Q: Hi doc I am from Kenya. I had a 3° hemorrhoid removed .I had been suffering from the hemorrhoid for the last 7 years. Now that it has been removed I am sore, going to the toilet is a nightmare that I dread. Could you please give me some tips on how to ease the pain?

A: Haemorrhoids, also known as piles, 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.
Now, for tips to help reduce your pain:

You can 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 )sitz bath) and also use some pain relief, if in pain.

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)

I hope this helps.

Have a great weekend, y’all 😀

The first-ever guidelines for preventing stroke in women don’t fool around. They offer ways to prevent this disabling and potentially deadly event from adolescence to old age.

Source: New guidelines aim to help women prevent stroke

Q: Good day Doc. Thanks for your teachings. Please I went to ask u if it is advisable to give a pregnant woman ACTM tabs or injections or is there any order treatment for as it regards malaria during pregnancy

A: Hallos! Thanks for writing in. The use of medications in pregnancy is always considered very carefully to ensure that there is no harm to the growing baby. So, the conversation on malaria in pregnancy always starts from prevention.

Sulphadoxine-Pyrimethamine (SP) with a common brand in these climes being Fansidar, 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). Is it safe in pregnancy? Yes and no. 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. 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 the gold standard had always been Quinine, Clindamycin, Proguanil which 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.

The Malaria Policy Advisory Committee in its meeting in 2015, did find that Artemisinin-cased combination therapy drugs may not be as toxic as had been previously thought in early pregnancy and called for a review of the WHO guidelines on the treatment of malaria in pregnancy to consider the timely use of ACTs in these cases. So, this is not a license for you to go take any ACT medication. Have a chat with your doctor and s/he will advice.

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 evil!

So, I hope this helps.

Have a good night, y’all 😀

Q: Dr. Ketch, I have a painful breast. I have been to a doctor and they say it’s nothing…no signs of breast cancer. What could it be??

A: Breast pain can be experienced as a burning or stabbing pain or it could be felt as soreness or heaviness. The usual locations are the outer portion of the breast and may extend to the underarms and sometimes, all the way down the arms. Breast pain is commonly not a sign of cancer.

Breast pain could be cyclical, in which case, it is linked to menstrual cycle or non-cyclical, in which case it is not linked to menstrual cycle.

Cyclical breast pain occurs at about the same time every month, starting about 2 to 3 days before the menstruation starts and improving after the period. The intensity of the pain varies during the period. This pain is thought to be related the effect of hormones and so women on hormone replacement therapy after menopause may experience this breast pain too.

Non-cyclical breast pain may be due to mastitis…a painful condition of the breast during breastfeeding. For more on this, please click on https://chatwithdrketch.com/2014/09/12/daily-health-tips-im-a-breastfeeding-mother-who-just-developed-a-painful-lump-in-my-breast-could-it-be-cancer/

It may also be due to medications, breast abscess (collection of pus in the breast), non-cancerous breast lumps .

If you have breast pain, it’s a good idea to have your doctor check it out especially if:

• The pain is continuous over a couple of weeks
• The pain gets worse
• The pain prevents daily activities
• The pain is consistent in a particular area.

A couple of exams like clinical breast examination, mammogram, ultrasound and breast biopsy will help make a definitive diagnosis.

I hope this helps.

Have a good night, people  😀

Yesterday, 6^th February was the International Day of Zero Tolerance for Female
Genital Mutilation.

Sadly, this trend still continues in our Nigerian society.

Please read below, a post I had made on this before.

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.

Have a good night, y’all 😀

Diabetes can lead to a host of complicated health problems, so keeping prediabetes from becoming diabetes is wise and studies show that it is possible.

Source: What is prediabetes and why does it matter?

Yesterday was World Cancer Day with the theme, We can, I can! So, what are you doing, individually and with any group you can influence to stop the burden of cancer?

Here are some tips…

• If you smoke, quit. If you don’t smoke, don’t start 😀
  • Ensure that your home is smoke-free and try not to be close to even second-hand smoke.
  • Eat healthy…more fruits and veggies. Lay off the processed foods.
  • Get some exercise every day. At least 150 minutes per week.
  • Reduce your alcohol intake.
  • Get your children vaccinated for Hepatitis B and cervical cancer
  • Get screened for cancer
  • And guess what? Breastfeeding is protective against cancers…one more reason to ensure that your baby gets this all important goodness 😀

Do you want to know mare about cancer? Perhaps, how some foods are related to cancer? Or perhaps, you always feel bloated and wonder why?

The book, Just For The Health Of It With Dr Ketch, explores these and other issues.

Get a copy of the book, Just For The Health Of It from any of these channels:

1) Laterna Books online shop with nationwide delivery. Just click on this link:https://www.laternabooks.com/laterna_product_details.php?v=15450&c=44

2) Another option for those in Lagos is Laterna Bookshop on 13, Oko-Awo Close, Off Adetokunbo Ademola Street,. Victoria Island.

3) If you’re outside the country, please visit Amazon through this linkhttp://www.amazon.com/Just-Health-Ketch-Pregnancy-Parenting/dp/9789398026/ref=sr_1_1?s=books&ie=UTF8&qid=1426246647&sr=1-1&keywords=just+for+the+health+of+it+with+dr+ketch+olalere+nkechi

For those in Abuja and environs, please call 07030739403 or pick it up at No 5 Bricks Market, Dawaki 11 Market, Dawaki extension.

For those in Awka, please call 08189944090.

Remember that this book is a great gift for anyone who wishes to live and eat healthy, lose weight, get ready for pregnancy and parenting. Buy copies for bridal showers, baby showers, Christmas gifts etc. It’s a gift that keeps on giving

Q: Please Doc what can be used to treat ring worm on the scalp in children?

A: Fungal infection of the scalp, called Tinea Capitis, is often found in children and is commonly called ringworm too. If you’re a parent and your child has had this, the embarrassment factor alone is significant enough to seek therapy 😀 Parents try all sorts from the conventional to the not-so conventional to take care of this. Anti-fungal creams, lotions and powders applied to the scalp for ages, don’t quite work. Creative solutions like rubbing petrol on the scalp, leaves a screaming child who still has holes and patches in his hair from the fungal infection. Where on earth, did that therapy come from? Petrol??? Seriously???? (like my daughter would say :D)

I have actually discussed this on this page before…but it certainly bears repeating 😀 Tinea Capitis may involve all or some parts of the scalp. The involved areas may look bald and patchy with small, round spots from broken off hair, swollen and inflamed etc. As is typical of fungal infections, they love moist and warm areas and will be encouraged to grow when one has a cut or bruise on the scalp, does not wash his/her hair regularly, sweats a lot and does not wash this off quickly and/or shares personal items of clothing like caps, hats, head scarves, towels etc The infection can also be spread by coming contact with ringworm on someone else’s body or even contacted from a pet.

Treatment is not achieved on the surface by using anti-fungal creams. This is achieved by taking anti-fungal drugs orally. This will usually be for a significant period of time, between 6 to 8 weeks. Using anti-fungal shampoos may limit the spread of the infection but does not get rid of it. Again, even if signs of quick results are seen, this does not mean therapy should be stopped immediately. The drug should be taken for the full period prescribed by the doctor.

During the course of treatment, pillowcases, combs, towels et al which are probably infected, should be disposed of, where possible. If not, they should be disinfected with bleach and washed in warm water.

Moving forward, personal things should be kept personal and not shared with other people 😀 Personal hygiene is key… children should be taught to take a bath and frequently too, especially after sweating. They should also stay away from stray dogs or those that have the infection (a bald patch on the dog’s fur may be observed)

Have a great weekend people 😀

Hi y’all! Hope you had a great week?
If you’re one of those that indulge in those suspicious looking drinks in funny looking bottles that supposedly cure any and everything from fever to jedi jedi, malaria and cancer, you should read this!

http://www.health.harvard.edu/vitamins-and-supplements/caution-always-key-in-using-herbal-medicines

Thank me later 😀

Q: Good evening ma’am! Please, help me out . I’m 25yrs and “inexperience’ Please, this last month I didn’t see my flow. What might be cause for I’m not under any medication

A: Hello ‘inexperienced’ girl 😀 Thanks for writing in.

Well, I’m glad to know you’re not on medication…but perhaps, the more material question would be, if you have had unprotected sexual intercourse in the intervening period between your last period and now. This is your most usual ‘go to’ question when a period is missing. So, if ‘inexperienced’ means that you have never had sexual intercourse, then we will be looking at other causes of a missing period.

A ‘regular’ menstrual cycle is supposedly one in which the cycle (the length of time from the 1st day of a menstrual period to the first day of the next menstrual period) is about 28 days but there is nothing abnormal about cycles that fall outside of this range. It could range from about 24 days to 34 days with ovulation happening at mid cycle. Indeed, in some women each period appears to have a different cycle. For young girls who have just started menstruating, skipped or irregular periods may occur.
What do people refer to as irregular periods? Well, if the time between each period changes, or the length of days of the period changes or indeed when the quantity of blood lost during each period changes, the period is termed irregular. What can cause these changes? They include:

• Changes in hormone levels, as is common in the puberty period or menopausal period (not an issue here)
  Stress
  • Excessive weight loss or excessive weight gain
  • Fibroids
  • Problems with the thyroid (hyperthyroidism)
  • Polycystic Ovary Disease (PCOD)
  • Scarring from previous surgery in the uterus
  • Breast feeding mothers may also experience irregular periods as the hormones released may delay return of menstruation. Remember, however, that this is not an effective means of contraception.

So, it’s always a good idea to keep a record of your periods: length of cycles, number of days the period lasts, presence of pain etc. If you keep a chart of this over time, you would be able to know what is normal for you.

Treatment of irregular periods depends on cause: fibroids, PCOD, hyperthyroidism all have to be treated. If irregularity is due to stress, learning coping mechanisms or relaxation techniques may help. Reduce weight or go easy on your exercise routine, if weight issues are a problem.

So, you might want to go and see your doctor to check you out.

All the best.

Good night y’all 😀