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Dr. Sylvester Ikhisemojie
There are certain myths in our society and one of the most enduring of these is the fact that when a woman is pregnant, she should literally put some aspects of her life on hold. Some women barely even want to continue working at their regular jobs while others seek every possible excuse to avoid going to work. The overwhelming evidence is, however, contrary to these attitudes and it is important, therefore, to make the facts known to all women and their husbands as well. In the hinterland, the culture is somewhat different as women continue to do their normal, regular day-to-day activities be it buying and selling, farming or even pounding yam for the menfolk to dine on. In the cities where the average educated housewife is highly westernised in outlook and conduct, the reverse is often the case; there is a lack of willingness to do much work. The evidence regarding the benefits of doing some kind of work is overwhelming. Physical exercise is said to benefit both mother and baby in that such physical exertion can give a woman both physical and mental health benefits. It can also give the newborn a potentially healthier start in life. Despite this, it is believed that just over one-third of all pregnant women in the cities and towns participate in any form of exercise, whether it is structured into their daily lives or not.
The suitable exercises during pregnancy can include brisk walking within the neighbourhood for a mere half hour about five times a week. Brisk walking is not paid for and therefore, freely obtainable. It provides good cardiovascular health to the woman without making a massive impact on the knees, ankles and hips. In that way, it is possible to walk to almost any distance of choice within the neighbourhood and at any time during pregnancy. Some family members and friends can also join in on it to make it more fun. It is important to choose sensible clothing, use proper footwear and avoid slippery surfaces and potholes so that falls can be prevented. In places like Lagos, it is also advisable to avoid the busy roads where you may be forced to make a sudden run for safety. Swimming is also a thorough sport as it exercises all the limb muscles at the same time as the abdominal muscles. Swimming also guarantees that respiratory exercises are mandatorily performed. This must be beneficial for all women whether they eventually undergo normal vaginal delivery or an operative one. If a caesarean section has been performed, the physically well-endowed woman is able to get up from the hospital bed quicker and ambulate earlier and thereby assisting in preventing post-operative complications that might ensue in those who are not as active.
As it is in walking, safety is paramount in swimming. Only those women who already know how to swim should engage in it during pregnancy. It is important to avoid diving into the pool or jumping, which are activities that might physically impact the abdomen. It is paramount also that you make use of a well-designed pool that has guard rails and steps with which you can obtain easy access to the water without the risk of slipping and falling. Swimming provides a pregnant woman certain buoyancy that helps to ease the weight from the joints especially during the latter stages of pregnancy. Similar benefits are obtained by practising yoga which a lot of women do not know about. Yoga classes begun prenatally are effective in teaching women what to expect and how to maintain posture. The benefits of yoga are immense as it helps to increase flexibility and teach calmness. Such an ability to stay calm is of vital importance during labour, an attribute mastered by Fulani women who are stoic and calm even during the second stage of labour. Yoga also helps to strengthen the muscles, stimulate the blood circulation and maintain a healthy blood pressure. It is advisable to avoid lying flat on the back as the weight of the growing baby can compress the major arteries and veins passing through the abdomen against the spine. This can reduce the blood flow to the heart and cause fainting attacks.
Such vascular compression can also reduce blood flow to the baby and imperil it. Additionally, pregnant women should not even think of lying on their abdomen. Another beneficial exercise is cycling, and it is best performed on an exercise bicycle within the comfort of your own home or in a gymnasium. Cycling helps to raise the heart rate and maintain the health of the cardiovascular system. No formal training is necessary before you start to get on it and as it is stationary, the risk of falling is almost zero. The bike helps to support body weight as in the course of engaging in it, the hips, knees and ankles are off the ground and do not bare weight. This is also true of engaging in low impact aerobics which can also be performed in the comfort of the home and involve simple stretching, bending and squatting exercises that do so much for maintaining a healthy muscle balance and tone. It helps to keep the heart and lungs in an optimal condition, both of which organs are so crucial to the mechanism of labour and the dynamics of a full recovery. The understanding of how these characteristics impact labour over the last four decades has fundamentally changed how pregnancy and delivery and their aftermath are now managed. The exercises that have to do with squatting and the squeezing of the pelvic floor at intervals ultimately benefit the woman immensely.
Intermittent pelvic squeezing movements are done as if to prevent urine or stool from escaping and they help to strengthen the pelvic floor. These exercises, known as Kegel exercises, help to tone up the muscles of the pelvic floor, assist the woman to push during labour and ultimately help also to prevent the leakage of urine following delivery. All of these exercises put together also aid in the prevention of deep vein thrombosis and in the improvement of sleep and emotional turmoil. It helps to keep the whole body tone and to keep it flexible and strong. And it supports and helps control the inevitable weight gain associated with pregnancy. If that can be helped, constipation, hypertension and gestational diabetes can also be substantially prevented in many more women. Most importantly, as the heart rate steadily gets better, the circulation also improves, and every part of the body gets to be adequately nourished. As mentioned in the previous paragraph, a substantially improved understanding of all these features has made the care of the pregnant woman radically different from one lifetime ago. Some 40 years ago, if a woman was having a baby the very first time, she would be kept in hospital for five entire days for monitoring. Now, 12 hours is enough, and she can be discharged home. For caesarean section as well, it would be five days before a woman would be allowed to drink even water; now such women can eat as soon as they are hungry. They can also be discharged home after two or three days. Even with these radical changes, complications of pregnancy and delivery have drastically fallen.
Questions and answers
Dear doctor, my son is 15 years old, and I have treated him twice for malaria now, first on December 17 and again on the 27th. The first time, I gave him Claritem by six for three days. When I was home on Christmas day, he was still running a temperature, so I gave him Fansidar and then I took him to see a doctor on the 27th at a primary health centre and tests were conducted for malaria parasites, typhoid, full blood count and ESR (Erythrocyte Sedimentation Rate). When the results came out, he was placed on Pipant and Amoksiclav 625mg which he has completed. Anytime he gets close to me, his body still feels warm. The result showed that the white blood cell count was normal and there were still some scanty malaria parasites and typhoid fever was negative. What more should I do again? 0802xxxxxxx
Well, you did well by taking him to see a doctor. It is better in the current circumstances to observe your son over the next two to three days to see if the warmth that his body currently displays will cease. If it does not, then go back to the healthcare centre where he was first seen for a necessary follow-up. He has used three different types of antimalarials over a 10-day period and that is about sufficient to kill off any remaining parasites. At any rate, it is likely that if malaria is the only problem he has as seems to be the case according to the results you sent, then you have probably treated him enough.
Dear doctor, my daughter is five years old and has developed recurrent itching and swelling in both eyes over the last three months. I went to see a doctor at a general hospital, and we were told that it is an allergy. I asked what kind of allergy she has but nobody has been able to tell me. We were given Antallerg eye drops but I cannot remember if I was told to use it two times or three times a day, and whether that is the reason why it keeps recurring. Please help me understand this problem. I am unhappy right now because she has been scratching her eyes since she woke up today. Thank you. 0708xxxxxxx
Yes, an allergy basically means that there is something specific in her environment that makes the body to respond so strongly to it by swelling up and causing such discomfort. You do not need to know all the complexities involved in this cascade of events, but you can be well assured that the number of times you are instilling the eye drops has got nothing to do with this recurrence. What this represents is that the particle or agent causing the itching, swelling and redness of the eyes is well within your environment and will cause this kind of reaction again and again. Usually, the instructions for the use of an eye drop would be inscribed on the packet by the dispensing pharmacist and if that is not the case with your purchase, you can always seek some more clarifications.
Dear doctor, I have a slight issue that has to do with dizziness, light-headedness, nausea and profuse sweating which I experienced not long ago. I first experienced a similar thing about six months ago, but it stopped suddenly after a few hours, but a few days’ episodes lasted the whole day, and it is still on as I write this. Besides, I have a slight pain in the right side of my chest, and I am a bit worried. Am I coming down with a heart attack? Please help me get a grip of this. Thank you. 0802xxxxxxx
It is possible that you are suffering from a disease of the inner ear that is characterised by all the features you complained about in your question. Usually, one ear is often involved but over time, it goes on to affect both ears and there may be associated hearing loss. Ringing in the ears can become constant over time and episodes may last from a few minutes to several hours but the interval between attacks varies a lot. You did not disclose your age or gender, but you should see a doctor first for a proper examination who may refer you later to a neurologist or an ENT surgeon for further tests and treatment. As for the pain in the right side of your chest, the temptation is to dismiss it as probably unimportant but if you are hypertensive, it is wiser not to be careless about this, especially if the pain is at a level that is deeper than the skin and ribs. Complain about it to your doctor but it is not the beginning of a heart attack to be sure.
Dear doctor, compliments of the season doctor and happy new year to you and your family. Sunday PUNCH newspaper is a great paper, and your column is one of the main attractions there for a person like me. My question is this: I have been hypertensive for more than 20 years and have used various medications. The current combination I am using is Amlodipine 10mg and Lisinopril 5mg and I have not missed the dose for even one day. My blood pressure is well controlled and the highest level I have obtained in the last four to five years has been 135mmHg, but the pulse rate has been consistently over 106 per minute for more than two weeks now. What do you think is suddenly wrong with me? I am 62 years old now, but I don’t feel anything else other than palpitations. Thank you so much. 0701xxxxxxx
Happy new year as well to you, sir and thank you very much for keeping a date with us every Sunday. What is likely is that having achieved such good control over your blood pressure, it is possible that the current dose you are taking, especially of the Amlodipine, would need to be reduced because that drug can cause a reflex increase in your heart rate. It is important for you to see your doctors about this. Their conclusion may be different, but they will, at least, have the benefit of examining you again and taking a decision about what the cause of your palpitations might be and what to do with your drug dosage.
Dear doctor, thank you so much for what you are doing for the people who read the Sunday PUNCH. Sir, I am 26 years old, and my good friend is two years older than me. We both work at an office in Lagos mainland. She sleeps around like something I cannot even describe; she has slept with three guys in our office where the staff strength is about 17. You can imagine that kind of atmosphere. On many days, she sleeps with multiple men, and she does not do this for money or some physical benefit like that. I have talked and talked to her, but she says she cannot help herself, and that she is addicted to sex. What do you advise me to do about this? She is such a nice person, and I am just afraid that she will do herself some harm one of these days. 0802xxxxxxx
She could be suffering from hypersexuality or nymphomania. The latter is a worse extension of the former but both of them are described as psychiatric conditions. You are right to fear for the safety of your friend and it is with the help of other friends within your circle that you will be able to find volunteers who can get her to go for psychological evaluation. There’s hope that some good will come from that effort.
Dear doctor, my three-year-old son swallowed a coin and we rushed to a nearby hospital where we were told that it was dangerous. He had an urgent X-ray and the coin as we were told is inside his stomach. My son has been booked for an emergency operation and we are confused. Please answer us urgently sir. Please, what do we do? I am afraid of an operation for someone so small. Thank you, sir. 0803xxxxxxx
This case was eventually solved when the parents were prevailed upon to take their son out of that hospital and take him home to observe his stools over the following 48 hours. In addition, they were instructed to return to a diagnostic centre for a repeat X-ray of the abdomen if the coin was not seen in that time frame. However, it was passed out the following evening after about 20 hours. Usually, an operation is not necessary for this kind of mishap unless it is causing an intestinal obstruction or is likely to penetrate the intestinal wall or is causing abdominal pains, vomiting and so on.
Dear doctor, I am 54 years old. I have hypertension and diabetes. My diabetes is so bad that I also take insulin 24 units every day. I have had both problems for about eight years now but in the last six months, I have not had an erection nor been able to meet with my wife. What do I do? Thank you. 0808xxxxxxx
You have a significant disease burden. With diabetes, there is progressive damage to the nerves which play a role in initiating erection. With both diabetes and hypertension, the vessels responsible for taking blood to the penis could become narrow such that such blood flow is reduced. You should see your doctors who will most likely refer you to urologists. Those experts will guide you regarding what should be done.
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