chatwithketch

A: If you’ve ever had a kidney stone, you surely remember it. The pain can be unbearable, coming in waves until the tiny stone passes through your urinary plumbing and out of the body. For many, kidney stones aren’t a one-time thing: in about half of people who have had one, another appears within seven years without preventive measures. Preventing kidney stones isn’t complicated but it does take some determination. Prevention efforts include drinking plenty of water, getting enough calcium from food, cutting back on salt (sodium), limiting animal protein, and avoiding stone-forming foods like beets, chocolate, spinach, rhubarb, tea, and others.

https://www.health.harvard.edu/blog/what-causes-kidney-stones-and-what-to-do-2019051716656

Happy Children’s Day! And no, I am not just referring to your children, I’m referring to you! 😀 You are somebody’s child 😀 My mother still sends me a message every 27th of May…so, go figure! 😀

And to celebrate today, we will take a question related to children….

Q: Hi Dr, my question is, ‘when does a baby start to grow? And is there a difference between the growing process or boys and girls?’ A: Hey! Thanks for writing in.So, when does baby start growing? Well, from the time of fertilization (union of the sperm and egg). If you use the 40 weeks of pregnancy typically used by your doctor, then that means that fertilization and commencement of growth of baby happened around week 3 (remember that we count from the first day of your last menstrual period and so that means that the 40 weeks includes your last menstrual period days).

I’m assuming that this growth refers to height and will focus this discussion on that. A person’s final height is as a result of a combination of factors: genetics (if your parents are short, you are more likely to be short), nutrition (during the critical growing up years and especially before birth), general health and hormones (growth hormone, thyroid hormone and sex hormones). Having said these, there’s no hard and fast rule really, as some ‘short’ parents give birth to tall children and vice versa.

The fastest period of growth is experienced before the baby is born. Thereafter, another growth spurt is experienced during puberty with boys generally growing more than girls do. During this period, the growth plates (areas of growing tissues located at the ends of long bones. These are the areas where bones grow) are very active until they end of puberty when they mature, fuse and stop growing. Once the growth plates are fused, growth has been concluded and height cannot be increased. There is no specific age at which this occurs really: people who start puberty early will probably stop growing before others who started later.‘Normal’ when used to describe height can vary from place to place with differences in ethnic groups, cultures and continents.

Sometimes, there may be a medical condition associated with height variations (short or tall statures), but most people are normal and just at the lower end of normal (for the short) and at the higher end of normal (for the tall).If the cause of ‘shortness’ is a medical problem or a hormone deficiency, this can be rectified. For instance, if there is a deficiency of growth hormone, this may be administered. However, this can only be done in children…before the growth plates fuse (at about 14/15 years for girls and at about 16 years for boys). Once this has happened, no drug can increase height. Surgery in which the legs are cut apart and then gradually separated to increase height is an option, with attendant possible complications of infection and of course, fracture. Not really advisable.

So, from the time the baby is born, focus on the right feeding. Start with breast milk. Breast milk, beyond being cheap, temperature regulated and readily available 😀 is formulated with everything your baby needs for each stage of his growth. It’s chock full of immunoglobulins (which makes them resistant to illnesses), vitamins, minerals, proteins, fats and oils. So, it is indeed a complete meal! It also helps the womb to return to normal size after childbirth. From six months, baby is ready to be introduced to some other food.

For a long time, the standard teaching had been to go for rice cereal as the first add-on meal because it is bland and babies tolerate this well. Other studies question this wisdom now and suggest that foods like meats with lots of essential nutrients like iron may be a good place to start. What should you do? You can boil beef/chicken very soft and blend it up for baby. If baby tolerates this, then by the next week, you could try adding some rice cereal. Try not to introduce more than one food per week so that you have time to study how your baby adapts to it and of course, look out for/isolate food allergy. And, to start off, only one meal of the complementary feed should be given daily. The rest should be the usual…breast milk 😀 This will, of course, as baby tolerates.

From one year of age, you can add cereals and it’s also okay to introduce cow milk at this time. Full cream cow milk is advocated at this time for proper brain development. Thereafter, please switch to skimmed/1%/2% milk as full cream milk has a lot of saturated fat which may contribute to poor heart health. Grains, green leafy vegetables, cow milk, honey, whole eggs can be introduced after the baby turns 1 year old.

Generally, other weaning foods that can be introduced include:Boiled egg yolk (egg whites contain substances that baby may react to), sweet potatoes, fish, chicken, beef, fruits like banana, avocados, boiled beans (with skin removed if possible) etc

Simple recipes include: blend some chicken or beef with the stock or mash a banana and add to baby’s cereal.Our local cereals can also be used and fortified with some breast milk or formula.As baby tolerates these meals, you can get a little more adventurous.Boiled carrots mashed with some coconut oil or a little yoghurt with mashed banana may not go amiss too.

I hope this helps!

Have a good night, y’all 😀

Q: Good evening Doc please am having this pain on the upper right side of my chest. Please what is the cause?
A: Chest pain is not necessarily a sign of a serious medical condition, but because it could be potentially life threatening, chest pains should be checked out in the hospitals.Common causes of chest pain include:

Chest sprain/sprain. This condition would typically be relieved by rest and is brought on by a chest injury or exertion

Heartburn. Typical symptoms include regurgitation (bringing up) of ingested food and/or bitter tasting fluid, feeling bloated. Symptoms usually start after eating and are usually described as burning.

Anxiety or panic attack. Symptoms include palpitations and fast heart beats, dizziness, sweating and is usually triggered by a stressful situation

Pneumonia. Associated symptoms include coughing (yellow or green mucous), high temperature and chest pain on breathing in and out

Shingles. Symptoms include skin rashes that turn into blisters and tingling on the skin

Heart problems. This is the key reason why chest pains should be checked out in the hospital because it could be a heart attack, which is life threatening. Other common causes include angina (caused by poor blood flow to the heart) and pericarditis, in which the protective covering around the heart becomes inflamed with leakage of fluid into it. Chest pain from heart problems is usually described as pressure, fullness, burning or tightness in your chest

So, my advice would be to go get checked out in the hospital and this should be immediate if the chest pain spreads to the back, neck or arms; makes your chest feel tight or heavy, lasts for more than 15 minutes, starts with sweating, shortness of breath and/or feeling of being sick

All the best!

Q: Hi Doctor, is it possible for a 3 month-old baby to start teething?

A: Your baby is certainly in a hurry :D. Seriously though, babies start teething at different times. On the average, most children start teething at 6 months. Some start earlier than 4 months (as early as 2 months) and some others may wait up to a year or even after, to start the journey. Some children are even born with one or two teeth. These are called natal teeth and ‘No, this is not associated with witchcraft or enemies pressing remote controls’ as we like to think in Africa 😀 Some children also develop their own teeth within the first four weeks of life. These are called neonatal teeth. Natal and neonatal teeth can cause problems with feeding and may even be swallowed. The paediatric dentist will decide whether to remove them or leave them alone based on factors like whether the teeth are loose, excess etc.

Generally though, in instances like the one addressed in the question, provided the teeth do not negatively affect baby’s feeding, they are left well alone.

Have a fab evening 😀

Hey Doc, of recent, I have been having this splitting of urine which is of concern to me. What baffles me is that it doesn’t happen all the time I urinate, and also it tends to occur less when I am well hydrated. Please your advice will go a long way. Thanks Dr Ketch

A: A split stream of urine is typically caused by urinary obstruction. Some conditions that can lead to this include problems of the prostate gland and urinary strictures.

A urinary stricture is the narrowing of the urethra (the tube that leads urine out of the body). This, naturally, leads to restriction of the flow of urine out of the body leading to a variety of medical problems.

This condition is more common in males than females because of the position of the urethra and although sometimes the cause is unknown, common causes include

• Straddle injury (falling astride an object),
• Endoscopy (a procedure in which an instrument called a probe is inserted into the urethra)
• Prolonged use of a catheter
• Trauma or injury to the urethra or pelvis
• Sexually transmitted infections
• Cancer of the prostate or urthra
• Prostate enlargement
• Previous prostate surgery

The prostate gland is a small organ located just below the bladder. It produces semen and the urethra which transports urine from the bladder and semen from the prostate, passes through the prostate. This organ grows throughout a male’s life and sometimes grows so big that it blocks the flow of urine from the bladder. This condition is known as Benign Prostatic Enlargement or Benign Prostatic Hypertrophy or Benign Prostatic Hyperplasia. This is more likely to happen as people age and when there is a family history of this.

The symptoms of this are also typical for urinary strictures and include

• Feeling like urinating very frequently
• Feeling the need to urgently urinate
• Not being able to start urinating immediately despite the urgency
• Straining at urine
• When the person does start urinating, the flow trickles 
• Split stream of urine
• Feeling that the bladder was not completely emptied
• Urinary tract infections due to the fact that there is always urine in the bladder encouraging the growth of micro-organisms
• Bladder stones
• With time, kidney function becomes reduced

These are some of the symptoms that may bring the person to the hospital. The doctor will perform a detailed examination which include a rectal examination and order an array of tests.

Treatment modalities include medications and surgery. The doctor will determine which works best for you.

Prostate-friendly diets include loads of fruits and veggies and less fat in the diet. Exercising daily and limiting alcohol intake are also thought to be helpful.

Having said all this, the first thing you need to do is to go see your doctor and get yourself checked out.

All the best!

Q: Doctor please, how can I treat thrush infection? I’ve taking several antibiotics but they are not working. I keep having white discharge. Please, l really need your help and drug prescription

A: Thrush/candidiasis is caused by an organism called Candida, a fungus (yeast). This infection can result in cheesy white (like ground melon/egusi seeds) vaginal discharge and vaginal itching. This itching can lead to irritation in the vagina which can become further infected by bacteria.

Candidiasis is very common in diabetics (the sugar in their urine makes the vagina a rich culture medium for them) and pregnant women who have altered glucose tolerance. This infection is also common in people whose immune systems are compromised and people who wear tight panties that do not allow their delicate inner selves to ‘breath’. Preferred materials for undies would be cotton and should be loose (I see my fashionistas frowning :D). It also happens in people who take a lot of antibiotics. Normally, some bacteria and fungi (yeast) co-exist peacefully 😀 in the vagina. To encourage this peaceful co-existence, the bacteria produce some acid that hold the yeast in check and prevent their over-growth. When antibiotics are abused, this leads to a situation where the yeast takes over 😀 (almost like a coup, right?). Though this infection can be passed on through sexual intercourse…especially oral-genital contact, it’s not really called an STI because women who are not sexually active can be infected with this.

Treatment is with anti-fungal vaginal tablets and/or anti-fungal cream which can be used for between 1-3 days depending on drug of choice. A single course dose of Fluconazole can also be taken orally. Any of these regimen may be extended if the infection is complicated…let your doctor be the best judge of that 😀

Prevention is targeted at causes:

• Wear loose fitting cotton undies 
• Stay away from or limit time spent in hot tubs or saunas
• Stick strictly with the prescription for antibiotics in terms of quantity and duration
• Change out of wet clothes eg swim suits as soon as possible

Now, this infection can be treated using oral drugs (tablets to be taken by mouth) (antifungals and not antibiotics) but these are not recommended during pregnancy and breastfeeding. Vaginal pessaries and creams are better bets in pregnancy. However, because of the very small possibility of hurting your cervix (the neck of the womb), it is advisable not to use the applicator to administer the pessary. Instead, use your finger to insert the pessary. It may be necessary to continue the drug application for about 6 days as opposed to the shorter 3-day course. Your doctor will confirm diagnosis and advice on medication duration.
For more on candidiasis, please click on the following links:
https://chatwithdrketch.com/2014/06/26/daily-health-tips-why-do-i-have-recurrent-candidiasis/
https://chatwithdrketch.com/2014/03/07/daily-health-tips-toilet-infection-seriously/
https://chatwithdrketch.com/2014/04/27/daily-health-tips-is-vaginal-discharge-normal/

Good night people 😀

Q: Doctor. I gave birth to a baby boy and he is now 6 months and 1 week and I have no menstruation  for the past 6 months. Also after giving birth, I have been a pure breastfeeding mom. My concerned is whether I will get pregnant because this week we made love without anything (protection).  I am only frightened  that I might get pregnant, Doc. I am not ready and more over baby is still 6 months. I am very worried about it. Thank you. Please help me Doc

A: Hello and Congratulations on your new baby!

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 😀

However, the pattern of your menstrual cycle prior to your previous pregnancy (if it was regular or irregular) also plays a role. The duration of your labor and the presence of complications like bleeding after delivery could all play a part in the return of your period. Exclusive breastfeeding and presence of underlying infection also could delay the return of menses. Don’t stress out about this for now…. except if you are really looking forward to another pregnancy soon. If this is the case I would advise you see your doctor for a proper evaluation. Otherwise enjoy your period of no bleeds 😀

And please, discuss contraception/family planning options with your doctor. I’ve had quite a number of people writing in to ask if breast feeding protects against pregnancy and if it was possible for them to get pregnant even before their periods return or if it was safe to breastfeed a baby while pregnant. The answers by the way, are yes to getting pregnant while breastfeeding, yes to possibility of getting pregnant before periods return and yes to breastfeeding while pregnant.

So, could you be pregnant? Only time will tell. If you do confirm that you are not pregnant (after a pregnancy test), then please visit a family planning clinic and start contraception.

How is your week going?

Have a good night, y’all 😀

Q: I’ve noticed that each time I eat snacks especially doughnuts or meat pie or anything fried, I will be feeling burning sensation in my stomach; at the same time making me feeling thirsty always, even after drinking water. I tested positive to H. pylori and I was treated. It’s been over a year now and I don’t know if it is what is still affecting me even with pain, headache or eye pain

A: Thanks for writing in.

There are two conditions that may often be confused, one for the other: Peptic ulcer and Gastro-Esophageal Reflux Disease (GERD).

Gastric acid is secreted normally in the stomach to help the process of digestion. 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. Infection with an organism, Helicobacter pylori (H. pylori) has been found to be a cause of peptic ulcer.

GERD, on the other hand occurs when stomach acid backtracks into the esophagus causing heart burn.

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

For GERD, there are also conditions like pregnancy and obesity that make this condition worse and there are also foods that encourage this. Examples of these ‘foods’ are fatty foods (as appears to be the case here), alcohol, orange juice, chocolate and coffee, onions, tomatoes, peppermint and spicy foods.

So, I suggest you keep a food diary over a period of time and try to figure out the trigger foods. If you suspect tomatoes, try to confirm this by having a ‘tomato meal’ and watching for heartburn and an unpleasant taste at the back of the mouth. If this is not the issue, perhaps it’s a weight issue or even over-eating.

Treatment is targeted at the acid and healing the esophagus. Remember that occasional heartburn is not regarded a problem but if it happens frequently, like two or more times every week, then it becomes a problem and is now referred to as Gastro-Esophageal Reflux Disease (GERD). So, drugs used can stop acid production, reduce acid production and cause healing of the esophagus or neutralize the effect of the acid.

Prevention involves trying to avoid your trigger foods (quite a number are actually healthy maintaining a healthy weight, avoiding heavy meals just before bedtime, try eating smaller meals and avoid tight clothes that may also put pressure on your abdomen.

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.

Have a fabulous evening and remember…no heavy meals before bedtime 😀