chatwithketch

Q: Good evening Doc, Please I am 31weeks pregnant, and I have noticed an odorless water coming out from my vaginal, I don’t think it’s urine. It just flows without urine urge, no pain, nor any sign of labour, Nothing else…just the flow

A: Thanks for writing in, dear.

Amniotic fluid is the fluid that surrounds and cushions a baby while in the womb. The fluid is contained within a sac called the amniotic sac. Usually just before a woman goes into labour, this sac ruptures and the fluid is released…that’s what is referred to waters breaking. When I had my last baby, my waters broke right in the hospital reception! And so, there was I with water all over my legs and people in the reception area watching 😀 It wasn’t quite funny on that day! But I digress…

Sometimes, this sac of fluid bursts or it could start leaking very gradually before the pregnancy is 37 weeks. This is called Pre-term Pre-labour Rupture Of Membranes (PPROM)

Question is whether what is leaking is urine, amniotic fluid or vaginal discharge.

Here are some tips to help you know:

If it’s urine, it has the peculiar smell of urine and is usually leaked when one coughs, laughs or sneezes.

If it’s vaginal discharge, it’s there constantly and may be clear, white or yellowish

If it’s amniotic fluid, it’s likely to be clear, or slightly mucoid and/or blood stained and it wets panties continuously irrespective of whether one laughs or not

The most significant issues with PPROM is the danger of infection, premature birth and the dangers associated with it.

So, my advice would be to see your doctor immediately so he can examine you and make a diagnosis. He will confirm whether indeed it is amniotic fluid and then take a decision as to what step to take next. If the leakage is little, you may be asked to stay in hospital for a few hours while wearing a sanitary pad to check for whether it becomes soaked. An ultra sound scan, vaginal exam etc are also useful in making a diagnosis.

If you develop a fever, the discharge changes to green, develops a foul smell, you experience vaginal bleeding, contractions, abdominal pain or baby appears not to be moving as normal, be sure to see a doctor immediately.

Enjoy the rest of your day, y’all 😀

Have you ever wondered common places in your house where germs hide? People readily think of the toilet…but have you spared a thought for other areas or things in the house? Well that’s why we’re here! Let’s tell you some top hiding places for germs:

• Studies have shown that germs really love the kitchen sponge. Take a little moment and think about it and it may not be so strange! To disinfect it you could soak it in lemon juice or bleach, wash in the dishwasher or just hand wash it. Do this every evening after the night washing up is done.

• Your TV remote: This is a no-brainer right?! How many times do you reach for the remote control daily…while eating (with those very grimy hands), after having had a fumble in your nose, after rushing out from the toilet (before washing your hands) to catch the last few minutes of that show etc. Use some anti=bacterial wipes to clean your remote controls or add some hand-sanitizer to some tissue/kitchen paper and make sure you reach all the tiny nooks and corners.

• The bathroom and kitchen faucets. We touch them with those dirty hands that need washing and pay them no heed afterwards. Be sure to give them a good scrub every night before bed.

• Light switches and door knobs: Everybody uses them: children and adults alike and we smear with all sorts of germs. Guess what? They really thrive there.

• Shower curtains: Notice the colour change on your shower curtains after a few years of use? They come from soap scum and bacteria which have the perfect breeding ground given that these curtains get wet every day and stay wet. Wipe Down Curtain After Showering.

• Your gas cooker, micro-wave, oven etc knobs. We touch these very often in the kitchen and forget to clean them. Grimy germs make their homes there.

So, get cleaning people! Have a great weekend 

Have you ever heard of the phenomenon, ‘white coat hypertension?’ It happens in people who typically have normal blood pressures at home and other non-medical settings, but develop a temporary rise in blood pressures when they visit the hospitals for medical appointments.

Are you one of those? Want to learn more about this? Read! https://www.health.harvard.edu/heart-health/high-blood-pressure-at-the-doctors-office-but-not-at-home?utm_source=delivra&utm_medium=email&utm_campaign=WR20190913-BloodPressure&utm_id=1574091&dlv-ga-memberid=11052531&dlv-emuid=6b19e29b-9b0e-4e39-8520-42bd14e0d959&dlv-mlid=1574091

Q: Hello Dr. Ketch. Can a pregnant woman take paracetamol in the first trimester?

A: Don’t be quick to go take any medicine 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 medicine against the potential benefits. 

Having said that, paracetamol has been routinely used during all stages of pregnancy for the management of pain and high temperature. There is no clear evidence that this has any adverse effect on the baby, especially when taken at the smallest effective dose for the shortest possible period.

For a related post, please click the link below: https://chatwithdrketch.com/2017/11/29/hlwdk-daily-health-tips-is-chloroquine-safe-in-pregnancy/

All the best!

Q: Hello Doc, how’s life with you and your beautiful angels? My regards to all. It feels good to write in again. My problem is about dark patch round the eyes, remedy pleeeease! Is avocado useful in anyway in connection to this?

A: Hello dear! Thanks for writing in. My and I are fine, thank you 😀

The skin around the eye is very thin and as a result, any movement of fluid in or out of the area is very visible there. Typical examples are the dramatic sunken eyes when one is dehydrated (maybe from stooling) and the equally ‘gossip-worthy’ swollen eyes after a night of crying 

Usually in the body, fluid would move from an area of low salt concentration to an area of high salt concentration (osmosis). After crying, your salty tears are an attraction for fluids, which move from areas of low salt concentration to accumulate there. On the other hand, going on an alcoholic binge (drinking till you drop) causes dehydration with the accompanying sinking eyeballs.

Now dark circles may be ‘false’ and just look that way when puffy eyelids cast shadows on the area or due to sunken eyeballs as people age. Real dark circles however, may occur due to prolonged bouts of crying, allergy (as may be the case in the question here, with the associated itching), having a cold, drinking a lot of alcohol, rubbing or scratching the eyes often, exposure to sun, ageing, sleeping with make-up on and it also runs in families…I bet you didn’t know that one 

Other causes of dark circles include sleeping positions. If you sleep on your side or on your tummy, thanks to gravity fluid will also accumulate around your eyes. Let’s also not forget the commonest cause…burning the candle on multiple ends!

Treatment will be based on the cause. If it’s due to a cold or allergy or sinus problems, when these are taken care of, then the symptoms will disappear. Modification of lifestyle habits like removing all make-up at night, wearing sunglasses and using sunscreen when out in the sun, changing sleeping positions by sleeping on your back (if possible) or elevating your head with more pillows and leaving alcohol and your eyes well alone (no scratching and rubbing of eyes!)  may also be helpful.

Quick fixes for these bags include using concealer or even foundation to cover it up. Using cucumber slices on your eyes or teabags are also helpful as short term measures. By the time you hit your 30s, you really should invest in a good eye moisturizer because this is the first place to show the sign of aging 

Other solutions include surgery and injection of fillers etc.
Remember that no matter how many concealers, surgeries, moisturizers et al you use, if you don’t rest and avoid fatigue, you’ll just be throwing money down the drain. And this also goes for avocado oil which some people swear is a great remedy for this.

If these circles persist, however or seem to be just under one eye, please see your doctor or dermatologist for more advice.

So, as you all start contemplating where to hang out next weekend, be sure not to show up at work with the ‘telling’ bags under your eyes on Monday 

‘ Have you ever had one of those days where you are so weary, you can’t seem to do anything except binge-watch Netflix? ‘ Perhaps you should be taking further actions than just,’Netflix and chill’ 😀 Read! https://www.health.harvard.edu/blog/dont-take-fatigue-lying-2017041411485

Q: I was having stomach problem even to the extent of losing weight, so I went to hospital, did some tests and found out that I’m H. pylori positive. They gave me some drugs. After taking all these drugs, nothing has changed. I am still feeling hungry and thirsty even after eating and drinking. I haven’t even added 1 pound since then. It has been 2months now. Please what could be the problem. Always feeling as if my tummy is burning

A: Infection with Helicobacter pylori (H. pylori) has been found to be a cause of peptic ulcer. Peptic ulcer is a sore in the stomach, esophagus or duodenum and occurs when there is either over-production of this gastric acid in the stomach or reduction in the quantity of mucous that protects the stomach from the acid.

In the past, it was thought that spicy foods caused peptic ulcers. However, there’s no evidence to support this, though spicy foods can certainly make the symptoms of ulcer worse. Smoking, stress and drinking alcohol are also likely to worsen the symptoms of peptic ulcer. Caffeinated and carbonated beverages may also be culprit. Ulcers are also common in people who take certain pain relieving drugs known as Non- Steroidal Anti-Inflammatory Drugs (NSAIDs) like Ibuprofen.

People with peptic ulcer usually complain of burning abdominal pain or even sometimes, chest pain as the pain can be anywhere from the breast bone to the navel…giving room for a wide range of descriptions, typically burning. The pain is usually worse at night or when the stomach is empty.

People with ulcers may vomit blood or pass out fresh or altered blood in stool. For the latter, the stool looks tarry black. Complications of peptic ulcers include internal bleeding, leakage of the acid into the abdominal cavity etc

Treatment is targeted at reduction in acid production, neutralization of acid, treatment of Helicobacter infection, promotion of healing or protection of stomach lining. Your doctor will determine the best option or combination(s) with your active participation, of course

Thus, prevention is targeted at switching pain relieving drugs (if you have an ulcer, please stay away from NSAIDs), reducing your level of stress, stopping smoking and reducing your alcohol intake. Maintaining a healthy diet filled with loads of fruits and veggies, which provide sufficient vitamins to aid healing, is also a good way to go. It is still not very clear how H. pylori infections spread but it is thought to be probably from person to person or from food and water. So, judicious and very frequent, hand washing will certainly help

Does milk help? Well, temporarily but it quickly makes it worse. Milk coats the surface of the stomach, reducing the pain but then stimulates more acid production. Sounds like you can’t win, aye?! ;D

So, see a doctor first to confirm whether the H. pylori infection is still active and also to understand your new symptoms and then s/he’ll advice on treatment.

Q: Good evening Dr. Ketch. please can women with PCOS who can only menstruate, ovulate by taking medication, conceive and put to birth without miscarriage?

A: Ovaries are small bean-shaped organs on either side of your womb. Every month, your ovaries develop sacs called follicles from where eggs are released monthly and female sex hormones produced. After the egg is released every month, the sac disintegrates. But sometimes, the egg is not released and the sac remains or the egg is released and the sac does not disintegrate. This follicle becomes the fluid-filled cyst sac. Usually this is not a problem as it could form during every menstrual cycle and usually resolves on its own. These cysts are called the functional cysts. However, these cysts could get very big and in some instances become twisted or they could rupture causing problems. This latter type is called pathological cyst.

Examples of pathological cysts occur in PolyCystic Ovarian Syndrome (PCOS) and endometriosis. In the former, small cysts appear all over the surface of the ovary and is also associated with irregular menstruation and high hormonal levels. In endometriosis, the tissues of the uterus (womb) are found outside of the uterus. These two pathological cysts are associated with fertility problems. Functional cysts are hardly associated with fertility issues except they become extremely large.

So, is it possible to become pregnant with PCOS? It is not impossible. To help improve your chances, maintain a healthy weight, eat healthy, exercise, monitor your ovulation and time sexual intercourse to coincide with this time.

Treatment depends on your particular situation. Your doctor could order serial scans to continually observe the size of the cysts and see if they reduce in size. Another treatment option is the use of birth control pills to prevent the development of more cysts in future menstrual cycles. The final option is surgery.

Risks associated with pregnancy in a patient with PCOS include miscarriage, high blood pressure, premature birth and diabetes mellitus. The risk of these can be reduced by monitoring PCOS symptoms and taking extra care during pregnancy. Your doctor will advise on the best course of action based on your history.

All the best!

Q: Hi Dr. Ketch, I appreciate the good work you are doing in here. Please, I want to know the condition that causes boils to grow in every part of my body – in my nose, eyes, arm pit, vaina, back chest and even my laps. This usually happens two weeks to my monthly cycle and these boils are usually painful but goes after some days. Could this be infection or what? Please help me with answers. I am not on any preventive pregnancy drug, I do natural family planning

A: 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 😀