chatwithketch

Q: Good evening Doc. How has your day been? I gave birth 7 weeks ago through C.S and I had flow for 3wks after which I was seeing discharge (not really discharge but I don’t no wat to call it. Blood and watery and the blood was faint (kind of). I saw this for about a week and later nothing was coming out again.

Had a nice time with my hubby last week and in the last 4 days now I’ve been seeing blood again. I don’t want to assume that menstruation has started. So please Doc help me out

A: ‘Bleeding’ after having a baby is normal whether you had an episiotomy or not. As the placenta separates from the uterus when the baby is born, the blood vessels where the placenta was attached start to bleed…understandably, because they are open  They bleed into the uterus (womb). As the womb starts to contract, it seals up the blood vessels such that bleeding stops significantly.

So, the ‘bleeding’ after having a baby is a mixture of blood, bacteria and tissue that has sloughed off the uterus. This discharge is called lochia. In the first couple of days, there’s more blood in lochia giving it a bright red colour which eventually becomes more watery and pikish and eventually becomes yellowish/whitish. This whole process may last 2 to 4 weeks or may come and go, as in the case described above. So, it’s not really a problem 😀

Be sure to check the level of bleeding though and if you feel uncomfortable, please see your doctor. General rules of thumb that suggest there may be a problem are:

• If you’re bleeding heavily…perhaps you’re using a sanitary towel every hour for at least 2 hours or are passing out big clots.
• If your lochia has a bad smell and you start having fever and chills
• If your lochia is still bright red after 4 days of delivery.
Where in doubt, please err on the side of caution and see your doctor.

Ordinarily, sexual intercourse should be considered from about 6 weeks. At this time, you would have gone for a post-natal check and the doctor would, hopefully, have given the A-okay. Return of menses following delivery is varied between individuals. Some women would see theirs a few weeks after, some others after a few months or even a year, while in others there is no return of menses before another pregnancy begins.

Different women also report different changes with their menstrual periods after childbirth. Some report longer periods. Others report shorter periods; some others report less pain and others observe absolutely no change at all. So this could very well be your period but I suggest you see your doctor to confirm this.

Have a great week ahead! 😀

Q: Good evening Doc pls I had ectopic 8 months ago and want to be pregnant again. Please any help or advice?

A: This must have been a trying period for you…first a pregnancy and then finding out that it’s ectopic! My heart goes out to you. But you are strong, because only a strong woman will come through it and look at the way forward. You will be fine. Keep your chin up and be open to possibilities.

To summarize for those who don’t know, ectopic pregnancy is a situation in which a pregnancy implants outside of the womb (uterus). Usually, fertilization of the egg by the sperm happens in the fallopian tube and then this fertilized egg travels to the uterus where it is implanted. In ectopic pregnancy, this doesn’t happen. The fertilized egg may attach to the ovary, remain in the fallopian tube (tubal pregnancy), attach to another organ in the abdomen or the cervix. None of these places are ideal for supporting a growing life and so there is a great threat of serious bleeding.

Ectopic pregnancies are usually discovered in the first couple of weeks of pregnancy (it would have been discovered by the 8th week of pregnancy). The patient would usually come into hospital with complaints of light abdominal bleeding, abdominal pain or cramps, extreme dizziness from the bleeding. If the tube ruptures (bursts), patient could faint from profuse bleeding into the abdomen.

The risk factors for ectopic pregnancy include history of previous ectopic pregnancy and/or Pelvic Inflammatory Disease, STIs, failed tubal ligation (tying up of the fallopian tubes for people who no longer want to have more babies), congenital abnormality of the fallopian tubes, pregnancy while on Intra Uterine Contraceptive Device (IUCD) etc

Once the doctor makes a diagnosis of this, he will choose from either giving a drug to dissolve the pregnancy tissues, if the pregnancy has not progressed too far and the fallopian tube is not ruptured; pin-hole surgery (laparoscopy) is also an option here. However, if rupture of the fallopian tube is suspected, the whole fallopian tubes and ovary may have suffered significant damage needing their removal. In cases like that, IVF is an option.  IVF by the way, means Invitro Fertilization and is the process of fertilizing a woman’s egg with a man’s sperm cell outside the human body. In the early days they were called test tube babies. Unfortunately, IVF is not a cheap procedure and you do need deep pockets and loads of patience because it may take a while. But, if you can afford it, please go for it.

You could still have a normal pregnancy if the fallopian tube did not rupture and this was discovered early. Let your doctor guide you.

Give your body time to heal and do everything that improves your chances of having a successful pregnancy and healthy baby. Eat well (more fruits and vegetables) and try to work out daily…even if that means taking a walk for about 30 days. Get support from family and friends and remain positive…pregnancy is more likely to happen if you’re relaxed and focused on living a full and happy life as opposed to fretting about it.

Remember that adoption is also an option to consider.

So, speak with your doctor and find out what options are available to you.

I wish you all the best and I’m giving you a huge hug with my heart right now 😀

Q: Good day doctor. I had tears about 8 weeks ago. I feel pains whenever I pee

A: Congratulations on your new baby!

For any one who had an episiotomy (a surgical tear to help ease the passage of the baby), you probably froze in shock at the pain you felt when you first tried to sit down, right? Well, I did! It was just plain excruciating to attempt to sit, much less, adjust yourself to a more comfortable sitting position. Then, do you remember the first time after that when you tried to pass gas or urinate, as in the case here? It was sheer agony! Agony that melts away as you behold the bundle of joy that was a result of that process 😀 Now, if you haven’t had your baby yet, this may sound very scary, but there’s a solution for this pain.

Ever heard of a Sitz bath? It’s a warm water bath that helps cleanse the perineum. Just in case you wondered, the perineum is that space between the rectum and the genitals. The right temperature of water is the one that you can handle without sustaining burns. Putting a few drops of this water on the inner surface of your wrist can help confirm this.
Plain warm water is sufficient but some people add salt to the water which is soothing. Your doctor may also suggest other things he/she may want you to add to the water.

To prepare this, you can either use the plastic Sitz bath kit, (a special bowl specificallymade for this whichfits on your toilet seat so you can sit down easily on it), or your bath tub. Be sure to thoroughly scrub your plastic Sitz bath kit or bath tub before and after use. If using the bath tub, add sufficient warm water to sit on and then get in. To get the job done properly, you can try hanging your legs out of the tub. Usually, you are encouraged to sit for 10 to 15 minutes on the water. Pat the perineal area dry after you’re done. Do not rub vigorously…remember the area is sore and if you’ve had stitches, it could mess things up. This can be repeated up to 3 to 4 times daily as needed.

To ensure that the episotomy site heals well, use prescribed pain medication, avoid sitting on hard surfaces. Try using a pillow ( a regular or circular one/boppy pillow). Avoid constipation and indeed diarrhea and try placing a pad over the suture area while bearing down to poop. Urinating presents a challenge as pain is experienced during this process. Try using water to rinse off afterwards, preferably using a squirt bottle.

Eat healthy, keep the surgery site as clean as possible and enjoy your time with your baby. This too shall pass. Be sure to let your doctor know if you have concerns.

Have a good night y’all 😀

Q: Water is coming out from my breast. It is not breast milk It brown in color what is d course

A: A collection of tissues called the endocrine system is responsible for the production of hormones, which control various functions in the body like metabolism, sexual reproduction, mood etc. Sometimes, these hormones are produced in excessive or too little amounts throwing the whole body off.

Treatment of hormonal imbalance is dependent on the cause. The hormone, prolactin which is responsible for lactation in nursing mothers may be produced even when one is not lactating. Focus here is on reducing this hormone levels as will be described below. So, the doctor has to investigate to find out the exact cause of the imbalance and then treat accordingly.

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 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.

If you notice this, please visit your doctor who may try to express this discharge to study. The discharge may also be clear, 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.

To determine cause, the doctor may do a scan, take tissue sample to examine (biopsy) etc. Treatment depends on cause. If due to pregnancy or breastfeeding, it will eventually stop. If due to stimulation, the discharge will continue as long as the stimulation is present. If due to injury, it will also stop with healing. If the discharge is due to medication, stopping the medication is sufficient to bring this to a 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 you 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.

Generally, causes of breast discharge include:
• Pregnancy
• Breastfeeding: The release of milk may also persist for a while even when breastfeeding has been stopped.
• Stimulation of the nipples during sexual foreplay or even pressing the nipple by people who are worried about the nipple discharge or friction between fabric and nipple can lead to nipple discharge.
• Breast abscess or infection
• Hormone imbalance
• Injury to the breast
• Some medications
• Cancer of the breast

Bloody discharge, discharge from one breast only and discharge that happens spontaneously without the breast being touched or pressed is likely to be abnormal. These should be checked out as soon as possible in the hospital.

If the discharge is present during a menstrual period and persists into the next cycle, please see your doctor too.

High prolactin levels are associated with infertility and so this could be a factor in your case. Please see your doctor who will take a proper and detailed history from you and decide on the best treatment option.

I hope this helps.

Good night y’all 😀

Today is World Polio Day with the theme, ‘One Day, One Focus, Ending Polio.’

In honor of this day, I repeat a post I had made on polio a while back.

A couple of years ago, I was notified of a case that involved one of the hospitals on our private Health Insurance scheme and the child of one of our enrollees. This child had a fever that had been on for a couple of days and so the parents were not comfortable anymore and decided to go to the hospital. Predictably, the hospital decided to place this child on antibiotics irrespective of the fact that nothing pointed to the fact that this anything more than a viral infection.

This child could take orally and could very well have taken this unnecessary antibiotic by mouth, but for some reason (whether by request from the child’s parents who wanted something they perceived to be more potent or as a show of ‘we know what we are doing here’ by the hospital staff), a decision was made to administer this drug through intramuscular injection (in English, injection into the muscle…in this case, the butt specifically). To cut a long story short, a while later we got involved as we received a letter from the company of the child’s parent stating that the hospital was incompetent and administered an injection that made the child lose function of her lower limbs. We stepped in and eventually, the gist of the story was that this child was incubating the wild polio virus and the intramuscular injection this child had received converted this to paralytic polio! In English, this child now found it difficult to walk. Just like that!!!

Okay, why am I telling this story? Well, first it was world Polio day on the 24^th of October…sometime last week. As the events to mark the day were rolled out, I thought about this case I’d just told you about and I wondered about that child and how much use of her limbs she has now. And then I wondered how many other parents coerce their health care providers to give ‘stronger’ medicine in the form of injections so that their children would be better, quicker? How many healthcare providers fall for this ‘persuasion’ or even sometimes, downright ‘instructions’ from their patients or patient’s parents? How many even have an idea of how Polio is transmitted and how they can effectively guard against this? If you don’t have the right knowledge, you’ll fall for anything. A good example of this is a story I heard about a quack practitioner somewhere in the country a couple of years ago who made money off hardworking traders by claiming that he could help them wash out the impurities in their blood. For the people who fell for this scam, he would admit them into his ‘hospital’ and then set up an infusion with diuretics in it. In simple terms, diuretics are drugs that make you urinate a lot. So the guy sets this up and then fixes a urinary catheter (a tube that collects urine from a person’s bladder into a urine bag) for them so they can see the quantity of urine their bodies were making. The impurities were meant to be in the vast amounts of urine being poured out! I am just shaking my mind at the amazing gullibility and ignorance that makes us fall for anything and makes unscrupulous people take advantage of us. By the way, this guy was picked up by the police some time back.

But, I digress…back to the Polio discourse. How is the polio virus spread? It is spread through faeco-oral contact. I will describe this. A child with the wild polio virus defecates and sheds the virus in his or her poo. This faeces can contaminate water sources or can get into food as a result of inappropriate or lack of hand washing and basic hygiene and this cycle continues. Once one case is diagnosed, it is thought to be an epidemic already as one can be a carrier of the virus for a long time before symptoms actually show. The initial symptoms include fever, tiredness, headache and limb/neck stiffness.

Not everyone infected with the virus actually develops paralytic disease. There are some pre-disposing factors to the development of paralytic disease and they include intramuscular injections (like the baby in the story above), injuries, strenuous exercise, pregnancy, immune deficiency and removal of tonsils. Does this mean we should trash our exercise routine (you wish :D) or not get pregnant (let’s watch you convince your spouse :D)? The point being made is that these groups of people are prone to this and should ensure that they practice proper hygiene and sanitation to prevent this, given its mode of transmission.

All children below the age of 5 years should be immunized and booster doses given whenever the Government sends out her officials to do so. It’s not cool to send them away as if they were some troublesome ‘pests’ disturbing your peace. Their jobs save lives. If enough children are immunized, the cycle of infection can be broken and our children will live healthier, longer and better lives. Remember, there’s no cure for polio…only treatment to deal with the symptoms.

Have a good night y’all 😀

Hello y’all! What did you have for breakfast today? Was it healthy? or not? ;D Well, here’s Harvard Health’s recipe for healthy breakfast. Read!

https://www.health.harvard.edu/blog/a-doctors-recipe-for-a-healthy-breakfast-2017100612479?utm_campaign=shareaholic&utm_medium=facebook&utm_source=socialnetwork