Chapters’ Track EBU City, Feb. 12, 2010– February, the month of hearts, still remains the busiest Fellowship night ‘Go Red for Women’ Cmonth for the PHA-Cebu Chapter as highlighted by 3 major activities. The 11th Postgraduate Course was successfully held with the theme “Re- turn to the Heart”. The Course Fellow- ship Night saw the final realization of the GO RED FOR WOMEN – Cebu ver- sion with no less than Dr. Lerma Noval at the helm of the preparations. The launching was attended by PHA Vice President, Dr. Eleanor Lopez who was the speaker of the night. “The Love Birds”, the Cebu Chapter’s husband- and-wife dancing teams debuted with a medley of ballroom dances. Special guests for the night were friends from the POGS who presented an all–red exciting mini fashion show. The “younger” group of members with Drs. Junia and Galang, Cardio Fellows and friends from GSK delighted the audience with a presentation of dance hits through the years. The affair was a fitting beginning to a hopefully year- long celebration. Retro/Prospective Paper Presentation February 11, 2010 was the date of – Dr. Bernadette Halasan (1st place), the Research Paper Contest. Eleven Dr. Rhodette Arevalo (2nd place), and papers (5 Case Reports and 6 Retro/ Dr. Honey Alcantara (3rd place). This Prospective Studies) were presented was immediately followed by the 2nd petual Succour Hospital, Cebu Doctors’ University Hospital (3rd place). with the following winners: Regional Interhospital Cardiology Quiz University Hospital, Chong Hua Hospi- The Chapter also went full swing Case Report Presentation – Dr. Bowl participated in by 12 teams from tal, Cebu Velez General Hospital, Sacred into its advocacy thrust. Together Richard Myles Montesclaros (1st the hospitals of the Visayas Region Heart Hospital, Vicente Sotto Memorial with the PCP-CV Chapter, the mem- place), Dr. Karen Caudor (2nd place), (Cebu – Visayas Community Medical Medical Center; Bacolod – The Doctors’ bers went to Cotcot, Liloan, Cebu to and Dr. Cecile Jaca (3rd and 4th place); Center, Cebu City Medical Center, Per- Hospital, Inc.; Iloilo – Western Visayas plant 100 mangrove trees last April Medical Center, West Visayas State 11, 2010. Cebu bags top 2 prizes in final rounds University Hospital; Tacloban – Eastern Finally, ACLS training was held at the CEBU City, Feb. 12, 2010 – Even while experiencing an economic setback, Visayas Regional Medical Center). And Cebu Doctors’ University Hospital last Cebu managed to conduct its significant Heart Month activities, said PHA the winners were: Cebu Velez General March 6-7, 2010. This was conducted Cebu president Dr. Roy Entienza. Hospital (1st place), Chong Hua Hospi- for the Internal Medicine and Anesthe- This year’s search for Oratorical and On-the-Spot Oratorical and On-the- tal (2nd place), and West Visayas State sia Residents of the institution. ♥ Spot Painting bets for the Manila Final rounds posted a significant increase in the number of respondents from the different high schools in the city. Quizbowl 2010 a hit “We never felt as triumphant “our representatives bagged first place in the The annual quiz bowl sponsored by Therapharma on February 11, 2010 at National On-the-Spot Painting contest and second place in the Oratorical the SWU Auditorium, was participated in by the Doctors’ Hospital Inc. of Bacolod; contest grand finals,” added Entienza.♥ Western Visayas Medical Center of Iloilo; West Visayas State University Medical Center of Iloilo; Eastern Visayas Regional Medical Center of Tacloban; Sacred Heart A well-attended post grad course Hospital; Perpetual Succour Hospital; Cebu Doctors’ University Hospital; Chong Themed “Return to the Heart “on Feb. 10, 2010 at the Waterfront Hotel, the Hua Hospital; Cebu City Medical Center; Visayas Community Medical Center; Cebu 2010 Postgraduate Course was well-attended both by members of the society Velez General Hospital; and Vicente Sotto Memorial Medical Center. The winners as well as the general practitioners in the region. The theme was specifically were: First prize -- Cebu Velez General Hospital; second -- Chong Hua Hospital chosen by its scientific chair committee, Dr. Walter Acusar.♥ and third-- West Visayas State University Medical Center. ♥

page 19 • February-March-April 2010 Chapters’ Track News Council on CPR’s Bugarin, FDA to screen Lavapie conduct ACLS in Balanga BALANGA, Bataan, February of the most dedicated and dynamic food supplement ads 28, 2010 – The PHA Central Luzon members of the council. The Balanga- By Gynna P. Gagelonia and the Bataan Medical Society, in based Bugarin and Cabanatuan-based MANILA, February 26, 2010 – The popu- supplements with good evidence of effi- larity of food supplements in the country cacy and should become prescription drugs; cooperation with the PHA Council Lavapie, are fixtures in almost all of the raises many issues, including questions on lack of data on safety and drug interactions; on Cardiopulmonary Resuscitation, Council on CPR regional rounds. quality and ethics. we need to make physicians aware of the conducted Advanced Cardiac Life A roundtable discussion took place The trade’s meteoric rise is record break- potential herbal-drug interactions; and ing. The market is flooded with supplements need to educate the general public on the Support from Feb. 26-28, 2010. last March 3, 2010 in Subic Bay, Zam- that is gaining overwhelming acceptance by real values of food supplements. The trainors were Drs. Orlando bales. It was a big success in terms of the consumers even if labels indicate "No According to the Advertising Standards Bugarin and Francis Lavapie, two turnout and impact. ♥ Approved Therapeutic Claims." Council, “the use of testimonials or en- In this country, there is so much liberal- dorsements portraying the product as a ity given to dietary supplements which cure of, or relief from, an ailment or medical are being marketed as wonder “drugs” condition that is not substantiated by clini- Iloilo embarks on a series of BLS with cure-all hype and who knows what cally based studies shall not be allowed; ILOILO CITY, March 2, 2010 -- The PHA Western Visayas Chapter embarked potential harm it may cause the public and “the ‘NO APPROVED THERAPEUTIC on a series of Basic Life Support Workshop from March to May 2010. In at- especially those with medical conditions CLAIM’ in all television advertisements and maintenance drugs. should be shown/flashed in a separate tendance were doctors, nurses and volunteer health workers from district The unbelievable media influence and frame with no other copy or visual at the hospitals and health centers. endorsement by celebrities has supported end of a material, said Kahn, an eminent The residents and nurses of the Iloilo Doctors Hospital attended a three- this multi-million industry for years now. name in advertising and radio. A media forum called by the Philippine He also said, “one observation I find day rigid training in Basic Life Support & Advanced Cardiac Life Support from Heart Association on the “2nd Summit on in most categories that most cases/com- April 2 to 4, 2010. Supplement” at the Bayview Hotel, Roxas plaints revolve around one competitor filing A follow-up Regular Basic Life Support and Advanced Cardiac Life Support Boulevard, City of Manila, presented the a case against another and questions the current trends and certain facts and falla- substantiations of their claims. In the case which was attended by doctors and nurses from the Iloilo Mission Hospital, cies on health supplements – in particular of the food supplement category, no one Western Visayas State University Hospital and the St. Paul’s Hospital, took place those supplements that claim to be benefi- has filed a case against another competitor. on April 9, cial to the heart. It makes you wonder why.” The speakers and resource persons were The Department of Health and the Food 2010. Health Secretary Esperanza Cabral, Food and Drug Administration are are now going Meanwhile, and Drug Administration Director Nazarita to replace the one-liner “no therapeutic the chapter, Tacandong, and leading officers of the PHA claims” with a disclaimer in Filipino transla- led by Dr. –vice president for external affairs André tion: “Mahalagang paalala: Ang (name of Kahn (The Role of Media in the Promotion product) ay hindi gamot at hindi dapat Glenn Mana- and Propagation of Food Supplements); gamiting panggamot sa anumang uri ng ay hosted three treasurer Dr. Saturnino Javier (Synopsis sakit. And “wastong nutrisyon at regular roundtable of the 1st Summit on Supplements) held na ehersisyo ang pinakamainam na pagpa- in May 2009; director Dr. Eugene Reyes panatili ng kalusugan,” said Cabral. discussions (Food Supplements for the Heart: Are They The new definition of food supplement from January Effective?) and Advocacy Committee chair as contained in Republic Act 9711 or the to February Dr. Maria Adelaida Iboleon-Dy (Beginning Food and Drug Administration Law, says of the Summit as an Undertaking of the that a good or dietary supplement “shall 2010. PHA), the moderator of the forum. mean a processed product intended to According to Javier, the objectives of the supplement the diet that bears or contains summit are: “to provide a venue for discussion one or more of the following ingredients: Hangos: We’re bringing home the bacon of pertinent issues concerning health supple- vitamins, mineral, herb, or other botani- CAGAYAN DE ORO CITY, Feb. 21, National Oratorical and On-the-Spot- ments; to present and review available evi- cal, amino acid, and dietary substance, to 2010 – A euphoric PHA Northwest- dence; to determine sectoral responsibility and increase the total daily intake in amounts Painting Contest championship rounds accountability among involved stakeholders; conforming to the latest Philippine rec- ern Mindanao delegation, led by in Manila. to define future directions in the processes ommended energy and nutrient intakes Dr. Sylvia Hangos, flew back to their William Christian Dela Cruz, 14, related to these supplements.” or internationally agreed minimum daily hometown today. They were met by Cabral emphasized that “many of these requirements. It usually is in the form of a student of St. Joseph Institute of food supplements are not only claimed to capsules, tablets, liquids, gels, powders equally exhilarated Chapter mem- Technology, won first prize. He got have beneficial effects on the cardiovascular just like drugs, but are not represented for bers and teachers from the St. Joseph a plaque and P20,000.00 cash, while system, but even more importantly the fact use as a conventional food or as an item of Institute of Technology and Butuan that there are hidden side effects of many a meal or diet or as a replacement for drugs Frederick Mayol, 16, from Butuan City food supplements on the cardiovascular and medicines.” City School of Arts and Trade. School of Arts and Trade, placed 2nd system, many of which are in fact adverse.” Tacandong said that "screening the Together, with the parents of the prize in the painting tilt. He got a Reyes said that “natural” is not equiva- commercial advertisements of food or winners, they savored the joy and lent to “safe” because these supple- dietary supplement will prevent the mal- plaque and P15,000 cash. ments are not always backed up by actual practice of some manufactures of making pride of bringing home the bacon. Buoyed by their victory, the NW evidence.” He added that majority of food false claims about their products like its The chapter bagged the major Mindanaoans vowed to prepare this supplements have no evidence for their health benefits that help cure certain prizes in the Heart Month 2010 early for next year’s competition. ♥ claims of efficacy; there are a few food conditions like drugs”. ♥ page 20 • February-March-April 2010 management and prevention of heart disease in especially in the youth. A goal to shed off five to EDITORIAL... From page 2 women. 10 % of obese body weight can positively affect Health Advocacy. Rising as an icon of national Despite knowing that the risk of heart disease cholesterol, blood pressure and sugar. Cutting on heart health, the PHA led by Dr. Mariano Lopez in and stroke increases with age, a good percentage of calories by 500 per day coupled with 30 minutes of 2005 revisited its Mission and Vision dubbed MV people are unaware of values for their blood pressure, moderate activity, or a pedometer goal of 10,000 2012. With map and compass in hand, Dr. Cesar total cholesterol and blood glucose. Data from PHA’s steps per day can potentially bring weight loss of Recto marked his term as 53rd PHA president with project EVA (Evaluation of knowledge, attitudes one to two pounds per week. Physical activity does focused priorities on achieving PHA’s vision 2012, and Practices of Filipino Women on CVD and risk not need to be structured exercise and can involve coinciding with what remains of the National factors in Metro Manila) showed that 80% of women creative ways to move like walking office floors and Decade of Cardiology. Successor Dr. Efren Vicaldo perceived CVD as the second most common cause of stairs during coffee breaks. Not many know that intensified PHA campaigns especially Healthy morbidity and mortality and cancer as the number stress at home or work can increase CVD risk by an Lifestyle with the revival of Doc Fit. one perceived killer and hence most feared. Poor alarming 75%. Mental and emotional depression We have come to the age of lady presidents, dietary habits came out as the most important risk has also been linked to increased risk of CVD in starting with Dr. Ma. Belen Carisma in 2008, who factor for heart disease (78%). Stress ranked second women; hence early professional help should be made a stand to fully raise the flag of women’s (38%) while hypertension ranked 5th (14%). When resorted to. Women with high-marital stress also heart health. Dr. Maria forced to rank risk factors, are less likely to remain free from recurrent cardiac Teresa Abola took up the The rampant bahala na Metro Manila women re- events than women with low-marital stress. baton with undaunted garded high cholesterol, Though the call to address CVD awareness, courage despite the attitude of most Filipino hypertension, and smoking prevention and management is an all-year-round large-scale drawbacks women to give priority to as the top three risk factors voyage for the PHA, this merged February-March- on existing and newly the males is a health threat to heart disease and stroke. April issue of PHAN displays various activities of the conceived projects of the Only 13% believed that PHA and its chapters during two stand out months PHA on account of crisis that gravely complicates menopause has an impact to attest that the PHA is not only an icon of national after crisis besetting the effective management and on the heart and blood heart health but an effective warrior against CVD. country. With the con- prevention of heart pressure. As we see the dawning of a new set of leaders certed efforts of the new disease in women. First time cardiovascular for our country as well as anticipate the turnover of generation cardiologists events are often fatal in a new set of officers for the PHA, may the mission of of the PHA, GMA declared women so the emphasis the PHA to reduce the ravages of heart disease in the in 2009 (Proclamation No. 1675) that March of should be placed on management of risk factors country ring strong and clear in every member. As every year is Women’s Heart Health Month. before clinical presentation. The first guidelines for PHA intensifies efforts in promoting cardiovascular Cardiovascular disease ranks CVD first among all women for preventive cardiology came out in 1999. health in the coming years, may there be continuity disease categories in hospital discharges for women. Nearly two-thirds of women who die from CHD have in programs even as leaders change so that PHA will Nearly 37 percent of all female deaths in America oc- had no previous symptoms. Almost half of women shine brighter and rise higher as we steadfastly and cur from CVD, which includes coronary heart disease over the age of 45 have hypertension and about intently finish the race set for us as an organization. (CHD), stroke and other cardiovascular diseases. 40% have hyperlipidemia. Low levels of HDL may be Looking forward, may we, in genuine unity sincerely As soon as a woman reaches the age of 40, 23% a stronger risk factor for women over the age of 65 work together towards our vision to make the Philip- will die within one year of a heart attack. Women than men in the same age group. Recognizing these pines a leading center of cardiology in the region. under the age of 65 years are more than twice as high risk individuals is important so that they can be likely as men to die from myocardial infarction targeted for aggressive risk factor management even World Health Organization. http://www.who.int/topics/ (heart attack) Thirty eight percent of those who if they have not had an event . Most research over the cardiovascular_diseases/en/ American Heart Association. Downloaded April 2006. www. survive die in the first year compared to 25% in last two decades or so has involved predominantly americanheart.org men. Within six years , 35% of women have a men with women mostly being excluded. And treat- Wenger, N .You’ve Come a Long Way, Baby. Cardiovascular recurrent infarction compared to 18% of men . ment prescribed for women has often been based on Health and Disease in Women. Problems and Prospects. Circulation. 2004;109:558-560 Despite grim statistics, misperceptions still exist studies done on men. As an offshoot, CVD deaths in American Heart Association. Downloaded April 2006. www. that CVD is not a real problem for women. men are apparently declining while that of women americanheart.org PHA Council on Women’s Health chair Dr. remain the same or may even be increasing . Project EVA: Evaluation of knowledge, attitudes and Practices of Filipino Women on CVD and risk factors in Metro Manila Milagros Yamamoto, along with its members is The PHA emphasizes that the management of risk Mosca L, Grundy S, Judelson D et al. Guide to Preventive Cardiol- passionate in addressing the problem of miscon- factors is cost effective. Educating women during ogy for Women. Circulation. 1999;99:2480-2484 ceptions about CVD in women. On March 24, 2010, clinic visits is essential to identify risk factors and to Research on Cardiovascular Disease in Women. Fact Sheet 2003. the Women’s Heart Health Manual entitled Assess- implement earlier and more aggressive control of Downloaded April 2006. www.ahrg.gov Wenger, N .You’ve Come a Long Way, Baby. Cardiovascular ment and Management of Cardiovascular Risks in identifiable risk factors like smoking, obesity, high Health and Disease in Women. Problems and Prospects. Circulation. Women was launched to serve as a short guide for blood pressure, cholesterol and sugar and even home 2004;109:558-560 health care practitioners. Massive dissemination of and work stress. Smoking increases the risk of a heart Research on Cardiovascular Disease in Women. Fact Sheet 2003. Downloaded April 2006. www.ahrg.gov knowledge is needed to close the gap that exists attack up to six times in heavy smokers. Smoking ces- Johnson, P and Manson, J. How to Make Sure the Beat Goes On. between the perceived and actual risk of CVD in sation can drop the risk by 50% within the first year. Protecting a Woman’s Heart. Circulation. 2005;111:e28-e33 women. The rampant bahala na attitude of most After the fifth year of cessation, the risk for CHD can Orth-Gomer K, Wamala S, Horsten M et al. Marital Stress Worsens Prognosis in Women With Coronary Heart Disease. The Filipino women to give priority to the males is a level off to that of a non-smoker but passive smoking Stockholm Female Coronary Risk Study. JAMA. 2000;284:3008- health threat that gravely complicates effective also increases the risk of CVD. Obesity is on the rise 3014 ♥ page 21 • February-March-April 2010 WCE 2010 Highlights WCE 2010 Highlights 14th World Congress Pearls from of Echocardiography, Vascular Ultrasound Dr. Nanda & Allied Techniques in Manila By Erlyn C. Demerre, MD he room was packed. Delegates were keen to catch pearls on the evolving trends in echocardiography, specifically, 3 and 4 dimen- Posts 1,200 sional echocardiography, from Dr. Navin Nanda, international president of the World Congress of Echocardiography and president of the International Society of Cardiovascular Ultrasound. turnout As 3D echocardiography emerges in the horizon of cardiac imaging, its T ANDALUYONG CITY, Feb. 17, 2010 -- The Philippines through routine use in everyday clinical practice is starting to be appreciated by mentors and students of cardio- the Executive and Organizing Committees of the 14th vascular ultrasound. World Congress of Echocardiography, Vascular Ultrasound Side by side with Dr. Homobono Calleja, president & Allied Techniques (WCEVUAT) rolled the red carpet to of this year’s World Congress of Echocardiography, 1,200 delegates, consisting mainly of cardiologists, and Vascular Ultrasound and Allied Techniques, Nanda, Mpredominantly echocardiographers, who converged for the Opening Ceremonies created the right mood for broad-based learning on at the Isla Ballrooms of the Edsa Shangri-La Hotel, Mandaluyong City. day 1 of the congress. Calleja stressed the importance of defining the evolution of previous approaches in cardiac imaging in order to appreciate the currently marketed techniques while Nanda showed the cutting advantage of the newer applications of echocardiography. Nanda illustrated the principle behind 3D echocar- diography and its advantage over 2D echocardiography, supported by clear real-time images of the utility and clinical edge of 3D echocardiography. “3D echo gives direct visualization of cardiac structures and can help in the assessment of the severity of valvar stenosis without the use of Doppler tech- nology” he remarked. He also emphasized that pressure gradients especially of the aortic valve can be overestimated because of localized increase in pressure gradients, which can be picked up by the very sensitive Doppler. Of the several advantages that 3D has over 2D echocardiogra-phy, particularly for volume measurements, visualization of septal defects and evaluation of valves, Nanda stressed its growing importance in clinical practice for the quantitative assessment of valve stenosis and regurgitation. Beautiful images of the vena contracta of regurgitation through the tricus- Seizing the opportunity to host a est in the Philippines as an emerging pid and mitral valves as visualized on 3D flashed on the screen as Nanda went colossal task and once again show the medical tourism haven, as well as on to say, “It obviates the need to make mostly incorrect assumptions that the much-vaunted Filipino brand of hos- a time-tested medical convention valve is circular or elliptical in shape. 2D assumptions may be wrong.” pitality, the organizers put together a venue for international scientific The presence or absence of prolapsed atrioventricular valves and its charac- formidable and well-respected roster gatherings. terization have always posed a challenge to the novice, and the expert echocar- of local and foreign speakers who are The opening ceremonies easily diographer. Now with 3D echo, exact identification of the prolapsing scallop or all recognized experts in this field of made an impact on the mix of locals segment is feasible, as well as the identification ofruptured chordate. Making endeavor. and foreigners in the audience, with 3D sound so easy, he went on to describe the ability of 3D to discriminate be- Anchored on the theme “Cardio- its enviably festive and warm ap- tween left atrial appendage thrombus and pectinate muscles. In many centers, this could have led to inappropriate anticoagulation of patients evaluated by vascular Imaging 2010: Its Impact on peal. Natrapharm’s Buganda Troupe’s transthoracic 2D (TTE) and even transesophageal echo (TEE). He ended his talk Clinical Practice”, the Congress proved high-energy rendition of a mix of by presenting a case of a 27-year-old female with a left ventricular thrombus to be a stirring scientific meeting dance pageantry afforded everyone given chronic warfarin therapy which seemingly had no effect on serial 2D echo that showcased the numerous recent glimpses of the colorful and rich Fili- evaluation. However on 3D, dissolution of the thrombus was clearly seen. developments in the field of echocar- pino culture. Pfizer’s Chorale sang the Nanda, succinctly and successfully showed the important role of 3D echo diography from renowned experts all Philippine national anthem. in clinical practice -- 3D echo is here to stay and soon, will be inevitably part over the world. The personalities on stage were of routine echocardiographic examinations. ♥ The meeting also triggered inter- led by Health Secretary Esperanza page 22 • February-March-April 2010 WCE 2010 Highlights WCE 2010 Highlights Cabral, the guest speaker; Drs. Homobono Calleja In her inspirational message, Cabral cited that “Men should be the guardian of God’s creations. and Navin Nanda, presidents of the XIVth WCEVUAT; the previous stagings of this major medical congress ..We have compromised our resources. We are on one of Asia’s leading voices in the global arena of have drawn over 18,000 participants, and have the brink of ecosystem collapse. Each of us has to do Enviromental Law, lawyer Antonio Oposa Jr., the been instrumental in the rapid advancements in his share in saving the environment from degrada- keynote speaker; Dr. Raul Jara, over-all chair of the the science of echocardiography and cardiovascular tion. How many doctors do we need to save our XIVth WCEVUAT. ultrasound. seas? I am just a storyteller, law is the medium.” They were joined by the chairs of the various She added “I am quite sure that the interac- Nanda, president of the International Society sub-committees of the Organizing Committee --Drs. tion and sharing of knowledge and ideas that will of Cardiovascular Ultrasound and concurrent Maria Adelaida Iboleon-Dy (Publicity); Ma. Belen transpire over the past few days will indeed be very XIVth WCEVUAT president hailed the efforts and Carisma (Socials), Aurora Gamponia (Registration), fruitful. I hope that the gains made in this congress enthusiasm of all the people involved in putting Saturnino Javier (Publication), Eleanor Lopez (Fi- will be utilized to further advance the frontiers of up this enormous undertaking. He was later pre- nance), Roberto Raymundo (Physical Arrangement), medical knowledge, and help to improve the lives of sented the Maharlika Award in recognition of his Peter San Diego (IT & Documentation), Edwin Tucay millions of people, not just here in the Philippines but pioneering works in various aspects of utilization (Exhibits), Milagros Yamamoto (Hospitality &Hotel all over the world.” She added “now that it has come of echocardiography. Accommodations); Drs. Diana Jean Roxas (co-chair, to our country, a country that is proud of its tradition For his part, Jara emphasized that “the meeting Scientific), Mary Ong-Go (chair, Scientific), Joel as a haven of medical innovation and excellence, is a collaboration among cardiologists in this part of Abanilla (deputy secretary general), Norbert Lingling we are hoping that it will equal, if not surpass the the world. He elaborated how he has witnessed the Uy (secretary general); presidents of sponsoring successes of the past Congresses”. involvement and dedication of all the committee chairs associations -- Drs. Marie Simonette Ganzon (Philip- In his topic “The Coral Triangle”, Oposa said that to ensure the success of the scientific congress.” ♥ pine Society of Vascular Medicine), Mariano Lopez (Philippine Society of Echocardiography and Maria Teresa Abola (Philippine Heart Association). In his opening remarks, Calleja enthused “I hope that aside from learning from this convention, you will enjoy the hospitality and beauty of the Philippines.”

page 23 • February-March-April 2010 WCEFebruary 17-19, 2010 Edsa Shangri-La Hotel Mandaluyong City

page 24 • February-March-April 2010 page 25 • February-March-April 2010 WCE 2010 Highlights Session Highlights By Myla Gloria Salazar-Supe, MD RHD and Prosthetic Valves Scoring Systems in MS and PTMC Outcome Dr. Raul D. Jara, head of the Non-invasive Diagnostic Cardiology Division of the Philippine Heart Center cited sobering figures of the preva- lence of Rheumatic Heart Disease (RHD) in the Asia-Pacific Region, reminding the audience that RHD remains a significant cardiovascular problem among developing countries such as ours. Balloon valvuloplasty (PTMC) has risen in prominence mainly because mitral stenosis is RHD’s most common presentation. Wilkin’s scoring system Chua and Buhayan has been widely used since 1988 to determine artworks on exhibit the suitability he Convention was also a showcase patients. His works started getting noticed in 1988, of patients sent of the other side of cardiology. when he won the National Human Rights Photogra- for PTMC and Pieces of paintings done by phy Contest for his snapshot entitled “The Right to predict its out- renowned cardiologist Dr. Wiliam Live” and was featured in a local magazine. come. However, Chua and photos by Nilo Bu- His exhibits in 2007 and 2008 at the PHC Art there are con- hayan, a medical technologist at the Philippine Gallery earned him the Top Grosser Awards trasting views T regarding to Heart Center, were showcased during the three- consecutively. Best day WCEVUAT congress. known for his pictur- what should be The works of the very talented Dr. Chua have esque shots of land- considered an been exhibited in art venues here and abroad: and sea-scapes, he was optimal score. COLORS FROM THE HEART and IMPRESSIONS FROM commissioned by the There is also an overlap in the descriptive defini- THE HEART (Edsa Shangri-La Hotel), HEART ON WCEVUAT organizers to tion of say, a grade 1 lesion, versus that of the next 5TH AVENUE (Philippine Center, New York) and display his works. ♥ grade level, lending a lot of subjectivity to how HEART: SKETCHES IN EDEN (Philippine Embassy, an echocardiographer may interpret such lesion. Washington, DC). Modification of the scoring system to include the The versatile artist has also joined Group Art commissural morphology, has led to better out- Shows at the Glorietta Art Gallery, Metropolitan comes, in the Philippine Heart Center’s experience. Museum and Ayala Museum. His paintings are Significant calcification of the commissures, and also featured in books, and graced the cover of the subvalvar apparatus together with leaflet mobility 2010 WCEVUAT souvenir program. were the most important morphologic criteria for a Buhayan cultivated his knack for pho- successful PTMC, with presence of atrial fibrillation tography to escape from the stark inversely affecting outcomes. realities of the hemodialysis unit, Dr. Jara ended his talk with a challenge. “We in where he has been posted for the the Asia-Pacific Region, as well as in the develop- past 10 years. He wanted to bring ing world, in comparison to the Western World (as the beauty of the outdoors by we see more of these cases, in greater complexity) capturing God’s creations on may be in the best position to study these cases, film; and inspire hope among the and offer the best solution.” page 26 • February-March-April 2010 WCE 2010 Highlights 3D, PISA, Vena Contracta, and other ceeded to show the audience that the regurgitant including a Starr-Edwards valve implanted some Imaging Modalities in MR Assessment orifice is neither elliptical nor circular in most cases. 45 years ago and still currently functioning, Concurrently the head of both the Heart Valve Cen- Many factors affect regurgitant volume. Among the normally and abnormally functioning valvular ter of the Tufts Medical Center in Boston, USA, and its cases presented was the increase in severity of MR in prostheses, the varied reasons for failures such as Cardiovascular Ultrasound a patient with chest pain versus his echo when he was pannus formation, and dehiscence to name a few, Research for the past five without angina. “Though current practices in quan- while correlating the echo images with that of the years, Dr. Natesa Pandian, tifying regurgitation may leave a lot to be desired, I explanted specimen. believe they still have a place in the assessment and was both the chairperson Problem of Prosthetic Valve Mismatch for this session as well as treatment of regurgitation lesions.” As medical director of the Echosonographer the keynote speaker. He Program of the Mayo School of Health Services, tackled the various mo- Echo of Prosthetic Valves Dr. Daniel Borgeson has seen quite a number of dalities of assessing mitral Dr. Lidiette Esquivel, director of the Echocardiogra- patient-prosthetic valve mismatch (PPVM). The last regurgitation, focusing on phy Laboratory of Hospital Mexcico in San Jose, Costa lecture for this session, his dissertation was replete the strengths and limita- Rica, shared her expertise with illustrative cases, defining the various indices tions of Proximal Isovelocity Surface Convergence on the echocardiographic that made up a mismatch. Area (PISA) as a method for quantifying regurgitation, interrogation of prosthetic Despite the grueling two-hour marathon session, and how 3-dimensional echo has mostly supplanted valves and the hemodynamic the ballroom remained full –packed, standing- these modalities. “PISA is not a direct measurement of characteristics inherent to room-only till the very end, a testament perhaps the regurgitant lesion; it does not tell us its shape or each valve type. Interspersed that valvular heart disease would always remain a size … it is like going to point A then point C before within the lecture are many challenge for the echocardiographer. There was no getting to point B.” graphic examples of various time left for the audience to ask questions in an open Pandian noted that the assumptions on which types of valves (biologic as forum but the faculty was kind enough to clarify PISA was based were mostly erroneous and pro- well as metal prosthesis) issues privately after the session ended. ♥ Plenary Sessions Key Messages By Dr. Liberty Yaneza The echocardiographer’s role method particularly for small nfants who are <5 in interventional closure cases; kg in weight Assessment of Sub-clinical • Advantages of this hybrid procedure are namely, atherosclerosis 1. It simplifies surgery, 2. It only requires a small chest Dr. Ernerio T. Alboliras (USA) incision, 3. It avoids coronary bypass or shortens • Closure of congenital defects using occluder is cardioiplegic arrest, 4. It shortens hospital stay and now a common interventional pediatric procedure decrease hospitalization cost Alboliras Gerhard-Herman • With ASD, it is only the secundum type that expanding plaque hence maintaining an almost is amenable to ASD closure and not to be recom- Evaluation of Subclinical normal lumen on angiogram) mended with other types of ASD such as ostium atherosclerosis: EFT, IMT, CAC and ABI • EFT through evaluation of brachial mediated primum, sinus venosus, or coronary sinus ASD Dr. Marie Gerhard-Herman (USA) flow is an important test to detect endothelial • With VSD, only the paramembranous and • There are at least 12 available tests to detect sub- dysfunction which is the harbinger of atheroscle- muscular VSD are amenable for Amplatzer oc- clinical atherosclerosis; four are commonly requested rosis; healthy endothelium not only induces va- cluder device but not in patients with associated laboratory tests namely Endothelial function test (EFT), sodilatation but exerts other positive pleiotropic AV canal defects Intima Media Thickness (IMT), Coronary Artery Calcifi- effects such as inhibition of platelet aggregation • Hybrid procedure (surgery with interven- cation (CAC) and Ankle brachial Index (ABI) and smooth muscle tional procedure) is being done in ASD and VSD • The importance of early detection of sub-clinical • IMT abnormal result is likewise proven to be known as PerAtrial closure of ASD and Perven- atherosclerosis is encouraged to hopefully prevent or proportional to CV events. Normal and abnormal tricular closure of VSD respectively decrease cardiovascular events for patients with risk IMT result should be less than <0.5 and more • Per atrial closure of ASD is recommended par- factors for CAD than 0.8 respectively. The presence of significant ticularly for small infants that are at risk for vascular • The reason for the limitation of coronary angio- plaque would probably give a value of >1.5 injury and with no possible vascular access gram to detect sub-clinical atherosclerosis is that • ABI determination is important to detect • Perventricular closure of muscular VSD the lumen maintains an almost normal lumen even presence of peripheral arterial disease. ABI of requires direct vision of the muscular VSD though with significant plaque due to what we call 0.90 is considered normal, while 0.71-0.90 , 0.41 through surgical approach then application of Glagov phenomenon (the vessel exerts compensa- to 0.70 , <0.4 are for mild, moderate, and severe closure device; another attractive alternative tory outward enlargement to accommodate the PAD respectively. ♥

page 27 • February-March-April 2010 By Saturnino P. Javier, MD So Cabral will go to hell? f Lipa Archbishop Ramon Arguelles, vice chairman of the Catholic Bishops’ Conference By their strong pronouncements, the Catholic bishops maintain in no uncertain terms that of the Philippines-Episcopal Commission on Family and Life (CBCP-ECFL) is to be religious tenets should dictate the direction and believed, Dr. Esperanza I. Cabral, Health and a colleague in the Cardiology profession, nature of government programs and campaigns. has already one foot firmly entrenched in hell. How shall we now invoke separation of the Church IWhat has Cabral done to deserve this castigation country who oppose the distribution of condoms. This and the state? from an eminent Catholic prelate? is clearly debatable, as there are many practicing The selective name-calling of an official carrying Cabral took over the reins of the Department Catholics who use condoms, as well as oral contra- out her sworn mandate as a health official over and of Health (DOH) from Dr. Francisco Duque after ceptives and other artificial means of contraception above plunderers, murderers, rapists, kidnappers her stint at the Department of Social Welfare and for that matter. The statement thus may seem like and cheaters is a misplaced and inappropriate ti- Development. She quietly assumed the health a hasty generalization of the pervasive sentiment rade. For the millions of Catholics who listen to their post early this year. However, her first few weeks amongst the Catholics vis-à-vis their stand on the religious leaders in times of crisis and difficulties, at the DOH were far from quiet. In fact, they were condom issue. what was the message –- that Cabral has commit- controversial and stormy. Cabral and the DOH are armed with statistics to ted a crime far worse compared to many others that Alarmed by the rising incidence of HIV in the support the measures they have taken. Data from Philippine society has become immune to? country, registering one of the highest growth rates the DOH showed a total of 4,424 HIV/AIDS cases Yet, as the Philippine Daily Inquirer (March 5, in Asia, Cabral took on the challenge by embark- from 1984 to December 2009. The DOH secretary 2010) editorial clearly stated, the bishops’ voice ing on new strategies to invigorate the campaign explained in several interviews that the Philippines that loudly lambasted and denounced a public against the dreaded AIDS. On Valentine’s Day this is in a state of an HIV/AIDS epidemic, citing that at servant who was carrying out a mandate to ad- year, she allowed the distribution of condoms by the rate we are going, there will be 30,000 people dress urgent health needs, was the voice of moral DOH personnel along with flowers in public places with HIV in the Philippines in three years.Most im- righteousness and guidance that was distinctly in Sampaloc, Manila such as the Dangwa Terminal portantly, Cabral explained that the “doubling time” muffled, if not squelched, on those occasions that as part of the campaign against HIV. for HIV-AIDS cases has accelerated from 10 years to such was most needed. Where was this voice when Naturally, the religious sector did not take the one year. Edsel Salvana, a consultant at the Sagip the Ampatuans were mass-murdering civilians and strategy too well. Aside from the initial pronounce- HIV/AIDS clinic at the Philippine General Hospital, journalists in Maguindanao? Or when corruption ments of Bishop Arguelles, Marbel Bishop Dinualdo maintained that 90 percent of all HIV cases were assumes unimaginable scales and depths, when Gutierrrez questioned Cabral’s Catholic orientation sexually transmitted. numerous journalists are being silenced and slain, for resorting to a strategy that does not embody the What the bishops must contend with is that ac- when politicians flaunt adultery and infidelity? Who teachings of God. Sorsogon Bishop Arturo Bastes cording to Salvana, HIV cases worldwide declined should be in hell when publicist Dacer and his driver similarly lambasted Cabral and the program. Both by 17 percent from 2001 to 2010, but the number Corbito were slain and buried in Cavite? Who should bishops called for her resignation. She was called of cases in the Philippines rose 334 percent in the go to hell when the casino worker Edgar Bentain immoral –- or at least her actions as DOH secretary same period and by 400 percent in 2009, when 835 was slain and put inside a barrel and concrete were. Her Catholic orientation was doubted, even cases were recorded. poured over him? her parenting and rearing skills were challenged. What will a health secretary do to confront this If name-calling is the game, one who pushes for By their orientation and vocation, the Catholic alarming situation? Should she now distribute measures to arrest the rising incidence of HIV in the bishops expectedly had to denounce the strategy rosaries and prayer books to couples on Valentine’s country should be called the Arrestor. For one who of Cabral and the DOH. However, in asking for the Day to remind them of their Catholic values? nurtures and pushes for a campaign in order to con- resignation of someone whose approach did not Sexual promiscuity and multiple partners are trol the spread of AIDS in the country, a better name jibe with their own agenda and by resorting to fertile substrates for the spread of HIV -– whether should probably be a Protector. One who does her name-calling of a public servant who had employed Catholic or non-Catholic, Asian or Caucasian, hetero- job by confronting a problem head-on in the midst means within the province of her office and budget sexual or homosexual. To be fair, the DOH is pushing of a HIV epidemic should be called a Banger. And for to counteract a health menace, the bishops trig- for a three-pronged approach to the HIV problem providing people with means to protect themselves gered the ruckus that did not sit well with, or may –- abstinence, monogamy and protection during from a fatal disease and thus possibly saving lives, in fact alienated, many Catholics themselves. sexual intercourse. Since obviously and practically one may just be called a Savior. Bishop Gutierrez argued that the campaign one cannot stop people from having sex, the DOH Before I am called names, no blasphemy is does not respect the big number of Catholics in the zeroed in on measures for protection. intended on the last one. ♥ page 28 • February-March-April 2010 Cardio Viewpoints By Florian R. Nuevo, MD, DPBA, FCBCA Perioperative Use of Betablockers: From the Anesthesiologist Dr. Nuevo is the chair of the World Federation of the Societies of Anesthesiolo- What is our attitude to peri- and also identify those patients gists Executive Committee, and is the incumbent president of the Asian Society operative beta blockade? who would have severe responses of Cardiothoracic Anesthesiologists. A respected past president of the Philippine It is clear that there are two groups to beta blockade leading to severe Society of Anesthesiologists, Dr. Nuevo is affiliated with the UST Hospital, Philippine that require beta blockade: (1) vas- bradycardias and severe hypotension. Heart Center and the Chong Hua Medical Center in Cebu. cular patients with recent positive The latter brings forth the dimension provocative cardiac testing (based on of pharmacogenomics in affecting WHAT is anesthesia work like? tion and autonomic nervous system. the Poldermans data), and (2) patients outcome of treatment regimens using The practice of anesthesiology is As a rule, with deepening depths of an- already taking beta blockers. However, betablockers. basically “ facilitatory.” Our profes- esthesia, there is a reduction in blood we need to clarify if the “vascular sur- Results of numerous studies now sional services is not to render cure; pressure, similar to what happens gery” mentioned in guidelines exclude suggest that genetic polymorphisms anesthesia is necessary to make during physiologic sleep. The observed carotid surgery. Peri-operative beta may contribute to variability in re- possible a treatment, i.e. a defini- tachycardia would normally be due to a blockade has never been shown to sponses to beta blockers. Response tive surgical plan, or such service is sympathetic response to laryngoscopy be beneficial in patients for carotid to these drugs is highly variable, needed for a diagnostic procedure and endotracheal stimulation or a more surgery. This remains to be disputed. where 30–60% of patients with hy- to be done with ease, and/or be intense surgical stimulation, or such Several “Class IIa” recommenda- pertension treated with beta blocker acceptable and safe for the patient. observations have been drug-induced. tions are also important to consider. monotherapy will fail to achieve The need for our expertise arise in Whereas bradycardia may be due to a The word “recommendations” even adequate blood pressure control. This the control of acute postoperative vagal response to surgical stimulation, deserves more clarification. The variability may be accounted for, in pains, in patient resuscitation, in or due to very deep anesthesia, we exact phrasing of the ACC/AHA docu- part, by genetic polymorphisms. the acute critical care of patients, in must always rule out hypoxemia as a ment is: “the recommendation in Ser49Gly and Arg389Gly, two airway evaluation and protection; precursor to the bradycardia. favor of treatment being useful/ common single nucleotide polymor- and for the anesthesiologist who effective; some conflicting evidence phisms (SNPs) in the β1-adrenergic sub-specialized in pain medicine, Do you follow the clinical prac- from single randomized trial or non- receptor gene (ADRB1), have been his tasks include the management of tice guidelines prescribed by the randomized studies; additional studies most extensively studied. In vitro cancer and non-cancer chronic pain. American Heart Association and with focused objectives needed; it is studies showed that the serine- The clinical practice of anesthesia American College of Cardiology? reasonable to administer treatment; toglycine change at codon 49 in- requires not only the general knowl- By and large, anesthesiologists benefit>>risk.” creased agonist-promoted receptor edge of diseases, but also requires an follow published set of guidelines as The ACC/AHA paper does not have a down-regulation and that receptors understanding of the complexities of embodied in the ACC/AHA 2007 Peri- sophisticated reference for the risk of containing Arg389 had higher basal the surgical interventions involved in operative Guidelines, which state the surgery. For instance, intra-peritoneal and isoproterenol-stimulated recep- every case. Furthermore, it requires following recommendations for beta surgery is classified as intermediate risk tor activities. Because β1-adrenergic the good clinical assessment, sus- blocker medical therapy : -- this could include any laparoscopic receptors containing Ser49 and/ tained vigilant patient monitoring, Class I (useful) surgeries, or the variety of colectomies. or Arg389 have higher activity, one on top of the skills needed to secure 1. Beta blockers should be contin- Orthopedic surgery is characterized as might expect that patients carrying a vascular access, ensure an adequate ued in patients undergoing surgery intermediate risk, this would put total Ser49 and/or Arg389 would have a airway, and the capacity to provide who are receiving betablockers to knee replacement and other major better response to β-blocker therapy. sound clinical judgment quickly and treat angina, symptomatic arrhyth- spine surgery in the same category. Data from several studies suggest decisively during critical times. mias, hypertension or other ACC/AHA Prostate surgeries using laparoscopic that blood pressure responses to class 1 guideline indications (level of approach with robotic assistance do β-blocker therapy may differ by Can you comment on the in- Evidence C). not entail the same risk as with the ADRB1 genotypes. teraction of anesthetics and 2. Beta blockers should be given to open radical prostatectomy. Data on the association between betablockers? patients undergoing vascular surgery In the light of the POISE trial, we ADRB1 polymorphism and blood In the usual course of events, who are at high cardiac risk owing to need to have better assessment of pressure response to a beta blocker anesthetic agents would affect the the finding of ischemia on preoperative patients who are at high risks of may also help explain the underlying circulatory function, respiratory func- testing (level of Evidence B). developing perioperative stroke, See page 30 page 29 • February-March-April 2010 CARDIOLINKS... From page 29 By Angeles A. Yap, MD physiologic mechanism for the differences in blood pressure response to a β-blocker between Caucasians and African-Americans. Compared with African-Ameri- cans, Caucasians have a higher frequency of Arg389Arg The doctrine genotype (53% vs 34% in African-Americans) in the ADRB1 gene. Also, Arg389Arg has been identified as a predictor of good response to metoprolol. of Res Ipsa Loquitur Therefore, the genotype frequency difference In cases involving medical too complex to fall within that cat- between the two races may play a role in causing negligence, the doctrine of res egory. Furthermore, jurisprudence response differences to beta blocker therapy. This will ipsa loquitur allows the mere cardioand the ruled that expert testimony maybe be confirmed by prospective studies powered to evalu- existence of an injury to justify used and specific acts of negligence ate the relative influence of ADRB1 polymorphisms a presumption of negligence on law may be introduced. This is even on clinical responses to β-blockers in both African- the part of the person who con- more difficult considering that Americans and Caucasians. trols the instrument causing the expert witnesses, more often than Numerous studies have tested changes in resting injury. Literally known as “the not, are doctors who don’t want to heart rate and exercise heart rate before and after a thing speaks for itself”, the Doc- entangle themselves in law suits. beta blocker relative to ADRB1 genotypes. In healthy trine of Res Ipsa Loquitur casts Because of the difficulty, US courts, volunteers, metoprolol treatment was associated upon the defendant the duty to have recognized three situations with greater reduction in both resting and exercise come forward with an exculpatory explanation to when the third requisite of res ipsa loquitur is heart rates in Arg389Arg compared with that in rebut the presumption or inference of negligence satisfied: (1) when the act causing the injury is Gly389Gly,[15] whereas atenolol was not. on his or her part and relieves the plaintiff of the so palpably negligent that it may be inferred as a Thus, we cannot be absolutely certain of the pa- necessity of proving the defendant’s actual negli- matter of law, i.e., leaving foreign objects, sponges, tient’s response to beta blockers. First, it is important gent act , which is the reverse in ordinary cases. scissors, and so forth, in the body, or amputation of to recognize how anesthetic technique/ anesthetic The doctrine however does not allow the jury to a wrong member; (2) when the general experience agents and beta blockers would interact. Hopefully, make judgment of negligence by the mere fact of and observation of mankind teaches that the result the future is bright for the practical applications of the injury alone but the plaintiff must show proof would not be expected without negligence; and (3) pharmacogenomics. that the requisites for the doctrine to apply must when proof by experts in an esoteric field creates an be present, namely: (1) the occurrence of an injury; inference that negligence caused the injuries. The Epilogue (2) the thing which caused the injury was under the last requisite is satisfied by showing that the injury While we have the criteria to classify whether the control and management of the defendant; (3) the causing the accident or occurrence was not due to patient is undergoing a high, intermediate or low risk occurrence was such that in the ordinary course any voluntary action or contribution on the part surgical procedure, we must also be able to correlate of things, would not have happened if those who of the plaintiff. Here again, this element is easily and risk stratify out patients based on the disease had control or management used proper care; (4) met when the injury-causing accident occurs dur- profile of the patient and the current state of control the absence of explanation by the defendant; and ing surgery while the patient is unconscious. Once of his co-existing problems like diabetes, hypertension, (5) the injury-causing occurrence was not due to these requisites are satisfied, the jury is permitted heart failure and renal failure, among others. any contribution on the part of the plaintiff. “ Of to infer negligence on the part of the defendant In reality, while it is true that the peri-operative the foregoing requisites, the most instrumental is in the absence of a satisfactory explanation in the use beta blockers protect the heart, there are other the “control and management of the thing which circumstances of the case and the defendant is organ dysfunctions that can contribute to operative caused the injury. This requisite is satisfied by made liable for damages. morbidity and morality. Furthermore, the health care showing that the plaintiff’s injuries were caused by 1. Cantre, vs. Go G.R. No. 160889, April 27, 2007. environment such as extent of preoperative assess- an agency or instrumentality within the exclusive 2. Res Ipsa Loquitor in Medical Negligence Case. ment, the level of postoperative care, the intraopera- control of the defendant. Usually the plaintiff must Greenstreet, Patricia, K. tive and postoperative monitoring resources, and the also demonstrate that he or she was in a position of 3 Ranos v. Court of Appeals, citing St. John’s availability of drugs, do influence outcome. corresponding lack of control to avoid the injury. This Hospital and School of Nursing v. Chapman, 434, I encourage the anesthesiologists to discuss with element is easily met in medical negligence cases in P2d 160 (1967). the surgeons and the cardiologists, the identified which the plaintiff’s injuries occurred during surgi- 3. Metropolitan Mortgage & Securities Co., Inc.,; problems, the anticipated complications, and as a cal operations while the plaintiff was unconscious. Zukowsky v. Brown, 79Wash. 2d 586, 488 P.2d 269 team, do the proper risk stratification of the case at The third requisite is often the weakest point of a (1971); PacificCoast R.R. v. American Mail Line, Ltd., hand. It is best that anesthesiologist make known medical negligence res ipsa loquitur case from the 25Wash. 2d 809, 813, 172 P.2d 226 (1946). to both the surgeon and cardiologist the anticipated point of the plaintiff, but the strongest defense as 4. Jackson v. Criminal Justice Training Comm’n, 43 difficulties in the context of the place of work ie: the OR far as the respondent is concerned, because the Wash. App. 827, 830-31, 720 P.2d 457 (1986). environment and also the level of medical and nursing determination is generally made on the basis of 5. Ampil vs. Agana. G.R. No. 127590 , January care provided by the hospital. Teamwork is obviously “common knowledge,” and medical facts are often 31, 2007 ♥ a key to success. ♥ page 30 • February-March-April 2010 Travel Photography By Nick M. Cruz, MD ith an endless list of international cardiology confer- importantly, how a particular scene was captured. ences that are up for grabs, it is a standing joke among Travel photography includes a variety of subjects. The main objective physicians that the surest way to get to see the world is for the photograph to express a “sense of place” so that the viewer would is to become a cardiologist. feel being present in that particular location at that particular time. A good Thus, a Filipino cardiologist, usually takes pride in travel photograph, of course, still has to possess the basic elements of proper Whis/her collection of photographs of interesting places both here and abroad. lighting, composition, and dynamic design. Such a photograph should tell a The featured pictures are documentation or proof of being there, but more story in the most interesting way possible.

Teenagers Outside the Vatican Museum I saw this group of teenagers just outside the Vatican Museum, seemingly bored and tired of waiting either for their in- structor or friends. Although the background is not sharp at all, the viewer could ac- tually not mistake it for a modern structure like a mall or a park. ♥

Boracay Sunset by Dr. Rod- ney Jimenez The use of back- lighting forming the amazing silhouettes of sailboats with people, plus the intelligent use Hercules in Bronze by Dr. Nick Cruz Not all pictures of the rule of thirds in dividing have to be taken in full. Sometimes a photograph may the sky, occupying two-thirds even create more impact if only a part is captured, or of the frame and the sea and as in this case, may even be more interesting if taken occupying the lower third, from an unusual perspective.I shot this picture of make this photograph a visual Hercules inside the Vatican Museum from what can delight. ♥ be considered a worm’s eye view. ♥

Giza Pyramids by Dr. Edgar Tan A familiar scene, the Giza Pyramids give a different perspective of the subject. The photograph presents 3 interesting elements: the foreground shows tourists in different positions and directions and different colors of outfit. This gives dynamism to an otherwise predictable subject. The picture establishes the setting and weather. ♥

page 31 • February-March-April 2010 Travelogue

Acacia-lined Rizal Boulevard “Nemo” in Dumaguete waters Silliman Hall built in 1903 UMAGUETE CITY, popularly known as the “City of Gentle People” is the capital city and main port of Negros Oriental, the province that occupies the Delightful Dsouth-eastern half of Negros Island, in the Central Visayas region of the Philippines. Every Dumagueteño knows the legend of this once-coastal town known for its lovely maidens and their power to attract visitors and usually keeping them for good. Stories tell of the adventures of By Erlyn C. Demerre, MD Muslim pirates from nearby Mindanao who came to the shores of Negros Island ”to snatch/ swoop” or Dumaguete is a wellspring of talented, gentle people who in the vernacular to “daggit” the ladies of the island. In the early years of the Spanish rule, Diego Lopez are the City’s richest resource and tourist attraction. If you Povedano designated the place as “Dananguet” stay long enough or even decide to retire in Dumaguete you because of its reputation of always being threat- will find it a pleasurable experience and a wise decision. ened by pirates in search of slaves. Murillo Velarde in 1734, popularized its present name Dumaguete. higher learning in Dumaguete, providing the city with In 1811, a church and a bell tower were built off a unique university town atmosphere throughout­ Lee Plaza Dumaguete the coastline (now called Rizal Boulevard). The its sprawling 35 hectare green campus dotted with in the heart of the city belfry served as a watch tower where men would century-old acacia trees adjacent to and within the take turns scanning the horizon for any sign of city’s business hub. another marauding attack. Today, this imposing Silliman is the first Protestant university in the moss stained stone landmark, right next to the country and the first American private university in magnificent St. Catherine of Alexandria Cathedral, Asia founded in 1901. According to the Commission stands as the oldest bell on Higher Education, Silliman tower in the Visayas. ranks 2nd if the University of Aside from earning the the Philippines system is taken reputation of maidens’ fair as one. Overall, it is the 4th top and tourists’ lair, Dum- performing school in the Phil- aguete has earned for her- ippines, and hence is a favorite reputation that without Silliman there is no Dum- self the high distinction educational destination for aguete City. But now, true to its legend of having of being the acclaimed approximately 30,000 students the power to attract people, Dumaguete is known “center of learning in the from surrounding provinces the world over especially to Europeans who love south.” To this day, Dum- and cities in the Visayas and the richness of the natural resource of the Island as aguete City is referred to Mindanao. well as the simplicity and hospitality of the people. as a university town due Among the famous land- From an estimated male dominant population of to the presence of four marks of its campus are the 116,392 (2007 census) comprising 9.05% of the universities namely Sil- Silliman Hall (built in 1903) population of Oriental Negros, the City swells to a liman, Foundation, St. Paul and Negros Oriental which houses the Anthropology Museum, the Luce daylight population of approximately four times the State University (NORSU) and a number of other Auditorium (considered as the CCP of the South) and original number on account of tourists, students and colleges where students, professionals and artists, its Marine Laboratory Museum which houses the 2nd residents from nearby towns who regularly visit the scholars and the literati from all over the country largest whale bone collection in the world. city for what it could offer. and abroad converge. The City has a land area of 34.26 km² that to the The medical needs of the locals and the growing Silliman University is the dominant center of naïve is found somewhere in Silliman because of the number of tourists and retirees are met by one page 32 • February-March-April 2010 Travelogue government and two private hospitals namely, the Negros Oriental Provincial Hospital, the 100-bed Holy Child Hospital and the 150-bed Silliman University Medical Center Foundation Inc. (SUMCFI). The Imposing Dumaguete belfry latter signed a memorandum of agreement with St. Luke’s Medi­ tower built in 1811 right next to cal Center (SLMC) on March 19, 2010 with SUMCFI administrator the St. Catherine of Alexandria Roberto Montebon and Dr. Joven Cuanang , SLMC senior VP and Cathedral fronting the Rizal chief medical officer, as signatories. SUMCFI VP/Medical Director Dr. Park and boulevard Verna Reyes stood as witness. The MOA will institutionalize referral system between the two hospitals, support continuing medical education for the staff and develop collaborative research. SUMCFI has achieved and sustained accredited residency training programs in Internal Medicine, Pediatrics and Family Medicine headed by Dr. Junabeth Caballes-Credo, Dr. Elminda Oracion and Dr. Erlinda Lim-Juan respectively, while the Department of Surgery is in the process of accreditation. As proof of Silliman’s commitment to education, the medical staff of SUMCFI bonded together to form a medical school. With just 9 students 5 years ago, presently, about 71 students have benefited from the school’s hybrid problem based learning. The school’s litmus test will be the first batch’s medical licensure boards come August this year. Dr. Jonathan Amante is the current Dean of Silliman University Medical School (SUMS). With the growth of the hospital and its staff and through the efforts of Montebon and the supportive leadership of Silliman University’s president, Dr. Ben Malayang, an impressive 4-storey medical arts building now stands as an icon of progress within the hospital campus. The massive infrastructure houses doctors’ clinics and new private rooms on the first two floors while the top floors will be dedicated to specialty centers like cancer and renal units. According to Montebon, a new fully computerized, centralized queuing system is now operational at the doctors’ offices that have efficiently streamlined outpatient traffic. Large computer monitors are strategically placed in spacious waiting areas for patients to view their numbers, queued on a first come first serve order as well as doctors currently serving patients. Dumaguete has raised many doctors, among whom are Drs. Johnny Magbanua, Susan Michaela Ozoa-Denura, Silahis Oliver- Rosario, Karen May Arboleda-Sayson and Erlyn Cabanag-Demerre, all practicing adult cardiologists in Dumaguete except Demerre who is based in Manila. The most senior of the pack, Dr. Johnny Magbanua is a product of the UP-PGH. Well-loved by the community and respected by his colleagues, his opinion is valued both in the clinical arena and the academe. Magbanua finds the smiles and thanks you’s from his loyal patients as the most rewarding part of his career. Known to be very caring to his patients, he finds it most frustrating when there is nothing more that he can do to alleviate their pain and suffering. Now on his 35th year of private practice, he has seen the tremendous rise of cardiovascular disease in Dumaguete claiming top ranks in morbidity and mortality. “Sadly, the efforts of medical societies remain inadequate in addressing the

page 33 • February-March-April 2010 problem”, Magbanua laments. He observed that St. Luke’s Heart Institute. this rise in CVD is attributable mainly to lifestyle The youngest in practice is changes. “My advocacy then and now is aggressive Dr. Karen May Arboleda- preventive measures in conjunction with tailored Sayson. A graduate of Per- management”. Magbanua served in the editorial petual Succour Hospital-Cebu board of the Philippine Journal of Cardiology (PJC) Heart Institute 18 months ago, when Dr. William Chua was editor in chief of this she finds her young practice official scientific publication of the PHA. so challenging. “You have no Dr. Silahis Oliver-Rosario who hails from choice but to do optimal medi- Davao is running on her 15th year of practice. cal management for patients Reputed to have daily long lines of patients at who cannot afford invasive her clinic, she has this to say about her life in tests and procedures like an- Dumaguete, “ Quality of life is very important gioplasty or open heart sur- to me. Here, I have more quality time with my gery”. When asked about the family and I don’t have to rush to avoid the hustle awareness of women’s heart and bustle like that of the big cities. Life is simply health in Dumaguete, “Most great especially if you are with the Lord”. When are not aware that women are asked about her private practice, “I rely on my equally at risk with men” she clinical assessment and have learned not to be so remarked. much dependent on high-technology diagnostic Dr. Julia B. Maape is Dumaguete’s lone pediatric outsourcing (BPO). procedures, considering its cost. The loyalty of my cardiologist who shuttles from Bohol and Dum- Dumaguete is a wellspring of talented, gentle patients is amazing” aguete to dispense of her duties. people who are the City’s richest resource and Dr. Susan Michaela Ozoa-Denura, a true Recently, the Oriental Negros Emergency Rescue tourist attraction. If you stay long enough or even blue Sillimanian, born and bred in Dumaguete, is Foundation, Inc. (ONE Rescue) with office base at the decide to retire in Dumaguete you will find it a at her best after starting­ private practice 9 years Foundation University was organized to provide free pleasurable experience and a wise decision. It is ago. “We don’t have a complete cardiac diagnostic rescue and out of hospital emergency medical services a haven of tourist hot spots especially for divers laboratory and that is a big limitation as well as a including trauma as well as offer community educa- and nature lovers. Hotels, restaurants and resorts challenge. We need to send patients to Cebu or Ma- tion on disaster preparedness and the prevention of various flairs abound that could cater to almost nila for work-up”. When asked what she finds most and handling of emergencies. Dr. Kenneth T. Coo, Dr. any discriminating traveler. The non-smoking, no rewarding in her practice she says, “same as urban Rosalind F. Yu, and Dr. Karen A. Sayson attended the alcoholic beverages Bethel Guest House and the practice, it’s rewarding in the sense that we offer Philippine Heart Association’s Trainors Course for ACLS Spanish inspired La Residencia Hotel along Rizal hope and try to make a difference in the lives of and BLS in November 2009 and are now actively cas- Boulevard offers a warm Dumaguete brand of cardiac patients as we apply the skills our mentors cading the knowledge to resident physicians, health hospitality matched with a breathtaking coastal taught us”. Despite the shortage of residents over workers, and interested lay groups. Classroom training panoramic view of Cebu Island. Malls like the Lee the years, when human strength is stretched many is regularly held at the Lee Plaza. Plaza, Hypermart and Cang’s Inc. flourish because times and consultants take on the responsibilities of The once quaint coastal town with a university residents of neighboring towns and cities who used a fel­low or resident doing bedside monitoring and atmosphere has creatively developed a competi- to go to Cebu to shop now flock to Dumaguete for a spending nights in the ICU with toxic patients, Dr. tive business environment well assimilated into leisurely paced spree. This is affirmed by the recent Denura keeps her sanity by reminding herself “ours this rapidly blooming tourist haven. The Business opening of Robinson’s Mall in the outskirts of the is a calling of service”. Though she places in highest Processing Association of the Philippines (BPAP), City and SM plans in the offing. priority her role as a mother, Denura has devoted Commission on Information and Communications Despite the current flow of human traffic her time to further the expertise of the staff at the Technology (CICT) and the Department of Trade and the steep slope of business and industrial Holy Child Hospital. Two years ago, she requested and Industry (DTI) declared Dumaguete along with developments in Dumaguete, it has one of the the Council on CPR under Dr. Raul Ramboyong to Baguio City as the new entrants to the top 10 best lowest crime rates among Philippine Cities its size, train residents, ICU and ER staff on BLS/ACLS. outsourcing locations which are projected to gener- making it an ideal place to raise a family and earn Both Rosario and Denura are products of ate $ 1.2 billion in revenues for business process a living on the side. ♥

Silliman Medical Center page 34 • February-March-Aprilcampus showing 2010 the MAB at the right page 35 • February-March-April 2010