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When is the right time to visit a doctor? Which symtpoms should never be ignored?
Cholangitis: is an inflammation of the bile duct system. The bile duct system is found in the liver and is responsible for the transportation of bile from the liver, or to be precise, from the gall bladder, to the first part of the intestine, which is called the duodenum. Bile juice is made in the liver and stored in the gallbladder. In times of digestion, it’s then transported to the duodenum for the digestion of fats and small cholesterol.
Cholangitis is mostly caused by bacterial infections, and in other circumstances, it could be a chronic infection as the result of an autoimmune condition. An autoimmune condition is when the body identifies its own cells as foreign cells, hence attacking them.
Cholecystitis: this is an inflammation of the gallbladder either due to blockage of the bile duct system with a gallstone or bile sludge. Gallstones are small stones composed of cholesterol that usually form in the gallbladder. Gallstones are a common condition that affects nearly one in every 10 adults.
In medicine, we differentiate:
There are six major risk factors for the formation of gall stones, which include:
Cholecystolithiasis: simply refers to having gallstones in the gallbladder.
Choledocholithiasis: this is a term that refers to having gallstones in the bile duct system.
There are some underlying factors that can lead to more frequent building of gallstones. These factors include:
Let’s have a look at the signs and symptoms:
-Let look at how are these diseases diagnosed:
Now let’s delve into how the above diseases are treated:
So, you may ask yourself, are there ways to reduce the risk of getting cholecystitis?
remember to always seek medical advice.
So, what do we understand by this?
Meningitis is an inflammation of the protective layer membrane that covers the brain and the spinal cord. Anyone can get meningitis, from small babies to older people, and it can be very severe, causing brain and spinal cord damage and long lasting disabilities.
Meningitis is caused by various agents, like bacteria (Neisseria meningitidis, pneumococcal bacteria, and bacteria causing tuberculosis), viruses such as HSV, chickenpox, and other harmless viruses. An infection caused by the HSV, chicken pox viruses, or bacterial meningitis is considered an absolute emergency that needs immediate treatment with antiviral or antibacterial drugs. Meningitis caused by bacteria can be treated by giving antibiotics, depending on the bacteria that caused the meningitis in the first place, and it should be an antibiotic that can pass through the brain-brain barrier.
Before we delve into the topic, it is important to state that, meningitis can be prevented through vaccination. The meningitis vaccine can be given to children from the age of 12 months and all other age groups, especially those living within the meningitis belt. So, what exactly is the meningitis belt? These are the regions in Africa that are highly affected by meningitis, hence, a recommendation for the meningitis vaccine for kids of the age of 12 months as well as a pneumococcal vaccine.
Meningitis is spread by respiratory secretions through sneezing, coughing or kissing. In some cases, we do have meningitis carriers who can spread the infection yet they don’t suffer from it.
Children are mostly affected by bacterial variants, for example, the pneumococcal variant, which is also the leading cause of pneumonia.
What are some of the signs and symptoms of meningitis?
The symptoms do not appear in any order and to some extent, some patients do not show any of the of the signs or symptoms stated above.
The incubation period for bacterial meningitis is around 2 to approximately 4 days but can also extend to 10 days. It is very important to recognise bacterial meningitis at an early stage and begin with antibiotic medication, as it is crucial because it can quickly end in death within hours or days.
The incubation period for viral meningitis is around 2 to 14 days. It mostly begins acutely, lasting a few hours to a few days. HSV or chickenpox virus caused meningitis, also needs early therapy with antiviral drugs. Other less harmless viruses that cause meningitis can heal by themselves after a couple of days to weeks. But since we cannot differentiate which viral infection or bacterial infection is causing meningitis, it’s always advisable to seek medical advice.
Let’s delve into the diagnosis of meningitis
So how do you treat a meningitis?
Exposed people to those affected with bacterial meningitis are also given a prophylactic antibacterial medication to help reduce the Spread.
It is crucial to always begin an early antibacterial or antiviral therapy because if meningitis is not treated properly or early enough it could lead to severe long-term problems such as:
Always seek medical advice and remember prevention is better than cure, so do get vaccinated as well as your children.
Cancer of the cervix happens when normal cells in the cervix change into abnormal cells and grow out of control. Most people whose cervical cancer is found and treated early do very well. The cervix is the bottom part of the uterus, where it meets the vagina. The cervix is composed of two main types of cells. The outer layer of the cervix is covered with cells called squamous cells. Squamous cell carcinoma of the cervix is the name for a cancer that affects these cells. The cervix also includes glandular cells, which line the canal of the cervix that leads into the uterus. These cells can also become cancerous; when they do, they are called adenocarcinoma of the cervix. Although they arise from different types of cells, squamous cell carcinoma and adenocarcinoma of the cervix are treated similarly in the early stages.
Risk Factors
Most cervical cancers are caused by infection with a virus called human papillomavirus. HPV is spread by direct skin-to-skin contact, includi ng sexual intercourse, oral sex, anal sex, or any other contact involving the genital area (eg, hand-to-genital or mouth-to-genital contact). HPV infection can also cause a noncancerous condition called condyloma, which is caused by genital warts.
HPV infection is very common. Approximately 75 to 80 percent of sexually active adults will acquire a genital HPV infection before the age of 50. There are many types of HPV, and these affect different areas of the body. Most HPV infections are temporary because the body’s immune system effectively clears the infection.
Risk factors for cervical cancer include:
Symptoms
Typically, cervical cancer develops slowly over several years. In some cases, the cancer does not cause any symptoms, while in others, it causes abnormal vaginal bleeding or discharge. This can include vaginal bleeding between menstrual periods, bleeding after sex, or bleeding after menopause. This bleeding may be spotting or heavy bleeding.
Other symptoms may include:
Diagnosis
Pap testing and human papillomavirus (HPV) testing are commonly used together to screen for cervical cancer. If a Pap test shows abnormal cells, further testing is essential, as treatment of abnormal cells of the cervix can prevent cervical cancer. A biopsy of the cervix involves removing a small piece of tissue from the cervix. The biopsy is performed during an office visit using a procedure called colposcopy. The colposcope, which is similar to a large magnifying lens, magnifies the view of the cervix. This allows the clinician to better see the location, extent, and degree of cervical abnormalities that may not be visible with the naked eye alone.
The tissue obtained during the biopsy is examined with a microscope to see if cervical cancer cells are present. In some cases, more of the cervix will need to be removed for biopsy; this is done through a procedure called cervical conization or a cone biopsy. This can be done either in the operating room by a surgeon using a scalpel or in the office using a loop electrosurgical excision procedure (LEEP). LEEP is performed with a device that uses an electric current to remove a piece of the cervix. You will usually get the results of the biopsy one to two weeks after the biopsy is done.
CT-scan or MRI of the Pelvis Region: to determine spreading of the tumor to other organs or regions of the body.
Treatment
Cervical cancer can be treated in different ways:
Prevention
Cervical cancer can be prevented through:
Pneumonia
Pneumonia is an inflammation of the lungs that is mostly caused by bacterial infections but can also be caused by viral infections. It is the most common reason for deaths in developing and in industrial nations.
In Kenya, pneumonia is responsible for approximately one in five children’s deaths. It claims approximately 8,000 to 10,000 children’s lives annually.
Pneumonia takes about two to four weeks before healing. For small children and older people people with lung and heart conditions, the infection will take longer and even probably require hospitalization due to the severity of their conditions.
As mentioned earlier, pneumonia is caused by vectors such as bacteria and viruses, and in patients with a reduced immune system, pneumonia can also be caused by fungi.
Some of the factors that increase susceptibility to pneumonia infections include:
Pneumonia can be categorized into:
-Viruses such as: Influenza, RSV, and Corona Virus
mostly caused by minor bacteria and fungi
Let’s look at signs and symptoms of pneumonia:
Now that we know the signs and symptoms to look out for, let’s dive into how we diagnose pneumonia:
Now that we know the different diagnostic steps, let’s have a look at how he treats pneumonia.
Please note that not all kinds of pneumonia require antibiotics, hence the need to draw blood to differentiate between a bacterial, viral, or fungal infection. This is crucial to avoid the high rise of resistance in antibiotic therapies.
We do say prevention is better than cure, so how can we reduce the frequency in which pneumonia occurs in our general population? The main method of pneumonia prevention, especially in small children and older patients is vaccination.
-small babies and children can be vaccinated against Haemophilus and pneumococcal disease at the age of two months. Older patients as well as patients with a reduced immune system can also prevent the severity of pneumonia by getting vaccines against the named bacteria above.
For more medical gems, keep at Doki’s Advice.
This is a malignant tumour found in the lining of the large intestines up to the rectum.
The large intestine is known for its role in the digestive system to absorb water and remove waste from the food we eat.
Colon and rectal cancer mostly occur at older age, but by a particular number of people who have certain gene mutations, this cancer can occur at an early age, for example, at 30 without them realising it.
Colorectal cancer is the third most common cancer in the world and the second leading cause of death globally.
According to the data required from Globocan, there were an estimate of 1,354 new cases and 937 deaths from colorectal cancer in Kenya in 2018. Other data sources have noticed that there is a rise in colorectal cancer cases in Kenyan rural areas and that it is the fifth most common cancer in sub-Saharan Africa.
Let’s delve into factors that increase the risk of colorectal cancer:
-Some protective factors would be:
Now that we know the risks and protective factors, let’s have a look at the signs and symptoms of colorectal cancer:
So how do we diagnose colorectal cancer?
After a proper diagnosis of colorectal cancer the next step would be to discuss with your oncologist and surgeon what the individual therapy plan will look like. This is determined by factors like
-Let have a look at the different therapy options
Which therapy regime each patient needs depends on some of the factors noted above. Some may need a Stoma bag after an operation. This will also be discussed with you during the planning stage for the therapy needed.
As always, seek medical advice and keep it Doki’s Advice for more info gems.
It does not in totality equate to dizziness but is a form of dizziness accompanied by a whirling, spinning sensation with a lack of postural stability or balance. Can be accompanied with Nausea and Vomiting
Vertigo can be a disease on its own, but it can also be a symptom of a chronic or acute condition.
For a better understanding, let’s remotely understand how balancing works. Balancing involves a complicated connection between the brain, inner ears, eyes, spine, and muscles. Disturbances, injuries, and infections of the above-mentioned can result in dizziness or vertigo.
Causes range from benevolent to life-threatening conditions.
Let’s start with the common ones:
Side effects of Medications such as antibiotics, chemotherapy, etc.
* Specific forms of migraines, like vestibular migraines.
*Motion Sickness.
peripheral Vertigo involving the inner ear (vestibular organ)
Today we focus on peripheral vertigo as a result of malfunctioning of the inner ear.
It’s important to note that the inner ear, being one of the smallest organs, has a complex ib structure with very many microscopic structures coordinating earing and balancing. We will spare you the details of how it works.
Peripheral vertigos include:
The most common vestibular disorders.
Vertigo or dizziness with acute onsets may last a few seconds to a few minutes.
The vertigo manifests itself with a change in body posture: turning in bed, movement of the head.
Trigger in layman’s tongue: irritation of the inner ear due to loose microscopic fragments detaching themselves from their fixation and circulating within the microscopic inner channels of the ear.
The diagnosis is clinical.
Therapy is the repositioning of detached fragments with physio—therapeutic special vertigo training.
2.Neuropathia Vestibularis.
Patients present with severe vertigo, mostly associated with nausea and vomiting and conspicuous loss of balance.
It is believed to be associated with an inflammation of the inner ear.
The diagnosis is also clinical after a thorough examination to rule out possible central causes.
Patients profit from steroids such as prednisolone and other symptomatic medications like vomex.
3.Meniere Disease.
Presents with a triad of tinnitus, loss of hearing, and severe vertigo.
Red flags of acute dizziness or vertigo:
In acute onsets, it is important for a clinician to note that most Vertigo’s are harmless. Underlying disorders may be overseen.
These include strokes of the brainstem, tumors, or even cardiac conditions.
It is important to rule out these conditions.
Using MRI scans. Long-term ECGs.
The most important thing is to always do a thorough clinical examination and a well-sourced patient’s history. When in doubt as a clinician, better do more tests than ignore your instincts.
Lastly, as a patient, before presenting yourself with dizziness, ask yourself simple questions like:
Did I hydrate well? Is my blood sugar okay?
And, as always, seek medical advice for better treatment.
Prostate cancer is one of the most common types of cancer. Prostate cancer occurs in the prostate, which is a wall-nut-shaped gland in males. The function of the prostate is to produce seminal fluid that transports and nourishes sperm. Many prostate cancers grow slowly and are confined to the prostate gland, where they may not cause serious harm. However, while some types of prostate cancer grow slowly and may need minimal or even no treatment, other types are aggressive and can spread quickly. Prostate cancer, when detected early, has a better chance of being successful.
What are the risk factors for prostate cancer?
It’s not clear what causes prostate cancer. However, the following risk factors may play a role:
What are the symptoms of prostate cancer?
Prostate cancer may show no signs in its early stages. When advanced, it may cause the following symptoms:
What are the complications of prostate cancer?
How is prostate cancer diagnosed?
How is prostate cancer treated?
Remember to always seek medical advice from your practitioner.
Generally, it’s difficult to get accurate data due to circumstances such as:
Low collection accuracy and underdiagnosis. A huge number of cancer patients could go undiagnosed, especially if they lack adequate funds for diagnostics and treatment, hence avoiding going to hospital.
Most of the data collected comes from Nairobi and other urbanised settings.
Most leading cancers in Kenya are:
Approximately 75% of cancer cases are diagnosed in late stages due to factors named above as well as lack of awareness.
So, let’s dive into lung cancer as well as other types of cancers we will handle in coming articles.
Lung cancer is a malignant tumour growth that can occur in either side of the lungs or both. This can either be the main tumour or a metastasis (cancer spreading) of other types of cancers of the prostate, breast, head, neck, kidney, and womb, just to mention a few.
The downside of most cancers is that they have no initial symptoms that one could watch out for, in order to push one to go for an early check-up.
Nonetheless, lung cancer patients could experience common symptoms such as:
There are two main types of lung cancer:
The type of lung cancer a patient has determines the kind of therapy they will require.
The age at which most people are affected is around the age of 40 and above. Rarely does it occur to younger patients.
The most common cause of lung cancer, as we all know, is of course, smoking, which accounts for approximately 70% of the cases. This does not mean that nonsmokers cannot develop lung cancer.
Other causes of lung cancer among nonsmokers are:
Let’s see how lung cancer can be diagnosed:
– NSE: Mostly high in small-cell lung cancers
– LDH: generally, suspiciously high in most cancer patients, regardless of the type of cancer
– CYFRA-21: mostly determined to check therapy responsiveness.
Now that we know what methods we use to detect, lets dive into diff therapy regimes. These are also determined by how big the tumour is, how many of them are there, either on one side of the lung or both, and how far it has spread to other organs.
-Which therapy regime is appropriate for each patient is dependent on the stage of the cancer at the time of diagnosis, the patient’s capability to withstand a particular therapy regime, and their general health situation.
-Always seek medical advice from a professional oncologist, surgeon, and oncology-radiologist because the treatment of a lung cancer patient is a multidisciplinary therapy concept.
-Other than that, avoid smoking. If you are already a smoker, do your best to stop smoking or do smoking cessation therapy.
And as always, for more medical gems, keep it Doki’s Advice.
-This is one of the most common conditions in the world currently affecting the whole world in large numbers.
-3% of adults in Kenya are affected by diabetes, but in this number, we haven’t considered the large number of children and adults who are undiagnosed.
-So, I know most of have heard the word Diabetes and have an idea that it’s a condition whereby blood sugar levels are too high. I want us to dive deep into this disease to better understand it and how much damage long term high blood sugar levels affects those with diabetes.
-Before we get into that it’s good to clarify that there are two main types of diabetes known by the general public, type 1 and 2 but there exit two other types. Let’s have a look at all 4:
-Now that we know the various types of diabetes let’s start from the top.
-This type of diabetes can develop from a young age mostly to around the age of 25 to 30 years. The downside of it is that it can also start at any age but isn’t as common.
-As earlier stated, the pancreas gradually reduces the production of insulin until it eventually doesn’t produce any at all. The amount of blood sugar then increases over time, which can cause serious damage to organs like the kidneys, blood vessels, eyes, and nerves.
Cause oy type 1 diabetes:
Symptoms of type 1 Diabetes
– deep breathing,
– nausea and vomiting
-a fruity smelling breath
-falling into a coma
Diagnosis of type 1 diabetes:
-HbA1c test- this is a test checking the level of glycated haemoglobin. This value can also be used to control how good one’s diabetes is being managed.
-Determining of the C-peptid: This is a part of an insulin molecule. In type 1 diabetes patients its missing since they can’t produce insulin at all.
Intervention/Treatment:
-The basic rule of treatment of diabetes type 1 is that all patients need an insulin therapy. If you remember, we said earlier that a type 1 diabetes patient doesn’t produce any insulin. This means these patients require insulin to enable them to regulate and propel the uptake of blood sugar in the required cells.
-Now how much insulin each patient requires depends on different criteria’s such as: Eating habits, body activity, and severity of insulin resistance in the body.
Insulin therapy schemes:
Conventional insulin therapy:
-This is giving fixed insulin doses at specific times of the day e.g., in the morning and evening. This would also mean the patients need to eat at specific times and specific amount of bread units, since the insulin doses are particularly fixed depending on this cycle.
-So, what is a bread unit (BU) or as some may call it a carbohydrate unit (CU)? This is used to calculate the amount of carbohydrates contained in food. One BU is equal to approximately 10 to 12g of carbohydrates.
-Example of how this works: Patient A with type 1 diabetes applies the insulin at 7am in the morning and 7 pm in the night. 2/3 of the insulin doses is therefore injected at 7am and 1/3 of the doses at 7pm. The patient is then required to make sure that they have their meals at specific times and specific amounts of bread units e.g., breakfast at 7:30am lunch at 13pm and dinner at 7:30pm.
Intensified insulin therapy:
-In this therapy regime the intention is to imitate the natural blood sugar management in the body.
-How do we go about this?
-patients inject themselves a long-acting basal insulin (e.g., insulin glargine, insulin Levemir): this can be done either once a day or twice a day
-Patients then inject a short-acting insulin depending on the meals they take and blood sugar levels at the time of application. (e.g., insulin lispro, insulin apart, insulin glulisine or normalinsulin)
Insulin pump therapy:
-This type of therapy is where the patients get an external pump on the body that continuously injects insulin depending on the blood sugar level.
-This therapy regime is mostly applicable for children as they are not capable of controlling and doing the self-application of insulin or also for adults whose blood sugar management isn’t satisfactory.
-The downside about this therapy is that it’s important for the patients to frequently check their blood sugar levels to avoid hypoglycaemia which can lead to a diabetes coma and if not treated early could lead to death.
-Please note for diabetes treatment: always consult your doctor and do regular check-ups to check if your diabetes management is under control, hence helping reduce diabetes complications. We’ll talk about these complications after looking at all the other types of diabetes.
As explained on our previous article, in type 2 diabetes, the body is either incapable of producing enough insulin to breakdown blood sugar through sugar uptake in the necessary cells like the liver, muscles, kidney, fatty cells or the brain cells, or the insulin sensitivity is so low that blood sugar uptake in the named organs is not guaranteed.
In most cases type 2 diabetes Is associated with the metabolic syndrome.
-What is this syndrome you may ask? It’s a term used to describe a combination of diabetes, high blood pressure, abnormal cholesterol and obesity that together increase the risk of heart diseases, stroke and other conditions affecting the blood vessels.
Symptoms of a metabolic syndrome:
Complications of a metabolic syndrome can include:
Symptoms of type 2 Diabetes: just as type 1
– deep breathing,
– nausea and vomiting
-a fruity smelling breath
-falling into a coma
Diagnosis of type 2 diabetes:
-HbA1c test- this is a test checking the level of glycated haemoglobin. This value can also be used to control how good one’s diabetes is being managed.
– When your blood is drawn by your doctor the HbA1c is the value they determine to see if it lies within the normal margin or above (normal values would be between 4.5% and 5.7%…..For values above 6.5% one would the give the diagnosis: Diabetes). Now disclaimer this value may also slightly differ depending on the parameters each lab uses.
-Determining of the C-peptid: This is a part of an insulin molecule. In type 1 diabetes patients its missing since they can’t produce insulin at all.
Interventions/Treatment:
-Now here there is one slight difference to type 1..and that is one can start with oral medication unlike type one where insulin application is non-negotiable.
-Now since we live in a modern society therapy is a bit modified to fit each patient specifically. This kind of modified type of therapy takes into consideration a patients Life expectancy, other ailments, other medications that they take, risk of someone having hypoglycaemia and so on.
-There are different type of antidiabetic medications for example:
-Now at this point I know your asking what is a long term blood sugar value right?. This is the Hb1Ac value measured from your red blood cells as described above and it can also be used to determine how good the given therapy inclusive of eating habits have been working for at least the last 3 Months. Why 3 Months you ask? Because red blood cells have a 3 Month life expectancy before they are replaced with new cells.
– Metfromin + Dapaglifozin /Empaglifozin
– Metformin + Dulaglutid/Liraglutid
– Metformin + Glibenclamid
-Metformin + any one of the above + insulin
Disclaimer: You should always consult a medical doctor before taking any medication for advice. This because some of these medications have different side effects and could be inappropriate for one patient but appropriate for another.
Some side effects from some of these therapy regimes include:
-Signs such as:
Want to find out more on diabetes? Keep it at Doki’s Advice and remeber to always seek medical advice before any treatment and when you notice any of the symptoms above.
Upper gastrointestinal Bleeding (GI-Bleeding)
-This is bleeding that occurs in the upper gut, stomach and/ or the duodenum (this is the first part of the small intestine).
-What do you have to look out for if you suspect that you are having upper GI-bleeding?
Here are some signs:
-What should we understand by this? This is when one loses a large amount of blood that the body suddenly goes into a shock mode:
-What to look out for when in shock?
-If this happens seek medical attention ASAP!
-Now that we know what signs to look out for, lets dive into the various causes of upper GI-Bleeding.
-Signs of gastric Ulcers: heartburn, indigestion, or reflux.
-Stomach acidity can increase due to factors such as: bacterial infections or medication like Ibuprofen taken for a longer period without taking PPI’s (PPI are drugs meant to reduce the acidity produced by special stomach cells).
Prevention and Treatment of upper GI-Bleeding
Avoiding excessive consumption of alcohol
Avoid excessive smoking.
Early and thorough treatment of bacterial infections caused by H-Pylori
By prolonged use of anti-inflammatory drugs supplementary use of PPI’s (These are medication to help reduce stomach acidity).
In cases of bleeding, seeking immediate medical attention with interventions such es endoscopic haemostasis
Lower Gastrointestinal Bleeding (GI-Bleeding)
Now let’s jump into the lower part of the GI-Tract and look at the signs and symptoms, evaluate causes, and look at the interventions.
Lower GI-Bleeding is occurring in the lower gut. Lower gut is considered to start from lower small intestine and the whole large intestine till the rectum.
Let’s have a look at some signs and symptoms:
General symptoms:
Specific Symptoms for lower GI-Bleeding:
Now that we know what to look out for let’s see what causes bleeding of the lower GI-Tract
Whoo! Now that we know all these causes let’s have a look at what interventions we have:
How do you prevent all these you may ask? Now here it gets a little bit tricky because some of these could be genetically caused like colorectal cancer or CIBD. Despite all that, here are some things one could do:
Diet for GI-Bleeding
Understanding the cause of the diagnosis is always necessary to adapt nutrition in patients with gastrointestinal bleeding.
Generally, foods rich in iron are recommended as one can lose a lot of iron during bleeding especially if it is extensive. It is also advised to eat small meals more often while your digestive system heals. Some lifestyle adjustments are also necessary, that is restricting alcoholic drinks, smoking, caffeine (coffee, regular tea, chocolate), mints (peppermint and spearmint), garlic, onions, fried, greasy, or spicy foods, high acid foods such as citrus fruits and juices, bubbly drinks, tomato products if one engages in them. Alcohol and smoking should be avoided as they increase stomach acids and lead to ulcers which worsen the bleeding. The general idea with food is to avoid foods that cause either heartburn, nausea, or diarrhoea.
Examples of recommended foods are red meat, shellfish, poultry, eggs, beans, raisins, whole-grain breads, and leafy greens.
For more informative Reads…. keep it Doki’s Advice.
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