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General

What is CHRONIC SUBDURAL HAEMATOMA?


Our guest is Dr Mrs Opara. A consultant Neurosurgeon. Neurosurgery is an aspect of surgery that is concerned with SURGICAL TREATMENT of patients with injury to, or diseases/disorders of the brain, spinal cord and spinal column, and peripheral nerves within all parts of the body.

Like most people would say, it is the most difficult aspect of Medicine with most of their surgeries lasting over 24hours. We’ve 95 Neurosurgeons currently in a population of over 200million.

She is someone I really look up to, she’s young, beautiful, eloquent and she makes you just want to fall in love with Neurosurgery. She’s an inspiration to me.

Today I’m honoured to have her as our guest. Neurosurgery is the busiest speciality and having her squeeze out time to grace this interview is something I will forever be grateful for.

She will be talking on CHRONIC SUBDURAL HEMATOMA. I chose this topic because it is quite common in our environment yet, the awareness is almost zero.

Let me share this story…

A 65 yr old man hit his head on the wall while leaving his room. It was a minor trauma and so he went about his daily activities. Three weeks later, he left his house and on his way way back home at night he started feeling drowsy and confused.

Guess what he did? He parked his car on the road side, locked it up and laid on top of it. He slept there. Meanwhile his family was worried, called his phone countless times with no response only for him to be found sleeping on top of his car. Strange right? Following change in his behaviour, he was taken to different places before he was finally diagnosed of having Chronic Subdural Hematoma. He was referred to Neurosurgeon and had his surgery done.

Today he is alive and healthy going about his activities. Guess what would have happened if he wasn’t diagnosed? Your guess is as good as mine…

What is Chronic Subdural haematoma

A condition in which there is a collection of blood under the covering of the brain that has been there for a while. Brain has 3 coverings…PIA ARACHOIND and Dura. Dura is directly under the skull. When there is collection of blood under the dura it is called Subdural haematoma.

When is our said to be a Chronic Subdural Haematoma?

When the accumulation is more than 3 weeks- Chronic Subdural haematoma, acute , 3days-3weeks subacute

Epidemiology

It is more common in elderly patients, those above the age of 60yrs

It can be found in either of the sexes, however trauma seems to be more in Males gender, so there is slight Male preponderance.

Causes

Quite a number of things have been associated with it. Most cases of chronic Subdural, there is some history of trauma to the head which is usually minor. Like someone hit his head on the wall while leaving his room, fall on the floor, usually not associated with loss of consciousness.

There is shrinkage of the space between the dura and the rest of the brain. The dura becomes more intimately adherent to the bone. Some bridging veins that course from the surface of the brain to the Subdural space to link up with the veins within the bones called Diploic veins. These veins become more fragile as one ages. The combination of these two factors make it easy for the coins to rupture if there is a minor trauma to the head.

They rupture and begin to sip blood gradually into the SDS. It takes a while before the symptoms begin to manifest usually due to pressure in the brain or irritation of the area the bleed is.

Risk factors

  • Old age usually above 60yrs
  • Diabetes mellitus
  • Hypertension
  • Clotting disorders like hemophilia
  • Some medications like blood thinners

Diagnosis

Usually from the history and symptoms. Symptoms are myriad. Could range from just having headache, down to changes in mental status (ie the degree to which one’s active and alert being more drowsy, sleepy than usual etc)

  • Headache
  • Abnormal behaviour
  • Weakness on one side of the body
  • Seizures

Image guidance diagnosis is done with CT-SCAN which shows a collection of blood in the Subdural space. Below is a CT-SCAN of a normal brain (R) and one with chronic Subdural haematoma (L)

Once diagnosis is made, patient must be referred urgently to a Neurosurgeon.

Treatment

Treatment is by surgery, unless it was an incidental finding and not symptomatic

Complications

Complications of non treatment is worsening clinical state.

Recurrence

Infection

Prognosis

The prognosis is almost excellent It has a beautiful outcome when detected on time.

Advise for the General public

Any complaints that has to do with the brain like chronic headaches that is not responding to paracetamol , or noticed abnormal change in behaviour and/ or in sleep pattern in an elderly person. See a Doctor so it can be diagnosed early. Not all abnormal behaviour is old age related. And once a diagnosis of Chronic Subdural Hematoma is made, ensure you’re referred immediately to a Neurosurgeon.

Thank you ma, I’m sure the readers have a lot to take home after reading this. We appreciate

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General

My Medical School Tales


Dr Ola

Good morning and welcome back! To my blog. It’s been a very long break🤗

Today, I’ll be sharing with you the story of my journey through my medical school. The good times, the bad moments and most importantly, the difficult times.


Just like yesterday, I remember gaining admission to study Medicine and Surgery in Imo State University, Owerri for “6 years” . A supposedly 6yr program was stretched to 11 years! Five (5) extra years, without failing or repeating any class. I must share my experience, I thought to myself, hopefully it will inspire someone. Who knows?


Like every science student in college, my dream was to become a Medical Doctor. I also aspired to become a Medical Doctor; a decision that was influenced largely by my very brilliant friend and classmate in F.G.G.C. Umuahia, Linda Agalaga (of blessed memory). However, I wasn’t the I-must-be-a-Dr-or-I-die type. I kept an open mind, I had a second option in Medical Biochemistry. Which at some point, I actually preferred to Medicine, for reasons I still couldn’t understand. Thank God my choice for medicine turned out to be the right one for me

During my first year in medical school, I was young, naive, fragile, but not timid. You can’t be a Feddy girl and be timid, that was out of the question. But it wasn’t a smooth year for me. I made it through the first professional exam (MBBS) with a “50” in Physics. This particular score changed my life. Yeah, you will know why….

The initial in-course assessment exam I wrote after the first year was the first medical exam. The first year course exams were classified under the basic sciences. I challenged myself, I read, I read and I read. The result came out and I scored 79%. “I can do this then!” All it requires is time, dedication, determination and… indeed, the feeling was reassuring. Subsequently, I didn’t just study to pass, I aimed for the highest score I was capable of, always! Graduating as the best in my class remained a secondary thought. I didn’t just ever want to be under anyone’s mercy. I wanted to pass, effortlessly.


Medical school requires 5 professional exams to qualify as a medical Doctor. You must have heard us say “MB”, it actually means BACHELOR OF MEDICINE, BACHELOR OF SURGERY (MB;BS). So we write 5-MBs. This exam, according to Guiness book of Record, is the MOST DIFFICULT EXAM IN THE WORLD. Guys, really they’re! The fear of Medicine is ,was and will always be the beginning of wisdom.

Faculty of Medicine, unlike other faculties does not use CGPA. Rather the MB examination results are presented as “PASS”, “FAIL” or “DISTINCTION”
The pass mark in Medicine is 50%, while to be awarded a distinction one needs to score 70% and above; a feat that is much easier to imagine than accomplish. The MB examinations generally involve a written (theoretical) component, an oral component and, during the later clinical stages, practical clinical examination conducted by both internal and external examiners using live patients. No doubt, this exam is very difficult, however with proper planning, hard work and grace one can excel, exceptionally.


Where do I even start from? The “Almighty” paediatrics had a way of putting students on their toes. The exam is reputed to have the highest failure rate. In some instances, over 70% of the candidates could fail! Maybe because the lecturers have a passion for babies and children, making them punish severely any student who makes avoidable mistakes. Others like Pathology, Biochemistry, Surgery and Medicine all had their peculiar challenges. Oh! Grace found me… realizing how much effort we all put in for these exams and still seeing a lot of my colleagues having one challenge or the other. Truly, it’s not of he that readth or writeth, but of God that shows mercy. I have to add, provided the hard work is proportional…

This girl called Ola…

Let me brag a little… she’s this smart, fashionable, hard working, game changer, always willing to learn, industrious, skillful, innocent looking, young girl. Very very captivating, yeah. But never jokes with her studies.

Ola is an enigma, she rules her world. I always told myself, YOU MUST BE A GOOD DOCTOR. I WANTED TO BE A VERY GOOD DOCTOR. SMART. ACKNOWLEDGEABLE. COMPASSIONATE. Through out my medical school training, I met very good Doctors, very good and inspiring ones that I looked up to. I wanted to be to my patients, as they were to theirs. I also met bad ones, or rather mean ones. I learnt from all, irrespective. My goal was to be a DOCTOR. THAT WAS THE ONLY IMPORTANT THING TO ME.

Life asides being a “Medic”

No medical student in Nigeria can deny the fact that the program takes a toll on one’s social life.
On my part, I made concerted efforts at balancing my social, spiritual and academic life. Even politics. I left none unchecked.
My social life wasn’t boring. In fact, I had a way of taking a break from the stress of academics once I felt intellectually saturated. The most important thing is not to forget the reason why you’re in school, with that mindset, everything can be taken care of with proper planning. I made out time for my family too, they are very important to me.
I got involved in a lot of extracurricular activities. Politics, church activities,  skills acquisition,  personality development, etc.

Friends…

I wasn’t so lucky, I must say. I had my fair share of backstabbing, jealous coleagues masqurading as friends, who peddled heartbreaking gossip with attendant betrayal. At some point, I made the decision to stay on my own. Over 70% of my medical school years was just me, myself and I. I can’t deny the fact that this also helped me academically.

I strove through with the realization that I may not have a true friend among my mates, I had no option but to be at my best. Attend lectures, clinics, ward rounds, theatre sessions, tutorials, etc. I never missed out of my academic program. Yeah, I was a one man squad, choosing not rely on anyone for my academic progress.

However, later stage of the program, I met really amazing friends…Dr Uba Justice, Dr Chika, Dr Mandy, Dr Kenneth, Dr Peace, Dr Chidera, Dr Solomon, etc. I bless God for them🙌

R-L. Dr Mandy, Dr Chika and Dr Ola
With Dr Mandy and Dr Chika

Happy moments…

Relationship…

This part of my life is very personal and at the moment not appropriate for public consumption.

Achievements…

First, I was one time the MOST BEAUTIFUL GIRL IN MEDICINE.

One time VICE PRESIDENT , Imo State University Medical Students Association. A position that gave me a glimpse into the true nature of human political life and how easy it is to influence others positively through change. However, this is a story for another day.

I learnt a lot of skills as a student. Wig making, graphic design, blogging, online marketing and retailing. A lot! I combined all these with my studies and, they never weighed me down. Queen!

I made this wig, I designed the dress…

Academically, I graduated with an amazing result. Looking back, I never saw myself bagging these awards. Yeah, I had always known I was a smart chap, but with the kind of “brains” we have in medicine, I made it!!! I graduated with a total of Seven awards.

Distinction in Medicine

Best in Paediatrics

Best in Physiology

Best in biochemistry

Just to mention the notable ones.

Medical school helped me in discovering potentials I never knew I had. I realized I could achieve just anything I put my mind into. Just anything. No matter how difficult the course appeared to be, I always scaled through. For me failure was never an option. Just passing wasn’t an option either. I wanted to pass and pass well….! And I did!!
I’m most grateful to God, my parents (Chief & Lolo Theodore Otis Ndukwe) and my siblings (Barr. Mrs Theodora, Officer Millicent, Engr. Eustace, Vivian and the last but not the least, Blaise-Kizito) , Lecturers, friends and relations. Thank you for the love and support. It ended beautifully. Thank you.

My parents….

Looking forward, I hope to make myself proud. I hope to be the Good doctor I’ve always talked about. I hope to be meek, kind, gentle, understanding and tolerant. I pray never to be the “bad” doctor I always criticized; I pray I don’t ever have to be in a position where I have to choose money over a patient’s life. I hope to be the role model our sons and daughters would have. I hope to write my name in the sands of time. All I ask for is for God’s direction. His purpose for me, I shall fulfil ❤❤

Dr OLA

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General

Why spend time on Social media?


Why spend time on social media (SM) if you’re not benefiting from it?

I’m not talking about the short term benefits such as getting “likes” and “followers”, except you’re an “influencer”.

The benefits I mean are…
I. Financial benefits

  1. Health benefits
  2. Information benefits
  3. Psychological benefits

The aim of this post is to highlight the Health benefits of Social media presence.

Not many of us are opportune to have Medical personnel around us either as friends or family.
So we depend solely on hear-say or what our physicians say. Physicians we only get to see when we’re sick. Unfortunately…

So, I’m going to do something I expect a lot of people to benefit from.

I’m going to make a thread of Doctors you must follow on social media (Instagram, Facebook or twitter).
This is based on my own unbiased observations.

I shall introduce to you Doctors whose SM accounts I have gone through and, are also a huge asset to patients, the general public and medics alike.

They churn out health information that many pay to have. They do it with the sole aim of raising awareness on health.
So without bias, I took out time to make this thread based on Public health awareness, engagements and willingness to educate followers free of cost (or with a little token consultation fee if need be).

Medicine is shifting towards PREVENTIVE RATHER THAN CURATIVE MEDICINE in most developing countries.
So following them will give you a lot of health benefits…

It is unfortunate that the health benefits potential of SM presence is underutilised, rather most individuals expend so much energy in less productive ventures.
Sad but true!

Disclaimer: this is not a sponsored ad; neither is it based on sentiments nor personal reasons. I do not even know most of them personally.

Stay tuned

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General

MEET DR STELLA, THE FIT DOCTOR!


Dr Stella Achimole

Happy New Year Friends.
In our first post for the year 2021, I shall be bringing you a series of interviews aimed at motivating you towards adopting a healthier lifestyle this year. Our first guest for the year is a Beautiful Medical Doctor who doubles also as a FITNESS COACH.


Dr Stella Achimole studied at Sumy State Medical University but currently works in Abuja. Her hobbies include reading and working out.
I have known Dr Stella for over 17 years!
She’s a Medical Doctor with an AMAZING AND WELL-TONED BODY; a combination of beauty and brains that many only fantasise about but indeed a reality.
We all can have a piece of her by reading this post over the next few minutes.
Sit tight and enjoy

You are most welcome Dr Stella to my blog. As a fitness Doctor, what motivated you to become a fitness Dr and how long have you been training?

I have been working out consistently for 8 years now. What motivated me? Who doesn’t like to look good? I’m a sucker for good skin and perfect health. Back then in Medical school there were girls that really worked out and I just caught the vibe. The power it attracts , the sense of knowing that after the sweat/hardwork, the results are amazing.My motto is “ LOOK 20 AT 50”

What is a typical day for you as a medical Doctor and fitness coach?

I  wake up 4:30am , pray then I run off to the gym , finish up my workout before work resumes at 8am. I am a planner so I plan my week before it starts. I have loads of shifts at the hospital so I always find a way to fix my workout program in. I arrange my meals for the week, I write down my daily workout programs for the week, I arrange my social media post for the week.

What are the different types of exercises one can do? What is the effect of exercise on weight?

There are loads of exercises one can  do . My favorites includes: squats, push-ups, sit ups with weights .            Combining exercise with a healthy diet is a more effective way to lose weight than depending on calorie restriction alone. Exercise can prevent or even reverse the effects of certain diseases. Exercise lowers blood pressure and cholesterol, which may prevent a heart attack.In addition, if you exercise, you lower your risk of developing certain types of cancers such as colon and breast cancer. Exercise is also known to help contribute to a sense of confidence and well-being, thus possibly lowering rates of anxiety and depression.

Are in Door exercises as effective as outdoor ones?

The short answer is yes. Providing you are prepared to put a little time and effort into your workout at home, it can be just as effective as a gym workout. It all depends on the individual, some people prefer to see others working out to find motivation and know that if they did not make the effort to go to the gym, then they would not bother carrying out any exercise at home. However for others, the prospect of going into a gym is daunting and therefore exercising in the comfort of their own home is much more appealing.

There’s a myth that exercise reduces breast and buttocks fats in females. Is this true?

It is still a myth–but you can tone and sculpt your backside. When you reduce your overall body fat, see them disappear but however sculpting is never difficult. Can you lose weight from just your butt?The idea behind losing weight from one particular body part is called spot reduction. The thinking goes that you can target specific areas of the body and selectively decide where the fat will disappear. But it has shown time and time again that spot reduction is as much of a myth as unicorns. That’s because fat cells are distributed all over your body,                                            Working a certain muscle group doesn’t mean that you’re going to lose the fat that covers and surrounds that muscle. However, you can still train a specific muscle group. People often use the terms “spot reduction” and “spot training” interchangeably, but they’re actually different. “One is BS, forgive my language and one can help build a booty,” Spot training is the idea that you can develop a certain muscle or muscle group by training those muscles.”

How long is one expected to exercise before the changes become obvious?


My clients always ask me “how long will it take to see results?”. And it’s a good question. Whether they want to build muscle or increase aerobic endurance to run 10K in a set time, everyone is looking for RESULTS.                                          

  Just remember that to get results, you need to do ‘regular physical activity’. This means doing at least 30 minutes of physical activity on most days of the week. If you can’t, then try to be as physically active as you can in your current state of health. Any activity is good activity and something is always better than nothing.                                 Let’s go medical here let’s talk about the heart. HEART RATE – CHANGES WITHIN A COUPLE OF WEEKS.                             The heart is a muscle, and as you get fitter, it will become stronger. This leads to an increased stroke volume, which means your heart will pump more blood per beat than before. This can, in turn, decrease your resting heart rate. Resting heart rate can decrease by up to 1 beat/min in sedentary individuals with each week of aerobic training, at least for a few weeks. studies have shown smaller reductions with fewer than 5 beats following up to 20 weeks of aerobic training.  Your maximum heart rate typically stays unchanged with regular training and is more likely to decrease over time as part of the normal aging process. People who are fitter also tend to have a heart rate that recovers faster after exercise

Are abdominal exercises effective if I want to lose fat around my tummy ?

The problem with many abs exercises is that they promote the idea of ″spot training,″ aka focusing on one body part during exercise to change it. No matter how you slice it, spot training your stomach cannot get you ripped abs. ″You could do 1,000 crunches and sit-ups a night, but if there is a layer of fat on top, you will never see your abs come through,” abs are made in the kitchen,” but you can also credit genetics for whether you have a six-pack or not. Trainers are well aware of this, so exercise classes often diversify which abs moves are included for maximum benefit for all body types. As for what you can do? “Focus on full-body exercises that force you to use your entire core and burn fat and calories overall.

How safe are these exercises during pregnancyand lactation?

Gentle exercise during pregnancy keeps a woman’s body strong and better able to bear the physical stressors of pregnancy, as well as get ready for labor and delivery.
Gentle postpartum exercise, after clearance from an Obstetrician can help a woman lose baby weight and improve postpartum anxiety and depression.                                          Walking is usually considered the safest prenatal exercise option, but some women may struggle with going longer distances in their third trimester, if swelling feet and abdominal pressure become an issue. Consider finding exercise classes and fitness choices specifically geared toward pregnancy, such as prenatal yoga, swimming or water aerobics. If you are healthy and you are not experiencing complications in your pregnancy, continue this level of activity throughout pregnancy, or until it becomes uncomfortable for you to do so.
Be guided by your doctor, physiotherapist or healthcare professional.

How important is nutrition? And what are the short term and long term benefits of exercise?

Have you heard the phrase “you can’t out-exercise a bad diet,” and this is the bottom line when it comes to maintaining a healthy body. Nutrition and exercise are both important parts of losing fat and gaining strength. Nutritional habits will have a far greater impact on your body composition and physique goals than any other fitness component. When a combination of exercise and healthy nutrition are implemented is when successful body change happens. So here you go.     

  Thanks for having me Ola.

You are welcome! And Thank you Dr Stella for resonating the workout passion. I’m aware this has motivated a lot of us to keep fit. Of course, everyone wants a healthy and younger looking body irrespective of age.
A beautiful body boosts confidence and oozes grace.
Definitely, we’re hitting the gym this year!
It was delightful chatting with you and, we look forward to doing this again soon.

If you have any questions please drop them here. You can follow Dr Stella on Instagram @the.fit_dr

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General

Epilepsy, the untold truths.


Good morning and welcome back to my blog!

Today, I will be sharing with you the Untold stories about Epilepsy and this was triggered after a 59mins chat with my friend who is Epileptic.

I’ve known her for years but I last saw her over 10years ago.

On seeing her 2 days ago… We chatted for a while. She asked me a lot of questions concerning health and most importantly EPILEPSY.

She is 31years old . Her first Seizure was at 27years. Prior to that, she never had a seizure.

In her words: “I had a misunderstanding with my mother in- law and she threatened to deal with me. Few days after that I started having seizures. Whenever it happens, I fall on the ground, drooling saliva and urinating on my body. No one comes close to me because they believe I will spread it to them. Look at my body Ola, I’ve scars all over from the frequent falls. The other time I woke up naked infront of my house. No body tried to cover me up. Everyone avoids me like a plaque even her husband. Then she broke down in tears.

At this point, my whole body was in shock. I still didn’t believe in 2020 people still think this way. Ignorance at it’s peak

So I tried to pacify her. Then asked her these questions:

  • Does it give you signs before it starts?
  • How long does it last ?
  • Have you seen a Doctor?
  • Any history of seizure in your family?
  • How frequent does this happen in a week?

She has never visited the hospital for it. But has been to over 15 prayer houses. It normally gives her a sign (aura) which is Abnormal taste, which precedes the seizure with 10-15mins. The frequency varies ,could be as much as 10 times in a week to as low as twice in 2 weeks.

So I tried to debunk some of the myths /misconceptions about Epilepsy.

Misconceptions about Epilepsy (myths)

  • Epilepsy is demonic or caused by village people
  • The saliva of the person is contagious
  • You should put a spoon or metal in the mouth to prevent clenching of the teeth
  • Crude oil is needed in children. It is not spiritual
  • People with Epilepsy are disabled
  • You can swallow your tongue

These are all false


EPILEPSY


Epilepsy is a disorder characterized by recurring seizures (also known as “seizure disorder”)

A seizure is a brief, temporary disturbance in the electrical activity of the brain.

That one had one episode of seizure/convulsion doesn’t make her /him Epiletic. It has to be recurrent before the diagnosis of epilepsy is made.

What causes epilepsy?

Electrical storm in the brain

All brain functions — including feeling, seeing, thinking, and moving muscles — depend on electrical signals passed between nerve cells in the brain

A seizure occurs when too many nerve cells in the brain “fire” too quickly causing an “electrical storm”

In about 70% of people, the cause is not known.

In the other 30%, causes include

  • Head trauma
  • Infection of the brain
  • Brain tumors
  • Stroke
  • Hereditary
  • Factors that disturb brain development

Symptoms of Seizures

– Periods of blackout or confused memory
– Occasional “fainting spells”
– Episodes of blank staring
– Sudden falls for no apparent reason
– Episodes of blinking or chewing at inappropriate times
– A convulsion, with or without fever
– Clusters of swift jerking movements of the body that may involve the both the hands and/ or legs or any other part of the body

Diagnosis

This involves patient’s history and interview of eyewitness(es)

  • Examination
  • Tests : blood, EEG, CT-scan etc

Treatment

The aim of treatment is to help these patients lead a productive life. Treatment could be

1. Medication
2. Surgery
3. Nonpharmacologic treatment:
Ketogenic diet
Vagus nerve stimulation
Lifestyle modifications

With appropriate treatment and strict adherence to treatments, the seizures can be controlled. Some patients even go for so many years seizure-free.

Complications that arise when not treated:

– Seizures can be potentially life threatening with brain failure, heart and lung failure, trauma, accidents
– Sudden Unexpected Death in Epilepsy (SUDEP)
– Even subtle seizures can cause small damage in brain
– Long Term problems like fall in IQ, depression, suicide, Social Problems, poorquality of Life

Things that trigger seizures

If you’re epileptic or knows someone who is. These are some factors you must know

  • Missed medication (Number one reason)
  • Stress
  • Anxiety
  • Hormonal changes
  • Menstruation
  • Dehydration (not taking enough water)
  • Lack of sleep
  • Illicit drugs
  • Alcohol
  • Certain drugs
  • Fever in children

DANGEROUS THINGS YOU MUST AVOID

Don’t restrain person having a seizure
Don’t put anything in the person’s mouth
Don’t try to hold down or restrain the person
Don’t attempt to give oral antiseizure medication
Don’t keep the person on their back face up

Don’t put crude oil or palm kernel oil into the baby’s mouth. This can lead to aspiration and dearg ev

Safety Concerns

Epileptics can’t engage in these activities as long as seizures are not controlled.
However, most will advice them to stay away until 2years after the last seizure

Do you agree with me that most Road traffic accidents are probably due to an Epileptic driver?

1 Driving: a person with epilepsy must be free of seizures that affect consciousness for a certain period of time.
2. Climbing altitudes
3. Swimming/ Bathing alone
4. Operating heavy machinery or weapons that can be dangerous
5. Cooking, hot water (very common ensure you’re making your medications and always stay away from fire)
6. Taking care of babies

“…I just need everyone to remember that things happen for a reason, and that we will cope with whatever comes our way. It is okay zeèßae1qnot to like it, as seizures aren’t fun and can be scary.

Epilepsy doesn’t have to rule our lives — as long as we have people who will listen to us, believe us, and give us honest answers.”___Dr Shahin Nouri

Thanks for not sleeping on me☺️. Please do well to share. I feel there’s need to raise more awareness on this. See you in the comment section

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General

World Diabetes day: The 3Ps of Diabetes Mellitus you need to know.


Introduction:

Diabetes Mellitus ( DM) is a medical condition caused by insulin deficiency or body’s resistance to insulin. Insulin is a hormone which aids in carbohydrate metabolism It is the commonest Endocrine disorder. In this condition, there’s an increased blood glucose(sugar) level.

Before I continue, let me share this story with you.

During my obstetrics and gynecology posting. I met this patient who was married for 6years with no child. She presented with her husband (Tochi) a 34 year old man, on her 4th visit, it was found that he had erectile dysfunction. After thorough examination and investigations, it was discovered he had Diabetes Mellitus and this led to the his inability to sustain an erection.

However, with adequate medical care, they finally had a baby girl.

This year I was in the ward with a few of my friends when we heard there was a paediatric emergency. We rushed to the ward and it was Tochi’s younger sister. She was 15years with diabetic ketoacidosis (a complication of diabetes). The girl was diabetic and wasn’t properly diagnosed and managed. They lost her 💔

If Tochi had brought his whole family for screening, she won’t have died.

Epidemiology

8.8% (415 million ) of adults aged 40-59yrs have diabetes
To rise beyond 642 millions in 2040 (1 in 10 adults)
175 million cases undiagnosed
75% live in low-and middle –income countries.
Caused 5.1million deaths in 2013
Every 6 seconds a person dies from DM
Africa: ≈ 19.8million adults (4.9%);
Nigeria has the highest no of people living with DM (3.9million)

Types

Has two major types: Type 1 and type 2

Type one is more commonly seen in those below the age of 30years and in children.

Type 2 is the most common type. Above 90% of the cases. Has strong family tendency. And seen more in adults above 40 years. There’s increasing prevalence of this type.

Other forms include Gestational diabetes (seen in pregnancy); Hybrid forms of DM; secondary DM etc

Risk factors

1. Autoimmune disorder (For type 1) whereby the body sees the cells which secrete insulin as “foreign” and destroys them.

2. Environmental factors: viruses like HIV, mumps,EBV; some drugs and chemicals.(type 1)

3. Diets: Nitrosamines (found in diets like smoked meats) and coffee have been proposed as potentially diabetogenic toxins.

Bovine serum albumin (BSA), a major constituent of cow’s milk has been implicated since children who are given cow’s milk early in infancy are more likely to develop type 1DM than those who are breastfed

Studies show that type 2 DM is associated with overeating especially when combined with obesity and under activity.

4. Genetic predisposition for both types especially type 2.

5. Obesity: the risk of developing DM increases tenfold in people with a body mass index (BMI) of more than 30kg/m²

Symptoms

Type 1

It runs a very short course.

Type 2

About 80% of Nigerians don’t know they are diabetic, and 50% globally because it has a slow onset

Both present with

Polyuria

Polydypsia

Polyphagia

Forget the medical jargon. Just so you don’t forget the 3Ps: Polyuria (excessive urination), polydypsia (increased thirst for water) and polyphagia (increased appetite)

Weight loss/gain

Hyperphagia( predilection for sweet foods)

Hyperphagia

Erectile dysfunction

Eye problems

Recurrent infections like recurrent vaginal infection can be a symptom of DM

Etc

Diagnosis

The diagnosis of DM is made from
the presence of diabetic clinical features and
biochemically confirmed increased blood sugar.

Presence of diabetic clinical features
Polyuria, polyphagia, polydypsia unexplained weight loss etc are necessary but insufficient for diagnosis

Whenever you notice any of these symptoms please see a physician. If there’s history of DM in your family, also see a Doctor.

However, regular medical check up is advised because Type 2 which is the more common form can run a long course unnoticed!

Complications

They can not be exhausted. Too numerous to mention. Many patients present with complications

Kidney failure

Stroke

Blindness

Damage to blood vessels and nerves

Recurrent infections

Diabetic ketoacidosis

Diabetic foot ucler

Coma/death

Etc

Prevention

Healthy diet

Exercise

No smoking/excessive alcohol consumption

Weight loss if overweight

Exclusive breastfeeding is encouraged

Regular screening

Adherence to doctors advise to prevent complications

Today the 14th of November 2020, is WORLD DIABETES DAY. I hope we all join hands to fight this common enemy. Get yourself screened!

Disclaimer: name, dates, or any other identifying details of the patients in this story were changed to protect privacy.

Categories
Cancers

PANCREATIC CANCER; THE SILENT, THE AGGRESSIVE, THE FATAL


If you use an iPhone, iPod or iPad, then you must know Steve Jobs the former chief executive officer (CEO), and co-founder of Apple Inc. who died on October 5, 2011 aged 56 years.

Steve Jobs

He was quite wealthy and, no one would expect him to die at such a young age. This confirms the saying that “money can not buy life”.

Nevertheless, his death can not be entirely attributable to the disease, but he displayed a level of ignorance for one of his calibre. He was diagnosed with Cancer and refused treatment for 9 whole months and, rather sourced for alternative healthcare. That was tantamount to Suicide(wikipedia).

Today, I want to create awareness of this dangerous disease. One of the most aggressive cancers. In fact, like one of my teachers would say, it is one of the fastest ways to die. Gives no prior notice, it just hits and death is in weeks.

Overview of the Pancreas

The pancreas is one of the organs in the body responsible for the secretion of some enzymes, hormones like Insulin which helps in carbohydrate metabolism and utilization. It is located in the abdomen.

Cancer of the pancreas

Cancer of the pancreas is on the rise. It’s a very aggressive tumour and it occurs quite frequently in West Africa. Most patients present with advanced disease.

The peak age of occurrence is 65-75 years. However it has been found in much younger age (Steve was 45 years when he was diagnosed in 2003)

Risk factors

It has a familial background in 10% of patients. With those with at least first two relatives with ca Pancreas, the risk increases by 18-57 fold!

Chronic pancreatitis: This is the inflammation of organ. And the principal cause is Chronic alcohol abuse

Cigarette smoking

Diets rich in fat and protein

Diabetes Mellitus (it occurs twice as frequently in diabetics as in the general population)

Presentation

  • Loss of appetite and unexplained weight loss of about 11kg over a few weeks are usually the first and most constant symptoms of this cancer.
  • Pain is prominent in 80% of cases. It is characteristically a dull ache,  located in the centre of the upper part of the abdomen (epigastrium) which is felt more severely while lying flat with head up (supine). Ache is also aggravated by food intake, or the pain may just be a persistent back pain.
Persistent back pain
  • Jaundice (Yellowish discoloration of the eyes) is the 3rd most encountered symptom occurring in over 75% of cases.

These are the 3 main symptoms. Others may include

  • Diarrhoea, retching and vomiting
  • Liver enlargement which may be as a result of spread to the liver
  • Though rare, but there could be psychiatric manifestations like depression and paranoid psychosis.
  • Passage of blood in stool or dark coloured stool.

Once any of these are noticed, please see a physician fast.
The prognosis of this cancer is poor and there are some available screening tools (tumour markers).

Diagnosis

A high-resolution abdominal ultrasound scan or CT abdomen (with contrast) are readily available for picking out this cancer.

Treatment

Surgery and chemotherapy. Patients with jaundice need operative treatment without delay (Steve refused this for complete 9months. Who knows maybe he would have survived because he had a milder variant of this cancer, not the most aggressive types). Jobs was first diagnosed in 2003, he chose to pursue alternative therapies, including acupuncture, herbal, diet and fruit juice therapy and spiritual consultations. Many of these therapies he found on the internet. An act he regretted till death(wikipedia). Please don’t be like Steve.

The prognosis is poor. But with early intervention after surgery, median survival is about 11-20months and without surgery 6months. Contrary to what some believe, pancreatic cancers can be treatable. Early detection of the disease greatly contributes to the likelihood of successful treatment. Unfortunately, pancreatic cancer can be difficult to detect in its early stages when treatment has been known to be most successful. In addition to pancreatic cancer treatments such as surgery and chemotherapy, new clinical trials are being conducted every day to help combat advanced-stage disease.

Prevention

1. Adequate medical check up: U.S. Supreme Court Justice Ruth Bader Ginsburg who died on September 18, 2020 at age 87 due to complications related to pancreatic cancer. She was first diagnosed with early stage pancreatic cancer in 2009. She had no symptoms of the disease at the time – it was discovered during a regular checkup. She was an inspiration to cancer fighters.

Justice Ruth Ginsburg

This shows that the importance of regular medical check up can never be over-emphasised

2. Avoidance of alcohol and cigarette smoking

3. Health diet: A healthful diet can contribute to maintaining a healthy pancreas

Disclaimer: This isn’t for diagnostic purposes.

Categories
Cancers General

Tobacco evil, multiple effects


I met Jack a few years ago. He was practically everything I wanted. We got talking and I couldn’t help but admire him. He was an awesome fellow. But I always noticed he had a whiff of nicotine breath each time we met.
By the 3rd week, he confessed to me he was addicted to smoking cigarettes following a request from him to smoke in my presence.

He smoked at least 2 packs of cigarettes each day, he admitted.
Seriously, I tried to talk him out of it. But when it was clear to me he wasn’t ever going to change, I walked out of his life without looking back.


You can call me selfish, yes, but I don’t want to spend my life taking care of a partner who failed to take care of himself while he could, or battling with a disease acquired through passive smoking.

Tobacco kills up to half of its users.

Tobacco kills more than 8 million people each year. More than 7 million of those deaths are the result of direct tobacco use while around 1.2 million are the result of non-smokers being exposed to second-hand smoke.

Cigarette smoking, according to the CDC, causes more preventable deaths each year than the combination of HIV, illegal drug use, alcohol use and motor vehicle injuries.
Smoking is addictive and sometimes difficult for those who smoke to easily walk away from this habit. This addiction also drives up the profit of Tobacco companies. They ain’t gonna stop producing cigarettes anyway.

You can have some of these effects of cigarette smoking even without being an active smoker. Passive smoking is as dangerous as active smoking. Passive smoking is the inhalation of smoke (secondhand smoke) by persons other than the active smoker.


We probably all know at least one person who smokes cigarettes. The effects on the body are varied and widespread, however, no one has told you these things I’m about to share with you today…

  1. Smokers are at an increased risk of CANCERS:
    Smoking can cause cancers almost anywhere in the body.
    Lung cancers, in more than 90% of cases are caused by smoking. Lung cancers are also seen among passive smokers and rarely among non-smokers. The link between smoking and lung cancer is very strong and almost always diagnosed very late.
    Mouth, tongue, laryngeal, esophageal, liver and stomach cancers are also strongly linked to smoking.
    Pancreatic and skin cancers have also been linked to cigarette smoking.
    Many who smoke also ingest alcohol. This combination exponentially increases the risk of all cancers.
  2. Chronic obstructive pulmonary disease (COPD) is a medical condition that affects the respiratory system. In this case, the chemicals from smoking cigarette destroys the lung tissues, making them less efficient in their function. Individuals tend to cough a lot with copious sputum production and poor body oxygenation. It is progressive and irreversible, usually leading to respiratory failure and even heart failure. It commonly reduces the life span of affected individuals.
    Tobacco smoke is capable of triggering an asthmatic attack even in previously undiagnosed individuals.
  3. Atherosclerosis which is the thickening of blood vessels can lead to stroke, heart failure and other diseases. Smoking leads to premature or a rapid ageing of the blood vessels, making them stiffer, clogged and narrower.
    This limits blood flow to vital organs of the body including the brain (causing a STROKE), heart (causing HEART ATTACK or myocardial infarction), kidneys (causing KIDNEY FAILURE), eyes (causing DETERIORATION IN EYESIGHT), leg vessels (causing pain on walking or CLAUDICATION) and the penis (causing ERECTILE DYSFUNCTION).
    Male smokers produce less viable sperms and are more likely to be infertile compared to their non-smoking peers.
  4. Cigarette smoking in pregnancy causes low birth weight, premature labour and an increased risk of sudden death of the baby (within the womb) before it is delivered.
    Smoking also makes it more difficult for a woman to get pregnant.
  5. For those who are so concerned about their skin, smoking damages the skin. Making it rougher, wrinkled with an increased risk of developing skin cancers.
    If you want a smooth and shiny skin, then smoking cigarettes actively or passively must be avoided at all cost.
  6. Maintaining a beautiful set of teeth is out of the question with cigarette smoking. Tobacco blackens the teeth and causes gum disease with early enamel erosion. Regular toothaches and dental visits is their lot. I am yet to see a smoker with an inviting healthy smile.
  7. A bad breath is the norm with smokers too. Long after smoking, it stays with them. A bad breath among smokers can not be eliminated simply by brushing the teeth or licking tom-tom, as the breath comprises exhaled air from the lungs. It can be irritating, a regular source of a bad impression from strangers.
  8. Exposure to cigarette smoking at an early age causes delay in lung maturation.
Exposure to cigarette smoking at an early age causes delay in lung maturation.

These effects, which by no means is exhaustive as smoking affects every organ in the body, can similarly be caused by either smoking cigars or pipes. So one does not go on playing the ostrich.
You mustn’t be an active smoker to have any of these, passive smoking can also result in these.
Do you see why I said what I said? I can not suffer for another man’s foolishness.

Bringing an end to the habit of smoking is, admittedly, not an easy endeavour. It requires a strong personal desire to quit and stay smoke-free.
One will need:


*Family and friends support…Encouragement from supporting family members can be motivating.


*Behavioral changes (like avoiding joints/clubs or places where others smoke and seeking a diversion for when the cravings arise).


*Nicotine replacement therapy (nicotine patches) help when those who were avidly addicted develop withdrawal symptoms like headaches and the shakes.


*Prescription drugs to discourage smoking are also available.


*Join a support group. These groups comprising anonymous repentant addicts who chose to support each other may be uncommon in Nigeria for now. But some organizations can be reached by phone or online for psychological and material support.

Support group

Taking the first step by making a firm resolution is key as the necessary help can easily be assessed wherever one is in this country.
Say no to cigarette smoking, and say NO today.
Do not wait until the claws of a debilitating disease bring you down to a level of helplessness, forced to give up this habit when it is too late.

The clock is ticking

Disclaimer: The character depicted is fictitious. Any similarity to actual person living or dead is purely coincidental

Categories
General

LET’S DISCUSS UROLOGY


“I am in awe with the expertise I’m bringing to you today. We are honored to have an important guest. I am thrilled. It was a pleasure to listen to him talk. Today, he will enlighten us on his medical speciality, Urology.

Ladies and gentlemen, I present to you Dr Martin Igbokwe, a Consultant Urologist with Zenith Kidney Centre, Abuja.

Dr Martin Igbokwe

A Fellow of West African College of Surgeons(FWACS), and also a Fellow of National Postgraduate Medical College of Nigeria (FMCS). He has acquired skills both locally and internationally in Surgery and Urology.
His undergraduate training was at the Obafemi Awolowo University, Ife where he finished with honors in Orthopaedic surgery and had his residency training at the Obafemi Awolowo University Teaching Hospital, Ife. He’s had additional international exposure in Senegal (Endourology and Uro-oncology) under Prof Serigne Magueye Gueye (President, WACS). Also trained in Capetown, South Africa on kidney transplantation, minimal access surgery under Prof Andre Van Der Merwe.
In his words, residency was quite accomplishing, because he was trained by the best.

His hobbies include watching television, jogging & working out, spending time with his kids and also writing research articles as he has over 20 publications in Medical Research Journals.

What does it take to be a Urologist?

Training to be a urologist involves:

  1. Passing the Primary exam enabling one pursue a residency training program. This is only possible on completion of the MBBS, internship and NYSC.
  2. An initial 3year Junior residency training through all the specialties in Surgery.
  3. Then the Senior Residency where one is assigned to Urology for another 3years.
  4. On passing the final exams one qualifies as a Urologist and is addressed as a “Fellow” eligible for appointment as a “Consultant”.
    The training process assesses both Research works, clinical acumen, knowledge and character.

What attracted you to this medical speciality?

I will say my parents. My dad was a Medical Doctor, my mum a nurse. So they made me develop interest in Medicine.
However, my interest for the Speciality developed during my Housemanship, and NYSC.
Reason being the High tech gadgets needed to operate as a Urologist.
The various Mini Access Surgeries done in this speciality, and the fact that there are few emergencies. Most of the cases are “elective”. All these suited my personality.

How long have you been a Medical Doctor?

I’ve  been a Medical Doctor for 12 years. And a consultant for 2years.

Not many people know what this speciality is about. Tell us about the scope or various branches or aspects of this practice.

Urology is a subspecialty in Surgery that focuses on the male genito-urinary system which involves surgical treatment of kidney, ureteric, bladder, prostate, urethral, testicular and penile diseases including andrology and male fertility issues. In women, we manage the female urinary system. Majority of our clients are males. In addition
My major interest is in Endo-urology (trans-urethral resection of the prostate, Stone surgeries etc) and kidney transplant.

Tell us more about your personal experience in this field

It has been a worthwhile experience. I do not regret anything. I feel fulfilled and happy doing my job.
For instance, we performed 99 kidney transplants last year, and this year we have done over 40, including 20 during the Covid19 pandemic with excellent results and satisfactory outcomes. So you can see, it has been great!

Dr Martin Harvesting kidney from a Donor.

Are there Misconceptions in your experience i.e. reality vs patient expectation.

Of course, there are.
First is the misconception that Urology is only for Men. That is absolutely false. I’ve already mentioned Kidney diseases like stones, tumours, failure, bladder diseases; these affect both males and females , and VVF is even specific for women alone.

Another misconception is that Prostate surgery causes erectile dysfunction and sterility.
Information is power. So we always try to educate people and create awareness. Ignorance is the cause of these misconceptions.

Also, about Urology being a specialty for just the male doctors.
Honestly, Urology is a male dominated field with over 200 males in Nigeria. However, we still have female Urologists. We have 5 currently in Nigeria, and we expect more women joining soon.

What is the future of the practice in Nigeria?

I must say the future of Urology in Nigeria is so bright.
Nigeria is a big market with highly specialized people in Urology, however due to lack of facilities in most Government owned Hospitals, other countries benefit from this in the form of medical tourism. Yes, you see patients travelling to countries like India to have a kidney transplantation and then return to have the complications managed by Nigerian doctors. Many cannot continue with follow-up abroad. But we thank God that this is now available in Nigeria. The COVID-19 pandemic has also provided a huge opportunity to encourage self-development. More people have seen the need to develop our own local hospitals and increase their capacities. So in the nearest future, I see Robotic Medicine being practiced in Nigeria.
All we need is to develop our resources as a country.

Finally, how can you be contacted

Facebook : DrMartiniUrology

Twitter: DrMartinUrology

Instagram: drmartiniurology

Click the icons below to follow him on social media 👇👇

. E-mail is martini4life@yahoo.com.

Thank You Dr Martin for this great opportunity. I believe most, if not all my readers are now truly informed and sensitized on what Urology is about. And definitely knows when to request for a Urologist.

Nigerians need not travel (again) for a kidney transplant beyond Nigeria. The expertise and wherewithal for it, at a cheaper rate, is available to us now.
Be informed and stay healthy.

Urology is beyond the Male Genitalia. It also focuses on bladder and even VVF in females

I’m excited, The future we hoped and prayed for is already here.

Thank you so much

Prayer is man’s greatest power
Categories
Cancers General

COLORECTAL CANCER: THE CHADWICK CANCER


COLORECTAL CANCER : THE CHADWICK CANCER

Some weeks ago, the internet was set ablaze following the death of the legendary actor, Chadwick Bozeman who died on August 28, 2020 at the age of 43 years. He died from Stage 3 COLORECTAL CANCER.

Chadwick Boseman

His death obviously, has created more awareness on this cancer. However, besides just knowing the cause of his death, I deemed it necessary, additionally, to let us know the peculiar characteristics about this common cancer.

Colon simply means ‘Large intestine’. The rectum begins after the large intestine and ends at the anus.

Colorectal cancer is cancer occurring within this two segments, colon and or rectum.

It is the third commonest cancer worldwide in both sexes.

Cancer of the colon is more common in women, while rectal cancer is commoner among men.

It occurs at any age but especially between 40 – 79 years. The highest occurrence is seen in those between 60 – 79 years. Chadwick was 43 years when he died.
Chadwick was diagnosed four years ago and he had quietly lived through a series of surgeries and chemotherapy without announcing it, while at the same time embarking on his daily activities. Early this year, he was noted to have lost weight making friends express some concern about his health.

Associated Risks for developing colorectal cancer

*Diet:

  • Red meat- beef, pork and their processed varieties like bacon and ham increase the risk of this cancer. Those who eat two portions a day are at increased risk over those who eating one portion a week.

  • High intake of fat, especially saturated fat.
  • Low intake of fruits and vegetables in diet.

*First degree relative having the cancer increases the risk of having it.

*Pre-existing conditions like adenoma, ulcerative colitis

Hereditary : about 10-15% are hereditary which also predisposes to breast, uterus and gastric (stomach) cancers.

*Obesity

*Exposure to radiations

HOW DOES IT PRESENT (SYMPTOMS)

👉 The most important and common symptoms of colorectal cancer are CHANGE IN BOWEL HABITS AND ABDOMINAL PAIN. It may be diarrhea, constipation or both.

👉 Passage of blood or mucus in stool
👉 Unintentional weight loss
👉 Lump in the abdomen
👉 Persistent abdominal discomfort – feeling bloated, cramps.
👉 Weakness and fatigue
👉 Bleeding from the anus

The symptoms are usually ignored especially by younger people. I hope Chadwick’s painful demise will awaken the desire to take our health more seriously and never take any body changes for granted.

What you must do

  • Healthy diet :

  1. consume more of fruits and vegetables, while grain cereals, and eating fish every other day is protective. Reduce the consumption of processed meat and fatty meals.

  • Once you notice any of the above symptoms please see a Doctor, a general surgeon preferably.Each one can easily tell when something is wrong with his/her body (bowel habits).I repeat once you notice any of the symptoms please see a doctor.
    He will most likely carry out a colonoscopy (visually examining inside the colon using a scope) and take a biopsy to make a diagnosis.
    This facility is increasingly available to us in Nigeria.
  • Know your family history of cancers. Once you have a family history of colorectal cancer, you must have a colonoscopy.
  • Avoid sedentary life. Exercise more often.

When detected on time, the outcome is a lot better and with a family history, early screenng is always beneficial and can be life saving.

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Categories
General

STROKE, WHAT YOU MUST KNOW


Ladies and gentlemen, our guest for today is Associate Professor Sidney Oparah, a Chief Consultant at the University of Calabar Teaching Hospital.

Associate Professor Sidney Oparah

He has been a Medical Doctor for over 22 years and a Clinical Neurologist for 14 years. His hobbies are travelling, painting and drawing.

It is definitely a great a pleasure to listen to him share with us all we need to know about this very common illness in our environment, from his wealth of knowledge and experience. Let me share this fascinating interview with you. Enjoy


WHAT IS A STROKE?

Stroke is a health condition that occurs when the blood supply to a part of the brain is suddenly cut off. Especially, if the loss of blood supply lingers upto 24hrs. However, we don’t have to wait for 24hours to make the diagnosis of stroke.

What are the various descriptions of stroke in the population

Majorly, it has spiritual connotations. They believe it’s as a result of witchcraft attack, or an evil spirit has attacked. Infact the Ibo’s call it “MBA AGBARA” which means a spirit has evoked the person.

WHAT ARE THE NEUROLOGICAL DISEASES THAT  ARE NOT STROKE?

There are quite some diseases that mimic stroke but are not Stroke. They include

conditions like a tumour in the brain

A fall especially in the elderly can lead to blood accumulation compressing that part of the brain.

Epilepsy especially in ‘Todd paresis’ in focal seizure. That part of the body that was involved in the convulsion becomes weak, and this weakness subsides completely after some minutes or hours.

Low blood sugar

Brain abscess

Some forms of Migraine headache

Bacterial /Viral infections of the brain

All these manifestations will not be as sudden as it in stroke. So they’re not stroke

How does a stroke present?

The brain controls the rest of the body. So the manifestations depend on the part of the brain affected and the extent of  brain injury.


It is always of sudden occurrence because it has to do with blood vessel. Generally they present with,

Deviation of the face
  • Weakness on one side of the face. The face deviates to the good side
  • The weakness of the hand, leg or both.
  • Headache may or may not be present
  • Problems of vision
  • Difficulty with speaking. May understand you, but may not vocalise, or may not understand nor vocalise.
  • Numbness
  • Difficulty in movement of any part of the body
  • Difficulty with balance

What causes a stroke with emphasis on the common causes in Nigeria?

The actual cause of stroke still remains “sudden” loss of blood supply  to a part of the brain. Which could be as a result of
1.) obstruction to a blood vessel (Ischemic stroke)
2.) Rupture of a blood vessel (hemorrhagic stroke)


There are however RISK FACTORS. We usually classify them into NON-MODIFIABLE RISK FACTORS AND MODIFIABLE FACTORS.

The Non-modifiable factors are factors that are not within our control and they include


1) Increasing Age: The risk of stroke doubles for every 10 years after the age of 55 years. However, it doesn’t mean someone below 55 years can not have a stroke. This shows that increasing age doubles the risk of stroke.  Unfortunately, we can not do anything about it.

2) Male gender : Stroke tends to occur more in males than females especially before menopause. This is believed to be as a result of some level of protection the female sex hormone oestrogen confers. However, after menopause,  the risk is same

3) Black race: The risk is higher among the Negroes than the Caucassians.

4) Having a previous stroke is a risk factor for a repeat stroke. 
5) Family history of stroke especially from first-degree family members like father, mother, brother or sister. It increases the chance and possibly due to genetic factors. These are all non-modifiable because we can not do anything about them.

The Modifiable risk factors are those factors which are within our control and they include

  • Hypertension , which is the most common risk factor. Infact, hypertension should never be forgotten as the number one cause of stroke.
  • Poorly controlled Diabetes Mellitus
  • Cigarette smoking
  • Obesity or overweight
  • Alcohol
  • Sedentary lifestyle
  • High cholesterol level especially the Low density cholesterol also known as ‘Bad cholesterol’
  • Blood diseases like hemophilia
  • Heart conditions like valvular heart disease, abnormal heart rhythm which can encourage clot formation
  • Use of oral contraceptives pills, oestrogen supplementation after menopause in Hormone replacement therapy.

There is something called Stroke in the young.
A condition where stroke occurs in those less than 50yrs. The causes include

  • Sickle Cell Disease which is common in the young and is a risk factor for stroke in the younger age group.
  • HIV infection which is found more in persons of reproductive age (15-49years)
  • Recreationsl Drugs like cocaine causes constriction of the vessels which can lead to loss of blood  supply to the brain.

In what ways can we readily diagnose a stroke?

For a layman, look out for some of the symptoms of stroke, and the timing too. Was it of sudden onset? Which is characteristic of stroke. Check out for the symptoms earlier stated.

  • Tell the person to look at you , then you look at the face and see if it’s shifted to one side. If it’s not obvious, you tell the person to smile. It will be more obvious.
  • Raise the hand to see if there is any difficulty in doing so or if there is any weakness.
  • Ask the person to talk (speech) and look out for any changes.

For the physician, he does an objective assessment to confirm the symptoms stated by the patient or the relative and examines the patient thoroughly. Then send for an urgent Brain CT scan which is the investigation of choice.

CT scan is an advanced form of Xray.

It shows if there’s a stroke, the location of the occlusion and the type of stroke. Other imaging like MRI can also be done.

Normal brain CT scan

The Physician will also look out for the likely cause of the stroke by asking the relevant questions and sending for some investigations depending on the likely cause.

How should stroke patients be optimally managed when they do occur?

The management of stroke is divided into four phases

Acute phase
Early Subacute
Late Subacute phase
Chronic phase

In the management, it should be a very fortunate thing to treat the stroke as early as possible in the Hospital especially in the acute and early Subacute phases

Once there’s “FAST” which stands for

F- FACE DEVIATION

A- Weakness of the ARM

S- Change in SPEECH

T- TIMING which are all of SUDDEN ONSET
You have to quickly bring the person to the nearest hospital. This is not the time for prayer house, traditional healers, Patent medicine dealers, pharmaceutical shops, native doctors, etc.

In the management

For acute phase,

The clot causing an iscaemic type of stroke can be dissolved in hospitals where they have facilities for such a treatment, if there are no contraindications.
If this is done within the first 3 to 4 and a half hours, the outcome is encouraging. Thrombolysis (the breakdown of the clot) within first 4 and half hours can be quickly done with a certain drug.

However, the drawback is our patients normally present late, beyond this window period (3 to 4 and a half hours) and the drug which dissolves the clot is not readily available in this part of the world.

But you have to also handle other issues like blood pressure control, blood sugar control, adequate hydration, etc

Physiotherapy
Speech therapy
Other forms of rehabilitation including occupational rehabilitation would be needed. Even after the stroke survivor is discharged from the hospital , physiotherapy should be continued for some time.

Are there alternatives to hospital care of stroke patients?

Stroke management must be in the hospital. So there are no alternatives to hospital care.

Is having a stroke the end of one’s normal activity, like his job, sexual activity and social activities?

No. There is a 1/3rd rule in stroke. It shows the outcome of stroke

I/3rd of stroke patients die from the stroke.

Another 1/3rd recover with little or no deficit

And the remaining 1/3rd are left with moderate to severe deficit

The ones with little or no deficit go back to their normal life.

Those with moderate to severe deficit will need rehabilitation.

Sexual activity is not affected.

People should understand that stroke is an illness, a disease. No one calls for that. There’s something called Post-stroke depression.
It can be a bit challenging, but it is beneficial to be well motivated.
In fact, the recovery in motivated persons is much better. It’s not the end of life

What are the challenges to diagnosis and management of stroke in Nigeria?

It could be from the Society, Physician or the Authority.

  1. Level of society

Inability to recognize a stroke

Coming to the hospital late

Ignorance and unhelpful beliefs, and attitudes toward stroke

Poverty

  1. Level of the Physicians
    Though not common, there can be misdiagnosis. Mostly as a result of the patient/Doctor ratio here, which is very abysmal.
    You see one Doctor attending to so many patients, and some of them may have some tendencies to inadvertently gloss over some issues. However, this should not be an excuse for negligence.
  2. Level of government
    Most of the imaging facilities are expensive, and require constant power supply. We all know what the power supply is like in this country.
    Some of the facilities needed are not readily available in this part of the world like CT scan, MR1 machines etc
    Even when they are available , they’re not very affordable. The reality is that people pay out of their pocket for health care in our setting. For example to do an MRI in Calabar, costs #70,000, while the cost of CT-scan ranges from #40-50,000
    Then what’s the minimum wage? #30,000!

And what solutions can you offer towards these challenges?

There’s need to create more health awareness on stroke like you’re doing with your blog and I must applaud you for that. Also, the government should pay more attention to the Health care system and provide the necessary facilities needed to better the healthcare of her citizens.

What can Nigerians do to prevent having a stroke?

Anyone that wants to prevent stroke must do this

-Know your blood pressure
Hypertension does not give signs. That’s why it’s called a silent killer. And it still remains the commonest cause of Stroke

Know your blood pressure

And once the blood pressure is up to 140/90mmHg, you must work with your doctors to keep it under control.

It is important to check your blood pressure at least once a year if you’re not Hypertensive.

More often if there’s a history of high blood pressure,
And even more also if there’s a history of high blood pressure in the family.

-Know your blood sugar especially for diabetic patients

-Cholesterol level both for High density cholesterol (good cholesterol) and Low density cholesterol (bad cholesterol)

-No smoking. Smoking doubles the risk for stroke.
If someone quits smoking, over time, the risk for stroke reduces.

-No excessive alcohol.
Alcohol should be in moderate amount.
However, studies have shown that there is no benefit of alcohol. No amount is harmless
It affects the brain (stroke), liver, kidney.
It has has been implicated in some cancers like colonic cancer and breast cancer.

-Healthy diet
Especially avoid saturated fat
Eat more of unsaturated fat

Rule of the thumb is, if the oil congeals under room temperature is likely to be saturated fat. Avoid such oil. Omega3 & 6 are good.

-Eat more of vegetables and fruits, nuts high in potassium.

-No added salt, it doesn’t mean you should not use salt. It simply mean after cooking, no extra salt.

Avoid refined sugars especially for those who have diabetes.

-Exercise
30mins in a day up to 5 days in a week is highly recommended

It decreases the risk of progression of heart conditions

Beneficial to having good blood pressure readings, losing weight and maintaining a healthy weight, and carbohydrate metabolism.
Helps in optimizing insulin sensitivity. Insulin is a hormone that helps in metabolism of sugar.
It is advisable to perform activities you’re likely to continue. Consistency is key. It must not be jogging up and down.
One can adopt other activities like climbing up and down the staircase several times every morning, briskly walking around your house, deliberately parking your car at an appreciable distance from your office etc. For me, I love to wash my cars every morning.

For overweight and obese patients, weight loss can help in increasing the good cholesterol, while reducing the bad one. It also helps to reduce blood sugar in diabetic patients.

Apart from this, it is important for people to know the symptoms of stroke and take appropriate actions like rushing the person to the hospital

If you have any medical conditions that can cause stroke, you should cooperate with your doctor to manage such conditions like hypertension, diabetes, SCD, etc

In conclusion, what in essence should anyone do if he sees someone suspected to have suffered a stroke?

Always remember “FAST

Quickly rush the person to the hospital.

The burden is higher in this part of the world, with hypertension as the number one risk factor.

Stroke is something we can manage and the best place to manage it, is in the hospital.

Once again, if you suspect someone has had a stroke, quickly rush the person to the hospital. It is not the time to deliberate on prayer houses, patent medicine dealers, money, native doctors etc.

Comply with the instructions from the doctors and other health care providers, and put in some of the measures that aid in prevention of stroke.

Categories
General

PROSTATE


Are you a man, above 40 years of age, and you do not know your current PSA level? You cannot be my friend. Well, let me make excuses for you and pardon you. But after reading this and you still don’t make a conscious effort to know your PSA level, ”KINDLY DELETE MY NUMBER PLEASE” 🤣🤣

At a bank a few weeks ago, I met this elderly man. He stood behind me on a queue. He asked to be excused to go ‘ease’ himself, so I could keep his position for him. I noticed he was practically 🏃 running to go.

After 15 minutes, he was yet to return. It was almost my turn, so I assumed he must have found an alternative or probably changed his mind and gone home. Lo and behold there he was.

“What took you so long Sir”? I asked

“My daughter you won’t understand” he replied.

Well, that was it.

A few minutes later, a discussion on Covid19 ensued among the customers. They all had differing views about Covid-19; with a majority, still thinking it is a “scam”. I did not want to be part of it, however I couldn’t help it after a particular lady claimed she knew people who were told they were infected while they never did. I was compelled to join the conversation at this point.

I tried to buttress the fact that Covid-19 is real. “While safety measures must be observed, however, it is not a death sentence. Once you observe symptoms, please do the needful by seeking appropriate medical attention.”

I didn’t realize the way I spoke and the manner in which I contradicted the lady was very obvious to him. He moved closer to me and asked
“Are you a Health worker”?
I smiled. I was not surprised. Of course.

I introduced myself, stating clearly, who I was. He lowered the tone of his voice and confided in me why he wasted so much time when he went to ease himself.

“My dear, for over a year now, I’ve been finding it very difficult to urinate.”

“Difficult? How exactly Sir?

“Whenever I’m pressed, no matter how hard I strain, the urine takes a little time to flow and I also noticed I now urinate more often than I used to and, my urine doesn’t flow well anymore.”

And

“How old are you Sir?” I asked

“You should see a Urologist.” I explained to him who a Urologist is. I reassured him all he needs is to see a Doctor.

So this brings me to today’s topic for discussion…

PROSTATE CANCER


The Prostate is an organ seen only in Men. Prostate cancer is the commonest cancer in men and it is the second leading cause of death in men after lung cancer.

Ideally, every man above the age of 40 years should go for routine annual medical checkup. An assessment of the prostate gland is part of this routine. The prostate gland also never stops growing and can become so big as to cause an obstruction to urine flow.

Factors increasing the risk of Cancer of the prostate are:

1. Age: more in those above 65 years


2. Black race (commoner among blacks than in whites)
3. Hereditary factors: if there is a male relative who has or had it, chances are higher
4. Increased animal fat intake
5. Increased calcium intake

Fats


The only way to prevent prostate disease (be it cancer or enlargement) is to be castrated. Eunuchs do not have prostate enlargement.

Eunuchs do not have Prostate cancer

Factors decreasing the incidence:
i- Isoflavavenoid
ii- Carotenoids e.g tomato, red oil
iii- Vit E
iv- Selenium
v- Red wine.

Tomatoes should be your friend

PSA stands for *PROSTATE SPECIFIC ANTIGEN. PSA is produced by the prostate gland and the level is readily measured in the blood of men. It gives an idea of the state of the Prostate gland. The value is increased in Cancer of the Prostate, However it does not always signify there’s cancer, because other factors can causes its increase.

If you notice any of these changes below, go see your doctor:

Frequent urination
  • Inability to control urine
  • Straining to urinate
  • Delay in initiating the urine even when you’re pressed
  • Inability to pass urine
  • Reduction in urine volume
  • Blood in urine or semen
  • Frequent urination
  • Frequent urination at night
  • Inability to hold urine
  • Poor urine flow
  • Urge to always urinate even after voiding
  • Frequent pain or stiffness in lower back, hips, pelvic or rectal area, or upper thighs
Frequent pain


These and a few others should never be taken for granted.

Prostate cancer is not the only cause of these symptoms. Enlargement of the prostate, which is common above the age of 40 years, can.

Therefore, it means any man above the age of 40 years must have his Prostate examined. When prostate cancer is detected early in the disease, the chances of achieving complete cure is very high. Prostate cancer is very common. There are no two ways about it.


 
I am living proof that if you catch prostate cancer early, it can be reduced to a temporary inconvenience, and you can go back to a normal life.
Norman Schwarzkopf

This post is not just for men alone, but also for that wife, mother, daughter, sister or a friend to any man above the age of 40 years…this is as important to you as it is to them.
Let’s fight this Cancer. A stitch in time, they say, saves nine (and money too).

This has not changed.

I come in Peace

Disclaimer: This post is not for diagnostic purposes. It is strictly for awareness and educative purposes.

Categories
General

LET’S TALK COSMETIC SURGERY


Our guest for today is a Plastic Surgeon. His passionate dedication to Medicine is inspiring.
We estimate that he has personally mentored at least 1000 new Doctors and has set an extraordinary “yes, you can” example for many of us.

He is someone a lot of people  look up to, because of his great skills and passion for the practice.

The practice of Plastic Surgery is the story he will share with us today. In his words, “The Transformation is not just in the body of our clients, but also in their mind and energy levels. It is a very rewarding practice”

Ladies & Gentlemen, I give you …Associate Professor Kingsley Opara.

Associate Professor Kingsley Opara

What are your hobbies outsides of Work?

Hobbies are animal farming and playing tennis.

What does it take to become a Plastic surgeon?

Different countries/ regions have their unique training programs. Here in Nigeria, you need to go through the Residency training in general surgery up to the part one level, and then go through a senior residency training in plastic and reconstructive surgery for another 3 years. After which you pass your board exams to qualify as a Plastic Surgeon

But of course you need to further build capacity going through other training programs relevant to your interests and practice. For example I got further training at Ganga Hospital in India, and Georgia plastic and reconstructive surgery Hospital, Atlanta, Georgia, USA

How long have you been a Medical Doctor, and what attracted you to this medical speciality?

I have been a Doctor for 25 years now and a plastic surgeon for about 15 years. For me, I couldn’t picture myself doing anything else. The results can be quite dramatic and the satisfaction you get when you see the smiles return to the face of a satisfied client cannot be qualified.

Not many people know what this speciality is about. Tell us about the scope or various branches or aspects of this practice

Breast augmentation using patient’s own fat

Plastic surgery involves two major subdivisions. Cosmetic surgery and Reconstructive surgery. Cosmetic surgery involves improving the form or appearance of a part of the human body, while reconstructive surgery involves replacing a part of the body or restoring function to a part of the body

How widely available is it in the country?

We have qualified plastic surgeons in most states who can provide good service. Our center is however the first cosmetic surgery center offering a full range of cosmetic surgery/Aesthetic services in Port Harcourt and it’s environs

Liposuction of the lower back and waist line with fat transfer to the Hips and butt

I have come across most of your works and they’re incredible, I must say. What are the challenges of this speciality practice?

One of the major challenges facing the practice of cosmetic surgery in Nigeria is the misconception by a lot of Nigerians that those who have cosmetic surgery done are vain. Having been in this practice for several years, I have come to realize that most of the cosmetic surgery clients are accomplished people who are bold enough to go for what they want. People who consider investing in their bodies worthwhile. The good news is that many Nigerians are beginning to accept cosmetic surgery as a worthy investment capable of increasing ones productivity by improving his/her self esteem

Tell us more about your personal experience in this field.

The response to Cosmetic Surgery in Nigeria is a little bit different from what’s obtained in the western world. Outside this country, a lot of people are open about having cosmetic surgery. Cosmetic surgery clients don’t have any problem being seen walking into a Cosmetic surgery clinic. They’re more open to telling their friends they had a plastic surgery procedure done.
Here, your client has a procedure and tells her friends she got her shape from dieting and exercise, because she doesn’t want to be judged by the society.
So that affects referals coming from your clients. The bad publicity resulting from some of the negative occurrences involving one or two plastic surgery practices in the country have also not helped matters. These are some of the few challenges.

However, we are seeing an increasing demand for plastic surgery. Many more Nigerians are beginning to approve of plastic surgery, and are less judgmental in their response to any one who has had a plastic surgery procedure done..
Many more ladies want to have good curves, with a narrow waist line, and they go for it.
Many clients after their procedure confess to having an Improved Body self image with consequent improvement in their productivity. So the positive effect in the lives of the clients is actually obvious to us. A lot of clients who have had this procedure, you see them evolve in their level of self confidence.

It shows right from their communication to their dressing. And that gives us a lot of satisfaction. The Transformation is not just in the body of our clients, but also in their mind and energy levels. It is a very rewarding practice.

And today, what are you going into?

Today, I’m going to be reviewing my patients for the week and also those for surgery. Incidentally, I’ve 4 clients for the week. Two of them are for Brazilian Butt Lift (BBL), one is for liposuction of the upper arm, and one is for liposuction of the entire back and arm.
The patients for BBL want a 360 liposuction. We will try them on their garments, make sure they’re ready in terms of laboratory investigations and other preoperative preparations necessary before undergoing such procedures.

Brazilian Butt Lift (BBL)

Cosmetic surgery doesn’t just end at the procedure, we also follow them up. So will take them through the post operative instructions. From tomorrow, our surgeries will Kick off. We expect the day to be very busy. We also take alot of photographs today. Show the patients the areas we need to work on and results to expect.

So give us an example. Let’s say I’m coming for a Tummy tucking.  So what should I expect…as to patient preparation.

If you have booked to have a Tummy Tuck. At first consultation, we assess you. Assessment involves General health assessment to make sure you’re fit for the procedure,
Also take a detailed history to make sure Tummy Tuck is the procedure recommended for you. Some patients come for consultation with a procedure in mind only to find out at consultation that they need an entirely different procedure to achieve their goals. So at consultation, we assess their expectations and try to match their expectations with what is realizable. We also advise patients to stay off some drugs like Aspirin and quit smoking for at least 3weeks prior to the procedure. In addition we take the client through pre and post operative instructions. So we make sure you understand everything about taking care of yourself before even going into having the procedure. We advise 2 to 3 consults before the procedure which is aimed at

  • Assessing the patient
  • Educating the patient
  • Re-enforcing some of these information we have given the patient to make sure he or she really understands.

Pre operatiively, we also try the garments. Also, If patient is markedly overweight, we encourage weight loss before the procedure.

Liposuction with Tummy Tuck
Liposuction of lower back with fat transfer to the Hips and butt

How can you be contacted. Location, website, email, Facebook, twitter, Instagram.

Location: No 5 Tom Inko Tariah Avenue, Rumumogba Estate Port Harcourt, Rivers state.

Regal Plastic Surgery Centre

Website: http://www.regalplasticsurgerycentre.com/

Instagram: Regalplasticsurgerycentre

Phone number : 08103050166

Facebook: Regal Plastic Surgery Centre

E-mail: regalplasticsurgery@gmail.com

Liposuction of the arms

Breast Augmentation with implants

Thank you so very much Dr Opara for granting this interview. I’m certain my readers will enjoy it and have all their doubts and misconceptions about Cosmetic surgery sorted out,and they would certainly know the various aspects of Plastic surgery and when, where and how to seek for a Plastic Surgeon. Friends, if you’re in need of a plastic Surgeon and you’re within Port Harcourt and it’s environs, you definitely know what to do. You’re in safe hands. Please do well to visit and follow him on Instagram, Facebook, Twitter and also visit the website

Associate Professor Kingsley Opara

https://www.instagram.com/regalplasticsurgerycentre/

Categories
General

COVID19: A MESSAGE FROM “WHO”


Home caregivers for people with suspected or confirmed COVID-19 should:


✅ Ensure the ill persons rests 🛌 , drinks plenty of fluids and eats nutritious food.


✅ Wear a medical mask when in the same room with an ill person. Do not touch the mask 😷 or face during use and discard it afterward.


✅ Frequently clean hands 🙌 with soap and water or alcohol-based rub, especially:
• after any type of contact with the ill person or their surroundings
• before, during and after preparing food
• before eating
• after using the toilet.


✅ Use dedicated dishes 🍽, cups, eating utensils, towels and bedlinens for the ill person. Wash dishes, cups, eating utensils, towels, or bedlinens used by the ill person with soap and water.


✅ Identify frequently touched surfaces by the ill person and clean and disinfect them daily.


✅ Call 📞 your health care facility immediately if the ill person worsens or experiences difficulty breathing.

COVID19 is Real. Stay safe. Protect yourself and your loved ones in 7 steps👇👇👇👇

Categories
General

“THAT PAIN KILLER MAY BE YOUR KILLER”


Yesterday, I visited a friend of mine in her clinic as I usually do. On arrival, I observed an unusual crowd had gathered in front of the clinic.

So I walked in and met her trying to resuscitate a man who was probably in his 40’s. She gave him Intravenous fluids (drips), and about 3 pints of blood because he was severely anemic with low blood pressure. His Packed Cell Volume was 14%. He was critically ill.
A general surgeon was already on ground for an emergency Exploratory laparotomy (this is a surgical procedure whereby the belly is opened up to find out the cause of problem)


So this is his story.
He is a middle-aged man with a 2years history of constant backache. As an Engineer, his job is tedious; he figured it was the cause of this persistent backache. For this, he had been taking painkillers for months.
About 3months ago, he noticed the pain had worsened. He visited a patent medicine dealer who increased the dose of the painkillers he had been taking. So for 3months, he had been on a double dose of ibuprofen, which he took thrice daily. He sometimes took piroxicam also, at night when the pain became intolerable.


A few weeks later, he noticed the color of his stool changed from the usual yellowish-brown to a somewhat darkish color. However, he felt it was a result of the drugs he had been taking recently in addition to the painkillers. As the days went by, he noticed inexplicable but subtle changes in his body including a distended abdomen. This didn’t stop him from going about his daily routine.


On the night before his presentation to the hospital, he vomited frank blood. In his wife’s words, “it was a large amount of blood”. He vomited blood several times, and also passed bloody stools.
Within a few hours, he became dizzy with new-onset chest pain; he was barely conscious at presentation to the hospital.


On examination, he was very pale, almost white.

Following resuscitation, he had emergency surgery for multiple bleeding peptic ulcers. It was a miracle he survived. The bleeding was stopped, and two more pints of blood were given.


This was the side effect of the painkillers he had been taking. We sometimes abuse these drugs without knowing they could have fatal consequences.


Ibuprofen, Diclofenac, Piroxicam, Naproxen, and many other painkillers described as Non-Steroidal Anti-inflammatory Drugs (NSAIDs) can cause peptic ulcers, bleeding as well as kidney damage.

Say no to NSAIDS abuse

Stop abusing them.
Whenever there is a need for you to be on Pain killers…see a Doctor who will choose an appropriate type.
These drugs are for a short course, do not let your painkiller kill you.

I hope you have learnt something new today. Please drop your comments.

Categories
General

DIARRHOEA: CHILDREN DON’T HAVE TO DIE


Before I share my story, I have just a question for you.
Did you know diarrhoea is the 2nd leading cause of death among children less than 5years old?

Without mincing words, in the course of my PAEDIATRICS POSTING, diarrhoea was the commonest cause of death. I can’t say for sure if this is as a result of ignorance on the part of the Mothers, but what I know for certain is, this should never cause death as much as it does if only these mothers did the right thing!

The Story


One cool Sunday evening I visited the Children Emergency Room (CHER) to see if there were new patients to clerk as I typically did.
On arrival, there were lots of patients, but this particular patient whose story I’m about to share was more eye-catching. He was unconscious and grunting, while having an oxygen mask on. The doctors were doing their best to save him
Then sitting beside him was a young woman, in her late 20s’, weeping profusely, with a man standing behind her, whom I presumed is her husband and by extension, patient’s father.

I couldn’t just walk away without at least consoling the crying woman. I really hate to see people cry, at least not around me. Sigh

“Good evening, I’m Ola”. I said
“Can I talk to you?” I asked
I was expecting the “No” response, but surprisingly, she nodded in acceptance.

I made it clear to her I needed to take a history from her, and also gave her the option to return later when she felt it was ‘OK’ for her to talk. She chose to speak at once.

He was a Five Months old boy. Their first child.
He presented to us with 7 days of Diarrhoea, having about five episodes on the first day. Just watery, pale coloured stool. She stopped feeding him soon afterwards as she assumed the foods (both breast milk and other foods) were contributing to this. With no improvement.

This is the patient.

On the 3rd day, she was informed by her friends that Baby had ‘Jeddy-jeddy’, some claimed it was as a result og ‘teething’.
So on hearing this, she was relieved.
Hours later, the frequency of the stooling progressively increased. She again got worried and this time, gave him some herbal concoctions. All to no avail.
She visited a patent medicine dealer who then prescribed DIASTOP.
With diastop, the diarrhoea stopped. However, she noticed the baby was not getting any stronger or better, rather weaker and also his urine flow drastically reduced, as the baby had one diaper on all day as against the usual per 5-6per day.
She informed her husband of the need to take him to the hospital, but he refused.

So fast forward to this day at CHER. Baby‘s condition got worse. He was unresponsive, breathless, with multiple fits ( (seizures) and a weak cry. He had been given palm kernel oil, scent leafwater. Instead of getting better, he got worse. So at this point, she decided to bring him to the hospital.

To be frank… a lot of things went through my mind. I still could not comprehend why this keeps recurring. It was the umpteenth time I was experiencing such. Like a ‘norm’. Mothers bring their children to the hospital after all their trials and errors had failed. Just when the condition has deteriorated, and they come expecting the doctors to perform a “Miracle”.
These children are hapless. But repeatedly, their parents fail them. Most of them pay with their lives. Why is this so? I imagine poverty plays a big role too.

“You have to love your children unselfishly. That is hard.  But it is the only way”
-Barbara Bush

Well, that’s by the way.
I counseled her but I also knew baby was a ‘red flag’. However, I tried to be positive,
The following morning, I visited and I was told “ we lost him”

Let’s discuss Diarrhoea in Children

Diarrhoea is defined as the passage of three or more loose or liquid stools per day (or more frequent passage than is normal for the child).

It is the 2nd most common cause of death among children less than 5 and also the leading cause of malnutrition in this age group.

Risk Factors

Lack of exclusive breastfeeding.
Bottle feeding
Poor maternal hygiene
Poor immunization Coverage
Malnutrition
Lack of access to clean water
Maternal ignorance

Causes

These include:

1. Viral.Rotavirus is the commonest cause of diarrhea in children in this environment.
2. Bacterial. E. Coli is the 2 leading cause in our environment.
3. Protozoa
4. Fungi . Echeteria echeteria

Complications of Diarrhoea

  • Dehydration which is the commonest cause of death.
  • Malnutrition 
  • Seizure
  • Hypoglycemia (Low blood sugar)
  • Electrolytes imbalance

What to do…

  • Continue feeding the child. Preferably give only breast milk.
  • Give ORS or SSS
  • Give vitamin A and Zinc
  • If the diarrhea persists , See a Paediatrician.

10 THINGS EVERY PARENT OR PROSPECTIVE PARENT MUST KNOW.

  1. NEVER WITHOLD FOOD IN A CHILD WITH DIARRHOEA. Withholding feeding reduces the blood sugar level and this can result in Seizures or even death. Also, the child to becomes ‘DEHYDRATED’ which can lead to kidney failure. It is one of the commonest causes of death in these children.
ORS

2. ORS. ORS. ORS. (Oral Rehydration Salt).
The importance of this can never be overemphasized. If you must take home one thing today, LET IT BE THIS. ORS is widely available and affordable (less than #50 a sachet).
This should be the first thing every mother ‘must’ give her child who starts passing watery stools. It is a lifesaver! It works like magic. It is only when this fails that you should bring your child to the hospital.
An effective alternative is SSS or SALT SUGAR SOLUTION.
I will be making a post on this… “HOW TO MAKE SSS / ADMINISTER ORS PROPERLY at a later date. Stay tuned.

  1. NEVER USE BOTTLE FEEDS/ FEEDING BOTTLES. Plate and spoon is the WHO recommendation. It is more hygienic.
No bottle feeds
  1. VITAMIN A AND ZINC should never be found wanting in your home. If you must administer any drug, it should be these.

  1. VACCINE. Your child must be adequately immunized for age. Some of the vaccines help to prevent this disease. ROTAVIRUS vaccine is also available in some hospitals, however, it is not FREE.
Vaccines

  1. HAND WASHING. You or the person that prepares baby’s food must wash your hands frequently with soap,  before :
    • feeding your child
    • after changing babies diapers
    • after using the restroom. You must maintain good personal hygiene.
Hand washing technique. A simple handle washing could help to prevent lots of infectious diseases like Diarrhoea, Covid19, Typhoid Fever, etc.

  1. No concoctions or herbal drugs. No. You’re harming your innocent child.
  2. No Antibiotics. Never you give a child passing WATERY STOOL ANTIBIOTICS. As earlier stated, the commonest cause of diarrhoea in our environment in children less than 5 years is ROTAvirus. So antibiotics won’t work. Only a Doctor can administer antibiotics when it is necessary.
  3. Exclusive breastfeeding for the first 6 month.
Exclusive breastfeeding for 6months.

10. Never you take your child’s health for granted. Once you notice any changes in your child’s health, go see a Doctor

Diarrhoea kills faster than you can imagine. And these deaths are highly preventable. Forget the Myths of Jeddy-Jeddy, teething and what have you. It is not caused by any of these.

Prevention is better than Cure

Disclaimer: name, dates, or any other identifying details of this patient in this story were changed to protect his privacy

Categories
Cancers

LIFE OF AN AVERAGE NIGERIAN DOCTOR



As a young lad in secondary school, it was a thing of pride to be among those considered worthy of being part of the “science” arm of the class. With all the chemistry and physics…oh dear, what a waste now. Biology was my joy…I could draw the most beautiful of cockroaches; I knew the life cycle of the butterfly, cocoons, and all. Oh, how much I reveled in my elements then.

Cockroach


So as the time approached to write the secondary school certificate exams, and subsequently the almighty JAMB, it was only a matter of being counted among the elite who had decided to pen down the choice of “Medicine” as a career option.
It was also “Medicine” as a second choice…


I didn’t know jack about Medicine. I wanted to be called “Dr”; my parents were delighted at the thought of having a Dr in the family.
I was raised in average family background, with a father who was a Civil Servant and a Teacher for a mother. My lot could be described as being born with a silver-plated spoon. A good basic education was key to my subsequent academic success but on the back of parents who gave their all, sacrificed in excess of what I got to learn later to be from genuine selflessness.
Hmmmm, sometimes I wish…

I chose to do Medicine and gained admission to one of the best Universities in the country. We, “medical students” strolled around the campus with an air of arrogance. Well, some did.

However, some hated their choice right from the onset while only an insignificant number changed course after the first baptism of PHY 101, 102, and 103. The nightmare that was biochemistry.

Kreb cycle

The kreb cycle remained what it described ever in my memory…only a cycle. I read it with my eyes open only to forget once I blinked a couple of times. I could make no point of it. I avoided reading it and didn’t bother about it in the exams. I began to wonder if this was “Medicine”. And this toil continued throughout the length of the course.


It became more familiar to my imagination at the clinical end. The wardrounds, clinics, theatre sections, Community medicine postings, lectures etc. In the hospital, we interacted with the senior Drs, Professors. We looked up to them. Admired their carriage, knowledge but not their lifestyle.
Only a few of my teachers lived a life of opulence, a handful really. Then the strikes. The resident Drs strikes were frequent and sometimes long. The University staff also had their share of strikes.

A six-year course, on paper, stretched further and further. It was frustrating to see my friends in Economics, Sociology, or even Industrial Physics finish and graduate after four (4) years. It was frustrating, to put it mildly. Our friends in Engineering supposedly would graduate after 6 to 7 years. My set graduated after 8 and a half years of schooling, without exam repetition.

At last a Dr, Dr. A.A. was like a badge of honor. My efforts had been fruitful. The sleepless nights, the endless cramming, the deprivations- social and nutritional had now come to an end…or so I thought.

Then on graduation day, our lecturer told us “your MBBS is the certificate you need to start studying medicine”. What…? Hell no. And that statement is true, only if you choose to practice “Medicine” at a higher level. Most of us did, eventually.
Practicing with only the MBBS certificate can make one rich, no doubt, but it comes at a price to the clients and patients.


We learned about the USMLE, UK Plab, and the residency training in Nigeria. Residency here takes another 6 to 7 years to complete. Meanwhile, it’s very competitive to get into one. The training can be grueling, and humiliating if you have horrible supervising consultants.

The junior residency was a nightmare. One is overworked, sent about like a houseboy by senior residents and consultants alike, and looked down upon by the medical students. The professional exams are expensive and could be a potential banana skin. Many times examiner dependent. It was horrible.
The pay was at best enough for your daily needs. Not suffering, but not able to afford many luxuries.
The years passed, the salaries remained meager. We looked forward to it from month to month. We made fun that a resident Dr could not afford to do a CT brain scan if he had a need for it. It was laughable. Pay has improved over the years as resident Dr can afford a lot more now than before, but the Nigerian economy makes rubbish of these gains. It’s just a rat race.


By the end of the residency program, one has the option of going into private practice as a specialist or going into public service. At this point, I was well into my thirties, I knew only medicine. I got a job quite alright, but that was all. It was again one payday to another. Sometimes you are able to get a little extra from extending your expertise beyond your routine job. That extra can be very rewarding depending on your expertise and scope of activity. The rarer your practice the more one can charge for his services. I know a surgeon who charges up to N2m for a case, while I have also seen one who runs his practice like a business model…a huge partnership with retainerships of multinationals. One depends on his hands to make money; the other is capable of retiring while the business remains productive.


For the vast majority the monthly pay is their gain. Some private hospitals do make a whole lot of money, but the business model is the problem. Revolving around the proprietor. The quest for self-improvement and greater financial reward can be overbearing too. Those who have the means, relatives living abroad, or with an early burning desire for a better life as a Dr. get to leave the country as soon as they obtain the MBBS degree. Those who leave much later, do so after they have had some experience here in Nigeria. About 65% of my graduating class is outside the country practicing. With each passing year, the proportion gets closer to 75%.


And if one chooses to practice in Nigeria, the challenges are enormous; The out of pocket payment system largely practiced here is inhumane. Nobody puts money aside for hospital expenses, No. From their savings they pay for everything. Only a few have health insurance. And most cannot afford basic care. Tests cannot be done, are too expensive, or come too late for the purpose for which it is meant. The produced result could also be outright wrong.

Patients may also be unable to afford basic medicines or surgeries. I believe medical care should be subsidized in this country. Many people die not because of their illness and cannot be treated, but because they lack the necessary means to obtain the right treatment.


I have seen patients die from tetanus or meningitis because they could not afford the drugs. I have tasked my Drs and sometimes students to raise money to get drugs for some patients. But to what end I ask myself most times when raised monies can only afford a day’s worth of drugs. A small contribution all the same.

Medical practice in a government-run hospital is very gloomy. The environment is dense with the stench of suffering among the people. Sometimes visiting relatives look more wretched than the patients themselves. They have had to deprive themselves to provide the little for the sick family member. Yet this is the last point of call for the vast populace.
The private sector deals mainly with those who can pay more for the same service, albeit, provided at a much-expedited rate. But it also provides an avenue for quackery and unprofessional practice. Ethical malpractice is also rife in government hospitals.

However, what I still find difficult to fathom is the ease with which Drs can readily abandon their patients already on admission to embark on strike action. It is understandable why they have to go on strike, but what role has the farmer on the bed post-op or, the child with a broken tibia got to do with it?


Compounding these is the lack of commitment from political officeholders. I once interacted with one who had weird ideas about how a hospital should be run. It is pathetic. Nothing touches them; even the coronavirus infection has ignited their desire to exploit the already abhorrent state of medical care in Nigeria, than a desire to fix it. For health workers to go on strike in the middle of a pandemic is not only condemnable but also pitiable.

Nigerian Doctors protesting.


Health is wealth means nothing in this country. I as a Dr want to work, work hard, and be adequately rewarded. Also to provide a level of service that is obtainable anywhere in the world. Most people talk about medical tourism India is providing. Yes. Both private and public hospitals in India aim to make more money by providing state of the art facilities with the attendant manpower. We read about procedures and treatment modalities in texts and medical journals…and it is as it is practiced in Europe and America. They put to pen what they do. Nigeria still does things not even recommended anymore. Most times not found in the texts.

Copyright , BusinessDay


So what other joy can a Dr have…to practice using the best available evidence, producing tangible and reproducible results while getting remunerated appropriately? To be fully committed to one job, and yet enjoy the little luxuries life has to offer.


I do encourage any Dr to go out and experience the world. Broaden one’s horizon and choose to practice at the highest level. It can be achieved here in Nigeria, but for others, they shall find their calling in other climes.

The smile of a recovering patient


However, medical practice also has its non-material rewards. The smile and laughter of a recovering patient despite the numerous challenges can be exhilarating. That sense of fulfillment of getting a diagnosis spot on when others have failed. For some, it is the elixir that enables one to continue in what one does. Only, I wish that the number of people who leave our care better off should dwarf into insignificance the number of those who succumb eventually. I just wish sick Nigerians come earlier for their necessary care.
The only regret I have in this practice…most of us, through the long period of training, have been shown only the narrow tunnel that is medical practice.

I now wish I know a lot more about the world, about business and making money. Not being daily surrounded by sick, sad, and incapacitated patients in an environment considered to be a cesspool of antibiotic-resistant organisms.


There are bound to be disappointments too. As a Dr, I realize now I can do anything, any course and excel in it; finish with a first class. I wonder sometimes how life would have turned out for me as an accountant, or computer scientist. But probably not in this life anymore or just maybe…we never say never in medicine. I still love what I do, as working on the human body instills into most people a certain degree of reverence. My only wish now is to make the best of what is left of the years ahead of me.

Written by A Medical Consultant.

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Blog Assessment Form


Hello delightful readers,

In order for me to serve you better, I need you to fill this form. I’m a highly motivated and enthusiastic, always willing to learn. I’m also very much concerned about the Health Ignorance in Nigeria. I need to make this blog your most reliable and trusted when it comes to Health.

Hopefully, your contributions will make a big change in my blog. Wishing you a blissful day.

Thank you,

Ola.

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WORLD SICKLE CELL DAY


I’m dedicating this day to my 15years old friend. Today, I want to remind you how strong you are. You’re a Conqueror.

There’s something spectacular about today. I already spoke to her mum this morning. It’s her story, she gave me permission to share it.

She’s going to be reading your comments. So do well to drop encouraging words.

Mrs J was a fresh secondary graduate when she first met her husband. She was 18years. They got married a year after. For her, it was love at first sight. He was her First and last. She said she didn’t understand exactly what Marriage was about, but she was certain it was the right thing for her.

In her words: “I was naive, but not stupid. He was priceless, his love was so sweet to be real, he was forgiving, loving, understanding, trustworthy, kind, caring. He was to me, what I read in books!”

“But what was his job?” I tried to interrupt

“He was a corper then, but now a secondary Teacher”. She said.

We got married and we had seven ( 7) children. 5 boys, 2 girls. She is the last (pointing at her daughter lying down in the bed) and…and…and…

And what? Madam? Are you crying? I understand perfectly whatever it is you’re passing through. Trust me. At this point, I Offered her a white handkerchief and waited for her to be done before we continue.

Deep in my heart, I wished it wasn’t what I was thinking. Could it be this …no, no…no. I rebuked it.

It wasn’t even what I thought. ..it was worse.

Let’s talk about her Daughter…

It was one of those busy school days, I met her in the ward. Beautiful young girl. But mare looking at her was heartbreaking for me.

Hello, how are you?

Something wasn’t right. But I needed to be certain.

“I’m fine. Thank you.” She said

I’m Ola. Can you see me? I asked

“No”. I can’t. I’m. …..B…Blind.

She told me she has been blind for 5years now.

It was so much for me to bear. We are always taught to be empathetic but not sympathetic. I didn’t understand why I felt that way. But I know why…let me tell you. I won’t talk about that now.

The striking thing about her was her Gait. The way she walked when I sighted her earlier that day. And this was the reason I came. I had no idea there was something more….or even worse. No idea she was blind.

“Isn’t this Hemiplegic gait?” I asked my friend. I was confused. This girl is certainly not more than 15years old. Stroke? At this age?? No

This was my first time of seeing a very young Stroke patient. I just felt life was unfair to her. But I still needed to be sure

She could barely walk, so her mother was trying to support her. It wasn’t an appealing sight for me. I could feel the pain in her mother’s eyes, the regrets, the agony. Yet she tried to be strong.

So from this day, she became my friend. I visited her almost every day in the ward, no matter how stressful my day was.

So back to Mrs J. This is my last child and the only surviving child. She burst in tears.

At this point, I lost my cool. I lost my strength. I couldn’t hold it. Tears rolled uncontrollably from my eyes. Holding her hands reassuringly…saying to her, it shall be well with you. You will overcome all these, God knows why all these are happening. We can’t question God, even though I wish we could.

So what killed them and why is your daughter here?” I tried asking…

She is A sickler. The ones that died were all sicklers. She had a stroke 5 years ago and later became Blind. That’s why she’s like this. This little girl has suffered so much because of my ignorance. I wish all this happened to me and not her!

I was speechless. I couldn’t even express how I felt, even this moment I still can’t. Please what is more painful? I’m asking you this because I don’t think I know.

But somehow, I still managed to express myself.

Are your Genotype and your husband’s “AS”? I asked.

“Yes. And we didn’t know till after my third child’s death”. She said

So what happened afterwards I tried to enquire.

Nothing. The Doctor told us. We started giving the other remaining 4 children Folic acid. We tried, and visited hospitals…they gave us options which were too expensive for us. We relied on God for a miracle, which never happened.

So they kept dying and now I’m left with just this one. I’m 42years old, I can still conceive but my husband and I have decided no more, I’m currently on family planning. We can’t continue to bear these pains.

I wish I knew all these before I got married. I wouldn’t have.” She was in pains, lamenting, blaming herself for all these. So I couldn’t let her continue. I already hit the points…

SICKLE CELL ANEMIA

It is an inherited blood disorder in which the red blood cells assume a “Sickled” shape as against their normal Biconcave morphology, this makes them easily prone to destruction and the normal life span of a red blood cell which is 120days is drastically reduced to 10-20days. This is the reason for the Anemia

Morbidity, frequency of crisis, degree of anaemia, and the organ systems involved vary considerably from individual to individual.

For one to be A Sickle cell patient, he must have inherited the defective gene from both parents. So mother and Father must be “AS”

Nature determines which offspring inherits this. For every pregnancy, the chances of having an ‘SS’ is 25%. So it is possible to have all children SS, it is also possible to have all AS or even AA. I’ve seen all these varieties. In some, it is a mixture of these.

CHARACTERISTICS

Screening for HbS at birth is currently mandatory in some countries like the United States. For the first 6 months of life, infants are protected largely by elevated levels of Fetal Hemoglobin, Hb F. So a child less than 6months will not manifest with features. Sickle cell anaemia usually manifests early in childhood, the condition becomes evident, as follows:

Jaundice
  • Yellowish discolouration of the eyes (jaundice)
  • Hand and foot swelling( dactylitis)
  • Gnathopathy
  • Palor
  • Crises
  • Frontal bossing
  • Asthenic built
  • Bone pains
  • Delayed growth, etc
Frontal bossing

Complications:

The complications of these are endless. It cuts across all systems in the body.

  • Chronic pains
  • Stroke
  • Blindness
  • Kidney problems
  • Poor wound healing
  • Bone infections
  • Heart failure
  • Organ enlargement like Liver, spleen
  • Recurrent chest infections
  • Social stigma, Depression,
  • All the complications from anaemia
  • Etc

However, with adequate care, most live their normal lives with reduced hospital visits. I know a Doctor who is Above 70 and is an SCD patient.

WHEN You hear “PREVENTION IS BETTER THAN CURE”, this is where it’s best applied. It should be prevented by all possible means.

The first step towards that is to know your genotype and that of every member of your family. If you’re “AA”, Lucky you. Lol. Hotcake

But if You’re AS or SS still fine. You just have to always thread with caution. “I Love you, I can’t live without you”, na for person wey never born SS o.

For all “AS & SS”, your first date with anyone you MUST ASK THEIR GENOTYPE. You can only marry an ‘AA’ And it doesn’t end there. Before you consider getting married to anyone, you both must go to a good hospital to confirm your genotypes, at least 2 different hospitals. I’ve heard of partners that lied, just to stay married. What a shame!

It is traumatizing. You can’t even imagine the constant pain your child will be on because of your careless mistake or even losing your children. It destroys homes. Do you see that Love? It will vanish

I’ve seen couples separate because of this. Don’t let anyone deceive you. Truth there is a lot of advancement especially in the Prevention of SS, but it is not readily affordable and available. How many couples can spend millions just to find out if the fetus is “SS” or not; and if “SS”, abort it? Even if the money is there, your Faith may not permit that.

However, if you are a Sickle cell patient or you know one who is, please the Importance of regular medical check-up can never be overemphasised. As soon as they are diagnosed, their hospital visits should be regular. Most complications can be prevented. In addition, the following must be observed in order to prevent Crises:

Water
  • Good Hydration: The person must stay hydrated at least 3 litres of water every day.
  • Avoid extreme temperatures. Not so cold, not so hot.
  • Good nutrition.
  • Avoid strenuous activities/stress
  • Avoid alcohol and cigarettes
  • Take their routine drugs (Folic acid, Hydroxyurea, antimalaria etc)
  • Vaccination against Hepatitis B virus(because of the frequent blood transfusion); Pneumococcal Conjugate vaccine because they’re prone to encapsulated organisms.
No strenuous activities

With these, they can live a normal life, devoid of crises and pains, or at least reduced to its minimum. However, they must “Make their Doctor, their friend”

Today,  June 19, is World Sickle Cell Awareness Day.
Over 400, O00 babies are born each year with Sickle cell disease. We can help reduce this, by creating awareness.

To all the SCD patients;  ” don’t ever let the pains destroy you, grow stronger from the pains”. You shall win this fight.

I am hoping to Raise Money, create awareness and lend my support to Sickle Cell Disease Patients in the nearest future. However, in my own little way…I hope this helps.
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Albinism


I for once have never been close to any albino till I met Amaka’s boyfriend (now Husband).

Amaka was my childhood best friend, and we have been pretty close since then. So a few years back she informed me she was getting married.

“Ola, he proposed, and I said YES!” SHE exclaimed.

See me blushing like ……I couldn’t have been any happier. You know there are friends you have that bring so much peace into your life; that every moment of your prayer you can’t stop praying for them. Amaka is that kind of friend. I always wanted her to be Happy.

Let me Tell you a little story about Amaka.

She lost her parents at the age of 5 through a motor accident. She was the only survivor. She lost not just her parents, her whole family. The 4 of them! Heartbreaking……

Her mother’s youngest sister decided to adopt her as her own child. (God bless this woman). You know growing up with our parents is one Blessing we all take for granted. Honestly you may never understand what it means to be an ORPHAN at a very young age or growing up in another family. Sad.

Nevertheless, as God may have it Her aunt was an Answered Prayer. She took care of her like her own. Unfortunately the woman had no child of her own. So Amaka was all she had.

Amaka is decent, a no nonsense girl,a confidant, an advisor. She is courageous and pretty. In summary, she was a God-sent friend. Jehovah knows how much I needed people like her around.

Amaka moved to Europe in 2011 for her university education. So there she met Kelvin, an Albino based in Abuja, she met on Social media.

Albino? Amaka of all the men in the world it’s an Albino you want? I asked her severally.

So there’s no Nigerian in Europe? No black skinned guy. All you want is an albino? Have you ever imagined how your children will look even they inherit this albinism? If you want to marry an ‘Oyibo’ why not marry a white guy over there…you rather go for a fake one. I always said all these to her.

Look , I loved Amaka and wanted the best for her. I never thought Kelvin was the best man for her. Knowing how much she has kept herself and prayed for a good decent man.

I felt she deserved better.Never have I doubted her sense of judgement. Look, when it comes to a friend that can help you in making important decisions about a life partner, family, etc she was that friend. She is filled with wisdom. The surrounding aura is honorable. She has a way of talking directly to my soul. I’m few months older than she is, but I respect her a lot.

So a part of me felt this maybe the best thing for her. She knows exactly what she wants.

So one fateful morning she called to inform me Kelvin was coming to Owerri, Imo state for a conference. So we could catch up if I don’t mind.

Me and Kelvin? What for biko? The fact he is an albino made me hate him for no just reason. I was stupid. Like I said earlier, she knows how exactly how to penetrate into subconscious, so as expected I accepted.

Fast-forward to a few days later. He was in town and we met. Damn!!! This guy was nearly Perfect.

Soft spoken, his charisma is out of this world, contagious smile, fluent, humble. Why did God make him an albino (I thought to myself)

We were supposed to meet by 1 pm. It was a hot afternoon, so he called and pleaded we make it 3.30 pm. I already knew why. You will understand the reason, soon.

This was the day we met. It was fun. He knows about Albinism almost as much you can imagine.

He wore a Long-sleeved White T-shirt, a hat , and sunshade.

Wow! This dude knows his onions. No wonder my friend fell for him, I muffled. I will come back to this later

Right now they’re happily married with two kids. A daughter who is an albino, and a son who isn’t.

Albinism

Albinism consists of a group of inherited abnormalities of melanin synthesis and are typically characterized by a congenital reduction or absence of melanin pigment. Albinism results from defective production of melanin from……..I’m not going into this now, it’s beyond the scope of this blog, lol. Just know melanin is the black colouring pigment of the skin. So in albinos, it’s synthesis is defective.

It is more common in Blacks

It can manifest as Oculocutaneous (affecting both the eyes and skin) or Ocular alone (affecting just the eyes) with the hair and skin colour normal.

The features of albinism include:

  • White hair
  • White skin
  • Sensitivity to light
  • Ocular (eye) manifestations like:


1. Refractive error and astigmatism

2. Nystagmus (may compensate with a head tilt that may help improve vision)

3. Iris depigmentation (usually blue-gray or light brown color)

4. Strabismus (the so-called four O’clock eyes)

Complications/challenges of being an albino:

Skin cancer, sunburn.

Reduced visual acuity

Social stigma

The commonest cancer they have is Cancer of the skin. The good thing about this cancer is that it can be highly prevented. So I expect everyone one if us reading this to tell all albinos you know about what you’re about reading now.

The big question is How Cancer of the skin be prevented In this subset of people?

Remember what I told you about Kelvin. The way he dressed…the long sleeves, hat, the time rescheduled our meeting for 3.30pm all these were for a reason and I’m going to explain all that to you.

They should always wear wide range hat and protective clothings

First… Avoid SUN!

They should ALWAYS WEAR LONG SLEEVES

A Wide range Hat

Wear sun absorbing colours like White, Red,etc

And try as much as possible to avoid Sun. And if they must go under the sun before 11am and 3pm they should USE AN UMBRELLA . All these must start as soon as the child is born.

Indoor activities are encouraged like office jobs. No outdoor activities as much as possible

SPF ! SPF !! SPF!!!

SPF

SPF means Sun Protective Factor

They should always, I repeat always apply it every day before stepping out of the house. It has different ranges, the appropriate ones for them are those above 30. So it comes in SPF_10,15,20,30,70,22, ETC. ANYONE ABOVE 30 IS OK . It is readily Available in supermarkets. You don’t even have to be an albino to use this ,I use it everyday. It protects us from the damaging effects of the sun. So the chances of having skin burn and skin cancers are reduced. A few body creams and lotions contain it too, so they should patronize such products. More interestingly it’s now embedded in some clothes. Yes,you read right. We now have SPF in clothes. They should wear such.

Regular medical check up

They should always go for regular medical check up. The importance of Early detection and prevention can never be over emphasized. When detected early this cancer can be “cured”. They also need to be seen by an Ophthalmologist because the majority have a poor vision.

Ladies and Gentlemen Today, the 13th of June is World Albinism Awareness day.

International Albinism Awareness Day is observed this day, June 13th every year. Its main aim is to support albino patients and discrimination against people with albinism, particularly in Africa.

Let’s spread the word. They are no less of a human. Until you treat people as your equal, you have no right to complain about the treatment you receive from anyone. The myths about their being mentally retarded is absolutely false, they are not. Kelvin is a first class Engineer. I’ve a Doctor friend who is an albino that I met a few months ago. I could go on and on.

All they may need is the right information. Once you see any albino, tell him/her this. The albinos you hate are the ones not well taken care of, if you see an albino that understands his condition and knows exactly how to prevent complications…you will be as Amazed as I was when I first met Kelvin.




Albinos may be affected by sun, however the socail stigma is more worrisome to them.
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MEN’S HEALTH WEEK


Dear Mr X….permit me to share our story

Nurturing yourself is not selfish – it’s essential to your survival and your well-being.”

Women are so celebrated and somehow the men are almost always left out…..

Well, let me tell you a little about My Friend… Mr. X.
Meeting him wasn’t just a coincidence, it was an eye-opener for me. It made me realize how much men are ignored in the society especially Healthwise. Well, I’m not laying the blame on the society per se but The MEN THEMSELVES. IRONICALLY…

Back to him
I met him in Abuja last year. He’s a 37-year-old hunky, dishy, hot, drop-dead gorgeous guy who is also well to do.

What exactly is this gist about…I know what’s going through your mind. Chill. Lol

So we met at a friend’s wedding. He was the best man. I was just a guest who interestingly picked the bouquet. Hehehehe. So as usual the MC officially wed us. Hahahaha
That was the beginning of our friendship.

So we got talking not so often though. Chatting was a better means for us even though this too wasn’t frequent. I got to know he is an Engineer who works with one of the largest Oil companies in Port-Harcourt.
Not married. Both parents are alive. He’s also into business, so he is just so much of a busy man.

While we were chatting one fateful night he informed me he was having serious headache, palpitations and feels dizzy. So I figured out he may be stressed out.I encouraged him to have enough sleep and if it continued, he should see his doctor first thing in the morning.

This brings me to my main reason for this discussion. Honestly, you won’t believe his response. You know our men are so concerned with the women in their lives that they nearly almost always forget to care for themselves.
They go about thinking they’re too strong. Powerful and immunity covers them. Well…let’s see.

“Doctor?” He asked
“Yes of course” I replied

“Hmmmmmmmm. I don’t have a Doctor o. Neither have I ever visited a hospital.” He said.

What? For me that was strange

Ok. He was 37 years.
So you mean a 37-year-old full-blooded man has never visited a hospital? 37 years on earth?? Wow!
“So what do you do when you fall sick? Don’t you go to the hospital for a routine check-up? What exactly do you do concerning your health?” I tried to ask so many questions at the same time because I couldn’t comprehend the fact that a 37-year-old had never been to a hospital. What!!!?

It was at this point it dawned on me that Hypertension could also be a possible cause of his symptoms. However, there was not enough reason to say that.
But for the avoidance of doubt, I asked “When last did you check your blood pressure?”

“Hmm… some months ago.” He said.
And it was 180/…..he tried to recall but wasn’t sure of the diastolic pressure.

180??? So what have you done about it?
I asked curiously having in mind he has never visited a Doctor as he said.

Nothing. I’ve checked it severally it’s always within that range but I figured out it’s due to the nature of my job. He replied.
Do you know what got me upset? This is someone that loves his girlfriend so much that when she complained of slight abdominal pain. He called me and was fidgeting. For abdominal pain o. Yet his own life, he took for granted.

Yeah shocked right? I know.
He is not my boyfriend tatafooooo. Amaigbo wie not kie you. Hahahahahahahahahhaahahahhahaha

I was flabbergasted. I couldn’t just believe He wasn’t joking. How could someone take pride in Ignorance? Are you a Doctor? Even if you’re are you to treat yourself? How could someone vomit such venom with so much alacrity?
Well, these were the things that went through my mind, but of course, I remained calm.

“Ok. Please tomorrow first thing in the morning go to a hospital. See a Doctor. Tell him exactly how you feel and let him have you examined and your Blood pressure checked.” I told him
I was a bit persuasive so he was forced to accept.

To cut the long story short… His blood pressure was 200/100mmHg.

Do you know what this means? 200? And he has been walking around. The complications of Hypertension are endless and it doesn’t matter how strong you think you’re. If a stroke hits you, you will realize how hard life can be. It is better prevented, always remember this.

Currently, he’s on drugs, very adherent to his drugs, and has been so grateful to me.

What is HYPERTENSION

It is when the blood pressure is above 140/90mmhg in an adult.

It is the one of the commonest non-communicable diseases in Nigeria.

It has a lot of causes 95% of these are * INCURABLE*.
It could be genetic or acquired
Some of the risk factors include:

Symptoms
Virtually none.
And it can go unnoticed for years until complications begin to manifest. This is why it’s called a Silent killer

This is the reason why every adult should regularly go for medical check up. Infact we all should have our blood pressure checked irrespective of age and sex.

Once your blood pressure is under control you have almost nothing to worry about.

Some of the complications include:

  • Stroke
  • Poor vision
  • Heart failure
  • Myocardial infarction (heart attack and sudden death)
  • Kidney failure
  • Peripheral vascular diseases

In fact, the list is endless. And the complications are IRREVERSIBLE.

Would you rather have a stroke or have your blood pressure under control? The choice is yours.

Nurturing yourself is not selfish – it’s essential to your survival and your well-being.”

THERE’S NO EXCUSE. Just virtually anyone can be Hypertensive.

So dear men, take care of yourself. It’s the only place you have to Love.
We care so much about you.

The purpose of Men’s Health week is to heighten the awareness of preventable health problems and encourage early detection and treatment of disease among men and boys. This month gives health care providers, public policy makers, the media, and individuals an opportunity to encourage men and boys to seek regular medical advice and early treatment for disease and injury. The response has been overwhelmin

I hope you enjoyed my story.

Mr x is doing so fine now…and……..

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ADPKD


The beauty of life is,while we can not undo what’s done,we can see it, understand it, learn from it, and change, so that every moment is spent, not in regret, guilt, fear or anger but In wisdom, understanding and Love
Jennifer Edwards

Adaku’s death Who is to be blamed? The patient, doctor or Government?
This is a very sad story. Typing right now… it’s still so difficult for me because I know how much this girl wanted to live, she fought, she prayed relentlessly, perhaps it was too late.

How did we meet?


I met her about four years ago on Instagram after I commented on a post (I think about a celebrity who died from Kidney Failure and I saw a comment where he was blamed for his death as a result of alcoholism. I tried to acknowledge the fact that while alcohol may be the cause of the failure, alcohol isn’t the only cause of kidney failure, and then went ahead to list other possible causes. She was among those who ‘liked’ my comment, then ‘followed’ me.
Without any form of formal or informal greeting or introduction she curiously asked: “ARE YOU A DOCTOR”? I tried to be nice (if you know me, you will obviously know I’m not always that nice, lol).
So I replied “GOOD MORNING. NOPE, BUT A MEDICAL STUDENT.

Adaku: Ok. Good morning. But do you know about Polycystic kidney disease?

Somehow I could read this anxiety in her from the way she chatted. So I tried to calm her down.

‘Yes dear’ I replied. Any problem?
Then at this point, she was typing endlessly……… I got tired of waiting and used the time to scroll through her profile.
All I saw was a beautiful, about 5.9 or 6ft tall girl likely in her early or mid-twenties. Chocolate skinned, long hair, with a beautiful smile… In fact, she was stunning! Then I noticed her frequent posts about JESUS, GOD, MARY. She was a catholic…a devout at that, however, it was too early for me to conclude.
Finally, the long-awaited chat dropped…..it was a long one. I read it and couldn’t believe what I just read.

Summary :
Her mother died of chronic kidney failure. She wasn’t probably informed of her condition on time. She battled with it for years in a private hospital in Lagos where she was diagnosed of kidney problem, however, she claimed her mum was not told the cause of her failure until they went to another hospital a few years after and there they found out her mother had a POLY CYSTIC KIDNEY DISEASE. And this was the cause of her renal failure and eventual death. It was indeed a piece of bad news. I felt so sorry for her. Tried to console her and encouraged her to be strong. That was the beginning of our friendship.

But little did I know there was something more……….
We exchanged contacts. She informed me she was 29years old. A graduate of Mass communication. Devout Christian. She was unemployed and single.

“Less than four weeks she revealed to me she had this constant pain in her flanks which has been on for more than 9years now. She has been taking ‘PAINKILLERS” FOR YEARS.”



Hmmmmmmmm I was dumbfounded. Then I didn’t have much knowledge on PKD but I was certain there was something wrong somewhere. So I simply pleaded with her to please go to any good hospital in Lagos, a tertiary one preferably.

Father was sick, her only Brother was in India still trying to make ends meet. I encouraged her to call her brother and anyone she Could for assistance and I offered to assist any little way I could.

Ok. To cut this long story short…..she was also diagnosed with KIDNEY FAILURE.

This girl was barely 29 years. She had same condition her mum had. She had cysts in her kidneys which damaged them.

This should have been prevented……yes. The hospitals her mother visited didn’t do enough.
It was already too late.
This is unfair.
She died last year, in the month of June.

She was never supposed to even be on painkillers. It worsened her condition. If she was employed she would have had access to a good hospital a long time ago.
I think everyone should be blamed especially the hospitals her mother visited. What do you think?

WHAT IS ADPKD?

ADPKD (Autosomal Polycystic Kidney Disease) or simply Polycystic Kidney disease is the most common inherited kidney disease worldwide. (This explains why she inherited it from her mother)
In this condition, multiple, continuously expanding cysts (looking like fluid-containing balloons of different sizes) gradually destroy both kidneys structurally.



The kidneys also appear to be 2 to 5 times bigger than normal.
It is also associated with cysts in other organs of the body like the liver, pancreas, as well as dilatation (or abnormal expansion) of blood vessels in the brain (which can lead to bleeding strokes) and, heart abnormalities.
Most who suffer from polycystic kidneys usually have a parent or direct relative who may have suffered from a similar kidney disease. However, the severity of the disease may differ among family members due to many factors (hers was worse than her mom’s because she was on painkillers)
Most times, patients may live a normal life until they are between the ages of 20 to 30years when they begin to manifest symptoms of the disease.
These include:
Pain in the flanks
passage of bloody urine
Hypertension ( I forgot to mention Adaku was hypertensive but she never took it seriously. She once measured her Blood pressure and it was 170/100mmhg.
Therefore, what can you do if you have a family history of kidney disease?

Talk to your family physician who will assess you, have you check your blood pressure and, send you for screening tests.

ADPKD can easily be diagnosed with an abdominal ultra-sound scan. A scan will also assess your liver and pancreas for presence of cysts too.

Other tests are a urine test for presence of blood, blood tests for kidney function and a heart and brain scan.

Genetic testing for genes for the disease can be identified in individuals
If a patient already has symptoms of a kidney disease, a good clinical assessment to determine the extent of damage will also be carried out. These will include tests already mentioned including some more complicated ones depending on available facilities.
Usually, a patient will be referred to a kidney specialist (nephrologist) for further management.
Patient management:
This comprises several stages or levels of intervention depending on the presentation and severity. These will include blood pressure control, prompt infection control, medical treatment to control cyst enlargement, aspiration of large cysts, laparoscopic surgery to remove large cysts, total removal of one kidney, hemodialysis and kidney transplant.
An expert (nephrologist) can only take decisions on the appropriate interventional treatment.
It is important to note that smoking, excessive alcohol intake, use of herbal medications injurious to the kidney, use of certain drugs like NSAIDs painkillers (e.g. Ibuprofen, diclofenac, aspirin) or such antibiotics like gentamycin in the presence of ADPKD can rapidly worsen the kidney function of a patient.
Life outcomes are better now when patients are diagnosed early, with expert management and patient cooperation.

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 Disclaimer: name, dates, or any other identifying details of my friend in this story were changed to protect her privacy

Categories
Cancers

BREAST CANCER


Breast cancer is the most common cancer affecting women worldwide.

It affects both men and women, but more common in women in a ratio of 100:1. I in 12 Black women will have breast cancer

Risk factors

  1. Age: rare before 20 years. More common in those >40 years.

  2. Gender: more common in women. Accounts for over 40% cancers in Nigerian women, and 1% in men

  3. Genetic predisposition

  4. Prolonged exposure to estrogen as in early menarche, late menopause, nulliparity (childllessness) and and prolonged use of oral contraceptive pill (over 5 years)

  5. Tobacco Smoking and alcohol consumption

  6. Previous breast lump

  7. Obesity

  8. Radiations

What do you know about it?
Ok! I know you know it is currently the most common cancer in women.
But do you know you can detect it at its earliest stage, and continue with your life?
Long ago, it was thought to occur only in elderly women, but now studies have found it can occur at an earlier age in African women.

Symptoms

Breast cancer usually presents as a

  1. Painless lump in over 90% of the cases. do this is the reason why you should always examine your breast every month, as you may never know until it’s too late.

  2. Blood stained Nipple discharge

  3. Nipple changes like inversion, retraction

  4. Ulceration of nipple and overlying skin

  5. Lump in the armpit or arm etc

Prevention

  1. SELF EXAMINATION. This simple method can help you detect breast cancer at its early stage, making prognosis very good.

How is this done?

  • Ideally it should be done every month #(7days after your menstrual flow).
  • Lying down face up (supine).
  • The two breasts should be examined. ….checking for a lump including the areola/nipple area.
    Don’t forget your #axilla (armpit). Yes, the breast can extend to that region in some women. It’s called Axillary tail. Lumps can be located in any part if the breast.
  • This is recommended for every female from #20years. Yes! 20years.
  • Any abnormality found should be reported to a Doctor.

However, if you have a relative who had breast cancer be it mother, aunt, sister, grandmother; in addition to Self breast examination, you should be examined by a Doctor every year.

  1. Prophylactictic mastectomy : this is the surgicsl removal of the breast to prevent cancer of the breast.

Angelina Jolie, the famous American actress and Academy Award winner, announced that doctors told her she had an 87 percent risk of breast cancer because of a certain gene she was carrying. Shortly after that, Jolie underwent a preventative double mastectomy.

Angelina Jolie

  1. Early marriage to ensure first pregnancy is achieved before the age of 30 years. First pregnancy after 30 years increases the risk of breast cancer.

  2. No tobacco or alcohol consumption

  3. Mammogram: Women with an average risk of breast cancer should undergo regular screening mammography starting at 45 years of age

  4. Avoid sedentary lifestyle and exercise more often.

Forget all myths you heard about it, an early detection provides you an excellent chance of long term survival.

Categories
Cancers

Questions on Cervical Cancer


So, I’ve received quite a number of comments and questions. People asking questions concerning the HPV Vaccine/Cervical cancer. I didn’t expect all that, and I must say I’m highly impressed. Incase you missed the post click here https://olasmedicalblog.wordpress.com/2020/06/05/cervical-cancer/

Yes, medicine now is focused on prevention rather than cure. Incase you missed the post click here
So I’m going to share a few of the questions here and try to answer as much as I can.

  1. I’m 32 years can I receive this vaccine?

Ans: It’s recommended for those between the ages of 9- 12 and this is to make sure every girl receives it before she’s sexually active. However, it has been extended to 26years (Catch up).

However, anyone who is sexually active should undergo a screening first. The screening method ranges from HPV screening, Pap smear, colposcopy etc. Because it has to be established one isn’t infected already.
However those over 26yrs can also receive it.

  1. Can a pregnant/lactating mother receive it?

Ans: NO

  1. Can a virgin receive the vaccine?

ANS: YESSSSSSS. In fact, they’re the perfect candidates for this vaccine.

4: Can the males also receive it?

Ans: Yes. The same virus (HPV) is implicated also in Anal cancer, Anal warts etc. So males can.

5: How much does this vaccine cost?

Ans: it is dependent on your area. Currently, it’s not readily available in most government hospitals but I know some private hospitals offer it. So the price is dependent on the hospital. We’re hoping in the nearest future it should be made readily available and affordable too.

  1. Are there other methods I can adopt asides the vaccine to prevent this cancer?

Ans: Yes. But, there’s a but the options include:

  • Being faithful to one faithful partner (very important) and avoiding multiple sexual partners.
  • Remaining a virgin all through your life, lol!

So the choice is yours.

  1. Why doesn’t condom prevent it like other STDs?

ANS: The virus is usually present in the perianal areas of the host….so condom only covers the halos. So any form of skin to skin contact can help the spread it

Thanks!

Categories
Cancers Women's health

Cervical cancer, what you must know.


The cervix is the lower portion of the uterus, an organ of the female reproductive tract. It connects the vagina with the main body of the uterus, acting as a gateway between them.

CERVICAL CANCER is a #sexually transmitted disease* caused by a virus Human Papilloma Virus (HPV) Strange right? It is usually seen among women above the age of 40 years. However the incidence is now rising in those less than 30 

Human Papilloma Virus (HPV)

It’s s the commonest gynecological cancer in our environment because of the absence of screening guidelines unlike in developed countries.

It is only seen in women who are sexually active and usually in those with multiple sexual partners So the big question is… What is multiple sexual partner*?

PREVENTION

It can be prevented through:

  1. Abstinence . Very straightforward. A virgin can’t have Cervical cancer. It’s that simple.

2.FAITHFULNESS: Not just being faithful to your partner but being FAITHFUL TO A FAITHFUL PARTNER. Yes,this is very important. If you’re faithful to your partner who has 3 other partners…..I’m sorry because it’s as good as nothing. Infact it also means you’re involved indirectly with those other partners of his and that also makes you at risk of acquiring this virus. So do you trust your PARTNER? Condom doesn’t confer any protection. Don’t ever forget this.

Condom does not confer any protection

3.VACCINE!:
This seems like the most realistic. The vaccine is available
It is recommended that they be given to all females at 11 – 12 years of age routinely, as well as girls and women age 13 – 26 years who have not been vaccinated (catch-up population), it can be given as early as 9 years of age.
These vaccines are preventive as they prevent cervical cancer and do not cute it.
All HPV vaccines should be given as a 3-dose schedule, with the second dose given 1 to 2 months after the first dose and the third dose 6 months after the first dose. The minimum interval between the first and second doses of vaccine is 4 weeks. The minimum interval between the 2nd and 3rd dose is 6weeks.

THOSE WHO ARE SEXUALLY ACTIVE BUT WISH TO RECEIVE THE VACCINE?

Individuals who are already sexually exposed who wish to receive this vaccine must first be SCREENED.

SCREENING:

This is important because Cancer of the cervix manifests slowly and first as a pre-malignant lesion (precancerous) which can take several years to become a full blown cancer. So when detected at this pre-malignant stage, it can be treated.

The screening methods include:
1. Papanicolaou test (Pap smear)

  1. HPV testing

3. Colposcopy

Who isn’t eligible?

Everyone isn’t eligible for it. It can’t be given to
1. Females less than 9yrs

2.Pregnant women. It is not

recommended during pregnancy and should be given after delivery.

3.HIV patients

Click here on the link above ☝️☝️☝️☝️☝️☝️ to read about this 22yrs old girl with Cervical cancer



If you reside in Imo or within its environs and wish to receive this vaccine,  please indicate here or drop Whatsapp message at 08058542816

Categories
Uncategorized

The Journey Begins


Thanks for joining me!

Good company in a journey makes the way seem shorter. — Izaak Walton

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