chatwithketch

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 😀

Q: Good morning Doc. Thanks for all your lectures. When I gave birth to my baby three years ago, I had a tear in my cervix which led to them stitching my cervix and after reading the write up  that injuries in cervix may lead to miscarriage, I want to know how long it takes the cervix to heal and if the miscarriage can still occur once I get pregnant. Thanks

A: Cervical tears are usual with precipitate labour/delivery because the rapidly descending baby’s head does not give the mother’s tissues time to stretch to accommodate the baby’s head. With these tears, there is the possibility of massive bleeding and of course, infection from the oftentimes, less than sterile conditions at delivery. There really should not be any problems with getting pregnant again or having the baby, normally. If your obstetrician feels that you need to have your cervix sutured (cervical cerclage) when you’re pregnant again, then that will also help prevent problems like miscarriage.

Typically, the cervix returns to its normal size within about one week and takes another four to six weeks to recover and heal from the effects of labour and delivery

How soon can you start trying for another baby? There are different schools of thought. Lots of studies have shown that there is nothing gained by waiting before trying again but World Health Organization suggests waiting at least six months before starting on that path. The latter advice may very well give your body time to heal before getting pregnant again. However, discuss this with your obstetrician who will be in the best position to advice.

All  the best!

‘It’s easy to eat your way to an alarmingly high cholesterol level. The reverse is true, too — changing what foods you eat can lower your cholesterol and improve the armada of fats floating through your bloodstream.’

Want to know more? Read!

https://www.health.harvard.edu/heart-health/11-foods-that-lower-cholesterol

Q: Good day Doc, can sexual intercourse open the cervix at 39 weeks of pregnancy?

A: An open cervix, also known as a weakened cervix or cervical incompetence is a condition in which the mouth of the womb is open leading to a risk of miscarriage. This may be caused by a previous injury to this area, typically after a surgical procedure. The weakness of the muscle can cause the mouth of the womb (cervix) to open too early during pregnancy, leading to a miscarriage.

Having said that, if the cervical incompetence is not a pre-existing condition, sex is generally considered safe during pregnancy. If your doctor has noted some medical issues that may cause some restrictions on sexual intercourse, he will communicate that.

Some issues that may cause a doctor to issue some restrictions on sexual activity, apart from cervical incompetence, include:

• Threat of a miscarriage
• History of pre-term labour
• Unexplained bleeding in pregnancy

If you’re not sure whether you belong to any of these groups or not, please ask your obstetrician.

Now, there also some risky activities during sexual intercourse in pregnancy:

• If you indulge in oral sex, hubby please do not blow into your wife’s vagina as this can lead to an air bubble being lodged in a blood vessel causing problems in mother and/or baby
• Having STI with an infected partner can lead to STI in pregnant mum. This infection can be transmitted to the baby. So, hubbies be sure that you stay faithful
• Anal sex is also discouraged.

Some have asked the question, ‘what if my pregnant wife gets pregnant again?’ Well, theoretically, this Is not possible because during pregnancy ovulation is supposed not to occur. Essentially, for pregnancy to happen, an egg was fertilized and once this happens, there’s a signal that goes to the ovary stopping it from releasing eggs since clearly, there’s no more need 😀 In some rare cases, however, after pregnancy has occurred, the ovary still releases an egg which ends up being fertilized leading to pregnancy in an already pregnant woman. This situation is called super-fertation. However, the incidence of this is very rare that it is not considered standard practice to tell pregnant couples to avoid sexual intercourse during pregnancy to avoid this. In fact, there appear to be just about 10 documented cases worldwide.

So, if the obstetrician had not documented incompetent cervix in that patient before, sexual intercourse at 39 weeks is unlikely to cause it. Where in doubt, please consult your obstetrician.

All the best 😀

Q: Good morning Dr. May you kindly illuminate on recommended quantity of fluid one is required to take each day  My concern is that after taking a glass of water, 5 mins later, I am going to bathroom. Is there something wrong with me?

A: Thanks for writing in. Water is important for life and we use it for very important functions daily: taking a bath, washing clothes, washing dishes, cooking and of course, drinking. The water we drink is very critical for a lot of bodily functions like digestion, excretion (when we urinate, pass faeces and sweat), movement of nutrients all around the body, keeping your joints nice and supple etc. If you also consider the fact that a healthy body contains about two-thirds, water, then it is clear that we can’t joke with our fluid intake per day.

Five tips to help you with this:

• Though, there are recommended amounts to take daily, it really depends on your activity level (notice how much more water you appear to need after a hectic workout?), where you live (notice how much water you also seem to drink when you live or visit the tropics as opposed to when you live in or visit a temperate region) and your health condition (for instance, people with UTI need to drink some more water).
• Generally, we are encouraged to drink 8 8-ounce glasses of fluid per day. This is approximately 2 litres of water per day.
• Any fluid counts e.g. milk, fruit juices, beverages etc. But try to remember that these other fluid sources, other than water, may contain calories that you probably don’t need
• An easy way to check whether your body is getting enough water in a day is to check your urine colour. If it’s dark yellow, you’re probably not getting enough. If it’s pale yellow in colour, you’re doing good
• If you don’t like the taste of plain water, you can jazz it up with a slice of lemon or limeand if you don’t like the taste of plain milk, like most children, you can add some flavor like vanilla to it.

Water is necessary for life itself. Be sure that you’re drinking sufficient quantities of this daily.

Hi Dr. It has been 11 months since I quit injection (contraception???) but I don’t go on my period. What can I do to get help?

A: Family planning injections work by thickening mucous in the cervix, preventing sperm from getting into the womb (uterus) or by preventing the ovaries from releasing eggs every month (ovulation) and so the person taking the injections can’t get pregnant.

Taking these injections affect women differently. In the first few months, there be excessive bleeding during periods, followed by a period of lighter periods. This may yet be followed by a period of irregular or no periods especially in women who have taken these injections for up to a year. Irregular periods should be discussed with your doctor to ascertain the cause. It may be due to the drug or due to an infection which needs to be treated. Prolonged periods can also be treated.

When these injections are stopped, it takes a while for ovulation to be restored because these injections are long lasting. It can be as long as 2 to 3 months. In some other cases, this can last for about a year or even up to 2 years. This has nothing to do with the duration for which the injection was taken. Typically, contraceptive injections are not suitable for women who wish to have children within a short period of time.

So, visit your gynecologist to confirm that there is no other cause of ‘missing period’ other than those suggested above.

All the best! Have a great weekend!

Q: Hello Dr. I have been to a high blood pressure routine check for 3 weeks and yesterday I was diagnosed for it. I know I take in lot of salt and fatty food. I’m not ready for the treatment because they said once I use it I won’t have to stop it. Dr. is it possible to avoid treatment and regain normal pressure if I reduce fats and salt in my diet? My last blood pressure was 180/90 and they said I might have a stroke. How can I avoid this doctor?

A: High blood pressure used to be defined as blood pressure reading of 140/90mmHg or more. Not anymore!
The new guidelines by the American College of Cardiology and the American Heart Association state that only blood pressure readings below 120/80mmHg can now be considered normal blood pressure.
A systolic blood pressure reading between 120 and 129mmHg is considered elevated blood pressure.
Stage 1 high blood pressure is between 130 to 139mmHg systolic blood pressure reading and between 80 to 89mmHg diastolic blood pressure reading.
Grade 2 high blood pressure is any reading above 140/90mmHg

Do you understand what systolic and diastolic blood pressures mean? Here are a few facts to guide you:

• Blood Pressure is the pressure with which blood pushes against your vessels as it passes through your body. A normal blood pressure allows blood to flow and deliver oxygen and food to different parts of the body.
• We measure blood pressure with two numbers (ie, 124/84 mmHg). The first number is called the systolic blood pressure and the second is called the diastolic blood pressure. These two numbers are written as ‘systolic/diastolic’ followed by the unit of measurement.
• Systolic blood pressure is your highest blood pressure measurement and is recorded when your heart contracts.
• Diastolic blood pressure is your lowest blood pressure measurement and is recorded when your heart relaxes and fills with blood

For elevated blood pressure, the new recommendations point to non-drug interventions like the follow:

• Reduce your risk generally by imbibing lifestyle modifications:

• Be physically active for 30 to 60 minutes on most days of the week. Try walking, biking, swimming, dancing or any other physical activity that you enjoy. Remember that even a little bit of physical activity is better than no activity at all.

• Eat a lot of fresh fruits and vegetables, low-fat dairy products and other foods low in fat and salt. Avoid fast foods, canned foods or foods that are bought prepared, as well as any foods where you can see the fat in them.

• If you are a man and take more than two alcoholic drinks each day or a woman and you take more than one alcoholic drink, drinking less will help to lower your blood pressure. A regular-sized bottle or can of beer or a regular-sized glass of wine are each equal to a single alcoholic drink.

• Keeping your body weight within a healthy range also prevents high blood pressure. If you are overweight, losing about 10 lbs (5 kg) will lower your blood pressure, and reducing your weight to within a healthy range will lower your blood pressure even more.

• It is important to stop smoking if you have high blood pressure. Smoking increases the risk of developing heart problems and other diseases. Ensuring that you live and work in places that are smoke-free is also important.

• Other lifestyle modifications include weight control, diet watch (portion control, use of less salt, using less oil in our foods and when we do use oil to focus on the heart healthy oils) etc

Changing your diet to the type described above can bring down systolic blood pressure by as much as 11 points, and each additional healthy habit you adopt can bring it down another four to five points.

For stage 1 hypertension with no cardiovascular disease and low risk for developing it, lifestyle changes still work.

However, 1) the presence of cardiovascular disease and stage 1 hypertension or  a combination of no existing cardiovascular disease but a significant risk of developing it, or stage 2 hypertension means that lifestyle changes have to be combined with medications.

How do you know your risk of cardiovascular disease? Click on this link and assess yours. It’s easy to use.

Therefore, I suggest, you have a long discussion with your doctor but be guided by him/her. If after careful monitoring, your blood pressure falls into any of the combinations that mean you should take medicines, please start on them. Taking a pill a day is a small price to pay to be here for your family and enjoy your life. And don’t forget the lifestyle modifications. Salt should be used very sparingly and the only way to this is really re-training our taste buds to ‘accept’ less salt as tasty. Remember that you can use spices to ‘jazz’ up your food.

All the best!

Good morning, DOCTOR. I am 3 months pregnant and last night I started bleeding. I don’t know what to do. Is it normal to bleed at this stage of pregnancy or am I losing my child?

A: Bleeding during pregnancy can be worrying whether it’s a little or a lot. However, it may not necessarily be the sign of a problem. Bleeding can occur in early pregnancy, close to or about the same time as the menstruation would and thus be mistaken for a period. This bleeding could be due to implantation as the fertilized egg implants itself in the uterus (womb). Other causes of bleeding in early pregnancy include ectopic pregnancy, miscarriage and infections.

For more information on ectopic pregnancy and miscarriage, please click on these links: https://chatwithdrketch.com/2014/08/07/daily-health-tips-what-are-my-options-after-ectopic-pregnancy-and-failed-ivf/

Daily Health Tips: Miscarriage And Infertility Re-visited

Bleeding in pregnancy may not necessarily be an emergency but because there are other causes of these episodes of bleeding, which are potentially life threatening like ectopic pregnancy, bleeding in pregnancy should always be checked out in the hospital. Better safe than sorry 😀

All the best!