chatwithketch

Q: Good evening ma’am. Please ma’am,  I want to ask a question. What could be the cause of stooling light blood and it smells so bad? And whenever I use the toilet, I feel pain in my anus. Please, I need an urgent reply ma’am. Thanks

A: Hello! Thanks for writing in.

The first question I have for you is whether the blood is bright red or altered (almost brownish/black)? If it’s bright red, it is likely coming from the anus or somewhere close by. If it’s altered blood, it’s likely coming from higher up in the digestive system eg bleeding from a peptic ulcer. You should see your doctor immediately, if you experience this.

Common causes of bright red bleeding include:

·      Anal fissure

·      Piles (haemorrhoids)

·      Cancer of the rectum or colon

·      Gastro-enteritis: infection of the stomach and intestines

·      Inflammatory bowel diseas

·      Anti-coagulant drugs

You cannot make the diagnosis of what is serious and what is not. So, I suggest you see your doctor to examine you and make a diagnosis.

I will discuss the first two conditions (anal fissure and piles) below;

Constipation can lead to conditions where the stool is so hard that it causes a tear of the skin lining the anus (anal fissure) leading to blood seen with the stool.

Prevention is focused on ensuring that you have enough fibre in your diet (fruits, vegetables, whole grain), getting at least 30 minutes of exercise daily and drinking at least 8 glasses of water daily. When you have the urge to poo, try not to delay it for too long. Go and try to take your time to do your business!

How can you help this?

§  Include some fibre in your diet. Fruits and vegetables, oatmeal, local rice and other whole grain meals are helpful.

§  Drinking at least 8 glasses of water daily. Remember that this number, 8, is not cast in stone. It’s just a helpful guide. If you’re in a hot area, you’ll probably drink more

§  Get at least 30 minutes of exercise/activity per day or on at least 5 days of the week.

§  If these do not help, you may want to see your doctor for a proper examination as some diseases like Diabetes Mellitus may also cause constipation.

Now for piles…

Piles, known as haemorrhoids in medical lingo are swollen veins in the anal canal. They can be internal, external or both internal and external can co-exist. Internal haemorrhoids occur when veins swell within the rectum and external haemorrhoids are found under the skin around the anus.

These haemorrhoids develop when there is undue pressure in the pelvic and anal area as can occur when people strain to pass faeces (if they have diarrhoea or are constipated), in pregnancy (especially the last 6 months), in obese people, people who eat diets low in fibre and people who practice anal intercourse. When women strain in labour, haemorrhoids can also be made worse. For those who love to visit the toilet with their newspapers and spend ages reading them in there, well, you’ve got breaking news!  Sitting on the toilet seat for prolonged periods can also cause haemorrhoids. As people grow older, the support structures for these veins also grow weaker…naturally 😀

Some internal haemorrhoids can be small veins which stay within the rectum. Usually these internal haemorrhoids, stay inside the anus causing no problems. Other internal haemorrhoids can be big veins that sag and protrude out of the anal canal. Straining would cause their delicate surfaces to bruise and bleed. Sometimes, the straining is sufficient to cause the haemorrhoids to protrude out of the anal canal. This is probably what has been described above in the question. When the haemorrhoids are compressed by anal muscles, the pain is made worse and the pressure can lead to cutting off of blood supply to the haemorrhoids.

External haemorrhoids can clot due to irritation forming a hard, painful lump under the skin around the anus.
People with haemorrhoids will complain of streaks of blood in the stool after stooling, blood on the tissue after cleaning up, anal pain, anal itching or a lump around the anus.

Treatment involves the use of ointments to relieve pain, inflammation and itching. There are other minimally invasive and surgical options available that range from rubber band ligation to surgical removal of the haemorrhoids.
You can also limit the discomfort you have by keeping the anal area clean, using wet wipes (non-perfumed) to clean up after using the loo, sit on a bowl of plain warm water for about 15 minutes about twice or three times per day and also use some pain relief, if in pain.

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

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

Remember though that there are other causes of blood in faeces. That’s why this case has to be checked out in the hospital so that a proper diagnosis can be made.

I hope this helps.

Have a good night y’all 😀

Q: Good morning doctor. I have dark circles round my eyes. It first started to show when I moved to a very sunny environment and sometimes my eyes itch a lot and as a result of scratching it might swell. I don’t know whether to see a doctor. It makes me lose confidence.

A: The skin around the eye is very thin and as a result, any movement of fluid in or out of the area is very visible there. Typical examples are thedramatic sunken eyes when one is dehydrated (maybe from stooling) and the equally ‘gossip-worthy’ swollen eyes after a night of crying 

Usually in the body, fluid would move from an area of low salt concentration to an area of high salt concentration (osmosis). After crying, your salty tears are an attraction for fluids, which move from areas of low salt concentration to accumulate there. On the other hand, going on an alcoholic binge (drinking till you drop) causes dehydration with the accompanying sinking eyeballs.

Now dark circles may be ‘false’ and just look that way when puffy eyelids cast shadows on the area or due to sunken eyeballs as people age. Real dark circles however, may occur due to prolonged bouts of crying, allergy (as may be the case in the question here, with the associated itching), having a cold, drinking a lot of alcohol, rubbing or scratching the eyes often, exposure to sun, ageing, sleeping with make-up on and it also runs in families…I bet you didn’t know that one 

Other causes of dark circles include sleeping positions. If you sleep on your side or on your tummy, thanks to gravity fluid will also accumulate around your eyes. Let’s also not forget the commonest cause…burning the candle on multiple ends!

Treatment will be based on the cause. If it’s due to a cold or allergy or sinus problems, when these are taken care of, then the symptoms will disappear. Modification of lifestyle habits like removing all make-up at night, wearing sunglasses and using sunscreen when out in the sun, changing sleeping positions by sleeping on your back (if possible) or elevating your head with more pillows and leaving alcohol and your eyes well alone (no scratching and rubbing of eyes!)  may also be helpful.

Quick fixes for these bags include using concealer or even foundation to cover it up. Using cucumber slices on your eyes or teabags are also helpful as short term measures. By the time you hit your 30s, you really should invest in a good eye moisturizer because this is the first place to show the sign of aging 

Other solutions include surgery and injection of fillers etc.
Remember that no matter how many concealers, surgeries, moisturizers et al you use, if you don’t rest and avoid fatigue, you’ll just be throwing money down the drain.

If these circles persist, however or seem to be just under one eye, please see your doctor or dermatologist for more advice.

So, as you all start contemplating where to hang out next weekend, be sure not to show up at work with the ‘telling’ bags under your eyes on Monday 

Have a great week ahead, family! 😀

Hugs!

https://www.instagram.com/p/BcMc7e4F2Eq/?taken-by=ddrketch

Q: Hi Doctor, may I ask: is it possible to get HIV from oral sex, whereby the female is HIV positive giving the blow job to a HIV negative guy? Cheers

A: Well, HIV infection through oral sex is not the usual route of HIV infection. However, it is possible. There may be small cuts in the mouth of the female who is HIV-positive from which the virus will gain entrance into the body of the male through the urethra (the opening at the top of the penis from where sperm and urine come out) or anus. In the same way, if an HIV-positive person receives oral sex, the virus can gain entrance into the partner’s body when semen and vaginal fluids get into the mouth.

This risk of contacting HIV through oral sex is increased in the presence of already existing Sexually Transmitted Infections, mouth ulcers, bleeding gums and sores in the genital area.

This risk of HIV infection through oral sex may be reduced by the use of barriers like condoms and avoiding ejaculation in the mouth. Use of pre-exposure drugs (prescribed for people at risk) and ensuring that anti-retroviral drugs (drugs used for the treatment of HIV) are being used correctly by partners who are HIV positive may also reduce risk of HIV infection through oral sex.

Generally for HIV/AIDS, remember the ABCs. Abstain…which is always the best bet if you’re not married, be faithful to one partner (who is hopefully being faithful to you) or use condoms.

For more on HIV prevention, please click on the link below:
https://chatwithdrketch.com/2014/07/02/daily-health-tips-should-i-use-emergency-contraception-as-my-regular-means-of-contraception/

Have a productive week ahead 🙂

Q: Good day Ma’am. Please, at what stage of pregnancy is one required to take Tetanus injection as a first time mum? Thank you.

A: Hallos! Thanks for writing in.

This is a very good question. I will discuss how this should be taken at different stages:

Tetanus Toxoid (TT1) injection is usually given at first contact; then 4 weeks after TT1, the next dose (TT2) is given. 6 months after this, TT3 is due and 1 year after TT3, it’s time for TT4. The final dose is given 1 year after TT4. This is the standard regimen and the five doses protect women throughout child-bearing years.

If you had taken TT1 to 4 before pregnancy, you will receive one dose at least 4 weeks before delivery.

If you had not received any dose of TT before pregnancy, you will receive 2 doses, 1 month apart before putting to bed. The first dose may be given as early as practicable in pregnancy. Thereafter, follow the rest of the standard regimen…with the 6-month dose occurring after pregnancy.

Why is TT injection such a big deal? Well, it is because it kills an estimated 180,000 neonates and up to 30,000 women annually[i]. Tetanus is acquired by exposing broken skin or dead tissue like a wound or cut umbilical cord, to the spores of Clostridium tetani present in soil. Poverty and poor hygiene increase the risk of tetanus. So, protect yourself and your unborn baby with TT injections.

All the best.

Have a good night y’all 😀

[i] http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/immunization_tetanus.pdf

Hi doc, please is it safe to use chloroquine tab during pregnancy? Thanks

A: Is chloroquine safe in pregnancy? Well, there’s no clear evidence that it is unsafe in pregnancy when taken in the normal therapeutic doses. But there is, of course, the issue of chloroquine resistance.

You didn’t mention if you wanted to take chloroquine for prevention or for treatment I will address both.

Fansidar, which is a specific brand of the drug Sulphadoxine-Pyrimethamine (SP) is used for the prevention of malaria in pregnancy. Its use for this is referred to as Intermittent Preventive Treatment of Malaria in pregnancy (IPTp-SP). In the first trimester, it is not recommended for use but from the second trimester, it is considered appropriate and indeed is recommended by World Health Organization (WHO) for administration to pregnant women. If you live in a malaria endemic area like Nigeria, your doctor will ensure that you get your Intermittent Preventive Treatment (IPT) courses for malaria (sulphadoxine-pyrimethmine) during your pregnancy, as your doctor has already done. The assumed rule before was for pregnant women to receive 2 doses of this drug (full dose of 3 tablets) but WHO has since clarified that the appropriate regimen is for women to receive the full dose of Sulphadoxine-Pyrimethamine from week 13 of pregnancy. She should get a full dose at every antenatal visit provided the last dose was taken at least one month before. There is evidence that women who received 3 or more doses of IPTp had children with higher average birth weights than those who got 2 doses.

Your doctor will ensure that the Folic Acid dose you’re getting in your prenatal drugs is not more than 0.4mg (the usual amount in most over-the-counter folic acid tablets). Doses of Folic Acid higher than or equal to 5mg affects the efficacy of the anti-malarial, SP. So, be sure to check with your doctor before you start buying other non-prescribed prenatal vitamins.

If you do have malaria Quinine, Clindamycin, Proguanil are considered safe by the WHO treatment guideline in the first trimester. But, don’t be quick to go take any of them without prescription. Remember that every drug is a potential toxin and your doctor is really in the best place to weigh potential risks of taking any drug against the potential benefits. To put this in perspective, a recent study appears to now suggest that acetaminophen (the main ingredient in paracetamol) may lead to Attention Deficit Disorder in children! And yet, we refer to it as ‘ordinary’ paracetamol. There is nothing ordinary about any drug, my friends J

Doing all of the above will be meaningless if you do not pay any attention to the environment.

Those anopheles mosquitoes that are associated with malaria need a place to lay eggs so they can muster the right army to wreak havoc. So deprive them of a breeding camp. Who would know the conditions necessary for a terrorist camp to be set up and make their homes or environment, the right one for that? Nobody…in their right minds at least        

If you have to go out in the evenings, depending on whether you will be out in mosquito infested areas, wear protective clothing that cover arms and legs, preferably in light colours. Mosquitoes love dark colours and the dark….no wonder their deeds are evilInsect repellent creams used on exposed areas are also not a bad idea.

Have a good night y’all 😀

Q: Please Dr. Help me out. I am addicted to using tampons instead of sanitary pads, how dangerous is this for me? Thank you and God bless your work.

A Hi dear. Thanks for writing in. I can understand your ‘addiction’ as tampons are convenient to use. The focus should be on using them right. Tampons are products like sanitary pads used to absorb menstrual flow. A tampon is cylindrical in shape and has a string at one end that can be used to pull the tampon out. Sometimes, this string may go inside your body but you can usually feel the tampon and pull it out.

There is a dangerous infection that can occur in females who use tampons. It’s called Toxic Shock Syndrome (TSS). It is not caused by tampons but because tampons in the vagina create a perfect environment for bacteria (staphylococcus aureus in this case) to thrive, a toxin is created that causes severe illness. Young teens with fewer antibodies to the infection are more likely to experience this than older females.

Symptoms of TSS include  sudden high fever, headaches, redness of the eyes, mouth and throat, vomiting, diarrhea, seizures etc. If you experience any of these, while wearing a tampon, remove it immediately and contact your doctor.

Here are general rules for using tampons safely:

·      Be careful when inserting tampons. Remember that , Staphylococci, Staph for short, are bacteria which can be found in people’s noses or skin all over the body, minding their own business until a cut or injury occurs giving the germs access into the body. So, introducing an injury while inserting the tampon, increases the chances of TSS.

·      Keep your hands squeaky clean especially when changing tampons

·      Change your tampons every 4 to 6 hours

·      Do NOT let it stay inside you for more than 8 hours.

·      Do NOT use tampons to absorb any fluid other than your menstrual flow. Don’t use it as you would use a panty liner.

·      Alternate between tampons and sanitary pads eg tampons during the day and pads at night.

·      Ensure the tampon is removed very quickly if you observe any of the following:

·      Pelvic pain

·      High temperature

·      Unpleasant smell

·      Vaginal discharge

I hope this helps.

Have a good night, y’all 😀

November 25^th every year marks the International Day for the Elimination of Violence against Women. Violence can be physical, psychological and/or sexual. In honour of this day, I repeat a post on female genital mutilation (FGM), a very ‘good’ example of violence against women.

Q: Good day Dr, please I need more enlightenment on child circumcision: is it also for female child? And what is the reason for it? Is there any negative effect?

A: Thank you so much for writing in. Circumcision is a no-no for the female child. This procedure called Female Genital Mutilation has been recognized as a violation of the fundamental human rights of the girl child and it has absolutely no medical benefit. Indeed, it subjects poor, defenseless and innocent children to needless pain and torture!

For those who don’t know, Female Genital Mutilation (FGM), also referred to as female circumcision is a procedure in which there is partial or complete removal of the female genitals or any other injury to the female genital organs for reasons other than medical. So, practices like cutting off all or part of the clitoris, cutting off the surrounding lips of the vagina, narrowing the vaginal opening, any harmful procedure to the female genitals like piercing, pricking etc in any combination, all form part of this very terrible act. Why do people do this? It is wrongly assumed in some quarters that this prevents a woman from being promiscuous in future (removal of the clitoris would greatly reduce sexual pleasure and for those that have the vaginal opening reduced, the sheer pain of having any object pass through that opening is enough to discourage sexual intercourse), it is culturally accepted as a means of showing modesty in some cultures, it is thought to be religiously appropriate (no one can show where any religion specifically states this) and others just do it, because everyone in their circle does this!

In the olden days, this was practiced by village birth attendants who would use unsterilized instruments, aiding the spread of diseases like HIV/AIDS. Today, this is still a concern but even more discomforting is the fact that some medical personnel (???qualified) also participate in this.

FGM causes immediate and long term complications. Immediate complications are not far-fetched. The child is subjected to terrible pain, she could bleed heavily and could even end up in shock. There may be injury to surrounding genital tissue and there could be introduction of infection, especially if the conditions are not hygienic or when unsterilized instruments are used.

Long term complications include difficulty with sexual intercourse especially if the vaginal opening was reduced. This also presents a challenge during childbirth. Other complications include recurrent urinary tract infections and infertility.

So, my advice is to all mothers who wonder about female circumcision is ‘leave your daughter’s genitals well alone! Love and care for her and as she grows, encourage her to take pride in herself and who she is. Encourage her to go out and conquer the world.’ The reasons usually given for FGM really boil down to wanting to control the girl child. Why is it wrong for her to enjoy sexual intercourse when it’s time? Several homes have been wrecked by the fact that the lady who’s been circumcised cannot enjoy sexual intercourse and/or has to go through several episodes of pain (sometimes, even her partner suffers pain too) before she can finally settle into it.
Finally, join the fight against this horrible act. Tell every mother you know about what you have learnt. Together, we can stamp this act out.

For more on this subject, please click on https://chatwithdrketch.com/2016/11/27/daily-health-tips-domestic-violence-in-the-news/

Have a good night, everyone!

• Q: You once helped me regarding my son’s issue when he was born. Now I am in-boxing you with my own issue. I am in my early 30s, and have incredibly strong erections almost every day to a point where my penis becomes a bit uncomfortable. They last almost 2 to 4 hours, it has been happening since the last time I tried to have sex, about 2 months ago. I no longer know if I am horny or they are just happening on their own… Many men out there are desperate for erections because of Erectile Dysfunction etc, and right now, I am desperate to stop these erections because they are getting to me. Well, I can say I am not sexually active, because I hardly have sex. Sometimes I think if I can have sexual intercourse always this will stop. Now I do not know what to think of it. I just want to be able to control my erections. I can’t even masturbate because I waste my energy when I do as I don’t reach the end. Dr. Ketch, tell me, is there a way I can stop these erections? My testosterone hormones are killing me. I become moody sometimes. Thank You. I will be looking out for the response on your page.

   

  A: Hello dear. Thanks for writing in.

   

  You will definitely need to see your doctor for proper evaluation and diagnosis, but it does sound like this is priapism. This condition, in which there is a sustained and oftentimes, painful erection of the penis, continues for hours beyond sexual stimulation (I suspect that ‘magun’ falls into this category 😀 I couldn’t resist that. Only Nigerians and Yorubas, specifically will get this joke!) or even when there is no sexual stimulation as described in your case. It is more common in men in their 30s.

   

  There are three types of priapism (ischaemic, non-ischaemic and recurrent) but to understand this, we’ll take a look at the mechanism of erection. An erection occurs in response to stimulation, physical or psychological. As a result of this stimulation, the blood vessels and smooth muscles of the penis relax, allowing increased blood flow to the penis. This is what causes erection. When the stimulation is over, the vessels and smooth muscles constrict causing the blood to flow out of the penis and become flaccid. In priapism, the order of events causing the blood to flow out of the penis is changed such that the

   

  In ischaemic priapism which is the more common type due to inability of blood to leave the penis, there is pain, rigid penile shaft but flaccid glans (penile tip) and the erection lasts more than 4 hours! Causes include blood disorders like sickle cell anaemia and injuries to the penis and/or pelvis, alcohol, cocaine and other illicit drug use, some medications like blood thinners and antidepressants, cancer of the penis etc.

   

  Non-ischaemic priapism is usually due to an injury to the perineum or genitals that results in poor regulation of penile blood flow. It is not usually painful and manifests as erection that lasts for more than 4 hours but the penile shaft is not fully rigid.

   

  In recurrent priapism, situation is similar to ischaemic priapism with erections that are painful, recurrent but ease after 2 to 3 hours. These erections may subsequently progress to become more frequent and more prolonged. It is common in males with sickle cell anaemia

   

   

  Any sort of priapism should be checked out with a medical doctor (urologist) to determine type, cause and management. Erection lasting more than 4 hours is an emergency and may led to damage of the penis and subsequent erectile dysfunction

   

  Treatment depends on cause and should be started as soon as possible.

  Options include aspiration (in which blood is drained out of the penis with a syringe), use of medications to constrict the penile blood vessels, treatment of underlying medical condition like sickle cell anaemia and surgery in some cases. Note of warning, though it sounds very simple to use a syringe to drain out the blood in the penis, you must never attempt it on your own. You must visit a hospital and let a doctor work out the best treatment option(s) for you.

  So, I suggest you see your doctor asap to get a proper evaluation and start on your journey to recovery.

  All the best!

  Have a great weekend y’all 😀