Death of a General

Wake of the retired general Angelo Reyes

Depression and Suicide


On February 8, 2011 the whole Philippines was stunned by the sudden death of the retired General Angelo T. Reyes.  He committed suicide in front of his mother’s tomb by shooting himself on the chest. His death brought an end to a political career marked with controversy, culminating in a corruption scandal that involved at least 3 former military chiefs during the Arroyo administration. He was 65 y.o.

What could have prompted Reyes to end his life? I had the impression of him being tough. He was never seen smiled in public.

First of all, who was Gen. Angelo Reyes? Angelo Reyes was born to a family of teachers. He exhibited excellence in academics by graduating a valedictorian in high school and 7th in his class in the Philippine Military Academy. He became a decorated military officer. He was appointed as Chief of Staff during Estrada administration in 1999, but gained national attention with his role in the EDSA 2 revolution, thus gaining the favor of Gloria Macapagal-Arroyo. He continued to occupy the post of Chief of Staff until 2001, after which he was appointed to various cabinet posts:  Secretary of Department of National Defense (2001-2003), Secretary of Department of Interior and Local Government (2004-2006), Department of Environment and Natural Resources (2006-2007), and Department of Energy (2007-2010).  His political career ended together with the end of Gloria Arroyo’s presidency. His bid to run for Congress failed due to disqualification case filed against him.

Two weeks ago in lieu of the accusation by his former military budget officer George Rabusa of him pocketing P50 million in military funds upon his retirement as AFP chief in 2001, he was summoned to the senate to testify. After the hearing he admitted on interviews that he was hurt by the harsh interrogation and insults hurled at him in the senate. He was publicly humiliated. Senate inquiries, especially on controversial issues are broadcasted live on national TV. His wife recounted how she saw the agony on his face when he came home on that day. According to his lawyer Bonifacio Alentajan, Reyes appeared disturbed and had lost some weight after the said incident. Few days before his death, as if imparting a farewell message he told his wife and children to be strong and to take care of each other. Experts said, those were the signs of depression.

So what is depression?

Depression is more than sadness or blues that we experience in our day to day lives. Some describes it as a ‘black-hole or a feeling of impending doom.  It is a sadness that doesn’t disappear. It engulfs your day-to-day life, interfering with your ability to work, study, eat, sleep, and have fun. The feelings of helplessness, hopelessness, and worthlessness are intense and unrelenting, with little, if any, relief.

Major depression is a disease that impacts approximately 5% of people globally. In 2004, Americans were found to be the most depressed population

Physiology of depression

For three decades scientists have attributed a chemical imbalance in the brain as the source of major depression. Mood-related chemicals such as serotonin, norepinephrine and dopamine– are low in the brain during major depressive episodes. In a study by Dr. Jeffrey Meyer results showed that brain monoamine oxidase A (MAO-A) — an enzyme that breaks down chemicals like serotonin, norepinephrine and dopamine– was higher in those with untreated depression. On average, MAO-A was 34% higher. Having more MAO-A leads to greater breakdown of key chemicals like serotonin.”

Depression is also being linked to Some structural abnormalities in the amygdala, basal ganglia and prefrontal cortex.

PET (Positron Emission Topography) and SPECT (Single Proton Emission Computed Topography) scans are two types of brain scans which show how active or inactive the different areas of the brain are. PET scans of depressed brains compared to normal ones show a significant reduction in overall brain activity. This is why everything seems ten times harder when you're depressed and why it's much harder to concentrate and remember things.

PET scans of depressed and normal brains

Causes and Risk factors of Depression

• Loneliness
• Lack of social support
• Recent stressful life experiences
• Family history of depression
• Marital or relationship problems
• Financial strain
• Early childhood trauma or abuse
• Alcohol or drug abuse
• Unemployment or underemployment
• Health problems or chronic pain

Signs and Symptoms of Depression

• Feelings of helplessness and hopelessness. A bleak outlook—nothing will ever get better and there’s nothing you can do to improve your situation.
• Loss of interest in daily activities.  No interest in former hobbies, pastimes, social activities, or sex. You’ve lost your ability to feel joy and pleasure.
•  Appetite or weight changes. Significant weight loss or weight gain—a change of more than 5% of body weight in a month
•  Sleep changes. Either insomnia, especially waking in the early hours of the morning, or oversleeping (also known as hypersomnia).
• Irritability or restlessness. Feeling agitated, restless, or on edge. Your tolerance level is low; everything and everyone gets on your nerves.
• Loss of energy. Feeling fatigued, sluggish, and physically drained. Your whole body may feel heavy, and even small tasks are exhausting or take longer to complete.
• Self-loathing. Strong feelings of worthlessness or guilt. You harshly criticize yourself for perceived faults and mistakes.
• Concentration problems. Trouble focusing, making decisions, or remembering things.
•  Unexplained aches and pains. An increase in physical complaints such as headaches, back pain, aching muscles, and stomach pain.

Depression and Suicide

Depression is a major risk factor for suicide. The deep despair and hopelessness that goes along with depression can make suicide feel like the only way to escape the pain. Thoughts of death or suicide are a serious symptom of depression, so take any suicidal talk or behavior seriously. It's not just a warning sign that the person is thinking about suicide: it's a cry for help.

Warning Signs of Suicide include:

• Talking about killing or harming one’s self
• Expressing strong feelings of hopelessness or being trapped
• An unusual preoccupation with death or dying
• Acting recklessly, as if they have a death wish (e.g. speeding through red lights)
• Calling or visiting people to say goodbye
• Getting affairs in order (giving away prized possessions, tying up loose ends)
•  Saying things like “Everyone would be better off without me” or “I want out.”
• A sudden switch from being extremely depressed to acting calm and happy.

Treatment of Depression

Treatment of depression varies on each individual. No one treatment is appropriate in each cases. The underlying cause of depression must first be established to overcome the problem. In most cases, the best approach involves a combination of social support, lifestyle changes, emotional skills building, and professional help.

How can you help a friend or relative who is depressed?

The first and most important thing you can do to help a friend or relative who has depression is to help him or her get an appropriate diagnosis and treatment. You may need to make an appointment on behalf of your friend or relative and go with him or her to see the doctor. Encourage him or her to stay in treatment, or to seek different treatment if no improvement occurs after six to eight weeks.

To help a friend or relative:

• Offer emotional support, understanding, patience and encouragement.
• Engage your friend or relative in conversation, and listen carefully.
• Never disparage feelings your friend or relative expresses, but point out realities and offer hope.
• Never ignore comments about suicide, and report them to your friend's or relative's therapist or doctor.
• Invite your friend or relative out for walks, outings and other activities. Keep trying if he or she declines, but don't push him or her to take on too much too soon. Although diversions and company are needed, too many demands may increase feelings of failure.
• Remind your friend or relative that with time and treatment, the depression will lift.

What do you need to do if you are depressed?

If you have depression, you may feel exhausted, helpless and hopeless. It may be extremely difficult to take any action to help yourself. But it is important to realize that these feelings are part of the depression and do not accurately reflect actual circumstances. As you begin to recognize your depression and begin treatment, negative thinking will fade.

To help yourself:

• Engage in mild activity or exercise. Go to a movie, a ballgame, or another event or activity that you once enjoyed. Participate in religious, social or other activities.
• Set realistic goals for yourself.
• Break up large tasks into small ones, set some priorities and do what you can as you can.
• Try to spend time with other people and confide in a trusted friend or relative. Try not to isolate yourself, and let others help you.
• Expect your mood to improve gradually, not immediately. Do not expect to suddenly "snap out of" your depression. Often during treatment for depression, sleep and appetite will begin to improve before your depressed mood lifts.
• Postpone important decisions, such as getting married or divorced or changing jobs, until you feel better. Discuss decisions with others who know you well and have a more objective view of your situation.
• Remember that positive thinking will replace negative thoughts as your depression responds to treatment.

References:

1. Death of a general: Who was Angelo Reyes?ABS-CBN News
2. Depression. National Institiute of Mental Health
3. Understanding Depression. Help Guide
4. Physiology of depression. Hard to Swallow  
5. How Depression Works/ Discovery Health
6. Depression’s Chemical Imbalance Explained/PscheCentral

Related Article:


Gen. Angelo Reyes, an honorable man

Are you having abnormal bleeding?

How to recognize cervical cancer

It happened several years ago during one of my night duties as a resident doctor at Laguna Doctor’s Hospital. The images of that scene are still vivid in my mind. A woman clutching a blanket between her thighs was brought into the emergency room. The cloth was all soaked in blood. She was bleeding profusely. Cervical cancer was the cause of her suffering. That’s how dreadful this disease is.

In the Philippines women usually do not go for cervical screening as part of their routine medical check-ups. Most see a doctor only when they already have symptoms, which is indicative of advanced stage. This can be attributed to economic factors and the apparent lack of awareness campaign on cervical cancer in the country. Lack of knowledge about cervical cancer can lead to late diagnosis and death.

Facts and data  on cervical cancer:

• According to WHO cancer of the cervix uteri is the second most common cancer among women worldwide, with an estimated 529,409 new cases and 274,883 deaths in 2008.
• The disease is the second or third most common cancer among women (cervical cancer and colorectal cancer are virtually tied for second place after breast cancer).
• About 86% of the cases occur in developing countries, representing 13% of female cancers.
• In Asia Pacific, about 266,000 cases of cervical cancer are diagnosed each year, with 140,000 women dying from the disease. It is the second most common female cancer in the region – where a woman dies of cervical cancer every 4 minutes.
• Each year, approximately 12,000 women in the United States get cervical cancer. In 2010 4210 was the reported death from it.
• Cervical cancer ranks as the 2nd most frequent cancer among women in the Philippines, and the 2nd most frequent cancer among women between 15 and 44 years of age.

What is cervical cancer?

The cervix is the lower, narrow end of the uterus. The cervix connects the vagina (birth canal) to the upper part of the uterus. The uterus (or womb) is where a baby grows when a woman is pregnant.

Cervical cancer is an abnormal growth that forms in tissues of the cervix. It is usually a slow-growing cancer that may not have symptoms but can be found with regular Pap tests (a procedure in which cells are scraped from the cervix and looked at under a microscope).  All women are at risk for cervical cancer.

Joey Albert, a cervical cancer survivor

Like all cancers, cancer of the cervix is much more likely to be cured if it is detected early and treated immediately. A classic example of a cervical cancer survivor is Joey Albert, a famous Filipina pop and jazz singer in the 80's.

What are the causes and risk factors of cervical cancer?

Human Papilloma Virus (HPV)

HPV is the main cause of cervical cancer. Because HPV can be transmitted by sexual contact, early sexual contact and having multiple sexual partners have been identified as strong risk factors for the development of cervical lesions that may progress to cancer.

Cigarette smoking

The chemicals in cigarette smoke interact with the cells of the cervix, causing precancerous changes that may over time progress to cancer.

Oral contraceptives

The pill may increase the risk for cervical cancer, especially in women who use oral contraceptives for longer than 5 years.

What are its symptoms?

Early cervical cancer usually has no symptoms. In most instances signs do appear when the cancer is more advanced. This does vary from woman to woman. You need to report to your doctor immediately if you experience any of the following:

• Abnormal bleeding. Women with cervical cancer may experience abnormal vaginal bleeding. This can be heavy or light bleeding during the month. 
• Unusual heavy discharge. An increased vaginal discharge is also a symptom of cervical cancer. It may be foul smelling, watery, thick, or contain mucus.
• Pelvic pain. Pelvic pain that is not related to the normal menstrual cycle can be a cervical cancer symptom. Many women describe them ranging from a dull ache to sharp pains that can last hours. It can be mild or severe. 
• Pain during urination. Bladder pain or pain during urination can be a symptom of advanced cervical cancer. This cervical cancer symptom usually occurs when cancer has spread to the bladder. 
• Bleeding between regular menstrual periods, after sexual intercourse, douching, or pelvic exam. Bleeding after sexual intercourse, douching, or pelvic exam can be cervical cancer symptoms. This is due to the irritation of the cervix during these activities. While a healthy cervix may have a very small amount of bleeding, many conditions may cause bleeding after activities like sex.

How is cervical cancer detected?

The Pap smear is the most common screening test. Because of the Pap smear test, the number of cervical cancer cases has dropped over the past twenty years.

The American Cancer Society recommends the following guidelines for early detection:

• All women should begin cervical cancer screening about three years after they start having sexual (vaginal) intercourse. A woman who waits until she is over 18 to have sex should start screening no later than age 21. A regular Pap test should be done every year. If the newer liquid-based Pap-teast is done, testing can be done every two years.
• Beginning at age 30, women who have had three normal Pap test results in a row may be tested every 2 to 3 years. Some women should continue getting tested yearly, such as those who were exposed to DES before birth and those with weakened immune system (with HIV infection, organ transplant, chemotherapy and chronic steroid use.)

How to reduce the risk of cervical cancer

1.   Get a regular Pap smear. The Pap smear can be the greatest defenses for cervical cancer. The Pap smear can detect cervical changes early before they turn into cancer

2.   Limit the amount of sexual partners you have. Studies have shown women who have many sexual partners increase their risk for cervical cancer. They also are increasing their risk of developing HPV, a known cause for cervical cancer. 

3.   Quit smoking or avoid secondhand smoke.Smoking cigarettes increases your risk of developing many cancers, including cervical cancer. Smoking combined with an HPV infection can actually accelerate cervical dysplasia. Your best bet is to kick the habit.

4.   If you are sexually active, use a condom. Having unprotected sex puts you at risk for HIV and other STD's which can increase your risk factor for developing cervical cancer. 

5.   Follow up on abnormal Pap smears. If you have had an abnormal Pap smear, it is important to follow up with regular Pap smears or colposcopies, whatever your doctor has decided for you. If you have been treated for cervical dysplasia, you still need to follow up with Pap smears or colposcopies. Dysplasia can return and when undetected, can turn into cervical cancer. 

6.   Get the HPV vaccine. If you are under 27, you may be eligible to receive the HPV vaccine, which prevents high risk strains of HPV in women. The HPV vaccine, Gardasil, was approved by the US FDA to give to young girls as young as 9. The vaccine is most effective when given to young women before they become sex. The available brands of this vaccine in the Philippines at present are Cervarix and Gardasil. 

7.   Eat healthy and watch your weight. Women who eat less fruit and vegetables may be at increased risk for cervical cancer. Overweight women are more likely to develop this cancer.

References:


1.    Cervical Cancer Statistics. Centers for Disease Control and Prevention 
2.    Who Gets Cervical Cancer? Centers for Disease Control and Prevention 
3.    Cervical cancer. National Cancer Institute 
4.    Philippines Human Papillomavirus and Related Cancers, Fact Sheet 2010 (Sep 15,    2010). WHO/ICO Information Centre on HPV and Cervical Cancer. 
5.    Human Papillomavirus and Related Cancers in World. Summary Report 2010. WHO/ICO Information Centre on HPV and Cervical Cancer (HPV Information Centre) 
6.    Cervical Cancer Overview.Emedicinehealth. 
7.    Vaccine Protects Against Virus Linked to Half of All Cervical Cancers. National Cancer Institute 
8.    Cervical Cancer Symptoms. Lisa Fayed, About.com Guide. 
9.    Cervical cancer vaccine: Who needs it, how it works. Mayo Clinic.