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The Curious Case Of The Everlasting Cough……by Peju Adeniran

If you ask most people what a drug addict looks like, they will paint you a compelling picture: “An Un-kempt person in rags with uncombed hair, sitting on a rubbish dump, and looking aggressive.”

Well, that is not quite right as we will see in a minute.

This edition, I want to focus on something that is very solemn and disturbing. A while ago, I served as a health consultant to an educational consulting establishment that focuses on child and adolescent education in Nigeria. In one of our programmes, we had cause to give a series of lectures about illicit drugs, drug use and the Nigerian child.

I had to give lectures to parents, not only about the dangers of drug use and the possible complications, but how to recognize and prevent drug use among their children and their wards.

What struck me the most was how, because of previous media campaigns and education programmes, most of the people had an idea of what a person with a drug problem looked like. Remember the one I shared at the beginning?

But the truth is that in many cases, signs of drug use are less obvious, much more subtle, and therefore likely to have caused a lot of problems and had a lot of consequences before they are detected.

It was a great irony to me that the first time I would hear about the “cough problem” it was brought to my attention not by doctors or medical media but by a patient.

She had come for a different complaint of her own and after consultations and counseling was already on her way out, when she turned back to me and asked if there was any permanent cure for her son’s cough.
“Cough? Tell me more,” I enquired.

“Well,” she said. “He has had this cough now, for over six months and it has refused to go in spite of the over the counter cough medication he has been using.”

The various tests showed that there was nothing wrong with him, nothing in his lungs or otherwise, but she didn’t know what else to do. I asked her to bring him in to see me, but they never came back.

I sort of forgot about it, until I read somewhere, in a newspaper I think, of someone who had written in to comment about a disturbing new trend involving teenagers and Codeine.

The article described an eye-witness account of some teenagers who had flocked outside a pharmacy before eventually cajoling a passing adult into helping them go inside and purchase something.

The man had hesitated, but after the promise of quick cash, eventually went in and came out with an innocent looking bottle of cough syrup that had Codeine in it.

She wrote in, a little concerned about what she just saw, but not really sure why.
Now, you see; Codeine is a powerful sedative drug, a popular pain-killer medication because of its selective effect on central nervous depression. It is also used to treat cough and cold conditions, mostly to allow the body to rest and accommodate the effect of the active ingredient in the drug.

Codeine also produces a dreamy or euphoric feeling of well-being, that could also blunt emotional feeling as well as physical and emotional pain.
This makes it nearly ready-made for addiction.

Some patients develop this addiction through no fault of their own but for others, it’s very deliberate. For the teenager with no access to “street” drugs Codeine can and has become, for so many, a convenient drug of choice, because it comes “clean in a bottle, is sold in a store, and is just a little fun”

As I paid more attention to these two incidents I finally uncovered a disturbing trend; that this thing has been going on for far longer than many of us parents, doctors and relevant authority have paid any attention to.

Teenagers, (and some adults actually) walk boldly into a drug store, complain of cough that does not let them sleep at night and then go: “please can I have that cough medication, the one that has Codeine it. Thank you?”

Febrile Seizures……By Eghosa Imasuen

Full disclosure: I suffered febrile convulsions as a child.

A Febrile seizure is a convulsion that is associated with a significant rise in body temperature in children aged from six months to five years. Families in Africa can tell an episode is on when the child suddenly goes into a fit when he/she has a fever caused by malaria, or other culprits like respiratory infections, ear infections, urinary tract infections etc.

This is what happens: The child suddenly goes stiff, the limbs start twitching and the eyes roll back in the head. A typical episode lasts for less than a minute, a period when the mother’s terror makes it seem like hours, ages even. The child may poo or pee, may breathe irregularly, and turn darker. There is almost no sequela after an episode. And most children will outgrow these episodes before they reach the age of five.

And because of the peculiarities of our environment—malaria, viral infections, bacterial sepsis, genetics—we have children who are exceptionally prone to these.

One sign in African adults who suffered febrile seizures as children are the “fever marks”—small facial scarifications. You must have seen them in friends; two small vertical lines, a few centimetres long, on either cheek. Thankfully incidence of these facial marks are declining as more and more parents become educated about what to do when a child convulses during a fever.

My mom tells me stories about my episodes. Of how, on the day of my first birthday party, I went swiftly from a fever to a fit as I had done a few months before, and she and Dad rushed me to the hospital. But as soon as I was in the car, with the wind rushing in and the lulling drone of the engine I suddenly relaxed and slept the rest of the way to the clinic. They had a hard time convincing the doctor of what had just happened. She says the doctor gave me paracetamol syrup, told her to continue the chloroquine she had already started giving me and the birthday went ahead as planned.

She recalls how she had to fight off my granny who wanted me to receive the facial marks, so that the convulsions would stop. She also remembers the old wives tales and other supposed remedies: palm kernel oil applied all over the child’s body will stop the convulsion immediately. Put the child’s feet in the fire, that will drive the demons away. Swathe the child in warm blankets so he can sweat the convulsion away.

None of those treatments work, and may actually worsen things. You see, no one knows what really causes febrile convulsions are. There is a genetic link, as having a first degree relative—parent, sibling—who suffered from febrile convulsions predisposes one to it. The only thing doctors are sure of is that the parent or care-giver must endeavour to bring down the temperature of the child. This can be via physical methods—tepid sponging, i.e., using slightly-above-room-temperature water to douse the child—or via oral doses of paracetamol or ibuprofen syrup.

The main concern for your doctor is to promptly distinguish your child’s febrile convulsion from more sinister causes of seizures in children. Thus when you get to the hospital, your doctor will ask about the duration of the seizure; doctors set a benchmark of fifteen minutes as the cutoff point between simple febrile seizures and complex febrile seizures. The doctor will ask if the seizures occurred at the height of a fever. He will ask how long the child had been sick. He will ask for a description of the attack, if the whole body was involved or if only a part. He will ask for a family history of such seizures. He will ask what the child did after the seizures—did he go back to playing; did he look normal. All these questions are to confirm what is probably true—that the child suffered from a self-limiting, albeit terrifying to watch, condition.

And you? What are you supposed to do? Keep the child away from danger. Never take a small rise in body temperature for granted.  Expose the child, tepid-sponge him, give him Emcap paracetamol suspension or any other paracetamol suspension (please do this while he is still awake, not when he is fitting. And go to the hospital as soon as possible.

What should you never do? Do not rub palm kernel oil all over the child, it will cause a rise in temperature and worsen things. Do not put the child’s feet in the fire. Do not stick a spoon in the child’s mouth in a misguided attempt to prevent him from biting his tongue; you will just end up worsening things. And, finally, do not mark the child’s face.

“Spanish Fly” and Other Concotions. . . . by Peju Adeniran

You will recall that in my last piece, I shared with you a story from when I was a “Baby Doc’ in medical school. My Professor had told me that in clinical practice I would find all kinds of human reactions to the idea of sex and sexual performance.

And so I return again to the sad story of the young undergraduate who, allegedly and inadvertently poisoned a friend with a “sex enhancing” drug presumably with the intent of not just having sex with her, but with plans to make the experience a much more pleasurable one for both of them.

As was alleged in news reports, the story ended tragically with an allergic reaction to the drug, and is still a pending investigation.

That story brings to mind how many people, (and I am restricting my comments to Nigeria where I practice,) dabble with sex enhancing drugs for entertainment without proper knowledge of what they really contain and the possible side effects.

Various potions and drugs from the benign to the ridiculous are advertised to enhance sexual desire and performance. When you run through the list from the harmless ones like malt stout and “suya” pepper, garlic marinated in alcohol, to “honey moon snacks” like exotic dates and nuts which are popular in the north, and the Yohimbe tree (Corynanthe yohimbe) bark steeped in alcohol to the dangerous ones like caffeine stimulants, herbal concoctions, and narcotic drugs, it becomes quite clear that bedroom anxiety is a real enough medical issue for many.

Let’s take the “Spanish fly,” which is the stuff of legends.

As a teenager in secondary school looking to head to University, one of the earliest stories I was told about the university was that girls who were too friendly with boys on campus would have “Spanish fly” slipped into their drink when they weren’t looking, and subsequently be robbed of their virtue.

I made a solemn vow there and then that when I got into the university, I would always have enough money to pay for my own soft drink and to never let it out of my sight.

It was a fortunate thing, even though disappointing for my curiosity that I never saw or heard about “Spanish fly” in all my years in the university.

But then I eventually got to see this drug in clinical practice when a patient who had been having sexual difficulty at home brought it to me, early one morning, to ask whether it was safe to use with his wife.

It was quite an unremarkable powdery substance in a small, brown bottle. He bought it at a very expensive price; he said and wanted to have a medical opinion on its safety, especially since his wife had asked him to.

Now you see, “Spanish fly” is a specific type of drug that is gotten from a beetle called Cantharis vesicatoria or Lytta vesicatoria.

The truth about it is this; when taken in moderate doses Spanish fly produces irritation of the genitals which results in an increase in blood flow to the area thus mimicking the engorgement and erection that occurs with sexual excitement.

However, this drug can be extremely toxic when ingested and may cause priapism; a very painful and dangerous condition in which the male has an erection for an extended period of time—hours or even days.
In spite of my lengthy explanation, my patient, holding on to the bottle with all the hope a person could have, still asked me;
“Ok Doctor, but… does it work”?
“Well, yes. And no,” I told him.
I had to break his heart that day, and to make sure he didn’t do anything stupid, I took the bottle from him before sending him home. The small brown bottle remains in my work drawer to this day. (And it is still unopened, I swear!)

Now, there are some people for whom sexual dysfunction is a real problem, and I do empathize, having seen first hand at work, how distressing a condition it can be.

Most problems of sexual dysfunction are not solvable by drugs, but instead through lifestyle modification and counseling.

But a great number of people continue to try quick and usually dangerous fixes to the problem of sexual dysfunction. And many others who have no real illness, just for the sake of increased performance and excitement.
Like many sex therapists preach, good sex actually happens in the head, and not quite solely in the genitals.

P.S: My patient and his wife saw a sex therapist, spent more time together as a couple and have come in to see me many times since then, and not once, has he ever asked to have his bottle back.

Cholera . . . .by Eghosa Imasuen

In a previous article I ranted about the misuse of antibiotics in the treatment of diarrhoea. That was a prelude to a series of articles on the topic of diarrhoea and its many causes. This time I will talk about a specific cause of diarrhoea.
Cholera has been in the news recently. Last year, an outbreak in the northern states of Nigeria had pundits abusing our government, our health-care providers. How could they let this happen? In Naija? In 2010? Shame! For an outbreak that was quite effectively contained I feel these pundits were angry with the government for other reasons. The reaction was prompt. The drugs were delivered. Doctors are working overtime in these places. In another part of the world, Haiti’s recovery from last year’s tragic earthquake was shaken by the reaction of some of its people to the cholera outbreak there—they believe that the aid agencies brought the disease to the island.
Cholera is caused by a rod-shaped bacterium called Vibrio cholerae. It causes a severe diarrhoeal illness, with associated vomiting, severe dehydration, and abdominal pain. Symptoms may start suddenly and quickly, sometimes as little as five days after contact with contaminated food, effluent, or other patients. The diarrhoea caused by the disease is especially profuse—the classically described “rice-water stool,” so described because of the flecks of detached damaged intestinal bits that float in the stool. An untreated cholera patient may produce as much as 8-10 litres of diarrhoeal fluid in a single day. This massive efflux is the result of a toxin produced by the vibrio cholerae bacterium that compels profuse amounts of fluid from the blood supply into the small and large intestines.
The transmission of vibrio cholerae is via the faeco-oral route. This simply means that after an infected person, or a carrier stools, somehow this contaminates either food or water, and the person who drinks the water or eats the food ingests live bacteria. (Note: It doesn’t mean that someone defecated in another person’s mouth o.)
Oddly enough, cholera is rarely spread directly from person to person. And vibrio cholerae is found naturally in some shellfish and plankton, but remember that there exist toxic and non-toxic strains of these bacteria.
Now for the serious bit: although cholera can be a devastating disease, killing rapidly before treatment can even begin, its prevention is very straightforward: sanitation and common sense. Living in a country with advanced water treatment infrastructure and sewage systems helps, but so does listening to mommy when she says; wash your hands after poo-poo, boil your drinking water, etc.

  • Sterilization: All materials that come in contact with cholera patients should be sterilized by washing in hot water using chlorine bleach if possible.
  • Sewage: anti-bacterial treatment of general sewage before it enters the waterways or underground water supplies helps prevent undiagnosed patients from inadvertently spreading the disease.
  • Sources: Warnings about possible cholera contamination should be posted around contaminated water sources with directions on how to decontaminate the water (boiling, chlorination etc.) for possible use.
  • Water purification: Chlorination and boiling are often the least expensive and most effective means of halting transmission.

There is a cholera vaccine available. It is used to stop outbreaks from spreading, and to prevent spread to health workers.

Cholera treatment works on two main premises. One is to attack the disease-causing organism itself, the other is to prevent death via dehydration of the sick patient. Aha, so this is where those famous antibiotics – tetracycline, flagyl ad septrin – come in.

Cholera has traditionally been treated with tetracycline. Antibiotics shorten the duration and lessen the severity of the diarrhoea. But the mainstay of cholera treatment has always been fluid replacement. Not diarrhoeal stoppage o. FLUID REPLACEMENT. This is what saves lives. In most cases simple oral rehydration therapy with the generic proprietary brands of ORT solutions used judiciously will keep a patient alive until the disease runs its course. Where the person is very sick, we may upgrade to intravenous fluids.
Nursing care is also important. Cholera is a disease that destroys the dignity of its sufferers. You literarily shit yourself to death. I remember the sniggers in class when we were first shown a cholera bed in medical school. The bed had a hole in the middle, a funnel that emptied into a bucket. When we asked our professor why the beds needed holes he told us that the diarrhoea was so uncontrollable in the acute phase of the disease that patients did not have time to ask for toilet breaks or bed pans. And that as the epidemics worsened, nurses did not have time to respond promptly to every patient. Our professor warned us about the dignity of the patient. He punished those who sniggered at the beds with extra call duty.

Are you taking care of your teeth?

EwellAfrica talked to Moyo Ajaja DDS, a dentist practicing in America about caring for our teeth.

Please tell us about yourself?
I am Christian and believe the human body is sacred and that neglecting our health is akin to desecrating a holy place. I fill many roles, I am a wife, mother, sister, daughter, friend, and a dentist. I am passionate about living a full life, using all my talents and encouraging all those around me to dream bigger!

A lot of people don’t consider dental health important until they have pain, can you give us a brief overview about dental health? Why are dental check-ups important?
The condition of the mouth is an indicator of a person’s overall wellbeing. Periodic (at least every 6 months) dental check-ups are important to protect, preserve, and restore oral health with early intervention in a disease process. Usually a dental check-up entails radiographic imaging, professional cleaning and examination of the teeth, gums, cheeks, palate, head, and neck. This exam includes the lymph nodes, muscles, joints and bones. From the state of a patient’s mouth a dentist can tell if that patient smokes, chews tobacco, uses recreational drugs, has uncontrolled diabetes, leukemia, or a compromised immune system.

How early should we start having check ups?
The American Academy of Pediatric Dentist recommends dental visits start as soon as a baby’s first tooth shows up and no later than the first birthday. Usually these appointments are to introduce the child and family to the dental environment (children this young are usually seen by a pediatric dentist) and provide the parents with milestones to expect with the child’s teeth and the way the child’s jaws fit together. Another purpose of these early visit is to educate parents on how to care for the teeth, diet, and what to do if the child has an injury to the mouth/jaw areas.
Does every dental check up include oral cancer screening or should we be asking our dentist about it? – Yes, every dental exam includes a visual oral cancer screening. You may ask your dentist about the findings. If there are any signs of abnormal tissue additional testing is usually the first step and the dentist will discuss those options with you when necessary.

What is the best way to clean our teeth?
Brush and floss! This is the best way to remove the bacteria layer (plaque) that accumulates on the gums and teeth. Brushing cleans about 80% of the tooth and gums and flossing cleans the remaining 20% surfaces that the brush bristles cannot reach. I recommend that patients use a soft bristled brush morning and before bedtime for at least 2 minutes and floss before bedtime. Most people underestimate the 2 minutes therefore I recommend using a timer or if you listen to the radio then brush for the length of a song.

How often should we change our toothbrushes?
Every 3-4months or as soon as the brush bristle start to fray. Remember that soft bristles are the gentlest on the gums. A medium or firm bristled brush can cause the gums to recessed and also damage the surface of teeth.

Toothbrushes/chewing stick? Can you compare and contrast the two?
The toothbrush is a relatively modern invention while chewing sticks have been used in many cultures for centuries. Some religions even promote the use of chewing sticks. Both of these instruments are useful for the mechanical removal of plaque from teeth and gums. Some studies have shown that when used properly, chewing twigs, stems, or root can be as effective as using a toothbrush because it cleans the surfaces of the oral cavity and increases saliva flow. Additional studies also indicate an antimicrobial agent in the plants chewed may reduce the bacteria known to cause dental decay and gum disease. The World Health Organization also recognizes chewing sticks as a valid instrument to maintain good oral hygiene. I want to emphasize that whatever method used to keep the mouth clean the key is to do this frequently, at least twice a day, clean in-between teeth with floss or similar interdental cleaner, and limit frequency of dietary exposures.

What is Gum disease?
Also called periodontal disease is an infection of the tooth supporting structures (gums and bones).
What are warning signs of gum disease? – The initial signs of periodontal disease is bleeding, swollen and red gums. This initial stage, called Gingivitis, is completely reversible with dental treatment and good home care practices. Without treatment gingivitis can progress to infect the jaw bones (Periodontitis) and cause bone loss. Tooth loss occurs once there is inadequate support from the gums and adjacent bones.

What can we do if we can’t afford dental treatment, are there options?
Yes there are many options. Start by dialing “2-1-1” a toll-free telephone service that connects people with local community organizations and government agencies. They will guide you through the resources available in your area.

What causes bad breath? How can it be treated?
Halitosis (bad breath) can originate from several areas. The lungs – a diet of onions and garlic can cause bad breath once digested and absorbed into the bloodstream some of its byproducts are expelled via the lungs. The mouth – inadequate hygiene or salivary flow allows bacteria to flourish and aids the decomposition of food particles. The rest of the body – a disorder elsewhere in the body such as respiratory infections, diabetes, gastrointestinal, kidney, or liver disease. Treatment is targeted at the cause of the bad breath dietary changes where necessary, dental treatment and good oral hygiene, and medical intervention if a systemic disorder is suspected. Alcohol and tobacco use also exacerbates halitosis.

What if anything is a key take home point you would like to leave us with?
Brush for two minutes at least twice a day, floss daily and schedule your next dental appointment today!

The Truth About Diarrhoea – By Eghosa Imasuen

When it comes to diarrhoea, ask any doctor what the most annoying, disturbing, and depressing misconception they have to correct amongst their friends, family, and patients is and they will tell you that it is the use of antibiotics in the treatment of diarrhoea.

Everyone I have worked with, every doctor, every nurse, every Health Extension Worker, has described how they cringe with embarrassment when seemingly educated people say things like, “Kai, bros  I wan purge die yesterday. If not for the Tetracycline/Flagyl/Septrin wey I drink, I for don die since.”

So first off, I am going to say this: Almost all cases of diarrhea are self-limiting episodes. That is if you give it time, it will stop on its own. Yes, you will feel some pain and discomfort but it will stop. Whether you took antibiotics or not, the “speedo” would still have to end on its own. ON ITS OWN! Good to get that off my chest.

You see, people, by far the most common infectious cause of diarrhoea—which is described as loose voluminous stooling, i.e., stool that takes the shape of the container  in which it finds itself—is viral. And antibiotics are used for the treatment of bacterial infections. Note that in the previous sentence I said that the most common infectious cause. The most COMMON CAUSE of diarrhoea is actually food poisoning, a two-worded entity that conjures up dreams of wicked stepmothers, and far-removed cousins, in our paranoid West African environment.

Food poisoning in this sense means getting sick from eating tainted food. What happens is that when food has been contaminated with bacteria through improper handling or poor hygiene or exposure, the bacteria thrives in it and produces certain chemicals that are consequences of its metabolism. These bacterial toxins, these by-products of the bacteria’s metabolism cause profuse diarrhea.
The irony is that diarrhoea may actually have been designed to serve a protective function. Because it causes prompt emptying of the gut, it ensures that the bacteria, in question, has minimal chance of thriving in an environment where it would otherwise be quite at home.
But the thing about nature is this: defence mechanisms have a way of actually killing what they
are supposed to protect, i.e., you. So the most dangerous complication of diarrhoea is the loss of fluids and electrolytes, the hypovolaemia and electrolyte imbalance that results is what kills people, sometimes, especially those at either extreme of the journey of life–children and the elderly–who can barely survive the assault on their delicate bodies.
By now it should be clear what the real treatment for Acute Watery Diarrhoea is: Fluid replacement in whatever guise – Oral Rehydration or IV-drips (in cases where vomiting has complicated the clinical picture.)
But, you say, where did the idea of tetracycline, septrin, and flagyl come from? First, tetracycline has saved countless lives in the fight against a major killer, cholera. The last two are used to treat the two main types of dysentery. (I should define dysentery here. Dysentery means bloody mucoid diarrhoea, sometimes painful.)

So, the point I am trying to make here is this, when you drink tetracycline or flagyl because you have diarrhea, you are doing three things; wasting time and wasting money and probably contributing to the rise of superbugs, extremely hardy multidrug-resistant strains of normally mundane gut flora.

(Brief Bio: Dr. Eghosa Imasuen, a Nigerian novelist, was born on 19 May 1976, and grew up in Warri. A medical doctor, he graduated from the University of Benin in 1999 and lives in Benin City, Nigeria, with his wife and twin sons. He is the Acting Managing Director of Royal Savings and Loans, a primary mortgage institution in Warri.)

Things You Don’t Really Learn In Medical School. By: Peju Adeniran

Reading the sad story of the University of Lagos female undergraduate, who was alleged to have died in unfortunate circumstances that had to do with sex, consent and an alleged concoction of sex pills my mind went back to a lesson l learnt many years ago in my 4th year of Medical school.

One of the lessons taught in Clerkship involved creating physician room scenarios where pretend patients, with pretend illnesses would be admitted, examined, diagnosed and treated by medical students under the guidance of the lecturers.

On this day, I was pretending to be treating a patient who was a middle-aged hypertensive man and had come into the emergency room in a hypertensive crisis, despite being long-term diagnosed of the condition and placed on properly designed medication.

I was presenting to a Professor, who we had nicknamed “Go forth and do like I say” because of his habit of admonishing his students to do just that.

I had my clinical case notes and had presented, to my mind, a near perfect scenario and how I, as a future doctor, would handle it. Everything had gone well until I got stuck at the final question that the Professor asked me:

“What is the first reason why this patient, who has been hypertensive for five years, would present in an emergency room?” asked the Professor.

All my answers were wrong, as varied as they were:  from the expected and logical “hypertensive stroke” or “cardiac arrest” to the illogical; “food poisoning?”

“All wrong”!” boomed the Professor. “In a middle-aged hypertensive man from these parts, from clinical experience, the most likely reason why he would present in your emergency room is sex!”

A pin could have dropped on the floor that day and it would have been heard on the other side of the ward.

Not quite getting what my teacher was trying to say, I asked him if he meant that a hypertensive patient could present in the emergency room from a heart attack or stroke that occurred during sex but he said a loud “no” and continued the lecture.

“This is what you must know,” began the Professor, leaning close towards us like he was about to tell the world’s most important secret. “You must always be careful when you are prescribing drugs, for instance like one for hypertension, even to a patient that might be currently at the risk of death. If the drugs will affect his ability to have sex, your patient will eventually stop taking your drugs and be non-compliant. So, the treatment will fail, the patient’s health will fail and you the doctor, would have failed them both!”

“But Sir…” I stammered in protest “Are you saying that a patient will fail to take his drug even though he knows that he  might die just because he doesn’t want to give up sex?…. That does not make sense.” I was incredulous.

Choosing to ignore my impudence, the Professor instead looked at me and asked.

“Baby doc, have you treated any real patients before?”
“No, Sir” I said sheepishly, now sufficiently humbled.
“Have you treated Nigerian male patients before?”
“Or perhaps you have been married to a Nigerian male before?”

Indeed, at year four, I hadn’t. So, silence reigned.

“Then you have no insights into the politics of sexual virility and the bedroom antics of the Nigerian male. You need to gain some insight because it is going to affect how you treat your male patients….”

This time I could only nod my bowed and chastened head in agreement.

“So, do not argue with me, just keep this in mind when designing treatments for your patients and go forth and do like I say.”

I never forgot that lesson, and it is fortunate that I did not.

Today, years later, and in clinical practice and experience of my own, I have seen that my esteemed Professor could not have been any more right. And that was the lesson that came to mind as I read about the girl who died after her boyfriend plied her and himself with sexual stimulants.

As the facts of the case are still currently under investigation, I will not state my opinion, professional or otherwise on the case per se. What I will, however, add is that our society is to blame because it keeps promoting the myth of sexual virility and performance, especially in the male thus leading to pressure and unrealistic expectations.

*Postscript/ introduction to blog
It is on a sad note, and while mourning Ella, that we introduce this blog, where you get to sit in with me in my physician’s room, and we discuss not diseases, but people and how we all cope with disease. Welcome to my doctor’s room, sit in that chair, and let me tell you what I know.

(Brief Bio: Dr Adeniran is the C.E.O and Editor in Chief of Docsays Integrated Services ( a health content production and consulting company based in Lagos., which also produces “The Docsays” radio show, a popular call-in medical talk show programme that airs three times a week on City FM 105.1 with immediate plans to syndicate. Her first degree is in Medicine, from the University of Lagos.)

The challenge is over!

The challenge has come to an end but your lifestyle changes should not.
Over the last 21 days we gave you tips that allowed you to

1. Eat more healthfully
2. Exercise more
3. Reduce stress
4. Get rejuvenating rest periods
5. Laugh more and bod with family
6. Release toxicity from your life
7. Embrace joy
8. Practice forgiveness

And so much more.
Your very last challenge is to incorporate all these into your lifestyle and the good news is that the challenge information is still online, here on the site so you can do it all over again if you like!

Live well, be happy and prosper!

Almost the last day!

Today’s challenge is simple but powerful!

Stop worrying!

We spend a lot of time worrying about everything under the sun. For Christians the bible actually commands us not to worry. Worry can be damaging to the body, by draining our energy, reducing our immunity and limiting our ability to be creative. 

Today your challenge is to stop worrying and we will give you some tips you can use to get it under control.

1. Write it down. When you find yourself up at 3am consumed with fear about some issue, write it down on a journal or note book.
2. Classify the worry into actionable or not. For example, If you are worried about the state of your finances. That can be actionable, because there are things you can do to fix it. However if you are concerned about global warming as a whole, that may beyond your control.
3. Those things that are actionable – create an action plan. If you are concerned about your weight, create an action plan about eating healthier and working out. If your money is funny, then create an action plan about how to reduce your spending and increase your income.
4. For those things that are not actionable, sometimes it is helpful to create a ritual around them. For those who are religious, pray about the concern and hand it over to God. For those who are not, perhaps you can tear out the sheet where you have the worries written and throw them in the trash or burn them, while determining that you refuse to harm your body by focusing on the negative aspects of life, because you choose to believe that life will be good.

Challenge countdown.

We are almost at the end of our 21 day challenge, but we still want you to finish strong!

Today your challenge is simply this.
Review the past challenges and figure out how to incorporate them into your new healthier lifestyle.
Create an action plan that includes tangible changes to your dietary and workout routines.
Get your family and friends on board!

See…simple and easy and worth it all!

Be well!