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What Exactly Is Staphylococcus…. by Peju Adeniran

Let me first say, that today’s story is not entirely mine.

The people I’m talking about today were not my patients directly.

It was a colleague of mine, who had been treating this couple for infertility, for about three months, who told me their story.

They had undergone tests and there was no medical evidence of any kind that would make fertility a problem.

One day they came into his office as usual and the woman had passed him a note on the sly indicating that she wanted to see him privately without her husband present.

My friend made her know that it was okay and a while later, she returned alone and told my friend she knew the cause of their infertility.

“Doctor, promise that you won’t tell my husband, but I know the reason why I can’t bear my husband a child. It is because of my staphylococcus and I have been treating it without his knowledge for a long time. If he knows that the fault is from me, he will most likely divorce me.”

She told him that she had been diagnosed  at a herbal clinic where she had gone complaining of waist-pain and sleeplessness.

My colleague was understandably depressed after she left and as we sat in the doctor’s lounge that day, he wondered.

“What is it that makes some people comfortable with the idea of  spreading wrong information just to make money from gullible people? It’s this kind of mis-information that makes the doctor’s job doubly difficult.”

My colleague was right. There is a lot f mis-information about Staphylococcus.

Staphylococcus is one of the most “popular”  bacteria in Nigeria today. Not just because it is common in incidence, but because it has been publicized as being the root cause of many diseases like “barrenness”, “waist-pain”, “moving sensation around the body”,  “genital discharge and itching”, “tiredness”, “heat inside the body”, “watery sperm” and a multitude of other “diseases”.

This mis-information started a few years ago. It was spread by some practitioners of “alternative medicine” and has remained a source of angst for practicing physicians in Nigeria.

Many times, patients come into the consulting room and tell you that they are infected with Staphylococcus. They then ask for treatment, instead of asking to be diagnosed for what their problem might be. Most of the time, they are wrong, and their problems have nothing whatsoever to do with Staphylococcus.

Staphylococcus is a common bacteria, especially in the tropical region. There are over thirty different species of the bacteria and not all infect humans; many of them in fact, prefer other animals, and each is responsible for a specific ailment.

This bacteria is usually found on the skin, clothes, around the face, and body environment of children, adults and the aged. While it can be responsible for some diseases, it simply isn’t true that it is responsible for all that is being claimed in its name.

These bacteria can live harmlessly on the surface of the skin, especially around the nose, mouth, genitals, and anus. But when the skin is punctured or broken for any reason, the staphylococcus bacteria can enter the wound and cause an infection.

Most of the time, they are minor skin infections which are more exaggerated in people with skin problems like burns or eczema.

Staphylococcus. Aureus, one of the most common of the lot, causes skin infections like folliculitis, (infected hair follicles) boils (furuncles),  impetigo, and cellulitis which are limited to a small area of a person’s skin. S. aureus can also release toxins (poisons) that may lead to illnesses like food poisoning or toxic shock syndrome

It is possible, but rare, to get infected through contaminated objects, because the bacteria is often spread through skin-to-skin contact, and can also be spread from person to person among those who live close together in group situations (such as in school hostels ). Usually this happens when people with skin infections share things like bed linens, towels, or clothing.

Warm, humid environments can contribute to staphylococcus  infections, so excessive sweating can increase someone’s chances of developing an infection.

Although it’s very rare, infections caused by S. aureus can occasionally become serious. This happens when the bacteria move from a break in the skin into the bloodstream. This can lead to infections in other parts of the body, such as the lungs, bones, joints, heart, blood, and central nervous system.

This is more likely in people whose immune systems have been weakened by another disease — or by certain medications, like chemotherapy for cancer.

Occasionally patients having surgery may get more serious types of staphylococcal infections.

Like we saw from the patient above, many myths surround Staphylococcus. Next week, I will show you some of the most common myths that surround this popular bacteria.

What Exactly Is Staphylococcus       Peju Adeniran

Let me first say, that today’s story is not entirely mine.

The people I’m talking about today were not my patients directly.

It was a colleague of mine, who had been treating this couple for infertility, for about three months, who told me their story.

They had undergone tests and there was no medical evidence of any kind that would make fertility a problem.

One day they came into his office as usual and the woman had passed him a note on the sly indicating that she wanted to see him privately without her husband present.

My friend made her know that it was okay and a while later, she returned alone and told my friend she knew the cause of their infertility.

“Doctor, promise that you won’t tell my husband, but I know the reason why I can’t bear my husband a child. It is because of my staphylococcus and I have been treating it without his knowledge for a long time. If he knows that the fault is from me, he will most likely divorce me.”

She told him that she had been diagnosed  at a herbal clinic where she had gone complaining of waist-pain and sleeplessness.

My colleague was understandably depressed after she left and as we sat in the doctor’s lounge that day, he wondered.

“What is it that makes some people comfortable with the idea of  spreading wrong information just to make money from gullible people? It’s this kind of mis-information that makes the doctor’s job doubly difficult.”

My colleague was right. There is a lot f mis-information about Staphylococcus.

Staphylococcus is one of the most “popular”  bacteria in Nigeria today. Not just because it is common in incidence, but because it has been publicized as being the root cause of many diseases like “barrenness”, “waist-pain”, “moving sensation around the body”,  “genital discharge and itching”, “tiredness”, “heat inside the body”, “watery sperm” and a multitude of other “diseases”.

This mis-information started a few years ago. It was spread by some practitioners of “alternative medicine” and has remained a source of angst for practicing physicians in Nigeria.

Many times, patients come into the consulting room and tell you that they are infected with Staphylococcus. They then ask for treatment, instead of asking to be diagnosed for what their problem might be. Most of the time, they are wrong, and their problems have nothing whatsoever to do with Staphylococcus.

Staphylococcus is a common bacteria, especially in the tropical region. There are over thirty different species of the bacteria and not all infect humans; many of them in fact, prefer other animals, and each is responsible for a specific ailment.

This bacteria is usually found on the skin, clothes, around the face, and body environment of children, adults and the aged. While it can be responsible for some diseases, it simply isn’t true that it is responsible for all that is being claimed in its name.

These bacteria can live harmlessly on the surface of the skin, especially around the nose, mouth, genitals, and anus. But when the skin is punctured or broken for any reason, the staphylococcus bacteria can enter the wound and cause an infection.

Most of the time, they are minor skin infections which are more exaggerated in people with skin problems like burns or eczema.

Staphylococcus. Aureus, one of the most common of the lot, causes skin infections like folliculitis, (infected hair follicles) boils (furuncles),  impetigo, and cellulitis which are limited to a small area of a person’s skin. S. aureus can also release toxins (poisons) that may lead to illnesses like food poisoning or toxic shock syndrome

It is possible, but rare, to get infected through contaminated objects, because the bacteria is often spread through skin-to-skin contact, and can also be spread from person to person among those who live close together in group situations (such as in school hostels ). Usually this happens when people with skin infections share things like bed linens, towels, or clothing.

Warm, humid environments can contribute to staphylococcus  infections, so excessive sweating can increase someone’s chances of developing an infection.

Although it’s very rare, infections caused by S. aureus can occasionally become serious. This happens when the bacteria move from a break in the skin into the bloodstream. This can lead to infections in other parts of the body, such as the lungs, bones, joints, heart, blood, and central nervous system.

This is more likely in people whose immune systems have been weakened by another disease — or by certain medications, like chemotherapy for cancer.

Occasionally patients having surgery may get more serious types of staphylococcal infections.

Like we saw from the patient above, many myths surround Staphylococcus. Next week, I will show you some of the most common myths that surround this popular bacteria.

The Hot Weather And Your Health …. By Eghosa Imasuen

Like most eligible Nigerians, I went to vote last Saturday. It was incredibly hot and we were in an open field. The only shade came from completely denuded trees and the small canopy under which sat the INEC officials and their paraphernalia. I sweated and sweated; it got to the point where I felt I was boiling in the steam from my reheated sweat. There was no wind to cool me down.

One of the things on my mind was Heat Illness. Heat Illness is a spectrum of disorders that occur due to exposure to heat, or lack of adequate cooling. It presents in symptoms as mild as a headache, to those as severe as loss of consciousness, convulsions (the Heat Stroke) and even death.

Somewhere next to me, an old woman swooned. She almost fell, and was caught by people next to her on the queue.

One of the common symptoms of heat illness is syncope. Syncope is best described as a short faint. It occurs because the body is trying to cool itself; the blood vessels are forced to dilate (i.e., widen) and thus the Blood Pressure drops precipitously and the person faints because of a reduction of flow to the brain.

As Nigerians are wont to do, they immediately surrounded her, some offering help, others gawking. I walked over to where the crowd had gathered, identified myself as a doctor and as soon as I discovered that two other doctors were already there, we forced the crowd back, asked for space then moved her to the shade, behind the INEC officials, well behind the ballot box.

I touched her. She was hot. Steaming. It was a counter-intuitive experience. The only hot people I had touched so far in my practice had been those with a fever. To see someone boiling hot and not shivering felt odd. She was not unconscious. She was delirious, was talking out of sync with her surroundings. She said she felt weak, felt hot, couldn’t breathe, needed air. The rambling slowed down to a murmur. We placed her in a supine position, ie, on her back, pulled open her blouse, took off her shoes, and one of us borrowed a file folder from the Youth Corpers and fanned her with it.

The mainstay of treatment of any form of heat illness is physical manipulation of the body temperature down back to normal. You want to expose the patient; you want to apply cold compresses. In those days, alcohol rubs were applied as these evaporated more quickly, but this is now frowned upon as it can cause increase in blood vessel dilation. A cool shade and ordinary cool water will do the trick. Also the water lost by sweating has to be replaced. This is normally done by a simple drink of water. But remember that sweat doesn’t contain water only. The patient has also lost electrolytes. This is one of the many uses of Oral Rehydration Solutions besides the treatment of diarrhoea. This is why oil workers in the rigs and offshore are sometimes dispensed salt tablets to suck on.

One of the doctors had run across the field to where hawkers had spread out their wares for sale. She came back lugging the contents of a cooler, the water from the melted ice. Another helper came back with satchets of pure water. We made the woman drink, and we soaked rags in the cool water and wiped her with them. We exposed her, all the while watching voters getting accredited; all the while scolding the INEC officials for keeping us out in the hot sun. Someone asked why no one came with an umbrella. A wag joked that that was the symbol of one of the political parties, and that it was an electoral offence to take party insignia with you to polling units. The woman who had fainted rested; the doctors, three of us, stayed with her, happy with ourselves to be out of the sun, and in the shade, behind the INEC officials, behind the ballot box.

Finally, we all got to vote and watched her as she walked home.

Man, Know Thy Teeth ….By Peju Adeniran

Life as a medical student was hard; there were books to read, lecturers to impress, patients to attend to, and a social life to try and fit into the mix.

The perks were therefore few and far between, but I’ll let you in n a little secret; one of the advantages was that as a young doctor, you could get access to free diagnosis, consultation, and even free medication when possible.

It was under one of these of F-O-C arrangements a few years ago, that I had a colleague take a professional look at my teeth.

Like most people, I consider myself to posses a good enough set of teeth; there were no obvious cases of tooth decay, I had not had any tooth pain or bad breath, so I figured I had nothing to worry about.

As I sat draped in the dental chair, I was handed a dental mirror that would allow me take a look at the back and sides of my teeth, I took it confidently and looked in, but to my horror, I discovered something shocking.

At the back and sides of my mouth were unsettling evidence of plaque and tartar that had left dark marks all round on the areas close to the gum line.

I was mightily appalled. “How had I let this happen?” I thought to myself.

Teeth are normally very resistant; they are often preserved even in skeletons and you can tell someone’s diet, even when they have been long dead, just by looking at the state of their teeth.

The top layer, called the enamel is whiter, like milk in primary teeth in children, and darker and stronger by the time the secondary teeth appear in adults. Enamel is very strong and can usually withstand a lot of pressure in order to protect the living tissue it encases.

But, enamel is not foolproof.

It can be worn down by eating too-hard foods for those who chew on hard bone frequently. It can be broken, if you use your teeth to open bottle tops for example or bite into a stone in your food or chip it against a hard object like the floor if you fall.

Enamel is also quickly decalcified (the calcium, which makes it hard, is removed) by acids, and these acids come from the sugars that we eat which are broken down into acid by the normal bacteria in our mouths.

Brushing twice daily, or at least about eight hours apart, or even rinsing the mouth by swishing water around after eating sweets for instance will help to reverse this reaction.

Brush for at least two minutes; recite the alphabet thrice while you brush to help you keep time.

Don’t forget to brush the tongue, in about 20 firm strokes, to remove bacteria.

After three months, your brush is full of the recommended limit of bacteria, and should be replaced.

What about getting the perfect, white smile?

Even though the teeth may look clean and perfect, like I thought mine were, not taking the time to clean the hard-to-reach spots at the back and sides can lead to plaque formation.

Dental Plaque is present in just about everybody’s mouths. If not gotten rid of, plaque will harden to form calculus, which leads to other problems such as gum/periodontal disease, which manifest as bleeding gums and bad breath.

Habits and daily routine such as cigarette smoking, coffee drinking and tea will leave stains on your teeth. Also taking too long between brushing sessions will allow food remnants leave permanent stains on the teeth.

Flossing is easy, and essential. Bits of food stuck between teeth, especially left for a long time can contribute to gum disease and decay.

With the right brushing and flossing technique Dental Plaque may be easily removed.

Calculus and Stains require a visit to your dentist’s office to be professionally cleaned off  nevertheless prevention is always better than cure.

Some long – term medications, like some anti-depressants, could contribute to gum disease; ask your doctor for help if you are taking any of them.

It is important not to ignore any sign or symptom of gum disease, as this can progress to irreversible stages of advanced gum disease (periodontitis).

When you know you have the perfect, healthy teeth smiling comes a whole lot easier!

Let me tell you a little secret (Tuberculosis Word) ….Peju Adeniran

It is hard to be brave as a doctor. It takes a lot of practice to act like you can cope with everything, and even then sometimes you cannot always win.

I remember the morning that I held my new born niece, just hours old, as she was about to be immunized.

Imagine this; she had just been through hours of squeezing and pushing through the birth canal, entering this new place that was noisy and bright, and the next thing her skin was being pierced by a painful long needle and bits of a virus was being pushed into her blood.

She wailed. Her mother wailed. I wailed too. But in spite of the fact that it was a painful thing to do and watch, we had no choice; my little niece had been born into a world that had Tuberculosis in it, and like the millions of babies born everyday, we had to do this to help save her live.

The Tuberculosis infection is one of those, that we refer to as a multi-system disease because instead of being restricted only to the lungs and manifesting as a cough, (which many seem to know about) Tuberculosis can actually be present in various parts of the body.

It is commonly transmitted though, through the lungs, when one inhales infected droplets. The organism that causes Tuberculosis likes to live in the lungs of an infected carrier. When this person coughs and releases droplets into the air, an infected, un-immunized person that breathes this in runs a high risk of contracting the disease.

An infected person can then develop symptoms that range from chronic cough, productive of blood or bloody sputum, weight loss, fever, wasting away of muscles, weakness, bone infection, and even sometimes invasion of the spinal cord.

Tuberculosis is therefore of great concern and cases of infection are treated with utmost urgency and seriousness. This was a fact that was brought home to me in my last three months as a medical intern.

“Engineer” was a man in his fifties who presented to the hospital where I worked as a case of TB infection. He was not a new case, in fact he had been diagnosed a year earlier.

Most patients with TB are often given what we call “DOT” or “Direct Observation Therapy.” This means the patient has to report at the hospital every day, for about 6 out of his 9 month treatment period to take his drugs under the watchful eye of the physician. This is to ensure that the patients take their drugs and do not pass on the infection to others.

This did not go down well with “Engineer” so by the time he was forcibly brought by his family to our hospital, he had defaulted in treatment several times, at previous hospitals and was already very frustrated.

“I will sign, I will sign!” he shouted. “I will sign that I’ll take these drugs at home everyday!, Im tired of coming to hospital like this!”

We felt pity for him, but unfortunately, we still could not release him to go home and risk being a bank of infection to everyone.

If you are infected like “Engineer” and you do not want to report to the hospital daily, please, please, please:

Be very careful of how close you stand to people

  • Cover your mouth when you cough
  • If you live in the same house with other people please ensure that the windows are open all the time and the rooms are well ventilated also.
  • Make sure to boil your clothes and bedding or those of an infected person in very hot water  (100 degrees) while washing, to rid it of bacteria
  • Tuberculosis infection is difficult within a healthy immune system. Always boost your immunity with proper nutrition and exercise
  • Stay away from children, especially those children in the first months of their lives, especially un-immunized ones. Please don’t carry them.

* As we celebrate world Tuberculosis day, remember that TB is a disease of community importance and for cases of suspected infection, the relevant health authorities in the community should be notified.

Sugar and Kids Behaving Badly ….by Ehgosa Imasuen

If there is one thing readers have noticed about my blog, it is that I thrive in being counter-intuitive. Today’s post will not be any different.

This article is for any parent who has sat through the aftermath of a birthday party, the cakes, the sugary drinks, the candy, and the children. The children turn hell raisers; noisy, disruptive, inattentive, hyperactive.

When my kids started school a year ago—it is a quaint little place, ten in a class, strict, nice—the proprietor gave us a list of foods she frowned upon in the school. We were to cut down on these: refined sugars, processed fruit juices, sugary drinks, and candy. This was great advice. Too much refined sugar is bad for you; it puts a strain on your ability to digest and metabolise it, and has been shown to be risk factor for the future development of diabetes, obesity, and associated problems. She did give these reasons but the primary one was that it affected the children’s behaviour. Now this is something I know to be wrong.

Experts say the notion that sugar causes children to become hyperactive is by far the most popular example of how people believe food can affect behaviour, especially among young children. But the fact is that sugar may actually be an innocent victim of guilt by association. Studies have shown that parents who feel that their children have had sugar automatically perceive their behaviour as hyperactive, and disruptive, even when no real change in behaviour could be measured scientifically. If the parent was left blind to what the child had had, they could not predict or associate the child’s behaviour with sugar intake.

What psychiatrists now assume is that the context of the sugar intake; parties, friends, excitement, may be the real reason for the perceived change in behaviour. Humans are very good at equating association with causality. Because two things happen together doesn’t mean that one causes the other. And this is where intuition can go awry. Every single fibre of your being tells you that when your child has had refined sugar he goes hyper. But the studies do not back this up. But where did the history come from? The idea that food might have an effect on children’s behaviour first became popularized in the 1970s by Benjamin Feingold, MD, an allergist who published the Feingold diet. He advocated a diet free of more than 300 food additives and naturally occurring salicylates found in plants and many fruits and vegetables to treat hyperactivity.

Since then, many studies have looked at the issue of food additives and hyperactivity. Most of these studies have failed to substantiate Feingold’s claims or have shown only a mild benefit in a small number of children with ADHD. And Feingold’s diet would have been helpful, if it was practicable; it banned the very foods that children like. And any parent who has had to fight off a three-year-old’s temper tantrum knows this simple truth: the little tykes always win.

There is a real condition called Attention Deficit Hyperactivity Disorder (ADHD). If you perceive that your child’s behaviour is disrupting family life or affecting their performance in school, it may be a symptom of a bigger problem, such as a conduct disorder or attention deficit-hyperactivity disorder (ADHD), and should be evaluated by a mental health professional.

But know this today; limiting your child’s sugar intake will not hurt, but it will not AFFECT the child’s behavior either.

Water No Get Enemy ….Peju Adeniran

To improve my health, I started an exercise program a few months ago. Before now, in conjunction with eating healthy, all I did for exercise was to take long, power walks in the evenings at least twice a week.

But as I grow older, it is has become apparent that this is not going to be enough; metabolism slows down the older one gets, and I need more than my usual to maintain my weight and health.

So, I joined a gym and met brutal Chioma, my gym instructor. While I will save my adventures with Chioma for another day, I will talk about working out and water.

More than half of our bodies and our entire planet is made up of water, so Fela knew what he was saying when he sang ‘Water No Get Enemy.”

But many of us are ignorant of the ways in which water can be useful to us aside from just drinking, cooking and washing.

In the spirit of World Water day, let us share some tips on how water can help keep us stay healthy and well in and out of the gym.

  • Water is an excellent detoxifier. Our bodies need water for the huge amount of the chemical processes that go on in our body especially in the digestive system.
  • When it comes to digestion the question is “to drink or not to drink?” Well, it depends. The stomach uses a natural acid, Hydrochloric acid, to digest food. Over-dilution of this acid by drinking too much water WHILE eating could hamper the digestion. But drinking water 30 minutes BEFORE and two hours AFTER eating will help in rinsing out your stomach of food debris and keeping it ready for the next meal.
  • Muscle-building is a useful tool in the gym to tone up the body and increase your metabolism rate. However, when you first start weight-lifting, you will experience minute muscle tears and re-building. Myoglobins (the cellular protein unit in your muscle) will be released into your blood stream for disposal. These proteins, because they are heavy could damage your kidneys, especially if you have some degree of prior kidney damage. So, when body-building ensure to increase your water intake to flush the proteins.
  • Do not limit your imagination to the fact that water is only available in the liquid form and in your glass. Many of the popular fruits and vegetables have a high amount of water, and are more interesting ways to hydrate your body.
  • Water is a great friend of your skin. Drink water and sweat your way to clearer skin by eliminating toxins through your skin pores during your cardio work out. Increase the rate of toxin removal by drinking water.
  • Water is also useful for practical weight loss purposes. If you are doing weight training for instance and have no dumbbells, no problem. Take a look at this; a litre of water is approximately 1kg of weight. Therefore if you are training with 1kg dumbbells, just take a litre container of water, fill it up and you have one kilogram to work with. You want two kilograms, use two litres etc. Note that different liquids have unique weights and this only holds for water.
  • Water your hair and nails from the inside! Challenge your hair to grow by drinking 8 cups or 2 litres daily, and watch your hair and nails sprout like plants!
  • Water is the first medication with most domestic accidents. Chemical splashes on/in the skin, eyes, ears and nose? Flush vigorously with water, then rush to hospital. Same with accidental ingestion of MOST poisons
  • Water is recommended in copious amounts for all people, except for those that are suffering from certain chronic kidney ailments. Everyone else should keep drinking up!

Toju’s Curious Case Of Tuberculosis!!! ….Eghosa Imasuen

I was a twenty-six year old doctor, had just finished NYSC and was working in a private hospital near Agboju on the FESTAC axis of Lagos. A mother brought in her son, Toju1 who she complained had not been thriving for the last few months.

Not thriving? If there ever was an understatement, that was it.

Toju was supposed to be sixteen but looked twelve. He had a swollen tummy, a trait that belied the fact that elsewhere he was all bones. He had also been suffering from anorexia (a technical term for loss of appetite; the better known condition mostly suffered by young girls is a psychiatric condition named anorexia nervosa.) Toju suffered from a low-grade fever, something which could only be guessed at from his history of suffering from night sweats, i.e., at around three every morning, he would break out in a profuse sweat, wetting his beddings. He had been to hospital, to church, and his mother had brought him to us because the resident doctors at the teaching hospital were on strike.

When I examined him, I found him to be small for his age; he was skinny, showed signs of recent weight loss, and was at the bottom percentile of weight and height for his age. He was pale. His tummy was indeed bloated, and from my examination full of  fluid; peritoneal fluid, i.e., fluid in the spaces between the intestines.

My diagnostic cap on, I recalled advice I had received from a consultant back in school. We were told that TB was the great imitator. It was more than a lung disease and could take on any form, present as any syndrome. In our peculiar environment—tropical, urban, poor—any odd longstanding illness had to have Tuberculosis as one of its differential diagnoses. So, from the moment I heard that the boy had been “somewhat ill” for upwards of a year, with multiple visits to many hospitals, I feared tuberculosis. Other symptoms that pointed in this direction were the night sweats and the pallor, the anaemia, and the weight loss. But he didn’t have the bloody cough, he didn’t have any cough. That should have taken my mind of TB, you say. Wrong. Tuberculosis usually attacks the lungs but can also affect other parts of the body. It affects the skin, the lymph nodes around the neck causing swellings called scrofula, and the spine, causing a potentially crippling condition called Pott’s Disease. You see, Tuberculosis is an infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis in humans. It is mostly spread via the air, moving from person to person in coughed-up air droplets and spittle. Mostly, I said. They are odder ways in which it is spread, one being via unpasteurised milk from an infected cow.

I told the mother what I thought he had. She said, that cannot be, Toju is not coughing blood. I said, I know. I will need to take a sample. I produced a needle and syringe, noted the surprise on the mother’s face when I swabbed her child’s belly instead of some vein on his arm and plunged the needle into his tummy. I aspirated some fluid. Immediately I knew that my suspicions had been correct. Even before they were sent to the lab, I knew what the child had. You see the fluid that filled his belly was of a golden hue, the classic straw-coloured peritoneal aspirate. The young man had abdominal tuberculosis.

I sent him for an x-ray, for a skin tuberculin test and for a sputum examination, and sent the aspirate for a microscopic examination (the Ziehl-Neelsen stain) and culture (using the Löwenstein-Jensen media.) Did I wait for the results to come before I began treatment? Of course, not. This is a common misconception; I blame the otherwise laudable campaigns by my colleagues in the medical laboratories. Yes, lab tests are important, invaluable, but they are principally a tool that only doctors are qualified to use; and lab tests were made to aid diagnosis, not be diagnosis in themselves. Your primary concern is the patient in front of you; you can either leave the patient to die and say you were waiting for a lab result, or you can begin treatment. The patient’s response to a line of therapy will also aid your diagnosis. So, I started the young man on first line Anti-TB medication and asked the mother to bring him back in a fortnight for a review of the results of the investigations.

The next time I saw Toju, the change set my heart aglow. It had only been two weeks but his cheeks had already started filling out, the swelling in his belly was down, and there was a spring in his step. I had heard that miracles of therapy came after a correct diagnosis but had never experienced anything this dramatic. The results proved that he had Tuberculosis. I transferred him to the health centre in his local government headquarters to continue DOTS (Directly Observed Therapy, Short Course.) I did not hear from them again—this was in 2003—but I imagine that today, he is healthy, finishing university somewhere, and has a sweet girlfriend that he plans to marry soon.

C’est la vie.

[1] Not his real name

Obstructive Sleep Apnoea and Snoring….by Eghosa Imasuen

We all know the relative or roommate or spouse who snores, who keeps us awake at night with generator and construction-worksite-like noises. And a few of us suspect that those who snore are blissfully unaware that they disturb us, that they might be affecting our health. But we do not suspect the health implications associated with snoring.

One of my anaesthesiology professors once asked me, during an operation he was covering, what the major sign of respiratory obstruction was. I racked my brain, reeling off highfalutin answers to this seven-worded query. Big answers to a little question. The real answer was little too. He told me: noisy breathing. One of the obvious signs that someone is having trouble breathing is noisy breathing. We already know this from the asthmatic wheeze, from the stridor of infantile epiglottitis and crackles of pneumonia. This is also true with snoring.

With snoring, the person suffers from a structural predisposition to obstruction. Whether from overweight, or from faulty anatomy, the person’s upper airways—i.e., the part of the breathing apparatus above the lungs, the throat, pharynx, and mouth—are prone to collapse during the deep sleep. This person normally doesn’t have any problems when awake as the muscles that keep the airways patent are working. But when they fall asleep, that is when the problems arise.

There are several stages of sleep. The initial phases in which there are varying levels of arousability—here the muscles are still under conscious control, even if they are unaware of this—and REM (Rapid Eye Movement or Dream) sleep. When we fall into REM sleep, our muscles are at their most relaxed state. The throat collapses, and if there was a pre-existing tendency to obstruction, the person snores. Now, as in all things in life, there is a spectrum of severity ranging from the small cute whistling snore, to the bring-down-the-house generator-noise type.

This brings us to the most common form of Obstructive Sleep Apnoea, OSA, and its consequences. In some cases of snoring, the obstruction becomes complete, the airways fully blocked off, and the patient stops breathing. We have observed this in relatives and friends. Some mischievous ones call this “changing gear.” When this happens, carbon dioxide levels in the blood rise and “awaken” the person. Conscious control of the airways is achieved and for a short while the snoring stops, and starts again. This cycle is repeated throughout the night. The end effect of this is that the patient does not sleep well. For years, the person’s brain has not been reaching its full resting state. There is associated morbidity with this: from increased somnolence (i.e., the tendency to drop off into sleep during the waking hours); to tiredness and irritability; structural defects in the brain’s blood circulatory architecture, we call this Cerebro-vascular Disease (CVD); increased predisposition to strokes, to the small-small strokes that doctors call lacuna infarcts that can lead to multi-infarct dementia; to a type of heart failure called cor pulmonale.

During the investigations in hospital of a patient with OSA, a sleep study is carried out by the ENT (ear, nose, and throat) surgical department. A multidisciplinary approach is advocated for OSA management. There are treatments. There is first the advice that the person loses weight. There is advice on sleeping positions; lie prone or on your side, the back sleeping position worsens snoring, and OSA. There is a machine called the continuous positive airway pressure (C-PAP) machine. This comes with a mask, or nasal canellas that are worn during sleep. Its name is self-explanatory. Models designed for the peculiarities of our environment come with rechargeable batteries. There are also surgical options for therapy. The option chosen by your doctor will depend on the results of your consultation and the subsequent investigations.

So, if you know a relative who snores, who seems to stop breathing during the night, whom you have to nudge repeatedly to stop the snoring; or you have been told by friends and relatives that you snore really badly and you find yourself increasingly tired during the day? Then go and see your doctor. It might be a sign of impending morbidity. There is no better evidence of the truth in the statement that a stitch in time saves nine.

I Feel Pain When I Laugh….by Peju Adeniran

When Sylvia* came to the hospital for the first time, it was on Sunday morning, when most people were in church. Infact, she came in straight from church, dressed in her Sunday best, bent over in pain and holding a note from her pastor.

The note read: “Please doctors, attend to Miss Sylvia* X, she is a worker who had to be excused from the church service because of ill-health.”

Well, she didn’t need a note to see a doctor in a public hospital, Anyway, alone with the female doctors, Sylvia undressed shyly, and proceeded to show us one of the most painful-looking inflamed hemorrhoids I had ever seen.

I wondered to myself how she had managed to walk, sit and stand properly, with that kind of swelling coming from her intestines.

While on her side and undressed, Sylvia told me that the pain from the piles was so bad especially when she was making a bowel movement, that she had trained her body to stop using the toilet all together.
“I got tired of seeing blood whenever I went in there, and sometimes I avoid going to where people crack jokes, because my bum bum pains me when I laugh hard.”

A hemorrhoid or “pile” occurs when a vein in the anus becomes swollen with blood, which has become trapped in it. Blood normally passes unhindered through the veins in the anus, back into the body and then returns back unhindered. But some conditions occur, when this blood flow is obstructed because of unusual pressure on them.

When the veins are blocked, it can also cause some degree of irritation to the skin above the veins, thereby causing the pain the people who suffer from hemorrhoids experience.

Hemorrhoids are one of the most popular illnesses in our society today. Not because they are most common in incidence, but because amongst those that practice and advertise “traditional medicine cures” they are frequently advertised as one of the conditions that people should come to them for.
 Sylvia had been consulting at a “traditional medicine” place for about two years with no relief before she eventually sought treatment from the hospital that Sunday morning.

She had been asked to drink various herbs; some of which were even inserted up into her, where the piles were, all to no relief.

As she wept on the table that day, I thought of how much easier her life could have been if only she knew a few things.

One, there are many possible treatments for piles, but by far the best, would be to not have gotten the piles in the first place. It is definitely a case of prevention being the best medicine.

How is this possible, you ask? By taking better care of our insides and intestines we can prevent this condition.

Sylvia, like most people who suffer from this condition, consumes a lot of processed carbohydrate foods, without including fiber; which she could have gotten from raw fruits and vegetables

She also confessed to me that since she went to a boarding school she had trained herself to not use the toilet regularly, which means she was often constipated.

Her daily water intake, from the consumption chart we drew up was also not impressive, meaning she didn’t also hydrate her intestines properly.

Eventually these bad habits caught up with Sylvia, and she ended up in pain, on the Doctor’s examination bed and being prescribed corrective surgery.

So, to prevent the condition above, it is wise to take care of your intestines by avoiding Sylvia’s unhealthy habits. It is also important to exercise often; weight gain, especially in the abdomen has been known to contribute to piles.

Pregnant women, because of their growing abdomen are, unfortunately, susceptible to piles, but thankfully, it is only temporary.

Here’s a fun fact to consider: people who sit for long on the toilet bowl, because of the pressure on the anal veins, with no support from under, could be increasing their risk for piles as well.

So, if you think that the toilet is the best place to read that newspaper or your new novel, you could be inviting PILES.

*she is well now, and allowed me share this story with you all.

The Curious Case Of The Everlasting Cough (2)….by Peju Adeniran.

Whenever I think of drug addiction in the young, Bariga comes to mind.

And even though I had lived in Lagos all my life, I did not think much of Bariga as a place, until one day, during a psychiatry rotation in school, a patient who was fighting drug addiction revealed that he was hooked on crack cocaine, a commodity that he easily bought off his friends who lived on the streets in Bariga. He said, he regularly bought wraps, for a mere 50 naira a hit.

The cheap price was going to be the first of my many surprises with drug addiction, as, for instance, I would later learn that in Northern Nigeria for example, a popular narcotic concoction of choice was made by boiling laundry blue, herbs and lizard droppings. (http://news.bbc.co.uk/2/hi/africa/2131440.stm ).

Another lesson, was realizing that many drug addicts did not necessarily use the narcotics or hard drugs that we have come to know and expect. In spite of available street drugs, most young addicts, (young in age and young in addiction) prefer to lean towards “softer” drugs at first, than to start at the top.

They like to use drugs, which they believe are cleaner, drugs they can “pull back from” believing that those ones are less addictive, and that they can stop them anytime they want.

That’s where Codeine falls into. If you recall, Codeine which has now become a ‘popular,’ ‘clean,’ and ‘soft’ drug came to my attention when a patient mentioned that her son had been on cough syrup for a very long time with no apparent relief from his symptoms, and also from the case of a woman who had seen children buy this cough syrup from a pharmacy with the help of an adult.

Weeks later, another case came up where a male senior secondary school student in a prestigious Nigerian school was found not only to have been abusing Codeine but had set up a lucrative business buying the bottles of cough syrup in bulk and selling in school to his classmates.

Matters came to a head when he was reported to the school by the parents of one of his customers who had had confessed his source. A search was carried out and hundreds of empty bottles of cough syrup were found under his bed.

His business had been going on for a long time, and everyone was amazed by how much money he had amassed by the time his business went bust. (The money was enough to amaze even his rich parents).

A codeine-high in a young person looks like this; a blunt, happy or dreamy expression all the time, with a reluctance to have an emotional response to anything; it is hard for people like this to get angry or anxious, some are immune to most physical pain.

It’s the classic prescription-drug addiction effect that has been described in movie and music stars; Michael Jackson being a famous example.

Now you can ask me; how could the parents have missed it in their children? Quite easy; they must have thought they had happy, easy going children.

Unfortunately, I was not privy to how the story ended. In spite of my efforts to follow up on how treatment for the addicted patient was sought and effected, not much was heard of how the case ended.

I still think of that case from time to time, and I am now deeply suspicious of people who come to me for cough medication especially those that recommend what medication I should prescribe for them especially when it involves codeine. In my head, I wonder if they planned on having an “everlasting cough” so I usually write a prescription for: “lots of rest, multivitamins and honey, then get back to me.”

We need to fight this everlasting cough epidemic!