“I do not smoke…” in this week’s issue of the MANILA MAIL (May 27-June 2, 2015; page A5)

Pilipinasblitz Forever
A column by Bles Carmona
For the week of May 27-June 2, 2015

I do not smoke…

Precisely because once upon a time, I did.

That’s how I started my first prize-winning essay for the Blue Collar Magazine in the early 1990s. In that essay, I did a bit of everything: related some personal experiences, spouted some statistics on how smoking adversely affects health, and added touches of humor. If you’d have read that essay, you would have thought: Here’s someone who quit smoking and lived to tell the tale. Good for her!

The truth of the matter is that from the time I started smoking at age 16 until I quit for good on New Year’s Day 2015, I have not quit only once. So you can say that my winning piece for that contest was good only for that year. The subsequent years had brought their own stressors and with these, the urge to smoke. I have attempted to quit smoking – and then relapsed- more than a handful of times. So why are we talking about this “yosi kadiri” (disgusting cigarette) topic?

Visiting our go-to website du jour for all things holiday, http://www.holidayinsights.com, I found out that May 31 is actually “World No Tobacco Day.” It’s pretty obvious about what this holiday is about, right? In the home country, there used to be a “Just say No to drugs” campaign and I’ve always wondered why there wasn’t a similar push against smoking, like a “Just say No to tobacco” kind of thing. Oh, of course I remember when the late Senator Juan Flavier, M.D. was still the Secretary of the Department of Health and one of the flagship campaigns of his administration was the “Yosi Kadiri” media promo. Not that my younger self would have been affected by any kind of anti-smoking propaganda, thinking myself above the fray and invincible, silently hoping that others would honor my “right” to smoke.

In 1988, the World Health Organization passed Resolution WHA42.19, calling for the celebration of World No Tobacco Day every year on May 31, and therefore World No Tobacco Day is always celebrated on that date. World No Tobacco Day is supported by medical organizations around the world. Many groups and organizations use this day to encourage individuals to quit smoking. They promote education of the issues and dangers of using all forms of tobacco, smoked or chewed, for example. Globally, this awareness campaign emphasizes the many health complications due to smoking, like chronic obstructive pulmonary disease (COPD), cancer, and blindness, to name a few. Let’s also not gloss over the fact that the nicotine in cigarettes is as addictive as the active ingredient in the more dangerous drugs we know like heroin or cocaine – and that is why it’s so hard to kick the habit. Yes, there is such a thing as a nicotine addiction.

There are many faces of tobacco use. My own grandfather, Lolo Johnny, developed emphysema toward the end of his life because of smoking. Emphysema is a disease that renders air sacs in the lung inelastic, preventing them from expanding and contracting like they usually do. This makes it difficult if not impossible to breathe – http://betobaccofree.hhs.gov/. He passed away from the complications of this punishing illness. Mang Nilo is a heavy smoker and you know what? His wife Aling Marta died due to the secondhand smoke. He’s still up and about, but I don’t know that he may be harboring regrets about losing his partner due to his smoking habit. On the other hand, Lolay, the grandma of my grand-aunt Lola Ester, used to smoke aromatic cigars with the lighted end inside the mouth, and she never developed oral cancer or anything else! She lived a full life until her mid-90s. However, don’t be fooled by this last example. Cigarettes definitely cause more harm than good. You do know that the former Surgeon General Dr. C. Everett Koop reported in 1988 on the addictiveness of nicotine, smoking-related illnesses, and the health consequences of involuntary exposure to tobacco smoke. During his tenure, smoking rates declined significantly and he was envisioning a smoke-free USA by year 2000. Dr. Koop passed away in 2013 but he did make inroads on how we as a nation view the ill effects of tobacco. So let’s say no to tobacco on World No Tobacco Day.

Here’s an example of a Quit Plan. Please note that the copyright of this form belongs to The Permanente Medical Group Inc., and it was developed by TPMG’s Regional Health Education (RHE).This was the form I used when I planned to quit smoking on April 22, 2014. Like I told you earlier, I eventually relapsed after a couple of months. I tried to quit again on January 1, 2015, and this time it stuck. I’ve been completely tobacco-free for five months now!
QUIT PLAN: I am ready to quit smoking
1. My quit date is _____/ _____/ _____
2. Motivations: “I am quitting because…” (give at least 3 reasons)
3. Preparation activities: “I will prepare to quit by…” (check all that apply)
o Getting rid of all smoking items
o Practicing not smoking during certain hours of the day and night
o Cutting back on the number of cigarettes I smoke to _____ per _____
o Not allowing smoking in my home
o Learning or practicing more methods of relaxation
4. Support and Resources: “I will ask support from…”
5. Triggers and Coping Strategies: “ I will cope with urges to smoke by…” (answer in terms of each trigger and what you’ll do instead of smoking)
6. Reward: “I will reward myself for quitting by…”
(Signature and date)

Otherwise, here’s what else we’re celebrating: Emergency Medical Services Week during the fourth week of May. This could be where we’d end up if we don’t give up our smoking habit. While we’re glad that there are fully-staffed emergency rooms to which we can go in times of severe distress of any type (“If you think you have a medical or psychiatric emergency, dial 911 or go to the nearest hospital…”), I believe that we should also spend equal time thinking about and implementing preventive health measures so that we don’t end up in the ER quite often. Benjamin Franklin was the one who reportedly said the eternal adage: an ounce of prevention is better than a pound of cure. So sue me for not being original but there’s really something to be said for preventing disease from happening in the first place. #

Find advisor Blesilda44 at KEEN.com, 1-800-ASK-KEEN (1-800-275-5336), extension 05226567 either by phone or chat: Mon-Fri 7-10 pm, Sat-Sun 7-11 pm Pacific. I speak English, Tagalog, and some Spanish. For personal readings (fee required), email me here: blessingsandlight725@gmail.com

“Are you feeling your age?” in this week’s issue of the MANILA MAIL (March 4-10, 2015; page A7)

Pilipinasblitz Forever
A column by Bles Carmona
For the week of March 4-10, 2015

ARE YOU FEELING YOUR AGE?

Upon the intersection of my current reading fare (Dr. Atul Gawande’s “Being Mortal”), the upcoming exact Uranus-Pluto square on March 16, and my recent high blood pressure and high blood sugar indicators, my answer is yes, I am indeed feeling my age.

Where does youthfulness end and decrepitude begin? Is there a defined divide where one day you’re feeling wonderful in the peak of health and the next day you all of a sudden become violently ill? (I’ve known of cases like these.)

Are we even aware that with each birthday we celebrate, we are also one year closer to the inevitable, whether that means some sort of bodily or mental breakdown or death? You know, I have to admit that I was operating on a plane of denial about my physical health. I mean, of course, I’m very vigilant about my mental health, regularly checking in with myself for signs and symptoms of my bipolar disorder. I am diligent about reporting even the slightest mood and behavior changes to my psychiatrist. However, when it comes to my physical diagnoses, diabetes and hypertension, I admit that I have been less than careful.

As my readers with diabetes know, this condition is managed by diet, exercise, and maintaining a healthy weight. If those are not enough, then we get prescribed diabetic medications and insulin. Somewhere between being told that I have adult-onset diabetes 15 years ago and now, I have been in denial about following the advice, warnings, and injunctions about my illness. I was 30 years old then, and the complications being described to me – heart attacks, eye problems, nerve and kidney damage, among others – seemed so far removed from my apparently “healthy” life.

Another facet of my denial came from my hypertension. I have not been that diligent in getting my blood pressure checked throughout the years, although every time I went to my doctor in the past, my blood pressure (BP) was always within normal limits. That’s a minor miracle, actually, because I used to smoke a lot apart from generally not leading a healthy lifestyle. This year, though, just when I’ve quit smoking since New Year’s Day, it’s ironic that my blood pressure chooses this time to shoot up and give me a scare.
Therefore, I am making it my intention to set my health straight this year. Lose the weight, modify the diet, step up on the exercise, and take my meds and insulin. Help myself as much as I help others. It appears that what I have here is an imbalance between giving and receiving: I need to receive healing as much as I give healing. However, my mentor taught me that it’s not actually we who are doing the healing but we just prime a person for healing to occur in her. The thing I have to remember is that the body and mind have the capacity to heal themselves. If we help them along by consciously doing the “right things” (diet, exercise, etc.), then the body and mind respond accordingly, generally speaking. It’s a bodymind intuition sort of thing.

Of course, what we cannot afford to remove from this equation is your personal practice of spirituality. Whatever you call your Supreme Being, it should be a part of your outreach and outpouring of thanks. (Astrologer Rob Brezsny calls God “the Divine Wow.”) I have not finished reading “Being Mortal” by Atul Gawande, but I promise to report on it once I do. That book describes what’s being done in the field of geriatrics and about the phenomenon of aging. I am excited to read the rest of the book.

Meanwhile, back to the subject of feeling our age. Truth be told, I’m turning 45 this coming April 4. On the face of it, I have no problem admitting my age and all that. I’m even proud to say my age, as if it were a badge of honor, and it is, if we equate it with wisdom gained over the years. Now I’m forced to admit that my other types of wisdom may have far outpaced my basic bodily wisdom, in which my bodymind intuition should have known better and steered me toward healthier choices in life. I need to feel more grounded and am seeking ways to do that. But now, with intimations of mortality staring me in the face, metabolic syndrome, frazzled nerves and all that, I’ve come all of a sudden to feel my age.

We may age, our loved ones may age, the world may age, but the All-Powerful is timeless and mighty. In our relationship with the Divine, we must never forget to express our gratitude for each day that we still wake up and feel relatively healthy.

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blessingsandlight725@gmail.com

“CARING FOR YOUR LOVED ONE WITH A MENTAL ILLNESS THIS HOLIDAY SEASON” in this week’s issue of the MANILA MAIL, page A7) www.ManilaMailNewspaper.com

Pilipinasblitz Forever
A column by Bles Carmona
For the week of Dec. 10-16, 2014
CARING FOR YOUR LOVED ONE WITH A MENTAL ILLNESS THIS HOLIDAY SEASON
Early this year, I was browsing through the offerings of The Book Shop in Hayward, my favorite local bookstore, and came across a precious resource that I promptly snapped up. It’s a book called “When Someone You Love Has a Mental Illness: A Handbook for Family, Friends, and Caregivers,” revised and expanded, written by Rebecca Woolis, MFT, a licensed family therapist with more than 20 years of experience in working with people who suffer from mental illness, and with their families. She is in private practice in Berkeley, CA.
I felt that it would be helpful to approach the topic of mental illness and stress during the holiday season from the perspective of the family, caregivers, and friends of someone with a mental illness. Although statistics says that 1 in 5 Americans suffers from some form of mental illness, a happier flipside interpretation of this fact also means that the other 80% of you are free of any psychiatric symptoms. If you belong to the “sane” and “normal” 80%, please count your blessings. Someone like me with bipolar disorder and my 20% group mates would have to contend with the same life challenges like you do but we have a disability which may impact our coping skills in many ways.
Here is an excerpt from Woolis’ book, a quick reference guide (one among many within its pages) and this is “How to behave around people who have a mental illness”:
1. Treat them with respect, even if you do not understand some of the things they do or say.
2. Be as supportive, accepting, and positive as you can.
3. Be calm, clear, direct, and brief in your communication with them.
4. Engage them in casual conversation or activities with which you and they are comfortable.
5. Do not touch them or joke with them unless you know them well and know they are comfortable with such interactions.
6. Do not ask a lot of questions about their lives.
7. Do not give advice unless they request it.
8. Do not discuss in any detail religion, politics, or any other topic that is highly emotional for them, as these topics may be intertwined with delusional thinking. Explain that these are personal or individual issues that you prefer not to discuss.
9. If they behave in ways that are unacceptable to you, calmly tell them specifically what they can and cannot do. (pp. 106-107)
Now the holidays, for some mysterious reasons, seem to either excite or depress people with mental illnesses. Folks are hustling and bustling all around, making party and family reunion preparations, thinking up gift ideas, shopping, planning a vacation, sprucing up the home, and doing a million other things during this season. These could be positive sources of stress that bring out the best in a lot of people, inspiring them to give their all into this festive, joyous time. However, for someone with a mental illness, facing these situations could be daunting, overwhelming, or downright confusing. The result could either be feelings and thoughts of amped-up excitement as they look forward to all the celebrations, or paralyzing depression at the thought of having to go through what in their minds will be a joyless holiday for one reason or the other. Sometimes the anticipation, the very thought of all that has yet to happen, could rob a person of the appreciation for the present moment. Conversely, if this holiday reminds them of a significant event in the past, then they can get sad, agitated, stressed out. Notice here that in both cases, there is an under-appreciation of today. Who was it who said that today is a gift and that’s why it’s called the present? My sentiments exactly. With a measure of mindfulness, we can ditch the guilt about the past or anxiety about the future and just focus on how blessed we are today, right at this present moment. You may say, yeah, easier said than done, to which I will counter, hey, it’s worth a try.
Now here’s what Woolis suggests in her quick reference guide on “Handling the Holidays”: You can help your relative reduce stress by:
1. Discussing plans in advance
2. Acknowledging any mixed feelings he or she may have. Do not make assumptions about how he or she will feel or act.
3. Keeping expectations realistic, especially regarding whether your relative can tolerate a gathering, for how long, and what kind of participation he or she is capable of
4. Respecting and supporting your relative’s choices and decisions regarding whether he or she is comfortable participating and in what way
5. Accepting your and relative’s limits
6. Helping your relative figure out how to handle some of the stress (e.g., how the person might answer questions, what task he or she might like to focus on, how long to stay, places to go to take breaks), if he or she is willing and able to discuss the event and his or her feelings. It may be important to acknowledge all family members’ needs, preferences, and limits before a workable solution can be reached. (pp. 166-167)

Now let’s talk about “Minimizing relapses.” According to Woolis, you must see to it that your loved one with a mental illness has a “therapeutic day-to-day lifestyle” which includes regular exercise, recreational activities, a daily routine, eating a balanced diet, and avoiding the use of alcohol and illegal drugs. Make sure that you can identify the early warning signs of relapse, such as: any marked change in behavior patterns (eating, sleeping, social habits); absent, excessive, or inappropriate emotions and energy; odd or unusual beliefs, thoughts, perceptions; difficulty in carrying out usual activities; impairment in communication; and any idiosyncratic (i.e., unique to the person) behavior that preceded past relapses.

When warning signs do appear, do the following: Notify the doctor and request an evaluation, maybe an increase in medication is indicated; maintain involvement in any ongoing psychiatric treatment program; responsibly decrease any known environmental stressors; minimize any changes in routine; maintain the “therapeutic lifestyle” described above, especially keeping the environment as calm, safe, and predictable as possible; and discuss your observations with your relative, talk about steps he or she might take to prevent another relapse, hospitalization, or incarceration. To minimize the impact of a relapse, it pays to be prepared: Have a crisis plan ready for yourself; keep emergency phone numbers and procedures in a convenient place; know your limits and how you will proceed if they are exceeded; and tell your relative calmly and clearly what your limits are, what they need to do next, and what you will do if those limits are exceeded. In some cases, you may have to call the police.
Be prepared. But also be kind to yourself. Neither you nor your loved one with a mental illness had a choice about your respective roles. However, from this point on, you know that facts and awareness are now being thrust upon you. Ms. Rebecca Woolis, MFT, in her book, “When Someone You Love Has a Mental Illness,” talks about various other topics which are so crucial in your shared difficult journey with your loved one. Her book is a valuable resource to me personally because I get to appreciate how hard it must be for my family and friends to cope when I am undergoing either the delirious hyperactivity of mania or the energy-less stupor of depression. Now through this book, they can be equipped with the tools to deal with me while at the same time protecting themselves by being urged to set limits.
This year marks my second relapse-free year and I am thankful to Spirit for guiding my thoughts, feelings, and behavior. I thank my family and friends for their love, loyalty, and support. I am thankful for my caring, competent, and compassionate psychiatrist, Dr. Gilda Versales, my doctor since early 2009. To all of you, blessings and light! Maraming salamat po sa inyong lahat!
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Find advisor Blesilda44 at KEEN.com, 1-800-ASK-KEEN (1-800-275-5336), extension 05226567 either by phone or chat: Mon-Fri 7-10 pm, Sat-Sun 7-11 pm Pacific. I speak English, Tagalog, and some Spanish. For personal readings (fee required), email me here: blessingsandlight725@gmail.com

“REMEMBERING DR. JUAN M. FLAVIER, DOCTOR TO THE BARRIOS” in this week’s issue of the MANILA MAIL (Nov. 12-18, 2014) (Image courtesy of tumblr.com)

Pilipinasblitz Forever
A column by Bles Carmona
For the week of Nov. 12-18, 2014

REMEMBERING DR. JUAN M. FLAVIER, DOCTOR TO THE BARRIOS

When Dr. Juan Flavier passed away last Oct. 30 at the age of 79, he metaphorically orphaned many a physician and health professional who considered him as their inspiration for serving in the rural areas of the Philippines. Dr. Flavier was an early pioneer of bringing medical service to the far-flung barangays of the country, writing about his experiences with the Philippine Rural Reconstruction Movement (PRRM) in his first book, “Doctor to the Barrios.”

Dr. Juan Martin Flavier (23 June 1935-30 October 2014) was a senator from the Philippines (1995-2007), and before that he served as the Secretary of the Department of Health (DOH) from 1992-1995. Flavier was born in Tondo, Manila then moved to Baguio City where he studied at the Baguio City National High School. He obtained his medical degree from the University of the Philippines Manila-College of Medicine, and his Masters in Public Health from the Bloomberg School of Public Health at Johns Hopkins University in 1969. From 1978 to 1992, he was the president of the International Institute of Rural Reconstruction (IIRR).

In his first non-fiction book, “Doctor to the Barrios,” Dr. Flavier shares his experiences about his medical service to the village folk in the provinces of Nueva Ecija and Cavite, both located in the Luzon island. I read this book on my own when I was still in high school. His subsequent books feature certain individuals in the barrios with whom he has formed friendships, including many humorous anecdotes and “parables,” as well. In the follow-up book, called “My Friends in the Barrios,” here is an excerpt from his foreword:

“When I joined the PRRM, I did so without previous exposure to the barrios. All my earlier life had been spent in cities – Baguio and Manila. So when I began to visit barrios and meet farmers, the experiences were intriguing and fascinating – it was a new world. Their language was poetic and different. Their ways did not conform with many of my own. Their humor and values made strong impressions on me. The strategy of knowing the farmers as a starting point for rural reconstruction made me aware of their humanity.”

President Fidel V. Ramos appointed Dr. Flavier Secretary of the DOH in 1992. Flavier’s sense of humor and upbeat personality helped launch many a department initiative with nationwide impact: Oplan Alis Disease, Oplan Sagip Mata, Kontra Kolera, Yosi Kadiri, Doctors to the Barrios Project, Pusong Pinoy, Stop TB, Family Planning, Araw ng Sangkap Pinoy, and many others. Dr. Flavier resigned from his post in order to run for Senator in 1995, and then again in 2001, becoming the 21st President pro tempore of the Senate of the Philippines. Aside from a perfect attendance record in all Senate sessions, Dr. Flavier authored and sponsored landmark legislations such as the Traditional Medicine Law, the Poverty Alleviation Law, Clean Air Act, Indigenous People’s Rights Act, Anti-Money Laundering Act of 2001, Barangay Micro-Business Enterprise, National Service Training Program for Tertiary Students of 2002, Dangerous Drugs Act of 2002, Plant Variety Protection Act, Philippine Nursing Act of 2002, and the Tobacco Regulation Act. (Wikipedia)

In the Journal of Infectious Diseases (1997;175(Suppl 1):S272-6), Dr. Flavier co-authored a study with Rudolf Tangermann and Maritel Costales titled “Poliomyelitis Eradication and Its Impact on Primary Health Care in the Philippines.” According to this peer-reviewed journal article, “through good routine immunization, the incidence of paralytic polio has decreased to low levels in the Philippines even before the national immunization days (NIDs) were initiated.” Since 1992 and I remember this quite well, there have been NIDs for polio eradication, promoted by Dr. Flavier himself in television ads about the Oplan Sangkap Pinoy. He was able to mobilize not just the health sector in volunteering for these events, but also the government in general, the nonprofit sector, big business, the Boy and Girl Scouts, and even TV and film actors and actresses. The study abstract further says: “National Immunization Days had a direct positive effect on child health through supplementary immunization with oral poliovirus vaccine, measles vaccine, and tetanus toxoid for childbearing-age women, as well as through the distribution of vitamin A.” The bottom line was that with improved surveillance for acute flaccid paralysis (AFP) and virus detection, wild poliovirus has not been isolated since May 1993. In addition to AFP cases, neonatal tetanus and measles are now being reported through the AFP surveillance systems in several regions. This was just one of the many successful health campaigns under Dr. Flavier’s leadership at the DOH. On the DOH website itself, Dr. Flavier is described as “perhaps the most popular Secretary of Health.”

I was still a medical student at the UP College of Medicine when Dr. Flavier was appointed Secretary of the Dept. of Health. At that time, there was an explosion of knowledge about community or grassroots medicine, utilizing modalities of alternative medicine like the use herbs, acupressure/acupuncture, reflexology, ventosa (cupping), and others. I remember being interested in all of those and would have wanted to explore some of them further, but it was not to be. Meanwhile, Dr. Flavier at that time was a ubiquitous presence in the media, promoting one DOH initiative or another, and the common tao can’t help but adore his jolly and positive presence. It was inspiring to see him at work. His charismatic personality endeared him to the masa. Clearly, in this diminutive man (in height only, not in spirit), the masses have found a champion for their health concerns, the personification of the government’s concern for the health and wellbeing of all Filipinos. Because of Dr. Flavier’s can-do and caring attitude, the attitude of most Filipinos became less resistant toward the government’s campaigns for health preventive measures. True, Dr. Flavier did incur the wrath of the Catholic Church hierarchy in the country for promoting the use of condoms and HIV prevention, but even an informal survey of Catholics at that time would reveal that the faithful think that the Church’s stand against artificial contraception was a little bit extreme.

When I was researching for sources for this article, I was dismayed that I cannot get a hold of any of Dr. Flavier’s books. The only hard copy I was able to borrow was his second book, “My Friends in the Barrios” from the Cal State East Bay (CSUEB) library. I tried Amazon and Alibris, wanting to buy his autobiography but it was out of stock. Maybe you and I could request the publishers to reissue Dr. Flavier’s books, especially in the light of his passing. Those books are timeless and I believe that we can all benefit from knowing how it is to serve in the rural communities which comprise at least 70% of our native country. Here are the books authored by Dr. Juan M. Flavier:

1. Doctor to the Barrios, Experiences with the Philippine Reconstruction Movement (1970)
2. My Friends in the Barrios (1974)
3. Back to the Barrios: Balikbaryo (1978)
4. Parables of the Barrio: Vol. I (1988)
5. Parables of the Barrio: Vol. II, Nos. 51-100 (1989)
6. Parables of the Barrio: Vol. III, Nos. 101-150 (1991)
7. Let’s DOH It!: How We Did It (1998)
8. From Barrio to Senado: an Autobiography (2009)

Dr. Juan Flavier’s diplomatic approach to the novel things he learned as a newly minted barrio doctor all those years ago paved the way for those of us who wonder how to mobilize community support for our projects and initiatives. Among the community-oriented lessons I have learned from reading Dr. Flavier’s books are: Start with where they are and what they know. Seek out the authority figures in the community and find out if they would work with you. Do not automatically assume that what you learned in medical school is superior to folk knowledge. Form friendships, be respectful, and be approachable. Simple lessons, sure, but these are the foundations of Dr. Flavier’s success as a barrio doctor and informed his legislation later as a Senator. He leaves behind a legacy of a life simply lived but with maximum impact on the Filipino psyche. His wisdom and humility will be missed.

Rest in peace, Dr. Juan Martin Flavier. You said, “Let’s DOH it!” With your exemplary life, Dr. Flavier, you surely did it and more.

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Find advisor Blesilda44 at KEEN.com, 1-800-ASK-KEEN (1-800-275-5336), extension 05226567 either by phone or chat: Mon-Fri 7-10 pm, Sat-Sun 7-11 pm Pacific. I speak English, Tagalog, and some Spanish. For personal readings, email me here: pilipinasblitz@gmail.com