Dear doctor, I took postinor [morning after pill] but I fear that I might be pregnant.

In fact I had sex at night and then took the I-pill early in the morning. Could I have conceived then, or two days later when I had sex again?

Dear Shakira, an I-pill is a single emergency pill (1.5mg of drug) taken only once in one’s monthly cycle. Many women are used to two pills (0.75mg) taken six hours apart, the morning after sex. Both types are then called morning after pills. You may be pregnant because you used the pill as a regular contraception instead of an emergency. The pill works among other ways by delaying ovulation and if you did not use other methods of protection like a condom you may have become pregnant after you had sex two days after taking the pill.

You needed a regular method of contraception instead of an emergency pill. Emergency pills can on their own delay or bring periods earlier. You, however, need to carry out a pregnancy test since a delayed period usually indicates a failed pill resulting in pregnancy. An ultrasound examination then will indicate how far along the pregnancy is since the pill may result in pregnancy in the fallopian tubes. Emergency pills do not maim the unborn so please see your obstetrician for ante-natal care instead of contemplating abortion.

Dear doctor, I have been having very heavy periods for four days with big clots on the third and fourth days. The doctor attributed it to hormonal imbalance. I was given norethisterone but instead it made the periods a bit light but prolonged for about 10 days. I opted to go back to my heavy-but-fewer days periods. It is a year since I last used norethisterone.

My last two periods were light and I thought I had stabilised. The current one has been heavy as if it is compensating for the blood that did not come out during the last two periods. Is there a possibility that the blood could have remained stuck inside the walls and came out now or could it as a result of the artemether lumefantrine malaria treatment I am on?

Again, the clots have different colours, with some dark red with patches that are light. Sometimes the clots appear lifeless, like a piece of flesh and do not dissolve on the pad. Could it be flesh coming out?

Dear Grace, periods result from shedding of the inner membrane of the womb. The build-up of the said membrane is influenced by sex hormones oestrogen and progesterone so that if there are problems with these hormones, a woman is likely to miss her periods or have them light or very heavy.

The blood shed, being a product of a membrane which is broken down by enzymes in the womb plus, may appear as pieces of flesh if the bleeding is heavy.

In cases of a bigger membrane build up, the enzymes may fail to completely break up the membrane which may then come out as clots of blood or flesh and not surprisingly in various colours. Also since you saw little blood the previous period, some blood may actually have been retained only to come out older and darker.

Problems of sex hormone imbalance do not only affect periods but also genital lubrication and fertility and therefore require serious management. As such, go back and visit your gynaecologist before it is too late.

Dear doctor, I have a friend who feels pain in her private parts. It was on and off but now her urine turns white when she urinates somewhere and it dries, and it smells as if it has been there for three days. What can she do?

Dear Vanessa, pain in the genitals may result from an infection by germs, an irritation by chemicals or mere fear (psychological). Urine is usually straw coloured and if one is not taking enough fluids, it may be deep yellow.

Urine smell largely depends on diet though a Urinary Tract Infection, especially with germs from the large intestines (E.Coli) may cause a bad urine smell. Of course, left to stand for some time, urine will give a stench because it undergoes changes.

A urine or genital check and evaluation of your friend’s psychological status may all be necessary.

Dear doctor, my best friend is in her eighth month of pregnancy and will be delivering anytime from now. Last December, she went for a scan and the results show that her baby has foetal multicystic dysplastic kidney disease.

What is this and what are the implications for her baby when born?

Will she have a normal delivery? Will her baby live a normal life? I am confused and do not know what to do. The doctor s at the clinic she has been attending antenatal did not explain this.
Godwin R

Dear Godwin, I am sure that if the lady asked the doctor, he would be able to explain what your friends unborn child is suffering from. Foetal multicystic dysplastic kidney disease, is when the unborn may in one or both kidneys have small water filled bags.

Kidneys have units called nephrons which produce urine and deliver it to urine collecting tubes and eventually reach the bladder for storage. Sometimes somewhere between the nephrones and urine collecting system may be blocked leading to urine filled bags (cysts). This disease may be associated with other organ problems including lungs and alimentary canal and hence after birth these have to be checked out and managed accordingly.

If the kidneys are not very big, the baby may be born the normal way and as such it may be necessary to carry out ultrasound examinations before labour.

The extent of the feotus’ problem after it is born, will depend on how many kidneys are affected because if it is one, it can live a normal life but the sick kidney may have to be removed to avoid complications like cancer or high blood pressure. Also, if the other organs are involved, this may spell more danger.

During pregnancy, the placenta does most of the kidney work but the kidneys produce water (amniotic fluid) which surrounds and cushions the baby and also help the lungs to mature.If there is no amniotic fluid the outcome may be fatal because the lungs as well as the kidneys will not function. So after birth, the baby’s problems will most likely worsen requiring attention from a doctor, especially for babies (neonatologist).

Dear doctor, what brings sleep during day?

Dear Siya, human beings sleep a third of their lives and normally this occurs at night. When, for any reason, a person does not have a good night’s sleep in terms of quality and quantity, he will pay for it by sleeping during the day.

One may fail to sleep at night because of lifestyle (students, party animals) or one may have a condition denying him/her sleep (menopause, painful joints or arthritis, anxiety and stress).

On a hot afternoon, after a fatty or carbohydrate-laden lunch many people may feel sleepy since much of the blood goes to the digestive system to help digest food or to the skin to help temperature regulation leaving the brain short on blood supply resulting in drowsiness.

Drugs which cause sleep at night (valium) or during day (many cough syrups) may make one drowsy during the day.

A person should normally be active during the day, and if he is disturbed by sleep then this may interfere with work or if operating machinery or is a driver, they may get accidents. It is important to look out for the cause and mitigate it.

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