followed my hunch to accelerate because if I lingered for a moment or two, I could have been easily hit by one of those falling trees or got stuck on the road. I was definitely relieved when I got to the Interstate where the trees are farther from the highway. But the driving was shaky. I had to put my vehicle on a four-wheel drive and drove slow and easy.

     I believe the main force of Isabel arrived just after 7:00 P.M. that day of September 18, not 8:00 P.M. as was being forecast, because when I shone my flashlight through the window at the back of our hospital at around 7:30 P.M. after I hanged my borrowed raincoat, removed my shoes and dried myself up a little bit, the three huge oak trees in our hospital’s picnic area had already fallen. The main force missed me by few minutes, but sometimes the difference between life and death is a matter of seconds. I realized then that I had gambled or risked my life for a pizza, a toothbrush and a bottle of shampoo all of which I didn’t get. But then, as Brandon Frazer said in the movie The Mummy, “I only gamble with my life, not with my money.”

The aftermath
     The aftermath of Isabel was like hell for many people. In fact, the Richmond Times Dispatch called Isabel, Isa-Hell. Without power, life was tough. For the first three days, all we ate were canned goods and some chips that were in our pantry for probably months or even year when the kids used to eat them. The grocery stores and restaurants were closed. Also, with only a couple of gas stations opened, the line was almost two miles long and thus I saw no reason wasting what’s left of my vehicle’s gas tank driving around looking for food stores or restaurants until at least more gas stations are open. Driving around was also dangerous because there were no traffic lights. Virtually all of them were out.

     The absence of electricity was definitely frustrating. As it dragged on from days to a week, it snapped the patience of so many people who, complained and blamed the utility company for not doing enough to restore their power. I was able to calm myself down by indulging on the knowledge that others were a lot worse than us. In fact they were, not just from Isabel, but also from the tornadoes that Isabel had spawned, about four or five of them, that touched down a couple of days later in places not far from us during the early morning hours. The tornadoes devastated and flattened more houses leaving only the toilet bowls that stood like unique huge mushrooms in an open field. The toilet bowls were still working though and still flushed water, but no privacy.

Getting used to difficult times
     I felt sorry for the people that had it really bad with Isabel and those hit by the tornadoes, but their terrible fate made me feel more fortunate and more grateful of our situation which was definitely a whole lot better than theirs, and helped me make up my mind to get used to living without electricity. It put me in the good frame of mind in a bad situation at a bad time to readily understand that the utility company was simply being overwhelmed by the extent of the devastation. In fact, thousands of electrical workers from Texas, Alabama, Florida, Georgia with their huge trucks and equipments came to help restore power in Virginia, but the damage was just too much to have the power restored for every one in a matter of days. They were able to do it though, after more than two weeks.

     Once you have accepted the fact that the situation is beyond your control and there’s nothing anyone can do about it but to wait, life becomes a lot easier to live. You have no choice but to learn to get used to the situation, or your days and nights would be filled with worries, bitterness and frustrations. You would become powerless and miserable. It would be like allowing the circumstances to basically take your life away from you.

     The most difficult to get used to was taking cold shower every morning in the dark. As soon as the cold water hit my body, it took my breath away. It stiffened the muscles of my back although that little one in front shriveled. Poor thing. It shrunk to a pitiful size like the turtle’s head trying to hide in its shell every time I took that cold shower. Another difficult thing to get used to was inhaling the fumes of the lamps or lamparillas. It gave me headaches.

Life is not fair
     With many trees around our yard, it’s surprising that none of them succumbed to Isabel. Most of our neighbors had at least one or two trees uprooted by Isabel. Our next door neighbor had her garage destroyed and a car crumpled by a fallen tree. It’s because of the so many fallen trees bringing down the electrical wires and posts with them that our area was one of the last ones the utility company fixed and restored.

     Isabel devastated so many properties and changed the lives of the many people here in Virginia and North Carolina in particular. Lucky for me the only debris I needed to pick up were the leaves and the broken tree branches littered all over our yard. Others have to pick up the pieces and debris of their lives for a long time. Life is not fair. It never was, and it never will be. It’s better to learn to get used to it, expect the worst and hope for the best.

Making the best of the bad situation
    The experience with Isabel and its aftermath has dramatically altered my perspective in life. I’ve learned to appreciate every little thing than I used to. Things I took for granted have become more precious. For the first time in a long time, I realized how bright and beautiful the stars are in the dark. Since I was forced to sleep early every night and I often woke up between 3:00 A.M. - 4:00 A.M., while it was still dark and quiet, I had the pleasure of evoking pleasant memories as well as fantasies by looking at the stars. Alone in the dark, the vast universe has a way of taking you to fantasyland and to a dream-like state that makes you indulge on the memories of the blast in the past. I guess the absence of the moon made the stars more magical.

     When the world around is swallowed by darkness, the beauty of the sky that is adorned by the stars of different sizes and brilliance is breathtaking. I believe the stars were winking at me every time I was staring at them. I wished I had a telescope. I could have seen them smile. There was nothing like it, and I’m grateful to have the opportunities of having been captivated by such natural wonder that can only beheld in the wee hours of the morning when darkness rules the world and all you could hear is the sound of silence broken only by the intermittent songs of the crickets and the occasional barking of a dog from a distance.

And then there was light
    Our electricity was finally restored almost two weeks after, in the night of the 13th day to be exact, but another more than two weeks was needed to restore our cable Internet connection. Because we had nothing in our refrigerator and freezers since we had to throw them away, for they stunk to high heaven after several days without electricity, I had to go to Wal-Mart late in that night just to buy some food to cook and coffee to brew for breakfast in the morning. We probably had more than a hundred pounds of fish and meat as well as other food items that were spoiled in our freezers and fridge.

     The morning after our electricity was restored, the hot shower felt like heaven. The omelet I cooked tasted like it’s the best food I’ve ever eaten in my life. Indeed for almost two weeks eating canned goods and food from outside, I’ve missed the food cooked in our own kitchen. Dining in restaurants every day and night for almost two weeks following the loss of electricity made me feel like eating was no longer an enjoyment but an obligation for the necessary nourishment; not a pleasure but a penalty for bad luck. Food was more of a filling than a great taste, and thus less satisfying.

     I guess I could have gotten used to eating food from different restaurants and enjoy, but if you’re like me who, would rather cook your own breakfast and brew your own coffee, you would probably have the feeling that something is definitely missing. I prefer to make my own coffee in the morning especially on weekends. I just enjoy it – the aroma while the coffee is still brewing and the taste that is so satisfying, particularly drinking it while reading the morning paper.

The stuffs of life
    One thing that Isabel had demonstrated to us is that everything we have no matter how precious, including our own life, can be taken away at any time or at any moment. Each of us is put on this earth to learn, love, laugh, share, appreciate and enjoy. We should make the most out of every single day by stopping and taking a little time to notice and make important the little things in life that all too often we overlook as we hurry ourselves to our daily routines. They can be something to cherish and savor and make our day enjoyable.

     We are all blessed with a universe filled with many things to be grateful for, things of beauty we can derive pleasure from, things to appreciate, love and enjoy. We can go to the river or beach, for example, walk barefoot and enjoy the pleasant feeling of the water lapping our legs, or the unique sensation of the rocks or sands that come in contact with the soles of our feet. We can stop at the ice cream or yogurt place on our way home from work and cherish and savor a scoop or two or even three of our favorite flavor.

     Certainly, there are many “important things” in our life that we feel we need to think and worry about like work, family, children’s problems that affect us, mortgages, etc. “So why waste our time on trivia,” we ask. But gratefulness or gratitude needs awareness and practice to develop, and what could be a better way of expressing our gratitude than to enjoy the things we are blessed with, the little things that are called the stuffs of life.

Gratitude, a neglected virtue
    Gratitude is essential in life because gratitude provides balance and healing of the mind. Gratitude gives us the feeling of being connected to the world around us and to the people in our lives. It helps us convince ourselves that every one deserves to be happy. Suffice it to say, the more we spend our lives wanting what we don’t have, the less grateful we are with what we already have, and the less we think of others.

    Also, gratitude makes it easier for us to cultivate the willingness to readily accept situations that are beyond our control and not allow such situations to disturb or depress our mood, to put our mind in distress, and to rob us of the happiness that is always ours to experience. It also makes it easier for us to learn to slide past the negative situations that confront us by making us realize that every experience good or bad is a profit, every step we take forward is a progress, and every barrier we struggle through is simply a reminder that long-term happiness is not the by-product of short-term gratification.

Conclusion
    Once again, everything you have whatever it is, however precious, including your life, no matter how hard you hang on to it, no matter how careful you take care of it, and no matter how much you work and spend for it, can be taken away at any moment. So enjoy what you have and be happy with what you are blessed with, no matter how little and how insignificant you may think they are. Enjoying them or being happy with them is the best way and may even be the only way of expressing your gratitude with sincerity.

     It’s practically impossible to find joy and happiness in things we are not grateful for, just as it’s practically impossible to be sincerely grateful for things we are not happy with. You cannot be happy with what’s given to you that you are not grateful for. Can you?

     Now go and hit the road. Visit a friend or do something with your family while you still can. Take the family for a hike, stroll in the park, or just sit on the side of the river and enjoy the babbling sound of the water. Or, have a hot dog on the side of the street and laugh at the mustard that accidentally spilled on your shirt. Spend time with the people who love you and be grateful for them. As they say: “Always count your blessings.” You’d be glad you did.

    An Unknown Author said: "Life is not measured by the number of breaths we take, but by the moments that take our breath away."

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Valuable Tips and Information

"When action grows unprofitable, gather information; when information grows unprofitable, sleep." --Ursula K. LeGuin

Safety and Security
    Identity theft. If it hasn't gotten your attention yet, it will be the next time you go to the post office. The Federal Trade Commission estimated in its study that 10 million people were victims of indentity theft last year. This study indicated that about 4% of identity theft begins with stolen mail - like pre-approved credit card applications that sit in your mailbox outside your house. The theft can open a credit card account in your name. Also, when you put your mails in your mailbox, you raised the red flag to indicate to the mail carrier that you have outgoing mails. That raised flag also tells the theft that your mail is ready for him to pick up. And what do you normally put in that box? Bills with checks in them, and criminals know that. They can get your account number from your check and other vital information about you depending on what's in your outgoing mail. So from now on, forget the time-honored tradition of letting the mail carrier pick up your outgoing mails for you. Drop your mails in the local post office or in the blue post office mail drop boxes that may be located on the street corner near you. At least don't put your mails in your mailbox during the night for delivery pick-up the following day.

    Radiation detectors on highways. According to George Vinson, California Homeland Security Director, the California Highway Patrol plans to install radiation detectors at truck inspection stations on major highways from Oregon, Arizona and Nevada. Manny Padilla, California Highway Patrol Assistant Commissioner, said that detection devices, which cost around $3,500 a piece and can detect chemical and biological threats, will be installed on pole-mounted radiation detectors at 38 of the state's weigh stations on both sides of the interstate. It's about time.

Military
    Mini-cruise missiles. According to Aviation Week and Space Technology, Boeing is building a prototype for a 1,000-pound cruise missile to destroy ballistic missile launchers. The mini-missile will have a range of 1,000 miles and could be fired from an F/A-22 Stealth Fighter. Carl Avila, director of advanced tactical missile programs at Boeing, says that the miniature cruise missile is set to fly at a speed of Mach 0.8 at an altitude of 25,000 feet and will carry enough submunitions to attack two to three targets.

     Virtual Soldier. DARPA (Defense Advanced Research Projects Agency) announced recently plans to help battlefield medics make more accurate diagnosis. According to Wired News, the Virtual Soldier program would develop technology that digitally recreates a soldier's body. "The idea is to use MRIs, CT scans, X-rays, and ultrasound to create a holographic medical electronic representation, or a holomer." The holomer would then be embedded on a chip in the soldier's dog tags. The way it looks, this technology would not be limited to the military. It could easily have applications in the civilian world also.

     Matrix Revolution. The Air Force recently unveiled a new breed of robots designed to protect Air Force facilities and personnel. According to an Air Force press release, new gadgets included a "robot that crawled up walls and across ceilings, another that clambered over rocks with six rotating legs and a third that wriggled like a snake through a pipe." The robots could initially be used for force protection. "One of the things we want, and have asked the industry to do," Col. Tommy Dillard says, " is to be able not only to detect - with robots - but to start a neutralization phase before we can get response forces out there." This is the rise of the machines, not rage against machines.

Medicine
    This information is taken from The Lancet - an analysis about antioxidant by Marc S. Penn, M.D. PhD, a staff cardiologist, The Cleveland Clinic Foundation, Cleveland, Ohio. A recent analysis of 15 large-scale studies showed that supplemental beta-carotene actually increases risk of dying from all causes by a small but significant amount and from heart disease in particular. It also showed that there are no significant cardiovascular benefits from Vitamin E supplements. The new recommendation is to stay away from dietary supplements that contain beta-carotene or its close cousin, Vitamin A. The jury is still out on whether they protect against cancer. The best way to get your supplements is by eating fresh fruits and vegetables.

Technology
    Computer. Samsung has unveiled a new computer flat screen monitor that you can adjust through the mouse like the car's rare view mirror adjusted through a button near the driver's seat. This new pivoting LCD screen is called SyncMaster 173P that will be available this month with a suggested retail price of $549. It has a software inside that allows you to control all the screen adjustments via your mouse, and there is no other adjustment anywhere else. Its picture quality is breathtaking.

    Cellular phones. Just like any other technology gadgets, cellular phones are getting smaller and more powerful. Phone companies are changing their models faster than the shoes companies are changing the style of their shoes. The smallest and cutest phone that is now available at a Cingular store near you is Siemens SL56. It features dual bands - 850/1900 MHz - Java and GPRS, up to three hours battery life along with rapid battery charging in a slide-out package that weighs less than three ounces. Motorola is releasing its MPX-200 smartphone that runs on Microsoft's Windows Mobile platform on AT&T Wireless network. The Sony/Ericsson has a new cell phone available this holiday season. With its clamshell design, it comes with color screen, interchangeable front and back covers and an integrated camera. This phone has the optional Multi-Action keypad that allows for simultaneous key presses for gamers, meaning you can move and shoot at the same time. This will be a hot item for youngsters in particular.

Miscellaneous
     This tip is courtesy of John Rosemond, family psychologist and founder, The Center for Affirmative Parenting, Gastonia, North Carolina. Children and chores: Never assign two or more children to the same task - they'll end up bickering over who isn't doing his or her share. Better: Give each child a separate task. You'll get more done - with a lot less arguing.

     This tip is courtesy of Charles Hagen, photography columnist, The New York Times. Film in your camera. Film with faster speeds reduces blurry image if a camera shakes or the subject moves. Film with ISO or ASA ratings of 400 and above are considered fast. Faster film may also prevent the flash on many point-and-shoot cameras from going on in relatively bright light by letting the cameras take pictures with less available light. Caution: Faster film tends to produce slightly more grainy-looking prints - which may become noticeable in large blowups. Helpful for all film: Have it processed as soon as possible after it has been exposed. Avoid film that is near or past expiration dates.

     This tip is courtesy of Car Care Council, 1 Grande Lake Dr., Port Clinton, Ohio 43452. The dangers of worn shocks or struts: Decreased braking effectiveness, poorer ride comfort and handling. Shocks or struts may be worn if: Your car bounces three or more times when crossing an intersection or crossing a dip in the road ... rocks back and forth several times when you stop quickly ... tends to drift left or right when you apply the brakes firmly at higher speed ... rocks or sways from side to side when changing lanes quickly ... leans and sways on tight curve like a freeway ramp. See your mechanic if you notice any of these symptoms.

     This tip is courtesy of Tom and Ray Magliozzi, the funny hosts of Car Talk in National Public Radio. Check you car's oil level after the oil has been changed by the dealer or a garage. Danger: Too much oil. Excess oil can be whipped into a foam by engine's crankshaft. Since the oil pump can't pump this foam, parts of the engine may not get sufficient lubrication.

     Web site for Philippines-Directory Resources that include news, books and web resources. Simply click on it to visit. Philippines-Directory Resources.

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ASOCIMAI - CIM Related Events and Activities

"Each of us has a spark of life inside us, and our greatest endeavor ought to be to set off that spark in one another." -- Kenny Ausubel

Forming a support program for medical malpractice concerns

Introduction: A thought on giving and getting
    I don't know about you, but I happen to believe that the most glowing and glorious thing one can do to his or her fellow being is to be of help. I'd like to think that it's what I'm doing through Brain Waves. Certainly, many of us don't need any help, but it doesn't mean that we should not offer it, or offering it is a sin. When you offer help by providing an idea, thought, opinion, information, or any other kind of help, you are basically giving someone at least one choice more than what that someone has. And one choice more is always better than one choice less.

     Suffice it to say, when it comes to help, we often think in terms of compassion and charity for the less fortunate ones, because they are the ones in need of help. And we often associate compassion and charity with how much money we can give regardless of whether or not we have the enthusiasm and the willingness to give. Sometimes we accept an undeserved guilt, and that's why we give because we feel guilty of what we have if we don't give. But we should not accept this guilt feeling because we don't deserve it. We did not become what we are now or did not get what we have at the expense of others. We worked hard for what we have achieved.

     Now what if the more fortunate ones are having problems and difficulties of their own? Would they be willing to help the less fortunate ones? Would they really have the compassion to give or help? Would they be enthusiastic in participating with our association's activities and promote its charitable functions?

    To me, the focus should be more on the goose than on the eggs. But in society these days, people with money are being milked like they earn their money at the expense of those who don't earn anything. The geese are being penalized for laying the golden eggs. Incidentally, one reason why many marriages end up in divorce is because many couples focus more on their financial situation than on their relationship, their physical, spiritual and emotional well-being - the eggs, not the goose. One reason why many children don't do well in school is because many parents focus more on their children's grades and achievements than on their happiness and well-being in order to learn to understand their children better, to love, trust and have a good relationship with them. I guess people are just too busy that all too often they don't stop and think who the goose is or what the goose stands for. They simply ignore the principle involved in the story of the goose that lays the golden eggs.

     It has been my attitude that if I do something for nothing, it's because I want to do it or I'm happy to do it, not because doing it would make me happy by relieving myself of guilt feeling. It's the same way if I give something to charity. It's my happiness I want to give or share, not some happiness I want to get by giving. Happiness in giving involves the real feeling of compassion and an honest self-acknowledgement of having more than others have and being more fortunate than others are. You feel like giving or sharing, all because you feel fortunate and grateful for what you have.

A suggestion started it
    One of the alumni has suggested that our association should form a support program for medical malpractice. This suggestion was circulated to every one of the alumni and thanks to Dr. Chi-Chi Maestrado and Dr. Mike Espiritu, we come up with something in forming this support program. So here is what we are going to do. Anyone of you can send question, suggestion, information, or comments regarding medical malpractice issues to my e-mail address and no name will be mentioned unless you specifically indicate that you want your name published. If it's a question, then I'll send it out through e-mail to every one for an answer, comment or opinion. Again, unless you indicate that you want your name published, no name will be included. The questions and answers will then be published in the next issue of Brain Waves. Further, any case you want discussed will be considered hypothetical.

Participation would sustain it; an apathy would end it.
     Malpractice liability has become a big threat for every practicing physician and it will continue to do so. Many years ago, physicians thought that such liability would get bad. They were wrong. It had gotten worse. It has defied the saying, "It would get worse before it would get better." No, it won't get better. You might as well get used to it.

    Malpractice liability is spiritually-disturbing, emotionally-depressing, intellectually-disrupting and financially-bankrupting. In some cases, it has led to a divorce and the subsequent break up of the family. Unfortunately, many physicians, having been used to privacy and being independent, keep their problems to themselves and so with their thoughts, ideas and opinions.

    Brain Waves would want to promote this support program for our association, but like any other program, it needs participation and in this situation, your participation is a form of help to your colleagues. You see, sometimes a little enlightenment, reassurance, empathy, encouragement, information and even a simple thought would be enough help for someone to gain back his confidence. So if you want to express your compassion, then this is one way of doing it. It's not a matter of whether or not someone appreciates your empathy or compassionate thought. It's a choice you make, and a choice you give. And it's a wonderful choice.

     Asking question and sharing your problem don't necessarily mean that you're not helping anyone. As a matter of fact, you are. Haven't you noticed that when someone asks question that could be related to your own problem, you may also benefit from it, not just from the comforting feeling that after all you're not alone with such problem, but also from its answer? If no one asks, none will benefit. So every question asked, every question answered, and every problem discussed, someone will benefit. If this is not a form of help, then what do you call it?

     Now here is the first question:

       Is there any Web site where we can log in for information regarding legal-health related issues?

    There are two Web sites and you can click on them directly:
    Medicine and Law

    Medical Malpractice Laws Summary States by States

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For Laughs Only

"Only one man in 1,000 is a leader of men. The other 999 follow women." --Groucho Marx

    A man went to a psychiatrist and said he was worried that he was becoming obsessed with sex. The psychiatrist showed him a photograph of a cow and asked him what it reminded him of?
    "A man and a woman making love," replied the man.
    Then the psychiatrist showed him a photo of a cupboard box. "Now what does this remind you of?"
    "A man and a woman making love."
    Next the psychiatrist showed him a photo of the Empire State Building. "What does this remind you of?"
    "A man and a woman making love."
    "Well," sighed the psychiatrist, "I have to say you do seem to be obsessed with sex."
    "Me?" replied the patient. "You're the one who keeps showing me dirty pictures."

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    A cardiac patient was told that he needed an urgent heart transplant. The surgeon said: "You can have a doctor's heart for 10,000 dollars, a rabbi's heart for 20,000 dollars or a lawyers' heart for 100,000 dollars."
    "Why are lawyers' hearts so expensive?" asked the patient.
    "Well," said the surgeon, "we have to go through a lot of lawyers to find a heart."

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    The celebrated American lawyer Clarence Darrow told a story about how easy it is for a lawyer in court to make a fatal mistake of asking one question too many.
    The dependant was accused of biting off another man's ear. His lawyer cross-examined the witness: "Did you see my client biting off the victim's ear?"
    "No, sir."
    Instead of stopping there, the lawyer pressed on triumphantly: "So how can you testify that my client bit off the victim's ear?"
    "Because I saw him spit it out."

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     A man was jumped in an alley by two muggers. He put up a heroic resistance, but was eventually overpowered and the attackers went through his pockets. They didn't find much.
    "You mean you fought like that for 50 cents?" said one mugger incredulously.
    "Is that all you wanted?" said the man, relieved. "I thought you were after of the 500 dollars in my shoe."

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Feature

"All the miles of hard road are worth a moment of true happiness." --Arnold Lobel

Thalidomide  - a once horrible drug is back to vindicate itself

Background History
    Thalidomide was originally developed in 1957 by a German drug company and was used mainly as sedative. It was found to have a calming effect on pregnant women. Many women develop morning sickness characterized by nausea and vomiting during the first trimester of pregnancy. Tragically, doctors around the world began prescribing Thalidomide to all women experiencing morning sickness, and many of these women were on the first trimester of pregnancy when the embryo is vulnerable to developing birth defects because it’s when the different organs of the body start to develop. It was the beginning of what turned out to be a horrible nightmare.

    In the early 1960s, there what seemed to be an epidemic of birth defects sweeping Europe particularly the United Kingdom and Germany. Thousands of babies were born with what doctors at first thought was phocomelia, an inherited failure of the limbs to complete development, forming instead flipper-like appendages. But inherited or genetic diseases do not just suddenly become epidemic, and so epidemiologists started looking for another explanation. They started asking – what do the mothers of these infants have in common? That’s when they discovered that all of them were taking Thalidomide for morning sickness at the time when limbs formation begins on the four – six-week embryo.

    Fortunately, the drug was not prescribed in the U.S. because it was waiting for FDA approval. It was not a question of safety as the reason why the FDA did not approve the drug yet. A bureaucrat found clerical mistakes in the application. She demanded the company to wait one more year for its approval. In the interim, serious side effects were discovered. The lady became a hero and received a medal. The drug was banned about 30 years ago. 

Accidental Discovery and Subsequent Studies
     In 1964, an Israeli doctor was treating leprosy patients with Thalidomide for a painful condition known as erythema nodosum leprosum (ENL) and surprisingly the drug alleviated the symptoms. Subsequently the drug was found to have powerful regulating effects on the immune system – it keeps the system in balance. Typically, drugs either enhance or dampen the immune system, but Thalidomide does both. For example in AIDS patients who were basically rotting to death, because their immune system has been destroyed by the virus, Thalidomide strengthened the immune response giving these patients who look like concentration camps survivors, their good health. In leprosy in which patients’ immune systems are over-charged or hyper-reactive in the fight against the bacteria causing them to develop painful nodules or cysts from autoimmune reactions, Thalidomide can down regulate the immune system, relieving patients from pain.

     In July 16, 1998, a biotech company Celgene received FDA approval to market the drug for ENL in leprosy patients. That's how it started and the drug was studied and tested in the fight against cancers resistant to chemotherapy. Doctors found Thalidomide to be most beneficial in fighting multiple myeloma, the second most common cancer of the blood. Like leukemias, multiple myeloma is a cancer of the blood cells residing in bone marrow resulting to bone marrow failures leading to anemia, weakness, fractures, bone pain, release of calcium and proteins that clog the kidneys causing them to fail. In this cancer, there is an overabundance of plasma cells that produce “myeloma proteins” and Bence Jones proteins that are detected in the urine – two diagnostic hallmarks of this disease. This cancer is characterized pathologically by angiogenesis that runs amok – patient develops miles and miles of extra capillaries that are snaking through the bone. This proliferation of new blood vessels makes this cancer notoriously resistant to treatment, because cancer cells are being supplied with nutrition through these blood vessels.

    It was in the wake of the infamous over-reporting of Judah Folkman’s work on angiogenesis inhibitors in 1998 that a link between multiple myeloma and Thalidomide emerged. When the wife of a patient with multiple myeloma called Folkman, she was referred to Bart Barlogie, at the Myeloma and Transplantation Research Center, University of Arkansas for Medical Science in Little Rock, who was working on Thalidomide. This patient and few others treated with Thalidomide had a remarkable response. Soon after, 83 others who had failed the standard chemotherapy received Thalidomide. They had an impressive 32% response rate – success defined as with no progression, measured by decreased levels of myeloma protein or Bence Jones protein, or fewer plasma cells in bone marrow. It’s a lot better than an almost certain painful death.

    As mechanisms of action in multiple myeloma, Thalidomide inhibits vascular endothelial growth factor and basic fibroblast growth factor. Thalidomide is now tested on renal cell carcinoma – a deadly cancer of the kidney. It is also on trial against Myelodysplastic Syndrome (MDS), a blood disease that leads to a deadly form of leukemia, commonly called AML - Acute Myelogenous or Myeloblastic Leukemia. In this syndrome, for whatever reason, some blood cells of the patient don’t mature. Over time these cells begin to crowd out the healthy cells and the person would have anemia, bleeding because the platelet formation is depressed, and becomes prone to infection because the white blood cells are also depressed. Thalidomide is used with the belief that it could help modulate the immune response and hopefully clear the immature cells from the bone marrow.

      With Celgene’s new safer version of Thalidomide called Revimid, Dr. Alan List of the Arizona Cancer Center showed that 16 out of 25 patients with MDS had clinically significant response. Twelve of these patients no longer needed blood transfusion to fight this disease. And 8 of 8 patients with the “5q-“ chromosome abnormality were cured of the disease. From a certain death to a cure is definitely amazing.

    Of the 46 patients dying of multiple myeloma ongoing Harvard study, 96% responded positively to the new Thalidomide version Revimid, or Revimid and steroids. In another smaller study, 71% responded. Clearly, Thalidomide is making a comeback like the legendary phoenix rising from the ashes.

     For more information and update of this drug, get into the following web sites below. They are the references or sources of this article.

    The Scientist (www.the-scientist.com). Celgene Pharmaceutical (www.celgene.com/thalomid).

-- Clem

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Announcement!
      Those who participated in the Medical-Surgical Mission in Cebu in 2002, a cruise to Scandinavia in August 2004 is planned. For more information contact Andy and Celia Yap at these e-mail addresses: sisenandoyap@yahoo.com or celiayap@yahoo.com. You can also contact Andy and Celia at this address: 10096 Fitzwater Road, Brecksville, Ohio 44141. Telephone: 1-440-526-2547.

This picture is taken at the CIM Dean's office in August of 2002, courtesy of Dr. Andy Yap. Dr. Yap was the president of APPO (American Philippine Physicians of Ohio) when Dr. Cardino was chosen as APPO's medical scholar in CIM. Left: Josephina Poblete, M.D., Dean, CIM; Middle: Marbert Cardino, M.D. 4th place, Philippine Medical Board, August 2003; Right: Sisenando Yap, M.D. General Surgeon, Ohio.

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