Hawaii Filipino Chronicle Supplement - September 19, 2020

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September 19, 2020


Filipinos, Second-Highest Rates of COVID-19 Cases in Hawaii WHAT’S INSIDE Providing Care to Hawaii’s Filipino WomenS2 Here’s What It’s Like to Work in the ICUS3 As Second-Worst Hit by COVID-19 in Hawaii, Filipino Community Remains ResilientS4 Taking Care of Our Eyes As We AgeS5 Surviving Covid-101S6 How HPV Vaccine Prevents Future Cancer S7 What is the best way to educate our childrenS8 Living the Long Life with 95-year-old Mrs. CalibosoS9 Gallstones and Gallbladder DiseaseS11


or over 20 years the Hawaii Filipino Chronicle (HFC) has presented an Annual Health Supplement for the month of September. Through the years we’ve covered the latest breakthroughs, cutting edge medicine, alternative medicine, guidance articles on a myriad of health conditions from diabetes to high blood pressure and eye care. This 2020 Health Supplement we are focused on the COVID-19 pandemic – that’s hands down the biggest health crisis in our lifetime. Since its outbreak in the United States early this Spring, the HFC has covered all angles of this merciless virus. For this Health Supplement cover story, HFC’s editorial assistant Jim Bea Sampaga shows how our Filipino Community specifically has been impacted as the second worst hit ethnic group in Hawaii, how Filipino health workers are making a difference on the frontlines, and lastly how COVID is impacting Filipinos in our mother country, the Philippines. Our local Filipino healthcare organizations like the Philippine Medical Association of Hawaii (PMAH) and Bayanihan Clinic Without Walls (BCWW) have also risen to the challenge to combat COVID. Filipinos are resilient. Our community is resilient. Mabuhay to all as we fight through this pandemic together! Story on S4




Providing Care to Hawaii’s Filipino Women By Elenita Alvarez, M.D.


have been taking care of Hawaii’s women and delivering their babies for the past 42 years. In fact, I’ve been taking care of four generations of women. I’m originally from the Philippines and went to University of Santo Tomas Medical School but did majority of my Obstetrics and Gynecology training in many hospitals in New York. Filipinos make up about 80% of my practice. Most of my older patients, who have been with me since child-bearing age, and some of my younger patients in my practice are immigrants from the Philippines. In my experience, Filipino women are at higher risk of some pregnancy-related issues. Partly because of limited access to healthcare and being unable or willing to take time off work, Filipinos often don’t go to the doctor. When they do, they already may have underlying health problems like diabetes, high blood pressure, or high cholesterol. Interestingly, if a Filipino woman is not yet diabetic, they still have a higher risk of gestational diabetes, which is a development of diabetes during pregnancy. Most of the time, the gestational diabetes resolves after childbirth. However, these women have a higher risk of developing diabetes in 10 to 15 years. When mothers have hypertension or pregnancy-induced hypertension called pre-eclampsia, there is a risk of low

birth weight babies. The mother’s high blood pressure causes poor circulation of blood to the uterus and baby which is why babies don’t grow as big. High blood pressure can be from poor eating choices. Salty foods common in a Filipino diet like spam, fried fish, and sausages, retain water and contribute to high blood pressure and weight gain. Because of this, it is not uncommon in the Philippines to have low birth weight babies because of their diet. Even with smaller birth weights of babies in the Philippines, there is a higher rate of cesarean births because of the short body stature and small pelvis of Filipino women. When these women migrate to the United States, not only are they still eating high salt foods, but now also eating more meaty and high fat diets, now resulting in bigger babies, who are likely delivered by C-section. Although generally rare in the world, the Philippines has one of world’s highest incidence of hydatidiform mole or molar pregnancy. This hydatidiform mole is an abnormal growth inside of the womb in the beginning of pregnancy. There is abnormal fertilization of the egg which results in growth of the placenta, but minimal or no growth of fetal tissue. A diet low in Vitamin A and folic acid is a risk factor for molar pregnancy, as well as other developmental disorders.

These vitamins are found in leafy greens and fruits, some in which have seasonal growth. Genetically, Filipinos are at risk of anemia due to a higher incidence of alpha thalassemia trait. Thalassemia is an inherited blood disorder that causes you to have malformed blood cells that are unable to carry oxygen resulting in anemia or low blood count and can cause fatigue. A mild form is not a problem for someone who has this blood disorder, but when both parents have this gene, there is potential to pass it down to the baby, causing severe genetic problems. The Bart’s hemoglobinopathy causes circulation problems starting in utero resulting in “blue babies”, pre-eclampsia of the mother, and even fetal hydrops in which the baby is so anemic that they don’t survive to birth. This trait is checked on prenatal work-up for anemia. Another observation I have is that depression is common with many of my migrant patients. Depression is more common with new environments with the culture or the transplant shock. Women have

to make many adjustments since they left their family behind in the Philippines. There’s also stress from financial problems. This can result in menstrual disorders, which are common within the first 6 months of migration. The Filipino community is flourishing here in Hawaii with generations with roots in the islands and the continued migration of individuals from the Philippines. We still have to take into consideration the social and lifestyle changes of our local and migrant women. I advocate that our women and children need to be up to date with their vaccines and screening tests. One of the new vaccines is for HPV, given from age 9 for prevention of general warts and cervical cancer. Cervical cancer screening tests should be considered from age 18 or within 6 months of starting sexual activities. The recent recommendation is that Pap smears are every three years unless abnormal and stop at age 65 unless there are problems. Breast cancer is the most common cancer affecting all women. Screening mammograms start at 40 years old. All women should do a breast self-exam mid-cycle. Males and females should get a screening colonoscopy at 50 years old. To have a healthy baby, mothers should have a healthy

mind and body. It’s important to have a well-rounded diet that is low in sugar, salts, and fats especially during the prenatal period. Avoid negative vices including smoking, drinking, and drugs during pregnancy. Everything the mom does, the baby does too. I would like mothers to consider cord blood donation at birth. There are stem cells in the umbilical cord which can help with treatments for lymphoma and leukemia. These stem cells, like blood, have to be matched with donor to recipient. There is shortage of stem cells available to match patients of Asian, Hispanic, Black, and Pacific Islander decent. This is a gift that can help our kababayans. Lastly, consider being more open with your doctors by talking about all your medical concerns. Be proactive and ask questions about your issues, testing, and laboratory reports. Don’t ignore abnormal signs and seek doctor help sooner than later. Be proactive about your health. Language should not be a problem, bring your interpreter, family member or see a Filipino provider--we speak your language and understand you.

DR. ELENITA V. ALVAREZ is an Ob/Gyn physician with a private practice in Kuakini and deliveries babies at Kapiolani Hospital for Women and Children. She is an active member of the Philippine Medical Association of Hawaii.




Here’s What It’s Like to Work in the ICU During The COVID-19 Pandemic By Jim Bea Sampaga


he COVID-19 pandemic has really pushed everyone to live, adapt and survive in the new normal. Almost every two weeks, Hawaii residents and businesses await updates on the island-wide lockdown order. Meanwhile, government officials are trying to limit the spread of COVID-19 with lockdown orders and increased testing as the total number of daily cases continues to rise. As of writing, Hawaii is nearing a total of 11,000 COVID-19 cases. For our frontline healthcare workers, risking their lives and chance to spend time with family and friends are a big part of their new normal. In the age of masks and social distancing, Filipino nurse Joshua Pananganan works closely with COVID-19 patients as a registered nurse at Pali Momi Medical Center’s Intensive Care Unit (ICU). As part of his new normal at work, his everyday ICU routine isn’t complete without the proper personal protective equipment (PPE). “The first thing I do before clocking in for the day is ensuring I have the proper PPE— N95 mask, surgical mask, goggles or a face shield, and hospital scrubs,” Pananganan said, noting that putting on PPE usually takes 20 minutes. PPE is an important part of a frontliner’s uniform and Pananganan makes sure that he and his colleagues are always wearing one. “We all take this very seriously,” he said. “If someone doesn’t have it on, we remind each other. It’s important to not only keep ourselves safe but also each other and our patients.” It’s hard to social distance with patients because providing care is a healthcare worker’s utmost priority. When there are COVID-19 patients in the ICU, they are intubated with at least five different IV infusions that are regularly monitored. Medications are given through the patient’s feeding tube. “Each time we go in and

Registered nurse Joshua Pananganan at Pali Momi Medical Center’s Intensive Care Unit. He stresses the importance of sanitizing and wearing PPE as safety measures against COVID-19.

out of a patient’s room, we are putting on and taking off the plastic gowns and wiping down everything, which can be a tedious process,” Pananganan shared. Working closely with COVID-19 patients, he said that he and his colleagues are practicing social distancing with each other. “We gear up to keep each other safe. We can’t really eat together during our breaks anymore because we also need to be aware of our situation and maintain proper physical distancing between ourselves,” he said. Since the pandemic began, hospitals had to implement changes in taking care of their patients. In Pali Momi Medical Center, there are currently two separate ICUs—one for COVID-19 patients and another one for non-COVID-19 patients who need intensive care. The new ICU set-up has been tough for everyone because as cases surge in the state, hospitals are also operating at or near capacity. “It’s a little stressful going to work because we don’t know what to expect,” he said. “Our team is more spread out now and caring for more patients, so it can sometimes feel like we’re separated from each other. We also all have a challenging time recognizing each other when we are wearing all of our PPE.” Despite the stress and challenges the new normal at the ICU brings, there is a stronger sense of teamwork and communication in their team.

“Working together with my nursing colleagues, respiratory therapists and critical care physicians are the utmost importance to ensure that our patients receive the best plan of care and treatment needed to combat this complex virus,” he shared. Families are also a big part of the ICU team. Before the pandemic, Pananganan would always engage with family members, encouraging them to visit often and consoling them

with hugs when a patient passes away. Now, hospital visits are done through video calls in an effort for families to “see” their loved ones amid strict social distancing rules. “We are used to family interactions and having them be part of the treatment plan. It’s sad when they’re not. Also, when a patient passes away, our staff are so used to being able to console our patient’s families. It’s not uncommon to see our staff hugging family members and trying to comfort them. We can’t do that right now and we miss it,” he expressed. Pananganan also worries that he might bring COVID-19 back to his own household. “I worry a lot about possibly contaminating others and bringing something home to our families, which is why we are so meticulous with our cleaning and PPE procedures,” he said. Some people still don’t believe the COVID-19 pandemic is real. But Pananganan reminds everyone that the virus is real and affects everyone without any discrimination.

“As frontliners, we see [COVID-19] every time we come to work. It very much affects our patients, their families, our healthcare workers and our families. It affects the community,” he explained. The Filipino community has the second-highest COVID-19 infection rates in Hawaii. Pananganan highly encourages everyone to do their part in following the lockdown and safety guidelines. “Wear a mask when out, social distance when you are with others and no gatherings or parties… please!” he exclaimed. “Even though we know it is part of our culture and can be difficult, we want everyone to be safe… so we can safely do our job in making sure you and your families get through this pandemic.” At the end of the day in the ICU, Pananganan takes a moment to show appreciation. “I end the way with a moment of appreciation for my health and well-being during this turbulent and uncertain time,” he shared. “We just want everyone to stay safe, take care of each other and stay strong during this time. I hope the pandemic ends soon.”




As Second-Worst Hit by COVID-19 in Hawaii, Filipino Community Continues to Be Resilient


By Jim Bea Sampaga

n Sept. 8, Honolulu Mayor Kirk Caldwell extended Oahu’s second lockdown order until Sept. 23. The “Stay-at-Home, Work-from-Home” order was supposed to be lifted on Sept. 10. “The one thing we’re not going to do a second time is rush to reopen and then have a second spike. We’re going to be much more cautious, much more conservative,” Caldwell said at a news conference. Non-essential businesses such as retailers, salons and gyms are closed while restaurants continue to operate for takeout orders only. Social gatherings are still banned. On the same day Caldwell announced the extended lockdown, the state Department of Health also announced the total number of COVID-19 cases in Hawaii surpassed the 10,000 mark. As of Sept. 16, the statewide total of COVID-19 cases is 10,946 with 103 fatalities. Twenty percent of the total cases are Filipinos even though they only make up 16% of the state population. This also makes the Filipino community the second highest in COVID-19 infection rates in Hawaii, following Pacific Islanders (30%). Frontliners, Essential Work Dr. Marel Ver, president of the Philippine Medical Association of Hawaii (PMAH), says their organization acknowledges the alarming rise of COVID-19 cases in the Filipino community. “As all members of PMAH take care of Filipino patients, we recognize this trend,” said Dr. Ver in an email interview. “Many physicians, through our own questioning and contact tracing efforts, have compiled similar reasons for this high rate [of COVID-19 cases in the Filipino community].” Despite Caldwell’s lockdown order urging Oahu residents to work at home, most Filipinos can’t bring their work home as they make up a large number of Hawaii’s frontline and essential workforce in healthcare, food, hotel and service industry. According to the Hawaii Center for Nursing, nearly one-third of registered nurses in Hawaii are Filipino. Many Filipinos also work in healthcare as doctors, nurse aides and caregivers. In an interview with KITV, PMAH president-elect Dr. Lyla

Prather said working in the healthcare and service industry “puts us at higher risk because we don’t have jobs where we can work from home.” Dr. Ver also notes that some essential workers are also working multiple jobs and riding the bus for transportation. “Usually, these jobs don’t have sick leave, nor can they miss time off from work,” said Dr. Ver. “The exposure to the outside environment and other people puts these workers at risk for contracting and spreading COVID-19. Therefore, it is important to take safety precautions en route and at work.”

Cultural Norms As Filipinos risk contracting the virus as an essential worker, they also risk spreading the virus to their family members in their multi-generational homes. Multi-generational homes are common among Filipino families in which multiple family members share the same spaces. With the majority of its residents being Filipino and Pacific Islander, Kalihi is experiencing the worst COVID-19

PMAH president-elect Dr. Prather and president Dr. Ver with the KN95 masks their organization donated to doctors in the community.

outbreak in Hawaii. Councilman Joey Manahan thinks multi-generational households contributed to the outbreak in his district. “Because they don’t have the space to quarantine properly, I’m hearing the numbers are going up every day,” Manahan said in an interview with Honolulu Civil Beat. Additionally, some people also pointed out that Filipinos often host large gatherings at home or outdoors such as funerals, church services and parties but Dr. Prather disapproved of this idea during the KITV interview. “I don’t necessarily think that statistically we are at higher risk or we don’t do any kind of a thing to prevent the spread. We do. We’re always really diligent about wearing our masks. It really starts with the knowledge in the home. Not just being able to distance, that’s very difficult for anybody in Hawaii because we are all about aloha,” she said. According to Dr. Ver, it’s important to be mindful of each other’s exposure risk because there’s no way to tell if a person is an asymptomatic

COVID-19 carrier even you all live in the same household. “The unfortunate scenarios we have seen come from the essential worker spreading the virus in their place of work when the actual initial exposure was from the person’s home from a family member,” she explained.

COVID-19 in the Philippines In the Philippines, the total number of COVID-19 cases is 257,863 as of Sept. 12. While the total number of fatalities is 4,292. Currently, the Philippines has the most COVID-19 cases in Southeast Asia. The Philippines started with multiple setbacks with dealing COVID-19, according to public health expert Dr. Susan Pineda Mercado who is a former Director of the World Health Organization’s Western Pacific Regional Office and the incoming Director for Food Systems and Resilience of the Hawaii Public Health Institution. “Unlike its neighboring countries, the Philippines has never experienced an outbreak of the magnitude of SARS or MERS-CoV. Hence, the expe-

rience and preparedness were not in place,” said Dr. Mercado. “We started without the capacity to do the testing. COVID-19 hospitals were not immediately designated. And organizing the response for isolation facilities took time. By April, more than 20 doctors paid for this inexperience with their lives.” Despite the lack of initial response, the Philippines was one of the first countries to ban all inbound and outbound China flights in late January and early February. It’s also the country with the longest lockdown in which they enforced an “enhanced community quarantine” lockdown since mid-March. By April, they required everyone to wear masks when going out. In mid-July, a relaxed community quarantine was implemented which caused a spike in the country’s COVID-19 cases. The lockdown was implemented without proper support in place for its citizens. As the economy crashes and businesses suffer, Dr. Merca(continue on S5)




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do said, “hunger was the biggest threat as people lost daily income and it was difficult to distribute food.” Overall, Dr. Mercado said that “the government has been very responsive to the needs of people, but given the severe economic backlash, urban congestion, crowding, poor living conditions and limited capacity of health facilities—it has been difficult; but in general people are cooperative and there is a sense of stability despite the uncertainty.”

tributed to doctors in the community.

Susan Mercado, M.D.

Layla Prather, M.D.

Marel Ver, M.D.

tracers who speak the native language and can convey proper isolation measures and explain important risk reduction measures. To communicate in a culturally sensitive way will get more compliance from the population, given that there is more understanding, connection, and mutual respect.” Through social media platforms such as Facebook, Instagram and YouTube, PMAH has been providing COVID-19 education and safety protocols to the general public in English, Tagalog and Ilokano. They are also starting an online series on Facebook Live where PMAH members share their experiences as frontline doctors fighting COVID-19. They have also partnered with various Filipino organizations to reach more audiences in the community. “Special communication campaigns are needed for the Filipino community, using individuals who are highly credible to deliver key messages,” Dr. Mercado added.

Losing your job also means losing your benefits including health insurance. Even though many Filipinos are essential workers, most of them still lost their jobs due to the tourism industry being greatly affected by the pandemic. Bayanihan Clinic Without Walls, a PMAH-affiliate organization, launched the Job Loss Program to provide free doctor visits to anyone who has lost their jobs or health insurance. Essential businesses should also provide a better workplace environment for their employees. “Workplaces will need to come up with protocols for safety, including zoning—or classifying areas into red, yellow and green in offices to protect vulnerable individuals who need to report to work, workplaces should do their own contact-tracing and not wait for the government to do this, or test results to come out,” Dr. Mercado explained.

world desperately needs a vaccine. The fastest vaccine ever developed was for Ebola, and it took 5 years to be created. “Currently there are 25 candidate vaccines, the two leading vaccines from the UK and China have just started Phase 3 of Clinical Trials, where the vaccine is given in double-blinded studies to patients who are at risk,” said Dr. Mercado. “Our human experience with this vaccine is 7 months, so unless we wait for a year, we would not know if there could be adverse effects of the vaccine on individuals a year after getting it.” As we wait for the vaccine, strictly following health safety protocols is the most effective defense we have against COVID-19. Always wear a mask, frequently wash and sanitize your hands and surfaces, and maintain a social distance of six feet from others. As much as possible, refrain from going out and meeting other people. Hawaii had a shortage of personal protective equipment (PPE) and PMAH provided $25,000 worth of imported face masks in which they dis-

COVID-19 Pandemic for Asian-Americans Hawaii’s lockdown orders pushed businesses on the brink of closure and left thousands unemployed. According to the Economic Policy Institute, the Asian unemployment rate in Hawaii is 21.9%. The COVID-19 pandemic has also exposed the mental health crisis in the Asian American community. The economy’s downturn, high unemployment rates and alarming rise of COVID-19 cases cause one-third of Americans to show signs of clinical anxiety and depression, according to the Bureau of Census. For many Asian Americans, physical and mental health visits, hospitalization and medicines are unaffordable, especially for those COVID-19 Vaccine, Safety without health insurance. In Protocols an American Association of Six months into the Retired Persons study, 20% of Quarantine, Health Services Dr. Rainier Dennis Bau- COVID-19 pandemic, the Asian American adults aged tista of Primary Care Clinic of 50 to 64 do not have health inHawaii also pointed out that HEALTHNEWS surance. there should be easy access for COVID-19 quarantine facilSending A Message PMAH strongly believes ities especially that there are that COVID-19 educational concerning household-level campaigns should be more ac- risks in the Filipino commuesearch shows that cessible in different languages nity. “Since multiple families one in six Americans especially for the at-risk comage 65 and older has a munity including Filipinos and can live in a single home, one Pacific Islanders. It’s also im- positive exposure can poten- vision impairment that cannot portant to hire contact tracers tially infect every member be corrected with glasses or who can speak different lan- of that household. Not every contact lenses alone. The risk member of the household has of eye disease increases with guages. “As people should be stay- their own room. Instructing age, yet many older adults ing home, TV, online media them to quarantine inside their neglect to see an ophthalmoland radio are very powerful. own home puts a lot of hard- ogist for care. The American We should strongly encourage ship on families,” Dr. Bautista Academy of Ophthalmology celebrates Healthy Agmasking, hygiene, and distanc- explained. Dr. Mercardo also supports ing Month to raise awareness ing in a manner that sounds this idea noting that “we need of the signs and symptoms of important,” said Dr. Ver. “There is a crucial im- to rethink how our cities and vision loss—and steps to help seniors take care of their sight. mediate need for contact communities are designed.”

Filipino Resiliency Filipinos are known for their resiliency especially during tough times. In a healthcare crisis comparable to the great influenza pandemic in 1917, the COVID-19 pandemic has truly changed our lives today and in the future. As COVID-19 cases continue rising, hospitals, healthcare providers and personnel are doing their best to take care of patients, ensuring that the community is safe. Burnout is becoming common in the healthcare industry. “Besides supporting the general community, PMAH supports our physicians with resources, education, and continued camaraderie,” Dr. Ver shared. To help relieve the burnout we are experiencing, Dr. Bautista said, “cooperating with our healthcare providers and our policymakers is of utmost importance.” Dr. Mercado hopes governments will realize and invest on the importance of public health. She stresses that surviving the pandemic “requires sacrifice and faith” but we need to do everything we can to prevent the spread of COVID-19. “Deep inside, I feel that God is rearranging our world, and it is important to stop and listen,” she said. “We are the solution to stopping the spread of COVID-19.” 

September is Healthy Aging Month

Taking Care of Our Eyes as We Age


“Many different conditions and diseases of the eye can affect our vision as we age. Some of the common age-related conditions include cataracts, glaucoma, macular degeneration, and diabetic retinopathy. Early detection and treatment is imperative in order to prevent severe vision loss from occurring,” said Steven Rhee, D.O., Cornea Specialist at Hawaiian Eye Center. Normal aging of the eye does not lead to low vision; it

is a result of eye diseases, injuries or both. Symptoms include loss of central and/or peripheral (side) vision, blurred or hazy vision, or night blindness. If you experience any of these problems, it is important to see your ophthalmologist, who will be able to check for and treat any underlying conditions. Most people with low vision simply require brighter lighting in their living areas. About half of all eye injuries occur in or around the (continue on S6)




SURVIVING COVID-101 By Glenn Wakai


arah Bolles relishes short walks around Salt Lake with her 13-yearold daughter Mia. While not a daunting feat for most, it is a miraculous activity for her. Six months ago, Bolles was in a coma at Kaiser Hospital Moanalua, one of Hawaii’s first COVID-19 victims and eventually one if it’s first survivors. She was born in California 35 years ago, then moved to Nevada before landing up in Hawaii. At age 8, she moved to Angeles City, Philippines, near Clark Air Force Base. She spent three years there and remembers having fun at a private school and learning to speak fluent Tagalog. Bolles would eventually return to Hawaii and attend Radford High School. She worked at Price Busters prior to landing a job at the Pearl Harbor Navy Exchange where she worked for the past 12 years. Life was comfortable. The first signs of trouble were headaches in midMarch. Within three days, Bolles developed a fever of 104.6 degrees. She already suffered from diabetes and asthma, which made her more

Covid-19 Survivor Sarah Bolles in the hospital and with her 13 year old daughter Mia before she tested positive for Covid-19 virus.

susceptible to contracting the COVID-19 virus. While waiting for her COVID-19 test results, Bolles experienced shortness of breath: “I just remember that day being at home and being scared and not being able to breathe. I thought, I have to call 9-1-1.” On Mar. 26, she was rushed to the emergency room. For three weeks, she was in a medically induced coma. Upon awakening, she recalls being fed through tubes, a multitude of injections, and an array of medications. During this ordeal, she lost 70 pounds.

As she recovered, Bolles went through a number of breathing exercises as well as physical therapy to regain her mobility. “At the time I could not walk, eat or even lift up my arms because I lost my muscle mass,” says Bolles. She wiped back tears and went on to say, “The biggest adjustment was feeling alone and secluded. I saw nurses and doctors, but no loved ones could come in. I thought about my family every day, especially my daughter. As a single mother, she was my motivation during my recovery to keep pushing.” In addition, Bolles credits her survival to the profession-

al staff at Kaiser and the drug Tocilizumab (a drug normally used to treat arthritis and cancer.) On May 5, six weeks after being admitted, Bolles was released from the hospital. She exited utilizing a walker. Since then she has quit smoking and eats much healthier meals. Bolles has 80% lung function and breathing will always be a challenge. “I am forever grateful and blessed to have survived,” she says. “I will always have scarring on my lungs and suffer from emotional scars.” She cannot get away from the daily updates on COVID-19 infection rates and

supplements, as well as your exercise, eating, sleeping and other lifestyle choices. Our eyes need good blood circulation and oxygen intake, and both are stimulated by regular exercise. Regular exercise also helps keep our weight in the normal range, which reduces the risk of diabetes and of diabetic retinopathy. Remember to use sun safety and protective eyewear when enjoying sports and recreation. As we sleep, our eyes enjoy continuous lubrication, allowing the eyes to clear out irritants such as dust, aller-

gens, or smoke that may have accumulated during the day. Some research suggests that light-sensitive cells in the eye are important to our ability to regulate our wake-sleep cycles. This becomes more crucial as we age, when more people have problems with insomnia. While it’s important that we protect our eyes from over-exposure to UV light, our eyes also need exposure to some natural light every day to help maintain normal sleep-wake cycles. Women are more likely than men to have glaucoma and women are also more

death toll. With the dramatic spike in cases in August, the disease is always haunting her. “I am constantly reminded everyday as cases are rising. It brings me back to when I was in the hospital,” says Bolles who acknowledges her struggle with Post Traumatic Stress Disorder. She is choosing to overcome her depression by facing her fears and focusing on helping others. Bolles utilizes social media to encourage everyone to wear masks, wash their hands frequently, and to physically distance. “Just think about the lives that you are saving when you are thinking about others and not just yourself,” she said. “We need to keep our hospital beds available for those who have other urgent health issues.” Bolles still suffers from mobility limitations. She cannot run, but she is making great strides forward. She has volunteered to take part in UH medical research and will be doing public service announcements for the Department of Health. “My outlook on life is different, I have a stronger faith in God. A closer bond with my daughter and family,” says Bolles. “I feel He guided me back to life, to give me a second chance to do better both physically and mentally. To share my story, in hopes that it makes a difference in the world.”  GLENN WAKAI is a State Senator and former TV news reporter.

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home, 44% during improvement projects. The good news is that nearly all eye injuries can be prevented by using protective eyewear, so every household should have at least one pair of certified safety glasses or goggles on hand. Because falls become more common with aging, it is important to take specific measures to reduce this risk. Consider taking these safety steps around the home to diminish the risks of injuring your eyes: • Make sure that rugs and shower/bath/tub mats are slip-proof.

• Secure railings so that they are not loose. • Cushion sharp corners, edges of furnishings and home fixtures. Systemic health problems like high blood pressure and diabetes that may be diagnosed or become more problematic in midlife can also affect eye health. One warning sign of both high blood pressure and diabetes is when the ability to see clearly changes frequently. Be sure to keep your ophthalmologist informed about your health conditions and use of medications and nutritional

likely to be visually impaired or blind due to glaucoma. Cataracts are also somewhat more common in women— and less likely to be treated. Women should be sure to adhere to their ophthalmologist’s follow-up appointment recommendations and treatment plans. Finally, it’s important to have a complete eye exam with your ophthalmologist every year or two after age 65 to check for age-related eye diseases such as age-related macular degeneration, diabetic retinopathy, glaucoma, cataracts, and other eye conditions.




How HPV Vaccine Prevents Future Cancer By Hazel Abinsay, M.D.


hat is HPV? HPV, or the human papillomavirus, is a very common virus. HPV has many different strains or types of the virus, but the most common ones are HPV 6, 11, 14, and 18. Some strains are higher risk and can cause cancer. In both men and women, HPV can cause genital warts, oral cancer, and anal cancer later in life. In women, HPV can cause cervical cancer. Cervical cancer screening is performed with pap smears in which samples of cells from the cervix are collected with a small brush. HPV is tested on pap smears as 9 out of 10 cases of cervical cancer are caused by HPV, which is about 11,000 yearly cases in the United States. Every year, nearly 200,000 women are diagnosed

with precancerous changes of the cervix. Over 4,000 women die of cervical cancer every year. HPV is also important in prenatal testing. In men, HPV can cause penile cancer and the other cancers as above. In the United States, over 14,000 men can get these HPV-related cancers yearly. How is HPV transmitted? When we think of sexually transmitted diseases (STD), we often think of chlamydia, gonorrhea, syphilis, or HIV. These diseases are treated with medications. However, HPV is actually the most common sexually transmitted infection. Both men and women can get HPV. It is spread through vaginal, anal, or oral sex. Patients who have HPV may spread HPV to their partners. It is often silent and does not cause any symptoms.

About 80% of sexually active people are infected with HPV at some point in their lives. There is no real way to tell which people have HPV, who will develop cancer or other health problems in the future. If there are symptoms, the most common presentation is genital warts, but signs of infection can appear weeks, months, or even years after initial infection. Is there a cure for HPV? There is no scientifically proven treatment or medication to kill the HPV virus. Your body’s immune system naturally can help fight the virus and eventually clear it. Medications can help symptoms like genital warts go away. Cancers can undergo appropriate treatment. However, depending on the strain of HPV, the virus can linger in the body for years.

What is the HPV vaccine? The HPV vaccine is one of the newest vaccines recommended for children. The HPV vaccine helps to protect a person from the most common strains – HPV-16 and -18, which account for 70% of cervical cancers, and HPV6 and -11, which cause about 90% of genital warts.

Many parents think that their child won’t become sexually active for a very long time so therefore won’t be at risk for HPV. However, according to the Centers for Disease Control (CDC), the average age for first sexual intercourse for both boys and girls is 17 years old. With that being said, pediatricians strongly encourage all patients to receive this vaccine as early as possible before they become sexually active or exposed.

Why is there some hesitation to receive the vaccine? Some parents hesitate to consent for their pre-teen or What are the vaccine recomteenager to receive a vaccine mendations? (continue on S10) that is associated with sex.




What is the best way to educate our children today during the COVID-19 pandemic? CAROLYN HILDEBRAND

Graduate Student, Urban and Regional Planning, University of Hawaii at Manoa, Ewa Beach “Pandemic or no pandemic, our communities will be more resilient in meeting the uncertain future if we pivot with three AIs - Ancestral Intelligence, Artificial Intelligence, and Appreciative Inquiry. In oversimplified terms, the best way to educate is to consider the context of the individual learner and provide the education that can be gained from nature or outdoors as well as from online or virtually. These are directed to hone intuition, smartness, and community-orientedness. Nurture curiosity, confidence, and care in facing and shaping the future. A sense of stability is helpful but there are barriers and impediments to this. As far as online learning, it can be more stabilizing to commit to it for the entirety of the school year instead of changing course every time the COVID19 situation changes. As far as non-virtual, it is a good time to nurture hands-on, do-it-yourself projects. The Hawaiian renaissance is showing the way as far as the first AI while we have to look at Asia and its much younger population for the second AI. At its core, the third AI is about just ways where education should not worsen the gaps between disadvantaged and privileged children. Stay safe and healthy.”


Retired Professor, Leeward Community College, Ewa Beach “We have always assumed that the curriculum prepared by the schools is the best and only appropriate curriculum for our children. This is not necessarily true. Our children need to be taught love for work, responsibility, cooperation, recognition and respect for diversity, problem-solving, and other similar humanizing values. These are lessons that can be taught and strengthened at home, hands-on. Parents can sit down and plan with their children a “practical and experiential” curriculum, create a schedule, and implement (perhaps “enforce”) them. Assign the kids tasks at home-like cleaning the house, washing the dishes or watering the plants. Make the tasks fun and collaborative, not simply assigning them like work to be done. Group activities like sharing stories, family weekend evening programs, cooking a dish or doing an art project are helpful tasks that can teach children multiple skills. The COVID-19 pandemic can be an opportunity to teach our children lessons that have been relegated to the back seat by traditional school curriculum. It’s an opportunity for parents and family members to reclaim a fundamental right and responsibility to mold children into becoming the best persons they envision them to be.”




Living the Long and Loving Life with 95 Year-old Lola

Filipina Caliboso

By Jim Bea Sampaga


t 95 years old, Lola Filipina Caliboso has been living her life filled with love and care. She’s funny, friendly, kind and helpful. She’s selfless despite what she had to go through during her childhood. Born on Jan. 2, 1925, Lola Filipina grew up in Rosales, Pangasinan with her older sister, Pacita. Their lives changed when their mother Irenea passed away when they were still young. Lola Filipina still remembers the moment their grandmother took her and left her at her Aunt’s place to live.

Growing Up in Pangasinan “I sat on the stairs [of my Aunt’s house] waiting for my grandmother, but she never returned. I was told later that this was my mother’s wish, for me to live with my aunt and her family. It was hard and tough living with my mother’s sister,” Lola Filipina recalled. Lola Filipina’s Aunt and Uncle didn’t support her education. She worked around the house and earned her own money just so she could attend elementary school. “[They] didn’t support me even just for one centavo to buy for my school supplies. I had to earn it myself,” she said. “Not just my Aunt but her husband is also abusive.” In her childhood, Lola Filipina suffered bruises and wounds from enduring the physical abuse from her Aunt and Uncle. Her elementary best friend would cry and pity her every time she would see her bruises. Passion for Education Despite having no support for her education, Lola Filipina was an active elementary student and leader at Villasis Central School. She loved going to school and interacting with her classmates and teachers. Instead of playing around,

she spent time with her teachers and helping them keep things in order around the classroom. She enjoyed learning about catechism and prioritized finishing her homework early. Lola Filipina’s love, dedication and passion for education didn’t stop after she attended school. She made sure to pass the same values and passion to her children and grandchildren. She believes that having a good education will give them better opportunities in life. When her children were young, she always made sure that they focused in school to achieve a good education. With her grandchildren, she built a relationship with them with her outgoing and funny attitude. She used to play with them, acting as if she was their age. As a hands-on grandmother to her grandchildren, she taught them the basics such as the alphabet and counting numbers before they even started going to kindergarten. One of her grandchildren would even tell her kindergarten teacher that her real teacher was her Lola Filipina.

Raising her two children in Ifugao Lola Filipina married a soldier at age 21 and had two children, daughter Pat Mencias and son Romeo Caliboso. She became a widow at age 28 and had to raise her two children on her own. The thought of remarrying never crossed her mind. Lola Filipina didn’t want her children to suffer and be treated differently as stepchildren, Filipina Caliboso at 95 years old. She will turn 96 years similar to what she had gone old on Jan. 2. through in her childhood. She also owned a coffee is her dignity and being help“She didn’t need a man in her life. She has us and we shop in Lamut. People used to ful to others,” Pat said. “She’s were a blessing to her. She call her “coffee lady” for be- very religious, hard-working worked hard and made a lot of ing the first one to introduce and kind.” sacrifices raising us,” said her that type of business in the Moving to Hawaii daughter Pat, who is now 71 area. In 1981, Lola Filipina imLola Filipina was also an years old. Lola Filipina and her chil- active member of the Catholic migrated to Hawaii when her dren moved to Lamut, Ifugao Women’s League in the Philip- daughter Pat petitioned her to after her older sister Pacita’s pines. According to Pat, Lola help with babysitting. Evenpersistence and constant nudg- Filipina enjoys helping the tually, she was able to petiing. In Lamut, she had a small community through activities tion her son Romeo who now sari-sari store (convenient such as visiting the sick, hold- lives in Seattle. She has seven store) and a buy and sell rice ing family prayers, fundraising grandchildren and eight great and corn business which helped and being active in church ac- grandchildren with one on the her raise and support her two tivities during the Holy Week. way in October. Currently, she lives with “The traits that I look up children’s education until they to the most about my mother Pat and her husband in Waipagraduated from college.

hu. Lita Segui, the daughter of Lola Filipina’s older sister Pacita, has also been living with them for the past four years. Pat petitioned her mother so she can experience and enjoy life in the US after working hard in the Philippines. “She worked hard raising me and my brother, assuming both roles of father and mother. It’s time for her to enjoy life here in the US,” Pat shared. “I love Hawaii and still like living here. I also traveled to Seattle, Washington to visit relatives. I’ve also been to Edmonton, Alberta, Canada and visited my sister Pacita Cawagdan, nieces and nephews and their families,” Lola Filipina shared. Lola Filipina held different jobs across Oahu. She worked at the Tuna Canning Factory in Waikiki in 1983 and at a burger stand along Ala Moana Beach Park. She was a housekeeper for a while for a family in Hawaii Kai. She was a dishwasher at the Cocina Kitchen in Dillingham Boulevard. She also started cooking and selling Filipino desserts such as puto (Filipino steamed cake) that people often ordered for parties. Known as the “puto lady,” she stopped cooking Filipino desserts for orders in 2017.

Living a long and healthy life According to the World Health Organization, the average life expectancy of Filipinos are 66 years old for men and 73 years old for women. Lola Filipina is turning 96 years old on Jan. 2. “I am truly grateful to God for giving me good health and strength every day,” she said. “I am most thankful to God for giving me my life. I was able to raise my kids on my own without anyone’s help. I was able to help other people whenever I can without expecting anything in return.” To keep up with her active lifestyle during her adulthood, Lola Filipina makes sure that she’s active and healthy at home, even during the COVID-19 pandemic. According to Pat, she has a set routine (continue on page 10)




VA Health Team Heading to COVID-Struck Hilo Veteran Care Home After Urgent Request From Schatz


.S. Senator Brian Schatz (D-Hawaii) announced on Sept. 11 that the U.S. Department of Veterans Affairs (VA) will be sending a team of infection control experts, nurses and other health care professionals to provide support in containing the COVID-19 outbreak at the Yukio Okutsu State Veterans Home in Hilo. “This medical team will be a big help in containing the outbreak happening on the Big Island,” Schatz said. “More help is on the way. My staff and I will continue working with the VA and state and local officials to make sure we are utilizing all the federal help that’s available.” According to the media release, the details of the VA mission include an onsite assessment of Yukio Okut-

su State Veterans Home for infection control issues and recommendations for “interventions, processes and procedures to address an outbreak of COVID-19.” In a letter urging for federal intervention, Schatz wrote, “I am concerned that the state and county have been too slow to respond to the crisis with the urgency it demands, including with a request for more federal assistance.” As of Sept. 13, 66 residents and 28 employees tested positive for COVID-19 while there has been a total of 12 deaths. In a news conference, Hawaii island Mayor Harry Kim said care home owner Avalon Healthcare Group and the state are responsible for the outbreak. According to the company’s contract tracing, it shows

(ASK A DOCTOR: How HPV Vaccine....from S7)

The CDC recommends that the HPV vaccine be given to pre-teens (both boys and girls) as part of the immunization schedule. It is routinely given as part of the 7th grade required vaccines around the age 11-12. The most common side effects associated with this vaccine are arm pain, redness, and swelling to the injection site. Some teenagers may faint after the vaccine but usually recover without issues. This vaccine is not recommended for everyone older than 26 years old, as it may not be as effective due to likely HPV exposure in adulthood. Is the vaccine effective? Since the introduction of the HPV vaccine in 2006, there has been a dramatic decrease in the number of cervical cancer patients diagnosed yearly. Cervical cancer was once the leading cause of cancer deaths in women in the United States. However, with cervical cancer screening and the HPV vaccine, it is now one of the most preventable cancers. Early vaccination can prevent over 90% of these HPV-related cancers. What should we do? We need to raise awareness that HPV-related cancers can be preventable, if we vaccinate against HPV early. If you are a parent, I strongly recommend HPV vaccination for your children, as it affects their future health. In general, men and women should seek medical care if they notice any abnormal growths in their mouths or genital areas. Women should have routine Pap smears as recommended by their doctors. High risk men, such as men with HIV or those who receive anal sex, should also inquire with their physician about anal Pap smears. Lastly, we need to appreciate that many years of testing this vaccine through proper science has made a significant impact to women’s (and men’s) health. DR. HAZEL ABINSAY is a pediatrician practicing in Kalihi and Ewa Beach. She is a board member of the Philippine Medical Association of Hawaii.

that the virus reached the facility through an asymptomatic staffer and a resident who was exposed at a Hilo dialysis center. “The second we learned, we were doing proactive measures certainly following all the CDC guidance as evidenced by such a long history of negative tests,” an Avalon Healthcare Group spokeswoman said. Aside from its Hilo nursing home, Avalon’s two other nursing homes in Honolulu, Avalon Care Center and Hale Nani Rehabilitation & Nursing

Center, are also struck with rising COVID-19 cases. In a letter to Avalon Healthcare Group, Schatz calls on The Yukio Okutsu State Veterans Home in Hilo the company to “review and resolve any deficiencies that improve infection control prac- could results in the spread of tices” as COVID-19 continue to COVID-19,” he wrote. “Residents of nursing persists at its three care homes. “I urge you to immediate- homes are some of the most ly review the practices, and vulnerable to COVID-19, and in particular the staffing and each Avalon facility needs infection control practices at to be sufficiently prepared to your facilities in Hawai`i and keep its residents and staff safe in other states to identify and during the pandemic.” 

(FEATURE: Living the Long....from S11)

like sweeping around the house and doing the laundry either by hand or using the washing machine. “Upon waking up in the morning, I drink my coffee, eat my breakfast, and then clean up after breakfast, mop floor if needed, and then go outside. Sweep outside the yard and water my plants. I usually go back inside the house when I’m done,” Lola Filipina explained. “I wash up and then sit down to either watch TV or call friends to catch up on the phone. I make sure to take my medicine after lunch.” Aside from doing various chores around the house, Lola Filipina’s energetic sense of humor keeps her moving. The house is always filled with laughter and entertainment every time she starts swaying her hips and showing her graceful movements in dancing. When asked about her secret for living a long and healthy life, she shared that she eats her meals regularly. “I usually eat Cheerios or bread with eggs for breakfast along with my coffee. My diet since I was young usually consists mostly of vegetables and fish. I seldom eat meat, Lola Filipina shared. “Eat more vegetables, less or no meat at all. Eat less rice.”

Caring for the Elderly Pat and Lita emphasized the importance of patience

Lola Filipina with her 71-year old daughter Pat Mencias.

when caring for the elderly. “Always be patient with the elderly when taking care of them. Listen to their life stories even if they repeatedly tell you about it,” said Lita, Lola Filipina’s niece. For Pat, patience and respect goes hand in hand. “Hear and listen to them. Say less and don’t argue with them. They have a set mind,” she said. They also make sure to care for Lola Filipina, especially now that we’re experiencing a pandemic. “I do the shopping for her according to her likes or taste: more vegetables, fish and soup. I make sure she has her bananas and not run out of her Ensure,” Pat said. “I make sure that she’s eating well. I cook for her and keep her company,” Lita added.

For her 96th Birthday As Lola Filipina looks forward to her 96th birthday in January, Pat shares a message she would like to say to her mother. “Thank you for everything you did for me and my brother, raising me for what I am today,”

Pat said. “You are a hard-working and loving mother. You always think of our welfare as well as Manang Lita, her sibling and children and other people.” Pat extends her thanks to her Aunt Pacita, Lola Filipina’s sister. Aunt Pacita’s persistence of having them move to Lamut, Ifugao from Pangasinan greatly helped their family. “We were raised in a nurturing environment with so much love and support. Aunt Pacita’s love for each other as sisters was inculcated in my heart–loving, kind and always looking out for each other’s welfare,” Pat shared. Pacita’s daughter, Lita, thanks Lola Filipina for treating her like a daughter. “She’s kind to us and helpful to others as well. I learned so much from her. She provides good advice to anyone who seeks for help morally, spiritually, mentally and financially,” Lita said. When asked about her message for Hawaii Filipino Chronicle readers about living one’s life and staying healthy and active on their senior years, Lola Filipina said, “Pray and be thankful each day. Eat healthily. Smile and always have a happy face, have a sense of humor in life. God is Love. Love your neighbor as you love yourself.” 




Gallstones and Gallbladder Disease By Ross SImafranca, M.D.


hat is a gallbladder? T h e gallbladder (GB) is a small balloon located under the right side of the liver, right underneath the rib cage. It is a storage tank for bile, which is a fluid that the liver makes to help digest fats. Bile is transported from the liver and GB through a tube called the common bile duct (CBD). The CBD empties into the small intestine where it mixes with food to aid in digestion. There is a muscle at the end of the CBD that closes off when we are not eating. This forces the bile to then back up into the gallbladder for storage. When we eat, the signals of digestion relax the muscle, allowing the bile to enter into the intestine, as well as squeezes the gallbladder for emptying. What are gallstones? Bile is made up of a few different components. When there is an over abundance of a certain component, usually cholesterol, they tend to clump together forming what is called GB sludge and then progressing further to form gallstones. Gallstones are rocks that can vary in size from tiny grains of sand to golf balls. How do I get gallstones? A few risk factors that seem to be associated with developing gallstones include: female, obesity (likely due to high levels of fats in the blood), pregnancy (likely from hormonal changes), rapid changes in weight, and age (the risk of developing gallstones increases with age; by age 75, 35% of women and 20% of men have gallstones). What types of symptoms do people with gallstones have? Not all people with gall-

stones will have problems. However, the usual presentation is upper abdominal right sided pain, sometimes traveling to the back. Many patients also complain of nausea or vomiting. They feel bloated and have no appetite. If the GB inflammation progresses, they may begin to have a fever or chills. These symptoms usually start within a few hours of eating a fatty meal. This is because when the gallbladder is squeezed for digestion of fatty foods, the stones can cause irritation of the gallbladder, or the stones can get stuck. The stones can get stuck in the GB, on the way out through the tube, or get stuck in the tube. Sometimes the stones get stuck in the tube that drains the pancreas, and patients can present with pancreatitis. Symptoms of pancreatitis include severe back pain or yellowing of the eyes or skin called jaundice. Many times, the stone unplugs itself from blocking the GB and flow is reestablished and the symptoms resolve over a few hours or so. This is called biliary colic. Unfortunately, the stones don’t just disappear. If you’ve experienced a painful episode once; it is highly likely that you’ll experience another, and another, and another. What is the treatment for gallstones? If symptomatic, then the entire gallbladder should be removed surgically. A cholecystectomy is mostly done using a laparoscopic approach, in which small incisions and a camera are used to remove the gallbladder. If we are unable to do it that way for whatever reason, then a larger incision (‘open’ approach) in the right upper abdomen under the ribs is required. If you’ve developed gallstones but have never had symptoms before, it would

probably be fine to hold off on surgery but close monitoring is highly recommended. I would also suggest eating a low fat, high fiber diet and continue to maintain a routine exercise schedule. Unfortunately, many patients have fallen victim to various non-surgical cures advertised on the internet claiming that the stones can be dissolved if only you drink a certain dietary blend of liquids. I recommend caution in trying these homemade remedies, not because they’re dangerous; but primarily because they just don’t work. In fact, in my practice, some patients try these alternative therapies, with no changes in follow-up GB ultrasounds. They usually end up having surgery for symptoms.

ER with maybe fever/chills, having an elevated infection count on their blood test, evidence of acute inflammation on some imaging test, and those needing to have emergency surgery, postoperative hospitalization may be needed.

How long is surgery and what is the recovery like? Symptomatic patients who have delayed surgery and whether or not the gallbladder is actively inflamed plays a role in the difficulty of surgery. Each time a patient has a painful episode, the GB gets thicker and scarred which can make surgery much more challenging. On average, a laparoscopic cholecystectomy takes about 30-90 minutes. Most outpatients go home the same day with prescriptions for pain medicine, stool softener, and maybe even a medicine for nausea. For those patients who are actively in pain, being seen in the

Are there any risks and side effects of having gallbladder surgery? Any surgery has risks including bleeding, pain, scars, injury to other nearby structures, and need for further surgery or procedures. For the most part, those risks are minor and quite rare and shouldn’t be the reason to delay or not have surgery altogether. Gallstones can develop into a life threatening condition and shouldn’t be taken lightly.

How long will I have to be out of work? Most patients can expect to be out of work anywhere from 2-4 weeks depending on how active their job is. I usually recommend no heavy lifting >10-15lbs, no strenuous exercise/activity, and no swimming/bathing for 2-3 weeks. The incisions need time to heal and doing too much too early will likely cause more pain and increase the risk of complications.

Many patients ask if there are any dietary restrictions after the surgery. Most patients actually see little change in their bowel movements. However, some do develop loose stools after eating oily/ fatty foods. Everyone reacts differently though. Some patients can have ice cream while others can’t. It all sort of depends on how each person’s body reacts. I encourage patients to avoid spicy or fatty foods at least for about 2 weeks and then to slowly introduce in small amounts different types of foods and see how their body responds. What are the risks if I don’t have surgery? We strongly recommend having surgery for symptomatic gallstones. If there is a delay, it is important to know the possibilities of what could happen. Usually, symptoms get worse over time. Pain increases in severity. Episodes may begin to last longer than usual and they may occur more frequently. As mentioned before, each episode of inflammation causes scarring of the GB to some degree. This could make things much more difficult during surgery thereby increasing the chance of open surgery which also increases the risk of having complications and possibly more procedures. Therefore, it is much safer to have surgery when the GB is not acutely inflamed. Waiting until a GB infection and having to have emergency surgery increases the risk of complications. Lastly, repeated bouts of GB inflammation increases the risk of developing GB cancer, which carries with it an extremely poor prognosis.

DR. ROSS SIMAFRANCA is a general surgeon practicing in West Oahu since 2007. He finished his medical degree at UH -JABSOM and general surgery residency at UH Department of Surgery. He currently serves on the Philippine Medical Association of Hawaii Board of Governors.


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