Clinic Notes

There used to be a kind and hardworking professor in our hospital. He died only few months ago. Yesterday, I passed by what used to be his office and the door bore another name. They have given Professor Akang’ s office to another man. That is not necessarily a bad thing, but it is instructive to me, and it should be to every doctor, particularly the younger ones.

Medical practice is demanding, and that is literal. Medicine stretches out her hand, daily asking you to give up your valuables, constantly placing a demand on your very being, your very essence, and you often cannot give enough.

They trained us to think that the more we give, the better we are, the more we are worth. So, we can be addicted to giving, to dashing out to the world, tangible pieces of our own lives. Ours is essentially a call to martyrdom. And martyrdom can be appealing. Let us not be confused though. Let us not believe a lie. As a man, you will not be able to save the world, regardless of what they tell you. That job description is taken already.

We should be dedicated doctors, committed to caring for our patients to the best of our abilities, but let it not be that we equate our lives to medicine, let it not be that we discard every other factor, sacrificing our own very existence on this hungry and cannibalistic altar.

For a young, ambitious doctor, the temptation is to say ‘I will begin to live a proper life when I have sorted out my career’. Well, people never really sort out their medical careers, never. In this job, your work is never done. That is why hospitals are open all day, every day.

Whatever a ‘proper life’ means to you, start living it today. I must know that I am not the one keeping the whole world alive, I am not the one keeping the world’s blood pressure and glucose levels down, I am not the one stopping cancers from spreading, I am not the one fixing the world’s fractured bones. When I am not there, the world will take care of itself.

A certain Dr Ameyo Adadevoh personally and literarily stood between Ebola and Nigeria one year ago. She gave her life for it. And the world applauded. That hospital most definitely has another consultant physician now. Her death did not stop people from embezzling funds that were meant to fight the same cause she so sacrificially gave herself for. That is the exact picture.

The doctor is in an abusive relationship with the world. Only that he often shows that he enjoys the relationship. The doctor himself has a name for that kind of behavior. It is called masochism. We should live the lives accorded to us. Shall we? I speak to you. I speak to myself.

For Effiong Akang and Ameyo Adadevoh.

Babatunde Yusuf

August 2015

Random non-medical things I learnt in medical school

I went to medical school at Obafemi Awolowo University, Ile-Ife and it was a rich experience for me. I passed, I failed, I was afraid, I was confident, I was broke, I won scholarships and even had to reject one, I made friends and most importantly, I learned. My learning was beyond how to diagnose acute appendicitis and leukaemia. These are some of the other things I learned that enriched my experience.

Endurance

From having four-hour sessions in choking, formalin-filled dissection rooms to having to answer 2000 questions at a go in a single exam to standing for hours moving from ward to ward during endless ward rounds, you simply can’t survive medical school without endurance.

Sticking together / Team work

You cannot afford to go through medical school alone. From access to critical information to someone’s place to eat Indomie® late at night (after reading the night away) to sharing a ride to a distant posting; you definitely need people.

Consistency trumps brilliance

I’ve seen brilliant people get withdrawn from medical school and average students going through relatively unscathed. Medical school is a marathon and not a sprint.

Everything has a strategy

Blind effort doesn’t yield much. There’s a method of doing everything. I learned this first hand durin my first time in 200 level. I read but I failed and had to repeat the year. It was different from the previous year in 100 level of physics and chemistry. This time, you needed to focus your reading and look at as many past questions you can lay your hands on to study the pattern of questions. I changed strategy, I found out what I should do differently and I passed with less stress the second time.

It’s not always about reading

50% of what you need to know in life you will be taught by someone, the other 50% you will have will have to find out yourself. Sometimes the 50% you are taught at seminars and ward rounds are usually high yeild. There should be a balance between reading and listening to teachings.

Are you at risk of developing breast cancer?

Good to be back on my blog again after a long break. I recently started my postgraduate training in radiology which left me little time for blogging. I apologise for keeping you waiting.

This write up has been at the back of my mind for some time and was inspired by my experience at work. In my institution, we hold fortnight multidisciplinary meetings about breast cancer. All health workers involved in the management of breast cancer (surgeons, radiologists, pathologists, nurses, social workers etc.) are usually present and we discuss patients care and follow up.

One thing that struck me in the past few meetings is the decreasing age of women with breast cancer. There is currently an unmarried 29 year old woman with breast cancer on our list being followed up!

I thought I owed it to women to educate them about the risk factors of breast cancer emphasising prevention and early detection. Incidentally, October is also the breast cancer awareness month.

Breast cancer is the leading cause of cancer in women and accounts for most cancer deaths. To be clear, there is no known definite cause of breast cancer but there are known risks. Breast cancer is also not preventable but the risks can be lowered. It can also be detected early.

The following are established risk factors for developing breast cancer:

Being female: 99% of breast cancer occurs in females. (Males also have breast cancer).

Age: It increases with increasing age.

Family history of breast cancer (especially in mothers, sisters and daughters).

Personal history of breast cancer.

Obesity increases the risk of developing breast cancer.

Alcohol consumption also increases the risk of developing breast cancer.

Exposure to radiation.

Having never being pregnant.

Having your first child at an older age.

Beginning your period at a younger age.

Beginning menopause at an older age.

Hormone replacement therapy.

It must be emphasised that these are risk factors that increases the chances of developing breast cancer and they don’t necessarily mean someone who has them will, with certainty, develop breast cancer.

Breastfeeding and regular exercising have been found out to lower the risk of breast cancer

The aim of this write-up is to create awareness about breast cancer risk factors and steps that can be taken to detect breast cancer early.

The risk factors that one has control over should be addressed e.g. losing weight, stopping/reducing alcohol intake, exercising more. There is nothing one can do about a family history of breast cancer or ones gender.

Early detection is a crucial determinant of survival of breast cancer thus the following are recommended:

Adult women should perform a self breast examination monthly. The idea is to be familiar with your breasts so that you can alert your doctor if there are any changes. (See picture at the end of article). Don’t panic if you feel a lump (8 in 10lumps are not cancerous) but schedule an appointment with your doctor.

Your doctor will then examine you and based on her (his) findings will order some other investigations which may include breast ultrasound scan (for younger women) or mammography (for older women) or removing a sample of breast cells for testing (biopsy) to further evaluate the breasts.

It is also recommended that women undergo annual breast cancer screening with mammography from the age of 40. For high risk women, annual evaluation of the breasts is recommended to start earlier.

I am appealing to you all, please inform your wives, mothers, sisters, friends, girlfriends, cousins, nieces an all females you care about (and those you don’t care about) about breast cancer and ask them if they have been screened.  Before that, have you been screened?

Feel free to ask questions in the comments section.

Many thanks to Kemi Akola for ensuring this article was put up.

Why you should stop smoking now!

Humans have been smoking for a while and it is not without ill effects. Smoking adversely affects all organs of the body and reduces the general quality of health.

According to the latest World Health Organisation estimates, tobacco eventually kills up to half of its users and kills nearly 6 million people each year, of whom more than 5 million are from direct tobacco use and more than 600 000 are nonsmokers exposed to second-hand smoke.

That smoking is injurious to the body has been widely publicized but the message has been largely ignored. Smoking is not only harmful but highly addictive. A single stick of cigarette contains 4000 chemicals which are poisonous and some cause cancer.

The chemicals that are most harmful are:

• Tar, a substance that causes cancer.
• Nicotine is highly addictive and causes physical and psychological dependency. It also increases cholesterol levels in your body.
• Carbon monoxide binds to hemoglobin in red blood cells, preventing affected cells from carrying a full load of oxygen.
• Components of the gas and particulate phases cause chronic obstructive pulmonary disorder (COPD).

Smoking causes the following cancers:

• Lung cancer
• Cancer of the larynx (voice box)
• Acute myeloid leukemia
• Bladder cancer
• Cancer of the cervix
• Cancer of the esophagus
• Kidney cancer
• Cancer of the oral cavity (mouth)
• Pancreatic cancer
• Cancer of the pharynx (throat)
• Stomach cancer

Smoking is also associated with the following adverse health effects:

Cardiovascular diseases: Coronary artery disease, atherosclerosis, stroke.

Smoking raises blood pressure, which can cause hypertension (high blood pressure) – a risk factor for heart attacks and stroke.

Smoking can cause fertility problems. Smoking also increases the risk of preterm delivery, stillbirth, low birth weight, and sudden infant death syndrome (SIDS).

Smoking worsens asthma and counteracts asthma medication by worsening the inflammation of the airways that the medicine tries to reduce.

Smoking can damage the blood vessels in the eye, causing a bloodshot appearance and itchiness.

Smoking increases the risk of gradual loss of eyesight and cataracts.

Smoking stains your teeth and gums.

Smoking increases your risk of oral disease, which causes swollen gums, bad breath and teeth to fall out.

Smoking causes an acid taste in the mouth and contributes to the development of ulcers.

Smoking causes pale skin and more wrinkles. This is because smoking reduces the blood supply to the skin and lowers levels of vitamin A.

There is hardly any benefit to smoking and it has a lot of harmful effects. It is better not to start smoking for the sake of one’s health because stopping can be difficult.

Help! I’m pregnant! What do I expect?

Well…congratulations! The 9-month race (minus the few weeks before you knew you were pregnant) has begun.

Pregnancy is a journey with different phases and can be a very stressful time in your life. If you know what to expect, the journey will be easier.

You should however note that every pregnancy is a different experience altogether.

Register for antenatal care as soon as you know you are pregnant. This gives health care providers more time to anticipate and prepare for any problem that may arise. Adhere to instructions strictly and this is not the time to use drugs anyhow. In fact you should not take any drug without checking with your health care provider.

What to expect?

Early in the pregnancy :

Nausea and vomiting (morning sickness)- can occur as early as the third week of pregnancy and at any time of the day. This is caused by a heightened sense of smell in pregnant women. Eating food in small portions and frequently may help. If severe, go to a hospital.

Food aversion, heartburn and constipation- these are caused by the generally reduced movement in the digestive tract.

Dizziness,tiredness- the low blood pressure and low blood sugar during pregnancy may cause these. Eating food rich in iron and being active may reduce the severity

Emotional distress- the interplay of the different hormones may take its toll on a pregnant woman. Worry, anxiety, delight and exhaustion can take their turns in mood swings. Reassure yourself that what you are going through is normal and look to your partner for encouragement.

Mid Pregnancy:

Growing belly- as the baby grows your belly protrudes.

Skin changes- your skin generally turns darker especially face, breasts and thighs. Stretch marks may also show up on those areas.

Breast enlargement- as the breasts prepare for milk production they may grow bigger and may become tender.

Shortness of breath- the lungs are processing more air for you and your baby so you may be breathing faster and feel slightly short of breath.

Bladder and kidney infections- there is an increased risk for both during pregnancy. If you experience a burning sensation when urinating or fever, back or abdominal pain, see a doctor.

Vaginal discharge-you may notice a thin white vaginal discharge which is normal. When the discharge becomes strong smelling, yellowish/greenish or accompanied by redness or itching, see a doctor.

Baby movements- these begin around 5months and continue throughout pregnancy. If you sense a reduction at ant time, go to the hospital.

Late pregnancy:

Weight gain- as the baby grows so does the placenta with more amniotic fluid being produced. All contribute to weight gain.

Leg swelling- The growing baby compresses on pelvic veins that return blood to the legs. Raising your legs on a pillow while you sleep may help reduce leg swelling.

Heartburn- the growing baby pushes the stomach out of its position causing heartburn. taking small and frequent meals may help.

Frequent urination- this is caused by the baby compressing the urinary bladder.

Backaches-the weight gain and relaxed joints can put some pressure on your back. Massaging might be of help here.

Warm-up contractions- they are weak and go unpredictably. True contractions are stronger, more regular and closer together.

These are just some of the things to keep in mind. Please attend antenatal care regularly and ask questions about anything not clear to you (there is no foolish question) If you notice anything unusual don’t hesitate to contact your health care provider. In this case knowledge is not just power, it is life itself.

How to identify fake drugs

A counterfeit medication or a fake drug is a medication or pharmaceutical  product which is produced and sold with the intent to deceptively represent its origin, authenticity or effectiveness. This may range from containing inadequate amounts of the active ingredient or no active ingredient to containing outright harmful or toxic ingredients.
Fake drugs can kill either directly through their harmful ingredients or indirectly by giving a false assurance that a life threatening illness is being treated when it’s not.
Drug counterfeiting is a global phenomenon and the multinational syndicates are akin to hard drug cartels. It is a multi billion dollar industry. Worldwide drug counterfeiting generated an estimated $75 billion in
2010, according to the Center for Medicine in the Public Interest.
Commonly counterfeited drugs in Nigeria are antimalarials, pain killers and antibiotics. A 2008 World Health Organisation study put the incidence of fake anti-malarials in  sub-Saharan Africa at 64 percent. This greatly undermines the roll back malaria programme .

The aim of this article is to give tips that help to to identify and avoid potential fake drugs. It is not always easy to tell fake drugs from genuine ones, however the following tips should help.

Source: buy only from registered pharmacies. Never from the road side, motor parks or public transport.

Price: if the price is too good to be true, it probably is.

Packaging: if the packaging appears suspicious or looks tempered with, has unusual fonts, spelling errors, do not buy.
If the batch number on the carton is different from that on the foil of the blister pack, do not buy.
If there is no NAFDAC number printed boldly on the pack or if it appears to be tampered with, do not buy.

Pill itself: if it has an unusual colour, shape or smell different from that which you are used to if you have been taking the drug before, do not use.

Verification: for drugs that have sms verification codes, if you don’t receive a response confirming genuineness, do not use.

Side effects: if you experience any unusual side effects, stop using immediately and consult your doctor or pharmacist.

Drugs are poisons, moreso fake drugs and great care must be taken to avoid fake ones.
Let me know your thoughts in the comments.

We are high on drugs!

A lot of us have the impression that the practice of medicine is about laying complaints to a doctor who listens to some imaginary sounds on the chest and abdomen, pokes around, may or may not order tests, comes up with a diagnosis and ,as a matter of compulsion, writes a prescription.

Emphasis on the last word- prescription.

We have come to expect drugs with every visit to the doctor. When a doctor legitimately does not prescribe drugs, we as patients feel there is something missing or that we wasted our time showing up in the hospital in the first place. Worse still, we feel the doctor is incompetent.

Cases like viral upper respiratory tract infection, viral gastroenteritis, stress related symptoms often diagnosed as malaria or typhoid most times do not need medications.
Some patients even have their diagnoses in mind and only show up in the hospital to tell the doctor what to prescribe! “Doctor, it is typhoid that is worrying me, write Ampiclox and Ciprotab for me”

Drugs are just one of the ways of managing patients. There are other things involved. Watching and waiting is the most appropriate approach to handle some cases. The practice of medicine is definitely more than just prescribing drugs. Reassurance and bed rest could be all that is needed in other cases.

Some do not even see any health care professional before using drugs. Everyone seems to be an ‘expert’ in health care these days. From neighbours to market women to colleagues at work, there is no shortage of opinions.

Our present world is most definitely an over-medicated one. We just love to pop pills. There are drugs for almost anything. (‘Teething’ mixture for babies anyone?) Drugs that should be prescription only are freely available on the open market. We would rather take drugs sometimes than modify our lifestyle or take other disease preventive measures. We would rather take supplements than eat good and nutritious food.

Unfortunately, physicians are under constant pressure from different parties to prescribe unnecessary drugs. The patients themselves, the pharmaceutical industry (Big Pharma) for obvious reasons, and the hospital system. The pharmaceutical industry is a multi billion dollar industry and is very ‘aggressive’ in her marketing. In 2005, global pharmaceutical sales totalled US$602 billion.

The great English philosopher-physician Sir William Osler (1849-1919) once said, “One of the first duties of the physician is to educate the masses when NOT to take medicines” How sorely is this needed today!

Indiscriminate use of drugs is not without its dangers: over and under dosage, drug resistance (especially antibiotics and antimalarials), adverse drug interactions, adverse drug reactions, chronic poisoning (all drugs are actually poisons), organ damage (chronic use of some pain killers have been shown to damage the kidneys)

The way we are headed is fraught with danger moreso with the emergence of strains of disease causing microbes that are resistant to available drugs. Indiscriminate use of drugs is a ticking time bomb that needs to be defused now.

Please let me know your thoughts in the comments.

Germs are good for you

Germs or microbes are the tiny organisms that  cause disease and make us sick. Diseases like pneumonia, urinary tract infection, food poisoning are all caused by germs. In fact the above diseases are associated with poor hygiene.

How then can germs be good for you?
     For starters, the whole of our body surface is covered with germs. The whole of our digestive tract from mouth to anus too. This set of germs have a natural mutually beneficial relationship with the human body. For example the germs in the intestine produce vitamin K necessary for blood clotting. The ones on the skin prevent more dangerous germs from thriving on the skin and causing infection.
      Very importantly the good germs play an important role in the development of our natural immunity during childhood. They stimulate the body to produce antibodies which fight off infections. Various studies have shown that children that were not exposed to these germs during childhood have a higher incidence of allergic diseases like asthma later in life.
      There is however a delicate balance between good and bad germs and things like indiscriminate antibiotics and medicated soap use tilt the balance in favour of the bad germs.

What should we learn from all these?
Not all germs are bad.
It’s okay to let children get a little dirty (for their long term health).
We should avoid unnecessary antibiotics which also kill the good germs.
We should avoid bathing with medicated soaps every time as this also kills good germs on the skin. (It’s okay every now and then)

It should be noted that there are instances where the good germs can be harmful for example when they cross to parts of the body which they don’t normally inhabit and also in persons with low immunity.

Those tiny little germs can be our friends after all.

Feel free to use the comments section to share your thoughts.

Are we (literally) eating our hearts out?

image from chriskresser.com

While it may be good to take some things ‘with a pinch of salt’, we may not want to take this advice literally.

Too much salt may be harmful to us by predisposing us to hypertension, stroke and heart disease. This is especially true about people who have immediate family members who have hypertension, stroke and heart disease. Hypertension harms the heart, kidneys, brain and even the eyes.

To be clear, salt is very important for the body’s proper functioning. It helps us conserve water in the body, it heps in balancing acids and bases in our body, it helps us maintain our blood volume and our muscles and nerves cannot function without it.

The problem is that most of us eat way too much salt, mostly out of habit, and our kidneys may not be able to get rid of all that salt and it accumulates in our bodies.

Salt (common salt or sodium chloride as the chemists will want us to call it) is made up of sodium and chloride and it is recommended that we take 2.4 grams of sodium a day which translates to 6 grams of sodium chloride a day (that’s just 1 teaspoon!). This 6 grams should include all of the naturally occuring salt in food, the one we use in cooking and the one we add at the table.

Too much salt in our diet contributes to hypertension, other heart diseases and stroke. (Several studies have shown this). Reducing the intake of salt can help prevent these diseases. We have to bear it in mind that our taste buds adjust and get accustomed to the amount of salt we take over time so they may need some time to adjust.

The following will help in reducing the amount of salt we eat:

1. Not adding salt to food on the dining table.
2. Using spices and herbs (eg onion, garlic, ginger, thyme) to add flavour to our cooking thereby reducing the amount of salt required.
3. Buying fresh food and vegetables instead of processed and canned food (a great deal of salt is used to preserve these canned foods!)
4. Using less salt that the recipe demands.
5. Rinsing canned foods to wash off some of the salt.
6. Choosing low sodium canned food if we opt for processed food (read the labels!).
7. Going easy on mayonnaise and ketchup, they are high in salt.
8. Eating lots of fruits and vegetables.

Eating too much salt is more of a habit and for our long term well-being we should kick this habit, shouldn’t we?

Caveat: some of us may have low salt in our body and I would not recommend this but this will help people with a family history of hypertension, stroke or heart disease.

Deadlier than HIV?

Almost everyone knows or at least has heard about the HIV virus and the fact that it is incurable and

image from national mirror

all that. It has enjoyed media attention and a significant level of awareness has been created. About 8million Nigerians live with HIV and a decline in the prevalence rate has been recorded for a couple of years now.

There is another viral disease affecting more than twice the number of Nigerians affected by HIV, more infectious than HIV but less known and less talked about and unlike HIV it is totally vaccine preventable.

Hepatitis is what I am talking about and it refers to a group of viral infections that affect the liver. There are 5 types A,B,C,D and E. Hepatitis B and C  are of the greatest concern of which B is the deadliest.

Hepatitis B affects 20 million Nigerians (1 in 8 Nigerians) but awareness is abysmally low. Most people that have it are not aware and it can be in the body for decades without causing any symptoms until the liver’s function has been greatly compromised.

It is the commonest cause of liver cirrhosis and liver cancer. It is transmitted through blood (sharing sharp objects, transfusion of infected blood, unsafe injections) and through sexual intercourse.

The good news is that it is preventable by vaccination and was included in Nigeria’s routine childhood immunization in the early 2000s but most adults are not immunized.

The earlier it is detected, the better the overall outcome for the individual and long term complications can be avoided.

Have you gone for Hepatitis B screening and have you gone for hepatitis B immunization? Please do share your experience in the comments.