Cervical Cancer

Cervical Cancer has been attributed to infection with HUMAN PAPILLOMA VIRUS (HPV). HPV infection is usually transmitted sexually.

…..to her, she was doing this to help her only child whom she gave birth to while in the penultimate year of secondary school.  Regrettably, she said, ‘ i had aborted a couple of pregnancies and had sex with several men while in secondary school and by then i was seventeen because i had to fend for myself as an orphan who had no one to help me, but this child just could not be aborted’.     … that is the result the doctor said. She has stage III cervical cancer at age forty-five…

Overview

Womanhood is a world on its own and it takes patience, knowledge, and pity sometimes for one to dabble into such world. They have their own peculiarities in every sphere of life. In the medical world, as cancer remains one monster to deal with, peculiar to women are some cancers like breast, cervical cancer. In this article, I would focus on cervical cancer which from my own little experience most women don’t know about until they come down with it.

Cervical Cancer

The cervix ( pronounced: saviks) is the neck or narrow portion of the uterus(womb) where it joins with the vagina. Cancer is simply when cells of a particular tissue undergo uncontrolled (and often rapid) growth. Thus cervical cancer is the cancer of the cervix.

Cervical cancer is the second commonest malignancy after cancer of the breast in women in developing countries ( Nigeria inclusive) and it remains the leading cause of death in these countries but the third commonest cancer in women in the world. Peak age when women present in Nigeria is 45 to 55 years. However, it is diagnosed in any woman of reproductive age group.

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The causes have been attributed to

  • Genital infection with human papilloma virus
  • Sex at a young age
  • Multiple sexual partners
  • Promiscus male partners
  • One who had or has a sexually transmitted infections. It is important to point out that HIV infection is associated with a very high increase in risk of cervical cancer.
  • Also, a patient with cervical intra-epithelial neoplasia can progress to cervical cancer

What makes the Doctor think A patient has it

*Though, there are some that may not have any symptom but will come to the hospital with abnormal Papanicolaou (Pap smear) result. This is in those that do screening

* abnormal bleeding from the vagina, majorly after sex

* bleeding from the vagina between menstrual period or after menopause

*offensive vaginal discharge which is characteristic

*pain on pelvic side

For those women that present late, they may have in addition

  • Backache
  • Leg pain/ swelling
  • Blood in the urine or bloody urine

Or the doctor investigates by looking at the cervix called colposcopy

How does the Gynaecologist treat

The treatment modality depends on the stage of cancer the patient presents with.

  • It may be surgery if it is at the early stage or
  • The use of radiation and chemotherapy for the more advanced cases
  • Or the use of chemotherapy or radiation for palliation for cases that have developed other things from it

Survival

There is a similar 5-year survival rates for radiotherapy or surgery for someone with the cancer. This survival also depends on the stage of the cancer. If stage I there is 70-80% survival rate but stage IV has 18% survival rate.

What is in this for YOU! 

The major cause of this disease has been attributed to infection with HUMAN PAPILLOMA VIRUS (HPV). HPV infection is usually transmitted sexually. Condom use may not prevent the transmission. The HPV 16 and 18 are the major serotypes of the cause. Thus, a lady or woman who has been introduced to sex life should get screened two years into sex life and every 3-5 years. In essence, those who should have PAP SMEAR done are

  • Ladies who have started having sex
  • Or above age 21

The American Cancer Society, American College of Obstetricians and Gynaecologist recommend that

  • 21-29 years should have pap smear alone every 3 years
  • 30- 65 years pap smear every 3 years or HPV and cytology testing every 5 years
  • Greater than 65 years no screening recommended
  • Less than 25 no screening recommended because women aged 21-24 are at low risk for invasive cervical cancer but they are at high risk for HPV exposure and associated lesions.

Any Vaccine.

The joy here is that, one could be vaccinated against the Human Papilloma Virus (which is not only for girls but also available for boys) but for girls majorly. The vaccine is useful in those who have not had the disease and no usefulness in one who already had it. The two HPV vaccines approved in the United States of America are Gardasil and Cervarix.

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THE GIST HERE is, please go and get PAP SMEAR done today and tell others about it. It is for your future, in other to live a meaningful life insha Allaah. So please present YOURSELF at any Government health care facility for details.

…. her sex partners were no longer patronizing her since they got to know about her disease as she even was no longer interested in that. She was no more lively, seems no hope for her. Her Chemotherapy drug has made her loose her hair, no beauty to display any longer. The radiotherapy also played it own part on the pelvis. At last, she gave up the ghost with a repentant soul. Don’t ask me if God would accept such repentance.  I leave YOU TO JUDGE…. this woman, this cervical cancer.

I.O Dada (Haniif ibn Toyin)

Childhood Cancers

To nurse one child in Nigeria with cancer, you need about N2 million on the average in a period of about two years

By Drs. Azeezah Shopeyin and Ajayi Abass 

Childhood cancers occur in children less than 15 years. They are devastating not only to the children but their entire family. In Nigeria, it creates a huge financial burden on the family as there is no supportive treatment plan for children and the cost of treatment is very high.

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Cancer leads to abandonment of treatment and consequently death of children. Hence, prevention of childhood cancers cannot be over emphasized. It’s important to note that in most fields of medicine, pediatrics have been found to be of significant challenge, because of communication challenges, and caregiver support.

Burden to public health

The international agency for research on cancer stated in 2004 that worldwide 160,000 children under 15 years get childhood cancers and 90,000 will die from it every year. In 2007, 71.2 of every 1 million Nigerian children below 15 years had childhood cancers.

Due to the lack of data in Nigeria, and the paucity of studies on childhood cancers, it is not easy to appreciate the burden of childhood cancers, this might be due to the preoccupation with infectious diseases which are said to cause about 25% of childhood deaths.

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In an 11year retrospective study conducted in northern Nigeria, by A. Mohammed and A.U Aliyu, it was noticed that childhood cancers were 8.44% of cancers diagnosed within that period. A male: female ratio of 1.5:1.

In 2014, Consultant Paediatrician, Oncology/Haematology Unit of the Lagos University Teaching Hospital, LUTH, Dr. Adebola Akinsulirie, said about four or five cases of childhood cancer are seen monthly at the LUTH. That will give you about 50 children in a year. That is big as far as cancer in children is concerned in Nigeria. To nurse one child with cancer, you need about N2 million on the average in a period of about two years.

Types of childhood cancers

The most common childhood cancers accounting for childhood deaths in Lagos  include kidney cancer (nephroblastoma) and blood cancer (Acute lymphoblastic leukemia and Acute myeloid leukemia)

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Lymphomas (solid cancer of white blood cells) are also quite common childhood malignancies and neuroblastoma (cancer of nerve cells), others include leukemias, bone and muscle tumors.

Causal or pre-disposing factors

The cause of most childhood cancers are unknown in about 75-90% of cases, 5-15% are due to familial and genetic factors( intrauterine viral infections, parental occupational/ radiation exposures, war-torn regions and disasters, elderly maternal age above 35, parental especially maternal smoking and alcohol consumption.

 

and <5-10 % are due to known environmental exposures and exogenous factors (food, radiation, dyes, infections like intrauterine viral infection Epstein-Barr virus and leukemias/ lymphomas etc). It’s important though to note that cancers generally are caused by a variety of factors and are not limited to a single causative agent.

How to recognize childhood cancers early

Complaints about any of the following that does not go away in a child:

  • Feeling of an unusual lump or swelling
  • Unexpected paleness and loss of energy
  • Easy Bruising
  • An ongoing pain in one area of the body
  • Limping
  • Unexplained fever or illness that doesn’t go away
  • Frequent headaches, often with vomiting
  • Sudden eye or vision changes
  • Sudden unexplained weight loss

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Prevention of childhood cancers

  1. Avoidance of chewing or smoking tobacco.
  2. Protection from sunlight.
  3. Limiting fats in diet
  4. A healthy diet with at least 5 portions of fruits and vegetables per day.

Management of childhood cancers

Childhood cancers are managed by a team of specialized pediatric cancer care specialists, including pediatric oncologists, pathologists, radiologists, surgeons, radiotherapists, nurses and support staff include the nutritionist, social workers, pharmacists and other medical specialists. First, a correct diagnosis is made; depending on the stage of the disease from Investigations carried out, the child is given drugs,  and surgical intervention or radiation therapy may be necessary.

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The challenges in pediatric cancer are numerous but surmountable if there is the will. These are

  1. Recognition of symptoms by parents
  2. Time of presentation/ late presentation
  3. Lack of funds by caregivers
  4. Limited diagnostic equipment/ facilities
  5. High cost of diagnostic investigations
  6. High cost of treatment
  7. Effects of cytotoxic drugs/radiation therapy
  8. Lack of political standing of their own as such children are forgotten in most policies.

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The above challenges can be solved if

  1. Adequate awareness is provided about childhood cancers
  2. Children are exclusively included in the NHIS
  3. Funding is provided for research into childhood cancers
  4. Facilities for diagnosis and treatment are provided.
  5. Provision of psychological support and social welfare services.

In summary

Childhood cancers are a source of significant burden to the child, parents, and caregivers; as such a lot of support is needed; financial, psychological, and spiritual. The distress from the disease, the financial implications, and stress of accessing treatment including the toxicity of the cytotoxic agents is of significant concern, however, children are more likely to recover from cancers when they are detected early and commenced on therapy as quick as possible.

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Dr. Azeezah Shopeyin graduated from the University of Lagos, college of medicine.With several years experience, she also has a master degree in public health. She’s interested in health education and promotion. She’s a wife and mother of two kids and she enjoys making people happy,

Dr. Ajayi Abass Oluwaseyi graduated from Ahmadu Bello University in Zaria. Also known as Juggernaut bn Yusuf, he is also a writer, an aspiring Neurosurgeon, and a Farmer. He currently works at the federal teaching hospital in Gombe.

ENGAGING CANCER

Cancer starts from errors in coding as a result of mutations which could occur naturally by heredity when cells are multiplying or induced by an external agent

Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. Not all tumors are cancerous and benign tumors do not spread to other parts of the body.

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Today, millions of people will march all over the world to commemorate the world cancer day. Irrespective of our religion, tribe, nation and political views, this is the day we highlight to fight this menace that has claimed the lives of millions and shattered the hope of many families.

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To explain cancer in simpler terms, biology has taught us all living things are made up of cells, be it unicellular (one) as the case of some microorganisms and multicellular (plenty) as the case of humans. The cell is the basic unit of life. Our cells contain the genetic material “genes” located in the DNA. These genes are made up of simple coding which defines the function of the cell.

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 The interactions of these gene replaces cells when they are damaged or need to grow. These lead to the formation and functionality of tissues, organs and different systems in our body. Just like a computer, made up with various coding and algorithms which help different softwares to work and at the long run function in tandem as a computer.

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Cancer starts from errors in these coding as a result of mutations which could occur naturally by heredity when cells are multiplying or induced by an external agent. Basically, these mutations could occur in genes that control the way cells grow; tumour suppressor genes (TSG) and oncogenes (ONC).

Tumour suppressor genes function like a break system in a car, it halts the growing of cells while oncogenes function like the accelerator of a car, maintaining the speed or rate at which cells multiply. When either of TSG and ONC is affected, what will happen is either cells multiplying at an abnormal speed leading to the formation of tumour in an organ. This occur due to the inability of TSG ‘brakes’ to reduce the speed or cells multiplying excessively due to much pressure on the accelerator, the ONC.

Causes of cancer

Some cancers develop when an individual inherits a bad gene with mutations, an oncogene or a tumour suppressor gene from parents. As the person grows, the mutations increase and finally cancer develops at a particular stage in life. It is like buying a bad computer which eventually develops fault during use.

Some viruses induce mutations in the coding in these genes leading to cancer. Similar to the way viruses attack our computers leading to the deletion of some important files on the desktop leading to software malfunction and sometimes might affect the hardware.

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Carcinogens, chemical agents like benzene that can cause cancer when inhaled or consumed can also induce mutations. It is like using a computer to visit bad websites with malwares, installing fake applications or software that is incompatible with your computer. Also, some environmental factors like exposure to radiation can lead to cancer.

Life style, practices such as smoking can contribute to the induction most cancers. This is similar to personal choices you make with your computer at your own risk, removing a flash drive inappropriately, shutting down your computer unexpectedly or using your computer in an environment where liquids could spill on it. These practices can crash your computer just as a smoker is liable to die young either by lung cancer or other respiratory disorders.

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Another key risk factor that could initiate cancer is aging. The processes that control cell reproduction malfunctions. This lead to accumulation of toxic reactive oxygen species that damage mitochondria (cell engine). For example, reactive oxygen species above normal levels can oxidize our DNA.

The cure, Our Hope

Although we have been blessed with an immune system that could detect and destroy cancer cells, many cancer cells are well equipped to survive and evade these cells. Scientists are left with the option of finding cures for cancer, however, every cancer seems to be different, making it difficult to cure all cancers with one drug. Also, cancers can be well-managed and prevented, telling us cancer is not a death sentence.

Early detection, you can revive a computer which is dragging or slow as a result of malware or viruses. Install an antivirus as quick as possible, there you go. Taking your car to a mechanic when it flashes check engine, when you notice the grip of the brake has reduced or when the clutch smells will definitely prevent a sudden disaster when driving.

As well, early detection of cancers will significantly increase the chances of survival. Doctors would administer different form of therapies just like an antivirus in a computer. Cancerous cells would die and in many cases total remission could occur. However, successfully scanning and deleting the virus on your computer does not assure you your computer can not be infected again, hence, Cancer patients who are in remission can also have reoccurrence.

Some cancers are gender specific, some are age specific, like prostrate cancer and there are recommendations for when to start detecting them.

Positive lifestyle, practices such as eating fruits and vegetables, exercising, quitting smoking, maintaining a clean environment and avoiding junks can reduce the risk of cancer. Recent studies have discovered that processed meats, canned foods, over cooking food such as brown bread could cause cancer.

The Future, Cancer will one day be treated like any other disease with significantly reduced mortality rate. The approach to getting a cure is like traffic rules, using camera speed checkers on the road to prevent excessive speeding of cars and arrest those who over-sped by giving them a surprise ticket when they get home. We would one day detect and arrest rouge cells before the progression of cancers. The use of bumps on roads to prevent over-speeding and also slow down drivers, we are already slowing down the rate at which ONC drive our cells to induce cancer. In the nearest future, our immune system will boosted and trained to apprehend bad drivers of our genes.

Mahmud Abdullah Opekitan attended Obafemi Awolowo University, Ile-Ife, Osun state, Nigeria between 2008 and 2011 bagging a B.Sc Hons Microbiology with a Second Class, Upper Division. He Also has a Master of Biomedical Science degree in Biomolecular Science- With Distinction. He’s currently wrapping up his Phd in Cancer Biology from Strathclyde Institute Of Pharmacy And Biomedical Sciences. 

Depression

You can’t love others if you don’t love yourself and you are selfish if you love yourself too much because few would embrace you. If you don’t love yourself at all, you need help, not death.

“Since the robbery, I have cried all day and night, I can’t believe I have lost it all, ahh! I am so sad, in fact, I am depressed, she said”

DEPRESSION IS NOT SADNESS

Sadness, like excitement, is a normal reaction to an unpleasant situation or life difficulties. Often times, however, ‘I am depressed as used in the story above is used synonymously with I am sad. By extension reducing the reality of the illness to just a mood- sadness. This misconception is what birth statements like “snap out of it”, “man up”, “you are just making a big deal out of it”.

Depression is a mental illness, associated with low mood, decreased energy, low self-esteem, loss of interest in previously exciting activities, appetite disorder (loss or excessive), a feeling of guilt, thoughts of death and disturbed sleep. Depression is way beyond sadness.

Signs and Symptoms of Depression

“It started with my being unable to sleep, but it soon got worse. I lost weight drastically and started experiencing somatization- chronic physical pains in various parts of my body, making me very weak and low-spirited, but no one at the time understood what I was talking about”.  

Again, sadness is not depression, sadness could for some is only a small part of depression and some others may not feel sadness at all. Depression has many other symptoms, including physical ones. If you have been experiencing any of the following signs and symptoms for at least 2 weeks, you may be suffering from depression:

  • Decreased energy, fatigue, being “slowed down”
  • Difficulty concentrating, remembering, making decisions
  • Persistent sad, anxious, or “empty” mood
  • Feelings of hopelessness, pessimism
  • Feelings of guilt, worthlessness, hopelessness
  • Loss of interest or pleasure in hobbies and activities
  • Difficulty sleeping, early-morning awakening, or oversleeping
  • Appetite and/or weight changes
  • Thoughts of death or suicide, suicide attempts
  • Restlessness, irritability
  • Persistent physical symptoms, e.g. diarrhea

Types

There are different types of depressive disorders and based on symptom severity, depression can range from mild to severe to very severe condition

Major depression

Major depression is sometimes referred to as clinical depression, unipolar depression or major depressive disorder. It involves low mood and/or loss of interest and pleasure in usual activities, as well as other symptoms for at least two weeks. Symptoms of depression interfere with individual’s daily life and normal functioning. Depression can be described as mild, moderate or severe; melancholic or psychotic (see below).

Melancholia

This is the term used to describe a severe form of depression where many of the physical symptoms of depression are present particularly slow movement. It is also characterized by complete loss of pleasure in everything or almost everything.

Psychotic depression

Sometimes a depressive disorder can be accompanied by loss \of touch with reality and experience psychosis. This can involve hallucinations (seeing or hearing things that aren’t there) or delusions (false beliefs that aren’t shared by others), such as believing they are divinities, prophets or evil, or that they’re being watched or followed. They can also be paranoid, feeling as though everyone is against them or that they are bad omens.

Antenatal and postnatal depression

In the days or weeks following birth, many women experience ‘baby blues’ which is a common condition related to hormonal changes and affects up to 80 percent of women. The ‘baby blues’, are common experiences, but are different from depression and tend to decrease within a week or two. Depression is longer lasting and can affect not only the mother but her relationship with her child, the child’s care and development, the mother’s relationship with her partner and other members of the family. Almost 10 percent of women will experience depression during pregnancy. This increases to 16 percent in the first three months after having a baby.

Bipolar disorder

In bipolar disorder, the person experiences periods of depression and periods of mania, with periods of normal mood in between. Mania is the opposite of depression, characterized by extremely “high” moods, energized behavior, having racing thoughts, little need for sleep, difficulty concentrating and feeling frustrated and irritable. It may sometimes affect the person’s touch with reality and has episodes hallucinations (seeing or hearing something that is not there) or having delusions (e.g. the person believing he or she has divine powers).

Bipolar disorder tends to run in families. Stress and conflict can trigger episodes for people with this condition and it is common for bipolar disorder to be misdiagnosed as depression, alcohol or drug abuse, attention deficit hyperactivity disorder (ADHD) or schizophrenia. A mild form of bipolar disorder is cyclothymic disorder

Seasonal affective disorder (SAD)

SAD is a mood disorder that has a seasonal pattern. The cause of the disorder is unclear, but it’s thought to be related to the variation in light exposure (Sunlight) in different seasons. Depression which starts in winter and subsides when the season ends is the most common.

Causes

“Mopelola was noticed in September in the year 2014 to be unduly withdrawn from people including keeping away from her friends on the ground that nobody loves her; almost at the same time, she has also been seen not to be participating in some of the church activities that were known to be pleasurable to her. Within a month of the onset of the condition, she has been observed to have reduced appetite for food as she claims that she has a need to engage in fasting and prayers to combat some negative thoughts that were running through her mind, such thoughts according to her include but not limited to thoughts of not “good enough, being worthless and useless and that there was nothing good about her future”. Consequently, she felt unhappy all the times and sometimes got angry at others around him. This condition has affected her ability to concentrate on her JAMB coaching class and her level of concentration has dropped significantly. Her parents in their state of being bewildered to have made many spiritual attempts to ameliorate the problem, only minimal improvement was noticed”

The thought that depression is mood-sadness, and sufferers being individuals “who can’t just get over it” consequently make the misconstrued cause of depression to be Weakness. Religious affirmations that link spiritual weakness to depression further make appropriate treatment less sought.

Depression like all illness have factors that play a role or make an individual vulnerable. They include;

  • Traumatic events
  • Other mental health problems
  • Physical health problems e.g. chronic or life-threatening health problems
  • Genetic inheritance
  • Childhood experiences such as neglect, loss of parent(s)
  • Medication, substance and alcohol abuse.
  • Sleep, poor nutrition, and exercise

Treatment

Depression – even the supposed worse cases – can be treated and individuals can recover and live a productive life. Like all illness, early detection and treatment greatly affect treatment outcome. The earlier the better.

While many may still argue that depression is caused by spiritual weakness or attack, I advise that while deliverance and other spiritual approach are being sorted, kindly visit a doctor. The goal is to be better, isn’t it? The first step to recovery is seeking help, speak to a doctor, your doctor may then refer you to a specialist after physical problems have been ruled out.

Depression depending on the diagnosis made can be treated with medications or psychotherapy or both. Treatment is often times individualized.

Depression can occur to anyone and at ages

According to the World Health Organization (WHO), depression is the leading cause of disability worldwide, and at least 350 million people are affected worldwide, this could be higher considering denial and treatment abstinence based on misconceptions or ignorance could hinder diagnosis in some sufferers. Although a common illness, it affects individuals differently

Depression in Women.

Women with depression do not all experience same symptoms, however, symptoms of sadness, worthlessness, and guilt are typical symptoms women have.

Depression is twice as common among women as among men. Hormonal fluctuations during puberty, menstruation, pregnancy, childbirth and menopause are probable causes amongst other factors such as genetics and abuse.

Depression in Men

Men although less likely than women also suffer depression and manifestations in men differ from those in women. Men are more likely to react to life difficulties with denial, anger, violence or substance and alcohol abuse. Some men may throw themselves into their work to avoid talking about their feelings or behave recklessly. Although more women attempt suicide, many more men die by suicide.

Depression in Children

Children are particularly thought to be free-spirited and do not “think”, hence can’t suffer depression.

“Most studies concur that about 1% to 2% of pre-pubertal children and about 5% of adolescents suffer from clinically significant depression at any one time and by the age of 16 years 12% of girls and 7% of boys would have had a depressive disorder at some time in their lives”.

The implication of the above is that in a primary school of about 300 children at least 3-6 of them will be depressed at any one time. Children with depression may pretend to be sick, refuse to go to school, cling to a parent or become excessively anxious. The normalcy of children makes recognition a bit difficult, however, a change in the initial behavioral or academic pattern are major red flags to watch out for.

Depression in Teens

As children grow into teenagers and adolescent, parental acceptance is second to peer acceptance, coupled with hormonal changes, teenage years can be tough and irritable moods are expected.

However, depression in teenagers often presents with persistence in irritability (hostile, easily frustrated, angry outbursts), hypersomnia, increased appetite or loss of it, extreme sensitivity to rejection (criticism). Depression if left untreated may manifest fully in reckless behavior, substance abuse or school desertion.

Unlike in adults, children and teenagers rely on adults (parents, teachers, and caregivers) in recognizing and helping them get help as ignorance of their feelings or their natural dependence may prevent them from getting help.

Takeaway

Prevention is better than cure, early detection and treatment will prevent disease progression

Self-care tips and general lifestyle modifications can help manage the symptoms of many mental health problems, and may also help to prevent some problems from developing or getting worse.

Reference

Depression in children and adolescents, 2015 edition by; Joseph M Rey, Tolulope T Bella-Awusah & Jing Liu pg. 2

Shadows in the Mirror by; Dr. Vivian Ikem

 

 

 

Rukayat Ogunbiyi is a Pharmacist and Public mental health advocate, inclined towards child and adolescent psychiatry. She was trained as an intern at the Federal Neuropsychiatric Hospital, Yaba. She is currently set to resume post graduate studies in Child and Adolescent Mental health at the Center for Child and adolescent mental health in University of Ibadan.

Anxiety and co…

Anxiety disorders are the most commonly encountered psychological disorders among adults

If you have never felt anxious, something is wrong with you. It is okay to worry temporarily especially when we have to make important decisions when we are faced with a challenge or a test/exam. However, it is a different case entirely when this is blown out of proportion. Anxiety disorders are the most commonly encountered psychological disorders among adults and they interfere with performance, relationships and other healthy daily activities.  Have you read about Stress?

Anxiety disorders are the most commonly encountered psychological disorders among adults and they interfere with performance, relationships and other healthy daily activities.

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Nobody wants to be labeled as crazy, especially in an African society where stigmatization thrives like wild-fire. For this reasons, critical issues pertinent to assessing anxiety disorders are bordered on;

  • Sensitivity to making the diagnosis
  • Anxiety in a mask of productivity
  • Other psychiatric diagnoses associated with it
  • Medical conditions and medications that can cause or exacerbate anxiety disorders.

Risk Factors

  • Shyness, or behavioral inhibition, in childhood
  • Being female
  • Having poor economic resources
  • Being divorced or widowed
  • Exposure to stressful life events in childhood and adulthood
  • Anxiety disorders in close biological relatives
  • Parental history of mental disorders

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The anxiety disorders that will be examined in this write-up will include:

  1. Panic disorder
  2. Generalized anxiety disorder
  3. Obsessive compulsive disorder
  4. Post-traumatic stress disorder
  5. Social phobia and specific phobia.

As each disorder is explored, emphasis will be placed on assessment of commonly encountered psychiatric and medical conditions that contribute to anxiety symptoms. However, before considering the specific anxiety disorders to be presented in this program, it is useful to highlight the following issues:

Psychiatric Disorders associated with Anxiety Disorders

  • Major depressive disorder
  • Substance abuse disorders – alcohol, marijuana
  • Somatization disorders (fatigue, chest pain, headache, insomnia, non-specific GI complaints)
  • Complex anxiety disorders – ( Post-traumatic stress disorder with Panic disorder)

Medical Conditions associated with Exacerbating Anxiety

  • Hyperthyroidism
  • Adrenal Dysfunction
  • Angina
  • Hypoglycemia

Medications and Substances associated with Exacerbating Anxiety

  • Stimulants (Amphetamines, caffeine, cocaine, and other over the counter “natural stimulants”)
  • Withdrawal from drugs, including alcohol
  • Heavy metals and toxins
  • Steroids
  • Rapid withdrawal from some antidepressants

General Action plan in dealing with anxiety and associated disorders

  1. Assessment for suicide risk, particularly in patients with depression and panic disorder, substance abuse or high levels of agitation.
  2. Identification of severity of anxiety disorder (chronic or episodic)
  3. Identification of substance abuse
  4. Assessment of key symptoms of panic disorder, fear of dying and/or fear of going crazy
  5. Assessment for depression or other mood disorder
  6. Inquiry as to the presence of anti-social behavior
  7. Exploration of presence of precipitating event or trauma
  8. Being alert to people with anxiety disorders who have insomnia, headache, non-specific GI complaints, cognitive complaints

We will be talking extensively about mental health and major associative conditions in the comings weeks. Stay tuned. Read about Stress here.

Harmattan Blues: Medical conditions that come or worsen with this harsh weather

The Harmattan is a dry and dusty wind which blows from the Sahara Desert over the West African subcontinent between the end of November and the middle of March. It is cold in some places and hot in others, according to differing circumstances.

The Harmattan brings desert-like weather conditions:

  • it lowers the humidity
  • dissipates cloud cover
  • prevents rainfall formation
  • creates big clouds of dust

Effect on our Health

Skin Conditions

Dry skin: (because of obvious loss of moisture) you may have cracked lips, cracks in the sole of the feet and even the skin itself. Some cracks even become ulcerated. Those with have a natural dry skin tends to have scales and blisters on their skin during this period

Also, when the weather is cold, Infants, children and the elderly are more vulnerable to a low body temperature (hypothermia; below 35 degrees centigrade) due to a sub-optimal temperature regulating mechanism.

Remedy

  • Keep lips and skin well lubricated: Shea butter does a great job.

ENT

Nose problems

Spontaneous nosebleeds are common for some people because the nose is at the forefront, takes in the dry dusty air that we breathe. So the nose tries to warm the air, acting like a conditioner, before it’s transported to the lungs where the air is utilized optimally.

The humidifying effect of the nose on the air leads to a dry mucous lining of the nose and induces a lot of nose picking. Excessive nose pickings or violent sneezing against a blocked nostril can damage blood vessels within the nose. The bleeding is usually from just one nostril and would need urgent medical attention

Remedy

  • When the air is really harsh, even breathing can become painful, thus, steam inhalation comes in handy. Thi will have a moisturizing effect that will soothe the nose.
  • Use a face mask when traveling through very dusty regions
  • Always have your antihistamine if you are prone to excessive sneezing from allergic rhinitis

Eye disorders (Acute red eyes)

Apollo (Viral Conjunctivitis) is very common from the mid-November month and is caused by a virus that the wind sweeps along its path. Although the virus is self-limiting, it can be a nuisance as it infects all family members if care is not taken. Also, there is a risk of secondary bacterial infection.

Allergic Conjunctivitis: when the eyes are exposed to the dust particles, mites, and pollen carried by the dry, cold and dusty wind, they can also irritate the conjunctiva leading to itching, redness, and a feeling of having foreign bodies in the eyes. Also, excessive dust particles and other infections may irritate the cornea, leading to acute keratitis which also presents with red eyes, eye discharge and other symptoms similar to conjunctivitis.

Remedy

  • Have nasal and plain/anti-allergic eye drops
  • General covering of the head is beneficial
  • maintain good personal hygiene

Ears

Due to the connection between the nose and the throat and the ears, some people who are prone to having ear infections finds this period a nightmare. They have blocked ears which may also have a purulent discharge as infection passes through the eustachian tube. Also, dust may get trapped in the ear and lead to infection of the middle ear, called otitis media.

Remedy

  • Use mildly wet wool to clean the ears
  • See a doctor if you have serious pain and discharge from the ear, you may need antibiotics

Other Infections

It is important to remember that meningitis caused by a meningococcal infection is usually experienced between February to May in the ‘meningitis belt’ and some parts of Nigeria. Thus, routine immunizations should be a top priority.

Blood

The harmattan also triggers sickle cell crisis in those with sickle cell anemia. Oxygen in blood is usually reduced in extremes of temperatures, like the cold or heat this weather serves. This extremity can induce the blood cells to coagulate under this external stress, and combined with the dehydration,  Thus, it is important that people with Sickle cell disorder take extra precautions, keep warm, and increase their water intake.

Remedy

  • They should just communicate properly with those around them to achieve a stable, healthy environment
  • They should seek medical help immediately when symptoms of a crises ensue.

Respiratory system

Asthma: After the air leaves the nose, some unfiltered allergens (pollens, dust, mites) can still reach the lungs thus leading to aggravation of asthma. A special precaution to reduce exposure to the dusty atmosphere is imperative for asthmatics and in addition, having their inhaler with them all the times is advisable.

Respiratory infections

  • Pneumonia: The dust particles may overwhelm the system and predispose it to infection. It is common place to experience excessive sneezing, cough and catarrh.
  • Flu is a contagious respiratory illness caused by influenza viruses and can cause mild to severe illness
  • Superimposing bacterial infection can take advantage of any imbalance and must be aggressively treated with appropriate antibiotics.

Remedy

  • Prompt treatment of respiratory symptoms like a cough, catarrh, and others is important.

Other recommendations

  • Air-conditioners should also be serviced to avoid harmattan induced symptoms. Wipe windows, fans with wet rags.
  • Wearing weather friendly dressing is advised. Citizens at this time should seek means of keeping warm especially by putting on warm clothing.
  • Proper eye hygiene and care in form of washing with clean water reduce exposure to dust and use of protective spectacles is encouraged during this period.
  • Take more liquid, especially water, during harmattan to prevent dehydration and heatstroke.
  • Observe a high level of personal hygiene to prevent the spread of the virus.
  • Drive carefully due to reduced visibility; try not to have an allergic attack while driving as well
  • Stay alerted; not only are fire outbreaks common observe your surroundings and not fall a victim to other’s carelessness or misfortune.

Mental illness as a curable disorder: Debunking common myths

Kunle Omo Ijoba sits at a particular spot all day, always, with his dress tattered and hair mashed into an untidy Bob Marley style. Sometimes he would accost strangers claiming they owe him money. The market was his home and he would seldom entertain the traders with his dance moves and sometimes reveal more that they bargain for; with genitals out like a ware in a trade fair.

The picture described above is something most, if not all, Nigerians are familiar with. Mentally disordered people litter the streets and from time to time and we may or may not encounter them. Unfortunately, the description above largely defines our knowledge of mental illness. Our socio-cultural beliefs have entrenched in us several myths and misconceptions that affect our overall reaction to mental illnesses resulting in unfair and unwarranted stigma, discrimination and inappropriate or lack of treatment for sufferers.

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The World health Organization defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

In a research done by V. O. Lasebikan et.al in a primary health center in Lagos Island, Nigeria, 400 people that consisted of 88 children and young adults below aged 29 years, 55 aged 30 to 39 years, 72 aged 40 to 49 years, 63 aged 50 to 59 years, and 122 who were above 59 years, (226 (56.5%) were females, and 250 (62.5%) were married) were assessed and;

  • psychiatric morbidity was significantly highest for respondents below 39 years
  • psychiatric morbidity was significantly highest among those who were divorced 72%

The most prevalent clinical syndrome was unexplained somatic complaints (57.5%), followed by depression among half (50.0%) of the respondents, any anxiety disorder (49.3%), primary insomnia (45.3%), and alcohol use disorder (11.3%). Between 2.0 and 7.8% of respondents had disablement in various areas of life, out of which the commonest was in the domain of family relations (7.8%).

symptoms

To bring about “change”, these misconceptions and myths need to be cleared out and the correct picture painted. The following statements are tailored to iron out negativity and bring to light the facts about the illness before we take a journey on specific mental disorders and how to deal with them.

1. Myth: Mental illness is caused by supernatural forces

Evil spirits, witchcrafts have been for so long been held as the cause mental illness. Due to this perceived causes, religious institutions have been consistently sought for a cure or more appropriately deliverance.

Fact: Like every other illness mental illnesses are medical illnesses. Research shows there are genetic and biological causes for psychiatric disorders, and they can be treated effectively.

2. Myth: Mental illnesses are incurable and lifelong?

Fact: When treated appropriately and early, many people recover fully and have no further episodes of illness. For others, mental illness may recur throughout their lives and require ongoing treatment. This is the same as many physical illnesses, such as diabetes and heart disease. Like these other long-term health conditions, mental illness can be managed so that individuals live life to the fullest. Although some people become disabled as a result of ongoing mental illness, many who experience even very major episodes of illness live full and productive lives.

3. Myth/Misconception: Mental illness is innate?    

It is customary for families to sort through genealogy in search of history of mental illness in the family their child is marrying into.

Fact: Vulnerability to some mental illnesses, such as bipolar mood disorder, can run in families. But other people develop mental illness with no family history. Many factors contribute to the onset of a mental illness these include stress, bereavement, relationship breakdown, amongst other life negativities. But then, it can be managed.

4. Misconception: Mental illness only affects bad persons (karma)

The lady who bewitched her friend’s husband, the wicked stepmother, the rich ritualist; which other one? Nollywood’s favourite karma dish is “madness”.  I suppose, these pictures are what comes to mind first when you see a psychotic person on the streets.

Fact: Everyone and anyone are vulnerable to mental health problems. Many people feel more comfortable with the notion of having ‘a nervous breakdown’ rather than a mental illness. However, it is pertinent to talk openly about mental illness, as this reduces the stigma through reorientation and helps people to seek help early.

5. Misconception: People with mental illness are usually dangerous

Fact: This is about the greatest misconception that results in great stigmatization. People with mental illness are seldom dangerous; in fact people with the most severe mental illness are rarely dangerous especially when receiving appropriate treatment and support. Some mental illnesses are associated with aggresiveness and impasitivity, however, it is extrememly important such persons get help as they are more likely to harm themselves before others.

The vast majority of people with mental health problems are no more likely to be violent than anyone else. Most people with mental illness are not violent. In fact, people with severe mental illnesses are more likely to be victims of violent crime than the general population. You probably know someone with a mental health problem and don’t even realize it, because many people with mental health problems are highly active and productive members of our communities

6. Misconception: People with mental illness should be isolated from the community

Some communities have a myth that if “a mad man bites you, you’d get infected with the madness too”

morningside-recovery-examines-mental-illness-discrimintation

Fact: Most people with mental illness recover quickly and do not even need hospital care. Others have short admissions to hospital for treatment. Improvements in treatment over recent decades mean that most people live in their communities, and there is no need for the confinement and isolation that was commonly used in the past. Besides, mental illness is not an infectious disease and cannot be passed from one person to another through coughing or touching.

7. Fact: Stigma is one of the biggest problems for people with mental illness.

One of the greatest obstacles to recovery from mental illness is confronting the negative attitudes from the society. These often mean that people with mental illness face isolation and discrimination just for having an illness. Positive attitudes of family, friends, service providers, employers, and other members of the community toward people with mental illness are critical to ensuring quality of life for people with mental illness and supporting recovery.

8. Myth: Children don’t experience mental health problems

Once, I saw an undressed child stand in front of a moving car without fear ; no emotions at all. The driver parked and shouted “ogbanje”, a melodramatic episode followed thereafter.

Fact: Even very young children may show early warning signs of mental health concerns. These mental health problems are often clinically diagnosed, and can be a product of the interaction of biological, psychological, and social factors.  Our culture could not describe the emotionless attributes in some children nor is it able to decipher the hyperactivity of some children, they simply label them as “ogbanje” or “hard/stubborn child”. Majority are unaware of developmental mental health disorders  which show first signs before a child turns 5 years old, or even before 14 in adolescent disorders and three quarters of mental health disorders begin before age 24.

9. Myth: Postpartum mental illness “abisinwin”only occurs in cases of spiritual attack or genetic in some families.

Still on the Nollywood matter.

Fact: Mental health problems among women who are pregnant or who have recently given birth are observable in all countries and cultures. “Abisinwin” postpartum mental is not as depicted by our southwestern indigenous movies. Maternity, third day or postpartum blues occur in 80% of women who have recently birthed a child, with characteristic emotional swings from euphoria, tears (often without sadness), restlessness, anxiety, to feeling of unreality and detachment from the new born. However, the persistent presence for at least two weeks of cognitive and affective symptoms maybe suggestive of a serious mood disorder. Postpartum psychosis occurs within 48-72 hours after birth.

10. Misconception: Prevention doesn’t work, it is impossible to prevent mental illnesses.

Fact: Prevention of mental, emotional, and behavioral disorders focuses on addressing known risk factors such as exposure to trauma that can affect the chances that children, youth, and young adults will develop mental health problems. Promoting the social-emotional well-being of children and youth leads to:

  • Higher overall productivity
  • Better educational outcomes
  • Lower crime rates
  • Stronger economies
  • Lower health care costs
  • Improved quality of life
  • Increased lifespan
  • Improved family life.

Friends and loved ones can make a huge difference. Communal support can be important influences to help someone get the treatment and services they need by:

  • Reaching out and letting them know you are available to help
  • Helping them access mental health services, first aids are possible
  • Learning and sharing the facts about mental health, help correct misconceptions.
  • Treating them with respect, they are not different from other ill persons
  • Labels are for clothes; not human. Do not use labels like “crazy, mad, Kolo”

Overview of Common Mental Disorders

mental_disorders

1. Schizophrenia
It is characterized by psychotic episodes with recurring functional periods of disordered thought procecess. Symptoms include; delusions, hallucinations, disturbance of thought, disorganized speech, difficulty in concentration and poor memory.

2. Anxiety Disorders
An anxiety disorder involves an inappropriate response characterized by feelings of apprehension, uncertainty or fear. This disorders can be differentiated into Generalized Anxiety Disorders (GAD), Panic Disorder (PD) amongst others.

3. Personality Disorders
Personality disorders are a combinations of patterns and behaviors that deviates markedly from the expectations of the culture of the individual who exhibits it.

Conclusively, Mental illness like every other illness requires specialists to diagnose and provide care. it is treatable, curable, and does not require advance technology; our perception of it will affect how we get approach it positively.

To stay mentally fit, let’s continue the conversation, share some of the myths and misconceptions you know that was not highlighted, together we change the narrative.

 

 

 

Rukayat Ogunbiyi is a Pharmacist and Public mental health advocate, inclined towards child and adolescent psychiatry. She was trained as an intern at the Federal Neuropsychiatric Hospital, Yaba. She is currently set to resume post graduate studies in Child and Adolescent Mental health at the Center for Child and adolescent mental health in University of Ibadan.