Reviewing ROJoson’s Facebook Project on its 7th Anniversary – June 16, 2018

I officially started using Facebook on June 16, 2011.

June 16, 2018, my Facebook Project is 7 years old and going on its 8 years.

On its 7th anniversary, I will make a review and evaluation.

In the past, I already made several evaluations (2011 December – 6 months after usage; 2013 – 24 months after usage; 2014 – 3 years after; 2015 – 4.5 years after; 2016 – 5 years after usage).  The overall result has always been positive and my friends have consistently wanted me to continue my Facebook Project or Postings.

In 2014 and 2016, I asked for formal feedback through a survey from my friends in Facebook.  The results can be seen in the following links (with 38 and 119 respondents respectively):

https://docs.google.com/forms/d/1-Fk7dQw4e8P08dPL_zpcs30AuyLJ41EFvp5Pt0B7Dv8/viewanalytics

https://docs.google.com/forms/d/1VCMZ0iYpDfLNDxkerOCtri-Y40kVdzzH6UuS0OVNkaU/viewanalytics

I will not conduct another survey to get feedback anymore this year.  Instead, I will just make an informal personal evaluation of my Facebook Project based on my formulated goals and objectives and observed outcomes.

The following was my first post in my homepage (profile page) in Facebook on June 16, 2011, spelling out the objectives and contents of my Facebook:

“My Facebook will contain my thoughts, perceptions, opinions, and recommendations (TPORs) on things of interest to me and on things that may be of interest and concern to my patients, to my colleagues, to my friends, and to my family.” 

Evaluation:

I have fulfilled all the objectives that were set at the start, namely:

“My Facebook will contain my thoughts, perceptions, opinions, and recommendations (TPOR) on things of interest to me and on things that may be of interest and concern to my patients, to my colleagues, to my friends, and to my family.” [I have “likes” and “comments” from all of my intended readers.]

I have been using the Facebook as a personal blog to:

o   Facilitate communication and keeping in touch with my patients, students, colleagues in the medical profession, classmates, friends, and with my family;

o   Advance my advocacy on “Education for Health Development in the Philippines,” which I started in 1989;

o   Share on my personal thoughts, perceptions, opinions, and recommendations (TPORs) in the following four areas: Medicine; Hospital Administration; Medical Education; and Life. (with focus on the following specific topics: Breast Wellness; Thyroid Wellness; Hospital Quality Management  System; Hospital Safety Promotion and Disaster Preparedness Program; and Problem-based Learning in Medicine and Surgery.) 

The missions of my Facebook Project are spelled out as such: to infoshare; to inspire; to improve.

Infoshare means to inform and share information and my TPORs (Thoughts, Perceptions, Opinions and Recommendations) which will lead to the other missions to inspire and to improve.

Inspire means to motivate changes for the better or learning on the part of my friends or readers.

Improve means to produce positive changes in behavior (learning) which is the ultimate target of my Facebook Project and Blogs, that is, Education for Health Development in the Philippines Program.

I am achieving the missions of my Facebook Project as evidenced by the responses of friends in my Timelines and the increasing number of requests to be connected or to follow me.

I have reached the 5000-friend Facebook Timeline quota in June 2017.  I have created an extension in the form of group page (Reynaldo O Joson 2).  As of June 18, 2018, 1030 am, there are 675 friends subscribed in this group. 

I am also achieving my OCIL objective in my Facebook Project.  OCIL stands for Online Collaborative and Interactive Learning. I started this in 1999 to conduct online learning sessions particularly with surgical residents, medical students, and students in hospital administration. Google “Online Collaborative and Interactive Learning ROJoson” and you will see the links.

One link is: https://rojosonocilonhospitaladministration.wordpress.com/2014/03/07/online-collaborative-and-interactive-learning-program-in-a-hospital-setting-rojosons-recommendations/

OCIL is learning being effected collaboratively with online interaction not only among the learner-participants but also with the facilitator. As the facilitator, I work on the premise that I don’t know everything though I know something on the learning topic and I recognize the importance of the help of my learner-participants through collaboration and interaction in coming out with a most fruitful learning session.

I have extended this OCIL (though informally) when I started using Facebook in 2011. 

For details on my FACEBOOK PROJECT, visit: 

https://rojosonfacebooknotes.wordpress.com/category/facebook-project-rojoson/

RESOLUTIONS:

  1. Will continue my Facebook Project with the same goals and objectives and missions until I become disabled, crippled or die or until Facebook closes down (pray and hope not).
  2. Will welcome more “friends” and “followers” probably at an increment of at least 500 per year in Reynaldo O Joson 2.
  3. Will try to increase or intensify collaborative and interactive learning from “friends” and “followers.”

ROJ@18jun18

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Evaluation of ROJoson’s Facebook Project – After 6 Months of Usage

Posted in December 2011

I officially started using Facebook on June 16, 2011.  Today, December 17, 2011, I am doing an evaluation after 6 months of usage.

The following was my first post in my homepage (profile page) in Facebook on June 16, 2011, spelling out the objectives and contents of my Facebook:

“My Facebook will contain my thoughts, perceptions, opinions, and recommendations (TPOR) on things of interest to me and on things that may be of interest and concern to my patients, to my colleagues, to my friends, and to my family.”

Aside from a profile page (homepage), I created “pages” and “groups.”

The following “pages” have been created:

  • Hospital Safety Promotion and Disaster Preparedness Program
  • ROJoson Medical Clinic
  • ROJoson Breast Wellness Clinic
  • Thyroid Wellness Clinic
  • Medical Anecdotal Reports

The following”groups” have been created:

  • MDH-ORC Safety Promotion and Disaster Preparedness Program
  • Hospital Safety Promotion and Disaster Preparedness Program
  • MDH Safety Promotion and Disaster Preparedness Program
  • MDH Sharps Safety and Waste Management System
  • Friends of ROJoson Medical Clinic
  • ROJoson Family

 

Data as of December 17, 2011:

Evaluation and Action Plans for Improvement:

  1. I have fulfilled all the objectives that were set at the start, namely:

“My Facebook will contain my thoughts, perceptions, opinions, and recommendations (TPOR) on things of interest to me and on things that may be of interest and concern to my patients, to my colleagues, to my friends, and to my family.” [I have “likes” from all of my intended readers.]

I have been using the Facebook as a personal blog to:

o   Facilitate communication and keeping in touch with my patients, students, colleagues in the medical profession, classmates, friends, and with my family;

o   Advance my advocacy on “Education for Health Development in the Philippines,” which I started in 1989;

o   Share on my personal thoughts, perceptions, opinions, and recommendations (TPORs) in the following four areas: Medicine; Hospital Administration; Medical Education; and Life. (with focus on the following specific topics: Breast Wellness; Thyroid Wellness; Hospital Quality Management  System; Hospital Safety Promotion and Disaster Preparedness Program; and Problem-based Learning in Medicine and Surgery.

2.      Difficulties identified:

  • Archiving of TPORs and Notes posted.
  • Keeping tab of statistics on“likes” in the Homepage and Group Pages.
  • Still with incomplete or few members in the Group Pages.

3. Action plans.

  • Create a site in WordPress.com to store the notes I posted in my Profile ( Homepage).  With categories to facilitate archiving and retrieval.  With site statistics.

Status: DONE

Created https://rojosonfacebooknotes.wordpress.comin July, 2011 with first posting on July 26, 2011.  Total posts as of December 17, 2011: 129.  Total views: 611.

Will put the wordpress.com url in my Facebook Hompage (DONE).

  • Will strengthen the Group Pages by adding more members as indicated.
  • Will put in more contents in the Pages, particularly on Medical Anecdotal Reports.
  • Will consider creating more archiving sites in wordpress.com especially for the Pages to facilitate archiving.
  • Will re-post or reiterate important TPORs in the Facebook at planned intervals, such as monthly or quarterly.

ROJ@18jun18

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Every person is insane or crazy in one way or another – what to do to control to promote mental health

Everybody is insane or crazy in one way or another.

This statement is supported by this article (see picture below).
https://www.livescience.com/5082-insane.html

insane


This insanity should be controlled so that 
– one can be happy and 
– one should not be a burden to family members and society.



Some tips on how to prevent modern insanity (from: https://www.livescience.com/7835-modern-insanity-crazy.html)

– Get more Zzzzs

A century ago, Americans were averaging nine hours of sleep every night. These days, according to the National Sleep Foundation, many people get less than seven, a trend that has been linked to an overall decline in mental health. Strive to get 8 to10 hours of sleep each night to help your brain and body fully recuperate.

– Seek social support

While our distant ancestors likely enjoyed being the best at something, say the best gooseberry spotter among their community of 50 to 100 individuals, in “today’s global village of 6.5 billion people, nobody is the best at anything,” Ilardi said. Finding a niche in a subset community may dissuade this inevitable ego knocker as well as provide other mental health goodies, such as halting rumination.

– Interrupt circle-think

Focusing on a problem or discomfort can be adaptive; it helps us find solutions. But when we become fixated, the repetitive stress can erode our ability to rebound. Rumination, Ilardi says, is particularly common when we’re alone, a state familiar to many inhabitants of developed countries. In contrast, our ancient ancestors rarely went solo. Having company or partaking in engaging activities can stop ruminative thoughts in their tracks.

– Walk it off

We evolved as recreational athletes. Our ancestors not only spent much of the day engaged in moderate aerobic activity but also undertook regular weight-bearing chores, such as digging ditches and building huts. Studies have shown, just 90 minutes of exercise a week can be as effective as psych-medicines such as Zoloft.

– Develop a world view

While research on the relationship between religion and mental health is inconclusive, individuals who have a global framework — a way of understanding the world, whether it be religious, philosophical or scientific — may have an increased ability to withstand blows to their mental health, Ilardi said.

 




Personal Resolutions
– Get enough and not too much sleep – 6 hours at least and 9 hours at most including siesta
– Seek social support – family, colleagues, friends and patients
– Control rumination
– Exercise – walk and stretching and flexing 
– Develop an understanding of life with acceptance of its imperfections

On “rumination” –

Rumination is one of the similarities between anxiety and depression. Ruminating is simply repetitively going over a thought or a problem without completion. When people are depressed, the themes of rumination are typically about being inadequate or worthless. The repetition and the feelings of inadequacy raise anxiety and anxiety interferes with solving the problem. Then depression deepens.

Rumination can be switched off by two good methods: 1) get out of the negative neural networks and 2) tackle one problem at a time with planning.

ROJoson’s Notes:

For the first one, I will do these as a priority:

– Interfering with rumination may be helped with a memory jogger for times I was feeling good by going over pictures and records of happy memories.

– I will try to get into new activities that will really make me feel good (music, movies, etc.)


ROJ@18may4

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Telemedicine – An Illustration

Telemedicine using email communication to give diagnosis and advices.

ROJoson – February 2018



On February 25, 2018, I received this note from a classmate who wanted to help a patient in Guimaras.



February 25, 2018

Hi Brods & Sisses!
Attached are photos of a 17yo charity patient seen by a doctor during Med Mission in Guimaras. Do we have any Brods/Sisses (From Iloilo preferred; from PGH , OK too) who are willing to help with her diagnosis & treatment?
Valdez Foundation will assist with logistics.

Dr. Bernard

 

IMG_2106

IMG_2104IMG_2105



February 26, 2018

Hi Rey
Do we have Brods/Sis in GSI PGH? Are you still an active consultant at PGH?
Who do I refer to ?
This patient is 17 yo female who had ultrasound of the neck 6 months ago showing  3.5×2.3 solid mass on the right and 2 masses on the left measuring 4.1×2.9 and 4.9×3.9 cm. Thyroid was normal. Pictures now show massive enlargement and fluctuation associated with 30 lbs weight in 6 months
Brods and Sisses have suggested CBC with differential and biopsy for a definitive diagnosis.
Dr. Bernard


February 26, 2018

Dear Bernard,

If the thyroid is normal, considering there are masses on both sides of the neck,  we may be dealing with lymphoma. Nasopharyngeal ca is a consideration too pending more data.

Are there masses in the axilla and inguinal areas?  If there are, then most likely lymphoma.
Yes, we have brods in GSI.  Rodney Dofitas is presently the division chief.  Tito Espiritu is another brod there.  I am still connected with GSI but not active already.
Where is the patient? in Guimaras?  Who can furnish us more data to get to a more definite diagnosis.  I don’t think CBC is critical in diagnosis.  If lymphoma is suspected, section biopsy and not needle biopsy is recommended.  
However, I need more data if I cannot examine her personally.
Rey


March 3, 2018
Question- for Dr. Rey Joson: How do we get in touch with Dr. Rodney Dofitas?
How do we go about scheduling a charity patient to be seen in PGH?
Details of doing the biopsy- outpatient?
         local anesthesia?
        approximate cost?
Question for Dr. Amy: Any more workup reports?
Pls see Dr. Joson’s email below.
Also, would the Valdez Foundation assist this patient’s logistics (transport/lodging/ hosp bills, etc) ?
Thanks.
Dr. Bernard


March 3, 2018
If I may suggest,
1. through such email communication which is equivalent to telemedicine, let me take a crack at a more specific clinical diagnosis first (with the patient at home base – Guimaras).  We need to have a more specific clinical diagnosis to be able to recommend a more cost-efficient move (what to do next in terms of medical management and where to send patient to – Iloilo or Manila.)   I need a clearer photograph of the patient’s head and neck and more data (a physician seeing the patient right now in Guimaras should be able to supply me with the needed info.)  The photos can be sent to me through this email.  I can also communicate with the physician to seek more data.  THIS IN EFFECT IS TELEMEDICINE and can facilitate the cost-efficient management of the patient.
2. After the clinical diagnosis, I can then recommend the best option to take in consideration of the working diagnosis – such as what further exams to make (needle biopsy, section-biopsy, x-ray, CT-scan, nasopharyngolaryngoscopy, etc).; where to have these exams done (Guimaras, Iloilo, or PGH); and which specialists are needed to treat her (eg, if lymphoma, medical oncologist with a biopsy done by a surgeon; if nasopharyngeal ca, ENT and radiotherapist and medical oncologist; if TB, pediatrician; etc.)  This illustrates the importance of a more specific clinical diagnosis which can be gotten through email / telemedicine and which can facilitate the cost-efficient management of the patient.
3. We can also look for specialists we know in Guimaras or Iloilo who we think can treat her properly and for free.  Last resort will be PGH.  Even in PGH, we have to know which department to refer to (based on our specific clinical diagnosis).
So, do you want me to take a crack for a more specific clinical diagnosis as outlined in No. 1?  If yes, give me clearer pictures and have a physician seeing her at present to communicate with me.
Or would you just outrightly refer her to PGH Department of Surgery c/o Dr. Rodney Dofitas and let Dr. Dofitas handle her (whether in his Division or refer to other Departments)?
My 2-cent worth.  My recommendations.
Dr Rey


March 3, 2018
Thank you, Rey.
I think your suggested “Telemedicine” practice is commendable.
To this end, we need contact information of the physician (one who examined the patient recently) in Guimaras or Iloilo-
Address, cp#, best time to call, email address
To further assist Rey with a clinical diagnosis
Amy, pls email althogether
Patient’s Detailed History & Personal Information
Physical exam
Labs
More photos
Thank you Rey for all the good work you do for the advancement of medical practice in the Philippines.
Bernard


March 3, 2018

Encounter date : Feb 17; 2018
Guimaras Provincial Gym
Jordan, Guimaras

Demographics:
Mary Ann Joy xxxxxxxxx  (patient)
Barangay Lawi, Jordan, Guimaras
CP #0936 467 4387
Date of Birth: December 27, 2000

HPI :
17 y/o female presented with bilateral neck mass weight loss of 30 lbs since September 2017 associated with difficulty swallowing
According to her mother , she underwent work up at local hospital with labs, CXR and Ultrasound.
Ultrasound report performed on 08/09/2017 showing normal thyroid , well marinated hypo echoic right mass measuring 3.5cmX 2.3 cm X 2.9 cm and 2 adjacent hypo echoic left solid mass measuring 4.1 cmX2.9cm and 4.9 cm X 3.9 cm

CXR report Negative ( per patient)
Labs : Results not available at time of exam

Social History ; Lives with parents . Youngest of 9 children , stopped going to school because of her medical condition

ROS : wt loss 30 lbs , no fever no chills ,
had epistaxis ; no hemoptysis
mild difficulty swallowing
Denies history or exposure to TB

Past Medical History :
Burn right hand from electrocution in 2015

Family History
Father :  xxxxxxx 50 y/old with poorly controlled Diabetes Disabled and stopped working as fisherman in 2000
Mother: xxxxxxx , 57 yrs old , healthy ,provider fir family works as charcoal maker; fuelwood gatherer; laundry woman – P 350.00 x 4 days / week income.
Contact # 09364674387

Physical exam – limited no neck mass
GS : Alert pleasant young female
HEENT : Pupils reactive , EOM intact
Diffuse bilateral neck mass , non movable ;
non tender. Skin intact , no redness, Fluctuant mass noted on left posterior  side

DRV

joy3

 



March 4, 2018

Dear Dr. Valdez,
Thanks for sending the history and physical examination findings, the pictures and the ultrasound findings.
17-year-old female with bilateral large neck masses extending from infraauricular to the almost the supraclavicular areas, nodular, thyroid gland apparently normal (based on ultrasound and on the picture – seems to have no midline pretracheal bulge).  There was mention of difficulty of swallowing (I don’t know how significant this is – may be caused by the heaviness of the neck masses) and also there was mention of epistaxis (again, I don’t know how significant this is – may be nonspecific).  
If we just focus on the picture of neck masses and no thyroid masses (putting on hold the difficulty of swallowing and epistaxis first), my primary clinical diagnosis is lymphoma [I will give a 80% degree of certainty]. (Bases: the hugeness of the neck masses which most likely are enlarged lymph nodes and the bilateral neck involvement and of course in the presence of normal thyroid gland.  If there is a mass in the thyroid gland, then we consider thyroid cancer with neck node metastasis.).   Pls. check if there are enlarged lymph nodes in the axilla and inguinal areas.  If there are, 99% we are dealing with lymphoma.
My secondary clinical diagnosis is a nasopharyngeal cancer (Bases: bilateral neck masses starting at the infraauricular areas which I assumed are lymph nodes and the epistaxis, if this is significant.)  The reason why I put nasopharyngeal cancer as secondary clinical diagnosis is because the NPCA does not usually present with huge and bilateral neck nodes.   Pls. check the oropharynx and nose for any bulge that could suggest the presence of a mass.
Can you ask the attending physician to give me answers to these questions:
1. Are there masses in the axillae and inguinal areas?
2. Are there bulging in the oropharynx?
3. How significant is the epistaxis?  how many episodes?  Is there unusual findings in the nose?
After I got the answers to my questions, I will make a decision on my clinical diagnosis, whether to stick to what I mentioned above or change it (depending on the additional info).
Then, I can recommend the next step.
Thank you.
Dr Rey


March 6, 2018

Thank you, Rey
I remember what our mentors in medical school taught us:  with a complete history and thorough physical examination one can arrive at a diagnosis 80% of the time and laboratory studies are done just to confirm the diagnosis. We believe in “clinical eye” based on extensive clinical exposure to diseases.
Hopefully we can clinch the diagnosis and will be able to help this girl soon.
Dr. Bernard


MRI Done:

joy_mri



Based on the MRI, primary diagnosis for me is lymphoma.

Just have to wait for the histopathological result of the biopsy.  Cannot move further in the management without the result.
If lymphoma, suggest refer to medical oncologist for further management – chemotherapy with or without radiation.
Dr. Rey


April 2, 2018

Attached are the histopathology report
As you stated Doc Joson – it’s Lymphoma (Non Hodgkins Lymphoma)
joy1
Few questions doc:
Would there be an advantage of sending her to Manila vs treatment locally ?  If she need radiation, would they have local faculty in Iloilo?
Estimated cost?
She is 17 yrs old,  adult status 18 or 21 yrs old in the Philippines?
I have requested a consent form from
Mary Ann’s parents  and indigent report . To date I have not received any.
Thank you Dr REY for your expert advice . Will plan strategy  with your advice to assist with her treatment  plan.


April 3, 2018

Dear Dr. Valdez,
I think the main treatment here is chemotherapy.  Look for a pediatric oncologist or medical oncologist in Iloilo.  The DOH hospitals there should have one.
Dr Rey





ROJoson’s Notes:
With the email communication, with the telemedicine through email, I was able to advise on the diagnosis and what needed to be done on the patient without the patient having to be transported to Manila.

ROJ@18apr4

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Universal Health Coverage – Roles of Physicians, Hospital Administrators, and Governments

Universal health coverage is defined as ensuring that all people have access to needed promotive, preventive, curative and rehabilitative health services, of sufficient quality to be effective, while also ensuring that people do not suffer financial hardship when paying for these services.

Universal health coverage has therefore become a major goal for health reform in many countries and a priority objective of WHO.

Good health is essential to sustained economic and social development and poverty reduction.

Access to needed health services is crucial for maintaining and improving health.

At the same time, people need to be protected from being pushed into poverty because of the cost of health care.

http://www.who.int/healthsystems/universal_health_coverage/en/



QUESTIONS:

HOW CAN PHYSICIANS CONTRIBUTE TO THIS CAUSE?

HOW CAN HOSPITAL ADMINISTRATORS CONTRIBUTE TO THIS CAUSE?

HOW CAN GOVERNMENT CONTRIBUTE TO THIS CAUSE?


ROJ@18mar6

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ROJoson’s Slide Projectors of Yesteryears

I acquired 2 slide projectors which I used for lecturing in the past when analoque (non-digital) slides were still in vogue.

First one was a 2nd-hand Kodak Carousel similar (not exactly) to the one shown below:

ec36d5035706e1a46ee0fba28050a0fc

I bought this in 1977 or 1978, 1-2 years after I started my general surgery residency in the Philippine General Hospital.  I think I bought it for about a thousand pesos.  My stipend as a surgery resident at that time was about P700 per month.  I saved in order to buy this slide projector (at that time, it was hard to get avail of a slide projector in the Department).  I also saved money to buy cameras for my medical photography.  The cameras came first before the slide projector.  What happened to this slide projector?  I think I eventually donated it to the Department of Surgery together with several slide trays after several years of usage and when digital cameras came into vogue.

About 10 years after I bought the Kodak Carousal, I bought another slide projector, a more portable one, which I used to give lecture to medical students.  I cannot remember how much I bought it then.  It is shown below.  It is still with me.  I am ready to give it up, still working, as part of my clutter management (declog / de-own), either sell it or donate it to whoever is interested.

IMG_6506

IMG_6510


ROJ@18feb28

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Walking the dog enhances compassion in me

If I recall right, my wife adopted Jhun-Jhun Bato (a dog) sometime in 2014.   Since then up to this writing (18feb6),  I have been taking turns in walking Jhun.  Note: In 2014, I reached my mandatory age of retirement from government services and I retired from hospital administration.

Today, when I walked Jhun (morning and afternoon), I told myself that walking a dog enhances compassion in me and for anybody who walks a dog regularly.

Vocabulary.com defines compassion as follows:

“If someone shows kindness, caring, and a willingness to help others, they’re showing compassion.”

If I walk my wife’s dog everyday as a routine (every afternoon and sometimes, morning, when my wife cannot walk him), I feel I show kindness, caring and a willingness to help him.

The dog has to pee and poo.  The dog is trained to pee and poo in the street, not in the house.  Walking him at least twice a day enables him to pee and poo (good for his health).

The dog has to do some exercises.  Although we allow him to roam around the house (unless there are visitors), he still need to walk long distance for his daily exercise.  Walking him half a kilometer at least twice a day enables him to exercise his legs (good for his health).

The other benefits on the dog’s side when I walk him, he meets and interacts with other dogs whether friendly or hostile and also walking outside the house breaks his boredom (oftentimes, we bring him along for a short and long car ride and excursion to the beach).

Doing the above, I got the feeling that I am showing kindness, caring and a willingness to help Jhun the dog.  For this, I think I am showing compassion to our dog.   Being compassionate to our dog I feel enhances my compassion for people, particularly my patients.

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anilao_junjun_rj_16jan31 (2)


ROJ@18feb6

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