New Hope in Kidney Cancer Treatment

AUTHOR'S NOTES: This article was published in The Big C Magazine.

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NEW HOPE IN KIDNEY CANCER TREATMENT

While there has been a growing awareness among Filipinos of cancers of the breast, cervix, prostate and colon thanks to extensive media coverage, little interest has been generated with regards to kidney cancer. This is unfortunate because kidney cancer poses a major threat to health. It is quite difficult to determine the number of new cases that are diagnosed in the Philippines each year. Needless to say, a significant number of people suffer from kidney tumors. Majority of these diagnosed cases (85%) are renal cell carcinoma (RCC), with pelvic urothelial tumors as the remaining 15%.

Risk Factors

According to Dr. Jose Vicente "JV" Prodigalidad, Head of the Section of Laparoscopic Urology, Dept. of Urology of the National Kidney and Transplant Institute (NKTI), there are a number of factors that puts an individual at risk of developing kidney cancer.
"Genetics plays a very big role," says Dr. Prodigalidad. "Another risk factor is gender – men are more at risk of developing RCC than women by twice as much. Other acquired risk factors are smoking, obesity, a sedentary lifestyle, and exposure to chemicals such as asbestos.

Warning Signs

Most early cases of RCC are asymptomatic. A commonly encountered warning sign, if present, is blood on urinalysis (microscopic hematuria) or visible in the urine itself (gross hematuria). Both would warrant further investigation with ultrasound or contrast studies such as a KUB-IVP or CT scan with IV contrast. Occasionally, pain may be felt in the right flank. For larger tumors, a flank mass may be palpable.

In some cases, RCC is an incidental finding on CT scan when a patient is being examined for another condition or when having an executive check-up.

"CT scan with IV contrast remains the best diagnostic procedure for determining whether a patient has a renal mass or not," notes Dr. Prodigalidad.

Staging of Kidney Cancer

In his clinical practice, most of Dr. Prodigalidad's patients were diagnosed at Stage I. "This means the lesion is 7 cm or less. It was originally set at 4 cm, but researchers have decided to increase it to 7 cm because even a tumor of that size, when taken out completely, is good for cure."

The stages of kidney cancer are as follows…

• Stage I = tumor is 7 cm or less and localized within the kidney; 80% survival rate
  
• Stage II = tumor is no longer localized within the kidney and has extended to the fat around the kidney but within the fascia (known as the Gerota's fascia); 60% survival rate.
  
• Stage III = there is involvement of the vessels and lymph nodes in the area; 35-40% survival rate.
  
• Stage IV = there is metastasis to the adjacent organs, intestines, liver or lungs; 10% survival rate.
  

Treatment of Stage I-III Kidney Cancer

At present, the real cure for kidney cancer is total or radical nephrectomy, which involves the removal of the entire kidney together with its capsule. Radical nephrectomy can be performed as an open surgery or by laparoscopy.

Says Dr. Prodigalidad, "Most urologists are more comfortable doing open radical nephrectomy because it allows for better visualization of the tumor and blood vessels, especially in Stage III cancers. With laparoscopic radical nephrectomy, the success rate is the same as open surgery if done by a trained surgeon. There is less blood loss and the recuperation rates are faster. In centers abroad, lap nephrectomy is slowly becoming the treatment of choice for Stage I and II tumors.

Another procedure is partial nephrectomy (the removal of the affected part of the kidney). However, this procedure is done when there is a risk of rendering the patient anephric, such as in patients with only one functioning kidney and in those who have tumors in both kidneys.

"You can only do partial nephrectomy if the tumors are small, they are located in the upper or lower poles, or are exophytic (the mass is projecting outward)," Dr. Prodigalidad points out. "If the tumor occupies more than one-half of the kidney, preservation of the vascular supply will be difficult. Without the blood supply, the rest of the kidney will die. Better go for total nephrectomy and leave partial nephrectomy to selected cases."

Treatment for Stage IV Kidney Cancer

Unlike other forms of cancer wherein surgery is not done in Stage IV disease, for kidney cancer, radical nephrectomy has two goals – 1) palliative and 2) reduction of tumor bulk.
Palliative nephrectomy entails removal of the tumor itself to help relieve pain as the tumor enlarges because it stretches the renal capsule, and to prevent significant bleeding.
Reduction of the tumor bulk, on the other hand, would make it easier for other palliative measures, such as radiotherapy and the use of biologic therapies (like interferon and interleukin-2), to work.

Drug Treatment For Kidney Cancer

According to Dr. Prodigalidad, "Kidney cancer is not really responsive to chemotherapy and radiotherapy that's why we call them 'chemo- and radio-resistant'."
Still, researchers have not given up hope in finding that 'magic pill' that could aid in treating patients in the advanced stages of the disease. One form of treatment being explored is biologic therapy, most notable of which is cytokine treatment.

In an interview conducted by Big C's Marian Martin-Layug with visiting Korean kidney specialist Dr. Yoon Koo Kang last October 13, it was explained that cytokine treatment, which involves the use of Interferon Alpha and Interleukin-2, act upon the immune system by promoting better communication between the cells so that they could act promptly against the cancer.

However, there is a drawback to using cytokines in renal cell carcinoma. "Cytokine treatment was not effective for the treatment of renal cell carcinoma, especially if it is metastatic," explains Dr. Kang. "Both Interferon Alpha and Interleukin-2 are very, very toxic. They are not used in all stages."

Dr. Kang also emphasized that cytokine treatment is not a standard of treatment for renal cell carcinoma. "These treatments are not effective enough so they are not standard. When you say that a treatment is 'standard', it means that these drugs are better given to the patient than letting them have no treatment at all. However, in the case of cytokine treatment, they are not effective enough to show the benefits.

There is current interest in two new drugs that have recently approved by the U.S. Food And Drug Administration. Called targeted therapies, these drugs are Bayer's Nexavar (sorafenib) and Pfizer's Sutent (sunitinib).

According to Dr. Kang, Nexavar acts as an inhibitor of the receptors of tyrosine kinases that promote tumor cell proliferation and angiogenesis (or the formation of blood vessels that feed blood to the tumor). "Nexavar has a dual effect on the tumor cell by targeting these two pathways. First one is the direct effect through the interruption of the signal transduction pathway that increases proliferation of tumor cells. The other effect is the inhibition of angiogenesis."

Sutent, on the other hand, roughly has the same mechanism of action as Nexavar, but it targets different signal pathways that promote tumor cell proliferation and angiogenesis.
Both Nexavar and Sutent can be given to patients in all stages of renal cell carcinoma. "Tumor reduction is difficult to achieve so we call these kinds of agents as cytostatic agents, not cytocidal agents, which are common in conventional chemotherapy," explains Dr. Kang. "Usually these drugs rarely reduce the cancer cells so an objective response is 30 percent size reduction (or what is termed as 'partial response'). In less than ten percent of patients, the partial response was achieved with Nexavar, with 70 percent of patients achieving a stable state, meaning that there is no increase in the tumor size. Around 84 percent of patients achieved either disease stabilization or reduction of tumor size. That activity translated into survival of two months."

Dr. Kang mentioned that other forms of treatment are being explored. "One interesting strategy is to combine the targeted agents together. At present, a clinical trial involving a combination therapy of Nexavar and Roche's Avastin, which is a monoclonal antibody, is in its fourth phase. How does this work? In the blood vessel, there are endothelial cells, which contain receptors, the most notable of which is the vascular endothelial growth factor (VEGF). Both Nexavar and Avastin act on VEGF producing a synergistic effect that prevents tumor cell proliferation."
Dr. Prodigalidad, however, pointed out that only a handful of urologists in the country would use these drugs in treating kidney cancer, most preferring the surgical approach, which remains the standard of treatment for this dreaded disease. "The prognoses for those patients who receive these kinds of therapy are not very good. It was depressing to see the side effects."

Vaccine Therapy for Kidney Cancer

There are a number of new treatments for kidney cancer that are being developed, including cryotherapy (a procedure that involves freezing the tumor) and High
Intensity Focused Ultrasound or HIFU. The treatment, however, that is showing promise for advanced kidney cancer is vaccine therapy.

Dr. Dante P. Dator, Chairman of the Dept. of Urology of the NKTI, explains, "When you say 'vaccination', there is no such thing as a vaccine that is universally accepted at the moment for cancer in general, and kidney cancer in particular, because what is being developed are specific 'vaccines' targeted against specific types of cancer. It is still in the experimental stage and work is in progress on at least two dozen malignancies, majority of them concentrated on malignant melanoma, multiple myeloma, colorectal carcinoma, prostate cancer and renal cell carcinoma (hence the interest of us urologists). In fact, the trials in the U.S. are now in Phase III. At the NKTI and Asian Hospital, we are in Phase I/II, which means that we are testing the safety and secondarily the efficacy of the vaccine."

Generally, tumor vaccines follow a simple principle as the vaccines that are being given to combat viral infections in children. "These tumor vaccines educates the body's immune system so that the body will recognize the cancer cells as 'non-self'," Dr. Dator further explains. "The cancer in principle is supposed to be foreign to us, but we do not recognize them as such, and therefore it proliferates, multiplies and can spread all over. The main issue is how do we get these cancer cells to be recognized by our immune system such that they will be destroyed by our body's natural defenses the same way they reject transplants and destroy viruses and bacteria."

There are two ways in which a tumor vaccine is created and administered. As Dr. Dator explains, "First of all, we make use of dendritic cells, the body’s scavenger or antigen presenting cell which is harvested by leukapharesis from the patient himself. These are then cultured, propagated and allowed to mature in the lab until sufficient numbers are attained. They are then exposed to the tumor antigens, which they readily capture and process and deliver to the lymph nodes where the cytotoxic arm of the immune system is activated and now educate these cells to act upon any part of the body containing these antigens. One method is to 'injure' the tumor to produce an environment of damaged and dying cells where the antigens are now 'exposed'. Cryotherapy using very low temperature (-40 degrees) lyses the tumor and the dendritic cells are injected intratumorally. The other method is to create a hybrid of autologous tumor cells, previously harvested and cultured and fused with dendritic cells and subsequently injected as a vaccine. These dendritic cells then activate the killer T-lymphocytes and other immune cells into attacking the tumor and any part of the body containing the tumor antigens.

The tumor vaccine was initially tested in a patient with malignant pheochromocytoma in 2003. As of this writing, dendritic cell vaccine therapy has been administered in patients with prostate cancer, kidney cancer, breast cancer, colonic carcinoma and malignant melanoma.

The initial results are promising. Some patients have demonstrated tumor regression while others have slowed down progression of disease. Of course, there are disappointments and much of the focus of worldwide research is to identify the patients who will best benefit from these treatment. Unlike chemotherapeutic agents, the only adverse effects noted with vaccine therapy are the same as regular vaccines, namely fever, fatigue and the flu-like syndrome.
According to Dr. Dator, "Immunotherapy is essentially non-toxic and it can be added to other treatments and repeated time and again. The results in animals and humans are promising and it may become the only way to control cancer if it has spread to other sites. It is still in its developmental stage but it should be remembered that any beneficial effect that prolongs or improves quality of life, whether achieved by the vaccine alone or in association with other treatments, would be welcomed by patients suffering from cancer."

Kidney Cancer Prevention

The three keys to kidney cancer prevention are the reduction of one's risks of acquiring the disease, knowledge of one's family history, and early detection.

Says Dr. Prodigalidad, "Since kidney cancer has a genetic predisposition, every Filipino must strive to know their family health history and be aware of the different cancers that are present in the family. If you know that you have that risk, then you would be more vigilant with your health habits. Don't smoke. If you are smoking, stop now. Keep yourself physically fit. Don't be a couch potato; be active. Of course, eat healthy. If there is a risk of kidney cancer in your family, have a regular urinalysis done. It is very important to try and catch the cancer early. Most cancers, if detected early enough, can be cured."

DOCTOR PROFILE: 2010 Pink Ribbon of Hope Awardee Dr. Tina Santos

AUTHOR'S NOTES: This is the complete interview/profile that I did with Dr. Tina Santos, this year's 2010 Pink Ribbon of Hope Awardee. The condensed version of this article was published in the Oct. 1-15, 2010 issue of Woman Today.

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DR. TINA SANTOS: TRUE CALLING

Many noted breast cancer survivors go into the advocacy because they or their loved ones have survived this dreaded disease. In the case of breast cancer surgery specialist and Gift2Life Founder Dr. Tina Santos, her choice to become a breast cancer advocate resulted from a true calling from God.

Please narrate to us how you became a breast cancer advocate. Were there personal reasons (such as a death of a loved one from the disease) which prompted you to go into breast cancer advocacy? When this is all happen?

There was no personal reason which prompted me to go into the breast cancer advocacy like a death of a loved one from the disease. I believe that my being a physician, becoming a general surgeon, and then differentiating into my current practice as a breast cancer surgery specialist and commitment to community breast cancer awareness are all God’s calling in my life. Looking back, I had been an average student in search of a potential niche in society. I felt then that my life had been trials & errors hoping to hit the role that will provide my comfort zones until the years 2000-2004 when I was clueless of where to find the true meaning of life. I prayerfully seek God and asked Him to help me discern His special plan and calling for my life, and asked Him to give me the faith and courage to follow, wherever He may lead me.

It was towards the end of 2004 that I realized that God had been pruning me into this mission even before I entered medical school but I was just too stubborn at times to follow His plans. I can say that since 2005, in the middle of God’s will and plan, I have been happiest and full of joy in my heart, regardless of the odds, in this mission called “breast cancer awareness” which God called me into with my Gift2Life Team.


What difficulties did you encounter when you first established your advocacy? How were you able to overcome these difficulties/obstacles?

The breast cancer awareness advocacy requires volunteerism, team work, and collaboration; and the initial and continuing difficulties range from:

• finding the core team players with the passion and commitment to the cause;
  
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• building, motivating, and sustaining the core team;
  
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• creating the non-profit organization, Gift2Life Inc, that truly embodies God’s will and plan for this mission called “breast cancer awareness”
  
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• building partnerships and collaborations for the cause and not for any branding / marketing purposes; resistance to change and politicking; personality differences; lack of resources to use; value-added strategies to consider and implement.
  

Proverbs 3: 5-6 has always been my refuge during these difficulties and please believe me, things just fall into places: “Trust in the Lord with all your heart, do not depend on your own understanding. Seek His will in all you do and He will direct your paths”.

Given your experiences with breast cancer patients, has there been an improvement with regards to information dissemination for early disease detection? What more needs to be done?

Yes, there have been improvements with regards to information dissemination for early disease detection because we have had several cases diagnosed during the early stages of breast cancer after our recommendations for mammogram, ultrasound, or on-site biopsy based on our risk factor assessment, clinical breast examination, and follow-up from our breast cancer awareness seminars and exhibits. Though sad to say, we still having a number of late stage and neglected cases of breast cancer from our breast cancer awareness seminars nationwide.

So much more are needed to be done for the following:

• collaboration of mission-based groups / organizations with similar purpose for maximization of resources and wider reach;
  
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• availability, accessibility, and affordability of clinical breast exam, screening mammography, breast ultrasound, breast biopsy, definitive breast cancer treatments to really achieve early detection and appropriate, timely, early treatment of breast cancer in the Philippines;
  

Please name some of the projects of your advocacy. Which particular project is most memorable to you?

Gift2Life has its all year round Free Breast Health Empowerment through:

• Breast Cancer Awareness (BCA) Advocacy Seminars (Empowerment Lecture, BSE Demo, Inspiring Breast Cancer Survivor Testimonies, and Question & Answer Portion) with On-site Breast Cancer Screening (Risk Factor Assessment, Clinical Breast Examination with Biopsy if needed, and One-on-One Consultation);
  
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• (BCA) Advocacy Exhibits (Information Exhibit Panels with on-going BCA DVD presentation) with On-site Breast Cancer Screening (Risk Factor Assessment, Clinical Breast Examination, and One-on-One Consultation);
  
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• Collaborative Definitive Breast Cancer Surgery with Our Lady of Peace Hospital in Las Piñas;
  
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• Collaborative Breast Cancer Clinic & Definitive Breast Cancer Surgery with Manila Naval Hospital in Fort Bonifacio, in partnership with the Philippine Navy Officers’ Wives Association (soon).
  

For the BCA Advocacy Seminars, we have activities in partnership with Philippine Wacoal Corporation which we call “Keep Abreast” and we have stand alone activities which we call Advocate Breast Cancer Consciousness Daily (“ABCD”) or Ating Breast Cancer Kaalaman Dagdagan (“ABaKaDa”), tailored to the social classification of the participants we have per activity.

For the BCA Advocacy Exhibits, we are always in partnership with Philippine Wacoal Corporation.

Benchmarking from our humble beginnings from 15 Dec 2007 until 11 September 2010, we have accomplished 156 breast cancer awareness seminars and 21 exhibits; advised > 5,000 individuals found to be at risk for breast cancer (of whom, 60% were recommended to have mammography and 40% to have breast ultrasound, on regular bases, for their breast health surveillances); and diagnosed > 50 patients with breast cancer from our on-site biopsies.

On an organizational level, the Keep Abreast Seminars are the most memorable to me because these seminars helped us create and propagate the breast cancer awareness domino effects. On a personal level, these seminars gave me the opportunities to develop my potentials as a community breast cancer awareness resource person. We started this in October of 2005 as an experimental breast cancer awareness seminar series held every Saturdays of October under the leadership of Ms. Ann Christine Palisoc, the Chief Operating Officer of Philippine Wacoal Corporation. I was then the President of another non-profit breast cancer organization. Keep Abreast developed into a commitment and partnership. Over time and with the birth of Gift2Life Inc, the Keep Abreast Seminars evolved to become an all year round collaborative campaign, now on its 5th year! In October of 2008, we developed and started the Keep Abreast Exhibits in malls, call centers, fun runs, and expos.

Please share with us your feelings on being given the Pink Ribbon of Hope Award. What opportunities do you feel would this award open to you and your advocacy?

I feel so blessed, delighted, and honored to be given the Pink Ribbon of Hope Award for 2010.
Kindly allow me to sincerely thank Senator Loren Legarda, Chairwoman and Founder of the Bessie B. Legarda Memorial Foundation, and Ms. Monica Aveo, Assistant Publisher and General Manager of Woman Today and President of the Bessie B. Legarda Memorial Foundation for this remarkable recognition. This will be a lifetime source of inspiration for me and for Gift2Life Inc, our nonprofit organization. I would like to share this award to the Board Members, Officers, Breast Cancer Awareness Core Team, and volunteers of Gift2Life and to all our partners and collaborators. This is the sweet fruit of our passion and efforts, and that together, we are making a difference! To all breast cancer survivors, patients, caregivers, and those who lost a loved one from breast cancer, this represents our faith and anticipation that someday breast cancer will also come to pass.

This award and media exposure will open more opportunities for partnerships and collaborations for the breast cancer awareness cause and will help save more lives among Filipinos both here and abroad. This award would not have been possible without God’s special plan and calling in my life hence, I would like to give back all the glory, honor, and praises to God with this award!

Is there a dream project that you would still like to undertake with your advocacy? What is this?

Yes, our dream project is the establishment of an Ambulatory Breast Cancer Specialty Center that will provide holistic breast cancer diagnosis, appropriate treatment, and surveillance services with:

• Short stay breast cancer surgery
  
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• Chemotherapy infusion
  
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• Hormonal and targeted therapies
  
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• Radiation therapy
  
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• Complimentary and holistic medicine
  
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• Treatment care of side effects
  
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• Screening, Diagnosis, and Surveillance
  
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• Consultation and Referral
  

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About Dr. Tina Santos

Dr. Tina Santos is a Physician of good standing since 1992, a practicing General Surgeon since 1997, and Breast Cancer Surgery Specialist since 2005.

She holds a Bachelor of Science Major in Psychology degree from Centro Escolar University and finished her Doctor of Medicine from Fatima College of Medicine in Metro Manila. She finished 3 months Clinical Clerkship Program in Surgery at Brooklyn Caledonian Hospital in New York. She completed 1 year Post Graduate Internship and 4 year - Residency Training in General Surgery at East Avenue Medical Center in Quezon City. She then underwent 6 months post doc research Fellowship Training in Breast Cancer and Melanoma Surgery at the University of California in San Francisco (UCSF).

She is a Fellow of good standing of the Philippine College of Surgeons, Philippine Society of Oncologists, Association of Women Surgeons, and American Society of Breast Surgeons. She has been a Resource Person for Breast Cancer Awareness Campaigns in the Philippines since 2005.
Having served > 200 different communities, government and private offices, church groups, schools, malls, call centers and still searching for more, some of her recent recognitions include:
1 of the 10 “Unsung Women Heroes Awardee 2010” given by the Soroptimist International Philippine Region last April 16, 2010;

Soroptimist International Ruby Awardee: “Making a Difference For Women Helping Women” given by the Soroptimist International-Metro Manila Southeast District and the Soroptimist International of Ortigas and Environs Club last March 6, 2010;

"Selfless Devotion in a Cause that contributes to Women and Society" by Philippine Wacoal Corporation given in June 2009, making her one of the Wacoal Women of 2009;

"Salute the Filipinas Exhibit during the Women's Health Month" given by SM Fairview in March 2009;

"Making a Difference For Women Helping Women" given by the Soroptimist International of Ortigas and Environs Club in February 2009;

"Commitment to Breast Cancer Awareness Advocacy by Sharing Medical Expertise to Promote Women's Health" given by Woman Today Asia Magazine in November 2006;

She is also the invited "Keep Abreast" Resource Speaker of the Philippine Wacoal Corporation since 2005 and the International Resource Person of Morishita-Seggs Pharmaceuticals Inc. since 2006.

Having more than seven (7) years experience in non-profit organizational management, she has MBA credits from the Asian Institute of Management, Philippines where Gift2Life is her on-going Strategic Management Project. She became past Chairwoman from 2006-2007 and past President from 2001-2007 of the Philippine Foundation for Breast Care, Inc.

"Doc Tina" is the current president of Gift2Life Inc.

CANCER SURVIVOR STORY: Interview with Rely Silayan

AUTHOR'S NOTES: This inspiring interview with Rely Silayan -- son of the legendary actor Vic Silayan and beauty queen Chat Silayan (herself a cancer fighter prior to her death) -- was originally published in Woman Today.

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FAITH & HOPE IN THE MIDST OF FAMILY CRISIS:
INTERVIEW WITH RELY SILAYAN

To those who don't know him, Rely Silayan may seem like an unfamiliar name. However, mention his father the late great actor Vic Silayan and his elder sister Chat Silayan, then you would know that he comes from a prominent family of newsmakers. To the members of St. Luke's Medical Center's cancer support group Corridor of Hope, Rely is a pillar of strength for his fellow cancer survivors.

In this exclusive interview, Rely shares with us his unique experiences as both a caregiver for Chat and, later on, as a cancer survivor himself, and how that special Silayan resiliency has helped them in their battles against this dreaded disease.

Rely, what was it like growing up in a family with the legendary Filipino actor Vic Silayan as your father?

We were just like any normal Filipino family. My Dad was pretty low profile. As an actor, he was not the 'boy next door' type; he was a character actor. But he was most popularly known for his voice. He was a favorite among past Philippine presidents and he was always asked to be Master of Ceremonies when there were state visitors.

Did your Dad ever encourage you and your siblings to go into acting?

He discouraged us actually. When we were studying, he told us not to make any decisions about going into acting until after we finished our studies. He said it's not a stable job, especially in the Philippines. It's best that we finish our studies. True enough, after we graduated, we lost all interest in acting. In the case of Chat, we were no longer able to prevent her from going into showbiz because she became a beauty queen. She was Third Runner-up in Miss Universe. So when she came back, it was natural that she would get a lot of offers, but she had already finished college by that time.

When was your family first stricken by cancer?

Just to clarify first, my Dad did not die of cancer. He died of heart failure. The first in my family to have cancer was my half-sister Mavic, who is married to former Quezon City mayor Jun Simon. She is a five-year survivor of breast since 2002-2003. Next was Chat. She succumbed to colon cancer in April 2006 after a two-and-a-half year battle. Then, five months after we buried Chat in Sept. 2006, I was diagnosed to have Non-Hodgkin's lymphoma. It's not just in my immediate family that cancer had hit us hard. Even in my wife's family. I lost my mother-in-law to lymphoma six years ago. In Oct. 2006 and April 2007 respectively, my brother-in-law and my wife's uncle died of colon cancer. So you can see our exposure to this disease.

With all these incidences of cancer, would you say that your family has a genetic predisposition for this disease?

Originally, I didn't think so, although my Mom had a lumpectomy a long time ago. She's 75 now and living in the U.S. We only found out during Chat's wake from our cousins on our father's side that we have relatives who had cancer.

Please narrate to us how you were diagnosed with Non-Hodkin's lymphoma.

It was in March 2006 while I was taking care of Chat. I found a lump ("kulani") in my groin area. I didn't think much of it because I was used to getting enlarged lymph nodes as a kid because I was always getting into the usual scrapes. I never told Chat about it. But later on, I found another lump. After Chat died, I went back to work in July. I was on a diet and my weight dropped from 160-165 to 123 pounds. I thought it was the diet working. However, when the first enlarged lymph node that I found grew to the size of a golf ball, I realized something was wrong. I decided to consult with Dr. Joven Cuanang, Medical Director of St. Luke's who was an old friend of Chat's. He ordered a thorough work-up. After three days, I found out that it was malignant. Dr. Cuanang entrusted me into the care of the Cancer Institute's Dr. Charity Gorospe.

How did you react when you found out that you too had cancer?

It really didn't strike me as a surprise because of our family history. When it came to me, I never thought to ask "Why me?" My question to God was "Did You prepare me for this?" Because I wasn't surprised, I didn't get angry. Initially, I was saddened, but I thought there's a reason for this.

How were you able to cope, to actually live with this disease?

The first step obviously was to learn more about Non-Hodgkin's lymphoma, and in this area, I am grateful that Dr. Gorospe thoroughly educated me about the disease, its treatments and its possible side effects. I have to admit that I was concerned when Dr. Gorospe told me that I would lose all my hair. I couldn't imagine myself bald. I haven't started chemo yet, but I was already thinking about how to manage the hair loss because I knew that it would be a source of depression. I was always conscious about how I look so I didn't like to see myself bald and looking sickly. The following weekend, I went to the mall with my family. I went off on my own and had my ear pierced and started wearing an earring. Three days after my first chemo, sure enough, my hair started falling off in clumps. I then remembered what my uncle – my Dad's brother – told me: "Give it a good fight, Rely. Don't be depressed." That very morning, I asked my son to accompany me to the barber and had my hair shaved off. At that time, I already had an earring, so I was smiling at my reflection in the mirror. I looked hip, a fashionista. As a show of support, my two sons also had their hair cut really short. From this example, you could see that I never really allowed it to affect me emotionally. I'm really giving this disease a good fight.

From whom did you get this positive attitude?

In general, I would say that the Silayan family always had a positive outlook in life. Even during depressing moments, we would find something to celebrate in it. If you saw us during Chat's wake and funeral, you would think that we're one wacky family. I think this positive attitude is one thing I also got from my Dad. Yes, he does look serious and he is strict, but he's a very jolly person. We had a lot of light moments with my Dad. Then, there are my experiences with my two sisters. Mavic is very supportive. We would share materials on cancer and new treatment methods. As for Chat, there is one thing I learned from her. As you know, when you're sick, your tendency is to look for attention and comfort. With Chat, it was the other way around. She would always comfort me and say, "It's okay, Rely. The Lord knows what He's doing." I only came to realize this after Chat died. Until her last breath, she was at peace. For her, it was more important to give comfort than to receive it, because she knew that she'll be leaving soon and that it would be more difficult for her loved ones who would be left behind.

It's very obvious that faith and spirituality is very strong in your family.

True, although I should say we never really saw my Dad as a very spiritual person because he wasn't really active in religious organizations. But one time in the late 70s, my Dad brought me along during one of his shootings in Sombrero Island in Batangas. For three days, we would sit near the seaside and wait for the sunset. He would say, "Son, wait until the sun touches the water" and then he would lead me into a prayer. That was personal experience with my Dad.

The spirituality of my sisters is really helping me, because the journey of a cancer survivor should be managed mind, body and spirit. You should be at peace with yourself and the world. You should have a constant communication with the Lord wherein you offer to Him all your fears and anxieties, because He will help you. Always pray.

While others find cancer a curse, have there been any blessings that have come out of this for you?

I feel thankful because if I had this twenty or thirty years ago, this disease is considered a death sentence. One thing good about being a survivor in this generation is that there are medical treatments available. Yes, it's expensive, but never forget that the Lord provides. I am also grateful to be given the opportunity to prepare for a graceful exit and to prepare my loved ones as well. There's this saying that you'll know your friends when the chips are down. With this experience, I have been most thankful for the support I'm getting from my doctors, family, the entire Silayan clan, and friends and former colleagues who stand by me in this fight. I really feel loved and cared for.

Having experienced being both a caregiver and a cancer survivor, what advice can you give to our readers who are experiencing similar trials?

If you are a caregiver, always give comfort and support to your loved one. It would give them the strength to give a good fight against this disease. If you have a relative or a friend who is sick, always offer a prayer for them. While you may not be able to help financially or in some other ways, there is great power in a heartfelt prayer.

For those who are cancer survivors like me, do not be ashamed to tell your stories to others. It is a form of therapy and it will help unburden your heart of the pain you are feeling. Also, by sharing your experiences, as I am doing with the members of Corridor of Hope, you also learn from your co-survivors not only how to cope with the disease, but actually draw strength and comfort from one another. After all, no one knows the trials that you are going through better than a fellow cancer survivor.

Diarrhea And Cancer: Interview with Dr. Roel Tolentino

AUTHOR'S NOTES: This interview with St. Luke's Medical Center's Dr. Roel Tolentino was originally published in The Big C Magazine.

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DIARRHEA AND CANCER

Most people do not associate diarrhea with cancer, the former especially being a common symptom of an infection of the gastrointestinal tract. While considered as an uncommon symptom, diarrhea can occur as a consequence of the cancer itself or as a side effect of the various treatments of this dreaded disease.

Diarrhea As A Direct Consequence of Cancer

According to Dr. Roel Tolentino, surgical oncologist with the St. Luke's Medical Center Cancer Institute, "Most of the time, we see diarrhea after surgery. But with regards to diarrhea during cancer, it's very rare, although we do see it in patients with carcinoid syndrome, pancreatic cancer, gallbladder cancer, and especially those with biliary tract cancer.

"In these patients, there is a disturbance in the enterohepatic circulation caused by an obstruction of the bile ducts by the tumor. If these patients eat fatty foods, these foods will not be absorbed by the small intestines. The fats will act as osmotic particles that will attract water into the lumen of the colon, thereby producing diarrhea. Another mechanism by which diarrhea occurs is that bile also does not get absorbed in the small intestines and when it goes into the colon, it becomes an irritant, producing watery diarrhea."

Diarrhea As A Direct Consequence of Treatment

In patients undergoing treatment for cancer, diarrhea is one of the most common side effects of therapy.

Chemotherapy. "The highest incidence of diarrhea would be found in patients undergoing chemotherapy," explains Dr. Tolentino. "The chemotherapeutic agents affect the rapidly-dividing cells in the body, which include the cells in the gastrointestinal tract. These cells become atrophic and would irritate the lining of the intestines. The thickness of the intestinal lining would be affected and there would be diarrhea because of inflammation."
Diarrhea rates as high as 50 to 80 percent have been documented in chemotherapeutic regimens containing fluoropyrimidines (Ex. 5-fluorouracil) or irinotecan. Reviews of several clinical trials involving a combination of irinotecan, high-dose fluorouracil and leucoverin in colorectal cancer showed early death rates of 2.2 to 4.8 percent as a result of gastrointestinal toxicity."

It is not just these drugs that could cause diarrhea. Says Dr. Tolentino, "Cisplatin can also produce diarrhea, as well as cyclophosphamide, methotrexate and oxaloplatin. Almost all of the major chemotherapeutic drugs can cause diarrhea."

Radiation Therapy. According to Dr. Tolentino, "With radiation therapy, the occurrence of diarrhea would depend upon the dose of radiation and the site in the abdomen that is being irradiated. Usually, a dose of 4,500 to 5,500 rads would produce minimal diarrhea, but as you go higher, the diarrhea becomes a great problem for the patient."

Changes in normal bowel functions can also be expected in radiation therapy to the abdominal, pelvic, lumbar or para-aortic fields. Aside from diarrhea, common side effects of radiation include cramping, gas, bloating and malabsorption.

Surgery. Postsurgical complications of gastrointestinal surgery that may lead to the development of diarrhea include increased transit time, fat malabsorption, gastroparesis, fluid and electrolyte imbalance, and dumping syndrome.

"When we do resection of the small intestine or colon," explains Dr. Tolentino, "the length of the gastrointestinal tract becomes shorter. Because of the faster transit time, food goes down immediately to the distal gastrointestinal tract. Surgery might alter your intestines' ability to absorb nutrients or fat and may result in diarrhea."

What about the current targeted therapies? Can diarrhea also develop? "Targeted therapies are a different kind of therapy. The side effects, including diarrhea, are lesser because these drugs target a specific metabolic pathway. These monoclonal antibodies are different from the usual chemotherapeutic drugs."

Infectious Diarrhea vs. Diarrhea in Cancer

The term diarrhea per se means that there is bowel movement that is more frequent than normal. But how would you differentiate diarrhea as caused by an infectious agent from diarrhea in cancer?

"The clinical presentation is the same," says Dr. Tolentino. "The patients would present with abdominal colic, the same crampy symptoms. The differentiating factor, however, would be fever, which is more common in infectious diarrhea. Fever is not common in patients with cancer. Also, if there is colon or rectal cancer, the first symptom would be constipation, not diarrhea, because the stools cannot pass beyond the obstruction. However, when there is an increase in pressure in the partially obstructed intestinal lumen because of trapped digested food, the stools will just come out, producing bloody, explosive diarrhea."

Treatment and Prevention

According to Dr. Tolentino, the treatment for diarrhea in cancer is the same as the treatment for infectious diarrhea. Oral rehydration preparations are given to prevent dehydration and to correct fluid and electrolyte imbalance. Antidiarrheal drugs such as loperamide and diphenoxylate HCl are not contraindicated.

However, it is the opinion of the good doctor that all cancer patients should seek medical advice for their ailments. "Patients should consult their attending physicians because they are immuno-compromised already. Antibiotics might be needed, and the antibiotic regimen for infectious diarrhea is different from diarrhea in cancer. In infection, we can give metronidazole and chloramphenicol, but in cancer patients, we may give neomycin, which is not absorbed by the intestine. Plus, antidiarrheal agents might not be adequate. It may be necessary to decrease dosage or temporarily stop chemotherapy, allowing a window of healing of about 2 to 3 weeks. After the diarrhea has been resolved, treatment can be continued."

Can a doctor predict which patients will develop diarrhea? "It depends upon the immune system and overall state of health of the patient. If the patient has a good immune system, he/she can resist the side effects of the various therapies. If they are healthy, the side effects, including diarrhea, would be lesser in severity."

Dr. Tolentino says that an ounce of prevention is worth a pound of cure. "Instead of eating three big meals a day, we advise patients with diarrhea to eat six small, frequent meals. Patients should avoid spicy foods and foods with lactose (such as milk and dairy products), and those that are rich in carbohydrates and fats. In those patients with mild diarrhea, they should eat more bulk-forming foods, especially the BRAT (bananas, rice, apples, toast) diet to reduce frequency of stools. Fluid intake should also be increased to at least 3 liters per day. Avoid alcohol and caffeine-containing drinks. From my clinical experience, probiotic foods such as yogurt help modify harmful gut microorganisms that have been implicated in the development of diarrhea."

Diarrhea need not be a life-threatening side effect of a treatment that is meant to save or prolong a life. With the right diet and strict medical supervision, cancer patients will not have diarrhea to add to their physical and emotional distress.

DR. GARY SY: Beauty Beyond Senior Years

Author's Notes: This article was published in Woman Today in 2009. This is a profile article on award-winning physician, Dr. Gary Sy. Sadly, not too many people were able to read this piece because of the magazine's limited distribution. So here it is.

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DR. GARY SY: "BEAUTY BEYOND SENIOR YEARS"

In these fast paced times we live in, the fine arts of listening and explaining are slowly going the way of the dinosaur. Sadly, this is a trend that is also happening in the medical profession, wherein doctors – unable to cope with the deluge of patients to their clinics – are forced to limit each consultation with brief questions on the patient's current complaint, a quick examination, and jotting down a lab request or a prescription. They don't have time to listen in-depth to their patient's complaints nor do they explain what their illnesses are doing to their bodies. This is a situation that Dr. Gary S. Sy knows all too well.

Birth of an Advocacy

As Dr. Sy admits, "In my early years of practice as a general physician and sports medicine doctor, I wanted to accommodate all the patients who come for check-up. But to be able to do this, I was forced to limit the time I spend for each patient, so I only concentrated on the complaints the patients are consulting me about. Most of the time, I didn't give the patients any further explanations as to what their diseases were doing to their bodies or the effects of the medicines that I prescribed to them. It's a procedure that most of my colleagues followed."

All this changed in August, 1997 when Dr. Sy was involved in a vehicular accident on the South Super Highway. A ten-wheeler truck slammed into his car, sending it flying across the road. The force of the impact caused Dr. Sy to slam forward with brutal force on the steering wheel, resulting in cervical whiplash and injury to his left shoulder.

In the months that followed, Dr. Sy wore a neck collar and suffered excruciating pain in his neck, back and shoulder. But nothing could describe the pain and disappointment he felt when his sufferings where brushed off by the doctors he consulted with.

"It really troubled me," confesses Dr. Sy. "There I was experiencing terrible pain, and yet these doctors seemed to think that I was overreacting. I would try to explain to them how I feel, but they would just slap me with one prescription for pain killers after another. Worse, none of these drugs worked."

Bitter realization came when Dr. Sy consulted with another doctor who would provide physical rehabilitation. "I was there very early because his clinic hours begin at 8 am. Also waiting was a stroke patient in a wheelchair. The doctor arrived at 11 am, and he did not even begin consultations at once. We had to wait for another thirty minutes. Being the first to arrive, the stroke patient was wheeled in, to come out only five minutes later. Although it was difficult for him to speak because of facial weakness, you could hear him cursing the doctor, saying that he waited for three hours and yet the doctor did not even bother to give any explanations about his condition or the medications he was taking."

Another eye-opener for the good doctor was those weeks in physical therapy. "Most of the patients undergoing therapy were Senior Citizens, and I would often listen in to their conversations. Aside from talking about their family and personal lives, they would discuss the qualities they like and don't like in their current doctors. Others would recommend the services of their own physicians. I was so touched by their stories and, having personally experienced what they are going through with their doctors, I prayed to God that if He would give me another chance, I would no longer be the doctor I once was and devote my medical practice henceforth to helping the elderly."

That opportunity came in January 1998. "I received a call from a family friend who is also a doctor, asking me if I would be interested in becoming a medical director for a company specializing in natural supplements. I refused at first, but then he told me that they would wait until I got better. In the meantime, they would send me literature about the product. When I saw that the supplement was effective for pain and muscle spasm, I tried it out and, by April 1998, I was completely healed. I did not take any other medications; just that supplement. To think that, back then, I was a non-believer in supplements, so I was amazed by its effectiveness in treating my aches and pains. Since then, I became a firm believer in supplements as a safe and effective complementary treatment. To fulfill the promise I made to the Lord, I established the Life Extension Medical Center in October 1998. But I felt that I was still not knowledgeable enough to handle geriatric cases, and I also wanted to learn more about natural supplements that could be helpful to the elderly. So, in 1999, I went to Romania and later to the Philippine College of Gerontology and Geriatrics to study Geriatric Medicine. Needless to say, by then, I was very ready to offer my services to my elderly patients."

Life Extension Medical Center

Life Extension Medical Center holds the distinction of being the first and only private medical center to offer free medical consultations and a wide range of medical services to the general public, with special focus on the health concerns of the elderly. But what is special about the center is that Dr. Sy personally sees to the welfare of each and every patient that goes there for consultation.

"The Lolos and Lolas who consult with the center suffer from common medical conditions that afflict the elderly, such as hypertension, diabetes, arthritis and stroke," explains Dr. Sy. "Obviously, they are already taking a lot of medications. I believe that if a patient is 70 years old, his vital organs are also 70 years old. Giving some drugs might be beneficial, but we should consider the possible side effects on a patient who's 70 years old. In my Geriatric Medicine practice, my principle is simple – The lesser a patient's drug intake, the better."

In order to minimize the popping of pain-killer pills among the elderly suffering from degenerative diseases like arthritis and rheumatism, Dr. Sy studied all possible treatment modalities that can be safely recommended to his patients. One very effective treatment for patients suffering from severe pain is Diathermy. It is the use of high electrical current to produce heat. It refers to a method of delivering core warming to deep body tissues for therapeutic purposes that effectively warm from within rather than from outside. Heat increases blood flow and makes the connective tissues more flexible. It lessens joint stiffness, pain, and muscle spasms. Diathermy is used to treat various forms of arthritis, frozen shoulder, back pains, muscle spasm, injuries such as sprains and strains.

"Since I strongly advocate preventive medicine, I would very much prefer to treat them in a natural way, including advising them to make the switch to a healthy lifestyle through dietary modification, the taking of vitamins and natural supplements, exercise, and giving up bad habits such as smoking and drinking alcohol. Behavioral modification is also important among the elderly…Bawal mainitin ang ulo ng gurangski ... Bawal masungit!!!" says Dr. Sy with a smile.

But it is not only diseases related to aging that Senior Citizens are afflicted with. Dr. Sy notes, "A good number of the elderly are lonely and depressed. They feel that they are being neglected by their children and their families. That is why I go out of my way to entertain them with stories and jokes. I don't treat them as patients. I consider them as my own Lolos and Lolas."

In order to better address the health needs of the elderly, Dr. Sy provides monthly lectures at Life Extension Medical Center. Not only that, he has several radio programs, the most notable of which are "Gabay sa Kalusugan" every Sunday on DZMM from 10 to 11 am and "Lunas" on DZRH every Mondays, Wednesdays and Fridays from 7:30 to 8:30 pm. He also authored two medical books "Gabay sa Kalusugan" Volumes 1 and 2, which are available in Mercury Drugstore, and is a medical columnist for several broadsheets.

Not surprisingly, Dr. Sy has received numerous awards for his pioneering work with the elderly, including the Outstanding Young Gerontologist of the Philippines from the Kapatiran Awards in 2000 and the Humanitarian Award from the Philippine United Senior Citizen Association (PUSCA) for 2000-2001. He is also a four-time recipient of the Outstanding Young Professional Awardee in Medicine and Allied Sciences from the Parangal ng Bayan Awards. For his work in media, Dr. Sy bagged the 2005 Catholic Mass Media Award (CMMA) in Best Educational Radio Program and the 2006 KBP Golden Dove Award in Best Public Service Program on television. His Life Extension Medical Center was awarded the Most Outstanding Geriatric Treatment Center by the Parangal ng Bayan Foundation's The Who's Who in the Philippines Awards in September 2001.

Beauty and the Elderly Do Mix

With all the many accolades he has received, one would think that Dr. Sy would be content to sit on his laurels. But, no. He continues to observe and study the behaviors and attitudes of his elderly patients. For the past eleven years that he has been helping Senior Citizens with their health problems, he has made an enlightening discovery about the elderly.

"I have observed this among my patients," confides Dr. Sy. "After I have treated all their aches and pains, they would then whisper in my ear, 'Doc, is there anything you can do for my wrinkles?' or 'Doc, I have these ugly eye bags. Can you remove them?' I realized then that even our Senior Citizens desire to be beautiful again. But, I'm not talking about regaining their youthful beauty, since we know that that's impossible even with all the advanced cosmetic procedures we have out there. What they want is to lessen the ravages of aging upon their physical appearance."

Suffice to say, it is a demand that needs to be met. Aside from medical services, Life Extension Medical Center now offers Health and Beauty Services, which includes the most popular Basic Facial Treatments, Acne/Pimple Treatment, and Deep Cleansing Facials. They also offer highly specialized beauty treatments that you used to find only in posh cosmetic clinics, such as diamond peel, non-surgical facelift and eye bag reduction treatment, facial warts removal, Sclerotherapy, I.V. Glutathione Therapy, Radio Frequency treatments, and Cellutrim Mechanical Massage. And these services are being given at very affordable prices that are easy on the pockets of Lolo and Lola.

According to Dr. Sy, "In all my years of medical practice I have come to understand the needs of our Senior Citizens. While we know them as to commonly complain about high blood and arthritic pains, they have this unspoken desire to be beautiful again. Sadly, this desire has to come second to whatever aches and pains afflict them. But once these pains are gone, I see no reason why they should not be able to avail of the beauty treatments that would enable them to be physically attractive again. Just like everyone else, even Lolo and Lola have the right to be beautiful."

(Do you want to know more about Dr. Gary S. Sy and his Life Extension Medical Center? You can make inquiries at Life Extension Medical Center, The Garden Plaza Hotel, Unit E, 1370 Gen. Luna St., Paco, Metro Manila, with Tel. Nos. 400-4205 and 522-4835 Loc. 315. You can also check out Dr. Sy's website at http://www.drgarysy.com)

The Burden of Obesity

AUTHOR'S NOTES: This article was originally published in Woman Today in 2007-2008. This piece was particularly interesting to me because this was about bariatric surgery for obesity.

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THE BURDEN OF OBESITY

No one knows just how heavy a burden obesity is than Mrs. Michelle Wilkerson-Butiu. She narrates, "Ever since I was six years old, I was already very heavy. I became conscious of my weight when I reached High School, and I tried to lose the extra pounds. I've done all the diets, including Atkins diet and pure vegetable diet. I even tried diet pills, but none of them worked. I kept on getting those pounds back. When I started having problems with my obesity, especially rashes that developed in the flabs of my stomach, my grandmother asked me why I don't have my stomach reduced? My aunt introduced me to her doctor, who recommended that I undergo bariatric surgery."

Obesity: A Growing Health Problem

According to Michelle's doctor, St. Luke's Medical Center's Dr. Reynaldo P. Sinamban, who is also a member of the American Society for Bariatric Surgery, "Around 2.6 percent of the Philippine population is overweight and morbidly obese. This is not purely an affliction of the affluent. You see it among lower and middle income groups."

Obesity is multifactorial, meaning it is caused by a number of factors, which include…
• Excessive food intake attributed to the "fast food mentality"
• Lack or no physical activity
• Genetics
• Endocrine problems, especially hypothyroidism

The term "morbid obesity" was derived from the number of metabolic complications (or "co-morbidities") that arise when one gains too much weight. Some of these co-morbidities are…
• Diabetes
• Hypertension and heart disease
• Joint problems
• Infertility
• Varicosities
• Snoring
• Sleep apnea

However, obesity's greatest impact is on the psychological well-being of the patient.

"When a patient is overweight, they already have some problems like diabetes and hypertension, which limits him/her from doing physical activities, but the psychological problems are rarely highlighted," Dr. Sinamban laments. "Obese persons can't enter the gym because they're too big. Others would not want to go out of the house at all. They can't date. They can't get work, because the perception is that fat people are lazy. So they suffer in silence. Can you just imagine how difficult it is for an obese patient to take a bath alone, especially among the young? They could not bathe well because they could not reach certain parts. They become ashamed and depressed. As a reward for depression, they eat and gain more weight. It's a vicious cycle. They seem happy and jolly on the surface, but it's only a compensation for their hardships inside."

But now, there is hope for the morbidly obese in bariatric surgery using Johnson & Johnson's BFAD-approved Swedish Adjustable Gastric Band (SAGB).

Candidates for Bariatric Surgery

Dr. Sinamban is often asked if bariatric surgery is the latest liposuction. "Bariatric surgery itself is not a cosmetic procedure. It is a major surgery that addresses the metabolic complications of obesity."

Who are the patients qualified to undergo bariatric surgery? These are patients with a Body Mass Index or BMI (computed as weight/height) of 35 and with co-morbidities. They are also given a psychological evaluation by their team psychiatrist.

"The patient is advised that bariatric surgery is not about sculpturing or contouring of the body. It's more of a health issue," says Dr. Sinamban. "Weight loss is just a bonus. What we're really addressing are the complications."

The good doctor notes that most patients are concerned about the drastic reduction in food intake. "We always prime our patients by making them go on a diet for two weeks before surgery. If there is enthusiasm and compliance for them to lose weight, the chances of success are high."

Bariatric Surgery and the SAGB

Bariatric surgery is performed laparoscopically by creating small incisions in the abdominal wall to allow passage of tubes and instruments. The uppermost part of the stomach is fitted with the SAGB, which is sutured to the stomach lining. Depending upon the weight requirements of the patient, the SAGB is inflated with sterile water that is injected through a port and tube outside the body. This tightens the SAGB around the stomach like a belt, forming a small pouch in the upper part of the stomach. As this stomach is filled with food, nerve fibers send early signals of fullness (satiety) to the brain. Eating more food that is necessary will lead to vomiting.

Michelle recalls her experience after surgery. "I was already ambulatory. At first, I was used to a big stomach so that I don't feel any food going in. The first time I ate after surgery, I felt the good inside the stomach, like it's going through a hole. After three tablespoons of soup, I was really full. I felt like I didn't want to eat more."

Food Intake After Surgery

Immediately after surgery, patients are first placed on a liquid diet for the first four weeks. In the next two weeks, small portions of mashed, pureed foods are allowed. Thereafter, the diet is gradually supplemented with normal foods. Because there is rapid weight loss during the first period, the patient is given vitamin drinks.

As Dr. Sinamban explains, "The surgery disciplines patients to be aware of what types of foods they can take. It's an awareness of calories counting."

Michelle discovered that she had lost her craving for certain foods. "I don't look for foods, like sweets or softdrinks. I am more attuned to the taste of food because I chew it thoroughly. Once I taste the food, it's okay. I won't look at it anymore."

Although surgery with the SAGB is reversible, Dr. Sinamban prefers that patient keep the SAGB for a lifetime to prevent weight regain. "Weight regain is always two times of what you lose. This is the major pitfall of dieting. You lose ten pounds now, but you gain twenty pounds later. It's a yoyo diet. Having the SAGB prevents them from overeating."

The Rewards of Bariatric Surgery

Individuals who are still doubtful about bariatric surgery should see the results.
As Michelle happily attests, "When I went through this procedure, I was very happy with the results. Within six months, I lost 170 pounds from my original 400 plus pounds weight. I am now 230 pounds and targeting my ideal weight of 150 pounds. I know how it feels going through a lot of heartaches, being ridiculed and being trapped by a big body. Going through bariatric surgery is the best decision I had ever made, because I did it for my husband, my son, my family and especially myself. If this worked for me, it can work for anyone."

Health Is In The Eye of the Beholder: Facial Signs of Illness

Author's Note: This article was originally published in Woman Today in 2007-2008.

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HEALTH IS IN THE EYE OF THE BEHOLDER: Facial Signs of Illness

Mirrors are indispensable beauty aids for women. But mirrors are not just meant to fuel a woman's vanity or serve as tools for checking for signs of aging. They can help you detect signs of illness that are noticeable on your face.

Mirror, mirror on the wall…Am I sick? Here are the common facial signs of illness and their possible causes.

SKIN

Dull, lifeless skin

Dehydration. Sallow skin results from inadequate fluid intake, which does not compensate for the water loss from the skin cells. To test for dehydration, pinch the skin at the back of your hand. If it does not spring back, that means you are not drinking enough fluids. Drink at least 2 liters of fluids daily, especially during hot weather.

Itchy skin

Eczema. Itchy, dry and flaky skin, which may also be red and painful, usually appears behind the knees or inside the elbows and face, but may also develop on the face. Moisturize skin with lotions. Use antibiotics or steroids for flare-ups or resulting infections.

Poor liver function. Itching that is prominent on the hands and feet. It is a result of cholestasis, wherein there is an accumulation of bile in the blood because it cannot flow freely from the digestive tract. Visit your doctor about having a liver function test done.

Change in skin color

Excessive beta-carotene. Eating too much foods rich in beta-carotene will, in rare cases, turn the skin orange.

Jaundice and liver problems. In the presence of liver disease, the natural pigment bilirubin is deposited in the skin, instead of being removed by the liver, resulting in a yellowish skin color. Have a liver function test done.

Spotty complexion

Irritable Bowel Syndrome. Causes skin flare-ups, diarrhea or constipation, or pain as the intestinal lining becomes irritated. Determine which foods or drinks irritate the skin and digestive system by keeping a food diary for a few weeks. Take probiotic supplements containing "good" bacteria (such as Lactobacillus acidophilus) to improve digestion.

Polycystic Ovary Syndrome. Hormonal changes cause acne flare-ups in women. Other symptoms include menstruation and fertility problems, weight gain and hair loss. Have a blood test done.

HAIR

Thin, lifeless hair

Iron deficiency. Iron is essential for hair growth. Hair changes are especially noticeable during menses and pre- and post-menopause. Take iron supplements as well as iron-rich foods, especially during your period.

Underactive thyroid gland. Causes hair thinning on the head and eyebrows. Other symptoms are dry skin, weight loss and fatigue. If thyroid disorder is suspected, have a blood test done. It is treated with daily synthetic thyroid hormone to replace deficiency in thyroxine.

Premature hair graying

Vit. B12 deficiency or Pernicious Anemia. Poor intake of foods rich in Vit. B12 leads to production of smaller numbers of red blood cells, which are abnormally large and have a short life span. Because Vit. B12 is essential for hair growth and pigmentation, premature graying is a sign of this deficiency. Other symptoms are weight loss, fatigue and diarrhea. This condition is diagnosed with a blood test and treated with Vit. B12 injections. Once the deficiency has been resolved, maintenance shots are given every 3 months for life.

EYES

Red or blood shot eyes

Infection. Resulting from the use of old make-up that causes irritation or infection. If seasonal, it may be caused by a virus ("sore eyes"). Discard six-month old cosmetics. Use antibiotic eye drops prescribed by a doctor.

Iritis or inflammation of the iris. May be caused by a viral infection, such as gastroenteritis, or triggered by autoimmune disorders like arthritis. Have your eyes thoroughly examined by an ophthalmologist.

Pale eyelids

Anemia. Pale color of the skin inside the lower eyelids instead of its usual bright pink indicates anemia due to iron deficiency. Other symptoms include headache, breathlessness, fatigue and brittle nails. Women need more iron (14.8 mg daily) than men (8.7 mg daily) because menstruation could lead to deficiency. Increase intake of foods rich in iron, such as red meat, green leafy vegetables, lentils and whole grain cereals. Also eat more Vit. C rich fruits and vegetables as this will help in the absorption of iron from other foods.

Twitching eye

Magnesium deficiency. Lack of magnesium causes random muscle contractions of the eye called myokymia. Women need 270 mg of magnesium daily while men need 300 mg per day. Eat more magnesium-rich foods, such as spinach.

Multiple sclerosis. Myokymia may be a sign of serious nervous disorders, such as multiple sclerosis. If numbness, weakness, tingling of the limbs and poor coordination are present, consult a doctor.

Drooping eyelid

Eyestrain. Straining of eye muscles due to working under poor lighting and staring too long at computer screens. Stress on the eyes also inhibits absorption of B vitamins, which help strengthen eye muscles. Do eye exercises to increase blood supply to tired eyes. While working, take a break every 20 minutes and focus on an object 20 feet away for roughly 20 seconds.

Stroke. Signs of facial weakness such as drooping of the eye or mouth may indicate a stroke. If arm weakness is also noticed or the person is unable to speak or can't understand what you say, seek immediate medical attention.

Lung cancer. A tumor that is located high in the chest so that it can press on nerves affecting the eye may cause drooping eyelids. Suspect lung cancer if more obvious signs, such as unexplained weight loss and coughing up of blood are observed.

White rings

High cholesterol. When there is too much cholesterol in the blood, fatty deposits called "plaques" form a white ring around the colored part of the eye or accumulate as small waxy lumps on the skin around the eye. Have your blood cholesterol levels checked. Remove saturated fats from your diet. Exercise regularly. Keep your weight down.

MOUTH

Pale lips

Iron deficiency and poor thyroid function. Insufficient iron and the existence of thyroid disorders will result in pale pink lips. Take iron supplements and have a blood test to check thyroid function.

Heart and lung problems. When oxygen levels in the blood drop, this causes the lips to assume a pale to bluish tone. See a doctor immediately when this occurs.

Dry, sore, cracked lips

Iron deficiency. Anemia as a result of lack of iron may result in dry, sore cracks at the sides of the mouth. Take iron supplements and eat iron-rich foods.

Diabetes mellitus. High levels of blood glucose promote growth of candida, a fungal infection, which attacks the thin dermis at the corners of the mouth. Other symptoms to watch out for are weight loss, thirst and frequent urination. Have your blood glucose levels checked.

Bleeding gums

Gingivitis. Caused by plaque build-up resulting from poor oral hygiene, which will lead to bleeding gums and periodontal disease (infection of the bones that hold the teeth in place). Factors contributing to the development of gingivitis are stress, poor diet, too much intake of spicy foods and alcohol (which leads to overacidity in the mouth that can inflame gums). Brush your teeth after every meal. Floss daily. Have a regular dental check-up.

Pregnancy. Gums become softer and more prone to bleed because of hormonal changes.

Leukemia. Because blood clotting is impaired, bleeding gums is an early sign of leukemia. Other symptoms to watch out for are weakness, fatigue, weight loss, infections, excessive bruising, and pain in bones.

Mouth ulcers

Accidental trauma. Caused by brushing teeth too hard, accidentally biting the inside of the mouth, tooth rubbing against the gums, and minor burns from hot foods and drinks.

Stress. Leads to lowering of immune system.

Poor nutrition. Deficiency in Vit. B12, iron and folate can lead to mouth ulcers.
To promote quick healing, use antiseptic mouthwash. If ulcers persist for more than 2 weeks, see a dentist since it may be an early sign of oral cancer.

Small, sharp teeth

Bruxism or tooth grinding. Because of stress or poor bite (makes the jaw unable to relax into a comfortable position), tooth grinding at night leads to small sharp teeth and other health problems, such as jaw pain, headaches and muscle tension. Consult with your dentist about wearing a mouth guard at night.

Cancer. Sharp teeth, broken crowns or fillings, with time, may rub against the mouth causing tissue damage, which may lead to pre-cancerous changes.

White patches on tongue

Oral thrust. Creamy white patches on tongue and gums. Can be resolved by oral anti-fungal mouthwash or lozenges.

Cancer. Persistent white patches that are not sore and cannot be scraped away are indicative of early oral cancer. Consult with your doctor immediately.