chatwithketch

Q: What drug can I use to control worm in my stomach? It disturbs me after eating. My stomach makes noise after eating.

A: Hey! Thanks for writing in.

How do you know your symptoms are due to worms? Was your stool (faeces) examined? It’s important that you visit the health facility to get a proper diagnosis so that appropriate treatment can be started.

Having said that, worms oftentimes do not present with any symptoms but sometimes people with this infestation complain of non-specific symptoms of the digestive system (like your complaint).

So, what is a worm (helminth) infection? There are different types. I will explain a couple.

A) Ascariasis – This is a type of roundworm infection and is one of the most common types of worm infections. This infection is spread when a person comes in contact with ascaris eggs in soil mixed with human feces or infected water. This is common in many developing countries, with poor sanitary conditions leading to people defaecating in fields and ditches and sometimes, human feces is used as fertilizer. When children play in this sort of environment and inevitably put dirty fingers in mouths or when unwashed fruits and veggies grown in the contaimnated soil, infection occurs

Most people will show no symptoms but a heavy infestation will cause problems depending on the area of the body affected.

In the intestines, the severity of symptoms depend on the number of worms

• Abdominal pain, which could be vague or severe
• Nausea and vomiting
• fatigue
• Diarrhea or bloody stool
• Weight loss
• Presence of worm in stool or vomit

In the lungs, they cause symptoms that resemble those of asthma

• Wheezing
• Persistent cough
• Shortness of breath

Prevention is really through good personal hygiene. Wash your hands before meals, before food prep, after using the bathroom, after gardening or coming in from outside. Just make it a habit to consistently wash your hands

Then practice good food hygiene too. Wash your fruits and veggies thoroughly before use, especially those that will be eaten raw. Drink only potable water – use bottled water (especially when you travel) or boil and filter your own water at home.

Other soil transmitted helminths are hookworm (usually causes iron-deficiency anaemia) and trichuris trichuria aka whipworm.

Diagnosis is by stool microscopy and treatment with anti-helminthics, mebendazole, ivermectin or albendazole is usually effective.

Surgery may be necessary in cases of heavy infestation to remove worms and repair damage or obstruction of the intestines, remove inflamed appendix or remove bile duct obstruction

B) Another example of infection caused by worms is elephantiasis. Elephantiasis is a disease condition in which there is swelling of the limbs, genitals or other body parts making them appear swollen and puffed-up, resembling an elephant. How does this happen? It actually starts with the bite of an infected mosquito (Aedes, Culex, Mansonia or Anopheles mosquito) which transmits filarial worms that block the lymphatic system. I see the look of confusion already on your faces! JWhat’s the lymphatic system, you say “)

Well, the lymphatic system is a network of vessels and glands distributed all over the body. They help to fight infections and drain excess fluids from tissues in the body. When this system is blocked, fluid no longer drains freely from the tissues leading to collection of fluids in the tissues, resultant body swelling and fever when this fluid collection gets infected. Chronic (longstanding) infection with these worms leads to elephantiasis with swelling (lymphedema) and hardening of the limbs. It really does require years of exposure to these infected mosquitoes for elephantiasis to occur. It is important to handle the infection before it gets to this stage.

Most people, however, will not have symptoms until years after being exposed when they develop these swellings.

There is no medication that is really active against adult worms. Focus is on management of symptoms. Exercise encourages lymphatic drainage, healthy diet, good skin care to prevent infection can help. Wearing special compression stockings/garment or having a special massage by a specialist to help lymph fluid drainage are also helpful aids.

Prevention of elephantiasis is key.

• Use of mosquito nets
• Use of medications to kill microfilariae in the blood
• Antibiotics for infections
• Surgical prevention of infected tissue

C) Schistosomiasis, another worm infection, is acquired by exposure to fresh water contaminated by snails especially in sub-Saharan Africa. Infection can persist for many years after exposure and symptoms include those of:

• Chronic renal failure
• Bladder cancer
• Portal hypertension

Diagnosis is made by:

• Stool microscopy
• Urine microscopy
• Schistosoma serology

Treatmentis usually with a medicine called Praziquantel.

So, as first steps, I suggest you go visit your doctor and get a proper diagnosis. After that, the right treatment option for you will be started.

Does exercising to relax sound like a misnomer? Well, read the question and answer below from someone who wanted to know if exercise was stressful.

Q: Can there be anything like stressful exercise?

A: I’ve been asked this question a lot of times. Some people think that exercise may actually worsen hypertension by causing more stress. This is a wrong notion. Exercise is useful in relieving stress by causing the release of body’s natural ‘feel-good’ hormones. These make you feel better, happier and look at your challenges, perhaps more benevolently!

However, if you have been sedentary for a while (that is, if you have not been involved in much physical activity for a while), please discuss your planned exercise regimen with your doctor before starting out.

You should also invest in heart rate monitors which ensure that you exercise within a ‘zone’ where you optimally lose calories and do not overdo it. You should also learn how to ‘roughly’ calculate your target heart rate…this is is that heart rate at which you burn calories optimally. We will look at the calculation of Target Heart Rate subsequently. But the rule of thumb is to take away your age from 220 and calculate 60% and 80% of that figure. Stay within that while exercising. The calculation (Karvonen method) is a bit more complex though and we will get into that another day.

For more on this, please click on the link below.

https://www.health.harvard.edu/staying-healthy/exercising-to-relax

Q: Good evening Doc, I am 38 weeks pregnant. On my last ANC visit the doctor detected a trace of +1 protein in my urine and my blood pressure was high. Please ma’am what food and things can I do to reduce protein and high blood pressure?

A: A high blood pressure reading in pregnancy with protein in urine is a worrying situation. Blood pressure readings are interpreted as same, pregnancy or no pregnancy. Any level more than 140/90mmHg is seen as hypertensive. This of course has some slight changes with the new classification of high blood pressure. A woman may already be hypertensive before pregnancy and on medication. She may be found to be hypertensive before 20th week of pregnancy in which case it is believed she had previously undetected high blood pressure or she may be discovered to have high blood pressure after the 20th week, in which case it is believed that this high blood pressure is pregnancy-induced (Pregnancy Induced Hypertension: PIH). This would usually resolve within 6 weeks of having a baby. If a woman with PIH goes on to develop protein in urine, she is at risk of preeclampsia (in which protein leaks from kidneys into urine) or eclampsia (in which the woman experiences fits and seizures)

The risk of preeclampsia is higher in women who have had this condition in a previous pregnancy, first pregnancies, women who get pregnant after the age of 40 years, women who are obese and women with multiple pregnancies or those who have a long interval between babies (greater than 10 years) or short interval between babies (less than 2 years) etc

High blood pressure in pregnancy needs to be addressed as this poses a danger to both mother and baby. It may affect the flow of blood and nutrients to baby leading to slow growth or pre-term delivery. It may also lead to eclampsia or separation of placenta from the uterine wall before the baby is born.

Your doctor will determine the best course of action and may prescribe medications (to reduce blood pressure, or to even prepare your baby’s lungs for life outside the womb given the anticipation of preterm delivery), hospitalization to monitor you or delivery of the baby if the doctor believes the womb is now a hostile environment for the baby due to any of the dangers mentioned above.

There are varying thoughts about strategies thought to help prevent this condition. However, ensuring that risk factors are reduced by reducing weight, eating and living healthy may be helpful strategies. For tips on healthy eating, please click on this link https://chatwithdrketch.com/2018/04/02/hlwdk-daily-health-tips-healthy-eating/

For more on blood pressure, please click on the links below:
https://chatwithdrketch.com/2013/12/10/daily-health-tips-blood-pressure-the-fact-behind-the-figures/

https://chatwithdrketch.com/2014/06/12/daily-health-tips-pre-hypertension/

https://chatwithdrketch.com/2013/12/11/daily-health-risks-my-high-blood-pressure-risks/

Be sure to make your antenatal classes interactive….the one or two that you have left. Ask your doctor questions about your health and indeed your blood pressure readings if they are cause for concern.

All the best!

Have a great evening, y’all 😀

Q: Good evening Dr. My partner and I are having a baby. She’s 37 on Thursday. For the past 2 weeks or so she’s been having some kind of fluid leaking from her vagina. It’s not urine – it’s watery and she’s been having a lot of pains in her lower abdomen almost like period pains. It’s awful to an extant that she has to flee outa bed a lot or sit up straight. Also there has been some kinda mucus that’s light yellowish that came out. Please shed some light on what could be going on. We have a Dr.’s appointment on Thursday as well .Thank you in advance

A: Thanks for writing in.

Amniotic fluid is the fluid that surrounds and cushions a baby while in the womb. The fluid is contained within a sac called the amniotic sac. Usually just before a woman goes into labour, this sac ruptures and the fluid is released…that’s what is referred to waters breaking. When I had my last baby, my waters broke right in the hospital reception! And so, there was I with water all over my legs and people in the reception area watching 😀 It wasn’t quite funny on that day! But I digress…

Though, you are quite sure the leaking fluid is not urine, here a few things you can do to check:

• If it’s urine, it has the peculiar smell of urine and is usually leaked when one coughs, laughs or sneezes.
• If it’s vaginal discharge, it’s there constantly and may be clear, white or yellowish
• If it’s amniotic fluid, it’s likely to be clear, or slightly mucoid and/or blood stained and it wets panties continuously irrespective of whether one laughs or not

Not sure if the 37 you mean refers to 37 weeks as age of pregnancy or 37 years as age of your partner J I will assume that it refers to age of pregnancy. At 37 weeks, pregnancy is considered to have been carried to term. Therefore, the mucous she saw may be ‘show’.  Show is a mucous plug that may be tinged with blood and is a sign that your cervix (neck of womb) is getting ready for labour.

The abdominal pasins he is having could be Braxton-Hicks contractions (these are ‘fake’ contractions preparing the womb for the main even :D). However, with the other symptoms she is having, the pains could very well be the real deal – real labour has started 😀

So, my advise is….forget your Thursday appointment and go see the obstetrician immediately. It appears your baby is about to make an early appearance 😀

All the best and congratulations in advance.

Have a good night y’all 😀

Want to sleep better? First tip…cut down on caffeine. Perhaps you don’t drink coffee but you take a lot of other drinks that are high in caffeine. Want to know what these are? Energy drinks, teas, chocolates and some sodas, too. Apart from the laxative effect of caffeine, it has other actions on the body:

Inability to sleep – not a good idea if you want a good night rest, right?
Rapid heart beat
Irritability
Nervousness
Irritation of the bladder
High blood pressure etc
The recommended daily amount of caffeine is 400mg which is about the amount of coffee in two 8 ounce cups of coffee. These are the dainty cups of coffee and not the huge mug-like (Who-send-you-come?) cups that a lot of us favour 😀

The energy drinks often contain huge amounts of caffeine and are used by people as a pick-me-up for different reasons. The thing is, if you haven’t slept for 3 days and you’re trying to complete that project by taking more energy drinks that will keep you awake, you will eventually pay for this…one way or the other. It is either the side-effects of caffeine take over or you do fall asleep! You can’t cheat nature (forgive the cliché). Your body needs rest when it needs rest and it will get it one way or another!

So, if you must, one energy drink (about 500mls) once in a blue moon may not hurt you but it may be more constructive to try to pace your activities and not try to get everything done at once. Eat healthy and get some exercise (at least 30 minutes) daily. Mixing these drinks with alcohol and other recreational drugs makes it a more dangerous ‘concoction’.

Please avoid energy drinks if you have been diagnosed with high blood pressure or you have a heart disease or at least speak to your doctor about it. Children and adolescents should stay off this. Pregnant women and breast feeding mothers should be especially careful.

For the other two tips to sleeping better, click on this link: https://www.health.harvard.edu/healthbeat/3-ways-to-get-more-restful-sleep

Having challenges keeping the weight off even though you’re doing all the right things? Here’s help for you!

https://www.health.harvard.edu/staying-healthy/small-tricks-to-help-you-shed-pounds-and-keep-them-off

I got a heart-warming message from someone who is on the road to mending following addiction to Pentazocine. S/he wrote in response to my post on this. Please click here if you haven’t read it: https://chatwithdrketch.com/2014/11/04/daily-health-tips-pentazocine-addiction/

S/he sent in the question below…..

Q: I am also addicted to Pentazocine. And with the help of my family members I have abstained from it for more than a month now. I know it’s not so long but I believe it’s a good sigh because I couldn’t stay without it for 48hrs before. But do you really think I can stop using this method??

A: Hello dear! I am so happy to read from you! Great job! Way to go!

Can you go it alone with just family for support? Yes, you can. There are two options: cold turkey (where you stop completely at once and ride out the withdrawal symptoms) or where you stop gradually and you reduce the dose of drugs from 3 ampoules daily, to 2 and then 1 and then on alternate days until it’s completely tapered off. Please try!

But where you have good centers around, it’s usually best to get into a voluntary program for drug addiction where there will be a combination of clinical psychologists and psychiatrists. A long hard look at one’s life including unhealthy relationships, toxic home/family environment etc will be encouraged. The program will involve detoxification, exercise, counseling and other creative activities like music, art, dance, drama etc. Being enrolled with a help group will also be helpful, if this can be found.

I’m rooting for you all the way and I assure you that there IS light inside this tunnel….not just at the end.

For those who have more questions on drug addiction, I reproduce below, a post I had made on the new face of drug addiction in Nigeria a few weeks back. Enjoy….

Many children hate cough syrup. Scratch that…they hate all medicines. However, there are some teenagers who take ten of bottles of cough syrup daily! Can their coughs be that bad? Could a doctor have prescribed all of that?

If you’re into pop culture, you may know that at parties, sometimes, these cough syrups, especially those containing codeine are added to drinks, to enhance the drinking experience L

And then we have those people who sniff glue. One would wonder if they love the smell that much or perhaps, it reminds them of something/someone pleasant?

Then there are those who inhale the fumes from soak away pits! Now you would consider that downright disgusting! What’s to like in the smell of poop?!

This is the new or perhaps, old face of drug addiction in Nigeria which is just getting a lot of face and air time now.

In the past couple of days and weeks, a lot has been said about drug abuse in Nigeria (codeine, tramadol etc) including bans et al. It is important that this conversation continues with great emphasis on control of ethical and prescription drug prescription. However, that’s one side of the problem – the supply side. However, the supply side exists because there is a demand for this. So, we need to take a look inwards to understand what drives the demand. When did our teenagers move from hating the smell and taste of drugs to ‘downing’ bottles daily? When did it become fashionable to sniff stuff? Who is most likely to be affected by this and what can you do if you discover this? This post will focus on prevention, treatment and enforcement.

First, why do people start taking these drugs? Codeine is an opiate drug which is addictive with potentially dangerous effects used for pain relief and also suppresses cough, which is why it’s found in prescription cough syrups. Pentazocine is another pain killer, originally thought to be non-addictive, but that has since been found to be a drug of addiction that affects mood and behavior. This drug is used for moderate to severe pain. A good number of people start using them first, because they were prescribed by a medical practitioner. Some users report that initially, they just liked how the drug took away the pain they were feeling (I’ve heard this a lot from sickle cell patients with bone crises) but when the pain reduced, they observed some other ‘great’ feelings they were experiencing like ‘euphoria’, ‘feeling good all over’, ‘no worries’, ‘relief for pain and the mind’ etc. Others do not have the excuse of pain. They have heard how good these drugs make one feel. Some conditions make people more at risk of this drug misuse and addiction. They include:

• Poverty
• Youth
• Unemployment
• Personal or family history of substance abuse
• Heavy tobacco use
• Stressful conditions
• History of depression and/or anxiety
• Previous history of alcohol misuse
• Regular contact with high-risk groups or environments

Why do these drugs make people feel this good? They depress the central nervous system leading to feelings of drowsiness and relaxation. They make the users sociable, euphoric and serene. For someone who is dealing with a lot of stress, these are desirable feelings making the users want to re-enact them again and again. The physical dependence that subsequently develop, lead to withdrawal symptoms when the drug is not taken. These symptoms include sweating and chills, irritability, abdominal discomfort etc. So, quite a number of users actually continue to use these drugs subsequently just because they do not want to experience these withdrawal symptoms – they can be quite severe.

Sniffing glue produces the same effect of depressing the central nervous system. For those who inhale fermented human waste, the fumes act as a hallucinogen causing change in perception and hallucinations.

How do we prevent this? When I say we, I mean all of us as a community of people either suffering from this, know people who are suffering from this or know people who are at risk of this. We all need to get involved.

For one, if you or someone you know has a prescription for these drugs, please have a long discussion with your doctor as to how to use, how long it should be used and what signs to look out for that might suggest dependence. I suspect the doctor will do this without prompting but as has always been my take on this page, you all have to be empowered with information about your health so you can make the best decisions for yourselves and your families. If the doctor does not provide the information, please ask. It is your right! While these drugs are still being used according to prescription, keep them out of the reach of children or indeed anyone who could misuse them.

If you’re a parent, are you providing adequate information and a safe home environment where your children can thrive in all ways? Are you comfortable discussing any issue with your children? Are you aware that if you’re not providing this education yourself, you’re probably allowing your teenager to learn from his friends and/or the internet…where he/she may very well be learning all the wrong things! Engage them in activities they are interested in like sports etc and encourage open discussions without judging.

To wean one off this, it’s usually best to get into a voluntary program for drug addiction where there will be a combination of clinical psychologists and psychiatrists. A long hard look at one’s life including unhealthy relationships, toxic home/family environment etc will be encouraged. The program will involve detoxification, exercise, counseling and other creative activities like music, art, dance, drama etc. Getting enrolled with a help group will also be helpful, if this can be found.

If you perhaps live in an area where none of the above can be readily achieved, you may have to go it alone…perhaps with the support of family. There are two options: cold turkey (where you stop completely at once and ride out the withdrawal symptoms) or where you stop gradually and you reduce the dose of drugs from 3 ampoules daily, to 2 and then 1 and then on alternate days until it’s completely tapered off. Please try!

Nothing good in life comes easy. One needs to work at this if one wants to be free and with all of us helping and pitching in to help, we should be able to arrest the demand side of this problem.

Stay drug-free y’all!