Q: Good evening doctor, please what cause boils on the armpit, breast, vagina, inside nose and buttock and thighs…very big ones at that matter? And what drug can one use? Thanks.

A: Your question is not very clear. Are the boils in multiple places occurring at the same time…or different times? While we consider that question, a few basics….

A boil, also called a skin abscess, is an infection of a hair follicle deep in the skin. Boils can occur in any part of the body, but most frequently in the armpits, groin, around the vagina/anus areas, around a tooth and at the back. They are often swollen, painful, and after a few days collect as a head of pus and debris (this explains what you noticed) which can rupture on their own when soft or ‘ripe’ or may require a health expert to cut it open and drain it (if it’s quite large).

The more common causes/triggers of painful lumps (which could be boils) in the armpits, include:
• Deodorants: These can cause skin irritation which can lead to boils. The delicate and sensitive skin of the underarms and the sweat that can accumulate there making it a rich culture medium for germs are factors that have been implicated. Solution: You may have to try another one…find one without fragrance or perhaps, formulated for sensitive skin. Reading the labels will provide this information J

• Shaving: A lot of people can identify with this…bumps in the underarm after shaving. This can happen if you do not shave properly. Try shaving after taking a bath when the hair is moist and the skin hydrated. If this does not suffice, you may have to find alternative means of removing underarm hair eg depilatory cream.
• Infection of the hair follicles from cuts or injuries to the underarm, or from friction caused by wearing tight clothing. So, be careful while shaving and try to wear clothes that are more loose fitting (especially under the arms) and/or focus on fabrics that can ‘breathe’ like cotton
• Dirt or debris from excessive sweating can clog up hair follicles leading to painful lumps. Personal hygiene is key. Don’t be miserly with bathing and be sure to ‘take care’ of the underarms and other areas like the groin that tend to accumulate sweat and raise a stink J
• Infections due to viruses or bacteria.
• Cancer of the breast may also present like this.

Boils in the pubic region, can be caused by an ingrown hair (the hair instead of growing upwards, grows inwards into the skin, this may occur following shaving), blocked hair follicles (from sweat, or a damp unclean environment), a sexually transmitted infection (herpes, when it’s just starting) a sign of some other disease like diabetes, or problems with the immune system, poor hygiene (especially during menses for women) and poor nutrition.

As much as you may want to, avoid squeezing or scratching it, allow it rupture on its own. This would help prevent further infection of deeper structures and skin, and also prevent spread to other areas. Apply warm water with a cloth on the boil for about 10-15 minutes, 2-3 times a day. Avoid sharing towels and washcloths with other people and keep the area clean and dry as much as you can. An antibiotic cream or mupirocin cream can also be applied (ask for this in a pharmacy shop). You may require antibiotics, which would be prescribed by your doctor, if he thinks you need them.

Further evaluation may be necessary if you have boils in multiple areas (as could be the case here), recurrent boils over several months, a very large boil, or boils on your face (including the nose that appears to be affected here) and anus.

I hope this helps.

Have a good night, y’all 😀

Q: Please doctor, can tooth decay/toothache cause miscarriage? What can someone do if pregnant and have toothache?

A: Forcing dental floss in between your teeth can cause periodontal disease, which can cause a dull toothache. Where periodontal disease is not caused by wrong ‘hygiene’ techniques, it could be due to gum disease. Gum disease arises due to lack of good dental hygiene, which causes plaque forming bacteria to accumulate in the mouth and lead to swollen and bleeding gums. If this happens and is noticed early, it can be reversed before it starts causing tooth loss and weakening of the gum and bone structure holding the teeth (periodontitis). Other culprits could be hormones (during pregnancy or menstruation) and chemotherapy.

In pregnancy, the high level of hormones can make gums become more sensitive than usual and thus prone to gingivitis. If this is untreated, it can progress to periodontal disease with release of bacterial toxins that cause infections in the gums. As a result, the teeth may become loosened with subsequent loss of bone and entry of bacteria into the blood stream. The bacteria can potentially be transported to the placenta where pre-term labour may be precipitated.

A systematic review of about 25 cases, some years back suggested an association between periodontal disease and adverse pregnancy outcomes like miscarriage, pre-term labour etc. While no evidence for a causal relationship between periodontal disease and pregnancy exists (that is, it has not been proven that periodontal diseases causes pre-term labour or miscarriage), good oral hygiene improves general health of mother and ultimately, baby.

So, if you’re pregnant and you have toothache, please see your dentist and also let your obstetrician know. Don’t go taking painkillers by yourself. Remember that every medication is a potential toxin and when pregnant, you have to be even more careful as whatever you take in could affect your baby. Your medical team will weigh benefits of immediate treatment against that of potential risk to pregnancy, if any.

For more on this topic, pleased click on this link: https://chatwithdrketch.com/2015/11/06/daily-health-tips-what-causes-bleeding-gums/

I hope this helps.

Goodnight, y’all 😀

https://www.instagram.com/p/BTwpeh3lAxV/?taken-by=ddrketch

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 😀