Category Archives : HEALTH

Girls: Growing Up

As the adolescent grows up, the body begins to change in size and shape. This change starts happening from around the age of 10 or so. The change could be earlier or later. You may suddenly find that your shoes and clothes do not fit you anymore. Hairs begin to grow in the armpits and the genital areas.

At this time, you also begin to get more conscious of your body and your appearance. What do people say about my shape, colour and appearance? Am I attractive to the opposite sex? If not, why? What do I do to ‘belong’? Your skin may become oiler and attacked by pimples. Keep your face clean by frequent washing (but not too much soap), avoid fried foods like those crunchy chips and burgers. Engage in regular exercise to prevent pimples and help look your best. Because you are growing very fast, your food requirements may increase. Eating a balanced diet with lots of fruits, vegetable and milk also helps you look smart and feel fit.

These changes happen because of adjustments in the natural chemicals in the body called hormones. Boys and girls have different amounts of different hormones. This is why some of the changes that take place are different for girls and boys- for example; boys have more body and facial hair growth than girls. Let’s look at some of the changes that occur in girls.

GIRLS

As a girl grows older, her breasts begin to develop. Sometimes there might be a slight soreness or pain as the breast grow. This soon passes. You must have noticed that breasts may be round, conical, upright, sagging, soft or firm depending on age and fitness. The two breasts may not be equal in size, experts say. The tips of the breasts are called nipples. They are dark in colour and highly sensitive to touch and temperature. If the darker areas round the nipples are touched and stimulated, they become hard and seem to stand out like goose body. This is called nipple erection. This happens to both men and women. The breasts produce milk only when a woman is suckling her baby and stops when the baby rejects the mum’s milk. If there is secretion from the breasts at any other time, experts say you should consult a doctor for explanation.

Women wear bra or brassiere to support their breasts. As a girl’s breasts grow, she may need to get a different sized bra every couple of years till her breasts stop growing. Some of you may need to wear a bra earlier or later than your friends. There is nothing unusual about this. Everyone grows at a different pace.

When to wear a bra?

You know you need to wear a bra when your breasts have grown big and jiggle, flaunt or bounce as you run; when they are heavy enough to pop out of your blouse as you move about. You may feel more comfortable wearing a bra especially if you go jogging or if you are the sporty type. The rightbra for you is one that supports your breasts like a second skin. Wear a bra that is neither too tight nor too loose and preferably a cotton one. Take off your bra at night to allow for proper blood circulation so that you can breathe comfortably while asleep.

Why is your child dull?

In a previous edition, we discussed the dream of every parent: a child which will excel in school and his chosen endeavour. We went on to discuss one of the factors which could mitigate against the realization of the dream. In this edition we shall discuss partial deafness as one other factor which could make a parent’s dream a mirage.

What Is Partial Deafness?

The loudness of sound is measured in decibels (db). The normal child hears sound whose loudness is between zero (0) and thirty (30) decibels. When a child fails to hear a sound whose loudness is 30 decibels or below, that child is said to be partially deaf. Partial deafness could affect one or both ears.

What Are The Warning Signs of Partial Deafness?

Parents and teachers are in best positions to recognize partial deafness early. Therefore they must always look for the warning signs which are listed below.

1.            Failure to carry out simple instructions correctly at home. In most cases, the child did not quite hear the instruction given and so carries out what he felt could have been the instructions. Such children are sometimes punished in ignorance.

2.            If a child listens to very loud music or turns on the television very loudly much to the discomfort of others in the living room, then he could have some hearing problem.

3.            If a child seems “inattentive” at home, then the parents should suspect hearing problem.

4.            If speech development is delayed in a child, hearing problem should be suspected. Normally, by the age of 6 moths, a child is able to localize sound and should turn and look directly at the source of sound; by the age of 2 years, he should understand simple commands and put words together. Failure to do this could mean partial or total deafness.

5.            If a child fails to easily hear what the teacher says in class even when in front of the class, then hearing problem should be suspected.

What Are The Causes Of Partial deafness?

a.            Discharge from the ear. This appears to be a common cause of partial deafness in our environment and is due to an infection of the middle ear. If a hundred school children are examined today, about 5 per cent will be found to have ear infection. Some parents do not take ear discharge seriously and so the infection is allowed to smoulder on leading occasionally to persistent “cold”.

b.            Wax. Wax is also very common in our environment. Wax prevents sound waves from reaching the ear drum and middle ear where it is augmented. If about 100 school children are examined, over 40 will be found to have wax in their ears.

c.             Foreign body: Some children are fond of putting foreign bodies such as bead or bean seed in their ears. If not removed, such a foreign body could prevent sound wave from reaching the ear drum and could cause infection in their ear. Both effects could lead to partial deafness.

d.            Infections: Certain infections like meningitis (infection of the covering of the brain) mumps and syphilis could produce severe hearing damage.

e.            Infection during pregnancy. If a woman is infected by German measles (rubella) during the first three months of pregnancy, the risk of deafness in the child is about 30 per cent. Syphilis is also incriminated but the risk is not as high as that of rubella.

f.             Neo-Natal Jaundice. If poorly managed, neo-natal jaundice could affect the inner ear leading to deafness.

g.            Birth injuries. Injuries to the head of the baby during child birth could lead to partial or total deafness. If the oxygen supply to the brain is compromised during child-birth, partial or total deafness could also result.

h.            Drugs. Certain drugs such as streptomycin or neomycin could cause deafness in the baby.

i.             Heredity. Certain malformations of the ear run in families especially the inner ear. Children born into such families are certainly at high risk of being deaf and so should be screened early through for early diagnosis and treatment.

Treatment.

Some of the causes of partial deafness are amenable to treatment and hearing restored to normal.

All cases of ear infection or pain in the ear should be seen by a doctor. Most of the infections succumb to appropriate antibiotics. Wax in the ear passage can be safely removed by trained personnel either by picking it out or by syringing. Foreign bodies can also be easily removed by use of instrument. Chronic ear infections will normally be referred by the general practitioner to the ear, nose and throat surgeon for expert management.

If hearing loss does not improve on treatment, then the use of hearing aid is recommended. Hearing aids may be available at E.N.T. clinics and hearing and speech centres in Nigeria.

Some of the conditions require surgery. Should the doctor advise an operation, the earlier it is done, the better for the child.

Prevention

1.            All children at risk (those who had neo-natal jaundice, birth injuries, etc.), should be    screened between 6 and 12 months to determine their hearing status. If partial deafness is diagnosed, a hearing aid can be fitted at 12 months of age to ensure proper development of speech.

2.            All children should be screened for hearing defect on entering primary school. This screening involves physical examination and audiometry.

3.            Ear discharge in children whether “milky “ or clear should be reported to the doctor for appropriate treatment. Even after treatment, these children should be seen regularly by the doctor to exclude any hearing loss.

4.            All pregnant women should take drugs prescribed by the doctor. Drugs such as streptomycin and neomycin should be avoided.

5.            Cleaning of the ear passage should only be done by trained personnel. Untrained personnel using cotton buds only succeed in pushing the wax further.

6.            All children should be immunized against measles by 9 months of age.

7.            Cases of persistent “cold” in children should be reported to the doctor. If left untreated, fluid could accumulate in the middle ear leading to partial deafness.

8.            Persistent fever should be viewed with seriousness and medical attention sought. It could be due to encephalitis or meningitis.

9.            Pregnant women exposed to rubella should still report same to their doctor so as to be given gamma globulin for protection.

10.          All children who are awkward, inattentive or slow in understanding should be taken to a doctor for hearing test.

The term “Neonatal Jaundice” (NNJ) refers to the yellow discolouration that appears in the eyes and/or skin of a baby anytime within the first month of life. It is due to an excessive amount of BILIRUBIN in the blood. Bilirubin is a pigment formed when the red cells (RBCs) in the blood die or are destroyed. Normally it is acted upon in the liver and passed out of the body through the intestines so that its concentration in the blood is very small. If however, red blood cells are destroyed too rapidly or in excessive amounts, or if the liver is not functioning properly, or if the intestine is blocked, preventing bilirubin from leaving the body, its blood concentration may rise and jaundice results.

We worry about Neonatal Jaundice because sometimes, bilirubin (especially when the blood concentration is very high, and before it has been acted upon in the liver) can enter the brain of the baby, causing severe brain damage or even death. The importance of preventing these very distressing events is therefore obvious.

What causes Neonatal Jaundice?

Sometimes jaundice is in fact “normal” in a newborn baby. It usually appears on the third day of life. It is only mild and does not persist for more than a week. Jaundice appearing within the first 48 hours, or rising above a certain bilirubin level, or present beyond the second week of life, is not normal and, therefore, requires investigation. The cause is not always found, but the most frequent causes in our environment include:

1.            Blood incompatibility:

Sometimes a baby’s blood does not “agree” with that of his mother. During her pregnancy, substances called ANTIBODIES then form in her blood and cross the placenta into the baby’s blood. These antibodies are harmful to the baby’s red blood cells, which they “attack” and destroy in excessive amount leading to Jaundice.

2.            G6PD Deficiency:

G6PD is a substance normally present in red blood cells. It protects them from being destroyed too easily. In some babies (usually boys) G6PD is deficient and the red blood cells are unduly fragile. If such babies are exposed to certain chemicals such as camphor often used in preserving the baby’s clothes, the fragile red blood cells are destroyed, and jaundice results. The camphor is absorbed through the baby’s skin. Some ointments and powders used commonly in dressing the baby’s cord and navel contain menthol and have the same effect.

3.            Infections:

Newborn babies are very prone to infections because they have little or no resistance. Some of these infections may cause neonatal jaundice. Certain infections such as syphilis or German measles (Rubella) affecting the mother during pregnancy may be passed onto her unborn child and cause neonatal jaundice. Newborn babies may also suffer from hepatitis, just like adults, and become jaundiced s a result of inflammation of the liver.

4.            Prematurity:

If a baby is born before the usual nine (9) months , the liver may not yet have developed enough to cope with the bilirubin formed in the blood. Consequently, premature babies develop neonatal jaundice very easily.

 

IRREGULAR MENSTRUATION. Yemi, an 18 –year old clerk has not had a period since her last D & C (standard abortion procurement) six months earlier, her fourth D& C since the age of 15 years. Each was done after she had missed her by about seven to ten days. No prior clinical examination of pregnancy test was done or even suggested. No counselling was given. We later found that Yemi had Asherman’s syndrome- a complication of D & C that may make her infertile. Was Yemi ever pregnant or not?

Menstruation is the outward manifestation of very complex series of chemical, hormonal and physical changes which occur in the female in anticipation of and preparation for normal pregnancy. If conception fails to occur, the lining of the womb is shed.

This shedding is menstruation. It is therefore described as the weeping of a disappointed womb. Pregnancy is thus the commonest cause of a missed period. HOWEVER THERE ARE OTHER CAUSES OF MISSED PERIOD especially in adolescence – I have emphasised this because many young girls like Yemi have gone to “procure abortion” or have been encouraged to “procure an abortion” by all sorts of practitioners in the country, simply because they missed their period. The need to confirm pregnancy before a decision to keep or terminate it cannot be over-emphasised. This, will definitely save many a young lady tremendous agony and misery in later life.

Menstruation is only one of the many changes that occur in adolescence. Adolescence is characterised not only by the magnitude and rapidity of physical changes of sexual maturation but also by an important process of psychic maturation. There are qualitative and quantitative changes in the sexual drive, affecting the behaviour of the adolescent. A change in role from dependent child to independent autonomous adult slowly occurs.

Psychological factors also have significant influence on the rhythm of menstruation. The normal menstrual cycle that is from the first day of the period to the first day of the next period is 28days plus or minus seven days (i.e. a range of 21 to 35 days). There is significant person to person variation in the length of the cycle and sometimes there is variation in cycle length in the same individual in the absence of disease or pregnancy. Irregular menstruation may present as infrequent menstruation (Oligomenorrhoea) where the length of the cycle is increased or as very frequent menstruation in which case the cycle length is shortened (Polymenorrhoea). In the adolescent age group, other abnormalities of menstruation worthy of mention would include: – excessive menstrual bleeding menorrhagia delay in onset or failure to start menstruation, and painful menstruation. Due to the very complex nature of the control of menstruation and the other factors which affect it, including emotional factors, the early periods may be very irregular and many of them are not associated with ovulation. It is not unusual for a young girl to have her menarche (first period) and not have another for months. It becomes regular after two to three years and would have regularised in most people by the age 18 years. In a small number of people, the periods however will remain infrequent even after the age of 20.

In this group of people in whom spontaneous conversion to regular cycles does not occur, a number of them would present later as sub fertile (or infertile) patients and would require treatment to have regular periods. There are also some abnormal conditions or diseases that may occasionally be the cause of irregular periods in the adolescent. It is therefore advised that if a girl has not established normal menstruation after the age of 16 years, she should see a gynaecologist. Most gynaecologists would normally and appropriately not start active treatment immediately unless an obvious abnormality is present.

However counselling will be done. If the condition persists after the age of 18 in the absence of any abnormality the patient is usually treated with contraceptive pills for about four cycles. Menstruation is regular when the oral contraceptive is used properly and after withdrawal of the pill, many of the patients would revert to a regular rhythm. If this fails a D & C (Dilation and Curettage) may be done. An additional number of patients would revert to a regular rhythm at this stage.  For those who haven’t hormone therapy using the pill may be repeated. Where this fails further treatment may be deferred until pregnancy is desired when ovulation may be induced and cycles regularised with the use of fertility drugs.

It cannot be over-emphasised that irregularity of periods especially in the adolescent should be managed by a competent and well trained doctor. It is even more important in our environment as there is an association with future fertility and this society still places so much weight on reproductive ability.

HIV, Exercise & Diet              

Introduction: ever since the dreaded HIV Virus was made known. It has been panic all the way. In this edition we shall take a careful look at useful hints on how to manage the dreaded Virus through exercise, relaxation and diet intake.

 

KNEE REPLACEMENT FOR THE ELDERLY

Her name is Josephine Fejokwu, a sixty year old widow from Delta State who resides in Lagos. History was made some years back in the Lagos State healthcare delivery system when she benefited from the first total knee replacement surgery done by a team of local surgeons at the Lagos State University Teaching Hospital, LASUTH, Ikeja. Consultant orthopaedic surgeon Dr. Ladipo Olawale led the team of surgeons from LASUTH and National Orthopaedic Hospital, Igbobi, in the operation that lasted for two and half hours. The sixty year old woman confided in Truhealth that her knee problem which medical experts called osteoarthritis of the knee started ten years ago.

Mrs Fejokwu explained how she became the first beneficiary of the free knee surgery. “I went for treatment at National Orthopaedic Hospital, Igbobi. I was told I needed to go for surgery for which I would pay about eight hundred thousand naira. At first I ran away. Later a doctor at Igbobi told me to go to Lagos State University Teaching Hospital. When I got there, the doctors examined me and asked me to report daily for treatment. One day, I was told there is a free surgery for knee problems. I could not believe it myself that the Lagos State would treat me free. It is unbelievable; so I thank God and I am very happy”. The Commissioner of Health, Dr. Jide Idris, said the surgery seeks to help elderly patients that cannot be accommodated in the major programme of limb deformity and corrective surgery started by the last administration. He said the state periodically sorts out cases who are adults with arthritis who require mobility aids but could not do operation .

He said “we decided to support the project when the recommendation was made for many reasons. We are equipping the facility in this teaching hospital which is supposed to provide specialized care for the patients. Secondly as a teaching hospital we are supposed to be training staff. So, this is another avenue to build capacity along other specialty. Thirdly, this is a crippling disease and some of the patients we have seen are very poor people who can also benefit from the free health programme. The Commissioner of Health further explained that this knee surgery was a pilot of programme which is a partnership between the state Ministry of Health and the company, Smith and Nephew who provided the instrumentation based on the fact that a number of implant of the knees were purchased from them.

Meanwhile, Dr. Ladipo Adewole who led the team of surgeons said the old lady was diagnosed for osteoarthritis which is a disease characterized by irreversible erosion of the cartilage which covers the ends of bones where they are approximated from joints. He added that the knee joint is formed where the lower end of the thigh bone (tibia) join. The knee cap (patella) is placed in front of this joint. Dr. Adewole explained that osteoarthritis is caused by localized pressure on the cartilage structure as a result of deformity or obesity, weakened cartilage structure due to rheumatic diseases and weakening of bone supporting the joint cartilage as is seen in sickle cell disease. He stated that the symptoms include pain, swelling, deformity and instability of the knee and the diagnosis is confirmed by x-rays.

In the past, medical experts treated osteoarthritis by administering pain relievers and anti-inflammatory drugs as well as physiotherapy, weight control, and waking aids. Results from this kind of treatment were largely unsatisfactory because of persistent pain and difficulty due to decreased mobility. By this bold step, Lagos state is poised to retain its place as the premier state in the provision of healthcare in Nigeria.

The prototype of the instrumentation for total knee replacement as it is known today was designed by an English man living in New York as far back as 1972. Presently 150,000 total knee replacements are performed in the USA annually.

POLIOMYELITIS (POLIO)

POLIOMYELITIS is an acute infectious disease that may result in severe physical handicap (paralysis). It has probably been recognized for centuries but first appeared in a medical textbook “disease of children” by Michael Underwood in the late eighteen century. The causative organism was discovered by Landsteiner in 1908. The virus is excreted in the faeces of affected person and is acquired through the mouth (faeces oral route) by faecal contamination of water, food and by direct handling.