Wednesday, March 30, 2016

How to manage pain in the anus


A young man who read my article on sexually transmitted diseases recently called for consultation. During the session, this young man told me about the persistent pain and itching in his anus any time he wanted to pass stools.
The young man said he had received treatment in many hospitals with no cure. So, he decided to go for herbs which he said initially helped him but later the pain grew worse. He had also tried drugs for piles and Staphylococcus Aureus infections with no relief. Now, he has blood in his stools. After a series of tests and examinations, he was diagnosed of proctitis and not pile as perceived by him.
Proctitis is defined as an inflammation of the anus (the opening) and lining of the rectum (lower part of the intestine leading to the anus). Symptoms of proctitis can vary greatly. One may first have only minor problems. Proctitis affects the last six inches of the rectum and can cause the following: pain during a bowel movement, soreness in the anal and rectal area, feeling that one did not completely empty the bowels after a bowel movement, spasms and cramping during bowel movements, bleeding, and possibly a discharge. Proctitis can last a short time or become a chronic condition (last for weeks or months or longer).
Causes
A number of conditions can cause proctitis. Sexually transmitted diseases are the most common: A person can get proctitis through anal or oral-anal intercourse. STDs that cause proctitis include herpes simplex, gonorrhoea, Chlamydia, and syphilis. Bacterial infections that are not transmitted sexually can also cause proctitis. People with Crohn disease or ulcerative colitis (inflammation of the digestive tract) may be more likely to get proctitis. Other causes are radiation therapy, injury to the rectum, or those taking antibiotics for other infections.
Signs and symptoms
The most common symptom of proctitis is called tenesmus. Tenesmus is a frequent urge to have a bowel movement. Inflammation and irritation of the rectum and rectal lining cause tenesmus. Other symptoms of proctitis include pain in the anus, rectum, and abdominal region, anal itching, bleeding from the rectum, passing of mucus from the rectum, very loose stools, watery diarrhoea and occasional constipation.
Treatment
The goals of proctitis treatment are to reduce inflammation, control pain, and treat infection.
Dietary control: Eat antioxidant foods, including fruits and vegetables .Eat foods high in B-vitamins, calcium, and magnesium, such as almonds, beans, whole grains, and dark leafy greens (such as spinach). Avoid refined foods such as white breads, pastas, and especially sugar. Eat less red meat. Use healthy oils, such as olive oil or coconut oil. Reduce or eliminate trans fats, found in commercially-baked goods such as cookies, crackers and margarine.
Specific treatments depend on the cause of proctitis. Managing underlying conditions helps to relieve symptoms. Medications may be used to treat sexually transmitted diseases, stds or clear up symptoms. Anti-inflammatory drugs, such as corticosteroids reduce inflammation and provide pain relief, antibiotics and antifungal clear up stds and other infections.
Immuno suppressant treat symptoms of Crohn’s disease and other autoimmune diseases, surgery may be necessary in the case of ulcerative colitis or Crohn’s disease.
Medications may be taken orally, applied topically, or delivered by an enema. With an enema, treatment is placed directly into the rectum. The patient may also be told to take sitz baths. A sitz bath delivers warm water and salt to the inflamed area and can provide relief.
Preventive care: There are several steps to prevent proctitis: Practice safe sex. Using condoms and having only one sex partner can prevent STDs that cause proctitis. Lifestyle modification: Avoid caffeine, alcohol, and tobacco. Drink six to eight glasses of water daily. Exercise at least 30 minutes daily, five days a week. Eating a well-balanced diet
When to seek medical care: Do you have any of the symptoms?  Especially if you have a history of high-risk sexual behaviour that may lead to proctitis, you should contact your health care provider to be checked.  Other minor conditions such as haemorrhoids (piles) also can cause similar symptoms. Your doctor can tell the difference and provide the right treatment.

Tuesday, March 22, 2016

Starting a career in medical field

A friend of mine, who is a nurse, recently invited me to give a career talk to a group of senior secondary school pupils in a public school. She needed professionals to talk to the pupils about the medical profession as part of her project in fulfillment of a degree programme in guidance and counseling. I was invited alongside a pharmacist.
In my submission, I told the youngsters that I was one of the best pupils in secondary school. My co-speaker, the pharmacist, also said he was the best in his secondary school.
After the talk, one of the pupils approached me and confessed that he was not among the best in his class because his academic performance was just average. He asked, “Doctor is there any hope for me? Will I be able to fulfill my ambition to become a health professional?”
I had to tell him that hospitals are not only for doctors, pharmacists and nurses. I made him to understand that there were other health workers in the background. I told him about colleges of health technology, which are virtually in almost all the 36 states of the federation. Also, I told him that such institutions were equivalent to polytechnics and they were established for the purpose of raising middle level health workers.
 Parental guidance
When the time comes to leave school, many 16 and 17 year-olds start to seriously consider what to do next if they fail to get good results in their final examinations.  In Year 11 or 12, the realities of adulthood, responsibility and work come rushing towards these pupils like a runaway train with its headlights on high beam. This is the time that parents help their children start their adult life in an industry that offers immense opportunities for travel, further study and career advancement.
I will start by talking about middle level health workers who are equivalent to technicians in the non-health sector.
Nigerian system
In the Nigerian context, schools of health technology or colleges of health technology were established in the late 1970s as part of  Nigeria’s Basic Health Services Scheme to train a new cadre of Public Health Care workers for the basic health units in the country.
Currently, these institutions train a variety of public health care workers, including community health extension workers, junior community health extension workers, environmental health officers, medical technicians and health information managers.
Courses offered
Dental therapy: A dental therapist is a member of the dental team who provides preventative and restorative dental care, usually for children and adolescents.
Dental technology:  Dental technicians work as part of the dental care team within a dental laboratory and so, they do not usually have direct contact with patients. They design and construct various forms of artificial teeth and orthodontic appliances.
Health Information Management: This was formerly called medical records, Health information managers design and manage information systems in the healthcare system. They collect and generate records and reports about patients who are being treated by doctors and other clinicians.
Community Health Extension Worker: They usually work in health centres in rural and medically underserved areas, where they see and treat patients and provide a range of community health services.
Medical Laboratory Technician: Medical laboratory technicians play an important role in the prevention and diagnosis of diseases, such as cancer, diabetes and AIDS.  Medical lab technicians work under the supervision of a laboratory scientists, physician and perform laboratory tests on specimen.
Environmental Health Technology: Environmental health officers (also known as public health inspectors) are responsible for carrying out measures for protecting public health, including administering and enforcing legislation related to environmental health and providing support to minimise health and safety hazards.
Pharmacy technician: A pharmacy technician, sometimes known as a pharmaceutical technician, is a health care provider who performs pharmacy-related functions, generally working under the direct supervision of a licensed pharmacist
X-Ray technician: Also known as radiologic technicians, these professionals are responsible for safely using radiation to record an image of a person’s bones and tissue. First, the technician must explain the procedure to the patient and situate him or her on a table.
One important thing to know is that this cadres are middle level health workers whose services are essential to the functioning of a health facilities. They are accepted into the civil service from grade level six or seven.
Basic pre-entrance requirement
The course duration ranges from two years to four years, depending on the programme.  One advantage of some of the courses is that it will earn the person a certificate in their chosen career. Some obtain a national diploma while some go further to have a higher national diploma. Pre entrance requirements is also four or five credits including Mathematics and English language.
Some of these courses don’t require University Matriculation Examinations and the institutions running these courses are all over the country, some of the programmes are run by the university teaching hospitals all over the federation.
Employment opportunities
The Nigerian economy has compelling needs in the primary health care sector. Most of the cadres mentioned above the mid-level health workers have a comparative advantage in the labour market.
The Babatunde Fashola administration had offered all  265 graduates of the College of Health Technology in Lagos automatic employment while attending the second convocation of the college.
I was in a primary school recently to encourage the pupils who were having their Career Day. Over a third of the class were kitted in ward coats (doctor’s coat) and nurses’ uniforms. This means that a greater percentage of the pupils had chosen to thread on the medical path.
Over 90 per cent of the pupils had not heard of the words, ‘radiographer’, ‘physiotherapist’ and ‘medical laboratory scientist’, although more than  40 per cent of them had done X-rays, over 70 per cent had undergone laboratory tests and over 10 per cent had had injuries before.
When the pupils who had encountered these professionals in hospitals were asked to name the areas of specialisation of those who had attended to them, these were their responses:
Pupil 1: What do I call the man who massages my legs when I have injuries?
Doctor: He is a physiotherapist
Pupil 2: I was coughing and did a chest x-ray in the hospital. I don’t know the name to call the doctor that took my x-ray.
Doctor: He is not a doctor, He is called a radiographer.
Pupil3: What do I call the man who drew my blood and took my urine for a test in the hospital?
Doctor: He is called a medical laboratory scientist.
Pupil 4: One woman gave drugs to my mum and described how to use them to her. Is she a nurse?
Doctor: No she is not a nurse. She is a pharmacist.
I had suggested to the head teacher that the career programme should be presented in the form of a drama script and the pupils should be assigned to play the role of health workers. A documentary or film was also suggested to him for subsequent editions.
My advice to the adolescent wishing to start a career in medicine is that they should be studious and seek counsel always. Certain medical care positions require a significant amount of training before one can start practising. This typically includes college, some graduate level course work and supervised clinical rotation.
Optometrist: Optometrists are primary health care specialists trained to examine the eyes in order to detect defects in vision, signs of injury, eye diseases or abnormality and problems. Optometrists make a health assessment, offer clinical advice and, when necessary, prescribe spectacles or contact lenses. In addition, they can dispense, fit and supply spectacles or contact lenses. To qualify with a doctor of optometry degree, a person needs to complete at least five years of undergraduate courses in the university.
A medical laboratory scientist is a pathology-based health care professional who performs complex chemical, hematological, histopathological, cytopathological, microscopic, and bacteriological diagnostic analyses on body fluids, such as blood, urine, sputum, stool, cerebrospinal fluid, as well as other specimens.
Medical laboratory scientists work in clinical laboratories at hospitals, physician’s offices, reference labs. To become a medical laboratory scientist, a person needs to complete at least five years of undergraduate courses in the university
Radiographer: Radiography is one of the most important tools in modern medicine. The use of X-rays, imaging and ultrasound enables diagnosis and assessment that would otherwise be impossible. A radiographer is an allied health professional who uses x-rays to produce radiographs of patients in order to help diagnose the patient’s medical condition.
Radiographers just don’t operate x-ray machines, but they also consult with patients before the procedure, explain the process to them, accurately position the patients’ bodies and make sure that the radiation levels are safe. To become a radiographer, a person needs to complete at least five years of undergraduate courses in the university
Nursing: There are different types of nurses, but the basic duties include providing patient care, making sure the doctor’s instructions are carried out, administer medications to patients, and observing the patients. They may also be responsible for explaining a patient’s illness to his/her family. A nurse can get certified in several ways: a five- year nursing degree (bachelor of nursing science) or a three-year certificate from a school of nursing.
Physicians/doctors:  You need six years of undergraduate medical school. To become a medical doctor, one must complete an intensive programme of undergraduate followed by hands-on training via clinical postings in a hospital setting. While attending medical school, future physicians select a specialty such as family medicine, pediatrics, surgery or obstetrics.
Dentists: You need six years of undergraduate medical/dental school to become a dentist. Dentists are mouth and teeth doctors. They prevent, diagnose and treat problems within the mouth,. They also repair chipped teeth, prescribe dentures, and perform root canals.
Physiotherapists: They are in high demand in the medical field. Individuals who work in this capacity help patients with physical disabilities and well as those who are recovering from injuries that impair their physical mobility. To become a physiotherapist, a person needs to complete at least five years of undergraduate courses in the university
Pharmacists: Pharmacists are the medication management experts of the health care team. Pharmacy is the science dealing with collection, preparation, and standardisation of drugs. Pharmacists, who must earn a qualifying degree, prepare and dispense prescribed medications. To become a pharmacist, a person needs to complete at least five years of undergraduate courses in the university.
Parents are to encourage their wards to put in extra efforts as these courses are highly competitive. Pupils should not be discouraged about the number of years spent in the medical school, but they should be supported and advised appropriately. This number of years is put into consideration in the placement of health workers in the civil service as they are started on higher grades.
The university pre-entrance requirement is also five credits including Mathematics and English language. Other compulsory subjects are Physics, Chemistry and Biology. Most institutions insist on having the grades at one sitting, while some institutions may require candidates who have distinctions in the sciences.

Wednesday, March 2, 2016

Medical management of domestic violence (2)

A victim of domestic violence had composed this threnody and posted it for the world to see and learn from it ‘’I got flowers today… It wasn’t my birthday or any other special day. We had our first argument last night, and he said many cruel things that really hurt me. I know he is sorry and didn’t mean the things he said…because he sent me flowers today. I got flowers today… It wasn’t our anniversary or any other special day. Last night, he threw me against a wall and started to choke me. It seemed like a nightmare. I couldn’t believe it was real. I woke up this morning sore and bruised all over. I know he must be sorry, because he sent me flowers today. I got flowers today… It wasn’t Mother’s Day or any other special day. Last night, he beat me up again. And it was much worse than other times. If I leave him, what will I do? How will I take care of the kids? What about money? I’m afraid of him and scared to leave. But I know he must be sorry, because he sent me flowers today. I got flowers today… Lots of them…Today was very special. It was the day of my funeral. Last night he finally killed me. He beat me to death. If only I had gathered enough courage and strength to leave him, I would not have gotten flowers today.’’
It is important to note that domestic violence does not always manifest as physical abuse. Emotional and psychological abuse can often be just as extreme as physical violence. Lack of physical violence does not mean the abuser is any less dangerous to the victim, nor does it mean the victim is any less trapped by the abuse.
Some examples of abusive tendencies include telling the victims that they can never do anything right; accusing the victims of cheating; keeping or discouraging them from seeing friends or family members, and controlling every penny spent in the household.

Others are taking the victims money or refusing to give them money for expenses, looking at or acting in ways that scare the persons they are abusing, controlling who the victims see, where they go, or what they do, dictating how they dress, and threatening to hurt or kill their friends, loved ones.
Intimidating the victims with guns, knives; pressuring them to have sex when they don’t want to; refusing to use protection when having sex or sabotaging birth control; pressuring or forcing them to use drugs or alcohol; preventing them from working or attending school, and destroying their property are other examples of abusive tendencies.
Management
Medically, management of domestic violence may take place through medical services, law enforcement, counselling, and other forms of prevention and intervention.
Counselling is a means of managing the effects of domestic violence. For the victim of abuse, counselling may include an assessment of the presence, extent and types of abuse.
Prevention and intervention include ways to prevent domestic violence by advocacy, education and prevention programmes.
Management of domestic violence is broad and entails having a safety plan in which the victims can make informed decision and never pressurised to follow any particular course of action. Only the victims can decide what is right for them in a particular situation. Individual autonomy, self-esteem and self-determination are encouraged and respected. Even if the victims decide to return to the violent situation, they are not likely to forget the information and care given and, in time, this may help them to break out of the cycle of abuse.
Medical support
(a) If the victims do not wish to return to their abusers, it is advisable for them to get the services, which include protective custody from local agencies, Non-governmental organisations offer help with contacting them. If the victims choose to return to their abusers, they are given the phone number of the women’s NGO’s or the women’s group for support.
(b) The victims may be advised to keep some money and important financial and legal documents hidden in a safe place in case of emergency.
(c) The medical team may help the victims plan an escape route in case of emergency.
(d) If children are likely to be at risk, referral may be made to social services or welfare department of the government if possible with the patients’ consent.
Domestic violence is not a respecter of persons as it cuts across the social stratum, wives of pastors, monarchs, doctors, lawyers, political office holders have also being victims of this. Some few ones are read on the pages of newspapers but there are thousands of women out there suffering from such violence.
Women who are victims of domestic violence should be careful of where to go for help. They are advised not seek help in another man’s home. They should not seek help or counselling in a closed place with a counsellor of opposite sex. They do not need to sleep in a pastor or doctor’s house while seeking help. They should not engage in alcohol or drugs as it may cloud their judgment
They should seek help in a professional way in the hospitals, NGO’s, ministry of social welfare, among others. Are you a victim of domestic violence? Call for help before it gets out of hands. Call 112 or 767 (Emergency numbers) or 999 (The police).
This is a clarion call for women to speak out since they are the disadvantaged when it comes to issues of domestic violence. Some women suffer in silence and their cases degenerate to such issues as suicide attempt, psychiatric problems and homicide.
Domestic violence against men happens occasionally, it is often unreported because of social norms and pressure. Those that do report such may face social stigma and denigration of their masculinity. However, such men who are victims of domestic violence are also encouraged to speak out.
Domestic violence is both a medical and legal issue but this piece is largely on the medical aspect