chatwithketch

It’s amazing how the people who you believe have got it all together, struggle the most with their self image and self-confidence. When my daughter was in secondary school, I would sometimes tell parents of new students how my daughter cried so much when I first took her to boarding school, in order to encourage them to believe that ‘this too shall pass’. But they would always look at me in disbelief. That’s because at that time, she had been both head girl of junior school and senior school in rapid succession and she was the voice of wisdom to everyone going through a tough time! So, who would believe it?! She looked like she understood why she was in school and was willing to do the work needed to graduate well. And she did! Class valedictorian! I was super proud!

https://atbgs.blogspot.com/2018/10/fake-it-till-you-make-it.html

Q: Please Dr., what is the treatment for temporary impotence?

A: Erectile dysfunction, also known as impotence, occurs when a man is no longer able to get or maintain an erection sufficiently enough to have sexual intercourse. It may be dramatic in some men, such that where they used to want intercourse very frequently, they find that there is reduced sexual desire.

Oftentimes, this may be due to just stress and better stress coping mechanisms help. However, because this is a sensitive topic, many men do not seek medical help such that this causes significant strain in their relationships. Other causes include depressions, relationship challenges, high blood pressure, high cholesterol level, high blood sugar, obesity, some medications, tobacco use, substance abuse, alcoholism etc

Your doctor will probably order some tests to confirm possible cause(s) and then decide on a course of action. Now I know that quite a number of men are quick to go and buy Viagra and some even overdose on it thinking the more they take the better the performance 😦 Please don’t do that! More seriously, these drugs are not for everyone and so if you have Diabetes Mellitus, heart disease, if you have had a stroke etc, please be sure to mention these to your doctor…and indeed you should not self-prescribe any of these (or indeed any other) drugs for yourself.

Treatment depends on cause. If this is emotional, psychological or due to stress etc, some degree of counselling may help. Other treatment options include oral medications like Sildenafil (Viagra), penis pumps, implants, injections etc. Please speak with your doctor to find out what options are available to you.

Remember that your partner may not understand what you’re going through and probably think that you no longer desire her. Be sure to re-assure her and let her be a part of your therapy. More importantly, try to be open about what is going on to your doctor so he can work with you to find the ideal solution.

All the best!

We can’t let the month of October pass by without celebrating the fact that the month is Breast Cancer Awareness Month.

Breast cancer is abnormal growth of the cells of the breast. Though it is more common in women, it can also occur in men. It is important to examine your breast regularly and note if there are changes. Some changes that may signify cancer, to look out for include:
• A lump or thickening of breast tissue that feels different from surrounding breast tissue
• A lump in one or both armpits
• Change in the skin of the breast eg giving the appearance of orange peel/skin of an orange
• Change in the shape, size or general appearance of the breast
• Nipple discharge (especially if it’s bloody) or recent inversion of the nipple
• Scaly skin around the nipple

Breast cancer may be inherited and so having a family history of breast cancer puts one at greater risk of having this. Other risk factors for breast cancer include:
• Being female
• Starting period at an early age….earlier than 12 years
• Starting menopause at a later age
• Hormone therapy during menopause
• Obesity
• Having first baby at age older than 35 years
• Increasing age: The older one is, the more at risk of breast cancer one gets
• Exposure to radiation like X-rays. That’s why people who work in environments where these tests are done have to wear protective clothing when running the tests.
• Drinking alcohol

If breast cancer is caught early, one has a greater chance of survival. Treatment of breast cancer depends on the stage of the disease, type of breast cancer, grade, size and how sensitive the cancers cells are to hormones. Treatment options include surgery (removal of lump or removal of whole breast or removal of lymph nodes), chemotherapy (medications that destroy cancer cells) and radiotherapy (using irradiation like X-rays to destroy cancer cells).
• Prevention of breast cancer in people with average risks includes:
• Eating healthy
• Keeping a healthy weight within the BMI
• Exercising
• Stopping or limiting alcohol use
• Speaking to your doctor about screening options open to you. Mammograms used to advocated for women 40 years and over. The new recommendation from American Cancer Society earlier this month recommends annual mammogram for women at moderate risk of cancer from 45 to 54 years of age and then every two years from 55 years onwards. U.S. Preventive Services Task Force mammogram guidelines recommend screening from 50 to 74 years.

So, be sure to discuss with your doctor so he can advice on your best options based on your personal history.

For related topics, please click on the links below:

https://chatwithdrketch.com/2015/04/05/daily-health-tips-breast-lump-in-a-man/

https://chatwithdrketch.com/2013/06/15/the-halfway-mark/

https://chatwithdrketch.com/2013/05/24/pinkie-swear/

Have a great weekend everyone!

Q: Good morning. What could be the cause when fluid is not coming out during sex?

A: In a male, ‘fluid not coming out’ could be due to a condition called anejaculation. Anejaculation is a situation in which there is failure of ejaculation. It can be primary (in which case it is present at birth and is a lifelong condition) or it could be secondary, as appears to be the situation here. In secondary anejaculation, the problem is acquired. The same conditions that cause retrograde ejaculation are also suspect here. Retrograde ejaculation (RE), refers to backward ejaculation. To understand this, a refresher course on how ejaculation happens is needed:

Usually, during ejaculation, the muscle at the neck of the bladder tightens ensuring that semen does not enter the bladder. In people with this problem, this muscle does not tighten enough to prevent backtrack of the semen into the bladder. So, in these people, their ejaculate during intercourse is usually very little (sometimes almost non-existent, even though they certainly know they have had an orgasm) or their urine after sexual intercourse cloudy as a result of the sperm going into the bladder and mixing with urine.

Retrograde ejaculation does not interfere with a person’s ability to enjoy sexual intercourse, have and maintain an erection or even climax. Usually, these people would show up in the clinic because of infertility.

RE and secondary anejaculation can start after a surgery on the bladder or prostate; it can occur as a side effect of some anti-hypertensive drugs (drugs used to treat hypertension), or as a complication of some surgeries or medical conditions like Diabetes Mellitus, multiple sclerosis or spinal cord injury. A few people are actually born with a weakness of this muscle that closes the neck of the bladder during ejaculation.

During the refractory phase of the sexual response cycle, it is also not possible for a man to achieve orgasm. To better understand this, a quick class 😀 There are 4 phases of the sexual response cycle: excitement, plateau, orgasm (climax) and resolution (when the body returns to its normal functioning). After resolution, men usually need recovery time. During this period (refractory period), the man cannot achieve another orgasm. This period may last for minutes, hours or even days…the older one gets, the longer the refractory period.

If RE or secondary anejaculation is caused by medications, your doctor may consider changing them or stopping them for a while. Otherwise, there are some drugs used to ensure the neck of the bladder is closed during ejaculation. Your doctor will weigh their side effects against their potential benefits in deciding whether to prescribe them to you or not. For those who desire babies, your doctor will also discuss options of ‘harvesting’ sperm to be used on your spouse.

For spinal cord injuries, the ejaculatory pathway may be intact or there may be need for penile vibratory stimulation depending on the level of the injury.

His doctor should be able to take a proper history, carry out a detailed examination and make a proper diagnosis.

In females, ‘fluid not coming out’ could be due to vaginal dryness. Vaginal dryness can occur due to variety of reasons and at any age. Usually the vagina has a thin film of fluid that coats it. This fluid helps lubrication during sexual intercourse, maintains the normal environment of the vagina preventing the overgrowth of organisms like fungi, flushing out dead cells and menstrual blood. The level of this fluid/moisture varies with the level of estrogen released in the body. During sexual intercourse, there is increased blood flow to the vaginal area leading to an increase in the volume of moisture. During menopause, however, the level of estrogen is very low leading to vaginal dryness, loss of elasticity and thinning.

The main consequence of vaginal dryness is the fact that it affects sex life such that these women experience significant pain and sometimes, bleeding. Other problems that vaginal dryness could cause include soreness, itching and burning around the vaginal area, recurrent urinary tract infections and frequency of urinating etc.

There are other conditions, other than menopause that can lead to low estrogen and consequent vaginal dryness. They include childbirth, breast feeding, cigarette smoking, some medications (like anti-estrogen drugs used to treat cancer) and douching. Douching refers to the practice of cleaning the vagina with a ‘cleansing’ fluid. For more on this topic, please click on this link: https://chatwithdrketch.com/2014/09/30/daily-health-tips-what-is-douching/

Other very common causes of vaginal dryness include a lack of foreplay during sexual intercourse, feelings of guilt, relationship issues, allergy etc.

Treatment depends on cause. If it’s due to low estrogen, the focus would be on replacing this either through Hormone Replacement therapy or through the insertion of estrogen pessaries (tablets, cream or ring) into the vagina) should help. If due to rushed foreplay, there should be a conscious effort to slow down allow enough time for foreplay and sometimes, discussion with the partner may be helpful. Avoid heavily perfumed products like sanitary towels, tissues etc which may lead to irritation of the vagina and subsequent dryness etc.

I hope this helps.

Have a good night, y’all 😀

Q: Good day ma’am. Please can you talk about pile in children?

A: Hey! Thanks for writing in and yes I can 😀

Piles known as haemorrhoids in children is not very common. Indeed, my first suggestion would be to get your baby checked out by a paediatrician to confirm that this is not due to problems like Crohns Disease (a problem-inflammation of the bowel) or even portal hypertension in which there is backwards pressure in the vein (blood vessel) that carries blood from the digestive tract to the liver.

Once these have been ruled out, we can focus on the more common cause of haemorrhoids in children which is constipation. The causes of constipation in children could be dehydration or even a lack of fibre in their diet. So, if you’re fond of feeding your baby highly processed foods without including fruits, vegetables, complex carbohydrates like local rice, beans, oatmeal etc, your baby could be at risk. If your child, also, does not get enough activity daily and spends more time in front of the television, computer or playing handheld/video games, this is a potential problem. Children who drink a lot of soda or soft drinks/minerals, as we call them in Nigeria, tea/coffee are prone to this. The caffeine found in these drinks causes the body to lose water and thus can cause constipation.

What can you do to help relieve the pain that your baby is feeling? Sitz bath is helpful. Help your child sit in a basin or bath tub of warm water several times a day (2 to 3 times). This helps to relieve the pain. When she uses the toilet, using regular tissue paper is out of the question as this will cause more irritation and itching. Unscented baby wipes or even wet tissue is a good way to go.

Pain relief can be with over the counter pain relievers (analgesics) like ibuprofen. You can also wrap some ice in a towel and have your child sit on this intermittently.
Childhood haemorrhoids usually go away with a fibre-rich diet, exercise, sufficient fluid intake in a day and loads of love 😀 If the symptoms persist after about two weeks, please check with the paediatrician again.

For related topic, please click on this link: https://chatwithdrketch.com/2014/03/12/daily-health-tips-help-please-i-have-chronic-piles-haemorrhoids/
Have a great evening, y’all 😀

Q: How to deal with stomach ulcers?  Especially food wise..

A: Thanks for writing in.

There are two conditions that may often be confused, one for the other: Peptic ulcer and Gastro-Esophageal Reflux Disease (GERD).

Gastric acid is secreted normally in the stomach to help the process of digestion. Peptic ulcer is a sore in the stomach, esophagus or duodenum and occurs when there is either over-production of this gastric acid in the stomach or reduction in the quantity of mucous that protects the stomach from the acid. Infection with an organism, Helicobacter pylori (H. pylori) has been found to be a cause of peptic ulcer.

GERD, on the other hand occurs when stomach acid backtracks into the esophagus causing heart burn.

In the past, it was thought that spicy foods caused peptic ulcers. However, there’s no evidence to support this, though spicy foods can certainly make the symptoms of ulcer worse  Smoking, stress and drinking alcohol are also likely to worsen the symptoms of peptic ulcer. Caffeinated and carbonated beverages may also be culprit.

Ulcers are also common in people who take certain pain relieving drugs known as Non- Steroidal Anti-Inflammatory Drugs (NSAIDs) like Ibuprofen.

People with peptic ulcer usually complain of abdominal pain or even sometimes, chest pain as the pain can be anywhere from the breast bone to the navel…giving room for a wide range of descriptions  The pain is usually worse at night or when the stomach is empty.

People with ulcers may vomit blood or pass out fresh or altered blood in stool. For the latter, the stool looks tarry black. Complications of peptic ulcers include internal bleeding, leakage of the acid into the abdominal cavity etc

Treatment is targeted at reduction in acid production, neutralization of acid, treatment of Helicobacter infection, promotion of healing or protection of stomach lining. Your doctor will determine the best option or combination(s) with your active participation, of course

Thus, prevention is targeted at switching pain relieving drugs (if you have an ulcer, please stay away from NSAIDs, reducing your level of stress, stopping smoking and reducing your alcohol intake. Maintaining a healthy diet filled with loads of fruits and veggies, which provide sufficient vitamins to aid healing, is also a good way to go. It is still not very clear how H. pylori infections spread but it is thought to be probably from person to person or from food and water. So, judicious and very frequent, hand washing will certainly help

Does milk help? Well, temporarily but it quickly makes it worse. Milk coats the surface of the stomach, reducing the pain but then stimulates more acid production. Sounds like you can’t win, aye?! ;D

For GERD, there are also conditions like pregnancy and obesity that make this condition worse and there are also foods that encourage this. Examples of these ‘foods’ are fatty foods, alcohol, orange juice, chocolate and coffee, onions, tomatoes, peppermint and spicy foods.

So for the person in the question, I suggest you keep a food diary over a period of time and try to figure out the trigger foods. If you suspect tomatoes, try to confirm this by having a ‘tomato meal’ and watching for heartburn and an unpleasant taste at the back of the mouth. If this is not the issue, perhaps it’s a weight issue or even over-eating.

Treatment is targeted at the acid and healing the esophagus. Remember that occasional heartburn is not regarded a problem but if it happens frequently, like two or more times every week, then it becomes a problem and is now referred to as Gastro-Esophageal Reflux Disease (GERD). So, drugs used can stop acid production, reduce acid production and cause healing of the esophagus or neutralize the effect of the acid.

Prevention involves trying to avoid your trigger foods (quite a number are actually healthy maintaining a healthy weight, avoiding heavy meals just before bedtime, try eating smaller meals and avoid tight clothes that may also put pressure on your abdomen.

So, see a doctor first to confirm the diagnosis….peptic ulcer or GERD and then he’ll advice on treatment.

Have a fabulous evening and remember…no heavy meals before bedtime 😀