Re-structuring

This pandemic has disrupted our daily routine -- both in a good and bad way. For us in the residency training, it somehow slowed things down. It lifted the daily pressure of complying with residency activities and focusing only on seeing patients which is a major breather for a short while until the hypo-productivity is dragging us all down. 

I live in routines, and a slight detour of my daily activities would be difficult for me to regain the momentum. Before the pandemic, I had so little time to sleep having to wake up very early in the morning so as not to be caught in traffic and doing my home readings late at night. I was used to that albeit complaining of this unlivable metro condition. This lockdown gave me so much time that I spent most of it having extra time sleeping because I no longer worry for the traffic. 

I feel like I've wasted my two months, except for the priceless time I spent with my daughter, Amal. Other than chief-resident's stuff, I've indulged way too much Netflix, which seems to be a bad habit now (oh, please watch Ertugrul, Hospital Playlist and Reply 1988 if you haven't yet. CLOY? I'm done with that too).

Ramadhan has passed, Alhamdulillah, I feel very spiritually productive though. I only missed very few tarawih nights and finished 8/10 tahajjud prayers. It's better compared to my performance in the previous years. May Allah accept our good deeds. 

As GCQ comes to a close, I need to re-structure my daily life. There is so much that needed to be done and I am not moving any finger to finish my tasks. Subhanallah. My research is still hanging and I need to be done with it so I can finish residency and fly to Jeddah as soon as possible. There is no getting used to this LDR thing. I don't want to miss my kids' growing up years. 

I reckon this covid virus will still linger but we are slowly transitioning back to our normal lives. Although it will never be the same again. If you really think about it, this pandemic is a major game changer and you know that somehow, it brings blessings. It changed the way how we lived and yet, it made us realize what is really important in this world.

What are your realizations? 

Living In Times of COVID

It was late 2019 when the novel coronavirus broke out in Wuhan, China. The viral infection manifests with flu-like symptoms of cough, fever, colds and sore throat. These are common symptoms usually ignored and resolve spontaneously. It has a minimal fatality rate but according to statistics, elderly patients and those with co-morbidities such as hypertension and diabetes present with severe manifestations.  There's no enough study yet to prove that drugs (hydroxychloroquine + azithromycin, oseltamivir) can bring cure, but more researches are being developed. Nobody thought that like the Chinese, the virus that is unknown to the medical experts would spread all over the globe, and no cure has been identified yet. 

It has been a month since Metro Manila and some parts of the country (as well as most countries all over the world) is in lockdown. Only frontliners --- healthcare workers, policemen, supermarket staff --- are allowed to go out. This posed a huge problem especially to the daily wage earners which constitutes a major bulk of the metro dwellers. Most people have lost income, largely those in the business sector, posing a domino effect on the nation's economy.

Almost empty Taft Avenue crossing Finance Road.

The virus held a tight grip to the entire world, it crippled the world economy and rendered people immobile in the safety of their homes, if they're lucky to have one. This has never occurred to the greedy beasts in the business industry, they thought nobody can stop them from gaining profits. This crisis has shown us small to large scale leadership. It has shown us who are the true leaders in the workplace, community and the nation as a whole.

Empty Rizal Park

5th week of lockdown

How's life for healthworkers like us?

Family Medicine female residents wearing a donated PPE from Quorom, a female lawyers' sorority group. 

PUI tent

My co-resident, Jhem.

Checked on Jhem at the triage.

We continue to work in spite of the risk and the anxiety of being infected. The chronic loopholes of the nation's public health is out in the open for scrutiny. I think it's too late to criticize, what we can do is to cooperate with the nation's leaders. I hope this government sees the importance of public health and gives value to it.

I know it will never be the same after this pandemic, people have lost their loved ones while some lost their jobs, I can only be grateful that I am one of those who only want this to be over so I can return to the normal daily grind of my residency training.

Right now, I enjoy the sweet calmness reigning all over the metro. I never thought I would hear the noisy streets in complete silence while I drive to almost-empty roads in Manila. It's a sad sight though seeing the homeless street dwellers, the only ones left on the streets begging food for daily survival.

 

I want our lives to return to normal again. I want to bring my baby out so we can enjoy the outdoors again --- the malls and her daycare. If there's one thing I realize, is how I lack time for my baby Amal. She's more than a year old but I haven't really seen her grow. I spend more time at work, coming home to a sleeping baby most of the time. InshaaAllah, after all these, I will spend more time with her especially during weekends, the way I was with her two older sisters.

In these trying times, we can only cling to our faith. Allah (subhaana wa ta'ala) has sent us an unseen enemy. He has shown us a sign of His might --- that He alone can stop the world, that He can topple the most powerful nation, the most powerful human being can fall into His mercy.

That Thing Called GDM

The individual uniqueness of every child, starts with a unique pregnancy. I must say that all my 3 pregnancies went smooth. I never had morning sickness or episodes of severe vomiting. Yes, I'm blessed that way. The only thing I was battling was increased daytime sleepiness which is a major struggle for a resident doctor (and a mom, too) like me who is expected to be awake and active 24/7. But, there's a peculiarity in every pregnancy. My 1st one was totally unremarkable while I had UTI and fetal malpresentation with my 2nd pregnancy that I ended up undergoing elective cesarean section. This time, guess what I do have? At 24 weeks, I was diagnosed to have Gestational Diabetes Mellitus (GDM) which imposes a lot of risks for me and the baby! What is GDM and how did I unexpectedly acquired it?

Gestational diabetes is a form of diabetes that is developed during pregnancy. It is usually diagnosed at 24-28 weeks AOG after a 2-hour 75-g oral glucose tolerance test. You can read more about it here, but the gist is, GDM occurs because "the placenta, which connects your baby to your blood supply, produces high levels of various other hormones. Almost all of them impair the action of insulin in your cells, raising your blood sugar."

Meaning, there is insulin resistance so a little intake of sweets from all forms raise the blood sugar immediately in multiple folds. Prolonged exposure to high sugar level poses risks for both mother and child. The mother will have a 7x risk of developing overt diabetes after pregnancy and a chance to develop GDM in the succeeding pregnancies. The child on the other hand will be macrosomic (large for gestational age) which is a risk for preterm birth, difficult vaginal delivery and cesarean section. Upon delivery of the baby, he will also have hypoglycemia which may have detrimental effects. It's scary to have GDM, right????

I really thought I will NEVER have the diseases since NONE of my family members on both sides of my family has it. Yes, my family is a bunch of hypertensives but gladly, non-diabetics. So how did I get it? I'll enumerate the risk factors for you, which means, if you have any of the following, you have a chance to acquire gestational diabetes too! Here goes:

• Prior GDM
• Glucosuria (you'll know when you have your urine checked, aka urinalysis)
• Family history or first-degree relative with Type 2 Diabetes Mellitus
• Polycystic Ovary Syndrome (PCOS)
• Age >25 (this is one of the culprits!)
• Overweight or obesity (and this one, too!)
• Macrosomia in previous or current pregnancy (defined as baby born >8 lbs.)
• Polyhydramnios in current pregnancy (your OB will suspect if you have extraordinarily huge preggy belly and confirmed through an ultrasound scan)

From the list above, I only have two risk factors, one is modifiable and the other is non-modifiable. I cannot do anything with my age, I just turned 33 last month and I am nothing but grateful to have reached this age. The downside of ageing is that everything in the body goes downhill once you do not practice a healthy lifestyle---hence, I am overweight by more than 10kg. I eat a lot. As in, a lot. I do not exercise (excuse: residency!) and I am in a department where there is a daily feeding program. Lol! I know what we do is a major contradiction to what we tell our patients but we're all ranging from overweight to being obese here. Pharma companies love feeding us so as our consultants. We do not run out of food, all sort of sinful food, on the table. My biggest sin is indulging. I indulged. A lot. And now I am facing the consequence. 

When I saw the result of my OGTT, dang! It hit me. All the milk teas I drank and all the chocolates I ate came back to me in a flash. They're the sweet villains to my growing bump! They lured me into the depth of destruction! Ugh. 

My OB advised me to see an endocrinologist but that would take me time. Thanks to my Endo  Fellow friend, Racquel Bruno (Iligan peeps, abangan niyo siya once she starts her practice there, she'll be the BEST Endo in town!) who's just a private message away. She put me under a tight diet---no white rice, no white breads, strictly NO cakes, ice creams, milk tea, biscuits and ALL sort of sweets. Huhu. How do you think I will live without RICE and BREAD? They're my LIFE! 

The most painful part is monitoring my capillary blood glucose (CBG) twice a day (pre-meal must be <94 mg/dl and 1-hour post-meal must be <140 mg/dl). Physically and financially painful. Glucometer is quite costly and so are the glucose strips! 

Glucometer.

How do I cope up with this? My motivation to force myself into following a low carbs, low sugar diet is my plan of undergoing a normal delivery and of course, for my baby. Aaaand I DO NOT WANT TO INJECT INSULIN ON MY BODY! (Insulin is the only medication for GDM, according to guidelines) So I shifted to eating brown rice and cutting my rice intake to 1/2 half cup a day. Yes, a day. No more breads too. I researched on the different kinds of food with low glycemic index which brought me to this meal plan:

• Breakfast: 1-2 pcs of boiled saba banana and 1 cup of milk (boiled banana is being sold outside the hospital), sometimes I opt to eat yellow corn for a change.
• Lunch: 1/2 cup brown rice and any viand available (I'm on brown rice for two months now and I'm loving it!). Fruits for dessert, usually banana or apple. 
• Dinner: salad or a piece of fruit and lots of water. 
• Snacks: peanuts or any nuts, and/or fruits

To be honest, I am inclined to eating healthy naman talaga, it's not as if eating more veggies and fruits are new to me. It's just that I got swayed to eating more of the non-healthy side and I indulged for quite some time (culprit: Family Medicine Department). Alhamdulillah I got back on track. I lost 3 kg on my first 3 weeks of dieting which, according to my OB, is okay since my baseline weight is overweight. Ouch. Lol! Also, I really feel much better now that I am eating healthy again.  

Having GDM reminds me that, one, I AM NOT EFFING INVINCIBLE! I may be a doctor and I know how to prevent the diseases and treat them, but temptations are always lurking around. We are human beings too and we are not exempted from any kind of diseases. Ironically, we, doctors, are among the most unhealthiest of people. We do not exercise, we do not eat healthy and we do not rest/sleep well. Second, having no family member who has diabetes does not mean I will not have it too. Diabetes Mellitus is not mainly hereditary, it can be acquired too, same with the rest of non-communicable diseases we are seeing such as hypertension and the metabolic syndrome. These diseases are siblings and they're born to an unhealthy lifestyle. #lamonpamore Third, I need to seriously think of my health now if I want to live longer for my kids. I don't want to be under maintenance medications in the future so I need to keep my body in top shape. 

Grabbed from the internet

Now if you're pregnant and reading this, THINK A MILLION TIMES before you get that slice of cupcake into your mouth. Wait for a few months before you indulge in milk tea and your favorite donuts. Those chocolate bars and chocolate cakes? They can wait in the fridge! 

I'll be giving birth in few weeks, in shaa Allah, and I have already talked to the husband to have a box of J. Co donuts and Gong Cha Milk Tea Cream Cheese with pearls right when I get wheeled out of the delivery room. Don't I deserve such sweet treats after months of deprivation? But I promise to cut down on sweets after delivery for my own sake. 

How's my sugar doing so far? Well, I got used to the routine of CBG monitoring showing that my sugar level is controlled. Alhamdulillah. I had my third trimester scan yesterday and the baby is appropriate for her gestational age and I have an adequate amniotic fluid. In other words, the baby is healthy, in shaa Allah. Please pray for me, guys, as I am determined to push myself for a VBAC (vaginal birth after cesarean section)! We can do this, baby! Bismillahir rahmaanir raheem.