chatwithketch

Stroke as the name implies refers to an incident that happens suddenly…without warning. It usually occurs when the brain is deprived of some of its blood supply and consequently oxygen supply. This can happen when there is a blood clot in a vessel in the brain or due to a burst blood vessel leaking blood onto the substance of the brain or around the brain. This blood leakage can lead to undesired pressure on the brain.

Oftentimes, people refer to a Transient Ischaemic Attack (TIA), as a partial stroke. This condition occurs when a blood vessel is partially blocked. This would usually be resolved within 15 minutes and is a sign that a major event (a stroke, proper) may not be far off. This is a warning that should be taken seriously.
It is important to know the signs of a stroke because if action is taken immediately, it can prevent permanent damage from being done. If the brain is deprived of its blood supply for about 4 minutes, irreversible changes begin to occur in the brain. If this deprivation continues beyond this time, permanent changes would have occurred that may affect different facets of the individual’s functions.

The signs of stroke to look out for are known by the acronym FAST.
• F stands for drooping of a side of the face. Ask the patient to smile and you will observe that the smile looks lopsided.
• A stands for weakness of one side of the body. Ask patient to lift both arms and it will be seen that one side is being ‘dragged’ or lagging
• S stands for speech difficulty like slurring. Patient cannot enunciate words properly again
• T stands for time. Once these symptoms are noticed, it’s time to call for help. In climes where there are emergency numbers like 911 or 999, please call these. Otherwise, efforts should be made to take the person involved to the hospital immediately.
Patients may also complain of sudden inability to move legs, feel confused, have blurred vision etc

There are risk factors for stroke and they include:
• Age: The older you are the more prone to stroke. People from age 55 years are more likely to have a stroke, though this can also happen in children eg those born with heart defects and those with Sickle Cell Anaemia etc
• Race: Africans and Asians are more at risk
• Sex: Females are more at risk…as if we don’t have enough problems
• Family history of stroke: The presence of this increases risk
• Previous history of a stroke.

Other risk factors:
• Hypertension
• Diabetes Mellitus
• Overweight
• Sedentary lifestyles
• Not eating healthy
• Smoking
• Drinking Alcohol

The rate at which one recovers from stroke and indeed the degree of symptoms experienced, depends on the area of the brain affected, how serious the damage to the brain is etc and so recovery will be different for different people.

Patience is key. Speech therapists may be needed to help the person re-learn the art of speaking. Physiotherapists will help improve motion on the affected side and indeed, mobility. Other therapists may help with eating…if swallowing is a problem, relearning the art of reading and reasoning etc

Usually, people who visit find it difficult to understand their speech during recovery and this can put even more pressure on the patients. Speak slowly and listen carefully so you can understand what they are saying.

Generally eating healthy with lots of fruits and vegetables, cutting out the white carbs (pastries etc), exercising (at least 150 minutes weekly), ensuring you are not overweight and quitting smoking help with reducing bad cholesterol and also preventing strokes.

One may need to walk with a stick as they re-learn the art of walking. Recovery may be long and tedious but the person has got to keep at it.

For more tips on preventing stroke, read!

https://www.health.harvard.edu/womens-health/8-things-you-can-do-to-prevent-a-stroke

Q: Good morning ma’am, my sister was raped last month, and we just found out yesterday that she is pregnant and she cannot keep the child because she will be getting married by December. She has been struggling to deal with the memory of being raped and finding out that she is pregnant is something she cannot handle. Please ma’am, is there any pills she could take that will help her get rid of the baby? Thanks

A: Hello dear, my heart goes out to your sister for what happened. This is just horrific!!!

There are two things every rape victim must always do…report the rapist to the police and get herself/himself checked out in a hospital. Usually when people are raped, they experience a deep sense of shame making it difficult for them to seek help and indeed prosecution for the person accused. This should not be. Please get her to seek help… to ensure that she does not end up with any STI. If she had also sought help early, she would have been given emergency contraception and been checked out by a doctor especially if there is suspicion of a genital tear etc. Further, raising the alarm ensures that the predator is not emboldened to do this to another person, ever again. Going to law enforcement as soon as possible would help as the clothes may contain some forensic evidence.Now in this case, it would appear none of this was done.

Before I start my comments on what I perceive as next steps, I would like to issue my regular disclaimer: On this page, I do not pass judgement or tell people what to do. I just try to provide enough information to get you to take the right decisions.

I absolutely sympathize with your sister. It is harrowing enough to deal with the issue of rape and then add to that the issue of pregnancy resulting from that. The psychological ‘wounds’ from rape are deep-seated and will find an outlet one way or the other, if not today, it will be tomorrow or next year…but it will come out sometime. I would recommend that she tells her fiancé. All things being equal, he would still want to hang around to help her deal with this…after all, your sister is the real victim here L Having said that, there is no guarantee that he will stick around and so if your sister decides to tell him, there is the possibility that her fiancé may head for the nearest exit. I know that having wedding close at hand makes it look like there’s only one option here, but that may not necessarily be so! Please get her to seek help and counseling.

For the pregnancy, termination is illegal in Nigeria. Beyond the legality of this, I suggest that she figures out how she wants to handle this with her fiancé and then, dealing with the pregnancy becomes more straightforward.

I wish she were close by so I could give her a hug and tell her that everything will be okay…and they will. It may look like all is wrong with her world now, but trust me, she will come through this stronger than before. There are really no easy answers here. I wish this was one of those questions where the path to take is clear and easy. This is not one of those, but it is in the dark and difficult times that we stretch and discover purpose. Get your sister to seek counseling. If she decides to tell her fiancé, I hope that he sticks around for the long haul; but if he doesn’t, it’s his loss. She needs to focus on her now. She has to let go of the experience she had in order to begin her life afresh without fear and hang-ups.

To help prevent other incidents of rape, practice personal safety and trust your instincts. If the situation looks or feels fishy, it probably is. Try to ensure you go with company if you must visit any friend of the opposite sex or better still, meet in a public place etc.

If you’re in Nigeria, Project Alert (http://www.projectalertnig.org/) and the Lagos Domestic Violence centers  (http://domesticviolence.com.ng/help-for-domestic-violence/) will also be able to provide some more practical support in terms of counselling and probably legal help, if required.

Remember that she needs to get herself checked for STIs and/or other infections while the discussion on the pregnancy and upcoming wedding continues.

Please tell her to stay strong, okay?!

Loads of love and hugs coming her way…

Have a great night, people 😀

Heart burn really has nothing to do with the heart. It is usually felt as a burning sensation in the chest which feels worse on bending down or lying down. Okay, why and how does this happen? You know that the stomach produces acid to help with food digestion, right? Have you ever wondered, how come this acid isn’t all up in your mouth all the time? Well, that’s because there’s a ‘lock’ or control at the junction of the esophagus and the stomach which prevents the acid in the stomach from coming back up into the esophagus. This ‘lock’ is called the Lower Esophageal Sphincter. This lock can get strained if the esophagus opens too often or if there is too much food in the stomach…so, if you regularly over-eat, you might want to re-think that 😀 A major no-no is a very heavy meal just before you lie down. It’s almost certain you may have a heart burn 😀

If despite your best efforts you still have a heart burn, here are tips to help you! https://www.health.harvard.edu/diseases-and-conditions/the-best-ways-to-manage-heartburn

Q: Please ma’am, I had unprotected sex, but he didn’t release; but I am just scared. What will I do to clear my fear??

A: Well, the first step towards never experiencing this kind of fear is to remember your ABCs. A is for abstinence. Honestly, this is your safest bet. If you’re not ready to deal with the responsibilities of having a baby, please leave well alone. You can’t have an STI, HIV/AIDS, or otherwise if you don’t have sex. In addition, you can’t get pregnant. Now, if abstinence is a problem, be faithful to one partner…who, hopefully, is being faithful to you too. If you can’t swear on this, revert to plan A. Finally, if all else fails, ensure that you use a condom to prevent STIs and pregnancy.

‘Not releasing’ implies that you used the withdrawal method of contraception. Withdrawal method involves pulling the male organ out of the vagina just before ejaculation. This method may protect against pregnancy if used well but does not protect against STIs. It has been argued in some quarters that the pre-ejaculate (a lubricating fluid) may contain some sperm cells and so even if your partner is able to withdraw before ejaculation, the harm would have been done. However, the sperm in the pre-ejaculate is not there at the time the fluid is produced, but is sperm from previous ejaculations that was probably left in the urethra. It is believed that urinating and cleaning the tip of the penis before sexual intercourse helps to clear the urethra of the sperm left from previous ejaculations.

So, is it possible that you could get pregnant with this method of contraception? The answer is yes. You should also worry about the potential for STIs. I suggest that you visit your doctor for confirmation of pregnancy – though most GPs would ask that you wait until you actually miss your period. Then, if you are not pregnant, I suggest that you visit a family planning clinic for help with choosing a means of contraception.

All the best!

Best,

Nkechi

Q: Good evening Doctor, please is ketogenic diet safe for everyone. I am confused about the high fat about the diet. Please kindly help me understand the diet since I really want to lose weight after child birth.

A: The keto diet is mainly used to reduce the frequency of epileptic seizures in children. it has been used for weight loss and achieves results short-term, in some cases. The long-term effects and safety are not really clear. So, if you want to lose weight after your baby, honestly, I’ve got no easy answers. It’s diet and exercise….oh and breastfeeding. But breastfeeding is not very helpful if one is not exercising and watching their portions. Again, the dictum of feeding for two here doesn’t also count.

The diet to focus on is the very same one we talk about all the time: fruits, veggies and complex carbs with focus on healthier cooking methods (less frying etc). Exercise should focus, initially on pelvic floor exercises especially if you’re leaking urine when you cough or laugh. To locate your pelvic floor muscles, try holding your urine when you feel pressed. If you are successful, then you have located the muscles you need. Then empty your bladder and lie on the floor. Contract those same muscles and hold the contraction for about 5 seconds and then relax it for about 5 seconds. Gradually build this up to holding the contraction for 10 seconds. Repeat this about 3 times a day. Once you no longer leak, you’re ready for your exercises.

Have you noticed how it is usually easier to lose the baby weight after your first baby and harder afterwards? 😀 Focus on building up your stamina gradually especially if you were not very active in pregnancy or before. Please remember to always contact your doctor before starting any vigorous exercise program. As you get into the groove, get down with your aerobics, strength training and sit-ups et al.

This is where breast feeding comes in, if you’re exercising and eating right, breastfeeding can help lose weight…as much as 300 calories per day. Does tying a wrapper tightly round your waist help flatten tummy? Honestly, I’ve heard people who swear by that technique. So, what I’ll say is, if it works for you, why not? Just don’t tie so tight as to stop blood flow 😀

How soon to start exercise after having a baby? Well, it depends on how active you were before and during pregnancy. If you were very active, you can start some light stretches as soon as you feel able. However, generally, we advise 6 – 8 weeks after birth to allow for a post-natal check to have been done. Again, start small and allow your body to get into the groove.

That’s it. And to learn more about the keto diet and side effects, click on the link below https://www.health.harvard.edu/staying-healthy/should-you-try-the-keto-diet

Q: Doctor please help me; I am not ovulating

A: Hey! Thanks for writing in.

How do you know this? Typically, the ovaries in females release an egg every month. If this does not get fertilized, the womb which had been getting ready to receive a fertilized egg, sheds its thickened lining. The release of an egg stimulates the production of the hormone, progesterone. This hormone is mostly responsible for keeping periods regular. But in some instances, a mature egg is not released regularly on a monthly basis and sometimes, no egg is released at all…meaning no ovulation. In this case, progesterone is not produced and the cycle is either erratic or bleeding, heavy.

This kind of cycle, known as anovular cycle, is quite common in adolescent girls especially in the first year after they start menstruating. Other causes of anovular cycle include hormonal disorders, obesity, weight loss, thyroid problems, polycystic ovarian syndrome, hirsutism and pituitary problems. So, if you believe you are not ovulating, please see your gynaecologist for a thorough check.

If you do have an anovular cycle, treatment options include lifestyle changes (focused on eating healthy, weight loss, exercise, stress management etc), medications to induce ovulation or to regulate menstruation and surgical (to remove part of the ovaries and restore hormonal balance)

For more related topics, please click on the following links:

https://chatwithdrketch.com/2016/12/22/daily-health-tipswill-i-need-to-take-pills-forever-for-pcos/

https://chatwithdrketch.com/2017/12/09/hlwdk-daily-health-tips-hormonal-imbalance/

https://chatwithdrketch.com/2016/09/29/daily-health-tips-thyroid-problems/

https://chatwithdrketch.com/2016/11/07/daily-health-tips-what-do-i-do-about-the-hair-growing-on-my-chin/

All the best!

Q: Hey Doc, please I need help. I wanna remove my IUD

A: Hey! Thanks for writing in.

What’s the problem? Your IUD can be easily removed by a qualified nurse or doctor. Have you visited one of them? Or you don’t know if it’s time to remove the IUD? Well, it depends on the time you had inserted.

There are two types: the Paragard IUD and the Mirena IUD.

The Paragard IUD is a copper-containing IUD. This is probably the one your wife had inserted. The copper is poisonous/toxic to sperm and the IUD also prevents implantation of the fertilized egg into the uterus, should fertilization still occur. Paragard can be used during breastfeeding and its removal leads to a quick return of fertility, generally. It usually prevents pregnancy for about 10 years after insertion.

The Mirena IUD contains hormones which make the cervical mucous extra thick preventing the sperm from getting to the womb and it also makes the lining of the womb thin such that even if a fertilized egg were to get there, it would not be able to implant on the thin lining of the womb. It also prevents ovulation. Mirena helps reduce the cramping pain of a menstrual period and also reduces bleeding. It prevents pregnancy for up to 5 years after insertion.

Side effects of Paragard include back ache, cramps, severe pain during menstrual period and heavy bleeding etc while Mirena can cause breast tenderness, weight gain, irregular menstrual cycles etc Both IUDs can also be expelled, spontaneously, that is for no reason.
There are warning signs to look out for when you have the IUD on. If you experience any of these under-listed symptoms, please see your doctor immediately.

• Severe vaginal bleeding with at least 2 sanitary towels soaked every hour for 2 or more hours.
• Smelly vaginal discharge. This could be associated with fever and chills
• Severe pain in abdomen or pelvis

General information about IUDs:
• They are more than 99% effective
• You and your partner cannot feel the IUD either during sexual intercourse or while checking for it
• Your partner may however be able to feel the string during sexual intercourse and the string can also be felt if a finger is into the vagina.
• People who have inserted IUDs may feel abdominal cramps or lower back ache for a few weeks after insertion
• Bleeding in between periods may also happen.
• There is a risk of infection if the user of IUD or her sexual partner have other sexual partners.

If you are not sure of the IUD you inserted, please visit your healthcare provider to confirm. The IUD is usually quickly reversible and so if you’re planning for pregnancy, you should be able to achieve that without much stress.

All the best!

Q: Dear Doc I am 21 years young Male. On April 2018, I fell in love with someone that she’s my partner now. We started unprotected sex on that same Month up until this previous September. At the end of July I tested HIV Negative; so still we were carrying on having unprotected sex up until she tested HIV positive on September 27 and still I’m Negative. I was the second person she ever slept with so doctors say it is possible. So is it really possible? I am scared

Is it possible to get infected with HIV the first time someone has sexual intercourse? Yes, it is. Is it possible to be HIV negative when my partner is positive? Yes, it is. Couples with different HIV statuses s are called sero-discordant couples. It is possible to have sexual intercourse with a partner living with HIV/AIDS and remain uninfected. Several studies have been conducted to find out why and different reasons provided for this include:

• Reduced frequency of sexual intercourse especially in the face of sexual promiscuity
• Possibility of inherent resistance to the virus
• Male circumcision
• Patients on anti-retroviral therapy with an undetectable viral load are highly unlikely to infect their sexual partners

It is important though, to go to a proper testing center to confirm that the results you have received thus far are valid. Generally, if the initial test is negative, a repeat test is done 3 months after the exposure to ‘close the window’. Some may stretch this to a further screen after 6 months. Be guided by your doctor. If you are still confirmed negative, then the focus turns to next steps.

Of course, there’s always a risk in having a sexual relationship with someone who is HIV positive if you’re sero-negative. However, it is no longer the death sentence that we used to think it was and indeed, you don’t necessarily need to become infected if you follow some basic rules:

Ensure that your partner takes her anti-retroviral drugs to reduce her viral load and reduce the risk of infecting you.

However, even with the above, you still need to wear condoms while having sexual intercourse with her.

If there is an accidental exposure, like a broken condom during intercourse, be sure to use post exposure prophylaxis. These drugs used to treat HIV are usually taken daily for about 4 weeks to reduce chances of becoming HIV positive.

You can also commit to taking a tablet everyday as part of the pre-exposure prophylaxis. This prophylaxis is essentially tablets used to treat HIV and can reduce the risk of contracting HIV. Remember that this should be used alongside condoms when having sexual intercourse.
Be sure to also test for HIV and other STDS at least once a year.

Now that you know your partner’s status, you must take every step to remain sero-negative. Knowledge is power!

All the best J

Q: Can infection cause watery sperm? My wife complained about it and we treated it but still she couldn’t take in.

A: Thanks for writing in.

One of the causes of ‘watery’ sperm is pre-ejaculate (a lubricating fluid) which may contain some sperm cells. It is believed that the sperm in the pre-ejaculate is not there at the time the fluid is produced, but is sperm from previous ejaculations that was probably left in the urethra. It is thought that urinating and cleaning the tip of the penis before sexual intercourse helps to clear the urethra of the sperm left from previous ejaculations. Diets poor in protein, frequent ejaculation as occurs in people who masturbate and exposing the testicles to high temperatures like in saunas could lead to a watery consistency of semen.

Just to be sure you do know what normal semen should look like, below is a guide.

Using WHO reference values, a normal semen sample should fulfill the following:

• Volume amount of sperm produced in one ejaculation): Greater than or equal to 1.5 ml
• pH (whether acidic or alkaline. If less than 7, it’s acidic and greater than 7 is alkaline): Greater than equal to 7.2
• Viscosity (being semi-fluid):  viscous
• Transparency: opaque
• Motility (percentage of sperm that move forward normally):  This should be more than 40%
• Morphology (percentage of sperm that have normal shape): This should be greater than or equal to 15% normal, oval sperm heads
• Liquefaction (time taken for the semen to become ‘liquid’): This should be complete within one hour
• Pus cells should be less than 1 million/ml or less than 5/hpf
• Total sperm count: This should be greater than or equal to 15 million.

The causes of low sperm count, which is often considered a cause of watery sperm, could be medical, environmental or due to lifestyle issues. Sometimes, the cause(s) can, also not be identified.

Medical causes include infections like gonorrhea and chlamydia, certain drugs used for cancer and fungal infections, hormone imbalance, undescended testes, varicocele (swelling of veins that drain the testicle) and cancer.

Environmental causes include over-exposure to industrial chemicals, heavy metals and X-rays; over-heating the testicles by frequently using the sauna and hot tubs; prolonged bicycling

Lifestyle causes include alcohol use, tobacco smoking, illegal drug use, obesity and emotional stress.

To get a woman pregnant, a man has to have at least 40 million sperm per ejaculate. People with low sperm count usually have less than this.
If you have been diagnosed with low sperm count, then do something about it. Here are some tips that could help to improve your sperm count. Treatment is generally based on the cause:
Stress has been found to contribute to infertility problems such as hormonal issues. So, prevent excessive stress and perform relaxation exercises. Remember that infertility and life in general can be stressful. Learn to relax.

Stop smoking because smoking significantly reduces both sperm count and the movement of sperm cells.

Prevent overheating of the scrotum: When scrotal temperature rises (caused by tight underwear, long stays in a sauna or Jacuzzi, for example) sperm production can be impaired.

Maintain a healthy weight: Not too under or overweight since weight influences estrogen and testosterone levels.

Stop using drugs: Prolonged use of recreational drugs (for example, alcohol, marijuana, cocaine)

If you have infections like gonorrhea and chlamydia, these need to be treated.

Surgeries can be done for varicocele and cancers. Radio and chemotherapy are also treatment options for cancer.

Medications or hormone replacements can be used for hormonal problems.

The major challenge with low sperm count is infertility. Sometimes, the treatments listed above do not work, especially when the cause is not known. But IVF is an option that exists for this group of people.

So, first thing is to confirm from the doctor what exactly the cause of the low sperm count is (if known) and then review your options from there.

All the best.

Have a good night, everyone 😀

Q: Please ma’am, how many days can implantation bleeding last?

A: Implantation bleeding is typically a small amount of light bleeding that occurs about 10 to 14 days after conception. It could last anything from a couple of hours to three days. This is thought to be due to implantation as the fertilized egg implants itself in the uterus (womb). This usually occurs in early pregnancy, close to or about the same time as the menstruation would be seen and is thus often mistaken for a period. But, it is usually lighter than menstrual…typically without clots. It would stop on its own and does not require further treatment. If the bleeding is heavier, associated with cramps or any other complication, please see your doctor.

Some tips to help distinguish implantation bleed from menstruation:

• Menstrual bleeding may have clots. Implantation bleeds have no clots
• Menstrual bleeding can fill sanitary towel(s). Implantation bleeds are usually described as spotting, as they just stain the panties
• Menstrual blood is typically bright to dark red. Implantation bleed is light pink to dark brown
• Implantation bleeds are usually shorter in duration than normal

As a rule of thumb really, any bleeding in pregnancy should be investigated as they may be due to more serious conditions like ectopic pregnancy, miscarriage and infections.

I hope this helps.

Good night y’all 😀