Official Publication of the FAR EASTERN UNIVERSITY Dr Nicanor Reyes Jr School of Medicine Alumni Foundation ECTOPIC MURMURS

Volume 24 Number 3 March 2013 Opinions and articles published herein are those of the authors and do not necessarily reflect that of the FEUDNSM Alumni Foundation

MEET US IN LAS VEGAS (PRESIDENT’s Tenderly Yours ) NOLI GUINIGUNDO MD 62

The Board Trustees, past and The price given to us kept on present officers of the changing; hence the decision FEUDNRSM to go to Monte Carlo Casino Alumni and Resort. Foundation will We hope for a good convene this attendance. We also hope for a Saturday, good show inspite of the ever

March 16, rising price of the airline 2013, in Las tickets. We probably do not NOLI C POPE FRANCIS, Welcome! GUINIGUNDO MD Vegas for its have much choice but to take Spring the quoted price of the meeting. different airlines. The venue this year is the To date, we do not have a Monte Carlo Casino and Resort. Pope. His Holiness, Pope especially if his health is We apologize for the earlier Benedict XVI, resigned on involved and at risk. announced venue in Treasure February 28, 2013. Our Archbishop of Manila, Island. The Las Vegas hotel He is the first Pope to resign Luis Antonio Cardinal Tagle is failed to communicate with Dr from office in more than 600 one of those being considered to Oscar Tuazon who made the years. But, he probably has all become Pope, Papabili . The arrangement for the meeting. the valid reasons for doing so, continue on page 11 MARCH IMAGE

Some of the FEUDNRSM Alumni Foundation scholars in white uniform outfit are shown with alumni, from left, Drs Frank Rabadam, Grace Rabadam, Farida Chua, Arsenio Martin, Melinda Fabito, Daniel Fabito and Philip Chua.

SEQUESTRATION FROM ASHES ON PECHAY on Medical Care ULYSSES M CARBAJAL MD 61 TO ASHES CESAR D CANDARI, MD 62 Introduction. Pechay is a CELSO DEL MUNDO MD leafy vegetable plant with Sequestration is the budget We’re all God’s cuts which will slash $1.2 symmetrically creations arranged trillion from coming from federal leaves. Each the ashes, leaf, which is spending over With His the next a verdant power, He widening decade. It has gave us life taken more CELSO DEL sheet, is fused MUNDO MD with the ULYSSES M with the than a year of human form, CARBAJAL MD tapered top of CESAR D anticipation We have all immortal souls CANDARI MD about whether a concave succulent stalk. within this pile of ashes, From the time of planting, a Congress and At the end of life we will go President Barack Obama would pechay plant matures within back to earth except our two to three months. If left strike a compromise, however, crying souls. finally it kicked-off March 1. alone longer, the plant sometimes bears a cluster of Enumerable articles have been Alive we are all dancing above written on these subjects. I have yellowish flowers. The tiny the troubled water, summarized them in tidbits for In the beginning we are solid everyone to make your own masses with immortal souls, take. In the first place the act Time will come when the was considered a last resort that physical being will turn to would force Congress and the crumpled ashes, Obama administration to reach From ashes to ashes we an agreement on federal deficit dissipate except our loosened reduction in order to avert large soul, cuts to defense and non-defense programs. Don’t waste time for solid mass What is its impact to that give heat like a burning Medical care? An up-to-date ember, statement from Massachusetts Let the ashes give the rays of Medical Society (MMS): More light to all the corners of the than a billion dollars in disaster world, relief, more than $350 million From when the ashes turn into for the Centers for Disease ashes, we have life no more, petals are finally shed, each Control and Prevention, and Just a pile of dusts, going back leaving a tiny fruit, which more than $133 million for the to earth where we all are consists mostly of a single seed. Food and Drug Administration from. A variety that is commonly are among the scheduled cuts. grown in school gardens and Mental health services, AIDS/ more so in farms is one which HIV prevention and treatment, had been introduced from and food safety programs are China. This is most commonly also to be reduced, as are used in Chinese restaurants. payments to health care May I now recount three providers. lessons in life, associated with Under the current sequester planting and harvesting pechay . rules, Medicare will be cut by A Lesson on Fairness. $100 billion over the next 10 From ashes to ashes When I was in grade one, continue on page 9 continue on page 7 CLINICAL IMAGE SSS A CURE IN TRIPLE-NEGATIVE BREAST DUCTAL CARCINOMA? These images are from a 41- (Figure 1 ), highlighted on confirmed a high-grade ductal year old woman who presented mammogram as a bright dense, carcinoma, Nottingham score with a palpable left breast irregular, poorly circumscribed 3+3+2=8 (acinar formation, nodule immediately posterior to and poorly demarcated mass in nuclear pleomorphism, and the nipple with periareolar the center of the left breast mitotic figures, respectively), inflammatory cutaneous tissue ( Figure 2). without basaloid features. The changes. Figure 3 , clockwise, ( A) the negative immunostain Ultrasound affirmed a 2.0- stereotatic-guided vacuum- represents (B) 0% estrogen cm tumor underneath the nipple assisted core-needle biopsy receptor, (C) 0% progesterone receptor and (D) under- expressed HER2; ( E) 90% p53, and ( F) 30% Ki-67. In addition, S-phase and DNA molecular evaluation showed aneuploid. The final results signified a triple-negative high-grade ductal carcinoma associated with unfavorable p53, Ki-67 and aneuploid DNA. The patient was administered with systemic chemotherapy of gemcitabine, nab -paclitaxel, and bevacizumab once every other week for seven months with significant improvement. The regimen was followed Figure 1 Figure 2 by bilateral modified radical mastectomies which microsco- pically were negative for residual malignancy. No new tumor in either breast was also noted. The mastectomy surgical margins were negative for malignancy. BCD Two sentinel lymph nodes A excised were negative for metastasis. Breast reconstruction was done shortly thereafter, and follow-up for 5½ -year, to date, showed no recurrence or metastasis. COMMENTS and LITERATURE REVIEW. F E Triple-negative breast cancer (TNBC) is defined as tumors Figure 3 that neither express hormone Patients with metastatic overall survival compared with receptors nor overexpress TNBC exhibit progressively patients with residual invasive human epidermal growth factor shorter response durations to disease. receptor 2 (HER2)/ Neu gene successive lines of therapy. Less than 10% develop a amplification. In a retrospective series of distant recurrence at 5 years, TNBC tumors account for 111 patients with TNBC, 14% and equivalent to that for approximately 15% of breast of whom presented with patients with other breast cancer cancers. metastatic disease at diagnosis, subtypes who experience a Clinically, they are highly the median duration of response pathologic complete resolution. aggressive and dispropor- was only 12 weeks (range, 0– Those patients with TNBC tionately affects young women 73.1 weeks) to first-line who do not experience a under 40, African American, therapy, 9 weeks (range, 0– pathologic complete remission and women who have a genetic 120.9 weeks) to second-line with the same chemotherapy mutation called BRCA1. chemotherapy, and 4 weeks have a much poorer prognosis The risk of recurrence is (range, 0–59 weeks) to third- — an observation that has higher than other breast cancer line chemotherapy. sometimes been referred to as types within the first 3 years. There is still an unattained the triple-negative paradox . Distant recurrences in the clinical need for effective FINAL DIAGNOSIS. brain and visceral metastases therapies that prolong survival Triple negative, high-grade are more common than in for patients with metastatic infiltrating ductal carcinoma hormone receptor-positive TNBC. Stage IA in complete tumors. In the absence of possibly remission for 5½ years. Therapeutically, despite curative therapies for metastatic A list of REFERENCES is being highly chemosensitive, disease, the goal of therapy is available upon request. their progression-free time is primarily palliative in nature, by CESAR V REYES MD 68 generally short; and there is leveraging systemic treatment about 25% of patients treated with minimal toxicity during with standard pre-mastectomy remission and at the same time chemotherapy achieve complete enhance quality of life by remission. delaying the onset of cancer- COMMENTS Chemotherapy-wise, related symptoms. Editorials, news releases, anthracyclines and taxanes are The patient illustrated here is letters to the editor, column useful drugs; and high response an instance in Stage IA TNBC proposal and manuscripts rates have been described for treated with first-line are invited. the combination of ixabepilone- combination chemotherapy capecitabine and platinums. consisting of nab-paclitaxel, Email submission, including The addition of antiangio- bevacizumab, and gemcitabine figures or pictures, genic drugs has also proven every other week. After only 5 is preferred. useful. weeks and 2 infusions, the A group of new drugs, poly- patient experienced mass size (ADP-ribose)-polymerase decrease and symptom relief. ECTOPIC inhibitors, showed favorable Following seven months of results in TNBC tumors with treatment, the patient achieved a MURMURS BRCA mutation. complete remission that, with There are also currently continuous therapy, persisted Deadline for the several ongoing studies with for 5½ years to date. April 2013 issue new drugs including epidermal Overall, patients who growth factor receptor experience a pathologic April 15, 2013 inhibitors, c-kit inhibitors, Raf/ complete response with Mek/ Map kinase inhibitors and neoadjuvant chemotherapy have Please address submissions mTOR inhibitors. significant improvements in to [email protected] both disease-free survival and FOR FREE to save our people from the democracy. The country’s continued Marcos rule and that economy is deplorable; peace PHILIPPINES is the very reason why you and and order are deteriorating all CESAR D CANDARI, MD 61 I are here this afternoon to over the country; the insurgents (The following is a speech appeal to the conscience of the NPA are becoming stronger. originally written in a book people of the United States, to There is a lag in productions, memoir as a remembrance of the the leaders of the government the Philippine peso is Movement for Free Philippines, and particularly to Mr Ronald continually losing its buying reprinted to commemorate the Reagan to stop support of a power, prices of food anniversary of the People Power government who has destroyed commodities and other daily Revolution.) and gutted the very main fiber necessities have skyrocketed to February 25, 1986 reminded of democratic principles in the a point where the consumer us of the Philippines. For it was with very little and limited EDSA People considered that the Philippines income could hardly afford to Power Revolt as a nation are one of the buy the basic family in the remaining bastions of requirement. Unemployment Philippines. It democracy in the Asian rate is rising. Human rights are has brought us continent now, that image is destroyed and there is no justice from a fading in the horizon. serve for those perpetuators of dictatorship to CESAR D Our dream and quest for crime who happens to be democracy. CANDARI MD democracy are fading indeed; supporters and cronies of the The past 27 the Philippines today under the Marcos administration. years was hardly any thing left Marcos government have lost You have seen and heard to be said. Except to remember its freedom and democracy that ladies and gentlemen, in the and be grateful. And, except to we have enjoyed in the past. current media coverage of the wonder over again. I delivered Ferdinand Marcos has devoted Philippines during the pre and my speech in that very day at the greater part of his twenty post election time of the dire the Movement for Free Philip- years of presidency in poverty of our people in the pines Rally in downtown San plundering the economy of the slums of Tondo, the media Diego, California. Philippines and corrupting its censorship, the brutality of the We have finally come to the civic institution. In the ultimate Army and police and the final hour and the election in the act of greed and larceny, he has brashness of Mr Marcos. On the Philippines our beloved country brazenly stolen and hijacked the other hand, you were able to see has ended but not over yet. expressed hope of the Filipino also the bravery and the Democracy has faced the people for a return to enthusiasm by which the toughest challenge of resur- democratic rule. Filipino people tried to insure as rection in the Island of the brave honest vote and ballot count. and the home of the free. It is We saw a nun who set in the the Filipino people’s turn to ballot boxes during the power make a judgment wherever they black out, about college are, here in the Unite States, in students standing up to armed Canada and other parts of the men, about common Filipinos world. And that is the very linking arms to protect the reason why we are gathered ballot boxes, some risking their here this afternoon. Those who lives. Ladies and gentlemen, the have committed to help the Filipinos proved beyond doubt Filipino people to regain their to the entire world that they lost freedom have done their want democracy back. But what share of the struggle to the had happened? Mr Marcos limits of their human capabili- stole the election. The will of ties. The hue and cry in the the people has been trampled. What remains now to be done is Philippines is for a change to a Cory Aquino, the 52-year- Marcos through Amendment 6 become true heir to our legacy old widow has the fallen leader to push aside the legislature in of liberty. Only then will the Benigno Aquino has shown a order to give way to his decrees. shadow of blood vanish from mandate of the people had it The will of Mr. Marcos has the face of the sun. We will and been free and a fair election. become a law. Now Martial must continue to seek for that The flagrancy of the Law is being hinted. Because wonderful dream—a return to electoral cheating attempted by of Amendment 6, this is a democracy. Marcos has the Marcos forces had been powerful instrument of deprived the Filipino people of staggering. We are told that oppression. It has spawned legal that democratic right in the last thousands of voters, who monster. Public decree N0. 20 years and finally the person supported Mrs Aquino, went to 1936 authorizes the detention of has awakened. the polls only to find that their persons at the sole discretion of Buhay, Lakas and names had been stricken out the President. This is what we Pagkakaisa (Life, Strength, from the voter’s lists. There are expect on this Martial Law. people power and Unity) shall rampant intimidations of pro My friends and lovers of be our battlecry! Aquino and some cases democracy, we have been The question to ask now is murdered. robbed of the chance to institute whether the wonder of the A good friend of mine Evilio change in our country’ EDSA revolution has Javier from the province of leadership. All we can do now diminished shattering the Antique where I came from was is to ask the Reagan dreams of the Filipinos? Did murdered in broad daylight at administration to align EDSA brimming with the faith the Provincial building where themselves with the forces of of the Filipinos have receded he was watching and democracy, to plead for justice with time? safeguarding the ballot count to be duly served to the robbers Indeed, we have a free for Mrs Aquino. Ballot boxes of democratic principles, the country, but to be free is not were openly stolen. Computer forces of evils -- the Marcos enough. The machinery of operators walked out off their government--. We ask your corruption is also set free and jobs in dismay after finding that help, peoples of the United running as it was in the time of vote totals were rigged in States of America. Mr. Regan, tyranny. The Filipinos got rid of Marcos favor. All these we implore upon you to stop the plunderer and looter of this occurred before the eyes of 600 support of the corrupt autocracy nation's wealth only to realize foreign reporters and scores of of President Marcos. that a new pack of looters had American observers and to the The Philippines is a country taken over. entire world. with closest possible ties to the After the EDSA Filipinos Just the other day, we United States of America. The now have a voice. No matter learned that Mr Marcos hinted U S. military facilities in that how loud the voice were no one of imposing Martial Law once country, the Subic Bay Naval is listening. No one really cares. again. Not only that he is going Station, and the Clark Air Force The post-EDSA Filipinos now once again to crown himself as Base are vital to our Pacific have a voice. But who is king, emperor and a military Defense. We have fought side listening? Nobody among governor. He will succeed again by side during the 2 nd world war politician really cares. to execute a masterful political for preservation of democratic It remains a wonder to maneuver. The Marcos principles. The United States of behold 27 years later. As constitution today, instead of America has given us, as a wonders go, we can say protecting the Filipino people nation, a legacy of liberty. everything about EDSA and yet from dictatorship, Marcos has betrayed that nothing, it had failed. That the institutionalizes dictatorship. legacy. EDSA spirit is dead, the The foundation of the What we want from you Mr Pilipinos are back exactly to Marcos dictatorship regime is Reagan is to stop military and where they were before EDSA; the total destruction of the old moral support of a man who the abject poverty and the system of check and balance. betrayed that legacy of liberty. blatant corruption of their The constitution now allows Mr Only then, will the Philippines government. To top it all, the ECTOPIC MURMURS March 2013 Volume 24 Number 3 page 7

Marcoses are back in power, an cultivate the soil three inches pechay among some 30 unimaginable happening. In around the base of each gardeners. Nick Joaquin's words, 'to have a plant at least once a week. Because your plants appear future again, a tomorrow again, How happy was my Mom the best , she continued. I will and that we didn't have to when she was invited to view offer you more than I had resign ourselves to a numbing the number-one plot in the offered the other gardeners. prospect of one damnable school garden — that it Then she dug into her purse Marcos after another .' belonged to her son! I felt good and showed me five shiny Why EDSA failed? to hear her say: I am proud nickels. I was suddenly Historians shall have the right of you, Uling! reminded that this amount of perspective; that the ideologues At that time, I also spent money was five times the cost will lament that the time during weekends to gather of a basket of Bermuda revolutionary zeal for reforms Bermuda grass in the fields, grass. Childishly, I estimated has fizzled out. Those compressing the wreaths and that this would buy enough traditional vested interests are clusters of grass into a fairly cookies and lemon drops to back in business as usual. That large bamboo basket. It would supply my needs for many days. Pilipino politics is out of order take about an hour uprooting Finally, Nana Itang won me and needs an overhaul. That the and gathering the said grass to over. She carefully uprooted all national purpose is aimless. fill one basket. This was then the beautiful plants, bundled That national unity is in tatters. sold 5 centavos a basket to them together, and left in a huff. That the EDSA spirit is dead. competing horse-owners in the When I arrived at home, I barrio. This amount was enough presented the money to my to buy three cookies and two Mom, triumphantly. ON PECHAY seeds of lemon drops. What is this? she asked. When the pechay plants That was handed to me by continued from page 2 attending the Barrio School in were close to maturing, the Nana Itang when she came to Santa Maria, plots of garden appeared gather all the plants from the San Nicolas, completely covered by the garden plot , I explained, Pangasinan, verdant leaves of pechay , innocently. my plot of spreading around luxuriantly What? exclaimed my Mom, pechay plants and symmetrically. How good I rather upset. was judged felt to see the fruition of my She bought also the plants of labor! my classmates and paid them the best. The ULYSSES M reason for this But this feeling of less than I was paid , I CARBAJAL MD was that I satisfaction did not last long. added, impishly. used a liberal amount of One afternoon, while I was She cheated and deceived fertilizer, consisting of watering the plants, Nana Itang, you! Mom cried out in a rare fit decomposed cow manure. who owned a sar-sari store in of anger. The price (Close to the ditch from which front of the school, sauntered to of your plants is ten times more we fetched water for gardening the school garden to present a than the money she offered to purposes was a pit into business proposal to the you . which sacks of dried cow gardeners. I want to buy your I was speechless. I thought I manure had been thrown and pechay plants ,” she offered, in a had been paid good money, allowed to disintegrate for a few positive tone. comparing this with the amount days). At first, I remained received from gathering Moreover, everyday (early unconvinced. I knew that my Bermuda grass. To cut the story morning or late afternoon), I Mom had once visited the short, my Mom and I rushed carefully watered the garden garden and was so proud of me back to the store of Nana Itang. plot. Also, I took time to for having the best plot of We found her cleaning the now- detached pechay leaves and arranging them for display in By this time, Auntie Nena, a late afternoon, he came just in the store. beautiful cousin of my Dad was time to see Auntie Nena and Itang, my mother addressed vacationing with us. I recall that me, sprinkling water over the her in a subdued voice, trying my Dad had been so accommo- many plots of rapidly growing hard to hold her feelings of dating that his cousins from pechay plants. He graciously anger. Why did you do this to Pangasinan loved to vacation offered to take the sprinkler my son? You know very well with us. I recall that at least two from Auntie Nena and did the how much the plants truly cost, of his cousins had found their watering himself. but you offered so little. lifetime partners after vacation- To cut the story short, Moreover, he is underage. You ing with us. Auntie Nena began to react should have acted the better. One late afternoon, a teacher positively to Mr Tukay’s visits. You should have been fair to a in town must have heard about Finally, she could not refuse his lad, who is too young to the presence of Auntie Nena, a proposal to take her to be his understand matters on money. teen-ager. Modestly, he came to lifetime partner. During How embarrassed I was visit in the pretext of inspecting the reception following the when Nana Itang returned the my garden. He did not even wedding ceremony, Auntie pechay leaves to us, and five converse with Auntie Nena. Nena came to me and hugged nickels thrown back to her lap. However, after he had left, I me. Even worse, I felt guilty for teasingly said to her Auntie, I Thank you, Uling! for doing something without sense he came to see you rather raising pechay successfully , she consulting my Mom. than my garden . said, her active dimples Second: Lesson on Her beautiful dimples tickling my cheeks. And she did Generosity and Love. My deepening, she simply shrugged not have to explain why. I schooling was interrupted by a her shoulders. He is too understood then that it was strange illness, characterized by old for me! she said, giggling. the pechay that finally won her excruciating pain in my knee During the next visit, the heart to admire the generous joints and lower back. This took teacher (Mr Antonio Tukay, I heart and loving hands of the place at the close of a com- later found out, was his name), giver of the pechay seeds — Mr mencement exercise in the came to my plot directly. Tukay, now an uncle to me. elementary grades in Artacho, Here is an envelop of pechay Disciplining with Love. Sison, Pangasinan. I spent the seeds ,” he offered with a smile. You might not believe this. But succeeding year in Bone, the Plant these seeds in a seedling it is true as night follows day. largest barrio of the box and when the seedlings During the third year of World municipality of Aritao, Nueva have grown about an inch high, War II, I was persuaded and Vizcaya. transplant them into your assigned by the late Mr Pablo Providentially, I came across garden plot . I was once more Poblete who was then the a book in Dad’s room — reminded of my prize-winning Northern Luzon Mission Ministry of Healing by E G garden plot of pechay when I Director of Education, to teach White. I had the luxury of time was a first-grader in Santa grades one to four in an isolated to read it through more than Maria Barrio School. I believed church school in Lantap, the once, and soon became I still knew the art of growing largest barrio of Bagabag, convinced to adopt vegetarian- the best pechay in the area. Nueva Vizcaya. nism. It was a pleasure watching I had never taken up a After six months of bed rest the transplanted seedlings grow. subject on the art of teaching. and meatless diet, my joints And Auntie Nena herself Fortunately, Mr Tukay, Auntie gradually and steadily stopped wondered and became proud Nena’s husband, was then aching. I started making a few about the beautiful garden plots principal of the Bagabag steps in the house, then out on that made our backyard the best Elementary School, only three the yard. Not long after, I began in the barrio. kilometers away. I had time to scaling the hill by the provincial Meanwhile, the school consult with him about text- road. In a month, I was strong teacher, Mr Tukay, continued books and even to observe a enough to do some gardening. faithfully visiting. And one ECTOPIC MURMURS March 2013 Volume 24 Number 3 page 9 couple of his teachers in their Next to his plot was that of whipped him in the presence of respective classrooms. Uncle Isidro’s. His plants were other classmates. This helped Tukay was gracious enough exuberant, and I praised him him regain his self-esteem. And to loan me much needed books. in the hearing Isaias, hoping soon he began to excel again in More significantly, my that the latter would be his class and finally raised the memories of gardening while in encouraged. A couple of weeks best pechay in the school Santa Maria and also in Bone later, Isidro came to my table, garden. seemed so fresh still to me. complaining that someone had Conclusion: These three Naturally and accordingly, I not stolen a few of his plants, experiences in gardening with only encouraged but actually replacing them with smaller pechay plants have taught me required that all the boys ones. I rushed to the garden to important lessons in life: engage in gardening. To further investigate. I noticed readily First: Be fair. Do not take stimulate them, I offered that there were plants on Isaias’ advantage of others’ weakness handsome prizes. plot that were wilting. It or lack of knowledge At this time, I boarded with was evident that these had been Second: A display of love the Pagaduan family, and was transferred from someone else’s can do wonders. The envelope assigned a spacious room. plot. of pechay seeds opened the Isaias, the only son of Mr and Why did you do this? I said heart of my Auntie Nena to Mrs Pagaduan, was one of my in a scolding voice. No reply accept Mr Tukay’s proposal for pupils in the second grade. He from the boy who now bowed marriage. Love, like pechay was a quiet boy, who seldom his head in shame! Then I plants, needs daily attention and would smile, even when proceeded to spank him three care. classmates joked with him. times, in the presence of other Third: Discipline must be I gave a few tips to the boys boys. But Isaias appeared done in love: it should be done on how to plant pechay untouched; no tears rolled down privately. More importantly, a profitably. I even helped his cheeks. timely and sincere apology can in preparing the seedbeds and, When I returned home from serve as a healing balm. later, in planting the tiny black school, I conveyed the incident pechay seeds. Within four days, to his Dad, who had all the the seeds wonderfully sprouted. while been so kind and accom- Ten days later, the seedlings modating, even helping me SEQUESTRATION were ready for distribution to plant oranges on the adjacent continued from page 2 the pupils, who would plant property which I had purchased years, with $11 million to be cut them in their respective plots. at his suggestion. As expected in 2013. This Each endeavored to do as I of a normal father, Mr is a 2% cut to had instructed. Apparently, the Pagaduan felt sad that his boy physicians prizes for the best three had acted mischievously. and clinicians gardeners rang out in their Nonetheless, the family (estimated at minds. One afternoon while continued to serve my needs $4.9 billion) inspecting the garden plots faithfully. Fresh vegetables and and 2% to behind the school/church fruit from his farm graced our CESAR D hospitals building, I noticed that Isaias’ dining table and my clothes CANDARI MD (estimated at plants were not thriving as were laundered clean and $5.6 billion) luxuriantly as those of the other punctually. and will lead to 496,000 jobs boys’. As the days moved on, I being eliminated in 2013 and a Isaias , I admonished, I want noticed that Isaias began to loss of 766,000 jobs by 2021, as you to win one of the prizes. falter in his class work. I began stated below. You must cultivate and water to feel guilty for having Even before the it started, your plants regularly. spanked him in public. statements gathered from Finally, I had to talk to Isaias analysis of the impact of alone, apologizing for having sequestration to medical care are hereby summarized taken factors cited were Medicare/ value for the community. from The Negative Employment Medicaid/ government Hospitals rank second only to Impacts of the Medicare Cuts in regulations , reimbursement restaurants as the top source of the Budget Control Act of 2011 , issues and uncertainty/ changes private sector jobs. by Tripp Umbach (see chart of health reform . Apparently, sequestration below). It is stated that physicians would not affect Medicaid, the Large scheduled budget would not escape the effects, as joint federal-state health reductions in Medicare are nearly 62,000 jobs would program for the poor. There projected to harm not only disappear from or fail to will be reductions in payments physician practices and materialize at doctors' offices to hospitals, physicians and hospitals, but also other and other health professionals' other care providers, including employers more indirectly tied offices through 2021. Medicare Advantage plans and to the health care industry. It is undeniable that office- the companies running the Research sponsored by the based physicians continue to Medicare Part D plans. American Hospital Association play a vital role in the economy. According to Dr Gary Wiltz, projected a total of 766,000 job Doctor’s practices supported the chairman-elect of the board losses through 2021 stemming about 4 million jobs in 2009, of the National Association of from the Medicare budget and today, the indirect and Community Health Centers, one contraction of about $120 direct impact of cuts to of the groups facing those cuts, billion over the decade. Medicare would destabilize said the reduced federal funding Sector job losses: physician offices across the will cause the centers to Hospitals 144,006 country. The future of the dramatically curtail services Nursing facilities 63,946 Medicare program is of concern and estimates that as many as Physicians/ offices 61,809 to most physicians. In addition 900,000 patients could be Laboratory 56,527 while these cuts alone will be turned away from care. Many of Home health 39,143 devastating to physician them cannot afford to go Real estate 35,040 practices and patient access to anyplace else . Food services 33,612 care, physicians are also facing A White House summary of Employment 23,498 present and future financial the sequestration’s effects Wholesale trades 12,965 penalties if they do not includes these health-related Health retail stores 11,444 successfully participate in programs: The National Most doctors are now multiple Medicare programs, Institutes of Health would be waiting to see what happens. It including the e-prescribing forced to delay or halt vital has been stated about 90 program, the electronic health scientific projects and make percent of doctors are record meaningful use program, hundreds of fewer research completely uninformed about and the physician quality awards ,’ which means that what the government’s doing. A reporting system, as well as the several thousand personnel lot of them are in this free- value-based modifier. could lose their jobs , the White floating anxiety mode . It has been proven that House said. Twelve thousand Even physicians with no hospitals are the largest scientists and students would be plans for career change are component of the health care impacted because the National worried about the profession for sector and employ more than Science Foundation would offer reasons related to Obamacare. 5.4 million people. Two out of 1,000 fewer research grants and A sweeping survey of 13,575 every three dollars spent on awards. doctors released in September hospital care goes to the wages The Food and Drug by the Physicians Foundation and salaries of caregivers and Administration would be able to found that 77 percent were other workers. do fewer drug approvals and pessimistic about the future of Business analysis stated that conduct 2,100 fewer inspections medicine. The main reason is the goods and services hospitals at domestic and foreign malpractice lawsuits which the and hospital workers purchase facilities that manufacture food president’s law did little to from other businesses create products. The funding cuts address. After that, the top additional jobs and economic could lengthen FDA reviews of ECTOPIC MURMURS March 2013 Volume 24 Number 3 page 11 new drugs and medical devices; Medicaid because it’s cheaper, The problem with the 1962 curtail CDC immunization and and that means lower Golden Jubilarians’ medallion infection control services, and reimbursements for doctors is almost resolved. For some delay research funding and because Medicaid is such a reason, the wording Medicine potentially slowdown ongoing poor reimburser. At the same Class 62 was omitted from the medical research. time that we’re increasing the bottom of the medallions and Cuts to the Mental Health need for more doctors, we’re about 20 Jubilarians returned Block Grant program would decreasing the incentives that theirs for engraving. mean that 373,000 adults and would normally attract people I brought them with me, children would not receive to the medical profession . about 12 and the other three mental health services. In my view sequestration’s given to Dr Hernani Tansuche This cut would likely lead to impact have a far- reaching to be relayed to the Michigan increased hospitalizations, consequences in the field of alumni. involvement in the criminal medicine. This is not good for We are still waiting for the justice system and homelessness the country, for the patients and rest from Dean Remy Habacon. for these individuals , according medical providers. I feel this is Now Class 62 needs about 20 to the White House document. a significant hack to health care, more and we have requested the Cuts to the AIDS drug which saves American lives and same from our Dean. Hopefully assistance program could result puts Americans to work. There it will also be available to the in 7,400 fewer patients having is no doubt that the impact of Class 62 . access to HIV medications, and cuts to hospital care would have I have requested for the the Centers for Disease Control ripple effects throughout our updated version of the MOA and Prevention could conduct nation’s economy. (memorandum of Agreement) approximately 424,000 fewer from Dr Rene Mendoza, but up HIV tests. to this writing, no MOA. This The Indian Health Service was the problem that I have and tribal hospitals and clinics MEET US IN previously mentioned in my would also be hit by President’s report. sequestration, with 3,000 fewer LAS VEGAS Dr Cesar V Reyes came up inpatient admissions and continued from page 1 with the printed invitation, 804,000 fewer outpatient visits, only negative comment in the CME brochure and registration according to the White House press is his form. I wish to acknowledge the analysis . young age. same and acknowledge him for It has been stated by pundits But as the good job. as many as 32 million people some of our We will again send the are expected to be added to the priests had information after the Spring Las health care system as a result of asserted, we Vegas meeting. Obamacare, half of those as a really do not We hope everybody got NOLI C result of the expansion of GUINIGUNDO MD know. opened their e-mail that contain Medicaid. Many doctors already If it is the reunion program, invitation, refuse to accept Medicaid God’s will then he can become and registration form. patients because the one. Until then, I hope we will government reimbursements for We are praying that he have a new Pope when the next services rendered are well becomes the next Pope. issue of the ECTOPIC below the market rates. It is a He has a lot of years ahead MURMURS is released. fact that doctors are concerned of him and with God’s will he I hope to see you all in Las about economic incentives. probably will be one of the Vegas, and later in Chicago. What has been stated is this: A longest-serving great Popes in God bless us. lot of people are going to leave the history of Papacy. NOLI GUINIGUNDO MD 62 private insurance and go on FEUDNRSMAF President MARCH QUOTE Tax collectors and sinners him. His son said to him, FEUDNRSMAF were all drawing near to listen Father, I have sinned against STUDENT to Jesus, but the Pharisees heaven and against you; I no ACHIEVEMENT and scribes began to longer deserve to be called AWARD complain, saying, This man your son . But his father Do you want to know a little welcomes sinners and eats with ordered his servants, Quickly bit more about the SAA ? them . So to them Jesus bring the finest robe and put it The cost for each SAA is addressed this parable: on him; put a ring on his $50. If you want your award in A man had two sons, and finger and sandals on his feet. perpetuity, it is $1050. the younger son said to his Take the fattened calf and You can label your award in father, ‘Father give me the slaughter it. Then let us your name, or in the name of share of your estate that should celebrate with a feast, because the person you wish to honor. come to me’. this son of mine was dead, and This is a challenge for you to So the father divided the has come to life again; he was channel the extra dollars of your property between them. After lost, and has been found . donation/ charity budget to a few days, the younger son Then the celebration recognize an honor-roll needy collected all his belongings began. Now the older son had student or two at the FEU- and set off to a distant been out in the field and, on NRMF medical school. country where he squandered his way back, as he neared the Your donation(s) are tax- his inheritance on a life of house, he heard the sound of deductible. Please make your dissipation. When he had music and dancing. He called check payable to freely spent everything, a one of the servants and asked FEUDNRSM Alumni severe famine struck that what this might mean. The Foundation . country, and he found himself servant said to him, Your Your donation this year will in dire need. So he hired brother has returned and your be awarded during the Student himself out to one of the local father has slaughtered the Recognition of the 2014 Balik - citizens who sent him to his fattened calf because he has FEU in mid-January at the farm to tend the swine. And him back safe and sound . He FEU-NRMF in West Fairview, he longed to eat his fill of the became angry, and when he Quezon City. pods on which the swine fed, refused to enter the house, his If you wish --- you can also but nobody gave him any. father came out and pleaded distribute your award(s) in Coming to his senses he with him. He said to his father person during the Student thought, How many of my in reply, Look, all these years I Recognition ceremonies at father’s hired workers have served you and not once did I FEU-NRMF! more than enough food to eat, disobey your orders; yet you If interested to set up a SAA but here am I, dying from never gave me even a young or two, please contact: hunger. I shall get up and go goat to feast on with my CESAR V REYES MD to my father and I shall say to friends. But when your son 6530 Dunham Road, him, Father, I have sinned returns who swallowed up your Downers Grove, IL 60516 against heaven and against property with prostitutes, for Phone 815-942-2932 x7565 you .I no longer deserve to be him you slaughter the fattened or [email protected] called your son; treat me as calf . He said to him, My son, In addition, if you are you would treat one of your you are here with me always; interested to establish a hired workers . So he got up everything I have is yours. But Professorial Chair Fund and went back to his father. now we must celebrate and in your name or of someone you While he was still a long way rejoice, because your brother wish to honor, please inquire off, his father caught sight of was dead and has come to life with the above contact person. him, and was filled with again; he was lost and has compassion. He ran to his son, been found . embraced him and kissed Luke 15: 1-3, 11-32 e-learning PATHOLOGY FOR UROLOGISTS: An Educational Program

Welcome to the updated version of pathology for urologists! This program is designed to help urology residents and fellows familiarize themselves with the pathologic features of common urologic entities. This will serve not only as a resource tool for your review but also as a quick reference guide to urologic pathology. This tutorial covers >250 different entities, encompassing pertinent histoanatomic structures to recent innovations and advances in the field. These include among others, newly recognized tumors and terminologies, latest classification schemes, current grading approaches (eg recent WHO grading for urothelial neoplasms, ISUP modified Gleason grading, etc), molecular alterations, and commonly used ancillary diagnostic techniques particularly immunohistochemistry. Main differential diagnoses and their distinguishing features are also presented. There are >650 high-quality images which include gross pictures, histologies, cytologies, special stains, other ancillaries, drawings and illustrations. A self-test is provided at the end for your own assessment. Descriptions are made short and concise (not >1 page per entity) but enough to cover the basics that urologists should know about pathology. The text is bulleted, key terms and messages are bolded or italicized, and some pathology lexicons are clarified. The images have labels in place and can be enlarged for ease of use in your laptops, tablets and even smartphones. Under the auspices of the American Urological Association, this is a free, quick comprehensive easily accessible web-based guide for genitourinary pathology. It is an educational tool designed mainly for urologists, but will also be good for medical students and pathology residents. Printing it in the ECTOPIC MURMURS , FEUMAANI News , INTRINSIC MURMURS and PMAC News , it is hoped it may reach our urologists, surgeons, and pathology colleagues and medical students and residents back home in the Philippines, especially the Far Eastern University, of this easy access free educational material.

The link is http://www.auanet.org/eforms/elearning/pathology/

Click on the table of contents to select the entities. Enjoy! GLADELL P PANER MD Assistant Professor, Pathology and Urology University of Chicago

COMMENTS Editorials, news releases, letters to the editor, column proposal and manuscripts are invited. Email submission, including figures or pictures, is preferred. ECTOPIC MURMURS Deadline for the April 2013 issue April 15, 2013 Please address submissions to [email protected]

FAR EASTERN UNIVERSITY DR NICANOR REYES SCHOOL OF MEDICINE

ALUMNI FOUNDATION

th 34 ANNUAL REUNION

& SCIENTIFIC CONVENTION

HONOREES

58 Class (Emerald Jubilee) Class 63 ()

Class 88 () 68 Class (Sapphire Jubilee) 73 Class () 78 Class (Coral Jubilee) 83 Class (Pearl Jubilee) Class 93 (20th Anniversary)

Class 98 (15th Anniversary) 03 Class (10th Anniversary)

CLINICAL PRACTICE ADVANCES 2013 ACCME accreditation provided by the PHILIPPINE MEDICAL ASSOCIATION in CHICAGO July 17 - 21, 2013 Intercontinental Hotel Magnificient Mile Downtown Chicago 505 N Michigan Avenue, Chicago, IL (800) 948-0424 (312) 944-4100 The link below will allow guest to book, modify and cancel their reservations online. Additionally, guest can book their reservation by calling our Hotel directly at 1-800-628-2112 (312-944-4100 for international callers) and identify themselves as participants of the Far Eastern University room block (or group code CHE). http://goo.gl/QqCHi Please note that your group rate is available until June 26, 2013 . Any reservations requested after this date will be based on availability and at the Hotel's prevailing rate. Please let me know if you wish to receive weekly reports reflecting your current pick up once the registration opens.

PMAC March Meeting Wednesday, March 20, 2013, 6:30 pm Maggiano Oakbrook, Oakbrook IL

Telephone 630-368-0300

QYSMIA Mark Stolar MD Associate Professor of Medicine, Northwestern University Medical School

RSVP to Sharon Elkin 1-877-732-7033 [email protected]

Spouse should be nurses/ office managers. There should be about 50 attending.

Please join the PHILIPPINE MEDICAL ASSOCIATION in CHICAGO PMAC Auxiliary PMAC & Auxiliary Medical Foundation in a fund-raising luncheon to benefit the medical surgical missions to the Philippines and in live OLIVER , one of the classics of all time, based on the Charles Dickens novel. Wednesday, April 24, 2013, at 11:30 am, show at 1:30 pm Drury Lane Oakbrook Terrace 100 Drury Lane Oakbrook Terrace, IL 60181 (630) 530-8300 Limited Tickets - $65 Choice of entree: roast sirloin, baked salmon, or chicken marsala Please RSVP by April 20 , 2013, with Marylyn A. Lopez [email protected] 815.355.5511 Clarita Mangubat [email protected] 847.963.040 Nancy Castro [email protected] 815.954.0094 Salvy Marino [email protected] 630.827.9471 OLIVER! One of the most beloved classics of all time, OLIVER! is the wildly successful British musical based on the Charles Dickens novel. After a successful opening run in the West End in 1960, OLIVER! has brought Dickens’ ageless characters to life, enjoying numerous critically acclaimed runs and revivals in the United States and England. Audiences will follow orphan Oliver Twist as he embarks on a life-threatening adventure through the dismal streets of nineteenth-century England. The sensational score includes Food Glorious Food, Consider Yourself, You’ve Got to Pick-a-Pocket or Two, I’d Do Anything, As Long As He Needs Me and many more.

FAR EASTERN UNIVERSITY

Medical Alumni Association in Northern Illinois

Fundraising Raffle * Drawing will be held on May 4, 2013 * Hilton Rosemont/ Chicago O’Hare First prize: 25% of total sales Second – fourth prizes: 25% of the total sales divi ded into three

Proceeds to benefit medical surgical mission to Cavite, Philippines, and project education for street children

Only 2,000 tickets will be sold. Need not be present to win. $10 per ticket $50 per six tickets

MACCHU PICCHU Tour/ CME October 4 - 11, 2013 Itinerary: Lima, Cusco, Sacred Valley, Machu Picchu, Lake Titicaca, and

a special added Golapagos Island tour Total trip cost per person, including international flights $2194 Not included in the price are Cusco city tour $75 per person Meals not specified in the itinerary (additional 3 lunches and 3 dinners $125 Tips Survival Travel Kit for guidance) For further information, please call NIDA BLANKAS HERNAEZ MD at 847-668-7385 or email [email protected]