You can be your own doctor

The thought of giving your doctor the boot may have crossed your mind every now and again. After all you would end up with plenty of savings in healthcare costs, and regain full control of your health destiny. Well, being your own doctor is an easy thought, but requires quite some effort to actualize and keep yourself in a desirable state of health.

Look around, you will find plenty of resources out there to help you replace the doctor with your good old self. There are TV shows, books, apps and all manner of self-proclaimed gurus with handy advice on self-doctoring. Well, you can look these up and decide whether doctoring yourself is something you may want to take up. And if you end up taking it up, remember it’s not a hobby, you’d be getting into serious stuff.

Let’s look at how you can doctor yourself. The good old common sense is the first thing. You know how this works. Take all reasonable measures to prevent disease. Sort out common and mundane ailments with simple remedies. Nobody really needs to go to the doctor’s to be reminded about how to prevent malaria, or how to ease off a simple headache. Just being proactive, and sensible, can keep you away from your doctor’s for long spells of time.

What about following handy advice from all those readily available resources? You will find many TV programs giving out tips on maintaining good health. Those manned by professionals tend to be very objective. But there are plenty of programs whose sole objective is to market a fad, or a product. Sucking up to a popular craze is unlikely to keep you away from your doctor for long. The same applies to medical publications. If you select your buys wisely, there’s no reason why you shouldn’t end up giving your doctor a run for their money.

Self-diagnostic tools have become commonplace. They tend to be simplistic, or pretty complicated algorithms that can interpret medical data and lead to a fairly accurate diagnosis. All you need is to identify a tool that fits your specific circumstances. You then key in specific data about yourself. The end product is not just a diagnosis, but also a recommendation and a prescription to boot. And the meds will be available online, and delivered to your door. Who needs a doctor, or a pharmacist?

But be wary of replacing a well-grounded professional with yourself as a lay person. True, some ailments are so simple that no one really needs a medical degree to sort them out. But a myriad of ailments are pretty complex, requiring a well-rooted scientific analysis and a carefully thought out treatment plan. There are obvious limits as to how much you can doctor yourself. You won’t be completely replacing your doctor anytime soon.

When advanced fertility treatment fails

Dear doctor,
I am desperately depressed after going through 3 failed advanced fertility treatment cycles. Do I have other options, or should I give up and just live childless?

Advanced fertility treatment is commonly referred to as test-tube babies. The scientific terminology is In-Vitro Fertilization (IVF). In simplified terms it means fertilization takes place outside the body, in highly regulated and specialized labs. Once the eggs are fertilized, they become embryos, and are then allowed to grow in the lab for a few days before being placed into the woman’s womb (uterus).

The availability of IVF has helped many couples, who would otherwise have remained childless. There are many reasons why couples may require IVF, ranging from simple to complex fertility problems. Even though IVF techniques have been refined over the years, many couples will go through IVF and still end up without a child. The frustrations of failure are not helped by the financial and emotional burdens of IVF treatment.

So why does IVF treatment fail? There are several steps to be followed during IVF treatment, lasting a few weeks. Each of these steps are critical to eventual success, and any sub-optimal response in any of the steps will influence the final outcome. Some women may produce less number of eggs, and of poor quality. The sperm numbers and quality may also be low. Such a combination would lead to poor fertilization and lowered potential for pregnancy. Once embryos are placed into the uterus, a pregnancy may not ensue, often referred to as failed implantation. Some women will get pregnant, only to end up with an early miscarriage.

Once an IVF cycle fails, attempts must be made to try and pinpoint the likely reason for the failure. You must arrange to meet your fertility team and critically review the failed cycle. Each component step of your treatment must be re-evaluated, in attempts to explain why the failure occurred. Alternate approaches must be defined for subsequent treatment, especially if any apparent gaps become evident. In some cases, it may turn out that everything was optimized from the outset, with no new modifiable approaches. That can be very frustrating, with no apparent reason for the failure.

Subsequent actions following the review depend on several factors. You could decide to try again with your current fertility team. Or you could seek another view with an alternate fertility clinic. If you decide the latter, get a summary of your treatment from the initial clinic as this forms the basis for alternate recommendations. True, 3 failed cycles can be an uphill task. You may decide to halt further treatments and possibly consider adoption. Or as you say, just accept to live childless. The psychological trauma can be daunting, some counselling sessions may come in handy to help you cope with the disappointments.

When delivery needs to be assisted

Towards the end of pregnancy, new anxieties arise about the baby’s delivery. For the majority, the onset of labor usually leads to spontaneous delivery. Some women will however require help in delivering the baby, commonly referred to as ‘Assisted Vaginal Delivery’.

Labor and delivery is a predictable event, but many variables come into play. Obstetricians and Midwives are trained to recognise and intervene when the progress of labor veers from the expected pattern. The final point when the baby is about to be born is referred to as second stage of labor. It is usually a short period, lasting no longer than one to two hours, but Obstetricians may allow a longer interval depending on circumstances.

There are occasions when spontaneous expulsion of the baby will not happen, and a decision must be made on how best to help. It may be that the second stage has lasted too long, the baby may get distressed, or simply that the baby’s position may not be optimal for spontaneous delivery. In other cases, the mother may just be too exhausted to effectively push the baby out.

In such situations, assisting delivery with an instrument comes in. The Obstetrician or Midwife must make a reasoned judgement on the safest way to deliver the baby. In most cases, the head is too low in the pelvis, making instrumental delivery safer than a Ceserean. The choice is between two instruments: Vacuum delivery or Forceps. Each of the instruments is designed to be applied to specific and safe points on the baby’s head. The mother’s pushing efforts are then aided with measured pulls, thereby easing the baby out.

Assisting delivery with an instrument raises a lot of anxieties in the prospective parents. There are genuine concerns on the safety of the procedure. Thus the most important considerations must always be directed towards the safety of the mother and her baby. The Obstetrician or Midwife carrying out the procedure must be fully trained, skilled and certified to use the chosen instrument. And the equipment must be in good working condition. An objective judgement must also be made that an assisted delivery is warranted. Any doubts must trigger consideration of an alternative mode of delivery, or a second opinion from a more experienced Obstetrician or Midwife.

The safety of assisted vaginal delivery is not in question. It contributes to saving lives of newborn babies, and also helps prevent maternal complications that may arise due to prolonged labor. The WHO identifies assisted vaginal delivery as a key component of basic emergency Obstetric care in developing countries. Increased uptake of assisted vaginal deliveries improves maternal and newborn health, parts of millennium development goals. Obstetric and midwifery training on skilled assisted vaginal delivery, coupled with patient education are the key to negating misguided concerns on assisted deliveries.

Keep your kids healthy this school term

The Christmas and New Year festivities are now behind us. We are now back to the hustle and bustle of life, with great optimism for 2018. Not to be left behind is our kids, who went back to school last week after a well-deserved break. We have a duty to support our children’s educational endeavors, and strive to keep them in the best of health.

A good starting point is integrating health into our children’s day to day activities. Teaching them about health early in life lays a strong background for continued healthy behavior into adulthood. Many diseases can be prevented, or at least moderated by healthy practices started in early childhood. We are talking of ailments that include infectious diseases, heart disease, diabetes and even some cancers.

Make sure your child is eating healthier stuff, and less junk. Their lunch boxes should contain mostly plant-based foods. We don’t have to spell these out, but they should include lots of greens, non-refined carbohydrates and fruits. Add some measure of lean animal products for their protein requirements, and boost this with plant proteins that include nuts and various kinds of beans. They can wash it all down with some water, or fresh fruit juices. If your child is getting their meals in school, help them select healthier servings. The school menu must have a variety of foods to choose from, if not give some feedback, or just default back to packing home prepared food for your child.

Kids are kids, and they will still be tempted to eat well-marketed junk. Allow some carefree days when they can have what they fancy. But keep it in check. They need to understand that all those fries and fizzy drinks are laden with unhealthy fats and sugars. Encourage them to remain physically active. This will burn all those unwanted calories, and help with their growing bones and muscles. Aim for at least an hour daily of whatever physical activities they enjoy, anything less is not good enough.

Don’t tire of reminding your children about seemingly mundane healthy habits. Washing hands must be ingrained into their routines. Many infectious childhood diseases can easily be prevented just by good hand hygiene. Talk more to your kids about the ills of drink and drugs. Don’t shy off telling them about sexual health as they transit into puberty.

After-school homework must be moderated to allow for some good rest prior to the next day. Make sure your child gets at least 8 hours of good sleep every night. It’s not all about academics, encourage your kids to pursue other talents. This will nurture their developing brains and give them more life skills as they mature.

Finally, make sure your children get all the recommended vaccines. And if they fall sick, as will happen occasionally, get them seen by a good pediatrician in good time.

Blow Off Post-Holiday Blues

The trouble with holidays is that they come to an end. One minute you're lying on the beach, the sun on your skin, thinking about which cocktail you'll order in the evening; the next you're back home facing a mountain of dirty washing, dead houseplants, 786 urgent emails and nothing to look forward to.So how can you get through this wall of post-holiday misery?

As the holiday season comes to an end, so, too, does the high octane way you've planned, shopped, traveled, and socialized. The holiday momentum of go, go, go, going screeches to a grinding halt.

Problem is, all the neurochemistry you needed to help you get through the holidays - stress hormones called cortisol and adrenaline – are leaving you feeling burned out, irritable, and just plain cranky.

Maybe your hopes for holidays with family and friends were unmet, and you now have to deal with emotional let-down. Then there's the march of the holiday bills -and thinking about paying the piper is not only depleting your bank account but your emotional well-being. All of these experiences are symptoms of Post Holiday Blues.

When that last drop of New Year’s Eve champagne is gone and the Christmas ornaments are packed away, many people enter a state of post-holiday blues. The anticipation and planning that begins with Jamuhuri (December 12th) ends when you open your eyes on the second day of January. It’s hot dry dusty, windy; the parties are over and it’s back to the daily grind. But you can beat the post-holiday blues.

Hitting January 2 is like going from 60 to zero in one day. The mandatory cheer, cooking, visitors, glitz, glitter, toys, a million chores -- have drowned out the drumbeats of war, the nuclear posturing, the fear of downsizing, all the doubts and fears, for a couple of weeks -- then, over, zip. What now?

Holidays often give way to 'divorce season. 'Tis the season for divorce, experts say. That's because the new year often brings a resolution from people to separate from their spouses, inquire about getting a divorce or start proceedings -- after delaying through the holidays for various reasons -- according to divorce lawyers and marriage counselors

The usual blah-blah New Year's resolutions -- lose 20 pounds, go to the gym more, spend more time with your family -- have a way of fading by mid-January as reality sets back in. You go to the office and facing you is a blank calendar. Before you get that sinking feeling -- think.

A blank calendar means, literally, a clean slate," "Think of something positive as of this very minute.

If you keep looking back at the old year -- especially last year -- you will get into a downward spiral.

Some Big Audacious Goals (BAGs)

Learn a second language. Even pecking at learning a second language can shake things up and head you in a new direction

Change careers. Every change starts with a defining moment -- maybe looking at your blank calendar of impending "same olds" can be that moment. Remember the job or city where you were happiest -- how could you get back to that?

Make more money. Start a second business. Find a safe place for your cash.

Join a dating service. No, not you married people! But if you are "between relationships

Plant a tree. The whole world is going green!

Whatever your BAG, it is not only important to put it in writing, but also to put in writing the steps you need to take and the obstacles you will face (this is allowable negative thinking).

Consolidate Your Position At Work

We are all living with tremendous uncertainty." It's much more important to identify what you do have control over. Do you have a "plan B," for instance? What if you do lose your job? Think about the worst and make a plan. "You can cut spending now," she says. Also, you can concentrate on communicating security and a sense of safety to your children, even if you don't completely feel it yourself.

Tips to Kick the Blues

Sleep. After prolonged periods of stress, the body needs more sleep to slow the production of cortisol and adrenaline. Schedule a pajama day to just do nothing and rest. Consider unplugging from technology to give yourself some time to refuel.

Exercise. Moving your body at least 30 minutes a day will help rid excess adrenaline and cortisol that keep you from relaxing and/or sleeping soundly. Walk, run, and play. Have a catch with the kids. Just move your body.

Look forward. Keep your eyes on the next prize. The next birthday, an upcoming concert, a sporting event, etc. This keeps you forward-looking into the year rather than concentrating on the past holidays.

Relive the Memories. Objects and experiences help us embrace memories. Make sure you wear that new shirt or have the holiday photos somewhere in view. Taking time to appreciate the best-loved holiday moments will offset sadness.

Talk about it. Sharing your emotional experiences with another can help you problem solve and feel connected, reducing the likelihood of depression taking hold. Talking is also a great way of revisiting happy moments, making sense of sad experiences and solidifying self-decision making.