chatwithketch

Hello everyone! I hope you’ve had a relaxing few days. As we all get back to work today, a few tips to keep stress and blood pressure down

https://www.health.harvard.edu/healthbeat/7-ways-to-keep-stress-and-blood-pressure-down

Happy Easter! He’s risen!

Have you ever paused to consider how the death and resurrection of Christ imitates our lives sometimes? Something absolutely terrible happens and we think ‘This is it! The end is here! I can never recover from this!’ But then, that’s you speaking within the limits of what you know. But, God shows up and that supposed failure becomes the stepping stone to great things! Halleluya!

In the same way that His death and resurrection brought great hope to humanity, may today mark the resurrection of peace, joy, happiness and everything good in your lives!

And now to our question….

Q: Doc what causes premature birth and frequent miscarriage, if it’s happening to the same woman?

A: What is prematurity? A premature baby comes into the world before 37 completed weeks of pregnancy. Babies born prematurely have to be in intensive care (Special Care Baby Unit) so as to give them a fighting chance. They are prone to having problems like apnea(where the baby sometimes stops breathing), anaemia (shortage of sufficient number of red blood cells to carry oxygen round the body), respiratory problems and low blood pressure etc.

Who is at risk of having a premature baby? Sometimes we don’t really know the cause, but it has been observed in mothers younger than 19 years of age and older than 40 years. Some cases can be brought on by chronic diseases which the mother already had before pregnancy like hypertension, Diabetes Mellitus or could be due to Urinary Tract Infections, other diseases of the heart or kidney, due to abnormal positions of the placenta in pregnancy or due to multiple pregnancy (carrying more than one baby in the womb eg twins). Smoking, drinking alcohol, drug abuse and failure of the mother to feed well during pregnancy are other factors that can lead to prematurity.

On miscarriages, often times, the cause of a miscarriage is not identified. Women who go through this need to understand this so that they don’t blame themselves unduly. Having said that though, first trimester miscarriages are mainly due to problems with the baby/fetus. These problems could be due to problems with the placenta. This is how the baby receives its nutrients in the womb and so, if this organ cannot deliver, a miscarriage might occur. There may also be a problem with the baby’s chromosomes, such that a baby may receive too many or too few genetic materials or there may be a damaged egg/sperm. Other associated risk factors include smoking and drinking alcohol, being overweight, malnutrition, increased maternal age, trauma and drug abuse. By the way, trimester is 3 months of pregnancy. Therefore, first trimester refers to the 1st three months, 2nd trimester, the 2nd three months and 3rd trimester, the last three months

So, my advice is, once you get pregnant start your antenatal classes asap and let your doctor know if you have any of the mentioned risk factors. In the developing countries like Nigeria, our survival rates for prematurity (depending on number of completed weeks of pregnancy) are not as good as in advanced countries. Let’s give our babies a fighting chance.

I hope y’all have had a great day!

Q: Hello! Dr. I have been facing a problem with my tongue where my tongue loses the ability to sense taste. This has occurred twice

A: Thanks for writing in. The disorder you describe is most likely hypogeusia, a situation in which one has a reduced ability to taste anything whether it’s sweet, sour, bitter, salty, and/or savory. The disorder in which there is complete inability to taste anything (ageusia) is rare. So, symptoms can range from reduced ability to taste a complete inability to taste. Oftentimes, when people report that they cannot taste things, actually have a challenge with smelling rather than tasting.

Some people are born with this disorder but in other cases, problems with taste and smell can be due to certain health problems, such as diabetes, high blood pressure, obesity, head injury, diseases of the nervous system like Parkinson disease and Alzheimer disease etc or even illnesses like a common cold, allergy or a sinus infection. Other causes include exposure to some chemicals or certain medicines, nasal polyps, hormonal changes, cigarette smoking, drug abuse eg snorting cocaine through the nose, dental problems etc. As people get older, challenges with sense of taste and smell also become more common.

To make a diagnosis, your doctor will run some tests which may include comparing tastes of different chemicals and measuring the strength at which you recognize any of the tastes, ‘sip, spit and rinse’ tests in which chemicals are applied to different areas of the tongue that are responsible for detecting different tastes etc.

Treatment depends on the cause(s), the severity of symptoms, age, judgement of the patient’s capacity to handle prescribed therapies and preference etc and could include changing medicines associated with disorder, treatment of underlying medical condition, counselling etc

Taste disorders can affect the patient’s general quality of life by affecting nutrition, the immune system and other medical conditions. So, every effort should be made to identify the cause and commence treatment.

All the best!

Q: What causes protein in the urine or in the body? Does it mean eating too much protein can be dangerous sometimes?

A: Thanks for writing in.

First point…even if a food is considered healthy, it doesn’t mean you should eat as much of it as you want. For instance, beans is healthy on so many levels but it also high in calories and so you still need to stick to the portion described. Moderation in everything!!

Protein molecules in blood are typically too large to be filtered into urine so that normally, very trace (very little/low) amount is present in the urine as healthy kidneys do a great job of filtration. Therefore, when protein is found in urine, it is abnormal and usually suggestive of the fact that the kidneys may be malfunctioning. This condition is known as proteinuria and the most common relevant protein suggestive of kidney disease is albumin. This can be detected using a dipstick test. How would you know without this test? Well, the urine could get very frothy if a lot of protein is being passed out in the urine…so that’s something to look out for.

There is a condition known as temporary proteinuria, which occurs in people with high fever and after very vigorous exercise. This is not a problem and as the name suggests, it is temporary. Proteinuria is also common in concentrated urine samples like first thing in the morning and when dehydrated. In some instances, it is found in young children later in the day even when it was not evident in the morning in a condition known as orthostatic hypertension (This condition, also known as postural hypertension, is a medical condition that presents as a sudden and abrupt increase in blood pressure when a person stands up). Again, this is not suggestive of a bigger problem

What diseases can cause this?

• Kidney disease, especially those affecting the filtering units. Diabetes can affect these filtering units
• For more on this, please click here: https://chatwithdrketch.com/2015/10/23/daily-health-tips-protein-in-urine-during-pregnancy/
• Urinary tract infections

People with proteinuria are more at risk of heart disease and so it is key to monitor blood pressure and ensure one lives a healthy lifestyle.

Treatment depends on the cause. Please be guided by your doctor!

All the best!

Q: What causes protein in the urine or in the body? Does it mean eating too much protein can be dangerous sometimes?

A: Protein molecules in blood are typically too large to be filtered into urine so that normally, very trace (very little/low) amount is present in the urine as healthy kidneys do a great job of filtration. Therefore, when protein is found in urine, it is abnormal and usually suggestive of the fact that the kidneys may be malfunctioning. This condition is known as proteinuria and the most common relevant protein suggestive of kidney disease is albumin. This can be detected using a dipstick test. How would you know without this test? Well, the urine could get very frothy if a lot of protein is being passed out in the urine…so that’s something to look out for.

There is a condition known as temporary proteinuria, which occurs in people with high fever and after very vigorous exercise. This is not a problem and as the name suggests, it is temporary. Proteinuria is also common in concentrated urine samples like first thing in the morning and when dehydrated. In some instances, it is found in young children later in the day even when it was not evident in the morning in a condition known as orthostatic hypertension (This condition, also known as postural hypertension, is a medical condition that presents as a sudden and abrupt increase in blood pressure when a person stands up). Again, this is not suggestive of a bigger problem

What diseases can cause this?

• Kidney disease, especially those affecting the filtering units. Diabetes can affect these filtering units
• For more on this, please click here: https://chatwithdrketch.com/2015/10/23/daily-health-tips-protein-in-urine-during-pregnancy/
• Urinary tract infections

People with proteinuria are more at risk of heart disease and so it is key to monitor blood pressure and ensure one lives a healthy lifestyle.

Treatment depends on the cause. Please be guided by your doctor!

All the best!

Q: Hello doctor, please what will happen to an O- mother that didn’t take the Rhogam injection after delivery but took it when she was seven month pregnant?

A: Thanks for writing in. The challenge here is that of Rhesus incompatibility…the fact that the mother is O negative and it would appear the father is O positive.

Usually in pregnancy, your blood and your baby’s blood do not mix. However, during the process of delivery (and some procedures during pregnancy), some degree of mixing of mother’s and baby’s blood happens. When this occurs, if your baby is O positive, your body starts to produce antibodies against your baby’s blood….literally. But, because your baby is being delivered or has been delivered, the antibodies have very little time to do any damage to the baby. They can only get rid of the small amount of baby’s red blood cells in your own body. So, baby number 1 is not a problem.

The challenge though is that these antibodies are now waiting for another opportunity to attack foreign blood cells. If you give birth to a baby that is O negative like you, this is not a problem. If, however, the next baby is O positive, those antibodies kick in and start to attack your baby’s red blood cells. It is for this reason that the Rhogam injection is given within 72 hours of delivery to ensure that your body does not mount the regular response of producing antibodies against Rhesus O positive blood. The injection deceives your body into thinking it has already produced antibodies, thereby protecting your baby as the particles of Rhogam cannot cross the placenta.

I hope in your case, that your first pregnancy involved a Rhesus negative baby…in which case the injection you didn’t take wasn’t needed anyway. Whatever the case, I’m glad you’ve taken the injection now.

Don’t beat yourself up over the injection that you didn’t take. It’s past. Let’s focus on the present and be sure to prevent future issues like this. Your doctor already knows what complications are likely to be expected and I trust that he will have the right team in place to handle these as best he can.

If there is a case of incompatibility though and it’s severe with the baby in danger, the baby can get special blood transfusions called exchange transfusions either before birth (intrauterine fetal transfusions) or after delivery. Exchange transfusions replace the baby’s blood with blood with Rh-negative blood cells. This stabilizes the level of red blood cells and minimizes damage from Rh antibodies already in the baby’s bloodstream.

I wish you the very best.

Lots of hugs!

Q: I am 15 weeks pregnant, every food smells bad to me, and I do not eat like before – even water. What is the cause because I do not understand?

A: Early pregnancy can be a trying time for a number of women as they go through tiredness, breast tenderness, loss of appetite, nausea etc.

Here are some tips to help you get back into the groove of eating normally

• Focus on portion sizes and try to eat small portions during each meal. You can use smaller plates (to stop you from feeling overwhelmed by lots of food on one plate).
• Remember that you can have 5 small meals: breakfast, a mid-morning snack, lunch, an afternoon snack and then, dinner. Good snack options are fruits, nuts, yoghurt etc
• If you cannot stand any snack at this time, go for a nourishing drink. This provides the nutrients you need in a drink form.
• There is a lot of focus on repairing damaged tissues at this time, so be sure to include proteins in your choice of meals. Good examples include fish, chicken, beef, milk, cheese, eggs etc. For more on protein sources, please click onhttps://chatwithdrketch.com/2015/06/26/daily-health-tips-how-can-i-get-more-proteins/
• In the same vein, starchy foods are also needed to help you build up your energy. So get at least one serving per meal. Good examples are rice, potatoes, bread.
• Attractive looking foods also look appetizing and are more likely to tempt a sluggish palate/appetite
• Exercise also helps to work up an appetite (be sure to check with your doctor before you start on any rigorous exercise regimen). You may not have the energy to get back into your regular exercise routine…assuming you had one before 😀 But taking a walk before meal times can help improve your appetite.
• As a result of the energy needs at this time, it may be necessary to have some foods that we ordinarily would not suggest 😀 And so, at this time, ice cream, butter, full cream milk etc. may be used to supplement energy needs. Please note that this is just for this period of appetite loss. Once you got it back, kindly ease off 😀 Remember a second on the lips, a lifetime on the hips 😀
• Cold drinks and even cold foods may be easier to also tolerate at this time. Be sure to stay hydrated by taking in sufficient fluids. Eat and drink slowly, generally during this period to enable you keep more down.

These tips should get you firmly back on your way to health and great appetite. In the meantime, keep your head high and your spirits up. Trust me…this too shall pass 😀

Loss of appetite may also be due to the nausea of early of early pregnancy where it appears the tummy cannot seem to keep anything down. If you feel nauseous, the following tips may help:

The standard teaching is to try eating some bland foods like Crackers biscuits or dry toast. That personally didn’t work for me. I preferred tart things…which some may want to avoid. I loved lemons during my pregnancies. They were the one thing guaranteed to ‘wake up’ my mouth and chase nausea far away. I also had a particular brand of very tart bubble gum, I indulged in grin emoticon These were key for me because, though I didn’t have the real bad case of morning sickness that sent you to the hospital, brushing my teeth in the morning always sent me into a bout of retching/vomiting. So, I always had a ready supply of the gum or lemon/lime to pop into my mouth once I was done brushing/retching! Not a very pleasant memory ;D

So, if lemons work for you to prevent nausea, go for it. Remember that moderation is key. A few drops (one or two) in a glass of water are enough to provide that tart kick that sends nausea far away. There is a catch here though…remember the heart burn associated with pregnancy. The acid content of lemon might make the heart burn and any pre-existing gastro-esophageal (stomach and esophagus/gullet) problems worse. So, this is all the more reason to be very moderate or stop if it exacerbates an already bad case of heart burn. Wherever and whenever in doubt, please be sure to see your doctor.

Other tips:
• Eat little amounts of food frequently as an empty tummy increases the likelihood of throwing up. Remember this is not an excuse to binge and over eat 😀
• Avoid fatty and greasy foods.
• Avoid smells that trigger nausea
• Cold foods may be preferable to hot as the former does not give off smells that may cause you to feel queasy.
• Get loads of fresh air and rest
• And drink sufficient fluids daily
Talking more generally, here are 5 general nutrition tips for a pregnant woman:
• Eat a balanced diet with a variety of foods from different food groups.
• Be sure to include a lot of high fibre foods like vegetables, whole grain cereals etc to deal with the constipation associated with pregnancy.
• Ensure you take your antenatal medications (prenatal vitamins) in addition to eating well.
• Be sure to also take foods rich in iron eg and foods rich in folic acid eg green leafy veggies and beans. Folate prevents deformities of the spine.
• Drink at least 4 servings of milk, other dairy products or calcium rich foods. If you don’t eat enough, your baby will start drawing on your own stock from your bones. So, drink up your milk!

 I hope this helps. All the best 😀

Q: I am 15 weeks pregnant, every food smells bad to me, and I do not eat like before – even water. What is the cause because I do not understand?

A: Early pregnancy can be a trying time for a number of women as they go through tiredness, breast tenderness, loss of appetite, nausea etc.

Loss of appetite may be due to the nausea of early of early pregnancy where it appears the tummy cannot seem to keep anything down. If you feel nauseous, the following tips may help:

The standard teaching is to try eating some bland foods like Crackers biscuits or dry toast. That personally didn’t work for me. I preferred tart things…which some may want to avoid. I loved lemons during my pregnancies. They were the one thing guaranteed to ‘wake up’ my mouth and chase nausea far away. I also had a particular brand of very tart bubble gum, I indulged in grin emoticon These were key for me because, though I didn’t have the real bad case of morning sickness that sent you to the hospital, brushing my teeth in the morning always sent me into a bout of retching/vomiting. So, I always had a ready supply of the gum or lemon/lime to pop into my mouth once I was done brushing/retching! Not a very pleasant memory ;D

So, if lemons work for you to prevent nausea, go for it. Remember that moderation is key. A few drops (one or two) in a glass of water are enough to provide that tart kick that sends nausea far away. There is a catch here though…remember the heart burn associated with pregnancy. The acid content of lemon might make the heart burn and any pre-existing gastro-esophageal (stomach and esophagus/gullet) problems worse. So, this is all the more reason to be very moderate or stop if it exacerbates an already bad case of heart burn. Wherever and whenever in doubt, please be sure to see your doctor.

Other tips:
• Eat little amounts of food frequently as an empty tummy increases the likelihood of throwing up. Remember this is not an excuse to binge and over eat 😀
• Avoid fatty and greasy foods.
• Avoid smells that trigger nausea
• Cold foods may be preferable to hot as the former does not give off smells that may cause you to feel queasy.
• Get loads of fresh air and rest
• And drink sufficient fluids daily
Talking more generally, here are 5 general nutrition tips for a pregnant woman:
• Eat a balanced diet with a variety of foods from different food groups.
• Be sure to include a lot of high fibre foods like vegetables, whole grain cereals etc to deal with the constipation associated with pregnancy.
• Ensure you take your antenatal medications (prenatal vitamins) in addition to eating well.
• Be sure to also take foods rich in iron eg and foods rich in folic acid eg green leafy veggies and beans. Folate prevents deformities of the spine.
• Drink at least 4 servings of milk, other dairy products or calcium rich foods. If you don’t eat enough, your baby will start drawing on your own stock from your bones. So, drink up your milk!

 I hope this helps. All the best 😀

Q: Hello Doctor, is coffee good while breast-feeding?

A: Coffee and other foods and drinks that contain caffeine should, definitely be avoided when breastfeeding as much as possible. Caffeine in coffee energy drinks, some soft drinks etc. This makes the baby irritable and by extension, makes sleep difficult for the baby.

Other foods to avoid or limit their consumption while breast-feeding:

Alcohol: This should be avoided at all costs.

Cigarette (yeah, yeah, I know it’s not food) should also be avoided as it reduces the production of breast milk.

If baby reacts to what the mother ate, efforts should be made to pinpoint what the mother ate before the incident started and then eliminating that from the diet to see if the diarrhea or allergy stops.

Make sure that you eat well: lots of fruits and vegetables and complex carbohydrates. Cut out the junk that will not help you achieve your weight loss goals and in addition have empty calories. In addition, drink sufficient fluids daily.

Be careful before taking any drug as most find their way into your baby.

Have a great night, everyone 😀

Q: Hello sir, please I would like to know if there is anything like child selection. If yes, please I want to know when one can have a baby boy.

A: Thanks for asking this question which I get from time to time 😀 I repeat the details of a post I’d made in response to this in addition to that of my guest blogger.

The issue of gender (child) selection raises ethical concerns worldwide, as it is feared that it could lead to neglect of the ‘undesired’ gender. It used to be thought that sexual intercourse on certain days or using certain positions guaranteed one sex or another, but these methods are, pretty much, unreliable.

Some people who undergo invitro fertilization (IVF), may be offered a procedure called Pre-implantation Genetic Diagnosis. This involves screening your embryos for the preferred sex. This procedure is not routinely/indiscriminately offered and is actually banned in some countries except there is a medical reason for it. Did I also mention that it costs a small fortune?

In the African setting, a lot of emphasis is placed on the male child. I can appreciate that you may be going through a lot of pressure. However, I would want you to know that children are gifts from God, and sex selection is not determined by you or anyone else. The selection process is done by Him.

Scientifically, there are the X and Y chromosomes. Each individual has two sex chromosomes. XX in females and XY in males. During fertilization, one chromosome is derived from each parent. Usually the Y chromosome is derived from the male (because they alone have the Y chromosome) and the woman can only give the X chromosome (because she has just X chromosomes). If the Y chromosome is not donated or selected from the male during the fertilization process, then a female child is formed, on the other hand, if the Y chromosome is selected(from the male/father), then a male child is formed.

It’s not really the sex of the child that matters, but how you raise them and make them your pride at all times. The guest blogger who contributed to this post comes from a family of five girls and they have made their parents proud; with 3 medical doctors, an engineer and a psychology undergraduate. She retained her father’s name and added it to her husband’s name, just to ensure the name doesn’t ‘die’ as is believed in the absence of a male child. Actually, in Rwanda, women typically don’t change their maiden names to their husbands’. They maintain their maiden names and trust me, they do not take the institution of marriage lightly at all!

So, what are your options? Be thankful for whatever baby you get….male or female and give them all the love you have in you. The grass is always greener in the neighbour’s backyard and so we always yearn for that which we don’t have. Turn the tables around and be thankful for that which you do have. Remember that if you have boys, it’s only a matter of time before you have daughters…when your son(s) marry 😀 and vice versa

Have a great week ahead y’all 😀

Q: Hello Dr, how can I treat hemorrhoids after giving birth?

A: Thanks for writing in and congratulations on your baby! Haemorrhoids are swollen veins in the anal canal. They can be internal, external or both internal and external can co-exist. Internal haemorrhoids occur when veins swell within the rectum and external haemorrhoids are found under the skin around the anus.

These haemorrhoids develop when there is undue pressure in the pelvic and anal area as can occur when people strain to pass faeces (if they have diarrhoea or are constipated), in pregnancy (especially the last 6 months), in obese people, people who eat diets low in fibre and people who practice anal intercourse. When women strain in labour, haemorrhoids can also be made worse.

It is important to consult your doctor to make a proper diagnosis.

In the meantime, limit the discomfort you have by keeping the anal area clean, using wet wipes (non-perfumed) or washing with unscented soap when cleaning up after using the loo, sitting on a bowl of plain warm water for about 15 minutes about twice or three times per day, applying cold compress and not standing or sitting for too long. Some believe sprinkling some powder there helps…it doesn’t! Avoid it J

To prevent this, ensure that your diet has sufficient amounts of fruits and vegetables. Remember that if you take a regular flat plate, half of this should be filled with fruits and vegetables, half of the plate with complex carbohydrates and the last half with proteins.

Limit the time you spend sitting on the toilet seat (read your newspapers elsewhere :D), use the toilet as soon as you feel pressed (that way the fluid in the stool is not absorbed making the stool hard) and then don’t strain when you do go. Drink sufficient quantities of water daily, exercise (to keep everything moving along nicely :D). Use pain relief only under the supervision of your doctor, especially if you’re breastfeeding.

I hope this helps you.

Have a fab weekend, everyone 😀

Q: Hello I would like to know if sitting in warm or hot water in the bath tub can damage the walls of the vagina or the vagina itself.

A: Hi dear, what you describe is a sitz bath and is typically used by women who have had episiotomies. Can it damage the walls of the vagina? No, especially if you follow the tips in this post. My assumption here is that the sitz bath is for an episiotomy.

What’s a sitz bath? This is a warm water bath that helps cleanse the perineum. Just in case you wondered, the perineum is that space between the rectum and the genitals. The right temperature is the one that you can handle without sustaining burns. Putting a few drops of this water on the inner surface of your wrist can help confirm this.
Plain warm water is sufficient but some people add salt to the water which is soothing. Your doctor may also suggest other things he/she may want you to add to the water.

To prepare this, you can either use the plastic sitz bath kit, (a special bowl specifically made for this which fits on your toilet seat so you can sit down easily on it), or your bath tub. Be sure to scrub your plastic sitz bath kit or bathtub, thoroughly, before and after use. If using the bathtub, add sufficient warm water to sit on and then get in. To get the job done properly, you can try hanging your legs out of the tub. Usually, you are encouraged to sit for 10 to 15 minutes on the water. Pat the perineal area dry after you’re done. Do not rub vigorously…remember the area is sore and if you’ve had stitches, it could mess things up 😀 This can be repeated up to 3 to 4 times daily as needed.

To ensure that the episotomy site heals well, use prescribed pain medication, avoid sitting on hard surfaces. Try using a pillow ( a regular or circular one/boppy pillow). Avoid constipation and indeed diarrhea and try placing a pad over the suture area while bearing down to poop. Urinating presents a challenge as pain is experienced during this process. Try using water to rinse off afterwards, preferably using a squirt bottle.

Eat healthy, keep the surgery site as clean as possible and enjoy your time with your baby. This too shall pass. Be sure to let your doctor know if you have concerns.

Have a good night y’all 😀