chatwithketch

Q: Hello doctor, I am writing from Uganda. I am living a very stressful life and very worried. I really need your help. My question is that, my wife is five months’ pregnant now. She went to the hospital two weeks ago and she was found HIV positive. I have been testing and they found me negative but doctors said I may be in the window period, so is it really possible to sleep with an infected person who is not on medication and you don’t get infected? If yes what can cause that? Do you think I still have a chance of not being infected because I have been sleeping with her? I am a very poor man. I really don’t know how to handle this situation. Please help and advise me doctor. May God bless you

A: Thanks for writing in. 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.

The fact that you have remained negative for so long is definitely note-worthy…you are one lucky fellow! However, 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: Dr. my immediate bro is masturbating and now he is ejaculating blood as sperm. I am afraid. What is really wrong with him?

A: Hi dear, thanks for writing in. It is certainly very disturbing to see blood in semen! This phenomenon, known as haematospermia or haemospermia in men under 40 years with no other symptoms related to more serious issues (which I shall discuss below) is usually not a major medical problem. Causes include:

• Inflammation of the prostate gland (where semen is produced)
• Inflammation of the seminal vesicles (where most of the fluid in the semen is produced)
• Cysts in the seminal vesicles
• Sexually Transmitted Infections like gonorrhea, chlamydia etc
• Following recent instrumentation eg after prostatic biopsy

These conditions would usually resolve on their own or require a course of antibiotics. Please be guided by your doctor.

Physical injury to the sex organs after fracture of the pelvis or injury to the testicles, excessively rigorous sexual activity or masturbation can cause blood in the semen. The latter appears to be the problem with your brother. By the way, if one is masturbating with another person, there is the possibility of an STI if objects (sex toys) are shared and/or if there is some exchange of body fluids. This now increases the chances of having blood in the semen because STIs are a recognized cause of this.

All the mails I’ve received on masturbation contain a common thread – that of feeling guilty. Some are also accompanied by a sense of low self-esteem which may have pre-dated this leading to excessive shyness and preference for masturbation, as opposed to talking to members of the opposite sex. The real challenge here is that there is nobody to talk to about these issues as we all tend to judge the people involved. The unfortunate fall out is that anxiety and depression may not be far behind if this cycle of guilt and low esteem is not addressed.

Any activity that holds one a prisoner of his/her desires has to be mastered. It has to be controlled otherwise, it rules the person’s life. Imagine being a slave to your sexual desires! :O And if this is accompanied by negative feelings like guilt, anxiety, depression etc, then it has to be decisively dealt with.

Counseling would be the way to go…I don’t know any of help groups here in Nigeria. I will make enquiries though. Or find someone who you feel you can trust and talk to. This person could be someone from home, church etc However, it’s important that people seeking help for any kind of issue, are not judged by anyone…from church or from other social circles. We all try to act as if we’re all holy and wonderful people but we all struggle with different stuff, just like every other person J Empathy is key here.

It is important to find out the why…what makes me want to do this again and again? What feeling am I trying to achieve? What am I trying to avoid? Indeed, going cold turkey and just deciding to stop could very well happen after this.

For more on this topic, please click on this link: https://chatwithdrketch.com/2014/08/05/daily-health-tips-depression-masturbation-and-over-protective-parenting/

Back to blood in semen….

Please note however that, if you develop the under-listed symptoms, especially if you’re older than 40 years, it may be a sign of more serious conditions and you should see your doctor immediately.

• Blood in semen which persists for longer than 3 to 4 weeks
• Presence of other symptoms like pain during urination
• Recurrence of blood in semen
• Presence of other risk factors for bleeding disorders, cancer etc

These more serious problems could be due to bleeding disorders, severe high blood pressure, cancer etc

So, please see your doctor and let him make a proper diagnosis.

All the best.

Q: Please Doctor, l have a problem about my breast in bring milk but I am not pregnant. Please help me

A: Some women who are not pregnant may have milky fluid come out of their breasts when they are not breastfeeding or even in women who have never been pregnant. This is called galactorrhea (pronounced gulactoria). This is not a disease on its own but a symptom of a problem. The hormone, prolactin which is responsible for lactation in nursing mothers, is usually produced in these cases.

This milky fluid can be expressed by pressing or it can spontaneously come out on its own. It can affect one or both breasts and usually there are no blood stains involved.

Sometimes, the cause of this discharge may not be known but some causes could be some medications, some drugs like cocaine, spinal cord injuries, some birth control pills, stress and even excessive stimulation during sexual intercourse.

Galactorrhea can also happen in men and new born babies! In new born babies this can happen if the mother has a high level of estrogen which crosses over into the baby and stimulates the formation of breast tissue and sometimes, some milky white discharge. Please note: this is NOT witchcraft!

If you notice this, please visit your doctor who may try to express this discharge to study. The discharge may also be clear (as in your friend’s case), bloody or even tinged yellow. These need further evaluation and the presence of lumps should also be checked for. The level of prolactin will also be assessed. This may, however, be normal in people who are overly sensitive to prolactin. In this class of people, prolactin level is normal but there is still milky discharge from the nipples.

Treatment is focused on the underlying cause if one can be found. If the problem is medication, please stop or switch to something else under the supervision of your physician (doctor). If there is a tumour producing prolactin, drugs can be taken to shrink it or surgery can be done. If no cause is found, drugs that reduce prolactin level are prescribed. Remember, that your friend could be pregnant and so a pregnancy test may not be out of place.

In the meantime, breast pads can be worn to prevent the embarrassing leaks from staining clothes, limit manipulation of breasts either by self breast examination or during sexual activity and try not to wear clothes in which there would be friction between the nipples and the material.

All the best!

We all want the perfect skin – healthy, wrinkle-free and just supple. Ever thought that coconut oil could be used as the perfect moisturizer for the perfect looking and fresh smelling armpits? And it’s all natural. No chemicals that destroy the ozone layer and damage your skin 😀 All the tips you need are all here! Read!

https://atbgs.blogspot.com/2018/08/healthy-skin_90.html?spref=fb

Q: Doc I’ve a question, If you have plus size breast and you don’t produce enough breast milk, what can you take to have enough breast milk, beside using formula milk? Thank you again

A: Congratulations on your new baby!

Breast milk is the best food for baby, generally speaking. The supply of breast milk is based on its demand. And so, if demand for it is high, supply will be high and vice versa. The more efficiently milk is removed from the breast, the more milk production is stimulated. And so, you need to make a conscious effort to get baby to suck more.

If your baby sucks, the let-down reflex ensures that your breast fills up with breast milk. Flat nipples can appear to be a challenge for breast feeding, especially for first time mothers but remember that babies are supposed to latch on to the areola (the black area surrounding the nipples) and not on to the nipples. Press on the areola with your thumb on top and fingers underneath and push back against your chest wall while pressing in with your thumb and fingers. This helps elongate the areola and so, provided you position the baby properly on the areola, breast feeding can go on with no issues.

Here are other tips that could help increase milk supply:

• Be sure that baby is attached properly and get him to suckle on the breast very often. Remember that breast milk production is a function of the breast milk let down reflex which is activated when baby sucks.
• If you can find a private space within your office where you can express milk, go for it.
• Increase the number of feeds per day. You could work with a timetable of a feed every 2 to 3 hours. In your case, as many times as is possible when you get back from the office.
• Switch breasts during a meal time. Let the first breast ‘empty’ before switching baby to the other breast. This can be repeated several times during a feed.
• Massage your breast and stroke towards the baby
• Perhaps over the weekend, room in with your baby and get him to feed as much as possible. The let down reflex will be greatly stimulated and so, you could even pump some for when you will be at work and freeze.

Personally, I found that using my hands to ‘milk’ my breasts produced sufficient amounts of breast milk for my always-hungry-can’t-seem-to-get-enough-food-baby. You may want to try that.

Drugs and foods that encourage milk production are called galactogogues. A number of local foods have been touted to help eg Pap (akamu, ogi), green leafy veggies like spinach, oats, garlic and ginger, nuts like almonds etc Go ahead and try out what works for you.

Have a great day! 🙂

Q: Doctor, please discuss cryptic pregnancy

A: There is not much medical literature on cryptic pregnancy, probably because it is an uncommon phenomenon and not really well understood yet. I will provide what information is available and advise anyone who thinks they have this condition to find a good obstetrician for active management and follow up.

A cryptic pregnancy is also known as a denied pregnancy or graviditatas ignota. In this situation, the pregnant woman unconsciously denies the existence of a pregnancy. Please note the word, ‘unconsciously’. Most times, symptoms of pregnancy (nausea, amenorrhea and abdomen swelling) are absent or greatly reduced, babies tend to be underweight and in many cases, pregnancy goes undetected by relatives and doctors

The reasons for cryptic pregnancy are not clear but some associated conditions are as listed below:

• Peri-menopause – For women who get pregnant around the time of menopause, there may be an absence of many physical symptoms of pregnancy. Just before a woman becomes menopausal, her hormones are ‘all-over-place’. The decreasing levels of estrogen mean that a woman could get pregnant and not know it. Ordinarily, estrogen helps the uterus/womb to grow, maintains the lining of the womb, increases blood circulation, and regulates the production of other key hormones. It is also responsible for those key pregnancy symptoms like spider veins, nausea, increased appetite, and skin changes. Therefore, when you don’t have them, you’re unlikely to think you’re pregnant. This could also happen in early menopause
• A low level of the hormone Human Chorionic Gonadotrophin (hCG). hCG is the hormone that is sought for when pregnancy tests are conducted. The level of this hormone could be low if the test is done too early in pregnancy. However, some believe that in cryptic pregnancies, the level of hCG is so low that it is not picked up by urine and blood pregnancy tests. As a result, the babies develop at a slower pace. Truth is, a lot of further research is needed to provide evidence for this
• Irregular menstrual periods may make it difficult for a woman to observe that she is pregnant
• Other reasons for cryptic pregnancies include inexperience, general lack of attention to body cues (usually, when these women discover they are pregnant, they start recalling incidents that should have alerted them), intense psychological conflicts about the pregnancy especially if pregnancy happens at a time when the woman is not ready (physically, emotionally etc) for a baby and other external stresses

So, I end as I started. This is a rare condition. The women with this condition would not really ‘know’ that they are pregnant and so this is probably more of an incidental finding at the time of delivery. If you do suspect that you are pregnant and it is not being picked up, then you should be seeing your obstetrician more regularly and he can advise on other specialties to involve after listening to and examining you.

All the best!

Q: Doctor, please discuss cryptic pregnancy

A: There is not much medical literature on cryptic pregnancy, probably because it is an uncommon phenomenon and not really well understood yet. I will provide what information is available and advise anyone who thinks they have this condition to find a good obstetrician for active management and follow up.

A cryptic pregnancy is also known as a denied pregnancy or graviditatas ignota. In this situation, the pregnant woman unconsciously denies the existence of a pregnancy. Please note the word, ‘unconsciously’. Most times, symptoms of pregnancy (nausea, amenorrhea and abdomen swelling) are absent or greatly reduced, babies tend to be underweight and in many cases, pregnancy goes undetected by relatives and doctors

The reasons for cryptic pregnancy are not clear but some associated conditions are as listed below:

• Peri-menopause – For women who get pregnant around the time of menopause, there may be an absence of many physical symptoms of pregnancy. Just before a woman becomes menopausal, her hormones are ‘all-over-place’. The decreasing levels of estrogen mean that a woman could get pregnant and not know it. Ordinarily, estrogen helps the uterus/womb to grow, maintains the lining of the womb, increases blood circulation, and regulates the production of other key hormones. It is also responsible for those key pregnancy symptoms like spider veins, nausea, increased appetite, and skin changes. Therefore, when you don’t have them, you’re unlikely to think you’re pregnant. This could also happen in early menopause
• A low level of the hormone Human Chorionic Gonadotrophin (hCG). hCG is the hormone that is sought for when pregnancy tests are conducted. The level of this hormone could be low if the test is done too early in pregnancy. However, some believe that in cryptic pregnancies, the level of hCG is so low that it is not picked up by urine and blood pregnancy tests. As a result, the babies develop at a slower pace. Truth is, a lot of further research is needed to provide evidence for this
• Irregular menstrual periods may make it difficult for a woman to observe that she is pregnant
• Other reasons for cryptic pregnancies include inexperience, general lack of attention to body cues (usually, when these women discover they are pregnant, they start recalling incidents that should have alerted them), intense psychological conflicts about the pregnancy especially if pregnancy happens at a time when the woman is not ready (physically, emotionally etc) for a baby and other external stresses

So, I end as I started. This is a rare condition. The women with this condition would not really ‘know’ that they are pregnant and so this is probably more of an incidental finding. If you do suspect that you are pregnant and it is not being picked up, then you should be seeing your obstetrician more regularly and he can advise on other specialties to involve after listening to and examining you.

All the best!

I don’t swim. I would love to swim but I just don’t 🙂 I remember when my children were younger and I would take them to swimming classes. I would settle down by the side of the pool to study for my MBA and later my MPH. It was during one of those study-swimming time that my son almost drowned, but for my watchful mother’s eyes! He removed his floaters, because he wanted to prove he was a big boy…and even though he was in the shallow pool, he could do what the big kids in the big pool could do. He didn’t make a sound, but somehow, I felt compelled to look up and found my son with terror in his eyes struggling in the water. My mother’s instincts kicked in! I jumped into the pool with my jean trousers and picked him up. It never crossed my mind that I couldn’t swim and I was putting myself and him at even greater risk. Thank God, the pool was shallow……

Anyways, as my children grew older, they begged me to learn and all wanted to teach me. Again, I have never taken them up on their offer 😀 One of the key issues that stopped me and which I keep warning them about is not to go swimming in just any pool. I worried about what germs lurked in the water just because of the anonymity people had to do stuff inside the water and not be seen, like blow their nose in there, urinate etc. 😦 Maybe, I have an overactive imagination! Or maybe not! If you’re checking into a hotel and planning to go swimming, please be careful. You may be at risk of ‘catching something’ Read!

https://www.health.harvard.edu/diseases-and-conditions/hotel-pools-and-hot-tubs-may-bring-health-risks

Q: Good day doctor. Can you please help me? I need clarity. If you had an implantation bleeding and found out that you are pregnant, how do you calculate weeks of pregnancy? Do you start from last period or the day of implantation day? Please help. Thank you

A: Implantation bleeding is typically a small amount of light bleeding that occurs about 10 to 14 days after conception. 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. 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.

Now, as to dating pregnancy, this is best done with the use of the last menstrual period – that is the first day of the woman’s last normal menstrual flow. However, if she is not sure of her dates, then a scan can be used. To date pregnancy, a first trimester scan gives the most appropriate approximation. The earlier it is, the more accurate it is likely to be.

I hope this helps 🙂