By Tedler D. Depaynos, MD
The lady patient is an OFW in the Middle East who just came home for vacation and to inaugurate the “little house” she built by sending parts of her earnings home. Incidentally because of her “chronic epigastric pain” which was diagnosed as “acid reflux” she consulted a Gastroenterologist who did a gastro-duodenal scope.
Actually she has been experiencing this malady for the past 6 years and has been taking medications prescribed by the MDs where she was working. There were many times however because of her tight schedule and because she sometimes had relief of her symptoms she missed her medications. She could recall that she also had a gastro-duodenal scope abroad at least 2 times. She did not bring the results because it was written in Hebrew.
The local Gastroenterologist she consulted informed her that there is “inflammation in some parts of her stomach” or simply “gastritis”. Above the gastro-esophageal junction, there are “tiny ulcers” which were biopsied. A smear on the ulcers was done which were positive for a certain bacteria called H. Pylori. She was so impressed with the Gastroenterologist who took time explaining to her in detail her findings and impressions.
The pathology of her condition may be due to the uncontrolled hyperacidity and acid reflux causing the inflammation and eventually the distal esophageal ulcers which were later infected by the bacteria called H. Pylori. Some medical textbooks however are not definite which comes first. The bacteria maybe the cause of the initial pathology and later worsened by the hyperacidity. Nevertheless, what is definite is that even if the hyperacidity is neutralized but the bacteria is not treated the ulcers would persist. The standard treatment is usually 3 medications comprised of 2 antibiotics and an anti-hyperacidity given not less than 10 days to eradicate the bacteria. She was given several medications by her foreign MDs but because of the foreign tongue she was not sure what those medications were for.
She was advised that a chronic or non-healing ulcer in the distal esophageal area may eventually become malignant. The pre-malignant ulcer is called Barrett’s Ulcer. Even though the biopsy was not yet in, the Gastroenterologist referred her to a surgeon to orient and prepare her for possible surgical treatment. Since she was scheduled to return to her work within 2 weeks she decided not to consult the surgeon. She promised herself to follow religiously the advice of her Gastroenterologist and to take all her prescribed medications and to bring with her even a year’s supply.
It was incidental that I learned of her condition when she invited me to her “little house” inauguration. Actually she showed to me the written instructions of her MD advising her to eat small meals, avoid fatty foods and not to eat within 3 hours before bedtime. She should elevate her head while lying down and avoid esophageal irritants like spices, citrus drinks, alcohol and even colas. Medications that also causes gastric irritation like steroids and other anti-inflammatory drugs should definitely not be taken. She was happy that she did not smoke.
JUDGE TABINGAN
The Honorable Judge could be seen sometimes drinking coffee all alone in popular restaurants just like any ordinary customer. Once he is recognized mostly by those who were once his law students or those who appeared before his court/sala, one would be surprised how they would bow and show their respect. There was once a one star general who suddenly stood at attention and saluted him bewildering his escorts.
Hon. Judge Monroe Tabingan is the Chief Executive Labor Arbiter in the Cordilleras who roused from the ranks. Recently he was recognized for disposing 98% of the cases filed in his court for year 2016. He is actually the topnotcher in the Philippines followed by a Labor Arbiter somewhere in Mindanao. Last November 3, 2016 he was given the Top Disposal Award in Manila. As the Judge limped to receive his award on stage, many of his younger colleagues had a hard time believing that he is the author of the textbooks they used when they were students.
To Hon. Judge Monroe, our sincere Congratulations and may your tribe increases.**
