chatwithketch

Q: Thanks Dr Ketch for all your advice. Please, at what age should my hubby stop bathing my daughter? She is 6yrs old now. During the week, we leave home early and so we help each other because we don’t want to have a house help and most times he helps with bathing the children.

A: Hmmm! Very valid question! You guys are getting into interesting territories! Important territories, too 😀

This issue actually goes both ways and indeed, the question should also be asked about when mothers should stop bathing their sons.
Children need their privacy and sooner than later may feel the need to voice out their need for this. I’m sure the husband in this case does not fall into this category but stories of parents sexually abusing their children also exist. We need to also be mindful of this…sad but true.

By the time a child is about 2 to 3 years old, he/she should be encouraged to wash their genitals by themselves. So, the parent bathes the child, but allows the child to wash the genitals while instructing/watching/supervising. Remember that these areas generally need just the gentlest of washes and so a child’s soft touch is plenty. This re-enforces the message that these areas are private and that not even mummy or daddy should cross these boundaries. Indeed, if a child has an injury on the genitals and an ointment or cream needs to be put on it, the cream should be put on the child’s hand and he/she should apply it by him/herself.

By the time a child is 4 to 5 years, he’s generally able to bath himself and should be given the privacy to do so…by both parents.
You know how you used to feel free to undress in front of your children because you felt….well, you just felt it was okay? Well, stop feeling so! By the age of, about, 3 to 4, fathers should stop undressing in front of daughters and vice versa. Around the age of 7 to 8 years, it may also not be cool for mothers to undress in front of daughters and vice versa. Now these are guides and depending on how fast your children catch on to these issues, you may have to fast forward these timings.

Generally though, as soon as a child stops feeling comfortable having you around when they are undressing or in the bathroom, please respect that boundary. My son kicked me out of his room and fired me from bathroom duties just before he turned 5 years. I was absolutely amused but I gave him his space. And I absolutely knock on his door before I enter.

So, kindly give your husband his sack letter tonight and let your daughter understand that she’s just moved up one more rung in the responsibility ladder 😀

What’s your take on this?

Have a good evening, people 😀

Q: Good morning, Doctor and God bless you much for always being there. I’m the lady that told you about my baby’s Mumps. She’s very fine now. Thank you so muchDoc I was wondering,..what should I teach her to call her Vagina? I don’t know if it’s proper and polite to use the real words as Vagina or Penis especially in public places. She’s my first child and I’m pregnant with my second child now.Please help me out. Thanks a lot.

A: Hey you. Thanks for writing in. I’m glad your daughter is better.Interesting question and I’m sure lots of parents will have lots of different views about what makes sense and what doesn’t.

Before I weigh in, I’ll tell you a story that I heard when in medical school. One of our professors was trying to explain why it was very important to ensure that in teaching couples about contraception, there should be no ambiguity. Say exactly what you mean and show it clearly with models or call precise names. So, the story was told of a medical doctor who was trying to explain to a couple how to use condoms. He didn’t have a model to use and show, had no pictures and probably figured that it didn’t make sense to ask the man to strip So, he told them to assume that his (the doctor’s) thumb was the patient’s penis. And he then proceeded to show the couple how to insert the condom over the thumb. It appeared communication had taken place. Everyone was happy, hands were shaken and everyone departed.A few months later, a visibly upset and confused couple returned to the clinic to see the same doctor. In summary, despite following the doctor’s advice and doing exactly what he’d told them, his wife still got pregnant. The worried looking doctor mentally tried to review what he’d told them while scanning through the pages of the couple’s folder. He asks the man how exactly he used the condom. The man thrusts out his thumb and tells the doctor that he put the condom on his thumb in exactly the same way the doctor did it during their hospital visit! The rest as they say is history!What am I saying? It is important to be very clear about what each body part is called and what can happen when inappropriate contact happens there. In these days where uncles, aunties and even parents have turned child molesters and pedophiles, it is important that children can adequately communicate what, if any inappropriate contact has taken place. It also helps the children to be comfortable in their skin and not feel that there is anything wrong with those parts of their bodies. They are private parts and should not be indiscriminately touched by anyone, even parents especially after a certain age, but they are also normal parts of the body.Teaching the right name helps make the children comfortable with their bodies. Be matter of fact and remember that this is just a prelude to the even more cringe-inducing conversation that you are going to have in a few years about sex education So start your practice with this and try not to look embarrassed.I know that the greatest fear is the embarrassment that one would feel if one’s child got up in public to scream ‘mum, my vagina hurts!’. I know. I would literally want to die too And why is that? It’s because we’ve literally made these words sound like bad words. They are not. They are names of body parts like nose, ankle etc. And if we all felt comfortable about it, there would probably be no shame.When I give health talks in some places and the conversation veers towards reproductive organs, grown men and women start giggling. I find it really fascinating! Really? What’s so cute about the names? Nothing! They are just not used to hearing it and this is most likely a hang-up from early childhood.Finally, if you don’t teach your child the right name, she will probably learn it from the internet as soon as she’s able to use a computer. And from then, all the other information you pass on may also become suspect That’s my take. What’s yours?Have a good night, y’all

Q: Hey Dr Ketch. I hope this meets you in good spirits. Is it safe to eat bitter kola during your first trimester? Someone told me it can cause a miscarriage. I’m 7 weeks gone by the way and the morning sickness is not kind on me at all. So far bitter kola relieves the nausea. Please enlighten me

A: Thanks for your question and congratulations on your pregnancy

Bitter kola typically contains caffeine and it is generally recommended to avoid caffeine in pregnancy. Although the amount in the serving portion of a piece of bitter kola may not cause a problem, please be sure to fully discuss your diet plan with your doctor.

To deal with the morning sickness of pregnancy, here are some tips:

The standard teaching is to try eating some bland foods like Crackers biscuits or dry toast. That personally didn’t work for me. I preferred tart things…which some may want to avoid. I loved lemons during my pregnancies. They were the one thing guaranteed to ‘wake up’ my mouth and chase nausea far away. I also had a particular brand of very tart bubble gum, I indulged in 😀 These were key for me because, though I didn’t have the real bad case of morning sickness that sent you to the hospital, brushing my teeth in the morning always sent me into a bout of retching/vomiting. So, I always had a ready supply of the gum or lemon/lime to pop into my mouth once I was done brushing/retching! Not a very pleasant memory ;D

So, if lemons work for you to prevent nausea, go for it. Remember that moderation is key. A few drops (one or two) in a glass of water are enough to provide that tart kick that sends nausea far away. There is a catch here though…remember the heart burn associated with pregnancy. The acid content of lemon might make the heart burn and any pre-existing gastro-esophageal (stomach and esophagus/gullet) problems worse. So, this is all the more reason to be very moderate or stop if it exacerbates an already bad case of heart burn. Wherever and whenever in doubt, please be sure to see your doctor.

Other tips:

• Eat little amounts of food frequently as an empty tummy increases the likelihood of throwing up. Remember this is not an excuse to binge and over eat

• Avoid fatty and greasy foods.• Avoid smells that trigger nausea

• Cold foods may be preferable to hot as the former does not give off smells that may cause you to feel queasy.

• Get loads of fresh air and rest

• And drink sufficient fluids daily

More importantly, women going through this need love and support more than ever. If you can’t stand cooking now, because of this, get help etc.

Some nutrition tips for a pregnant woman:

1. Eat a balanced diet with a variety of foods from different food groups.
2. Be sure to include a lot of high fibre foods like vegetables, whole grain cereals etc to deal with the constipation associated with pregnancy.
3. Ensure you take your antenatal medications (prenatal vitamins) in addition to eating well.
4. Drink at least 4 servings of milk, other dairy products or calcium rich foods. If you don’t eat enough, your baby will start drawing on your own stock from your bones. So, drink up your milk!
5. Be sure to also take foods rich in iron eg and foods rich in folic acid eg green leafy veggies and beans. World Health Organization recommends that pregnant women receive folic acid and iron tablets daily. Folic acid prevents neural tube defects which may occur during the first 28days of pregnancy. This is usually the period when quite a number of women do not even know they are pregnant. Thus, women who plan on getting pregnant should start on folic acid supplements at least 3 months before their planned date to safeguard against neural tube defects. If you haven’t started this earlier and realize you’re pregnant, start taking them as soon as possible.

Pregnancy provides an opportunity for a mother to adequately prepare her baby for life in 9 months. Make sure that you get all the nutrients that give your child a great health boost.

Have a great evening y’all 😀

Q: Good day ma’am. Thanks for always giving detailed answers to questions asked. I’m 30 weeks pregnant but my tummy is not big. Before the pregnancy got to 30 weeks I experienced spotting which spot. Now I am spotting. What causes spotting in pregnancy in the second and third trimester? Does it have effect on the baby? Went for check-up. My doctor says the baby is fine. Please hide my identity. Kudos ma’am

A: Thanks for writing in.

You were super smart to have gone to complain to your doctor. If he says, all is well, that’s great. But I will just talk generally about bleeding in pregnancy

Bleeding in late pregnancy may be due to a variety of issues ranging from infections to the ‘show’ that heralds the start of labour.

Causes of bleeding at this time include:

1. Cervical changes which can lead to bleeding after sexual intercourse
2. Infection of the cervix
3. Infection of the vagina

Other causes include:

• Placenta previa.
• Placental abruption.

These are two conditions that affect the placenta.

The placenta is created during pregnancy and is attached to the wall of the uterus (the womb) by blood vessels. It is through the placenta that the baby receives vital nutrients and oxygen and also through this that it excretes waste products. The baby is connected to the placenta through the umbilical cord. So this is a pretty important organ in the general scheme of things. The baby’s and mother’s blood do not mix in the placenta usually, though. The baby’s blood flows on one side and the mother’s on the other side.

The placenta usually implants at the top part of the uterus or the side, but in placenta previa the placenta attaches low in the uterine wall and covers the mouth of the womb (the cervix) partially or completely. It could be just low lying, near the cervix but not covering it, just covering part of the cervix or fully covering it. Due to this abnormal placenta position, pregnant women with PP would show up in hospital with bright red vaginal bleeding which may happen with or without contractions.

What causes this? Well, in instances where the placenta is bigger than normal or in cases where surgery had been performed on the uterus. Thus, women with multiple pregnancies (twins, triplets etc), who have had fibroid surgery or previous Caesarian Section, who have had children before may be at risk of this. Other risk factors include age at pregnancy older than 35 years, smoking, use of cocaine etc.

The doctor (obstetrician) will order a scan to confirm the diagnosis. Low lying placenta that hardly get to the opening of the cervix can actually be ‘drawn’ up as the uterus expands to accommodate the growing baby in it. However, the women with complete PP are most likely to go through Caesarian Section.

Can you prevent it? No, you really can’t 😀 What to do? Once you notice any vaginal bleeding, please be sure to see your doctor. PP is likely to cause bleeding from sometime around the second trimester of pregnancy, but of course, every episode of bleeding in pregnancy, irrespective of trimester, should be checked out in the hospital. Depending on the severity of the bleeding and the age of the pregnancy, the doctor would decide whether bed rest or emergency Caesarian section would be applicable. If bed rest is recommended, sexual intercourse and physical exertion including exercise, at this time may not be wise. Please discuss this with your doctor.

You’ve got to make sure that the person with PP is under the care of a good obstetrician. This is not the time to play hooky and try out different treatment options from unorthodox practitioners (not that any time is a good time, anyway :D). It may very well be that if the bleeding continues significantly, the baby may be delivered pre-term. So you have to be in a center that is equipped to handle that eventuality. Better safe than sorry 😀

In placental abruption, the placenta separates, completely or partially, from the wall of the uterus before the baby is born. This situation is not very common but when it does happen, it can deprive the baby of vital nutrients and oxygen and lead to bleeding in the mother. This situation may happen suddenly or may develop gradually with symptoms like vaginal bleeding, abdominal and/or back pain, sore uterus, fewer baby movements, contractions etc

We don’t really know the cause of placental abruption apart from the fact that it could be caused by trauma to the abdomen. Other risk factors include:
• A previous history of placental abruption
• Multiple pregnancy
• Premature rupture of membranes
• Substance abuse eg smoking
• Maternal age greater than 40 years

Now, remember that having a risk factor doesn’t automatically mean that you will come down with the ‘disease’.

Treatment depends on the severity of the abruption, the age of the pregnancy and the effect on the baby. Your doctor will make the call as to whether to go for an emergency Caesarian Section or keep patient on bed rest while waiting for baby to mature some more, depending on these factors.

Can this be prevented? Well, given the fact that we’re not quite sure of the cause, we can’t really do much other than try to guide against risk factors that can be prevented like not smoking.
Just be sure to let your doctor know that you have had this problem before so he can be extra watchful. With the right care, you should be fine.

So, I suggest you go see your obstetrician to confirm that this bleeding is nothing serious, if it continues

Have a great night, y’all 😀

Q: Good morning Doc, please I have a question. If sperm is mixed with blood, what is the cause?

A: Hi dear, thanks for writing in. It is certainly very disturbing to see blood in semen! This phenomenon, known as haematospermia or haemospermia in men under 40 years with no other symptoms related to more serious issues (which I shall discuss below) is usually not a major medical problem. Causes include:

·       Inflammation of the prostate gland (where semen is produced)

·       Inflammation of the seminal vesicles (where most of the fluid in the semen is produced)

·       Cysts in the seminal vesicles

·       Sexually Transmitted Infections like gonorrhea, chlamydia etc

·       Following recent instrumentation eg after prostatic biopsy

These conditions would usually resolve on their own or require a course of antibiotics. Please be guided by your doctor.

However, if you develop the under-listed symptoms, especially if you’re older than 40 years, it may be a sign of more serious conditions and you should see your doctor immediately.

·       Blood in semen which persists for longer than 3 to 4 weeks

·       Presence of other symptoms like pain during urination

·       Recurrence of blood in semen

·       Presence of other risk factors for bleeding disorders, cancer etc

These more serious problems could be due to bleeding disorders, severe high blood pressure, cancer etc

So, please see your doctor and let him make a proper diagnosis.

All the best.

Good night y’all 

Q: Good evening Doctor, I am 30 weeks pregnant and unfortunately my house help left for school about 3 week ago. Now all the house chores such as sweeping, washing, mopping etc. are on me now. Please, will this have any negative effect on the baby? I am very worried.

A: Hi dear. Thanks for writing in and congratulations on your pregnancy. I assume that it’s your first from your question 

So, pregnancy is not a death sentence or an illness, really. It is a natural condition and so, potentially, you can do a lot of things without any problem. Now there are caveats…if you have threatened abortion (miscarriage), your doctor will advise you to be on strict bed rest and not to lift a finger, literally  There are a few other conditions that may limit what you can do, but your doctor will definitely be the one to issue those orders. In any case, whenever in doubt, please consult your doctor.

Having said that, bending to sweep or mop is okay in pregnancy but it has to be done the proper way…bending at the knees and not twisting your body while at it  I suggest that you use the long-handled brushes/mops for sweeping/mopping as opposed to the local/native brooms/scrubbing brushes that require bending…in probably uncomfortable ways.

Pregnant women get lots of advice: from friends, mothers, mothers-in-law, colleagues, husbands etc. Sometimes it’s confusing to know what’s true and what’s not.

Here’s our take on some of them:

Advice

The first breast milk, colostrum, should be discarded as it is dirty and causes rashes in children

Fiction (False)

Colostrum is the first milk produced by the mother and is loaded with antibodies and nutrients needed by the baby. Babies should not be deprived of this milk.

Advice

Women should not take the prenatal vitamins (antenatal drugs) given at the hospitals because it makes babies grow unnecessarily big.

Fiction:

The iron tablets are important to prevent anaemia (blood shortage) in pregnant women and the folic acid ensures that baby’s spine develops well with no defects. In fact, it is advised that women who wish to get pregnant should start taking folic acid about 3 months before they conceive.

What other pregnancy myths do you know?

Thursday 29th October was World Stroke Day. In honor of that day, I repeat the post below:

Q: Good morning, Dr. Ketch. Thank you for helping us out health-wise. I’ll like to ask…as a Nigerian, do you know of any food that is healthy for a recovering stroke and hypertensive patient apart from Semovita and wheat? Thank you, ma’am

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.

There is really no such thing as a partial stroke. 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 notices, 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.

Perhaps, swallowing is an issue in the case mentioned above. Apart from that, if Diabetes is an issue, she needs to be on a strict diet and that will determine what she can or cannot eat. This will ultimately affect weight gain or loss. If this is a big concern, please discuss with her doctor. For specific foods to eat, reduce your intake of cholesterol and trans fat-rich foods. What foods can help reduce bad cholesterol in the body and increase the level of good cholesterol? Here are some examples:

Oats and other whole grains which form soluble fiber that reduce the absorption of cholesterol and in addition, give you a feeling of satiety for long. This prevents you feeling hungry more often and reaching for ‘unhealthy’ snacks Other foods in this group include okro, beans, apples, citrus fruits and garden egg (egg plants).
Soya beans, heart healthy oils like Olive oil and Canola oil, nuts (which should only be served in handfuls) and fatty fish like mackerel also reduce LDL.

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.
You may need to walk with a stick as you re-learn the art of walking. Recovery may be long and tedious but you’ve got to keep at it.

All the very best.
Have a good night, people