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Today is World Maternal Mental Health Day. It is a day to call attention to the mental health issues faced by women during pregnancy and in the 1^st year following the birth of their babies.

If you missed my post on postpartum depression, please check it out here: https://chatwithdrketch.com/2017/04/07/world-health-day-2017-depression-lets-talk/

There is, however, another condition that affects breastfeeding mothers and has sometimes been mistaken for postpartum depression…but it is not. Everyone talks about how fleeting the pain of childbirth is once the bundle of joy is held in the arms of the mother. It then appears ‘somewhat’ unnatural when mothers experience sadness in taking care of the baby or as this mother says, sadness when breastfeeding. This was a previously unknown situation and mother who experienced this felt alienated from family, friends and even their medical personnel as nobody appeared to understand what they were going through. Was this postnatal depression? Was this a psychological problem? I daresay in our environment, people would have asked if the woman was demon-possessed ;D

Well, researches have shown that this situation is called D-MER (Dysphoric Milk Ejection Reflex). The term dysphoric refers to dissatisfaction. Usually, when a baby latches on to the nipple of his mother for breast milk, the hormones, oxytocin and prolactin are released. Prolactin acts on the milk producing cells of the breast and the oxytocin acts to let the breast release the milk (let down reflex). At this same time, the level of dopamine decreases. In D-MER, the level of decrease in dopamine is extreme leading to sadness, feelings of negativity etc. This feeling is fleeting though, lasting seconds to few minutes as the level of dopamine normalizes. This feeling may also be precipitated at times when the milk ejection reflex is activated like when you think about feeding your baby or when he cries etc. Now it is important to note that while this does not happen to everyone, it is not a psychological problem, neither is it postnatal/postpartum depression.

So, what to do? Stopping breastfeeding may not be the answer, as you will be depriving your baby of all the vital nutrients he needs in his first few months of life. In some instances, just understanding what is going on is sufficient to help the mothers cope with the situation as they can identify when the symptoms start and stop.

In more extreme cases, there may be need to prescribe drugs which increase the level of dopamine in the body. Your doctor will determine what makes sense. Anti-depressants have not been found to be useful in this situation. I daresay more work will be done on this condition to better understand and provide relief for it shortly.

So, the message on this day is, show love to people dealing with maternal mental health issues like postpartum depression and don’t stigmatize them.

Good night, y’all 😀

Ever heard the one about how wearing bra was associated with cancer? Well, here’s what Harvard Health had to say about it: http://www.health.harvard.edu/blog/myth-busted-bra-wearing-not-linked-breast-cancer-201409097391

Enjoy the read!

This article by Harvard Health states that nearly 50% of people who suffered heart attacks didn’t know it at the time and only discovered this later, perhaps when an ECG shows up previous damage to the heart. Now that is scary!

Want to know more? Then, click on this link: http://www.health.harvard.edu/blog/heart-attack-not-know-2017041711596

Good night, y’all 😀

Q: Good evening ma’am, my baby doesn’t like taking my right side breast. Now one of my breasts is bigger. Can this cause me a problem in the future? And when is it good to take in after CS?

A: Hi dear, thanks for writing in.

There are several reasons why your baby may be ‘refusing’ the breast milk from one breast. They include:

Improper latching: If your baby is not latching on correctly to the second breast, then he/she is not getting enough breast milk. This may lead to a preference for the other breast. This may be due to differences with nipples or just positioning opf the baby.

Milk production tends to differ in both breasts and babies could prefer the the breast that produces the most or could very well like the side that produces less.

Ear infection could lead to baby preferring the breast that gives him the least discomfort with the infected ear.

Breast infection (mastitis) may also be a problem as breast milk from the infected breast would taste salty.

And it could just be that your baby feels more comfortable being nursed from the preferred side than the other. Other times, it’s actually the mother who has a preferred side she prefers to nurse from. I found myself in that position when I was breastfeeding J

What should you do?

• If you observed this when baby was born, it may be worth your while to have baby be checked out by a paediatrician to rule out any birth injuries. If this started suddenly, after a period of being happy to nurse on both sides, then it could be due to any of the causes listed above. Try changing the factors you can eg the position of feeding, ensuring proper latching on, nursing in a quiet, darkened room etc. if these do not work, please take your baby in to see the doctor.

• To deal with the lopsidedness that you have observed where one breast is bigger than the other, try the following:
• Start up with the smaller breast when feeding baby. If he/she is hungry enough, he/she may not notice the difference. Try this also when baby is rousing from a nap/sleep

• Nurse more frequently from the small breast

• Pump the smaller breast in between feeds.

While working on the smaller breast, ensure that you don’t let the preferred breast become too backed up with breast milk as this could lead to blocked milk ducts and subsequently, mastitis. For tips on dealing with this, please click on this link https://chatwithdrketch.com/2016/08/12/daily-health-tips-re-visiting-lumps-in-the-breast-of-a-breastfeeding-mother/

Generally though, feeding from one breast becomes a major issue, if baby is not getting enough milk. Otherwise, it’s not necessarily a deal breaker. Where in doubt, please see your baby’s doctor.

The answer to your second question on conceiving after CS, can be found here https://chatwithdrketch.com/2015/06/12/daily-health-tips-when-is-the-best-time-to-have-a-baby-after-c-section-or-a-still-birth/

I hope this helps.

Have a good night, everyone 😀

Q: Hello Dr. Ketch. I’m so glad to find your page. I just want to ask what a green poop means. My 3 year old & 1 1/2year old daughters sometimes poop green. A doctor once told me that green poop on children is bad, but she didn’t give the reason. Hope you can answer me Doc. Thank you

A: Thanks for writing in. It is important that we all develop the habit of asking our doctors questions. It is your right to fully understand what is wrong with you or your baby and receive sufficient information to make informed choices. It is not something the medic does when he/she is in a good mood. It must happen all the time!

In babies, green poo can be due to:

• Baby not nursing sufficiently from one breast before being moved to the other breast. This means that the baby gets more (watery) fore milk than the fattier, nutrient-dense hind milk.

• If baby is bottle-fed, it could be due to the particular formula being used. Try switching to another formula and see if it helps

• Diarrhea • Inadequate intestinal flora in breastfed babies In children and adults: • Eating a lot of veggies

• Diet rich in iron

• Diarrhea

• Presence of green food dyes etc

Where in doubt as to what exact cause is, please take them in to see their doctor. If diarrhea is the cause, we don’t want the added complication of dehydration.

All the best! Good night, everyone 😀

Q: Hello house, please a woman had a kind of heart attacked this morning and later results to stroke that affects one arm and leg, she’s in the hospital already. Please what’s can be done quickly to arrest the situation?

A: Stroke as the name implies refers to an incident that happens suddenly…without warning. It usually occurs when the brain is deprived of some of its blood supply and consequently oxygen supply. This can happen when there is a blood clot in a vessel in the brain or due to a burst blood vessel leaking blood onto the substance of the brain or around the brain. This blood leakage can lead to undesired pressure on the brain.

Oftentimes, people refer to a Transient Ischaemic Attack (TIA), as a partial stroke. This condition occurs when a blood vessel is partially blocked. This would usually be resolved within 15 minutes and is a sign that a major event (a stroke, proper) may not be far off. This is a warning that should be taken seriously.
It is important to know the signs of a stroke because if action is taken immediately, it can prevent permanent damage from being done. If the brain is deprived of its blood supply for about 4 minutes, irreversible changes begin to occur in the brain. If this deprivation continues beyond this time, permanent changes would have occurred that may affect different facets of the individual’s functions.

The signs of stroke to look out for are known by the acronym FAST.
• F stands for drooping of a side of the face. Ask the patient to smile and you will observe that the smile looks lopsided.
• A stands for weakness of one side of the body. Ask patient to lift both arms and it will be seen that one side is being ‘dragged’ or lagging
• S stands for speech difficulty like slurring. Patient cannot enunciate words properly again
• T stands for time. Once these symptoms are noticed, it’s time to call for help. In climes where there are emergency numbers like 911 or 999, please call these. Otherwise, efforts should be made to take the person involved to the hospital immediately.
Patients may also complain of sudden inability to move legs, feel confused, have blurred vision etc

There are risk factors for stroke and they include:
• Age: The older you are the more prone to stroke. People from age 55 years are more likely to have a stroke, though this can also happen in children eg those born with heart defects and those with Sickle Cell Anaemia etc
• Race: Africans and Asians are more at risk
• Sex: Females are more at risk…as if we don’t have enough problems
• Family history of stroke: The presence of this increases risk
• Previous history of a stroke.

Other risk factors:
• Hypertension
• Diabetes Mellitus
• Overweight
• Sedentary lifestyles
• Not eating healthy
• Smoking
• Drinking Alcohol

The rate at which one recovers from stroke and indeed the degree of symptoms experienced, depends on the area of the brain affected, how serious the damage to the brain is etc and so recovery will be different for different people.

Patience is key. Speech therapists may be needed to help the person re-learn the art of speaking. Physiotherapists will help improve motion on the affected side and indeed, mobility. Other therapists may help with eating…if swallowing is a problem, relearning the art of reading and reasoning etc

Usually, people who visit find it difficult to understand their speech during recovery and this can put even more pressure on the patients. Speak slowly and listen carefully so you can understand what they are saying.

Generally eating healthy with lots of fruits and vegetables, cutting out the white carbs (pastries etc), exercising (at least 150 minutes weekly), ensuring you are not overweight and quitting smoking help with reducing bad cholesterol and also preventing strokes.

She may need to walk with a stick as she re-learns the art of walking. Recovery may be long and tedious but she’s got to keep at it.

Have a good night, people J