LLSAINT:
I think before you make choice(s), you should consult a Doctor and with his advise, I do not think there would be challenges.

Thanks for that comment!

Yes - speak to a doctor, and do some research online about the different methods before you arrive at a final choice.

However, these methods all have some challenge/disadvantage or the other.

Take a few examples:

Condoms can split - no matter how careful one is.

The pill in some people can cause migraine/headaches.

The copper coil in some women can cause heavy bleeding...and so on.

None of them is free of a side effect, but some will be safer and more appropriate for a particular woman than others; and (most important) most women do not suffer the side effects.

Cheers

ToriBlue:
Well they say contraceptives makes a woman to gain weight.

Hi!

Thanks for reading and commenting.

Broadly speaking it’s not strictly true that all contraceptives cause weight gain.

That’s because there are so many of them (15 different types are available under the UK NHS system, for example!!), and they work differently.

Outside of natural methods (abstinence, lactation/breastfeeding, safe periods etc.), contraceptives include:

1. Tablet: Pill - Combined and Mini (Progesterone Only)
2. Contraceptive ring and patch - contains same as combined pill
3. Injection
4. Implant - usually inserted under the skin of the arm
5. Mirena Coil - IUCD – inserted in the womb
6. Copper Coil – inserted in the womb
7. Condoms
8. Other barriers like the caps/diaphragm
9. Sterilisation - male and female

Let’s quickly dispense with #6-9. These will not cause weight gain.

We know from studies that contraceptive #3 is most likely to cause weight gain.

But the issue I believe you address is with the contraceptive tablets (#1).

Weight gain has been known to happen when a woman is on the pill but the evidence we have says that the weight gain is small and not directly related to the pill.

I know that may sound confusing.

Practically – as with the patient discussed - it is difficult to say to her it’s not the pill making her gain weight since she is gaining weight despite doing her best not to.

Therefore, despite knowing the evidence, I agreed to change her pill.

The evidence from studies for weight gain with the tablets is not as strong as that with the injections (#3).

The same risk of weight gain will apply to the #2 as with the tablets; and this may apply to women who use the implant and the mini-pill.

Choice is best made after a discussion of pros and cons of the available methods (which they all have) to help the right decision.

Do you think this clarification would make a woman choose differently?

Cheers!

Earlier this week I faced a young lady across the table wanting to change her method of contraception as the Mini Pill she was currently using had made her gain weight

As she saw it, she had been doing everything right (but piling on the pounds regardless), since she’d started this pill and so it seemed the obvious cause of her problem.

Looking objectively at her medical 'facts', it was difficult to disagree with her.

Of course, only she can provide the actual evidence of whether she is following an appropriate diet and lifestyle that is supportive of NOT adding weight.

However, when taken at her word the only possible reason for her weight gain must be the daily consumption of Progesterone which constitutes the Mini Pill as we know it today.

When you look at the evidence available for how Progesterone affects the body weight, it shows: The Mini Pill does not directly cause changes in weight*.

From reliable studies women have reported weight changes including weight gain and weight loss while taking the Mini Pill but there isn't enough proof that this change is due directly to taking it.

From the same reports, it seems that where such observations are made with regards to weight gain it is usually not more than about 2 kg in a 12-month period.

So, what did I do with my patient? We rationalised the above information and agreed to change her pill.

She accepted that it was unlikely the current pill was contributing anything more than a small fraction of her weight gain and would focus her energies more on healthy eating and increased activity to achieve her weight loss goals.

Given her dissatisfaction with the old pill, we agreed to continue the Mini-Pill while opting for a change to the type. After 3 months, we would review her experience.

The solution was a lot simpler with my next contraception consultation: A lady who was very near the expiration period for her uterine coil arrived to say she could no longer feel her threads.

Usually women are advised to regularly check the Intra-Uterine Device (IUD) (commonly called 'coil') threads (after each menstruation or regularly at alternate months). The implication of not feeling the threads is either:

1. that the coil has been ‘expelled’ or fallen out of the womb through the vagina; or
2. that the coil may have perforated the womb**

In either case once the coil threads have been confirmed to be absent by physical examination by a clinician, the advice will be to use alternate contraception – pills, condom etc. – until an ultrasound scan (and other tests like X-rays if necessary) can be arranged to locate the coil.

And that's what we did.

Let me know what you think.

References:
*Progestogen-only Pills Clinical Effectiveness Unit March 2015 (Updated January 2016) - Faculty of Sexual and Reproductive Health Clinical Guidance UK
**Intrauterine Contraception Clinical Effectiveness Unit April 2015 (Updated October 2015) - Faculty of Sexual and Reproductive Health Clinical Guidance UK

How do pregnant women really feel about sex?

Sexual relations as we know can foster and build a relationship but also provide individual benefits - relaxation, enjoyment, and a sense of well-being. Who needs this more during pregnancy than women?

But I guess you'll probably say - they have a few other things occupying their minds and sex may not be the top 3 items. And you may be right in some cases.

After all, who's in the mood with all the sickness, tiredness, heartburn, increasing size on the one hand etc - all the joy that comes with pregnancy, right?

In many cultures and communities sexual feelings and desires seem to be more easily discussed among men. That women can have or enjoy such desires or feelings is sometimes discussed covertly.

Actually, women do have some points to weigh in on this issue even though our opinions on the matter tend to be less vocal!

A 7-year-old study* carried out in Portugal prompted me to examine pregnant women's attitude to sex.

It draws a few interesting conclusions after surveying the opinions of over 150 women who had just given birth.

It reassures us that sex during pregnancy is generally not harmful, but shines the torchlight on certain attitudes that people hold in respect of sex and pregnancy.


The main concerns - shared by the woman and her partner - are that the baby may be harmed by the act of intercourse, or especially for the men, that the baby may be watching the sexual act.

There may also be concern that it may lead to abortion, or some harm to the baby's development, but this is not accurate.

However, the article does note that there are certain conditions when the activity of sexual intercourse can lead to harm which have been demonstrated medically, namely:

1. Placenta Praevia - a condition in which the placenta i.e. the organ which supports baby's growth, blood and food supply in the womb is lying low in the mother's womb, and may be susceptible to injury from the penis 'bumping' the womb during intercourse, which may lead to bleeding.

2. Blowing into the vagina - This is practised during MouthAction to increase stimulation and is very rare, but can cause serious problems as large breaths of air into the vagina could lead to the air getting into blood vessels and trapped. If this happens, it can lead to blockage (called air embolus) and can cause death if the blockage is carried to the lungs; or may affect the blood supply to the baby and to harm its development.


Other interesting thoughts that came out of this study were:

A woman's sexual desires during pregnancy generally do not change - in nearly 40% of pregnant women, sexual desires were normal, but a smaller percentage said it reduced.

And the quality of sex during pregnancy was also explored - the respondents indicated that half of women felt they were just as satisfied during sex while pregnant as they were before they got pregnant, but, a third said it was reduced.

OK; so far we find that there are a few hang ups about the safety of sex in pregnancy but in the main it is safe; and a fair proportion of ladies do not enjoy this activity so much during their pregnancy - but a larger proportion do.

But how often does the pregnant lady have sex? My final set of charts touch on this issue.

This study tells us that in the last trimester - yes even when everything is 'kicking off; - the body size is at its biggest, tiredness may be more as the body is working harder to support the growing baby, leg swelling, heart burn etc - more women have sex than those who do not!

In the entire course of the pregnancy, the period during which women will most frequently have intercourse is in the first trimester; the reasons are as shared above.

We should keep in mind that the whole state of pregnancy is associated with other issues like tiredness or pregnancy related sickness.

Also, the female body produces hormones or chemicals which support both Mum and baby to a healthy pregnancy outcome, and while so doing there are some other effects that may develop including reducing libido or sexual desire.

That said, many ladies sail through pregnancy with hardly any effects but others don't and there is no single right answer.

Enjoy your pregnancy (both men and women) and enjoy your sexual relationship while being aware that changes may happen for a short while as it progresses.

As usual, its lovely to get your ideas on my thoughts here and your comments are welcome in the section below.

Stay Well!


*http://www.medicinenet.com/script/main/art.asp?articlekey=114509

[quote author=cherr post=55594097][/quote]

Cherr,

You're welcome.

Just my initial thoughts based on what you shared but its important to start working things out and I hope you find the services of a good mental health professional soon.

Best Wishes.

cherr:
I am a 23 year old female and i have borderline personality disorder.
I am ashamed to talk to anyone about it. I don't think therapy would work because I can't make a full sentence without telling lies.
I am very manipulative, I only make friends with people I can benefit from. I can go to extreme lengths to get what I want which includes stealing,lying. I easily discard friends when I don't need them. I am good looking and people tend to love me easily but I don't treat them right.
I have multiple sex partners just to feel loved. I am constantly afraid of getting dumped but I easily dump people.
I have stolen multiple times from people especially my closest friend even her clothes I would later wear them in her presence and manipulate her into believing someone else did it. I am not poor or hungry. I don't know why I steal. I go as far as stealing pants and bras . I can even steal N5 if I have 1 million in my account. The worse part of that I don't feel any remorse. I haven't gotten caught until recently (I am that good ) even when I got caught I still denied even though it was very obvious and still got out of it because I had a lot of people on my side.
I feel emotions to the extreme, when I'm happy it feels like I'm high on cocaine and when I'm sad I feel suicidal I even make nasty cuts on my body . If someone offends me I pretend to forgive them but I always make nasty revenge, my parents suffered this a lot,if I get beaten or scolded I make sure they fight, I even got my dad to kick out my mum multiple times.
I feel sorry for the people who love and care about me. Sometimes I treat them like they are all I've got and other times I treat them like trash, I don't even know why they still stick around. I see a you as the most amazing person in the world today and the next day you are a worthless piece of shit.
I have experimented with hard drugs to escape from myself but it just made things worse.
Sometimes I feel inferior and lack self confidence and other times I look down on people and make them feel like a nobody.
I know I sound like a terrible person but I try as much as possible to be there for people and help them. I'm not stingy.
I don't believe in God.
There are a lot of things I didn't mention. Please is there anyone like me here? Kindly share and I need advice. Thanks

Hello Cherr.

It's not easy to open up about your problems and seek for advice like you've done.

There is a mixture of different issues here and they may be all connected.

You say you have been silent on other problems you have, but from your post, I have identified the following:

1. Impulse control Disorder specifically Kleptomania; defined as “the inability to refrain from the urge for stealing items and is usually done for reasons other than personal use or financial gain”

2. Behavioural Problems

3. Drug Misuse

4. Low Self esteem

5. Erratic or unstable Mood

Behavioural patterns which you have described here that are manipulative or self-destructive may have been learned in response to an abusive situation at some point in the past.

Low self-esteem can be at the root of the behaviour where you’ve been ‘dumping other people’ and engaged in multiple sexual health partners to satisfy a need to be loved.

Low self-esteem and feeling that you are not good enough (in spite of being attractive) may also be as a result of Mood problems or childhood abuse.

Drug misuse on its own can lead to behavioural problems, low self-esteem, depression, other mood problems and several other complications – so no surprises then that it’s made no difference to your situation.

A correct diagnosis coupled with treatment (may include medication and counselling) would provide you the way forward to manage this condition.

I would recommend you seek the help of a good psychiatrist in the first instance. Then the problems can be properly categorised and the appropriate treatment sought.

Support from friends and family would be great, but don’t let the absence of either stop you.

Complete strangers have been known to help someone in need. You've taken a step forward already.

The biggest shame would be in not giving yourself an opportunity to get better and make the most of your life.

Stay Well.

Thanks for sharing this useful post.

Would add that it is important for Health Care Workers in ALL STATES to be up to date on the symptoms in adults and children and remember infection prevention best practices too!

Triage all patients with the relevant symptoms with care; remember travellers from affected areas acting as disease transmitters.

It's sad that after all the hoopla with Ebola, necessary structures nationwide were not strengthened sufficiently to prepare for such outbreaks including containment,monitoring, treatment, surveillance and availability of preventive vaccines.

That pandemics or epidemics will happen is certain. Our readiness is not.

Leaders have a certain responsibility and we should hold them up to it.

Blaming sex as a cause for this Meningitis C outbreak is wrong and allows governance deny responsibility to participate in solving the problem.

Stay Well.

Some illnesses are difficult to characterise.

This is important and speaks to their treatment.
For years, medical professionals have been treating Depression with a varied amount of success in many parts of the developed world.

So it isn't really a new problem, but gradually and certainly, Nigerians are waking up to the reality of this condition and its potential impacts on life as we know it.


Recognising Depression.
In low and middle income countries though, the very nature of Depression means its presence is subject to misunderstanding; and even when acknowledged may be trivialised or stigmatised.

On Sunday 19th March 2017 in Nigeria, a young male medical doctor flung himself into the Lagos Lagoon from the top of the 3rd Mainland Bridge, a popular land mark that connects the island aspect of Lagos state to the mainland.

I have not come across any information that indicates why this event occurred. Suicide is not new in  Nigeria and there are many motives - Depression being one out of many significant factors.

In the case referenced above, I do not know whether a depressed state of mind led to the act of suicide, but an event like this trending on the growing social media presence of many Nigerians means that people ask more questions and are more open to understanding the motives to Suicide.


About Depression.
Today I look at Depression - what it means, how we identify it and to a little extent how its treated.

If you are reading this post, you most certainly have experienced some form of depression in the past- regardless of your age, sex, education or social class.

Think of the way you feel when you are let down:
lost something precious or been robbed; lost a close relative; failed at an exam; dumped by a boyfriend; divorce; lost a contract you were really anticipating - we all know to some extent what being 'down' feels like.

Many people bounce back from these negative episodes - depending on our ability to cope, the significance or impact of the events or just support from someone who helps you get through the pain of the negativity.

In Depression there is a sense of permanence of that state of mind where pleasure or happiness can no longer exist. People depressed say they inhabit a dark place - sometimes they can't put it in words what they feel.

They speak of a lack of pleasure in activities that were previously enjoyed, a loss of hopefulness for a positive outcome in their future and a lack of motivation that many of us simply take for granted.

There may be guilt about something - an action or past inaction; which may or may not be related to regrets and especially feeling they have let important people in their life down.

There may be an emptiness inside that defies explanation or fulfilment and significantly prevents normal functioning - and many times, only when you look very closely.

There is some truth to the idea that a depressed person can mask their inner crisis for a long time, so that unlike physical ailments like asthma, heart disease or cancer when it may be possible to sight the evidence of illness by others; in the case of mental illness like Depression it is more difficult. 

Like physical illness Depression has degrees of severity - it can be mild, moderate or severe.

Someone with mild depression may have any of the features I have mentioned earlier but to an extent that is hardly noticed even by close family or friends. They may become easily annoyed or irritated by trivial issues, or they may seem less focused on usual tasks.

I think its also important to say that while Depression is a mental illness, did you know it can have physical effects?

Some people with Depression describe a headache like a tight band around the head; and yes, actually it can affect sexual desire (or libido); and sexual performance in both men and women.

In many people their sleep is affected - sometimes they have problems managing to sleep; in other occasions they sleep off but wake up several times during the night with the same result- poor, disrupted sleep.
In addition, people with Depression may wake up very early in the morning and struggle to get back to sleep.
As the severity of Depression increases, these symptoms increase in how strongly they are experienced; and they may affect relationship or work.


Dealing with Depression.
The way a person with any of the symptoms described above will deal with them varies. Some people may search endlessly - and in futility - for cures to a headache that never goes away, sleep problems or sexual difficulty.

Some people may just 'bear it' - wrongly believing it is their burden  to carry in an already challenging and tough environment. Some people feel 'they can't go on'. This last emotion is what may result in a suicide.

While we don't know exactly what causes Depression in most cases; there are some instances that are directly liked to certain key events - illness, death, job loss, even pregnancy (Have a look at our infograph on Post Natal Depression).

When someone in the absence of these events becomes depressed, we look at their genetic make up, their upbringing, their social status, emotional disposition to see if there is a clue to how they started to become depressed.

Many times we find some relation but no distinct cause.
Studies and research have revealed the impact of the 'Happiness Hormone', Serotonin and Endorphins. (Read more here).

Serotonin is a chemical  found in the brain which is thought to have a good influence on mood, emotion and sleep.  Endorphins which are also chemicals produced in the brain have been shown to be in greater presence during or after exercise and they reduce anxiety and make you feel good.

Severe Depression is treated by mental health clinicians (psychiatrists and clinical psychologists), but any medical doctor with  the most basic qualification has received sufficient training to at least identify and signpost our patients to the right specialist to help them.

Because - YES - Depression is treatable.
Can it be completely cured? Do we really know? This is still under consideration but people can have happy and fulfilled lives despite having experienced Depression at one stage or another.

We talk of different ways of treating Depression - depending on whether it is associated with an obvious event or stressor (like death or job loss); or where it is less obvious how Depression came about.


We treat Depression as it presents:If it is mild, the only treatment necessary may be to acknowledge and recognise the condition before using certain lifestyle measures to adapt one's mood. They can include exercise, Counselling treatment to help the person come to terms and regain control of their feelings and life.

Counselling is a lot more  than have a chat with a good friend although I must emphasise the value of a strong support network is in treating ANY type of Depression- whether mild or severe or whether associated with a significant life event or not.

When Depression is judged to be more severe then treatments can start to include - in addition to support with Counselling, the use use of medication which primarily affects the availability of the certain brain chemicals including Serotonin and other chemicals which was discussed earlier. 

To summarise then, recognition and acknowledgement of the condition - is a challenge because of the different ways it presents - but more awareness is being raised due to social media reaches.

Treatment is available and should be actively encouraged as it does make a difference and CAN save lives.

I hope this helps.

If you need to discuss this further, please contact info@askawayhealth.org!

Stay Well.



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All AskAwayHealth articles are written by practising  Medical Practitioners on a wide range of health care conditions to provide evidence based guidance and to help promote quality health care. The advice in our material is not meant to replace management of your specific condition by a qualified health care practitioner.
To discuss your condition, please contact a health practitioner or reach us directly through info@askawayhealth.org

Whatever your feelings about an average Nigerian, you are hardly likely to question their industriousness or enterprise; and their determination to survive.

In many places outside home, Nigerians are recognised for stellar achievements that seem to belie the challenging mix of contradictions that exist in the Nigerian state which has so much potential for brilliant developments.

Today, I turn my attention to certain places of ‘health care provision’ in Nigeria whose very existence and persistence despite a growing population with access to improving social media connections with other parts of the world inspire frustration and ridicule in equal measure.

No doubt, the provision of healthcare can be good business.
If you live in any of the busy cities of Nigeria, then of course you will be familiar with these places that do not officially meet the definition of a health facility but do their best to draw clients with strong promises of effective treatments of a variety of medical disorders.

As people will always have one form of complaint or the other, there is a steady demand for a set of payable services - hey presto! – business success.

It has now become popular in social media to share images of the signboards and notices of these ‘shops’.
To people of medical background, they are very amusing in the way they combine the ability to cure vastly different medical conditions; as well as the language used.

This is because some of the terms are 'adulterations' of real medical terminology, which therefore calls to question whether those who produce these signs and run these ‘’shops’ ever attended any Medical Laboratory, Nursing or Medical school.

Take a few examples in our gallery here.

The most common issues are with misspellings of basic medical terms such as:

Semen misspelt ‘seman’ for example; or Fasting, misspelt ‘fasten’ and Pregnancy misspelt ‘Pregnency’ in the images.
Root and Harb (maybe they meant Herb?) in image 3 doesn’t induce too much confidence in me when they advertise the ability to cure.

Others include:

‘Goloria’ for Gonorrhoea
‘Taiford’ for Typhoid
‘Civilis’ for Syphilis
‘Orsa’ for Ulcer
‘Diabitis’ for Diabetes
‘Fabros’ for Fibroids.


Help!!

Seriously – is it a joke? Maybe if you are brave enough to walk through the doors you are greeted with smiles and laughter and reassured – it’s a just a joke to get clients in – but No!

Really, the person who puts up these posts and boards wants the unsuspecting health care user to come in and place him or herself at their mercy believing they have the power to help them and cure their ailments.

Please don’t give me the argument that in Nigeria we speak multiple languages and English is not our first language.

To those who say – ‘it’s just words, it doesn’t matter’  I say:  Yes. It.  Does!

These boards/posts speak to carelessness in attention to detail and frivolous claims – is that how you want to be cared for?; or your relative and friends?

And if you think it escapes you then maybe your driver or house-help in a lower social stratum frequents these places, and you know, their lives also matter!

But more broadly, this speaks to negligence on matters of public safety and threats to public health in Nigeria. Poor health care provision is perhaps most consequential. 


Improving health care provision in Nigeria is an issue for multiagency collaboration at federal, state and local levels.

There is a need for political leaders to recognise that investing their political will and capital to drive the right policy supports with the appropriate regulation as well as resources in the health of Nigeria IS the most important investment of all.

It has potential positive, social, economic, and political multiplier effects and impacts that will lead to a fairer, just, equitable and greater Nigeria.

Quality universal health coverage that ensures access and affordability at the point of need is the unique safety-net that all Nigerians desire and deserve.

So, in interrogating the activities of ‘quacks’ running all kinds of ‘shops’ at every corner or turn in rural and urban neighbourhoods, offering false hopes and exploiting vulnerable Nigerians and victims of our weak health systems, the following questions are pertinent:
What are the qualifications of the owners of such establishments that permit them to offer the services they claim expertise in?
What are the tales told by those who use the service?
When things go wrong, what happens?

Perhaps governments at federal, state and local levels need to work collaboratively to agree on standardising and regularly accrediting health facilities and providers in Nigeria to improve quality and access to systematically eliminate quackery in health care delivery in Nigeria.

Finally – if you know someone who has used one of these places - good or bad experience and health outcome; I’d love to hear you share the experience in the comments section below!

Till then, Stay Well!


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**All AskAwayHealth articles are written by practising  Medical Practitioners on a wide range of health care issues and conditions to provide evidence based guidance and to help promote quality health care. The advice in our material is not meant to replace management of your specific condition by a qualified health care practitioner.
To discuss any medical condition, please contact a health practitioner or reach us directly through info@askawayhealth.org.