chatwithketch

Q: Good morning, Dr. Please is there any other way of getting rid of hernia on a female child except by surgery. Something like medication or injection. Thanks

A: Thanks for writing in. How old is this child?

A quick refresher class on herniae…

Hernia is the protrusion of an organ through a defect (like a hole or opening) in the wall of the muscle or cavity which usually holds it in place. There are different types hernias (or herniae) and they include:

Inguinal hernia: The most common type of hernia. It usually happens in situations where the pressure inside the abdomen is increased.

Other hernias include incisional hernia (where a protrusion develops from the site of a previous surgery, especially abdominal surgery), femoral hernia (which has the same risk factors as inguinal), umbilical hernia (common in black children where the umbilicus, aka navel does not form a small ‘button’ on the abdominal wall but protrudes) and hiatal hernia (where the stomach squeezes through a hole meant for the oesophagus (the pipe through which food gets to the stomach).

Typically, all hernias are caused by a weakness in the wall of muscles or containing cavities and an increase in pressure. Examples of activities that increase pressure in the abdomen are long-standing cough or frequent sneezing, carrying heavy loads regularly, straining at stool whether due to constipation or diarrhea etc. The walls of muscles are usually weakened in people who are obese, pregnant women, smokers and malnourished people. It is also more common in men and as people grow older.

What are the symptoms? People with hernia would usually notice a protrusion after a strain eg lifting something heavy or coughing. Sometimes, they are able to push it back. Other times they are not. The worry about hernia and the reason why they have to be treated quickly is that they may strangulate. Yes, just think about the word strangle and you understand what strangulate means J The protrusion may become squeezed by the opening through which it passes blocking off blood supply to the area protruding. Once a part of the body is deprived of blood, it dies. We don’t want that to happen!

The decision as to whether to go for surgery or not depends on where the hernia is located (inguinal and femoral hernias usually need surgery), the contents of the hernia sac and the symptoms. A truss (a supportive device that prevents enlargement of a hernia) may be prescribed by your doctor to help for a short period of time. Typically a doctor will schedule a surgery to repair a hernia. Complaints of pain in a hernia patient may mean strangulation, which need to be dealt with immediately. Umbilical hernia does not usually require surgery as the protrusions usually ‘return’ on their own. If this persists beyond 5 years, then surgery may be needed.

If you do require surgery, you don’t need to fret about it…really. This is not major surgery…it’s intermediate (sort of like half way between minor and major :D). Your doctor will provide answers to all the questions you have and of course, counseling. There are options for laparoscopic surgery which is surgery done through small incisions guided by a camera.

Preventive measures include having a healthy weight, giving up smoking, treating conditions that may lead to long-standing coughs, eating healthy to prevent straining at stool etc. These are the self-help options available to you now. I am worried though, about the possibility of strangulation. I suggest that you go to a Government hospital. Consultation fee will be moderate and a doctor will give you a proper diagnosis after examining you.

All the best!

Have a good evening, everyone 😀

Q: Hello doc. Good day. Please doctor can you talk about low thyroid in pregnancy and the causes and the remedy, please. God bless you Doc.

A: In hypothyroidism, the body does not produce enough of the thyroid hormones due to an underactive thyroid gland. The symptoms include tiredness, weight gain, constipation, increased sensitivity to cold, depression etc

Causes of hypothyroidism include autoimmune diseases (when the body turns on itself, producing antibodies that attack and destroy the thyroid gland), inadequate iodine in the diet, radiation therapy to the neck, thyroid surgery (in which some or all of the thyroid is removed) etc. Other factors associated with this condition include pregnancy, certain drugs etc Risk factors for hypothyroidism include white race, growing older, having prematurely graying hair etc.

The major issue causing the symptoms is the lack of thyroid hormones and so treatment is targeted at that. Synthetic thyroid hormones will be prescribed to help combat these. Effects on fatigue may be observed as early as two weeks after treatment is started.

So, please see your doctor for a proper examination and he/she will make a diagnosis after which a course of action will be determined.

Have a good night, everyone 😀

Q: Hello Dr. Thanks for the wonderful works you’re doing on social media. Please, in addition to breast milk, what can I give to my 3 months old son because my wife is finding it difficult to cope with her business

A: Congratulations on your new baby!

Breast milk is the best food for baby for the first six months, generally speaking. I’m a great advocate and will be telling you how your wife can make it work. The supply of breast milk is based on its demand. And so, if demand for it is high, supply will be high and vice versa. The more efficiently milk is removed from the breast, the more milk production is stimulated. And so, there needs to be a conscious effort to get baby to suck more.

If your baby sucks, the let-down reflex ensures that your wife’s breast fills up with breast milk. Flat nipples can appear to be a challenge for breast feeding, especially for first time mothers but remember that babies are supposed to latch on to the areola (the black area surrounding the nipples) and not on to the nipples. Your wife should try pressing on the areola with thumb on top and fingers underneath and push back against her chest wall while pressing in with her thumb and fingers. This helps elongate the areola and so, provided she positions the baby properly on the areola, breast feeding can go on with no issues.

Here are other tips that could help increase milk supply:

• Be sure that baby is attached properly and get him to suckle on the breast very often. Remember that breast milk production is a function of the breast milk let down reflex which is activated when baby sucks.
• If she can find a private space within her office/business space where she can express milk, encourage her to go for it.
• Let her increase the number of feeds per day. She could work with a timetable of a feed every 2 to 3 hours. In her case, as many times as is possible when she gets back from the office.
• She should switch breasts during a mealtime. Let the first breast ‘empty’ before switching baby to the other breast. This can be repeated several times during a feed.
• She should massage her breast and stroke towards the baby
• Perhaps over the weekend, let her room in with your baby and get him to feed as much as possible. The letdown reflex will be greatly stimulated and so, she could even pump some for when she will be at work and freeze.

Personally, I found that using my hands to ‘milk’ my breasts produced sufficient amounts of breast milk for my always-hungry-can’t-seem-to-get-enough-food-baby. She may want to try that.

Drugs and foods that encourage milk production are called galactogogues. A number of local foods have been touted to help eg Pap (akamu, ogi), green leafy veggies like spinach, oats, garlic and ginger, nuts like almonds etc Go ahead and try out what works for you.

I hope y’all had a great day! 

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‘Every day, retinal specialists are asked about the risks from blue light emitted from electronic devices. (Retinal specialists treat conditions affecting the retina, a thin tissue at the back of the eye that is responsible for vision.) Many people ask whether blue light will increase their risk of age-related macular degeneration and blindness.

I s the answer yer or now? Read to find out!
https://www.health.harvard.edu/blog/will-blue-light-from-electronic-devices-increase-my-risk-of-macular-degeneration-and-blindness-2019040816365

Q: Good day Dr. I have a problem. January this year, a condom burst but I got morning after pill the following day. In the very same month, I had my periods; also the following month (February). Then in March I only had my periods for 2 day and had drops. Normally it’s 4 days. I bought almost 5 pregnancy tests and they were all negative. Last month I went to the clinic and did another pregnancy test. It was negative so I took 2 months contraceptive injection. So now I am having back pains and every time I squeeze my right breast liquid comes out. Is it possible that am pregnant

A: The morning after pill which can be taken within 72 hours (some can be taken within 5 days) of unprotected intercourse, can help prevent pregnancy. But it does not protect you against sexually transmitted infections (STI) and this is a key concern given the recent history of burst condoms.

Please don’t forget that there is a simple ABC that guides these affairs. The first is abstinence. Honestly, this is your safest bet. If you’re not ready to deal with the responsibilities of having a baby, please leave well alone. You can’t have an STI, HIV/AIDS, or otherwise if you don’t have sex. And of course, you can’t get pregnant. Now, if abstinence is a problem, be faithful to one partner…who hopefully is being faithful to you too. If you can’t swear on this, revert to plan A. Finally, if all else fails, ensure that you use a condom to prevent STIs and pregnancy. As you have found out, this can also fail!

Contraception is a good option but the answer to proper contraception is not popping a pill in panic whenever you happen to have sexual intercourse. Emergency contraceptives have their place but they are not meant to take the place of regular contraceptives, as they are less effective than the regular ones. Regular use of these emergency contraceptives may cause your periods to become irregular and unpredictable. Is this the case with you? Have you been using the emergency contraception a little too often? It could explain your symptoms.

I think that you have probably thoroughly ruled out pregnancy now with the battery of pregnancy tests that you have done but perhaps, you should consider going to the hospital for a hospital-run pregnancy test and a general check, especially for STIs given the history of burst condom.

Breast discharge can be due to other causes other than pregnancy and breastfeeding and they include:
•  Stimulation of the nipples during sexual foreplay or even pressing the nipple by people who are worried about the nipple discharge or friction between fabric and nipple can lead to nipple discharge.
• Breast abscess or infection
• Hormone imbalance
• Injury to the breast
• Some medications
• Cancer of the breast

To determine cause, the doctor may do a scan, take tissue sample to examine (biopsy) etc
Treatment depends on cause. If due to pregnancy or breastfeeding, it will eventually stop. If due to stimulation, the discharge will continue as long as the stimulation is present. If due to injury, it will also stop with healing. If the discharge is due to medication, stopping the medication is sufficient to bring this to a stop.

Bloody discharge, discharge from one breast only and discharge that happens spontaneously without the breast being touched or pressed is likely to be abnormal. These should be checked out as soon as possible in the hospital.

If the discharge is present during a menstrual period and persists into the next cycle, please see your doctor too.

All the best!

Q: Greetings Doc, please my two-month-old exclusively breastfed baby cries much whenever he wants to poo and when he poops at last, it will be strong. Please what should I do?

A: In exclusively breastfed children, there can be episodes of lots of days without defaecation. This is not described as constipation. In children, the focus is more on the texture of the faeces when the child eventually defaecates as opposed to how often he goes. The ‘long duration’ in between stooling for exclusively breastfed babies is because the nutrients of breast milk are usually, practically all absorbed, leaving nothing to be excreted. Provided the eventual stool produced is not hard, then your baby should be okay.

I’m curious about the fact that you said your baby’s stool is strong. Is that because he cries before he poops? You should know that babies cry to increase pressure in their tummies, which helps push out the stool. It’s not about constipation. Where in doubt, it never hurts to see your baby’s doctor.

For more on constipation in babies, please click on https://chatwithdrketch.com/2014/10/15/daily-health-tips-is-my-2-month-old-baby-constipated/

Have a great night, y’all and a fabulous week ahead 😀

Q: It’s been two weeks now and my poop is green. What does that mean?

A: This question reminds me of an old show I used to watch, ‘You are what you eat.’ It involved amongst other things, an examination of stool to determine ones diet and body. I found it fascinating…useful but also disgusting! 😀  

Stool can take a variety of colours depending on diet and the quantity of bile in the faeces. Bile is initially bright green in colour and gets progressively darker/brown as the bile is acted on by chemicals and bacteria on its journey through the intestines.

Let’s take a look at different colors of poop and what they mean – this sounds absolutely disgusting! 😀

Brown – Normal stool colour. Bilirubin in blood, when broken down, ends up in the intestine. It is then acted upon by gut bacteria, which turn it brown.

White – No bile in stool or the patient could be taking some of those chalky anti-diarrheal medicines

Green – This could be due to food moving too quickly through the intestines and therefore the bile pigments not being acted upon by bacteria and other chemicals in the gastrointestinal tract. A good example of this sort of situation is diarrhea. However, eating a lot of green, leafy veggies, eating food with green colouring, taking a course of antibiotics (which changes the normal type of bacteria found in the gut and consequently, the stool colour) and some bacteria like Salmonella, can also turn stool green

Red – This signifies bleeding from the lower gastrointestinal tract or the presence of red food dyes in drinks and/or food. In situations like haemorrhoids where blood is ‘splashed’ on the stool, there are typically complaints of red stool colour

Black or dark brown – This could be due to bleeding from the upper gastrointestinal tract and/or use of iron supplements

Yellow – Excess fats and/or infections of the small intestine

I hope this helps.

All the best!