Dr. Edgar H. Tan, a consistent honor student graduated Bachelor of Science major in Biology cum laude from Silliman University in 1982. He was a Faculty Silver Medal Awardee and graduated cum laude when he earned his Medical Degree from Cebu Doctors' College of Medicine in April of 1986.

He spent one year of post graduate internship at the prestigious Philippine General Hospital from May 1, 1986 to April 30, 1987 and subsequently passed his Philippine Medical Licensure Exam rank #15 in August of 1987. He pursued further training in Internal Medicine from 1989-1993 under the New York Medical College Program where he served as the Administrative Chief Medical Resident for one year. He subsequently did his Fellowship Training in Clinical/Invasive Cardiology under the consortium of Metropolitan & New York Medical College Program from 1993-1996. After his medical training in New York he practiced Internal Medicine/Cardiology in the State of South Carolina from 1996-1997 with privileges at Marlboro Park Hospital Bennettsville SC & McLeod Regional Medical Center in Florence SC. He holds an active medical license in the State of South Carolina from 1996 up to the present. He decided to come back to Cebu and practice his profession starting February 1998. His foresight at keeping his US medical license active inspite of practicing medicine outside the US has come handy for US expats currently in the Philippines wanting medical care recognized by US HMO's.

Dr. Tan is board certified by the American Board of Internal Medicine, American Board of Cardiovascular Disease and Philippine College of Physicians. He is also trained and certified in the field of Nuclear Cardiology. He is a Fellow of the American College of Physicians, American College of Cardiology and Philippine College of Physicians. His extensive background comes handy by making available the highest standard of US quality medical care right in the heart of Cebu City.

He is affiliated with University of Cebu Medical Center (UCMed) as the first & former Chairman of the Department of Internal Medicine. He also is also affiliated with Cebu Doctors' University Hospital and Perpetual Succour Hospital. He is the former director of the Cardiac Catheterization lab and currently the Section Head of Cardiology Department at CDUH. His practice includes General Internal Medicine & Adult Clinical/Interventional Cardiology. He has admitting privileges at the University of Cebu Medical Center, Cebu Doctors' University Hospital & Perpetual Succour Hospital.

His office is located at Cebu Doctors' University Hospital Medical Arts Building 1, Suite 203-B, OsmeƱa Blvd. Cebu City Philippines. His office hours are 9am-12pm Mon-Sat. and 2pm to 5pm except Wed. and Sat. Tel: (032) 412-5136.

Email: EdgarTan62@yahoo.com or EdgarTanMD@gmail.com

Wednesday, September 16, 2015

The Art of Medical Practice: What is the Ideal BP?

Medical practice has evolved into a science that has become too guideline-centric. New graduates and practitioners alike are now so focused with guidelines-driven medical practice that they have now forgotten the very fundamental ethics in medicine and that's not only to " Do No Harm " but also must include us to think in a more rationale way on how to treat our individual patients.  HMO's find guidelines very handy as their bible to decide on which modality of treatment to cover or not and this is where the flaw and cracks start to irritate in me as a medical practitioner.

Blood pressure management has been a focus of endless debates and revisions over what is ideal and what is not. Too many guidelines that has confused not only the medical community but patients alike. We know for a fact as doctors of medicine of one fundamental truth....that is  " normal blood pressure has been conclusively shown to be associated with lower major cardiovascular events i.e. congestive heart failure, heart attacks and strokes " yet, our guidelines have always focused on cut-offs as if all patients are created equal. Authorities as what they call themselves must realized that we are not into the McDonalds business where french fries tastes the same regardless of which outlet you get it from. Our patients are not the same and will never be and that's where the fundamental flaw comes into play. 

The latest JNC-8 published in December 2013 on BP management boldly raised the threshold and recommended therapy on over 60 years old if their BP goes >150/90mmHg and >140/90 mmHg for those younger than 60 yrs old. This was done despite the lack of evidence supporting their recommendation while virtually ignoring the very basic evidence we have that targeting  less than 140mmHg have been shown to save lives.

I have always believed that each patient is unique and must be dealt with and approached individually rather than just another warm body that is either 60yrs old or less.  My guiding principle has always been to individualize therapy rather than just blindly following what guidelines want us to do. We know our patients more than anybody else and I believe that a targeted BP of 120-130mmHg or lower (as long as tolerated) remains to be the optimum target REGARDLESS OF AGE. It has worked for many in the past with studies to back it up so why should we just change because of some JNC-8 authors believe otherwise?

In the latest publication from a NIH-sponsored study  SPRINT (Systolic Blood Pressure Intervention Trial) on 9,200 patients published Sept. 11, 2015 conclusively showed a significant reduction by almost a third in the incidence of myocardial infarction, congestive heart failure and stroke for those randomized to a target BP of 120mmHg vs the recommended 140mmHg. This same group also benefited by having a reduced incidence of overall death by almost a quarter.

With these most recent findings I feel vindicated on what I have always  been doing and believed in......to keep BP goal as low as possibly tolerated regardless of age. This is in keeping with the hippocratic oath we all vowed as medical practitioners to do no harm and with good intentions do whatever we think  is best for the patient regardless of guidelines. 

It is not the intention of this article to bash on guidelines because it is for the most part evidence-based and our way of measuring what good clinical practice is all about. It is my belief however, that physicians  must not feel hostage to it and it is hoped that we physicians exercise open-mindedness and independence even if it means thinking outside the box  to do what is best for our patient because after all, the practice of medicine is an art and not a perfect science.


Sunday, April 28, 2013

The Healing Power of LOVE!

Scientific data and evidence supports the fact that  love  reduces stress, depression and anxiety, three major risk factors for heart disease.

Current data indicates that 30-35%  (about 1/3) of total mortality across the world are due to heart disease and stroke, six times more than infectious-related deaths.  This wealth of information makes it imperative  for doctors in stressing the importance of  not only adopting a healthy lifestyle but also making emphasis on  the positive impact that love can in order to stay healthy.

In one five-year study, 10,000 men at high risk of developing chest pains showed that men whose wives show them love have a lesser incidence of chest pains.  Another study of 1,400 men and women with coronary artery disease echoes the same positive impact of love and heart disease. After five years, 15% of those who were married or had a confidant were dead compared with 50% of those who were unmarried and had no confidant.

It is now generally believed  that love is indeed a powerful force to bring healing and if  given freely will heal not only the heart  but also heal the body. Spread love and  help heal the world one heart at a time.

Monday, March 04, 2013

Stem Cell Therapy: Fact? or Fiction?

Stem cells are the pluripotent cells responsible for healing and regeneration of the vaious organs that have been damaged like liver, skin and many more. It is present in the varous organs of our body and  has always been a subject of intense interest in the medical world for obvious reasons. While science can easily explain why cells or organs regenerate, it is very difficult to coax stem cells to become what we " scientists " want them to be. Just like anything else, it is easier said than done and it holds true for Stem cells as well.

The only medically approved and scientifically proven form of stem cell therapy to date is " Bone Marrow Transplantation " for patients suffering from various blood ailments like leukemia. Other than that, everything else that man wants the lay people to believe it can do is considered experimental and therefore of unproven benefit. These victims fall prey from friends giving them anecdotal claims of benefits from stem cell recipients. Have they not heard of  the word " Placebo effect? ", an effect where as much as 20-30% of patients may feel better even if they are not given real medicine?

We see a lot of patients fall for these unscrupulous medical practitioners promising rejuvenation as if they have finally solved the puzzle and the key to the fountain of youth. Typical patients include those that are elderly with a lot of money to splurge in the hope that they only lose money should it not work. These victims are victims of medical fraud much like " chelation for heart ailments " years back.....these would include the seemingly hopeless patients where medicine has reached the dead end and has nothing more to offer in terms of cure. 

To all patients considering stem cell therapy, I advise caution as this form of therapy is not scientifically proven and medical providers can't claim of any therapeutic benefit backed by randomized clinical trials at this time.  Until proven otherwise, I can only see " economics " as the main driving force for it's rapid growth in this country. This is not only unproven but also can be "potentially" harmful. 

To all medical professionals engaged in this form of therapy, I say to them, with the sincerest hope that they will remember our basic oath......our very own Hippocratic Oath we all subscribed to when we were sworn in as  Doctors of Medicine........that is...." To Do NO Harm ".

Monday, November 12, 2012

Tips to Handle the Anxious Patient

As a cardiologist I get to see a lot of patients either referred or self referral complaining of palpitations & chest pains for which many will eventually turn out to be negative for heart disease. Many times I can sense and pick them up the moment they come and start talking with their typical facies, body language, and overall demeanor....call it "SIXTH SENSE" if you may! These are some of the common things most doctors must observe their patient.

1. Typically young & middle aged female and less often males and the older age group. They are unaware that it is their heightened anxiety that is triggering all the " weird " manifestations that some feel as if it is the end of the world.

2. They may or may not have been seen by other doctors who has done tons of work up  to them and all are negative. Since they have nothing else to give, they may prescribe medications like vitamin B complex or for some astute physicians may give them anxiolytic drugs.

3. I believe this has some genetic component because I still have to see an  anxious patient with no family history of anxiety disorder. It is either the father or mother or both with the same problem....believe me! Patients typically suffer unconsciously from " Don't Ask, Don't Tell " policy....so if you as the doctor won't ask for these information typically patients don't seem to find this history important.

4. These patients are the most skeptical of all, so in order to fix them you need to understand that reassurance won't cut it out unless you prove to them that you have concrete basis for doing so. In my practice, I would typically do some routine things like physical exam, an office ECG and to some extent I find it necessary to do noninvasive work up like Echocardiogram and Exercise treadmill stress test. These tests I find it necessary to convince them that there is nothing wrong with their heart otherwise your advise won't hold water at all. For the severest forms I find counseling and with the help of anxiolytics help a lot.

5. In order for you to be successful at treating them you must:  Talk, Sympathize, Understand and Intervene. A combination of all these are very effective in fixing the anxious patient. Their trust can only be heightened if you tell them how the anxious patient feel even before they start talking. More often than not they will start to realize that all the things you said are true and by this time your patient has gained your trust and are cured 80% of the time. 

I can safely say that if doctors have the right skill and approach......only a few will end up requiring the help and intervention of a psychiatrist. Successful treatment needs the combination of physician understanding, counseling with lots of reassurance and sometimes with the help of anxiolytic  medications.

Monday, June 18, 2012

Simple Tips on How to find the right doctor!

Inspite of the internet making life easier for the tech savvy to research their doctor before the visit, there is no way to replace the good old face to face interaction to see if you found the right one for you. Here are some of the tips on how to make the experience a little easier in this day and age!

1. RESEARCH: In this day where information is readily available on the internet, it would be best if you can research your own doctor as much as possible including the ailment that you think you have. This way you are armed with the information about your condition and shoot all the questions you have when you go to see your doctor. Evaluate your doctor by the way he/she answers your questions. Try to test and shoot questions that you already know what the answer is and let him/her explain. His explanation will be your best tool to evaluate your doctor. Remember that doctors are humans, we are educated to treat but just like anything else in life, we are not created equal, so do your homework.

2. KNOW YOUR RIGHTS: It is the patients' right to ask and be enlightened. Some doctors get defensive when questions are asked of them. Professionals and properly trained docs should not feel insecure and should properly answer all questions asked of them....it is the patient's right to ask and be educated.

3. SECOND OPINION MATTERS: A second opinion from another health care professional couldn't hurt especially in major health decisions. Some doctors feel bad when their patients seek another doctor for a second opinion to the point of reprimanding the patient and this to me is not only wrong but absolutely unacceptable.  Doctors are humans and therefore can sometimes make mistakes so he/she must not feel bad if their patients seek other opinions. It is not  the doctors' decision to make but yours and yours alone. You as the patient should demand the place that is rightfully yours.......that's the drivers' seat.

4. ASK AROUND: There are places where doctor's information maybe quite scarce. Try to be resourceful and ask around,  colleagues, close friends, a neighbor, or maybe from the hospital personnel where the doctor works and get their overall evaluation as to who would be the best for your condition. The information you get may not necessarily be right but, at least you can have a start off point to do further research!

5. YOU GET WHAT YOU PAY FOR:  Personally just like anything else in life, if I need to purchase an item and I have no clue what is the best? The price is generally a good guide, the more expensive the better it must be and  while this is true to most it is not a 100% guarantee that you will like what you get.  In medicine, this dictum  has it's own validity as well, " You get what you pay for". Remember that "Health is wealth", don't settle for anything less. I remember one patient telling me this same quote and I just burst into laughter nodding in agreement.

At the end of the day, after your visit you as a patient you and you alone can judge whether your doctor is the one that will be best for you.

Sunday, January 29, 2012

Top 5 important information about Hypertension

I frequently meet patients being treated for Hypertension but inadequately informed or shall I say inadequately educated about their disease condition. This lack of important information can lead to a chain of problems like noncompliance to medications and therefore poor control of blood pressure. These are the top FIVE issues that are often overlooked by many physicians taking care of their hypertensive patients.

1. Hypertension must be understood as equal or above 140/90mmHg taken at rest. Elevated blood pressures taken during stressful situations i.e. emotional, mental or physical stress should not be qualified as these are stressors associated with a normal (physiologic) increase in BP. Normally BP returns to normal when the stress condition has been resolved.

2. Hypertension has a genetic predisposition in more than 90% of the time. In short, this is a genetic problem that we inherit from our parents and blood related relatives.

3. Since hypertension is an inherited disease, doctors can only prescribe medications to control and NOT CURE. It is in this light that your medicine therefore, needs to be taken for life in most cases. BP control is very important as it has been shown to reduce the risk of Congestive Heart Failure, Stroke and Heart Attack.

5. You must ask your doctor the most common side effect that is unique to the drug you are taking. Doctors often miss out on this information which I consider as vital. I have seen so many patients coming to see me for a simple side effect that would have prevented undue stress to them had they been forewarned. Example: Leg swelling is common for Calcium Channel Blockers, or electrolyte imbalance with diuretics and headache for ARB's (Angiotensive Receptor Blockers) not to mention cough that may affect roughly about 10% of patients taking ACE-Inhibitors.

If you have more questions about your condition feel free to ask your physician on your next visit to your doctors office.

Thursday, July 29, 2010

Calcium Supplements can break your heart!!

Calcium supplements taken to reduce the risk of fractures from osteoporosis among elderly women has been found to be associated with a 30% risk of developing myocardial infarction (heart attack) according to a recent study published in the British Medical Journal published July 30, 2010.

This study result showed that the use of calcium supplementation amongst our elderly women to reduce the risk of fractures should therefore be reconsidered. Previous trials on the calcium supplementation through changes in diet does not increase the incidence of cardiovascular side effects seen in exogenous calcium supplementation suggesting that perhaps these adverse effects maybe limited only to orally taken calcium supplements.

This finding is in keeping with what we already know with most other studies on the benefits of supplements including antioxidants where no documentation of benefit were seen when these supplements taken orally in a tablet form.

A good and balanced diet remains superior to any attempts to supplement in the hope of boosting your health........so the next time you pop in your vitamins?.........think again and ask yourself.........is this really good for the body? or just for the mind?

As a physician I see these everyday and I always have reservations against supplements and my patients can attest to that.........this study just affirms and has been consistent with my beliefs!