NOW that the EVAT is vat a matter of time, our lives will approximately a sleepless bangungot. What is the real bangungot anyway? This is supposedly a uniquely Filipino phenomenon (it’s not). Let’s find out what experts have come up with so far. Two distinct clinical entities appear to ignite the curiosity of doctors and both seem to have their own rational claim in explaining a mystery.

Bangungot is said to affect young, apparently healthy males who sleep, attempt to get up (bangon), groan (ungol) and die – wait, shouldn’t that be bangungol? (Well so much for amateur folk etymology!) However, if it really is a "sleep of death" as the Bard puts it, scrutiny will benefit all. Bangungot has its Asian equivalents. In northern Thailand, it is called lai tai. In Japan, it is pokkuri.

Acute Pancreatitis. The usual suspect is acute pancreatitis or the inflammation of an essential gland behind the stomach, the pancreas. Aside from digestive enzymes, the pancreas is more known as the source of hormones insulin and glucagon. The causes of acute pancreatitis are legion – from gallstones, viral infections, high lipid (cholesterol) levels, to alcohol abuse. One mechanism used to explain it is autodigestion: Normally inactive enzymes are activated within the pancreas and begin to eat up tissue. Why this happens is not fully known.

Signs & Symptoms. Acute pancreatitis presents with severe abdominal pain usually at the upper left side or upper middle, made worse by lying on the back. Pain is worsened by a heavy and fatty meal and alcohol. The patient can have fever, experience sweating, anxiety, nausea and vomiting.

Diagnosis & Treatment. Your favorite gastroenterologist is the doctor to see. Lab tests will show elevated pancreatic enzymes (serum lipase and amylase). Abdominal ultrasound, MRI or CT scan can reveal pancreatic inflammation. Treatment is mainly supportive because most cases resolve in one week. However, some patients take a turn for the worse particularly if the pancreas bleeds and necroses (dies off).

Brugada Syndrome. Bangungot is also associated with a relatively new (reported 1992) clinical condition called Brugada syndrome – a form of arrhythmia or abnormal heart rhythm. Normally, the heart beats regularly because of an electrical impulse that spreads efficiently from the upper chambers (atria) to the lower chambers (ventricles). As the heart muscle receives the impulse, it contracts thereby pumping blood. In arrhythmia, the electrical system suffers a glitch that interferes with blood pumping. Therefore, the heart can beat too fast, too slow, or irregularly.

Signs & Symptoms. In Brugada syndrome, the ventricles beat fast and blood circulates erratically – to the detriment of vital organs. If the beating becomes so fast (ventricular fibrillation), the person will lose consciousness and die suddenly – uncanny descriptions of bangungot victims. The person in arrhythmia may feel nothing but usually there is heaviness of the chest, shortness of breath, and the sensation that the heart is fluttering (palpitation).

Diagnosis & Treatment. Brugada syndrome may be inherited. A cardiologist will listen to the heart for abnormalities and request an electrocardiogram (ECG). Fortunately, a specific abnormal pattern identifies the syndrome. The treatment is the insertion of a special pacemaker called defrillator. Every time the electrical system malfunctions, the defibrillator jump-starts the heart.

Of course, not everyone who dies while sleeping had acute pancreatitis or arrhythmia. These just seem to be post-mortem favorites. The idea is to wake up after sleeping and not to sleep forever, yes? But to wake up to E-VAT, to gas as precious as gold, to an electricity bill meant for a building and not a house, and to wake up to what the philosopher calls "existential dread," one asks: "When is the bangungot now?" When one is asleep or awake?

Billboard. Congratulations to PL-Rottapharm for the launch of their much-awaited injectable hyaluronic acid Go-On. The local community of rheumatologists, rehabilitation medicine specialists, and orthopedic surgeons welcomed this new option for degenerative arthritis last October 25, 2005 at the Manila Peninsula. GoOn is useful in knee osteoarthritis for the control of pain. Congratulations to Product Manager Ms. Jenny Manalo for a successful program!

Fact/Factoid. Probiotics are "friendly bacteria" such as lactobacilli and bifidobacteria found in yogurt and fortified milk. The known benefits of regular intake include better digestion and boosting the immune system.

Dr. Brix Pujalte is an orthopedic surgeon. Contact numbers: 725-3820/727-0001 local 2175/711-6626/711-4276 and 936-5717. Cellphone 09175331557. E-mail: jsp@pldtdsl.net.