chatwithketch

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!

Today is World Malaria Day and the theme is ‘Zero Malaria Starts With Me.’ Every two minutes, a child dies from malaria…did you know that? What part are you willing to play to help end malaria?

The question for today focuses on malaria in this vulnerable age group.

Q: Good day Doc. My baby is 4 months old. Can she take anti-malaria? Mosquitoes have been biting her face,
A: Thanks for writing in.
When you have a brand new baby, one of the investments (which thankfully does not require a lot of money) you should make is to buy a mosquito net. This protects your very vulnerable baby and prevents malaria which can be quite severe in this age group.
Children become especially vulnerable to malaria at about 3 months of age when the immunity they received from their mothers start to reduce.
First tip is, do not treat your baby at home. Take your baby to the hospital. The doctor needs to confirm that what your baby has is indeed malaria. This involves running a test to check for the presence of malaria parasites.
The treatment of choice is still Artemisinin-based Combination Therapy (ACT). Be guided by your doctor for dosage and duration of treatment.
For more on malaria, please click on the link: https://chatwithdrketch.com/…/kill-a-mosquito-with-a-sledg…/
Have a good night, everyone 😀

Q: I’m sorry for coming to your inbox late in the night. Thank you for the sacrifice you are paying to educate all your fans. My nightmare is about my little daughter, who I delivered in late December 2017. She is one year and almost four months now. She didn’t crawl at all, and up till date, she only walks with the aid of the table and the bed side. I stopped breastfeeding her a month ago, because she is so much attached to me, that she doesn’t allow people to carry her. She is too fond of me. Whenever I drop her with my grandma, and she doesn’t see me, she will play with other people. However, when she sees me, she starts crying profusely, if I don’t give her my total attention. Like I must not stand up beside her or even go to the restroom. The ‘biggest’ of my trouble with her is her consistent crying in the night. I am almost fed up! I am affected by these challenges, health-wise. I want to know Doctor, is there anything happening to her, stopping her from walking medically? What drug or supplements can we use, to help her? She fears a lot, she doesn’t want to fall down. That is what I have been observing as the reason why she can’t take her hands off the table and walk without being guided. Please help doctor. I will be expecting your reply Doctor. Thanks a million.

A: Thanks for writing in…and please don’t be fed up. Trust me! This too shall pass 😀

First point to note is that although children develop at different speeds, walking is not considered to be delayed until the child is about 18 months and hasn’t started walking. Your baby is not there yet and from all indications, may have started walking by the time she hits that age. So, don’t borrow tomorrow’s trouble for today. Encourage and cheer her on and provide opportunities for these motor skills to be developed – let’s see how it goes J

For you and other parents who worry about their children’s developmental progress, here’s an approximate guide to different milestones. Please remember that each child is different and so variation is the rule of the game! 😀

• At 6 weeks, most babies can sit with their backs curved and require support. Head control developing. In ventral suspension (when held above couch with examiner’s hand supporting the abdomen) can hold head at level of body briefly.
• At 3 months babies have enough upper body strength to support their heads and chests with their arms while lying on their tummies
• At 6 months, typically babies can sit with support and when lying face down, can lift themselves up on forearms. When pulled up to sit, the backward flopping of the head that used to occur (head lag) would have stopped
• At 9 month, babies can get into sitting position alone and sit unsupported. Baby can also crawl but it’s important to point out that there’s a wide variation in the age of crawling for children and some of them never crawl. They totally skip this stage and walk 😀 Sound familiar to you? Your baby appears not to be interested in anything except the real deal, ‘walking!’
• At 10 months babies can pull themselves into standing positions and maintain that position holding on to supports
• At 12 months, babies can stand and walk with one of their hands held. They can stand alone briefly and/or walk alone.
• At 18 months, most babies walk well, run and can climb stairs while holding on to rails
• At 2 years, most babies can kick a ball and climb up and down stairs with two feet per step.
• At 3 years, babies can now climb stairs one foot per step and are able to stand on one foot for a few seconds.

When it is diagnosed that there is a proven delay in walking, it is important to determine the cause. Apart from the fact that this ‘supposed delay’ may just be a variation of the normal, delays could be due to the under listed: Delay in motor maturation

• Learning disabilities in which there is a delay in all developmental areas, with language and social skills being the most affected.
• Delayed motor maturation in which some children, otherwise normal in every other aspect, just walk late. This tends to run in families
• Cerebral palsy
• Reduced muscle tone as in Down’s syndrome
• Infections – eg meningitis
• Head injury.
• Malnutrition.
• Maternal antenatal infections or toxins.

If the paediatrican is convinced there is a developmental delay, then treatment will depend on the cause(s).

So, right now, you don’t need to worry. If you, however, do worry, please take your baby to see the paediatrician for appropriate history taking, examination and diagnosis.

All the best!

Source: https://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-depth/infant-development/art-20048012

Hello everyone! I hope you’ve had a relaxing few days. As we all get back to work today, a few tips to keep stress and blood pressure down

https://www.health.harvard.edu/healthbeat/7-ways-to-keep-stress-and-blood-pressure-down

Happy Easter! He’s risen!

Have you ever paused to consider how the death and resurrection of Christ imitates our lives sometimes? Something absolutely terrible happens and we think ‘This is it! The end is here! I can never recover from this!’ But then, that’s you speaking within the limits of what you know. But, God shows up and that supposed failure becomes the stepping stone to great things! Halleluya!

In the same way that His death and resurrection brought great hope to humanity, may today mark the resurrection of peace, joy, happiness and everything good in your lives!

And now to our question….

Q: Doc what causes premature birth and frequent miscarriage, if it’s happening to the same woman?

A: What is prematurity? A premature baby comes into the world before 37 completed weeks of pregnancy. Babies born prematurely have to be in intensive care (Special Care Baby Unit) so as to give them a fighting chance. They are prone to having problems like apnea(where the baby sometimes stops breathing), anaemia (shortage of sufficient number of red blood cells to carry oxygen round the body), respiratory problems and low blood pressure etc.

Who is at risk of having a premature baby? Sometimes we don’t really know the cause, but it has been observed in mothers younger than 19 years of age and older than 40 years. Some cases can be brought on by chronic diseases which the mother already had before pregnancy like hypertension, Diabetes Mellitus or could be due to Urinary Tract Infections, other diseases of the heart or kidney, due to abnormal positions of the placenta in pregnancy or due to multiple pregnancy (carrying more than one baby in the womb eg twins). Smoking, drinking alcohol, drug abuse and failure of the mother to feed well during pregnancy are other factors that can lead to prematurity.

On miscarriages, often times, the cause of a miscarriage is not identified. Women who go through this need to understand this so that they don’t blame themselves unduly. Having said that though, first trimester miscarriages are mainly due to problems with the baby/fetus. These problems could be due to problems with the placenta. This is how the baby receives its nutrients in the womb and so, if this organ cannot deliver, a miscarriage might occur. There may also be a problem with the baby’s chromosomes, such that a baby may receive too many or too few genetic materials or there may be a damaged egg/sperm. Other associated risk factors include smoking and drinking alcohol, being overweight, malnutrition, increased maternal age, trauma and drug abuse. By the way, trimester is 3 months of pregnancy. Therefore, first trimester refers to the 1st three months, 2nd trimester, the 2nd three months and 3rd trimester, the last three months

So, my advice is, once you get pregnant start your antenatal classes asap and let your doctor know if you have any of the mentioned risk factors. In the developing countries like Nigeria, our survival rates for prematurity (depending on number of completed weeks of pregnancy) are not as good as in advanced countries. Let’s give our babies a fighting chance.

I hope y’all have had a great day!

Q: Hello! Dr. I have been facing a problem with my tongue where my tongue loses the ability to sense taste. This has occurred twice

A: Thanks for writing in. The disorder you describe is most likely hypogeusia, a situation in which one has a reduced ability to taste anything whether it’s sweet, sour, bitter, salty, and/or savory. The disorder in which there is complete inability to taste anything (ageusia) is rare. So, symptoms can range from reduced ability to taste a complete inability to taste. Oftentimes, when people report that they cannot taste things, actually have a challenge with smelling rather than tasting.

Some people are born with this disorder but in other cases, problems with taste and smell can be due to certain health problems, such as diabetes, high blood pressure, obesity, head injury, diseases of the nervous system like Parkinson disease and Alzheimer disease etc or even illnesses like a common cold, allergy or a sinus infection. Other causes include exposure to some chemicals or certain medicines, nasal polyps, hormonal changes, cigarette smoking, drug abuse eg snorting cocaine through the nose, dental problems etc. As people get older, challenges with sense of taste and smell also become more common.

To make a diagnosis, your doctor will run some tests which may include comparing tastes of different chemicals and measuring the strength at which you recognize any of the tastes, ‘sip, spit and rinse’ tests in which chemicals are applied to different areas of the tongue that are responsible for detecting different tastes etc.

Treatment depends on the cause(s), the severity of symptoms, age, judgement of the patient’s capacity to handle prescribed therapies and preference etc and could include changing medicines associated with disorder, treatment of underlying medical condition, counselling etc

Taste disorders can affect the patient’s general quality of life by affecting nutrition, the immune system and other medical conditions. So, every effort should be made to identify the cause and commence treatment.

All the best!

Q: What causes protein in the urine or in the body? Does it mean eating too much protein can be dangerous sometimes?

A: Thanks for writing in.

First point…even if a food is considered healthy, it doesn’t mean you should eat as much of it as you want. For instance, beans is healthy on so many levels but it also high in calories and so you still need to stick to the portion described. Moderation in everything!!

Protein molecules in blood are typically too large to be filtered into urine so that normally, very trace (very little/low) amount is present in the urine as healthy kidneys do a great job of filtration. Therefore, when protein is found in urine, it is abnormal and usually suggestive of the fact that the kidneys may be malfunctioning. This condition is known as proteinuria and the most common relevant protein suggestive of kidney disease is albumin. This can be detected using a dipstick test. How would you know without this test? Well, the urine could get very frothy if a lot of protein is being passed out in the urine…so that’s something to look out for.

There is a condition known as temporary proteinuria, which occurs in people with high fever and after very vigorous exercise. This is not a problem and as the name suggests, it is temporary. Proteinuria is also common in concentrated urine samples like first thing in the morning and when dehydrated. In some instances, it is found in young children later in the day even when it was not evident in the morning in a condition known as orthostatic hypertension (This condition, also known as postural hypertension, is a medical condition that presents as a sudden and abrupt increase in blood pressure when a person stands up). Again, this is not suggestive of a bigger problem

What diseases can cause this?

• Kidney disease, especially those affecting the filtering units. Diabetes can affect these filtering units
• For more on this, please click here: https://chatwithdrketch.com/2015/10/23/daily-health-tips-protein-in-urine-during-pregnancy/
• Urinary tract infections

People with proteinuria are more at risk of heart disease and so it is key to monitor blood pressure and ensure one lives a healthy lifestyle.

Treatment depends on the cause. Please be guided by your doctor!

All the best!

Q: What causes protein in the urine or in the body? Does it mean eating too much protein can be dangerous sometimes?

A: Protein molecules in blood are typically too large to be filtered into urine so that normally, very trace (very little/low) amount is present in the urine as healthy kidneys do a great job of filtration. Therefore, when protein is found in urine, it is abnormal and usually suggestive of the fact that the kidneys may be malfunctioning. This condition is known as proteinuria and the most common relevant protein suggestive of kidney disease is albumin. This can be detected using a dipstick test. How would you know without this test? Well, the urine could get very frothy if a lot of protein is being passed out in the urine…so that’s something to look out for.

There is a condition known as temporary proteinuria, which occurs in people with high fever and after very vigorous exercise. This is not a problem and as the name suggests, it is temporary. Proteinuria is also common in concentrated urine samples like first thing in the morning and when dehydrated. In some instances, it is found in young children later in the day even when it was not evident in the morning in a condition known as orthostatic hypertension (This condition, also known as postural hypertension, is a medical condition that presents as a sudden and abrupt increase in blood pressure when a person stands up). Again, this is not suggestive of a bigger problem

What diseases can cause this?

• Kidney disease, especially those affecting the filtering units. Diabetes can affect these filtering units
• For more on this, please click here: https://chatwithdrketch.com/2015/10/23/daily-health-tips-protein-in-urine-during-pregnancy/
• Urinary tract infections

People with proteinuria are more at risk of heart disease and so it is key to monitor blood pressure and ensure one lives a healthy lifestyle.

Treatment depends on the cause. Please be guided by your doctor!

All the best!

Q: Hello doctor, please what will happen to an O- mother that didn’t take the Rhogam injection after delivery but took it when she was seven month pregnant?

A: Thanks for writing in. The challenge here is that of Rhesus incompatibility…the fact that the mother is O negative and it would appear the father is O positive.

Usually in pregnancy, your blood and your baby’s blood do not mix. However, during the process of delivery (and some procedures during pregnancy), some degree of mixing of mother’s and baby’s blood happens. When this occurs, if your baby is O positive, your body starts to produce antibodies against your baby’s blood….literally. But, because your baby is being delivered or has been delivered, the antibodies have very little time to do any damage to the baby. They can only get rid of the small amount of baby’s red blood cells in your own body. So, baby number 1 is not a problem.

The challenge though is that these antibodies are now waiting for another opportunity to attack foreign blood cells. If you give birth to a baby that is O negative like you, this is not a problem. If, however, the next baby is O positive, those antibodies kick in and start to attack your baby’s red blood cells. It is for this reason that the Rhogam injection is given within 72 hours of delivery to ensure that your body does not mount the regular response of producing antibodies against Rhesus O positive blood. The injection deceives your body into thinking it has already produced antibodies, thereby protecting your baby as the particles of Rhogam cannot cross the placenta.

I hope in your case, that your first pregnancy involved a Rhesus negative baby…in which case the injection you didn’t take wasn’t needed anyway. Whatever the case, I’m glad you’ve taken the injection now.

Don’t beat yourself up over the injection that you didn’t take. It’s past. Let’s focus on the present and be sure to prevent future issues like this. Your doctor already knows what complications are likely to be expected and I trust that he will have the right team in place to handle these as best he can.

If there is a case of incompatibility though and it’s severe with the baby in danger, the baby can get special blood transfusions called exchange transfusions either before birth (intrauterine fetal transfusions) or after delivery. Exchange transfusions replace the baby’s blood with blood with Rh-negative blood cells. This stabilizes the level of red blood cells and minimizes damage from Rh antibodies already in the baby’s bloodstream.

I wish you the very best.

Lots of hugs!