1 YEAR GONE - PMB's REPORT CARD

In exactly seventeen days, it would be 1 year since the current president was sworn into office. How has he fared so far I ask? What has he been able to accomplish? Is the office worse than he expected? Is it no more what it used to be in the early 80's? Well, that is for Mr. President to answer. Today, I just want to give my own personal appraisal of his time so far. For so reason, I don't have the patience to wait for seventeen more days. 

The last post I wrote before I took an almost 1 year holiday from blogging was one with the country in a terrible fuel crisis, funny that I should begin publishing  again with the same fuel kpalava. In the last one year, Nigeria has seen some of the worse fuel crisis in its history (well since I was born and that's a lot of years). Funny enough, sometimes I can't seem to rationalize the reasons behind these crisis. It's either the independent marketers are not satisfied or the Niger-deltans are blowing up the pipelines like they always do or just some other funny story. So, today you can imagine the feelings of many Nigerians when it was announced that the current price of fuel is N145/per litre since fuel subsidy has been removed. Well, let's all watch and see how it all plays out.

Secondly, let's take a look at the dollar, the exchange rate moved from N150 to $1 to well "they say the official exchange rate is N197 per $1 but I can't seen to find anyone who has changed at that rate in the last one year. Last I checked, a dollar was going for N320+. For a country that is highly dependent on importation, I wonder how we are suppose to fare. God dey.

PMB promised us security, well in that aspect, maybe there has been some improvement, because it's been awhile since I heard any gist on boko haram. So it's either really true that they have been slowed down or I don't really watch the news. But how do we explain these fulani herdsmen who are attacking people randomly all over the country? The worst part is oga president has not said a word to rebuke it. I'm not saying it's his fault oh! But when you are the leader of a large amount of people from diverse cultures who are maybe 50% ignorant and who get most news from hearsay/gossip (salt and pepper added), it is better to say a few words to pacify than to be quite.

The biafra issue of a few months ago is story for another day. I simply can't go into that now. (If you really want to know what I think of the matter, just hit me up in the comment box below).

Who can tell me the exact number of trips the president has been on in the past year. I've lost count and worse part is we mostly don't know the reasons for these travels. We still dey look.

Finally, the policies are killing us, and not softly. I think I believe PMB like GEJ has good plans for the country, the problem is the implementation. While GEJ couldn't seem to find the courage to implement and carry out "his plans", PMB is pouring his out without checks. He bans the ability of people to pay-in dollars to their domiciliary accounts, that plan backfires, then it's reversed. He bans the importation of generators, increase the light bill when PHCN (the Nigerian light company) carries out it's daily operations on generator. As I write this post, I'm running on generator. And so many policies I can't even bear to remember right now.

PMB may have great plans, but he can only succeed if he carries Nigerians along. That is one task I don't wish on anyone because frankly speaking, majority of us are a bunch of culturally, religiously, politically biased impatience people. My fellow Naija people try patient small,maybe there is a light at the end of the tunnel. Like I've always said PMB is not the messiah of Nigeria, he may be the John the baptist or even Isaiah , who knows? We still have a long way to go.

I don talk my own. Talk your own make we hear.

Cheers...

ZAPPED

Last day of the challenge and phew! It has been wonderful and stressful at the same time. I have discovered some new blogs, made some friends (I hope) and learnt many new things. Also, something else that was awesome was that my pageviews went up a bit more than the usual (quite exciting). I just had ice-cream to celebrate the end of the challenge, not very healthy, I know, but it had lots of fruits and nuts it in (that’s got to count for something right?) Plus I didn’t finish the whole bowl.

For today’s post, I’d go back to my psychiatric posting. I already told how my undergraduate psychiatric exposure was next to nothing here, however, it wasn’t until I heard the word “ECT – electroconvulsive therapy” that I realized how little I really knew in psychiatry. Electroconvulsive therapy is a form of psychiatric treatment in which seizures (convulsions) are induced in patients to provide relief from psychiatric illnesses like major depression, mania, schizophrenia e.t.c. It is usually used as a last line of intervention. 

After hearing about ECT for a week, I decided it was time to witness one. Basically, electrodes (almost similar to those used during an ECG) are applied to the temples of the head and the patient is zapped. They begin to convulse (lasts a few minutes) then they fall asleep. This procedure is repeated about 5-6x or stopped when the patient is responding. 

Photo credit: wikipedia

Typically, I’ve been taught my whole life that seizures are bad for the brain, so I couldn’t seem to wrap my head around the fact that doctors would intentionally induce one on people and it would be beneficial for that matter. Well, I saw for myself that these patients did improve with ECT before the end of my posting. 

ECTs have some side effects though and they are confusion and memory loss. Anyway, now I’ve seen that something good could come out from something bad like been zapped.

Cheers all, see you again next year.

YOU ARE WHAT YOU EAT

Have you taken out time to go through the nutritional content of the foods you eat? After my recent update, I've learnt a lot about food especially junk food. Yes, I agree, by Nigerian standard I am too skinny to bother about what I eat. I shouldn't even be thinking of such a topic. However, I strongly disagree mainly because I don't intend to start the battle later in the future. As they say, "prevention is always better than cure". Besides, what kind of a family physician will I make if I don't prevent you from getting a disease and wait to treat something that will most likely be untreatable but manageable like obesity, diabetes, hypertension, heart disease?

Last year, a few of my friends went on a weight watching exercise. I didn’t join them, (don’t need to), but I observed very closely, in combination with my experience working in a weight loss clinic and that gathered from my tutors for when I might need it in the future or for when I meet a person in need of it. I have written a few posts on how to lose some weight here and here, however, I realized that if we actually watch what we eat, then we can actually avoid much more than spare tires in the mid-section. Experts say that there are 5 key ingredients to losing weight and they are;

• Diet
• Diet
• Diet
• Diet
• Exercise

When I say diet, I don’t mean starve yourself, we’ve already learnt how that could lead to ulcers. I simply mean eat in moderation and avoid a few harmful substances in your diet while adding some others. A lot of African women pride themselves in been well endowed and many try everything on earth to put on a little weight (I was in that band wagon by the way). Somehow, more weight got translated to wealth in Nigeria. Somewhere along the line though, a Nigerian won the miss world contest and more harmful diseases closely related to our diets came to limelight and there was the turning point (for a few).

Here’s what I learnt, as you probably already know. The caloric need for an adult female is between 1400 – 1600kcal/day and for a male, about 1800 – 2000kcal/day. If you intend to lose weight though, you’d need to reduce your caloric intake. The key to controlling your diet is in counting the calories. I have met people who tell me that they eat only one meal in a day and the rest are just snacks. Well, if you belong to this category of people then I’ve got news for you. Let me site a few examples using a few snacks commonly known to many people especially Nigerians. This is because in Nigeria, manufacturers rarely give you the caloric intake on the packaging of the snack. They believe that writing out the ingredients and the net weight of the product is good enough.

Take shortbread biscuits as an example, did you know that each one of those yummy milky biscuit is 100kcal? You eat the whole packet of 10 or 12 and wash it down with a bottle of 50cl coke, which is about 250kcal by the way, and you say you just took a snack. And it may be just that – a snack, because it isn’t filling. But you have 1250 – 1450kcal already and you haven’t eaten your meal for the day. Let’s take a look at gala (sausage), each pack is 330kcal and usually we eat 2 with a bottle of coke for snack. That gives a total of 900kcal that is not your breakfast, lunch or dinner. Chocolates! (oh! I die!) Each bar of 50g contains about 250kcal. Take 2 and that’s 500kcal. Noodles?- that’s 350kcal for each 70g pack, and we can’t have just 1, it has to be 2 with carrots, green peas, tomatoes, sweet corn and eggs. Guess what total that would bring you to for a single meal. It’s unbelievable right? For your information, I was guilty of all these, just beginning to change.

I realized that there are a few foods that don’t add as much calories to our diets and also help our intestines and prevent or reduce the likelihood of diseases like colon cancer, diabetes, hypertension, obesity and so on. These foods are fruits, vegetables and water. Add these regularly to your diet and you would be surprised. They fill you up without adding as much calories.

X-RAYS

As a child, I have numerous episodes of upper respiratory tract infections (URTIs); from sinusitis to tonsilitis and so on, (still do occasionally). Unfortunately, it was never diagnosed, the doctors then just kept giving me lots and lots of pink cough syrup. I also remember having repeated chest x-rays.

As I grew up and became a medical student and then a medical doctor, I realized these must be what I'd suffered from as a child since I saw the same symptoms as I had. These days though, we have more specialists and more diagnostic tools and it makes diagnosing easier. I learnt that the x-rays needed for the diagnosis of URTIs especially sinusitis and tonsilitis aren't just chest x-rays but also x-rays of the postnasal space and the paranasal sinuses.

X-rays are a form of electromagnetic radiation. Most X-rays have a wavelength ranging from 0.01 to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz (3×1016 Hz to 3×1019 Hz) and energies in the range 100 eV to 100 keV. X-ray wavelengths are shorter than those of UV rays and typically longer than those of gamma rays.

X-rays have numerous uses, medical and others, for example it can be used for airport security. In medicine, it has both diagnostic (x-rays, mammography, CT scans, e.t.c.) and therapeutic (radiotherapy) uses. Be careful though, they can also be harmful as they cause cancers as they have been classified as carcinogen. Before a pregnant women does an x-ray, the benefits or the x-ray should be weigh against its risks. For further reading, go here.

Have you ever had an x-ray or any other form of  radiological procedure done before?
http://en.m.wikipedia.org/wiki/X-ray

W is for WAITING TO EXHALE

It’s the final week and I can’t say it’s been easy. Infact, it has become more difficult, (especially since I write my posts everyday). So, today I’m lazying about watching movies all day, couldn’t sit at my computer to write a line, couldn’t open a book to read, slept off at one point and woke up to continue doing nothing. Then, I ate dinner with hubby and wasn’t still too lazy to do the dishes, so I continued watching more movies. The problem wasn’t that I didn’t have a topic to write for letter W, (have had it for months). I have an angle that I wanted to go with, I just didn’t want to write a post and come off sounding like a little “know it all” and unable to relate with my readers.

So finally, I get up to go and do the dishes as it was getting too late and a thought from one of the movies (actually a line in the movie) came to my mind – waiting to exhale. That one line just about summed up what I wanted to say in my post. Again, it seemed to be a better title than the one I’d chosen earlier. Just so you know, it was “waiting room”. The waiting room: a place that so many people know as the reception in so many other organizations. It is a place where people wait to get attended to. In the hospital’s waiting room, there are so many things going on. Some people are waiting to see the doctor, and others are relatives who brought the patients. There are people waiting to hear the news on their relative’s health. The expressions are numerous, from sad, to tire, to pensive, to depressed and so much more. The one thing they all have in common though is that they are all waiting to exhale; waiting to breathe; waiting to be told that the news isn’t as bad as they’d thought; waiting to hear that even if it is indeed that bad, that they would pull through it all.

Have you ever been in the waiting room of a hospital before? What was your experience like?

VIOLENCE AT HOME

A few times, even though I’m not a relationship expert, I’ve had course to write some articles, mostly with my sister (she’s the one into all that relationship stuff). You can check them out here, here and here. I think I know a bit of what I and most people want in relationships and what we do not. Some are just in between, since no one is ‘perfect’. So, with this intro, I’d really love your thoughts on this conversation I had with a young lady in my consulting room.

• Me: Hello, good afternoon, how are you doing?
• Lady (Ly): I’m fine doctor, thank you
• Me: So how may I help you today?
• Ly: I want to carry out some tests, no I want an x-ray done.
• Me: Okay, why do you want an x-ray and for what part of your body?
• Ly: I just want x-ray of my back and chest.
• Me: Alright, but you haven’t told me why yet. Did you fall down?
• Ly: Okay, okay, my boyfriend beat me up and I don’t have any pains or anything, I just want him to spend his money.

My jaw dropped. I didn’t quite understand her reasons, but it was nothing new to me. Countless times, I have seen women assaulted by their spouses show up in the ER with black eye, some severely injured and they still protect and defend the actions of their abusers and I can’t just wrap my head around it. Even though I haven’t seen one, I have heard of cases where men beat their partners to dead. I keep wondering why these women keep staying. Could it be desperation, financial security or what?

Please anyone, I need to know

U is for ULCERS

I literally had no idea what to write about for the letter “U” until this morning, and I’m so glad with what I finally came up with – ulcers. Ulcers as we all know are open sores on either the external or internal surface of the body. They are breaks in the skin or mucous membranes that fail to heal. Just like obstruction, ulcers can affect many parts of the human body and each of them difficult to treat. Some are cancerous though many aren’t. Today, I’d like to focus on peptic ulcers.

Ulcers can be found in the mouth, I remember growing up and having those tiny, painful aphthous ulcers and taking vitamin C tabs to treat. They can also be found on the legs, seen in many people with poorly controlled diabetes mellitus, hypertension, trauma (seen too many of those). They can be found on the buttocks in many bedridden people. Ulcers can also be in the stomach and intestines, those are the peptic ulcers. Let’s go study a bit.

Peptic ulcers occur when the gastric fluid (acidic) corrode the mucous membranes of the stomach or intestines. They are usually caused by starvation (watch out those of you who are trying to loose weight the unhealthy way). They can also be caused by a bacterial called Helicobacter pylori. Some drugs like NSAIDs – pain relievers (diclofenac, ibuprofen, piroxicam) can both cause and worsen it. It can also be aggravated by eating peppery and oily foods.

The mistake is that many people think the treatment is in the medications alone ( I learnt that the hard way). For most of my patients, I use the 80/20 rule; 80% of the treatment is dependent on the patient and 20% on the doctor. Look at it this way, It is my job to make the diagnosis, prescribe the medications and educate the patient, but if the patient does follow the instructions, then they’d never get better, would they?

Also, chewing gum and sweets all the time in place of food is so wrong. The glucose in sweets and gums is too miniature for the acid produced, and most of the time we are just swallowing our saliva. A lot of stuff triggers the production of acid in the stomach in preparation for the digestive process. These triggers could be smell of food, taste of the food, chewing, e.t.c. When the acid finally sees no food, it digests the stomach walls (that's protein too).

To effectively get rid of the ulcers, you have to make some sacrifices;

• Eat healthy foods regularly, small portions is better than no portion.
• Eat at the right time. You can’t be eating breakfast at 11am, it’s now brunch.
• Avoid peppery and oily foods.
• Avoid fasting, but you can still pray (only the living can serve God).
• Avoid any form of painkillers except paracetamol and use those with caution
• Inform your doctors about your condition even if you are visiting for a different reason.
• Finally take your ulcer medicines as prescribed.

Ulcers have complications and they are scarier than been called fat, or been deviant. These complications include;

• Gastro-intestinal bleeding: usually results from the ulcer corroding a blood vessel on its path. I have seen people bleed internally to death because of this. Some have been caught on time and successfully managed conservatively, and some ended up in surgery with little chance of survival.
• Perforation: Here the ulcer eats up the wall of the stomach or intestine to the other side and the gastric contents (bile, acid e.t.c.) are emptied on the rest of the internal organs. They have to go through surgery to survive, if caught.
• Penetration: The ulcer eats up the intestine and starts to eat into an adjacent organ usually the liver or spleen.
• Malignant: Some become cancerous. Now that’s just bad news.

So there you have it on ulcers. Have you ever had any type of ulcer before? Share your story/experiences.

THE TEETHING MYTH

In Nigeria as with many parts of the world, there are myths that exist considering certain medical illnesses. For starters, myths are age long widely held, but false beliefs passed on from generation to generation. Since I knew anything thing at all, I’ve about them. Many of them have found their bases in medicine itself, most times, misinterpreted. A few of such myths include;

• Lying on the cold floor or staying in very cold environment causes pneumonia
• Drinking cold water makes labour difficult
• Taking a lot of sugar and sugary foods causes helminthiasis (worms)
• You should drink 2.5 – 3 litres of water a day
• Cracking your knuckles will cause early onset arthritis
• Giving a child meat would make him a thief
• Quickly applying salt and cold water or egg when scalded by hot water or steam prevents it from blistering or worse effects.

However, by far worse is the teething myth. It is the commonest I’ve seen in many paediatric clinics and by far the one with the most devastating effect. The belief is that an infant from 6 month to age develops diarrhoea, flu-like symptoms and sometimes fever when they are teething. They only show up at the hospital when the child either has a high fever, is vomiting of is dehydrated.

The purpose of this article is to dispel this myth and bring out the true reasons that these things happen at that age. It seems constantly teaching each mother as she walks into my consulting room has almost no effect, so kindly reshare to as many people and social networking platforms as possible.

The reason is simple really. From 6 months of age, certain events occur in the life of an infant that bring about the fever, diarrohea, flu-like symptoms and vomiting. They are;

• They lose their maternal immunity and aren’t yet able to develop theirs.
• They have started crawling about and can pick up objects, including those that may be infected and it goes directly into their mouths.
• This is the age at which most of them are weaned. In the course of weaning, not many mothers can properly wash and take care of their bottles (which is why cup and spoon feeding is now advocated), and germs can hide in its many nicks and crannies, exposing the child to more infections.

So, the child has virtually no immunity to protect him, picks stuff from the floor and puts it straight in the mouth and he is being fed with bottle whose level of hygiene is highly doubtful. The first symptom that inadvertently appears is the diarrhoea, then others. The greatest fear about all this is the dehydration that might eventually lead to the death of the innocent infant.

Also, many drug formulations have been introduced into the market in Nigeria as usual to exploit the fears of these mothers and some have been known to cause renal failure.

So now you know the truth, please share and reshare and save the lives of many more children.

SCHIZOPHRENIA

Today, I’d like to tell you about an experience I had during the psychiatric posting I just rounded up last month. To begin with, I have never a fan of the subject from school. I knew from day 1 that it was an area in medicine that I would never have anything to do with and my school didn’t help matters much in the way the lectures for the subject were conducted. As fate would have it, I guess my past decided to play catch up with me and bite me in the a** when I opted to specialize in Family medicine (I didn’t know there would psychiatry involved). Enough of my lamentations and onto the story for today.

It was a cool Monday morning and the first day of my posting (I was determine to do my best concerning psychiatry this time around), I was told that we had a new patient to see and that I should go with the resident doctor in the unit to see the patient, (to bring me up to date in history taking skills in psychiatry). We get to the consultation, and I see the patient to be clerked (asked questions). I thought to myself, “is this the person we are supposed to get any kind of information from?” To make sure, I had to voice my thoughts to the doctor. He answered confidently, “Yes”. I said, “okay”, then took my chair and moved it slightly backward (just so I can take off if the consultation went the other way plus it was my first day. I was freaking scared).

I’m sure you are wondering by now what I saw. Well, wait no longer, for here is the perfect description f what I saw:

A man with short, dirty “dada” on the head, (just incase you don’t know, dada is the very unkempt version of the dreadlocks our rastamen love to sport), peeking out from under his Jamaican flag beret, dirty shorts (couldn’t determine the former color), dirty singlet (the type we call ‘it was white’), a wrapper on top of it all. He also had a large piece of carton attached to his neck with a rope and he was holding a small ticket booklet and counting out numbers. In short, the typical person you see on the road and call ‘mad’ or ‘crazy’ (don’t allow a psychiatrist catch you saying that though). This is how the consultation went;

• Doctor introduces himself and me and asks: What is your name?
• Patient: Faculty officer
• Doctor: and your surname?
• Patient: Commissioner.
• Doctor: Where are you?
• Patient: I’m in my office.
• Doctor: Who are we?
• Patient: My tenants.

You can imagine how the rest of the consultation went. However, I realized he was violent (surprised me to know that they aren’t all aggressive, since we always call them ‘mad’). Finally diagnosis was SCHIZOPHRENIA. At the end of that day, I told myself, “welcome to psychiatry”.

N.B* within 2 days, he got better, enough to remember his actual name and where he’s from. It was an amazing thing to witness. The rest of the posting was one amazing experience after another, and I wondered why I wasn’t interested in psychiatry before.

Have you ever been up close and personal with a “mad” person before? How was the experience?

R is for RUSH HOUR

Another short poem to keep you busy or maybe put you to sleep.

Rush hour
Sounds like running water
It is usually like a race
To vanish without a trace
Many anticipate the time 17:59
For me it is 13:59

We rush like there is a deadline
When what we think is what to dine
Rush hour is not just for workers
It is also for home makers
Cos if you have a dinner date,
You do not want to be late

At work, we say we vanish like methylated spirit
I wonder what terms you use to describe it

Q is for QUIET DOWN

The hospital is considered to be a very busy place, and quite rightly so. There are always patients to see, surgeries to perform, counseling sections to get to and so on. The list is actually endless. However, there are a few times when the doctors, nurses, patient attendants and almost the entire staff at the hospital become relatively jobless. Suddenly, there are almost no patients to see and you find yourself almost praying that they start coming. Let me just say that the job of a doctor is quite weird. We want to continue to see patients, to keep your mind busy, learn new things and earn a salary, but we can’t pray for people to actually fall sick. (That would just be plain cruel).

The period when we have these quiet downs in the hospital (at least in Nigeria), are festive periods – Christmas and Easter. It is usually amazing how patients begin to get well “miraculously” and want to be discharged in time for the holidays. Infact, some that feel they can manage discharge themselves from admission or refuse it from the onset. I have seen a patient who told me he’d come back for a surgical procedure after the holidays.

When the quiet comes, I treasure it and wait for the next surge. Do you get quiet days at work? How busy are your holiday periods?

P is for....

On Saturday, I missed out on my post for "P". It wasn't intentional and definitely not without reason. I intend to play catch up with this post, however, I'm now confused as to which word or words to use for "P". Remember I told you to watch out for P when I wrote this post? I'd originally planned to write a post titled "PAY YOUR BILLS".

However, after my early morning post on a casserole sauce, I decided to do my Saturday shopping and house cleaning and write my P post in the evening. Events didn't go as planned, another P came to visit and it was PAIN. Funny thing though, the pain became an experience, a medical drama (because I had to sent my hubby out late at night - I'm talking 11pm - to get me some pain relievers when the pain was getting severe), ended up not using the drugs after they've been bought. And pain is definitely health related. I'm much better now, thank God!

However, I guess I'll stick with my original plan of pay your bills. Many of us don't like to pay bills, doesn't matter whatever kind of bill it is, light bills, water bills, phone, cable e.t.c. The worst however is the medical bills. I don't know why I think this, maybe because I'm in the health sector. But I believe the main reason for this is that a lot of people feel like it's a waste of unplanned money. Nobody plans to fall sick. For example, you don't get your salary at the end of the month as say okay, I'll remove N5000 for when I fall sick. But we remove feeding money, gas, electricity, even money to fix our hair and buy that jeans we've had an eye for since the beginning of the month.

Second reason, we have payment issues in the hospital is because most of the time, apart from the initial consultation and admission deposit (in the case of an admission), the next payment is post recovery for admitted patients. Finally, asking someone who lost a relative to pay their bills can move very quickly into a violent situation if care isn't taken.

To avoid too much long talk, this photo best describes what goes down when it comes to paying bills in the hospital.

Have a swell day.

O is for OBSTRUCTION

Yesterday, was a terrible online day for me, could barely send out my post for “N”, not to talk of visiting other sites, commenting on their posts or even replying comments dropped on my blog. It was soooo frustrating, aarrrggghhh!!! Anyway, I hope today is much better. Today, let’s take a look at the word “Obstruction” and what it could actually mean in medicine.

Say the words “obstruction to many doctors (especially the surgeons), and I can almost bet you that the first type they think about is intestinal obstruction. They are however, not wrong in coming to such a conclusion. There are many forms of obstructions in medicine; many involve the intestines one way or another. The many types include;

• Intestinal Obstruction
• Airway obstruction
• Anal obstruction (constipation)
• Urinary obstruction (or retention as it is called) – urethral stones, posterior urethral valve, enlarged prostate)
• Hernia obstruction (actually called obstructed hernia, but I had to make it rhyme. Lol)
• Lymphatic obstruction (as seen in elephantiasis)

Okay, okay so you get the gist. Almost anything part of the body can be obstructed and many diseases are caused by obstruction. I’d love to share a story with you (you know I love to tell hospital stories, that’s why my theme is medical drama). It was a battle choosing between which tale to tell.

So this teenager was brought in by her dad with a vague complain, she didn’t want to say it in front of her dad. (You know how female teenagers can be – rolling my eyes). Anyway, sent the dad out and found out that she hadn’t been able to pass stool for a few days now, and urine since that morning. Ordinarily, I would have been worried, but the person in front of me looked okay. So, I dug a little deeper, and did some examinations and realized that she was just severely constipated and that indeed, somehow, it compressed a part of her urinary tract making it impossible for her to urinate as well.

Soap and water enema solved the problem. The girl was smiling within minutes. That was the first time I’d seen anything like that. Guess what though, another patient came in with the same problem a few months later in worse pain, but I already had an advantage right? – Experience. Like they say experience is the best teacher. You mustn’t be the one have the experience all the time though, (it might just kill you). You also learn from other people’s experiences.

Do you know of any other types of obstructions? What experiences have you learned something new from? Leave your thoughts in the comment box.

Cheers....

NEVER SAY NEVER

In medicine, we are thought that there are no absolutes, no always, no musts and definitely no nevers. We are also warned not to play the hero card, no matter how tempted you are to do so. It actually saves some trouble in the end especially in a place like Nigeria. The patient’s relatives may just say you killed the patient with your hero move. Today’s story is one that continues to be surreal to me each time I think of it. Take a read;

Sometime last year, a patient is rushed into the hospital, in a very critical condition, and as usual, the ER doctor was called to see the patient while still in the car. This is done for 3 main reasons; to determine if the patient is alive or dead, to know whether the patient would be referred or if the patient would be taken in to the ER to commence treatment. The nurses were already whispering BID (brought in dead) among themselves, to tell yoou how bad the patient was. The doctor was actually being called to confirm the patient dead this time around. She got to the car, and during examination, noticed that the patient had a gasp. The next set of events happened in a blur.

She drew the attention of a senior doctor, who ordered that the patient be moved into the ER. Immediate emergency treatments (all them adrenaline injection into the heart, oxygen, CPR, name it) were instituted. Long story short, the man survived. He had just had a heart attack. Very rarely, infact, almost never have I seen a patient survive one of those. The funny thing about this story is that the very next day when he could walk, all the investigations done, showed no anomalies. (Don’t get that till today).

Moral of this lesson: never give up and give the very best of yourself that you have to offer. Never say never!

 Cheers…

MAD ABOUT MALARIA

Malaria is a very common disease in the tropics especially Africa. Of 100% seen in the out-patient department (adult and children), over 70% are treated for malaria. Many Nigerians are treated for malaria at least twice a year, others every 2 months. Didn’t know how else to tell you about malaria, since it’s so common place so, I decided this very moment to try this. I used to write poems as a teenager, guess I’ll give it a try again starting …. Now!

I am very mad about malaria,

Maybe, because it sounds like black Maria,

Yes, mad as in furious with,

Not mad as in crazy in love with,

Mad because it makes me sick,

And I can even lift up a wick.

It is indeed a very mean illness,

Killing pregnant women and children is heartless,

It is caused by deadly insects called mosquitoes,

Their sting brings on the woes,

It comes with a fever,

And makes you shiver.

There is also cough and the flu,

And sometimes, diarrhoea too.

Though it may seem simple to the Nigerian,

Go tell that to the British or American.

How can you differentiate it from ebola fever?

Or any haemmorhagic fever?

If left unattended to, or poorly treated,

Malaria can leave the human fitted,

With complications like severe anaemia,

Renal failure, hyperpyrexia, cerebral malaria.

Even though there is yet no vaccine

At least there are many medicines.

LEARN HOW TO SAVE A LIFE

Have you ever been in a class and you are wondering about the benefits of the particular lecture? Well, happens to me a lot, but not this time. This lecture wasn’t just about theory (talk and go), it was a practical class on how to save lives. As a doctor, it is my job description to save lives. I have seen people die, have resuscitated some and watched some die despite best efforts at resuscitating them, because in Nigeria, frankly, I don’t know if any hospital has a defibrillator and very few have a mechanical ventilator. Shocker right? Today I want to share with you an experience I had after learning about basic life support (not bragging) and I also would like to pass on this information to you as much as I can. (It is an extremely wide topic).

THE STORY:

She was a neonate and she had been on admission for many weeks because she was born premature with a very low birth weight. Finally she was doing well and gaining some weight and awaiting discharge. One day, she stopped eating and I happened to be the one on call that night. Following her symptom – we decided to rescreen for sepsis and treat accordingly. It was discovered that her PCV (packed cell volume – blood level) had also dropped. So in addition to antibiotics recommenced, we also transfused her. Our treatment didn’t seem to be having much effect on her. She just kept having apneic attacks (stops breathing) requiring persistent ambubagging, suctioning and CPR as her heart rate was also dropping. We did this the whole night. I’m talking about 10 hours straight on one child, alternating with the nurse on duty. Finally, at 6 am, it suddenly occurred to me that something could actually be obstructing her airways despite all our work. I picked her up, turned her around and instituted the anti-choking technique, repeating it about 4 times, then, I drop her back on the resuscitare. A few minutes later, you wouldn’t believe the thick mucus that found its way out of her mouth. The apnea stopped and less than 18 hours later she was crying for food.

LIFE SAVING TECHNIQUES:

There are many things that threaten our lives every single day, some we aren’t even aware of. The scariest of these are the ones that cause sudden death, one minute someone is talking to you, the next minute, they are gone. Sometimes, these situations arise in people that have health problems already like diabetes and hypertension. These are not techniques like cutting up someone’s throat in a restaurant because they are choking like Sandra Bullock did in “the heat” or even opening up the chest wall to let out air in a person with pneumothorax, Christina and her boyfriend from “grey’s anatomy” and Reese Witherspoon in “just like heaven” already showed us how. Lol.

Okay, first things first, Identify the problem. Is the person choking, gasping, unconscious? Are there any friends or family members around who can tell if the parson suffered from a previous illness and if they are on any medications? 

Note** you cannot save everybody by yourself, so if you are trying to help, also make sure that arrangements are been made to take them to the nearest hospital. It’s all about teamwork.

An unconscious patient: check if the pulse or heart rate and the respiration are present.

• If there is no pulse rate and no respiration, check the eyes for papillary reflex. The pupils are the small, round black part of the eye inside the cornea. The cornea can be black, brown, blue or green. Normally, when light is applied to the pupils, it reacts by constricting. In a dead person, the pupil is dilated (i.e. wide open and there is no reaction). If the pupils are dilated, there is no need resuscitating as it shows that the person is brain dead. Well, at least in resource poor countries where we don’t have life support machine to place a person on, and if we did have, it would be a strain on the family’s pocket.
• If the heartbeat is present and/or dropping, and there is no spontaneous respiration, commence CPR (cardio-pulmonary resuscitation). CPR involves doing chest compressions and breaths to the person. Breaths could be given with an ambubag or mouth-to-mouth. 30 chest compressions to 2 breaths in an adult and 15:2 in infants. When giving the breaths make sure that the chest wall rises up. Continue until help comes.

Wikimedia.com

• An unconscious diabetic: better to assume that the unconscious is from hypoglycaemia (low blood glucose). Just give the person a cube of sugar or a bottle of coke and rush to the nearest hospital. This is because hypoglycaemia kills a person faster than hyperglycaemia (high blood glucose).

In a choking adult, do the Heimlich’s maneuver.

• Wrap your arms the person from behind, with one hand firmly holding the other in a fist. Place your folded hand between the stomach (above the umbilicus) and the chest (just below the xiphisternum). Place the person’s legs at “at ease” position, and your right leg in between theirs. Then thrust upward to dislodge the object.

Thefreedictionary.com

• In infants, sit on a chair with your left leg slightly extended at the knee joint to about 100 degrees. Place the child on your left arm resting on your left leg, tilted head down and smack on her back 5 times, turn her over face up on the right arm and apply 5 chest compressions with the index and middle finger of the left hand. Check to see if the object comes out. If it dislodges, remove it, if not, repeat the process.

Photo credit: smmhc.adam.com

Where to check for pulses:

There are so many places in the body where the pulse rate can be palpated peripherally, however, with rapid decompensation, the body focuses blood supply to the vital organs like the brain, heart and kidneys and withdraws from the periphery like the legs. In these instances, it is better to check for the heart rate in these parts;

• The radial pulse is at the outer part of the wrist (same side as the thumb).
• The carotid pulse at the junction between the base of the mandible (jaw) and the neck.
• The heart rate on the left side of the chest. It is usually the last to disappear. Though very rare, some people have their hearts on the right side

I hope you would be able to save some lives with this information.

Cheers……

ARE WE PERFECT?

Just pondering on a very common belief and wondering why? Why do people say no one can have it all? Commonly, it is believed that a woman cannot have both beauty and brains. However, if she does, then there has to be some sort of problem with her relationship life, or she has to have some other form of unfulfilment. For a man, he either has to be a smoker, an alcoholic or a womanizer. Notice that nothing is said of how he looks, if he’s intelligent or even his pocket size.

These same postulators of the above mentioned theory go on to say that, “a good girl always gets the bad guy and vice versa”. These all cummulate to the one ultimate belief “that no one is perfect”. The funny thing about all these is that we all swallow it hook, line, sinker, fisherman and boat. We believe it and pass it on, to the next generation.

About being perfect: Is our creator – God – perfect? Does he make imperfect things? Like; does he set out to create a person then says, “Oh I just have to make this person as ugly as a duckling, and the next as beautiful as a swan?” Who says a duckling is ugly by the way and a swan is beautiful? (Its neck is too long – just kidding). But seriously though, who determines who and what is perfect and what isn’t?

I remember reading in the bible that we are made in his (God) image and likeness. If we are, how come we are imperfect and he is perfect? To show you that God tries to remove imperfection from the world, this is my medical evidence. Did you know that about 85% of first trimester miscarriages are those of fetuses with one chromosomal abnormality or the other?

I think most of our imperfections come from our experiences, decisions, mistakes and actions. For instance, a pregnant woman that smokes and drinks alcohol, shouldn’t blame anyone but herself if an imperfect baby is delivered. A young man with risk-taking behaviour has himself to blame if living life on a fast lane catches up with him.

Finally, I am sure that, in God and with him we are perfect just the way we are. This is just me thinking out loud. I may be wrong. I would like to know what you think about it though.

Cheers……

K is for KEEP CALM

Finding the title and what to write about for letter "K" wasn't particularly easy. Thought of writing a piece on kidney diseases, as it is one of the deadly diseases ravaging the world at the moment; enough to have a day allocated to it. Realized though that I already wrote that article here. *Phew!*. Today, I'll be telling you a funny story, something that happens in the ER more often that people realize. Here it goes:

Have you ever been in a situation that you felt totally helpless about? You want to scream but you just have to keep calm because there are so many other voices in your head giving you reasons why you can’t let go. Well I’ve been in some of those especially in the hospital. Most of the time it has to do with patient dissatisfaction, either they aren’t happy with the service they’ve received, or they lost a patient they believed shouldn’t have died or even sometimes transferred aggression; it has nothing to do with you or the system but they just need to blame someone.

Imagine this scenario; a young man is rushed into the emergency room on a Friday night by his “friends”, (weekends are the busiest days). He had been in a fight at the club over the usual – a girl. He sustained a deep laceration to the scalp from a bottle broken on his head and his was semi-conscious not just from the acute blood loss, but also because he was drunk. 

As is the protocol at my centre, the patient is placed on the couch for vital signs to be taken by the nurse and a quick assessment to be carried out by the doctor, me in this case. Minutes later, vital signs obtained, assessment completed and the friends are yet to return from the records where they were sent to, to obtain a new case file for the patient. The case file was needed at this time so I could write out my initial management and the medications can be collected from the pharmacy to commence treatment.

Further enquiries into the whereabouts of these friends revealed that they were still indeed at the records with no money to obtain the file. I wonder what happened because the next thing I know, these guys came back, no exploded into the emergency room, asking for the doctor, wanting to know why treatment couldn’t be started without a case file. I noticed that they too were drunk and now aggressive, tending towards been violent. They started talking about guns and shooting and all hell broke loose. 

That wasn’t a day to keep calm; I bolted through the back door as did some of the staff. I’m pretty such someone would have passed through the window connecting the ER and the pharmacy if it were big enough. The security finally got involved and exiled the boys from the hospital premises. Fortunately for the patient, certain other policies were in place in other for him to get adequate treatment and pay later.

If you are wondering why we have such a policy as “pay before service” in a hospital that is meant to save lives, then keep an eye out for “P”. Keep in mind that these guys had money aplenty to get drunk but not for their health.

JUGGLING JOBS

Last year as I planned and prepared for my wedding, (you can get the stories here and here), my siblings always teased me about having to do so many things at the same time. They used to jokingly call me the lady with 4 jobs; medical doctor, interior designer, blogger and wedding planner, lol. What we didn’t put into consideration was the fact that indeed I was going to have 4 jobs at the end of the wedding – wife/homemaker.

The tricky part then became how to create enough time handle these jobs efficiently. One thing is for sure, they can’t each be given 100% of my time but they can get 100% of my dedication. The final solution was quite simple – juggling.

Started and ended this post more times than I care to remember. Started with the post title “juggling duties” and ended with “juggling jobs”, guess that’s the point of the challenge. It has to be challenging sometimes, not just easy breezy.

INVESTIGATING THE PATIENT

Okay, it's time for my atozchallenge post for today and I is for Investigating the patient. I'll start with a story;

Once upon a time, a man fell ill and ran to the nearest laboratory to get tested. Since he wasn’t science oriented, he allowed the “lab scientist” run a test on him. At the end of the day, he was told he had ESR – erythrocyte sedimentation rate. These lab scientist administered treatment in the form of intravenous fluid with vitamin B-complex in it. After that, he paid N5000 and went home. When he didn’t get better after 3 days, he was in the hospital with this tale. I don’t know how I managed to hold my laughter. My laughter was caused by the fact that ESR is not a disease, it is a test!

In Nigeria, (don’t know about other countries) when people fall sick, they tend to follow 3 major pathways;

• the ones who seek care in the patent drug stores like I have elaborated here,
• the ones who go to the laboratories (within or outside the hospital premises) and,
• the ones who go to see the doctor for consultation and expert advice.

Of the above named groups, the first takes the chunk of the patient load (surprising eh!), while the third has the least, until the people in the 1st two groups develop complications or aren’t getting any better then, the equation slightly reverses. Today however, I’d like to take a look at the fraction that seek out laboratories and tests before consulting a doctor if ever they do.

Over the years, I have seen several patients who ask this one question after the consultation and are asked to go home on just medication. That question is “Ah ah, doctor! No test?” Many times I have also seen some who come and when asked; “how may I help you?” They reply; “doctor I did some lab tests, and here are the results.” Usually, I have to take a deep breath, collect the results, keep it on my desk and repeat my question. I do this to avoid any form of bias. To be able to effectively treat the person and not the paper (that might have wrong results by the way – anything happens in naija). The worst I’ve seen so far till date are the patients that go to some chemist shops or labs and stand on a machine that pretty much like a weighing scale to me, others are told to hold on to something. These devices, they say are from China (no offense), and they are able to tell a person the type of illness they are suffering from without drawing blood or urine or any specimen for that matter. It doesn’t matter if you were fit as a fiddle before you got on the machine; you just have to have a diagnosis allocated to you. Lol.

It finally hit me that this group of people placed more emphasis on getting a diagnosis from lab tests than from actually visiting a well trained doctor who can marry symptoms and signs and determine the necessary investigations. There are 2 schools of tort on the use of investigations for patients (at least that’s what we are being told), the American school that says, run a barrage of tests to find the cause and treat. The British school that says, take a good history, examine and make a diagnosis, then investigate along the pathway. For me, I think moderation is key, as always. To be able to differentiate between the patients who require a lot of tests, few or none at all. Because, in a resource poor country like Nigeria, it would be useless to a patient, to have plenty test results and no money left to obtain the required medications for treatment.

I would love to know how you really feel about doing investigations/tests.

A little fact: In many developed countries, the use of investigations/tests in medicine has been for a very long time (couldn’t find a particular date).This is not the case in Nigeria. I just found out from one of Ben Carson’s books that while they already had ultrasound scans in the USA in the 80’s, I did hear of one until 2005 and didn’t see one until much later. The CT scan and MRIs we hear of today and are still struggling to get (fairly used ones for that matter) into our federal hospitals have been since the 90’s if not longer.