chatwithketch

Q: Please ma’am, I want to know the meaning of Hepatitis B, and the effect on someone and the treatment for it

A: Hepatitis refers to inflammation (a situation that causes swelling, redness, heat and pain of affected area) of the liver cells caused by a viral infection or damage to the liver as a result of drinking too much alcohol.

The liver is an organ in the body which is usually found on the right side of your abdomen, just under the rib cage. Its job is to ensure that toxins taken into the body are rendered harmless, food is digested properly and the nutrients available in it, properly absorbed.

There are different types of hepatitis and some of them will not cause serious problems while others will cause long lasting damage to the liver and could lead to cancer.

The symptoms of liver disease include yellowness of the eyes and/or skin, dark urine, pale (light coloured) stool, itching, abdominal pain, abdominal swelling etc. You are more at risk of this if you work in a center where you handle body fluids (so this list includes healthcare workers). Other people who are more at risk include diabetics, obese people, people who take a lot of alcohol, drug abusers (this includes people who use illicit drugs and those who abuse prescription drugs), people who are in the habit of indiscriminate and unsafe sex etc

Hepatitis A: This is caused by eating food or drinking water contaminated by the faeces of someone who already has the infection. This is usually common in areas with poor sanitation. This infection would usually resolve after a couple of months but sometimes it could be very serious and life-threatening. Treatment is focused on symptoms like pain, itching etc

Prevention is vaccination with the Hepatitis A vaccine.

Hepatitis B: Hepatitis B infection is caused by the Hepatitis B virus (HBV) and it can cause very serious symptoms in people or it could very well pass unnoticed and be discovered by chance as in this question. The infections that occur in adults are usually acute and the body is able to clear the infection within 6 months. However, in a small proportion of adults and in a lot of infections occurring in children, the infection remains the body for a long time (chronic) leading to complications like liver failure and cirrhosis (long term liver disease in which there is scarring of the liver due to different types of liver disease) of the liver.

The symptoms include yellowness of the skin and eyes, dark urine, fatigue, body and joint aches etc. These symptoms vary in severity and appear about 3 months after infection.

Causes of HBV infections include contact with infected sharps like needles, sexual contact with an infected person, having multiple seal partners, sharing needles used for intravenous drug use.

If one suspects exposure to HBV infection, an immunoglobulin injection if taken within 24 hours can prevent the infection. Treatment depends on the type of HBV infection…whether acute or chronic. To confirm whether the infection is acute or chronic, the doctor runs a couple of tests.

The Hepatitis B surface antigen. A positive test result confirms that an infection is present but does not tell us if it is acute or chronic.

The Hepatitis B surface antibody. A positive test confirms that an infection had occurred but the body had developed antibodies to fight off the infection. This person is no longer contagious.

The Hepatitis B core antibody. A positive result tells us that a past or present infection exists. This is mainly interpreted in conjunction with the other two tests.

If the core antibody is positive and the surface antibody is positive, it means that the body had encountered this infection and fought it off in the past. This is likely to be an acute infection.

If the core antibody is positive and the surface antigen positive, it is more likely to be a chronic infection.

Treatment for acute infections focus on alleviating the symptoms noted above. Treatment for chronic infections focus on use of antiviral drugs and other medications that improve liver function. If liver function Is badly affected, transplant might be an option.

So, the first focus for you is to confirm if this is an acute or a chronic infection. That will determine the way forward. Remember that you can improve liver function by staying off alcohol, exercising, eating a lot of fruits and vegetables and not self-prescribing.

To avoid this infection, reduce your risk factors: Know the Hepatitis status of partner and be faithful to that person, where necessary, use condoms, stop the use of illicit drugs, do not share needles and other sharps, be careful with tatooing et al.

Vaccines are available for this virus and is now listed on the National Program on Immunization schedule. All adults who also have risk factors as noted above should also take this vaccine.

Hepatitis C: This is spread through blood to blood contact eg sharing needles. In a few cases, people can fight off the infection, but in most people, the virus survives and causes chronic (long standing) infection which can lead to cirrhosis and liver failure. There is no vaccine for this infection.

Hepatitis D: This is caused by Heaptitis D virus and only occurs in people already infected by the Heaptitis B virus as it requires the latter to survive in the body.

It is spread through blood to blood and sexual contact. Long term infection with this can put one at risk of liver failure and cirrhosis. There is no vaccine against this but given its relationship with Hepatitis B, vaccination against Hepatitis B can provide some protection against this as well.

Hepatitis E: This is caused by eating food or drinking water contaminated by the faeces of someone who already has the infection. This infection is usually mild and would usually resolve without treatment but sometimes it could be very serious and life-threatening. It can also become long term especially in people with suppressed immune systems.

There is no vaccine for this infection. Focus is on ensuring good hygiene.

Other types of hepatitis include:

Alcoholic hepatitis due to taking excessive amounts of alcohol over years. This can lead to liver failure, cirrhosis or liver cancer. Prevention is reducing your alcohol intake or stopping completely J

Auto-immune hepatitis is is a situation in which the body begins to attack its own liver cells for no reason. Treatment is the use of drugs to suppress the body’s immune system.

What foods should a hepatitis patient take? A healthy balanced diet, really. Stay off alcohol though as this causes further damage to the liver. Be sure to drink sufficient amounts of water daily and discuss all drugs you’re taking with your doctor.

I hope this helps.

Q: Hello doctor, my daughter have white substance in her private part I noticed it since when she is a week old and now she is two years old. Could she be having an infection?

A: Hello Mum! Thanks for writing in and being very observant!

Is it normal for a newborn baby to have vaginal discharge? Actually, yes it is. Baby girls may have clear, white, cloudy white or even bloody discharge after birth. This is as a result of your hormones that she was exposed to while in your womb. This is normal and should have disappeared by the time you go for your post-natal appointment.

Thereafter, the cause of the vaginal discharge can be a foreign body that got in there…a hair bead or even a bit of tissue left after cleaning up, for example. That is sufficient to cause significant discharge.

Other causes include:

§  Prolonged contact between skin in the genital area and faeces and/or urine

§  Other skin irritants like perfume, use of bubble bath and/or perfumed soap

§  Lack of cleanliness.

§  Bacterial infections

§  Other infections like measles

Poor personal hygiene is a common cause as children start to go to school and begin to take care of their hygiene themselves especially after using the bathroom. It is critical that our babies are taught to clean themselves properly by wiping from the front to the back. Please do some sort of spot check to ensure that they have cleaned thoroughly 😀

Is this discharge associated with itching? If so and the discharge is cheesy white and thick, it may be candidiasis. Please let the doctor confirm the diagnosis. He will take a detailed history and find out what exactly this discharge is or is not.

If it is due to candidiasis, it may be due immune system compromise by antibiotics and is also found in children diagnosed with diabetes.

To prevent this discharge, start by ensuring your baby wears loose cotton undies and do not give her antibiotics she does not need. As had been mentioned on this page before, all that is needed to wash your delicate inner self is clean water and clean hands. Teach her that. Ensure that your baby dries properly, especially the vulval area (pat dry) after a bath to prevent the build-up of fluid and warmth that encourages fungal growth. Discourage tight clothing and if anything, encourage her to wear skirts. Encourage her to also sleep without underwear at night as often as possible and if your home situation is conducive enough for it.

So, get her checked out by her pediatrician as soon as possible.

All the best.

Q: Good morning Doc, sorry for giving a private message. A friend of mine needs help and I wish I can get that from you. She is just getting close to 21 years of age but her problem is inability to restrict sex. She is almost getting to the point of “can’t do without it” this has been crashing her relationships because it makes her cheat not because her lovers doesn’t satisfy her but she finds solace in having sex whenever she is depressed. Any one close to her easily takes advantage of her because she hardly says no especially if she needs it. Please, what help can you get for her? How can she stop this? What should be done? What is actually wrong with her? Thanks as I await your response soon. Good morning

A: Hallos! Thanks for your question and for looking out for your friend.

Sexual addiction can also be referred to as hyper-sexuality, hyper-sexuality disorder or compulsive sexual behavior. People with this condition are pre-occupied with sex-related actions and activities, fantasies, urges and feelings which are difficult to control and interferes with their ability to maintain normal relationships, keep jobs and/or remain physically and mentally healthy. This addiction can range from sexual activities that provide acceptable forms of pleasure to the more deviant forms of sexual pleasure.

It is thought that this addiction is usually developed, not as a response to true sexual desire but as a coping mechanism in the face of stress and/or anxiety. This appears to also be the case in the person involved here. Some other underlying conditions that could contribute to developing this condition include altered levels of sex hormones, altered levels of some brain chemicals eg serotonin and dopamine, consequence of some forms of treatment for Parkinson’s disease and also as a result of diseases like epilepsy and multiple sclerosis. The alterations in brain chemicals can subsequently lead to long-term changes that produce effects similar to other types of addiction.

Symptoms of this condition include:

·       Recurrent sexual fantasies that take up person’s time and he/she feels powerless to control these urges

·       Unsuccessful attempts to control urges

·       Urge leads to play-out of sexual fantasies with subsequent feeling of guilt and shame

·       Participation in sexual activities that does not really give one sexual pleasure and/or satisfaction

·       Sexual behavior serves as escape from real-life problems

·       Continued engagement in sexual activities despite the knowledge that they could bring about negative consequences like STIs, loss of relationships (as described in the question) etc

·       Trail of failed relationships

It is best to see a mental health professional with experience in addiction/addictive behaviors. There should be no shame. Please encourage her to seek help and understand that this is an addiction like any other and with the right support, it can be broken. Treatment is usually a combination of psychotherapy (also called talk therapy), medications and self-help groups. The mental health professional may suggest some good self-help groups. The major focus here is on groups that will help build up her self-esteem and not beat her down for the paths she has taken.

It is important though that she discovers what drives her to these behaviors, avoid places where she is more prone to exhibit them and find healthier ways of coping with stressful situations. It is a long journey but she can make it with the right support.

I hope this all works out well. All the very best!

Q: Good day Dr. Ketch, I am a 22-year old lady. For 2 weeks now, I have been experiencing wounds on my both breasts especially on the areola and my nipples. It is itching and scratching me always. Please, what could be the cause and solution?

A: There are many different causes of nipple itch and they include:

§  Eczema that is usually found to run in families with a history of allergies. Preventive/control measures include using mild soap to take a bath, followed by a mild moisturizer. Also do not use water that is too hot for a bath as this dries out your skin and makes the itching from eczema worse. Use warm water if you must and then dab your skin leaving some moisture. Lock in this moisture with a moisturizer. Stress is also a trigger for this and so reducing your stress levels and exercising may be helping in more ways than one. Anti-histamines (helpful with itching) and over the counter steroid creams are also useful. For severe cases, please see your doctor for a prescription of more potent steroids, immuno suppressant drugs, ultra violet light therapy etc.

§  Friction: In this case, not wearing a bra or wearing a poorly fitted bra during exercise routines may lead to rubbing of the nipples against the fabric and consequent itching and/or pain.

§  Sensitivity to the weather (hot or cold), certain fabrics, detergents or even creams/lotions may lead to nipple itch and pain. If specific detergents or creams cause this, you may have to change them.

§  Pregnancy and breastfeeding can also lead to this condition. In pregnancy, the pregnancy hormones lead to the nipples being extra sensitive and during breastfeeding, the baby may not latch on well to the nipple, there could be blocked ducts or mastitis or breast abscess etc leading to pain. During pregnancy, be sure to choose bras made with fabric that can ‘breath’ like cotton. And during breastfeeding, be sure to get help with making sure you know how to put baby to the breast to prevent sore nipples etc.

§  Cancer (Paget’s disease of the breast) can also be a cause of nipple itch with eczema-like symptoms on the nipple and/or surrounding areola.

So, where in doubt…especially if you have tried to rule out the causes above, please see your doctor.

All the best!

Q: Please my anus is itching and paining me. What can I use?

A: I watched a comedy skit once where a lady sat on the floor and shuffled forward in a rather embarrassing way because she had an itch on her bottom! That was funny to watch but in real life, would have been downright embarrassing for both the person with the problem and the person watching.

Anal itch is itching in and around the anus and could be due to:

§  Infections: These could be bacterial (streptococcal or staphylococcal, fungal (the organism responsible for candidiasis), parasitic (due to worms like thread worms or even scabies), viral or due to sexually transmitted infections.

§  Personal care products: Using products that irritate the skin eg perfumes, toilet paper etc

§  Skin conditions like psoriasis

§  Other medical conditions like haemorrhoids, long term diarrhea, long term constipation, diabetes, kidney failure etc

§  Medications which may either cause the itch or make an already existing itch worse eg peppermint oil or even creams used for haemorrhoids.

A once in a while itch may not be a problem, but you need to get your doctor to take a look if you find that the itches are associated with bleeding, is persistent and/or anal area appears infected.

Given the wide array of causes, treatment is dependent on identified cause. If infections are the problem, they need to be treated, if due to personal care products, try switching what you use. Specific medical conditions need to be treated and medications can be changed or dosage adjusted. Your doctor will advise. If your itch appears more at night, an anti-histamine medication to stop the itch will be given in the first instance.

In the meantime, try to avoid scratching. I can almost see the look on your face, like , ‘yeah, right! It’s so easy not to scratch and yet I decided to write about it!’. I know, I know, but scratching just irritates the skin around the anus some more and may make you more prone to infections. So, to deal with the itch urge, use can place a cold compress there (just put some ice cubes in a small towel, cover it up and place where needed).

§  You also need to cut your finger nails to ensure that even if you do scratch while sleeping, you do not hurt yourself.

§  Be sure to cleanse thoroughly after having a poo. Plain tissue may hurt so you may want to consider using water to wash up and or wet a big ball of cotton wool…please don’t flush this oh!!!

§  Dress comfortably…cotton underwear and loose clothing help to prevent friction where you don’t need it J

§  Avoid constipation and diarrhea. Just keep your tummy contents moving smoothly by eating right and exercising

§  Avoid personal care products that cause irritation like heavily perfumed soaps, tissues etc

I hope this helps you.

Enjoy the rest of your day, y’all 😀

Hi! Doctor, Please I’ve being battling with goiter for the past three years now and I am scared of surgery. Please, is there any suggested treatment for it? Thanks

A: Swelling of the thyroid gland which is seen as a neck swelling is called goiter. But how does this develop? I’ll start from the beginning.

Hyperthyroidism is a condition that occurs when your body produces too much thyroid hormones. These hormones are usually produced by a butterfly shaped organ located at the front of your neck, called the thyroid gland. These thyroid hormones produced typically control the rate at which the body converts food t energy (metabolic rate) and also controls a whole lot of other cells and tissues like your bones (the hormones determine how your body incorporates calcium into your bones), the rate of your heart beats, your muscle contraction, cholesterol levels etc

Most cases of hyperthyroidism is caused by Graves’ Disease in which the body no longer recognizes the thyroid gland as part of it and produces antibodies to fight it. In response, the thyroid gland produces excessive amounts of thyroid hormones.

As in the case above, there may not be any family history though it is known to run in families.

Thus in hyperthyroidism, you may have no symptoms (leading to a chance discovery) or you may have symptoms including fast heart beats/palpitations, swelling of the thyroid gland which is seen as a neck swelling (goiter).The higher than normal metabolic rate would lead to symptoms like increased appetite, weight loss, sweating and increased sensitivity to heat, restlessness, tremors, tiredness, difficulty sleeping etc. In Graves’ Disease, there are also eye symptoms which include protrusion of the eyeballs, red and swollen eyelids, watering of the eyes and double vision.

The doctor will examine the person with symptoms and run blood tests to check for the level of thyroid hormones. Treatment could be with surgery, medications or a combination of both. The drug Carbimazole is an example of a medication used for hyperthyroidism, which stops the thyroid gland from making new thyroid hormones but does not affect the hormones already produced. As a result, it may take a while to notice an improvement in symptoms. The use of this drug may be for about 12-18 months in the first instance. This may be sufficient to deal with the situation. In some instances though, this may recur needing more treatment, probably with a different drug.

You will need blood tests regularly though to monitor the level of your thyroid hormones.

Depending on your degree of weight loss, you may need to have a dietician walk you through your diet paces and ensure that you are getting enough calcium and vitamin D. Wearing sunglasses, using eye drops that moisten the eye (artificial tears) and ensuring that the head is elevated when sleeping or lying down will help reduce the symptoms of Graves’ Disease. If you smoke, stop…this may help prevent developing Graves’ Disease or prevent the eye problems associated with it, if you already have the disease.

Treatment for hyperthyroidism is usually effective and so you should be able to live a normal life. You’ve got to focus on the positives and take on each day as it comes. You may not have to take drugs all your life but then again, depending on the outcome of your initial therapy, you may have to. This may sound daunting but really shouldn’t be. Many people take ‘self-imposed’ vitamin supplements every day

Just have a positive attitude about it and learn to look at this cup as half full rather than half empty. Keep your chin up and keep me posted.

Are you lactose intolerant? Do you know what that means? I’ll give you a quick refresher course…

Lactose is a natural sugar found in milk. People with lactose intolerance can’t digest lactose, which is the natural sugar found in milk. This is because they lack an enzyme called lactase. Some people with lactose intolerance cannot digest any milk or milk product at all, others are able to digest small amounts of milk and milk products.

Lactose intolerance occurs more commonly in adults and in the African, Asian and South American races. It appears to run in families. So, a positive family history means one has a higher risk of developing this. Lactose intolerance usually occurs during the teenage or adult years but some of these people are able to take some milk or milk products. Severity of symptoms depends on the degree of lactase deficiency and the amount of lactose in the person’s diet. Some cases of lactose intolerance can develop after diseases of the small intestine, as a result of ageing or even after stomach surgery. It could be permanent or temporary.

Some children are born with lactose intolerance and thus cannot tolerate any food that contains lactose. This includes milk and all milk products. Some pre-mature babies have lactose intolerance just because their bodies cannot make the enzyme needed to breakdown lactose yet. This is temporary though. As soon as the body starts making lactase, then the problem disappears.

The symptoms of lactose intolerance typically include bloating, gas, diarrhea and tummy ache when you’ve had excessive amounts of milk. Anyone with this condition can reduce the symptoms of lactose intolerance by trying the following:

 Try staying off dairy for a day and see if your symptoms decrease. . If the symptoms reduce, then gradually add back some dairy products and see if your symptoms start up again.
• Reducing the amount of dairy you take at any one time. Eg take a small amount of milk and sip slowly.
• Try out different dairy products and see what works for you. There are varying amounts of lactose in different dairy foods. Quite a number of people with lactose intolerance are able to tolerate yoghurt with live cultures. You could try different things and see what works for you.
• Taking lactase tablets prescribed by your doctor to help digest your dairy products. These are usually taken before you take the lactose. This may help but is not useful in all cases.
• Try taking milk with other foods as this may slow down the digestive process, changes the way the body absorbs it and ultimately produce less symptoms.

The main challenge that people with lactose intolerance have is figuring out other food sources that can replace dairy in their diets with the right amount of calcium. The article below from Harvard Health provides some suggestions.

https://www.health.harvard.edu/diseases-and-conditions/what-are-the-best-calcium-sources-for-people-who-are-lactose-intolerant

It’s just a few hours before we enter into a brand new year, 2018! It’s simply amazing! Intellectually and realistically, there’s nothing different about 1^st of January. It’s a date…just like any other. There’s no magic wand that transforms things overnight from December 31^st to January 1^st. So, when people say, I will do better in the New Year, there’s no guarantee that they will. Do better now!

However, psychologically, there’s something about the idea of New Year…it’s a new date; a cross-over into a new period of time and life. It signifies new beginnings and brand new opportunities to start afresh. And so, we all identify with that feeling of, ‘I’m done with the old year and ready to take on the New Year!’ Be sure to prepare inwardly, spiritually and deeply. Don’t get dragged into the New Year resolution squad…resolutions that oftentimes do not last till the end of the first quarter. Determine inwardly what you will do better, write it down and declare it to yourself daily as you work to bring them to fruition. Remember the bible says, ‘Write the vision, and make it plain upon tables, that he may run that readeth it. For the vision is yet for an appointed time, but at the end it shall speak, and not lie: though it tarry, wait for it; because it will surely come, it will not tarry.’ (Habakkuk 2: 2-3).

And with that, I wish you a ‘Happy and Most Prosperous New Year!’ See you in 2018!

We end the year with a condition that signifies new beginnings…pregnancy 😀

Q: Morning MA, would like to ask is it normal to sometimes have back pains at 4 weeks of pregnancy

A: You may start to experience more backaches as the weight you have put on starts to take its toll. Be sure to sit up straight on chairs with proper back support to help with this. Sleeping on your side with a pillow between your legs will also help. This may be the cause of your backaches but if they are very discomforting, please see your doctor. Better safe than sorry.

Other symptoms of pregnancy you should prepare for are:

Breast tenderness: this is inevitable as your breast ducts prepare for the job of lactation. Bra sizes could go up from 1 to several sizes up. Be sure to get a good support bra and keep going up sizes as your breast size increases. This will help reduce sagging.

Discharge: A thin milky discharge is normal during pregnancy. But if this becomes yellow, greenish or foul smelling, please see your doctor.

Heart burn and Constipation: These happen due to one of the hormones produced during pregnancy. The antenatal vitamins also play a part in worsening constipation 

Frequency of urination: As the baby grows in the uterus, it presses on the bladder making you feel like urinating more often.

Tiredness: As your body works overtime to support a growing life inside you, you would feel exhausted.

Food cravings and aversions: Well, I certainly had loads of aversions with my first pregnancy. I can’t remember any cravings as I couldn’t get any food to stay down. However, some people develop a craving for the oddest, craziest foods when pregnant. Go easy on eating for two though…the healthy living dictum of eating loads of fruits/vegetables and low calories does not change during pregnancy. The more you gorge or give in to the food cravings, the more work you have to do to get it off after the baby. However, if you find yourself craving things like clay, sand etc, please see your doctor as it could be a sign of iron deficiency anaemia.

Morning sickness/nausea: This is due to the hormones of pregnancy (again!). This may be mild or so severe that the person actually gets hospitalised. If your nausea is severe, please see your doctor. But generally, you can help push this back by eating some bland food especially in the mornings when it is worse like crackers or cheese.

Now for the red flags…these have to be heard and checked out by your obstetrician immediately:

Significant bleeding. If you’re not sure what is significant and what’s not, please see your doctor all the same. Better safe than sorry.

Severe abdominal pain: This could be a sign of a threatened miscarriage

Severe nausea/vomiting: This could lead to dehydration which could affect the baby adversely

Severe dizziness

Too little weight gain or too much weight gain: Try to keep weight gain between 11 to 15kg during the pregnancy. Your doctor could have recommended more or less depending on your pre-pregnancy state.

Pain or burning sensation when urinating: This could be a urinary tract infection. It needs to be dealt with.

Vaginal discharge: Foul smelling, yellow or greenish colour could indicate an infection and could affect your baby.

High fever: This could signify an infection.

So ladies, enjoy this fabulous state of pregnancy. Guys, give them all the support they need…and deserve. By the way, did I forget the amazing mood swings that are a very normal part of this state? Guys, be sure to respect and lovingly manage that. It’s all those hormones running amok in the body :D. You play a huge role in ensuring a successful outcome of pregnancy.

As for me, I’m done with all that stuff. I’m a grandmother in waiting! Loads of years before we get there, though! 😀

So, keep healthy people and don’t let pregnancy get you down. It’s really not a sickness :D. And the products of this process live forever in our hearts.

Happy New Year in advance, again 😀

A lot of people worry about strokes – ‘will I get one?’; ‘am I prone to one?’; ‘how can I prevent one?’ Well, this post tells you steps to take to prevent one even if you have a family history. Enjoy!

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