Friday, March 17, 2017

Familiar informations in Oncology clinic

Here are some of the informations that I learned and became more familiar with in my 3 month working for CIN KPNW Oncology and Hematology Department:

CANCER- a disease where abnormal cells uncontrollably grow and destroy the body.

ONCOLOGY- the study of cancer.

ONCOLOGIST- specialist of cancer

HEMATOLOGY- the study of the blood

HEMATOLOGIST- specialist of blood

METASTASIZE- cancer that spread to other parts of the body.

LOCAL RECURRENCE-  cancer that came back after treatment in the same place

DISTANT RECURRENCE-  cancer that came back after treatment in other part of the body.

CHEMOTHERAPY DRUGS- are used to treat cancer  either one chemo drug or combination with other drugs on treatment.

The WAY chemo treatment is administered to the patient is based on the following:

  • seriousness or stage of the cancer
  • patient choice
  • depends upon the effectiveness of the drug to the patient
ADMINISTRATION of chemo drugs:

  • Orally (oral pill)
  • IV (directly into the vein or intavenously)
                 a) PICC LINE ( Peripherally inserted central catheter) The catheter is placed in a large vein in arm. This remains in place for days or weeks. The dressing needs to be changed once a week.
                 b) PORT A CATH- has opening (septum) under the skin of the chest. Ports are flushed with heparin every 4 weeks when not in used to keep it from clotting. Ports are flushed with salin before, between meds and treatment.

CHEMO is given in CYCLES. Our patients see their Provider every start of their cycle to make sure that they are ready to pursue the next chunk of cycle.

ADJUVANT TREATMENT such as radiotherapy or systemic therapy is generally given after surgery to many types of cancer such as breast cancer, colon cancer, lung cancer, pancreatic cancer and prostate cancer.

PALLIATIVE CARE is prolonging life or reducing the symptoms. It is not curing the cancer but rather controlling the cancer cells to grow or spread.

HOSPICE. Some of our terminally ill patients are being refered here where they can be taken cared of.

HORMONE THERAPY is the use of drugs to prevent hormones from making cancer cells grow.

Our clinic administers ZOMETA, a strengthening bone drug to our patients who have hypercalcemia, osteoporosis and cancer. BISPHOSPHONATE DENTAL CLEARANCE is need before a patient is given zometa.

CT SCAN- images taken to diagnose disease.

DEXA/DEX (Dual X-ray Absorptometry) - scans the bone and measures bone mineral density (BMD). Our bone density decreases after age 35. Bone loss occurs faster to women after menopause.

MUGA (Multigated Acquisition Scan) a test that evaluates the ventricles of the heart. It tells if they are functioning properly.

Since I assist with Dr. Harvey who has a specialty in breast cancer, I am learning a lot about the mentioned disease. Women might choose BREAST RECONSTRUCTION for the following reasons:

  • make chest look balanced specially when wearing a bra or swimsuit
  • regain breast shape
  • so they do not have to use external prosthesis
  • to feel better about how she looks, regain confidence and to be happier with her body.
Reconstructed breast however is not a perfect match or substitute for the natural breast. If the tissue from the other part of your body will be used (tummy, shoulder or buttocks), they will look different after the surgery. Not all reconstructive surgery  is completely successful. The surgery will leave scars on the breast and areas where the tissue for the new breast mound was taken. The reconstructed breasts will not have the same sensation and feeling as the natural breast. the breast or flaps might die after reconstructive surgery or known as necrosis. This delays healing and more surgery is needed to fix it. Reshaping the other breast to match the reconstructive breast might be suggested.


  • PHYSICAL EXAM- 3 to 6 months visit with the Doctor for the first 3 years after first treatment,6-12 months for the next 2 years and then once a year thereafter.
  • GENETIC COUNSELING if you have family history of cancer
  • HORMONAL THERAPY- I learned that as part of the patient's treatment plan, she should continue hormonal therapy as per her oncologist. The purpose is to lower estrogen and progesterone to grow or block them from getting to any remaining cancer cells.
                     anastrazole (ARIMIDEX), exemestane (AROMASIN) and letrozole (FEMARA) are examples of Aromatase inhibitors (ALS) that are used to treat breast cancer in postmenopausal women. This stops the production of estrogen.

                      TAMOXIFEN is effective to both women who are premenopausal or postmenopausal women. Taken for 5  years up to 10 years by premenopausal women. 5 years up to 10 years or switch to an AL for the last 5 years for postmenopausal women.

Thursday, March 16, 2017

Work at Kaiser Permanente

Three months ago, I started working for Kaiser Permanente as an employee. I was assigned to be Dr. Harvey's medical assistant. She is an oncologist, with a specialty of breast cancer. But she also sees other cancer patients like lung cancer, colon cancer etc. I sometimes have the opportunity to work with other Providers when Dr. Harvey has no schedules to see patients. I have assisted Dr. Mansoor, Dr. Barnett and Dr. Boyle who are all Hematologist. I have also assisted Dr. Da Graca, Dr. Lackowski, Dr. Boriboonsomsin and Dr. Shohara who are all Oncologist. Working in this Oncology and Hematology Department is such a big blessing for me and my family. I'm definitely learning a lot in this field of medicine and science. 

Working with these wonderful medical assistants is a blessing! I belong to a great team as everybody is helpful, hard working, flexible and professionals.

L-R: Celeste, Bogdan, Stephanie, Irene, Eugene, Jeni, Liliana, Marina, John and Yvonne.

L-R: David, Roseann, Sergio, Alex, Heather and Robby.

I have finished the course

On October 14, 2016 I graduated in Medical Assisting program of Carrington College Portland Campus. It was a nine month course. I was blessed with a wonderful, skillful instructor, Ms. Laura Morrison. 

I thank Heavenly Father for blessing me with a supportive and loving Husband. "It is such a wonderful thing when someone you love believes in you" -Lucy Smith. During my half day schedules in school, Kevron works from home so he could take care of Miggie.

My Husband and children were my inspiration, strength and source of hope that helped me reached my goal.

At times, we needed Papa Rollie and Mommy's help. I am so grateful for having supportive and understanding parents. I am blessed for having them in my life.

I got a silver cord to hang in my neck as a token for obtaining a 3.9 GPA.

Here is our graduation ceremony program. I was one of the student speakers.

The proof of my success! I also was awarded a certificate for perfect attendance.

"To God, be the glory"


Thursday, September 1, 2016

Report on Breastfeeding

One of the defining features that distinguish mammals from other animals is their ability to feed their young nutrient rich milk.  In fact, the word “mammal” is derived from the word “mammary” which are the unique glands that are responsible for milk production.  Neither birds, reptiles, insects nor fish can feed their young milk.  For this reason, mammals dominate the earth, are more intelligent and have lower mortality rates relative to other animals.

Humans, the dominant mammal species, also benefits their young by feeding them milk.  Human milk is high in energy, proteins and fat.  It contains essential vitamins and minerals.  On top of that, it has hormones, beneficial bacteria, and enzymes that assist the baby.

Most of the milks energy comes from the fat content almost half of which is saturated.  The second highest source of energy in human milk is from sugar.  Human milk contains a unique form of sugar known as human milk oligosaccharides.  These sugars are ironically not digestible by infants, however, they provide the infant with the cultivation of beneficial bacteria as well as improving defense against pathogens.

Most of the protein in human milk is whey.  Whey can make up 60% of the total protein in human milk with up to 40% being casein.  The inverse composition is true for cow’s milk which is 80% casein and 20% whey.  Whey protein is demonstrated to help with protein synthesis by the body.  A small population is allergic to casein protein.
Human milk is high in vitamin C which assists the immune system.  Cow’s milk has none.  Human milk is also higher in Vitamin A and D than cow’s milk.  Milk contains up to 25 IU of vitamin D per liter of human milk.  In some regions, notably northern regions or regions with heavy cloud cover, supplementation is required at 400 IU per day for the first two months.  Calcium in human milk is relatively lower than cow’s milk, but it is in a more bioavailable form for infants.

A newborn human baby does not have a fully developed immune system.  During the first few weeks after delivery, the mother’s milk is high in protein and antibodies that assist the infant in defending against pathogens.  

There are many substances in human milk that regulates appetite.  Infants who breastfeed typically have lower caloric intake than formula fed babies.  This is despite the fact that human milk is more calorie rich.  Formula fed babies, without this hormone, will drink more leading to more consumption and higher calories.

There are over 600 species of bacteria in human milk.  Among these include beneficial bacteria that are also used as probiotics and used in the fermentation of milk products.  Many of the cultures are not found in cow’s milk or formula derived from cow’s milk.

Prolactin and oxytocin are responsible for stimulating the production of milk in humans.  Prolactin not only stimulates milk production in human females but in males also.  Typically, human females produce prolactin after childbirth.  It is not well documented how human males produce enough prolactin to start lactating.

The quantity of milk in humans can be stimulated or limited by several factors.  Regularly pumping via electric pumps into bottles is a good method of stimulating more milk production.  Heating and massaging the breasts before and during breast feeding has also been known to produce larger quantities.  In addition to greater quantities, massaging increases fat content in the milk.

Breast feeding can be painful.  Some women experience 30 to 60 seconds of pain in the nipple when starting breast feeding.  A momentary pause may help.  The pain should subside, but if it doesn’t, there can be other problems such as improper latching of the baby to the breast.  Improper latching is when the baby sucks primarily on the nippl.  Proper latching is when the baby sucks more around the areola [mayo1].  Other reasons for pain include infection of the milk ducts (mastitis) causing clogs or a yeast infection of the breast.  Heating or massaging can help clear clogs in the ducts.  Massaging breast milk onto the nipple and letting it air dry can also ease pain.

Nutrients and antibodies aren’t the only things passed from the mother to child during breastfeeding.  Substances that are harmful, such as nicotine, alcohol, and other drugs can be passed in the milk.  Breastfeeding mothers should not smoke or drink alcohol.  Some medications are okay, but others are not.  Consulting a medical professional should precede breastfeeding while taking medications.  Caffeine should also be avoided if possible or limited to less than 300mg per day.  Coffee, a popular caffeinated drink has anywhere from 35 mg to over 200 mg per 100 g.  Other drinks such as soft drinks and energy drinks also contain caffeine.  Psychoactive drugs such as cannabis may also have negative effects on infants who are breastfed, but the specifics of the effects are not well understood.

In addition to the things that should be avoided, there are activities that the nursing mother should do to maintain both her own health and the health and nutritional value of the milk.  A nursing mother should have a diet rich in diverse nutritional foods.  She should drink plenty of fluids.  Urine color analysis can aide in the identification of whether or not a mother is drinking enough liquids.  Clear to light yellow urine is a good indicator.  Darker urine indicates more liquids are required.  A nursing mother should drink up to 3.7 liters a day.

Many flavours can also be passed on to the child through the milk.  Eating a variety of foods, including spicy food can give the child a taste of what to expect later.  Whatever spicy flavor is passed on through the milk is usually not objectionable to the child.

Fats are also an important to have in variety.  It’s important to get different types of fats such as mono, poly, and saturated fats and fatty acids from food, including fish.  Fish have , EPA, DHA, and omega-3 fatty acids that help aid in the development of the baby’s brain, eyes and other systems.  These foods also benefit the mother to avoid postpartum depression.

Since regular pumping helps the mammary glands produce more milk, careful storage of the milk is necessary to prevent it from going rancid and becoming unusable.  Bottles, the pump and hands should be washed before and after usage.  Breast milk can be frozen, but to thaw it, warm water or a refrigerator is recommended for slower and more consistent thawing.  Microwaves can thaw unevenly and cause scalding.  Excess heat can also kill the beneficial bacteria contained within the milk destroying its nutritional value.

Human milk is without substitute in the mammalian world.  It’s evolved with humans to provide human offspring with the best chance at survival.  No infant formula or other mammal’s milk comes close to providing exactly what nutrients infants need when they need it.  It has immunization improving functions that can help the child’s defense against disease.  With those benefits there are costs and mothers should take into consideration a number of steps to avoid discomfort, and to help provide the best quality milk.
The American Academy of Pediatrics recommends exclusive breastfeeding for the first 6 months of the baby and continue until first year or longer as food is being introduced. Watch for signs indicating your baby is hungry: smacking his lips, suckling motions, sticking out his tongue, opening and closing the mouth and moving his head side to side as he was searching for the breast. Do not wait for him/her to cry for this is a late sign of hunger. Feed your baby between 2-3 hours interval during the day and 4 hours at night. She should be fed 8-12 times in the 24 hour cycle.

There are myths regarding breastfeeding. Some think that you can’t get pregnant while breastfeeding. Although, there are women that do not ovulate during breastfeeding, but it is not a reliable form of birth control. Some think that small breast do not produce enough milk. But breast size have nothing to do with the amount of milk production. Others believe that breastfeeding will make your breasts saggy or will change the shape of your breasts. Well, most women found that their breasts go back to its pre-pregnancy size after stopping breastfeeding. Breasts will always change in consistency after pregnancy. Factors like age, gravity and weight gain are some of the reasons of breasts size change. Sexual arousal is felt during breastfeeding. This is normal since the breast is stimulated which in fact is one of sexual activities. Additionally, the hormone oxytocin is released during breastfeeding which is also released during orgasm. Weaning should be done on the baby’s first birthday. It is really depends upon the mother and baby when to stop breastfeeding. It is a personal decision.  

Sunday, July 31, 2016

Got my BLS ID!

I really feel good about obtaining a BLS Provider Card! Yes I admit, I feel great about it because the whole purpose of it is to save lives of those in cardiac arrest. During our power hour, I was first trying to save an adult for almost an hour. The more I hear myself counting my compressions, the more determined I am to bring my patient to life. It is tiring for the arms  but I became so connected to my patient like as if he is a loved one or simply my brother. I will do my very best to help him/her. By the end of the power hour, I was asked to help an infant. During the compressions and breathings, it made me think of my own kids. It is heartbreaking. I am so grateful that i can be an instrument in the cause and purpose of CPR and AED.  

Monday, July 25, 2016

Research on Osteoarthritis

Osteoarthritis also known as OA is the most common form of arthritis. Millions of people worldwide are affected by this. It is sometimes called the "wear and tear" arthritis. But scientists now believe that it is a disease of the joint. Osteoarthritis happens when the cartilage or cushion tears or wears down leading to physical distress, difficulty moving and swelling pain. Joint tenderness can be felt during or after movement. Clicking and cracking sound are also signs of osteoarthritis. These negative effects may affect one's performance of ordinary tasks at home or at work. Simple activities such as fixing bed, opening a canned food, grasping a computer mouse, vacuuming a carpet or driving a car can be difficult to do. When lower body joints are affected, normal activities like walking, climbing stairs or lifting objects can also become difficult to do. When hand joints are affected, activities that involves grasping can be difficult as well. The most common areas of osteoarthritis are hips, knees, fingers and feet. Being active, healthy weight and other treatments can slow the development of this disease.

Many people believe that the effects of osteoarthritis can't be avoided. But hopefully, they can manage pain, stop joint damage and increase flexibility because their daily life, family and social life can be affected badly. The pain, reduced mobility and the side effects of medications can lead to other negative health problems. Hip or knee pain can cause the patient to sit for long periods of time which may lead to weight gain and obesity. Being overweight or obese can cause heart problems and diabetes.

People with osteoarthritis is in a dangerous situation of falling because of decreased function, muscle weakness and impaired balance. In fact, they have a chance of 30% more falls and 20% chance of getting a fracture than those without osteoarthritis. Medications like narcotic pain relievers can lead to fall because of dizziness and unbalanced position.

One of the factors of the development of Osteoarthritis is genetics. There are those people that inherit this rare defect of abnormal production of collagen in the body. Collagen is the protein that makes up the cartilage. This abnormal condition can lead to the development of osteoarthritis as early as the age of 20. Defects in the way bones fit together wears away the cartilage faster than usual.

As you get older, the risk of developing osteoarthritis increases. Women though are more prone to this disease.

Another factor is weight. Too much weight puts more pressure to the hips and knees. Being overweight for a long time can cause the cartilage to break down faster. Extra weight puts stress to weight bearing joints such as hips and knees. Research also showed that extreme amount of fat tissues produce inflammatory chemicals called cytokines that can destroy the joints.

Joint injuries and movements that are repetitious. e.g. fractures, surgeries or ligament tears. certain careers such as those athletes that repeatedly break their joints, ligaments and tendons and also those movements that require standing for a long time, bending and heavy lifting can speed up cartilage breakdown. Bone and joint disorders are also factors that contribute to the development of osteoarthritis.

Osteoarthritis diagnosis involves physical examination of the affected joint, checking of joint performance for tenderness, swelling and range of motion. The Doctor will also gather information of personal and family medical history which includes description of the symptom, how or when the pain started, information about other medical problems, location of the pain or swelling and how it affects your activities of daily living (ADL) and the medications currently taking. The Doctor may recommend imaging or lab tests to confirm diagnosis of the disease. These include: Joint aspiration, where the Doctor numb the affected area and then insert a needle to withdraw fluid. The fluid will be tested for crystals or joint deterioration; X-ray where cartilage loss is seen as well as bone spurs around a joint. Magnetic Resonance Imaging (MRI) produces detailed images of bone and soft tissues including cartilage. Blood tests and joint fluid analysis can help confirm the diagnosis.

There is no cure for osteoarthritis but treatments are available. Physical activities such as range of motion exercises, aerobic exercise, gentle stretching of the joints and walking around the neighborhood and easy body exercises can help ease pain, achieve healthy weight, maintain and improve flexibility and reduce stiffness. Yoga and tai chi can also help manage stiffness. Pain and anti-inflammatory medications are available for relief. Pain relievers such as analgesic which include acetaminophen, opioids (narcotics) and tramadol are available over the counter and through prescription. Over the counter Nonsteriodal Anti-inflammatory Drugs (NSAIDs) including ibuprofen (e.g. advil, motrin etc) and naproxen sodium can be taken at recommended dosage. Duloxetine (Cymbalta) is an anti-depressant that can treat chronic pain of osteoarthritis. Corticosteroid are strong anti-inflammatory medicines that can be injected or taken by mouth. Physical therapists can help with pain management. They can help create an individualized exercise program that will strengthen your muscles around your joints, increase range of motion and flexibility. Other exercise that s such as swimming or brisk walk can also help with the pain. Assistive devices such as scooters, canes, walkers, splints, shoe orthotics or helpful tools such as jar openers, long-handled shoe horns or steering wheel grips can help with functions and mobility. Nutritional supplements like avocado-soybean unsaponifiables, acupuncture and acupressure, massage, relaxation techniques and hydrotherapy are natural and alternative therapies that can help improve your well-being. An occupational therapist can give you advices that can help you face daily tasks or do your job that will prevent stress to your affected joints. According to research, tai chi and yoga reduce osteoarthritis pain and improve movement. If conservative treatments don’t help, there are procedures that can be performed. Cortisone injection is performed by numbing the area around the joint, then places the needle within the joint and injects the medication. This may relieve joint pain. But you can only have three or four injections each year because it will eventually worsen the joint damage. Hyaluronic acid injection may also give pain relief. Knee osteotomy can be performed by a surgeon when one knee is damaged. The surgeon cuts across the bone above or below the knee and then removes and adds a wedge of bone. Arthroplasty is the replacement surgery of the damaged joint being replaced by a plastic or metal parts.

The Osteoarthritis Research Society International (OARSI) established a standardized definition of Osteoarthritis. The purpose is to provide communication across the field and help advance drug development for OA. This will be recognized globally. They expect that this would help make the communication among industry and non-industry researchers, regulatory agencies, funding agencies, third party payers and patients easier. The definition is maintained by OARSI, and under their jurisdiction can be regularly refined as new scientific advances demands. The Foundation for National Institutes of health (FNIH) Osteoarthritis (OA) Biomakers Consortum project had significant progress in improving clinical outcomes for nearly 30 million people in the US that have OA of the knee and for those at risk. The Biomakers Consortum is a union of experts from the National Institutes of health (NIH), Food and Drug Administration, biotech and pharmaceutical companies, academia and diseased-focused non-profit organizations. The FNIH quest is to attain more exact ways to measure the progression of the disease and produce the expected and intended result of new treatments. The project is ongoing, discovering additional quantitative and semi-quantitative image assessments of the bones and cartilage in the knee joint. This was in the mid of 2013. That year there were 27 million Americans with OA. The knee OA is greater than the other medical condition to people age 65 and above. By year 2020, the number of people with OA will be doubled due to old age and obesity.