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BODY ODOUR. By Dr Kemi Agbaoye of medik247

I was on a flight to Abuja from Lagos once. I boarded early, found my seat, and got ready to enjoy the one hour flight. There were three seats on my side of the aisle and I had the window seat. I was glad because it looked like I was going to have the entire row to myself, but at the last minute, someone came and took the aisle seat, and with him came this really strong garlic-like odour. It was so strong that I had to reopen the vent I had closed earlier because I was cold. Better to be cold than to choke you know? Yet, I struggled most of the flight. I was shivering AND choking. Oh well. Garlic does have a lot of health benefits, and Asians know it. He was Asian.

 *BODY ODOUR:*

 *Definition:*
Known medically as Bromhidrosis or Osmidrosis is a chronic condition in which excessive odour, usually unpleasant, emanates from the skin.
Truth is everyone has an odour, but when it becomes unpleasantly excessive, and starts to affect the quality of a person's life, then there's a problem.

It is most common in postpubertal people (because the most common type only occurs after puberty) and Asians have been documented to be most dominantly affected, mostly because of their diets and clinical visits on account of resultant depression. A positive family history of Bromhidrosis in them is also a strong predisposing factor.
It is also more common in males than in females.

Pathophysiology*
How does it happen? There are two major types of sweat (human secretory) glands in the body;
 *The Apocrine glands*
These glands are found mostly in the axilla (arm pits), genital skin, and breasts. Some are also found in the periorbital (around the eyes) and periauricular (around the ears) areas. They are found in the reticular dermis and subcutaneous tissue and are controlled by the sympathetic nervous system. They are responsible for Pheromonal odours (basically that unique smell that everyone has that's distinct to them and makes them sexual attractive). They are not responsible for thermoregulation. They are larger. *Apocrine Bromhidrosis* is therefore, more common and it occurs when there is bacterial decomposition (commonest of which is corynebacterium species) of apocrine secretion, which yields Ammonia and Short chain Fatty acids, which have strong odours. The secretions by themselves are odourless. Bacterial action on them give rise to the unpleasant odour.

 *The Eccrine glands* are found all over the skin surface and are found in the dermis. They are responsible for thermoregulation via the production of sweat. *Eccrine Bromhidrosis* occurs when eccrine sweat softens Keratin (in hair follicles) and then bacterial degradation of this keratin yields a foul smell. Ingestion of garlic, onion, curry, alcohol, drugs (like penicillin and bromides) and toxins all predispose to Eccrine Bromhidrosis because they lead to excessive sweating ( *Hyperhydrosis* ). Excessive sweating leads to more softening of keratin, which in turn leads to more bacterial degradation.


*Precipitating Factors*
Are there things that can predispose you to having a body odour? YES! They include;
●Inadequate hygiene
●Medical or   dermatological conditions associated with Hyperhydrosis or over growth of bacteria, which include;
° Obesity
° Diabetes Mellitus
° Intertrigo
° Trichomycosis axillaris
°  Erythrasma
Others include
● Post - Laser treatments
● Foreign body in the nose in children
● Gout
● Scurvy
● Typhoid.

Symptoms and Signs*
The odour is usually mostly axillary (from the arm pits). It's described as pungent, rancid, musty or sour. The other common sites include the genital area and the soles of the feet.
There are usually no significant physical signs to be demonstrated by the physician, except in cases where there are concurrent illnesses, for example, fungal infections like Trichomycosis axillaris in which concretions are seen at the root of the hair follicles in the armpits.

*Investigations*
Not really indicated here; it is a clinical diagnosis. However, in cases of other concurrent illnesses, or where they are suspected, tests are requested for in that line.

*Treatment*
So what do you do when you can't seem to be able to get rid of that smell? (Please note that you should confirm that you actually do stink!!! Ask your loved ones! They say only someone who loves you will tell you that you stink. This is for such cases. Not people who "imagine" that they stink. 😉).
*Health Education*
Very important.
■ Use antibacterial soaps
■ Use antiperspirants
■ If you wear clothes with dried sweat on them, you will stink!
■ Avoid excessive intake of spicy food. Reduce your garlic, curry, e.t.c 🙂
■ Reduce Alcohol!
■ And while you're at it, stop smoking!!!
In other words, reduce the amount of toxins you load your body up with.🙂
■ Oh yeah, wash your armpits! Shave too!

*Medical Treatment*
■ Topical antibiotics can be used when disinfectants fail.
■ Treat underlying skin conditions like Intertrigo, Erythrasma and Trichomycosis axillaris
■ Botulinum toxin: please see your doctor! It basically aims to reduce sweat production by inhibiting the nervous system.

*Surgical Treatment*
Reserved for severe cases, especially those in psychological distress. Common among Asians.
■ Some of the Apocrine sweat glands with cellular and subcutaneous tissue  in the armpits can be removed, leaving behind the skin.
■ Superficial Liposuction Curretage; in which a tube is attached to the armpits and subcutaneous fat is drained out.

*Conclusion*
Body Odour is a medical condition caused by over secretion of apocrine or eccrine glands that becomes malodorous on bacterial breakdown. It can be managed by certain health practises, but when those fail, please seek medical help, because it has been found to be a source of social and psychological distress.

MYTHS ABOUT FEMALE VIRGINITY.

Bleeding doesn't determine a girl is a virgin so I decided to release this article to help educate our young men and women on this issue of girls bleeding during first time sex.

There's a very common myth in South and Central Asia (Pakistan, India, Bangladesh, Afghanistan etc.) and Africa (Nigeria and many other nations ) that you can tell if a woman is a virgin, by whether or not she bleeds the first time she has sex. There is zero truth in this. Not all women bleed the first time they have sex, as I'll explain in this post.
To understand why some women bleed and some don't, it's very important to understand what the hymen is. The hymen is a membrane that tends to cover part of the vaginal opening (it does not always block or cover the entire vagina, as some people mistakenly think). NOT ALL WOMEN HAVE A HYMEN. The hymen also differs from woman to woman - like all women have different heights and weights and features, all women also have different amounts and types of hymen. Some women have thick hymens, some have very thin hymens, and some women have NO hymens at all. Some women have larger hymens, some women naturally have a very little amount of hymen that covers only a small portion of their vaginal opening (and hence does not really get in the way, during first-time sex).
In addition to this, the hymen wears away on its own as you grow up. For most women, the hymen wears away on its own with exercise, bicycling, horseback riding - it can wear off with pretty much any other physical activity, even dancing! - or from using tampons when menstruating. Especially if the hymen is very small or thin, most of it tends to wear away on its own as a girl grows up.
If a woman is born WITHOUT a hymen, she won't bleed the first time she has sex. If a woman has a small or thin hymen, she might not bleed the first time she has sex. If a woman's hymen has worn away on its own (which is very common as girls grow up), she won't bleed the first time she has sex. The result is that the overwhelming majority - at least 63% of women - will NOT bleed the first time they have sex, according to a study published by the British Medical Journal. Women who do bleed include:
- Women with thick hymens (who constitute a small percentage of the population)
- Younger girls. Because the hymen wears away on its own with time, a 16-year old has a higher chance of bleeding than a 25-year old. By the time a girl is of or above the legal age of consent - 18, 20, 24 years of age, for example - most of her hymen is likely to have worn away on its own, meaning it's unlikely that she'll bleed a lot, if at all. However, even a young girl can be physically active, have a thin or small hymen, or have no hymen at all, meaning she might not bleed during first-time sex.
- Most often, women who bleed tend to be women who are dealt with roughly during sex. If the guy forces himself inside the girl, when she isn't ready, relaxed or aroused enough, he is likely to cause injury or bleeding. Because most people think it's normal for women to bleed the first time they have sex, they don't realize that this bleeding is a result of the woman having been hurt, and not of the hymen 'breaking.' Painful first-time sex is generally because the woman is not relaxed or aroused enough, and gets hurt as a result; it is rarely ever because of the hymen breaking.
The bottom line is that there is no way to assess female virginity. Bleeding does not have anything to do with virginity - it has to do with the kind of hymen a girl has, and hymens differ from girl to girl from birth. The result is that only a small percentage of women bleed the first time! (Only 37% bleed during first-time sex, according to the study published in the British Medical Journal.)
Why is this so important to be aware of? Women all over the world get abused, injured and even killed due to the myth of 'virgin bleeding.' Because most people (men AND women) think that bleeding is a sign of virginity, women who don't bleed the first time have been divorced, suffered from suspicion leading to domestic violence and abuse, and even killed for honour. Educating people that a girl does not necessarily have to bleed the first time she has sex - because not all girls have thick hymens, and some are born with no hymen at all - is important because it can literally save lives.
P.S: I understand that not everyone is able to share material like this, even if they want to. However, the only way we can educate people regarding this issue is if it goes into the newsfeeds of as many people as possible, if as many people as possible read it. So please consider sharing.  We need to make content like this visible to increase its reach, to educate people, to have impact.

HYPOTENSION. By Dr M Okenwa of medik247

This is the opposite of hypertension. It is when blood pressure is below 90/60mmHg.
If the BP falls gradually, it does not usually constitute a problem. But if the fall is sudden, there is noticeable symptoms which sometimes might be life threatening.

In practice however, blood pressure is too low only when it presents with noticeable symptoms.

Symptoms;
-dizziness
-thirst
-fatigue
-cold clammy hands and legs
-fast breathing
-blackouts
-lack of concentration
-pale skin
-fainting
-headache
-light headedness
-dark urine
-absence of sweat
-in extreme cases, unconsciousness.

Causes of hypotension:

-dehydration
-low blood sugar
-low blood level
-bleeding(blood loss)
-pregnancy
-thyroid conditions (hypothyroidism)
-excessive loss of fluid (diarrhoea and vomiting)
-adrenal insufficiency
-some heart conditions
-severe allergic reactions (anaphylaxis)
-antihypertensives like diuretics and alpha blockers
-lack of vitamin B12 and folate
-Viagra and other vasodilating drugs


TYPES

Orthostatic( sudden fall in BP as one stands up). Also called postural hypotension

Post prandial hypotension( happens after heavy food)
Vagovagal syncope (inappropriate nerve signal causing sudden fall in BP)

Shydrager syndrome

RISK FACTORS FOR DEVELOPING HYPOTENSION

*medication
*Age
*Some disease conditions

COMPLICATIONS

-Falls
-Inability to perform daily routines and duties.

DIAGNOSIS

See a doctor.
You will be interviewed and examined.
BP check using sphygmomanometer can confirm hypotension.
Tests like blood tests, ECG and others may be done.

TREATMENT

Treatment of the underlying cause
Withdrawal of causative drug
Increased salt intake
Drinking of more water and less alcohol
Volume resuscitation and blood transfusion
Early morning dose of caffeine can help.

LIFESTYLE

More water, less alcohol
Healthy diet.
Get up slowly (in orthostatic hypotension)
Eat small, low carbohydrate meals(in post prandal hypotension)

MONKEY POX OUTBREAK IN BAYELSA STATE, NIGERIA.what you should know.

Monkey pox virus outbreak was announced yesterday in Bayelsa region of Nigeria where over 10 persons including a medical doctor were diagnosed and quarantined. Here is what you should know about the virus

Monkeypox is an infectious disease caused by the monkeypox virus. The disease was first identified in laboratory monkeys, hence its name, but in its natural state it seems to infect rodents more often than primates. The disease is indigenous to Central and West Africa. An outbreak that occurred in the United States in 2003 was traced to a pet store where imported Gambian pouched rats were sold.

Monkeypox virus is a zoonotic viral disease that occurs primarily in remote villages of Central and West Africa in proximity to tropical rainforests where there is more frequent contact with infected animals. Monkeypox is usually transmitted to humans from rodents, pets, and primates through contact with the animal's blood or through a bite. Human monkeypox can be difficult to distinguish clinically from smallpox (to which it is closely related) and chickenpox (to which it is not).

Monkeypox virus which causes the disease in both humans and animals was first identified in 1958 as a pathogen of crab-eating macaque monkeys (Macaca fascicularis) being used as laboratory animals. The crab-eating macaque is often used for neurological experiments. Monkeypox virus is an Orthopoxvirus, a genus of the family Poxviridae that contains other viral species that target mammals.

The virus was first discovered in monkeys (hence the name) in 1958, and in humans in 1970. Between 1970 and 1986, over 400 cases in humans were reported. Small viral outbreaks with a death rate in the range of 10% and a secondary human to human infection rate of about the same amount occur routinely in equatorial Central and West Africa. The primary route of infection is thought to be contact with the infected animals or their bodily fluids. The first reported outbreak in the United States occurred in 2003 in the midwestern states of Illinois, Indiana, and Wisconsin, with one occurrence in New Jersey. The outbreak was traced to a prairie dogs infected from an imported Gambian pouch rat. No deaths occurred.

The virus can spread both from animal to human and from human to human. Infection from animal to human can occur via an animal bite or by direct contact with an infected animal’s bodily fluids. The virus can spread from human to human by both respiratory (airborne) contact and contact with infected person's bodily fluids. Risk factors for transmission include sharing a bed, room, or using the same utensils as an infected patient. Increased transmission risk associated with factors involving introduction of virus to the oral mucosa. Incubation period is 10–14 days. Prodromal symptoms include swelling of lymph nodes, muscle pain, headache, fever, prior to the emergence of the rash.The rash is usually only present on the trunk but has the capacity to spread to the palms and soles of the feet, occurring in a centrifugal distribution. The initial macular lesions exhibit a papular, then vesicular and pustular appearance.

Prevention and treatment
Currently, there is no proven, safe treatment for monkeypox. Smallpox vaccine has been reported to reduce the risk of monkeypox among previously vaccinated persons in Africa. The decrease in immunity to poxviruses in exposed populations is a factor in the prevalence of monkeypox. It is attributed both to waning cross-protective immunity among those vaccinated before 1980 when mass smallpox vaccinations were discontinued, and to the gradually increasing proportion of unvaccinated individuals.

 The United States Centers for Disease Control and Prevention (CDC) recommends that persons investigating monkeypox outbreaks and involved in caring for infected individuals or animals should receive a smallpox vaccination to protect against monkeypox. Persons who have had close or intimate contact with individuals or animals confirmed to have monkeypox should also be vaccinated. The people who have been infected can be vaccinated up to 14 days after exposure. CDC does not recommend preexposure vaccination for unexposed veterinarians, veterinary staff, or animal control officers, unless such persons are involved in field investigations.

Symptoms/Cures
In humans, monkeypox is similar to smallpox, although it is often milder. Vaccination against smallpox is assumed to provide protection against human monkeypox infection considering they are closely related viruses and the vaccine protects animals from experimental lethal monkeypox challenge.
Patients typically experienced prodromal symptoms of fever, headaches, muscle aches, chills, and drenching sweats. Roughly one-third of patients had nonproductive coughs. This prodromal phase followed 1–10 days later by the development of a papular rash that typically progressed through stages of vesiculation, pustulation, umbilication, and crusting. In some patients, early lesion will become ulcerated. Rash distribution and lesions occurred on head, trunk, and extremities; many of the patients had initial and satellite lesions on palms, soles, and extremities. Generalized rashes in some patient are also evidence.

Stay safe.

HOW TUBERCULOSIS HIDE IN YOUR BODY

Tuberculosis bacteria hide in the very cells that normally kills them.
We know more about how they evade recognition.

Tuberculosis affects millions of people worldwide. Treatment for it is often prolonged from six months to two years. Tuberculosis has been around  as long as human existed, says professor Trude Helen- https://www.sciencedaily.com

PAINFUL TRIUMPH! A true life story(must read) episode 22

The celebration lasted till evening. When it was getting dark, Ray excused himself to see his friend off. Chunks, according to Ray was his childhood friend. They attended same school but he got a job in another state, and ever since then, They hardly see each other.

" Let's go upstairs" Ada said, Dragging her up,

"Where are you taking her to? We're not done with the celebration" Ray's mum said, gently loosing her grip.

"Hope you're not planning to sleep with her tonight because she's sleeping in my room" She continued,

"..but mummy" Ada grumbled,

" No but Nne, She's spending the night in my room, If you don't like it go get your own daughter in-law" She said jokingly. Ada frowned and left the room.

"Why not go and freshen up while we wait for Ray" She suggested. Chi ran to Ray's room to bath and change to her night wear.

She gently pulled out the golden ring in her third finger and smiled. She laughed when she remembered how she was tricked to believing it was his mum's birthday.

She was still admiring the ring when the door opened. Ray was on a call when he entered so she waited for him to finish before asking,

" Why did you tell me today is your mum's birthday?" She asked frowning, pretending to be angry.

"Sorry baby, I wanted to do this in our usual spot, The garden. But mum and dad insisted i do it here. I wanted it to be a surprise" He explained.

"This ring is beautiful" She said in admiration. Girls love ring pass their lung sha

" Yes, Beautiful girls like you deserves beautiful things " He said kissing her forehead.

Love is indeed a beautiful thing

They were summoned later in the night by his father, so, they all gathered in the sitting room.

His dad was the first to speak,

" We welcome you once again to our home, I never thought this would happen too soon because at a point, i was already losing hope of witnessing my son's marriage. I've always wanted him to marry early but each time i bring up the issue, He got irritated and disappears from home for a very long time. I and his mother here have talked and talked all to no avail. When he told us earlier this years that he was going to bring a girl which he intends marrying home, I thought it was a child's play until the first day he brought you home. We were all very happy and since then we've been looking forward to this day, which happened to be the engagement, and we can't wait for the wedding.

Before this day, The family has been planning on how best to go about it and we've come to the conclusion that the wedding both traditional and white will be done in December when our relatives both home and abroad will be present.

Time is no longer on our side because December is in two months time. We are going to look for a perfect date to fix the ceremonies but before then, We would like to start with the normal procedures of knowing your people and paying the necessary price as tradition demand. Before we go, we would like to inquire somethings from you, What's the first step we're supposed to take?" the man asked her. She kept quite for a while before replying,

"I don't know" She said shyly.

" You know culture differs, we need to know so we can know how to go about it" Ray's mum said.

"I will ask my mum" She said.

"Why not call her now or give us her number" His mum suggested.

" I think we should go there and enquire ourselves" His father said.

After a brief negotiation, it was concluded they'd visit her people the next month to introduce themselves and know the next step to take.

******************************* One week later,

They were strolling around his vicinity, enjoying the cool evening breeze when they sighted a woman carrying a baby. Ray told her how much he loved babies and how he couldn't wait to have his.

They got to a house where no one is occupying, and sat down in front of the gate discussing the future of the kids they were yet to have

They concluded they were going to have four kids just like his parents. He will make sure they have all he lacked as a kid, The first son will take over his business just like he did, they would raise a doctor that would treat and take care of them when they get old, a barrister to defend them when trouble arises and an engineer.

They talked as if the children are there with them

There is no greater feelings like planning your future with a responsible man.

PAINFUL TRIUMPH! A true life story(must read) episode 21

"Hello ladies!" Ray greeted as soon as he joined them in the room, he was carrying a saucer containing some fried meats and a can of soft drink.

"Care for some?" he asked, stretching out the plate towards Chi. She shook her head and continued with what she was doing, The dresses and shoes were more important to her than anything as at then. She focused her attention on them as if they would fly away.

Girls don't joke with clothes and shoes. They are just like that

"Can i have some?" Ada asked reaching for the meats,

"Miss Glutton" Ray teased and she laughed.

Aunty Linda came up few minutes later to inform Ray about his friend that came visiting and also told the girls to leave everything they were doing and move to the sitting room because the party would soon start,

"Homo! Homo!" The man hailed when he sighted Ray running down the stairs.

"Chuks! Chuks! I thought you were joking when you said you would come" Ray said hugging his friend.

"Even if i miss any other events, I won't miss this one" His friend said and they laughed. He drew Ray closer and whispered something to his ear, Ray glanced at Chi and smiled, nodding his head. By then his dad was back from the church.

The men went to sat on the sofa while the women went inside the kitchen to get the foods and drinks. Men no get work sha. They are lazy like that

After a short prayer led by Ray's father, Ray's mother suggested the "Deed be done" first before refreshment. Whatever she meant by that, Chi didn't know. She kept starring at them like a lost sheep in the midst of wolves, wondering what they were up to. Ray's mother whispered something to his ears and he stepped forward smiling, cleared his throat and began,

" Eerrm, I don't really know how to put this, Forgive my manners, I'm a man of few words" He turned to Chi, Gently took her hand, drew her closer and continued.

" Mum and Dad, You could remember when i made a promise to you both, that I'm gonna present my wife-to-be to you before the year runs out" He paused and looked at them,

"Yes!" They said in unison, and he continued,

"Today is the day. Here is the girl i wish to marry. I don't need to introduce her to you people again because we've known her for long. She's the one my heart beats for and the one I'll like to spend the rest of my life with..." The applause coming from everybody gathered there obstructed his speech. They were all full of smiles. He turned to Chi when the noise had subsided and said,

"Chi, I don't have much to say but i believe meeting you was never a mistake, and I'm glad destiny brought us together. I want you to be my wife and mother of my unborn kids. In the present of my mum, Dad, Sister, Aunty and friend, I'm not gonna ask you if you wish to marry me. I'm begging on my kneels, Please, MARRY ME!" Ray said going down on his kneels.

She quickly covered her face with her palms shyly, Unable to utter any word,

Ada burst out laughing, she went closer and shook her vigorously,

"say something na" Ada screamed,

"I don't know what to say" She muttered, still covering her face.

" Say, Yes!" The women urged her.

"YES!" she blurted out, and everybody clapped in excitement. Ray quickly slipped the ring in her finger and stood up to hug her.

Ada quickly uncovered the cake and a light flashed from behind, that was when chi noticed a photographer in the house. She later learnt he was asked to stay behind and could only commence work if she said "Yes", It was a day she thought she would live to remember before devil shattered her hope, but that is story for another day.

They ate, Drank and danced together. When it was time to cut the cake, She noticed why Ada covered it earlier, It was written, SHE SAID YES.

To be continued.

PAINFUL TRIUMPH! A true life story(must read) episode 20

seven months gone and they were still bubbling. They had become more of lovers than friends. He took her out to so many places within the state and showered her with gifts, on some occasions, he had taken her to the various companies and businesses he was running. She got exhausted on each trip and after following him twice, She refused going again,

Ray must be a very strong man, she thought. No wonder he's always busy. He doesn't sit at a place. Running from one filling station to another plus other of his father's business, Including the plaza mounted in several places and schools.

"I can't wait for you to finish school so you can help me handle some of the businesses" He said to her. He told her why his father stopped trusting anyone with his business, and that was after his close friend whom he entrusted his business in his care sold some of his properties and flew outside the country with his family.

Trust is dangerous, they say.

The week was such a stressful one for them, while Ray was busy with his business, she was busy studying hard in other to make him and her family proud. He made sure she visits every weekend and sometimes they spend weekends in his family house with his parents and sibling, without his troublesome "Aunty" though

Then come the day she considered as one of the best days of her life, Her engagement.

It was on the month of October, on a Sunday, Ray called her as usual and they attended the early Sunday service together. They left the catholic church by 10 am and headed straight to his father's house. She was surprised when he took the road that leads to the family house because he never told her they would be visiting and they visited the previous Sunday.

" Are we going to your dad's house?" She asked, looking confused.

"Yes!" he replied "Today is mum's birthday, She asked me to bring you along else she won't allow me enter the house" he said laughing, but she didn't find it funny,

" You mean today is her birthday and you never told me! How can i go there empty handed, I would have gotten a gift for her" She said looking sad.

"Don't worry, I bought her a gift. You don't need to buy another one, My gift is yours as well...." he tried to explain, but she snapped.

" I can't just go like that! I need to buy something for her" She persisted.

Ray knew how stubborn she could be especially when she had made up her mind about something. He quickly stopped and ask her what she wanted to get for his mum, They drove into a shopping mall, picked some few items and left.

Getting to his house, She noticed how quite the whole place was unlike the day of his father's birthday. It was a very big occasion with many people trooping in and out of the building. She opened the car and went in leaving Ray behind. Ada was the first to see her and ran to hug her.

"Where's mum?" Chi asked looking around,

"So, you did not miss me, You're busy asking after mum?" Ada said jokingly, squeezing her face with that "I'm jealous" look.

"Please tell me where she is, I want to wish her a happy birthday before Ray" She said impatiently.

"Birthday? Today is not her....." it seemed she remembered something and paused,

"Oh, She's in the kitchen with Aunty Linda" She said, leading the way to the kitchen,

"What of dad?" Chi asked half way to the kitchen,

"He's not back from church" Ada responded.

"Mum, Happy birthday!" She screamed, running to hug Ray's mum.

"Thanks my baby, you are looking gorgeous" The woman said, planting a soft kiss on her forehead.

She washed her hands and was about joining them in the cooking when Ray's mum stopped her. She told her to go and rest because they were almost done with the cooking.

She went to the dining to admire the big cake on top of the table, Ada quickly rushed and covered the top with a foil, preventing her from reading what is written on the cake.

"Mum said nobody should go close to the cake!" Ada shouted. " Let's go inside the room, I have some clothes and shoes to give you. Sister Juliet sent them to us on Thursday" She added, taking her hands and leading her to her room.

"does she know me?" She wondered.

"She has seen your pictures and i told her your size" Ada told her.

They went into the room chatting and laughing as they chose the clothes.

But she wondered why Ray's mum didn't want to celebrate her birthday in a big way. But wait, something is fishy there, Ada mistakenly told her that day wasn't her mum's birthday before she suddenly remembered herself, Ray didn't wish her anything when he entered the house, rather he whispered something into his mum's ear and they laughed. Ada refused her seeing what was written on top of the cake. Well, whatever be the case, She knew it was going to be a good day.

To be continued

GALL STONE DISEASE. by Dr Ikenna Nduaguba

WHAT ARE GALLSTONES?
Gallstones are stone-like materials which form when liquid bile stored in the gallbladder hardens or crystallizes.

Bile contains water, cholesterol, fat, bile salts, proteins and bilirubin.

If the liquid bile contains too much cholesterol, bilirubin or reduced bile salts, under certain conditions, it can hardening or crystallize into stones.

TYPES OF GALLSTONES:
1.Cholesterol stones
2. Pigment stones

Cholesterol stones are usually yellow-green and are made primarily of *hardened cholesterol*. They account for majority of gallstones.

Pigment stones are small dark stones made of *bilirubin* which is a break-down [waste] product of red blood cells.

Gallstones can be as small as a grain of sand or as large as a tennis ball.

*Problem is*, gallstones can *block* the normal flow of bile [ the special juice ] if they lodge or occlude any part of the tube that transport the bile from the liver to the intestine.

This can lead to *inflammation*, and if blocked for a significant period of time, *severe infections*, affecting the gallbladder, liver or pancrease.

CAUSES:
*Cholesterol stones* - forms when bile contains too much cholesterol, too much bilirubin, or not enough bile salts. Or when gallbladder does not empty its content as it should.

*Pigment stones* - forms in hereditary blood disorders such as sickle cell anaemia, infection of biliary tree/structure or liver failure.

RISK FACTORS:
♦Women between the 20 - 60 years, twice as likely as men.
♦Increasing age over 60 years.
♦Pregnant women, women on birth control pills and women on hormone therapy.
♦Obesity.
♦Adult consuming diet high in fat and sugar along with inactive lifestyle.
♦Rapid weight loss associated with severe caloric and fat restriction. This is why any attempt to lose weight should be with proper medical supervision.
♦Heredity.
♦Some drugs eg. Fibrate hypolipidemic drugs.
♦Round worm infection: Over 70% of patients with pigment gallstones have part of round worm or their egg within the stone.
♦Sickle Cell Anaemia: Gallstones are disproportionately common in sickle cell anaemia in which deformed red blood cells are broken down releasing large amount of bilirubin leading to formation of pigment stones.

SYMPTOMS:
A typical gallstone attack can cause:
🔹Steady pain in the upper abdomen that increases rapidly and lasts from 30 minutes to several hours.
🔹Pain in the back between the shoulder blades.
🔹Pain under the right shoulder.
🔹Nausea and vomiting.

Gallstone attacks often follow fatty meals and they may occur during the night. Other gallstone symptoms include:
##Abdominal bloating.
##Recurrent intolerance of fatty foods.
##Indigestion.
##Belching.
##Colic.

When *complicated* by inflammation of the gallbladder, liver or pancreas, the symptoms may include:
🔹Low-grade fever.
🔹Chills.
🔹Yellowish colour of the skin and white of the eye.
🔹Clay-coloured stools.

Affected persons are to *see a doctor immediately*.

Many people who have gallstones have no symptoms and are said to be *asymptomatic* and the stones are called *silent stones*. They do not require treatment.

Gallstone symptoms are similar to those of heart attack, appendicitis, peptic ulcers, irritable bowel syndrome, pancreatitis and hepatitis. Therefore *accurate diagnosis is important*.

DIAGNOSIS:
When gallstones are suspected, the doctor is likely to request for an ultrasound.

*Ultrasound* is the most sensitive and specific test for gallstones.

Other diagnostic tests include CT scan, MRI and blood tests.

TREATMENT OPTIONS:
*Surgery* to remove the gallbladder is the most common way to treat symptomatic gallstones.

The surgery is called *cholecystectomy*.

Fortunately, the gallbladder is an organ that people can live without. Losing it would not even require a change of diet.

*Non-surgical approaches* only for cholesterol stones in special situations eg when patient is unfit for surgery include:
▪Oral bile salts therapy [for months or years].
▪Extracorporeal shockwave lithotripsy.

*PREVENTION*:
🔻Eat a diet high in vegetable, proteins, nuts, and other good source of fibres.
🔻Avoid eating too much fat.
🔻Maintain a healthy weight.
🔻Regular physical exercise.
🔻Avoid crash diets or very low intake of calories.
🔻Ursodeoxycholic acid treatment can prevent gallstone formation in the setting of rapid weight loss caused by very low calorie diet which are associated with high risk of new cholesterol gallstones [20 - 30% within 4 months].

TO THE YOUTHS OF THIS GENERATION by Oluwole David.

Look beyond what you can see and see beyond what you know.
Times have come and gone; seconds, minutes, hours, days, weeks, months, years, decades and centuries.

At a time, you were born, at a time you were celebrated. The reason of your celebration is defined by the various kinds of individual present at the time of your birth.

To your parent, you are a seed given to them as a fulfilment of his promise( be fruitful and multiply and replenish the earth). To friends and family, a new being has been added to the family so 'let's rejoice with those rejoicing'. To the enemies, a new Glory has been turned on and it is an opportunity to turn it off.
They all rejoiced and celebrated!

What about your generation, o ye youth?
Listen to me ye youth, you met chaos, troubles, tribulations, wickedness, injustice, immorality, idolatry, deciet, lies, waywardness in your generation and yet you fold your arms to do nothing about it?

Hear me now, o ye youth! Stand up to your responsibilities and wake up from your slumber!

The one who created you never gave you your strength to be wasted on vain pleasures and profane activities
You were given that strength and ability to change where you are.

Wake up o ye youth and look at your fathers, learn from their mistakes and add to your strength!

Wake up, you sleeping youth and retrace your steps back to your creator for revitalization back into his original purpose for you.

It is time to realise the weakness and limitations of your fathers, they strived but couldn't prevail, they wrestled but couldn't conquer! Will you also end up like them?

Get up! Charge yourself to victory and conquer your fears.

Tune the vain and profane use of your strength to accomplish the divine purpose of the one who created you.

Death looms- that is if you still want to do it the old way.

Let the passion of victory over the enemy of your soul burn you up.

Your fathers only knew him but lack the strength to overcome.

You are strong, his seeds abides in you and everything needed for you to achieve victory lies within you.

O ye youth, wake up and Triumph!

PAINFUL TRIUMPH! A true life story(must read) episode 19

"I call her aunty because .............." Ray paused and looked at her,

"Chi, I don't want to drag you to this. This is my family issue, we don't allow it go beyond the family. Nobody, not even my best friend know about this. Can we forget it please?" Ray pleaded.

"But you promised to tell me about it?" She reminded.

"Yes i did, but i don't want to involve you in the mess. Dad promised to caution her and i trust him on this. She will never insult you again i promise"He said.

"But I want to know her" she persisted.

"She's not important. Mum and Dad loves you and i love you too, that's what matters" Ray said.

"If you don't tell me, I'm afraid I won't follow you to your house again!" She said seriously. The words must have shocked him, He sprang up like someone that was bitten by a bee and began walking inside his room, he stopped on the way, turned and sat back again.

"Chi, Why have you refused to understand me? I'm doing this for your sake and that of my family. It's too early to start keeping enemies. Please, try and understand me?" He pleaded.

" OK, No problem. I don't deserve to know because I'm not a member of your family" She said biting her lips, something she does whenever she's angry.

"Come on, How could you say that. You will soon become one of us, very very soon" He was smiling at her but she wasn't smiling at all.

"So, can we talk about something else" Ray asked trying to change the conversation,

"If it's not about the woman, forget it" She said backing him. Yes, she's just stubborn like that.

Ray sighed heavily, beckoned on her to come closer and began,

" The woman I call my aunty is actually my biological mum..." Ray paused to check the impression on her face.

"What?!" She screamed. "But your mum was the person that packaged the food for us" she asked, totally confused.

"Yes, that was what i and my siblings thought before a serious problem started years back causing the secret to leak" He said,

"How come! What happened?" She asked anxiously,

"Calm down. I'm with you" He said.

"According to my dad, He met my mum in his second year in the university, he was living with his uncle while mum was staying with her elder sister. The other woman that came to welcome us is her niece, the daughter of that her sister, she's late now.

Dad told me she was in secondary school then. They started dating secretly, one day she took in and when she discovered, she ran to my dad crying profusely. They thought of what to do but couldn't come up with any idea. Dad was in school, still living under his uncle's care while mum was in SS3 preparing to take her exams. There was nothing they could do, the only option left was an abortion.

Dad confided in his friend who took them to a chemist in his hometown after lying to both families that they were attending a church program in another state. she nearly lose her life in the process but her womb was badly affected. She was later taking to the hospital where it was confirmed she had only 2% chance of giving birth in the future.

To cut the story short, Dad married her later when he was ready for marriage despite everything. They agreed on bringing a woman that would give them two or three children and in return, they would pay her off. Dad told me how difficult it was getting someone to carry on with the plan so he went to the brothel where he picked a lady who accepted to do that with a huge sum of money which Dad couldn't afford as at then. So, they agreed she would give birth to only two children with a lesser amount. The lady ended up giving birth to two girls who happened to be my elder sister. She was paid off and she left but dad wasn't satisfied because he needed a male child. He went to the same brothel after four years but the place had been converted to a church, he tried his luck elsewhere but couldn't find any other prostitute, so he called the same lady and increased the money to get her do the job. She didn't mind because she was already in her early 40s, no one wanted to marry her, all she needed was money. That was the lady you saw. After given birth to I and my younger sister she refused to go. She started giving one excuse and another and since she's the mother of my dad's children, Dad let her stay. Problem started when she started making trouble with my mum, claiming she's the rightful owner of everything that belongs to my father because she gave him children, she even went as far as threatening to take her children away if dad says otherwise (i.e denying her access to his properties)

My dad being a man that can't be easily intimidated quickly reacted. He involved a lawyer and after everything she lost the case and was thrown out of the house.

She later came back begging, saying she doesn't have anywhere to go, claiming our family is the only family she has. Dad forgave her but not until she signed never to either disturb nor fight any member of our family again. All these happened when I was in junior secondary school. To avoid trouble, dad built another house for her in her state and opened a big supermarket for her. He permitted her to visit anytime but vowed never to allow her live with us again.

" but why do you call her aunty instead of mummy" She asked, interrupting him. "My mum was the one that brought us up. All she did was just give birth and after three months, she dumps the baby for my mum and went after her business, she visited only when she wanted to collect money from dad and once the baby is two years, She returns back to the house fully to complete her task and then disappears again after delivery. When i was a kid, we were told she's my mum's younger sister and that's how we started calling her aunty" He explained.

"You said the lady i saw is your younger sister right?" she asked, and he nodded,

"Why is she bearing 'Ada' i thought it's meant for the first daughter?" She asked.

"Her name is Amanda, Ada is a name given to her by her classmates back in primary school after she participated in a drama, some students and teachers who don't know her real name started calling her Ada...."

"Oh, okay, but why was your mum, i mean your aunty angry with me, did i do anything bad to her?" She asked looking sad.

" she's a sadist. She doesn't like anybody. It's not just you, sometimes she doesn't answer my greetings. She's only after my dad and his wealth but dad is not giving her the chance. She's sad because he doesn't give her the attention he gives my mum. She hates it when we call her 'Aunty' but there's nothing we can do about it. We are used to calling her 'aunty' she can't take my mum's place. If not because the secret leaked, We wouldn't have known she gave birth to us. How can we even think of calling her mummy when she never cared for us, all she ever wanted was how to look good and make money. Last time she called me aside and complained about it, I told her it's either she accept the 'Aunty' in good fate or i start calling her by her name 'Angelina'.." Ray said and they burst out laughing.

"So, How long is she going to stay?" She asked him, "She's leaving tomorrow morning according to Dad. He only invited her because i told them i was going to bring you home today, I warned dad not to inform her as if i knew what was going to happen but he insisted, he felt it's proper to invite her....."

"Am i that important to your family? maybe that's why she wasn't happy with me, It could be that she had other things to do with her time" she wondered,

" I told you she's a sadist. Even if she had something important to do with her time, did anybody force her to come? As whether you are an important personality in my family, Yes you are! My other sisters would have been there if not that they are outside the country but you will get to see them soon. Chi, Let's forget this my aunty issue for now, It's night already, let's go to bed. I have work to do this week and i will be very busy" He said, and they rose to go, but before they retire for the night, he made her promise never to disclose all he told her that night to anybody.

PAINFUL TRIUMPH! A true life story(must read) episode 18

After the introduction from both sides, Ray's father apologized for what happened earlier and promised her it won't repeat Itself again. When they were about leaving, Ray's mother with the help of his sister packaged some foods, can drinks and fried meats for them. Ray thanked her and called the gateman to take the items to his car.

"Thanks for coming my dear, it will be our turn to visit you next" Ray's mum said caressing chi's hair.

"So, When are you bringing her again?" his sister asked him.

"Tomorrow" Ray replied jokingly, and they all laughed.

"Who's that woman" Chi asked as soon as they entered the car.

"Which of them?" Ray asked, adjusting his seat belt.

"The one that kept scolding me", Chi said frowning,

"I will tell you about her when we get home" Ray said to her.

They branched inside a supermarket on their way back to pick some few items, Ray used the opportunity to pick a night wear for her.

"Do you like this?" He said, pointing to a pink night gown hanged neatly inside the shop.

"Yes!" she nodded. It's better than the oversized boxer and baggy polo she has been using as a night wear, she thought.

Ray noticed how cold she had become after they left his house and he tried to cheer her up,

"Are you still worried about my Aunt? Don't worry, i will tell you everything once we get home" He said patting her back.

She went straight inside the bathing room to have her bath and get ready for the story, she was weakened by the incident that occurred earlier, she just found herself recollecting the things that happened and grumbling in the bathroom as she poured water all over her body, scrubbing it gently. Did she offend the woman in anyway, why was she so annoyed with her?

She was so engrossed with her thoughts that she didn't know when she spent close to one hour in the bathroom, Ray's voice brought her back to her senses. He had gone to knock on the door,

"Chi, Are you there?" He asked, Turning the knob.

"Yes! I'm bathing" She stammered,

" Are you okay" he asked feeling concerned.

"Ye..s" She replied, trying to sound normal.

"Okay, Meet me in the dining when you're through"He informed.

She quickly cleaned her body and left. She joined him later in the dining where he was already seated waiting for her.

"Chi, Are you sure you are okay, you look dull. Are you sick or you're still worried about my Aunt?" Ray asked, touching her neck to feel her temperature. She just nodded saying nothing.

"Come on, Don't tell me you're still bothered about that little incidence. Look. Everybody must not like you. Don't allow her attitude to weigh you down. Mum and Dad loves you, and that's the most important thing. Forget her! I promised to tell you about her and i will, but first you have to eat" He said, trying to calm her down.

She nodded and began eating her food slowly. Still worried but didn't show it. That's her nature, little things brings her down. She's emotional. Very very emotional.

PAINFUL TRIUMPH! A true life story(must read) episode 17

"Welcome to our home" Ray said, ushering her a seat.

Ray's mother and the other women went away as soon as they entered the house to get the food served. Ray's father went straight to the dining to wait for the lunch.

Chi took her time to observe the sitting room. It was very large and well furnished. She was lost in the family pictures hanged on the wall of the sitting room, trying to see if she could recognise any face in the picture. She smiled when she saw the picture of a toddler holding a ball, and she quickly recognized him to be Ray.

"Aahh! Aunty, you are here"

she quickly turned back and saw Ray hugging a woman seated in one of the sofa in the parlour. She wondered how she wasn't able to notice the woman when they entered. Perhaps, because the parlour is too big, or maybe she didn't look around when she entered.The woman only smiled weakly and sat back saying nothing.

But why didn't she come to welcome them like every other person; she wondered. Well, everybody must not come out to welcome visitors, she concluded. She turned back and continued starring at the pictures.

"Nne, Bring the food quickly!"Ray's father said to his sister. Men and food. They are just like that

She was still admiring the photos when the woman whom Ray addressed as "Aunty" walked up angrily to her and asked, "Don't you greet?!"

she felt a sudden fear surged through her. "Good afternoon" She said in a shaky voice.

Ray had gone upstairs leaving her in the parlour. He would have come to her rescue, she thought.

"It's okay! She's a visitor" Ray's father intervened sharply. He must have gotten irritated by the woman's attitude.

They ate and laughed happily except the "Aunty", she kept throwing glances at her which made her really uncomfortable.

"Hmmm! Mum, This food is delicious" Ray said, scooping a spoonful of rice into his mouth.

"I'm a good cook na" His sister boasted.

"My dear, Hope you're enjoying the meal?" Ray's mother asked Chi, and she nodded.

She watched as every other member ate with spoon, fork and knife. Hmm! There they go again. She's only used to the spoon. She looked at Ray who was busy cutting the chicken with a knife and munching the rice hungrily. He was even too busy to notice she wasn't eating. She wished she was born into a rich family like his. She turned and saw the "Aunty" pounting her mouth while looking at her wickedly. She wondered how she offended the woman in the first place.

"Which village do you come from?" The woman asked mockingly,

"No introduction until after the meal!" Ray snapped, mistaken her mockery for a genuine question.

"I mean, Which part of the bush village did she come from. She's not eating because she can't make use of the cutleries!" The "Aunty" retorted.

Ray quickly dropped his food and starred at the woman.

"I have told you to leave the poor girl alone for Christ sake, She's your visitor and you own her some respect!" Ray's father cautioned.

Ray got up immediately, quickly took Chi's hand and dragged her out of the dining. He opened a door close to the sitting room and they entered.

"Stay here. I'm coming" He said.

She saw him coming later with plates of food together with his mum, his sister and the other woman who followed them to welcome her. The mum apologized for what happened and they continued with their meal. His father joined them after they have finished with the food and clearing the dishes. That was where Ray formally introduced her to the family.

As for the "Aunty" she didn't see her again that day until she left. She learnt she had gone inside her room.

But who is she?

Well, That is story for another day.

The woman almost ruined her day. Just when she thought Ray got a wonderful family, but just like a proverb,

In every twelve there must be a Judas.

PAINF TRIUMPH! A true life story(must read) episode 16

"Forever, forever, forever, I like it i really really like it ee!" That was the music coming out from the car stereo as Ray drove her to his family house that morning. She just sat there following the lyrics and nodding gently. She was already exhausted after sitting for more than four hours in the church. It was the last Sunday of the month, also known as the "Thanksgiving Sunday" this is when collection of offerings are done more than five times for the building or growth of the church and rendering help to the beggars and orphanage.

"Sorry for the delay" Ray said once they got to the car as if it was his fault. That's one thing about him, always apologizing at every little mistake or delay whether or not the fault is from him. He bought some yoghurt at the church gate and handed them to her before driving out. As if he knew she was hungry. Chi smiled and heaved a sigh of relieve as they drove out.

"What a Sunday, Damn!" she cursed under her breath.

The journey from the church to his house was a short one.

"That's our house" Ray said pointing to a big white duplex with a black gate. She suddenly became scared. Apart from living and serving people as a help during her childhood days, She has never entered such a big mansion. She felt like jumping out of the car and disappearing into thin air. Ray was even too happy to notice her uneasiness. He increased the volume of the music as he drove closer, The "Beautiful Onyinye" track by the African artists psquare filled the air. He horned and without wasting time, A middle aged man with protruded belly opened the gate and waved at them.

Ray packed the car in front of the big house, increased the volume to it's maximum, hopped down from the car and started dancing. Chi gazed at him in awe, she never knew he was such a good dancer.

Two women suddenly appeared, shouting happily and running towards him. She watched as another lady with a man came out smiling broadly. The lady ran ahead of the two women and hugged Ray tightly. Chi recognised the face. She was the same lady she met at the birthday party many months back. Yes! She introduced herself as Ray's sister, she remembered.

They all joined him in the dance including the man and the gateman who opened the gate earlier. Chi became confused on what to do,

"Should i go down or remain in the car" She thought. She was still battling with her mind when Ray gently lose hold of his sister's grip and danced towards her. He opened the car door and held her right hand, gently taking her out of the car. By then, She was already shivering, she wished the ground would open and swallow her.

Immediately she was out of the car, the women rushed to hug her like people that have been expecting her for ages. This got her really surprised because she was thinking they will look down on her. The fear that engulfed her earlier suddenly disappeared. She found herself smiling at them.

"This face is familiar" The lady said trying to recollect where she had met her,

"Yes, She was in Uche's birthday party" Ray said,

"Ehee! No wonder. Chi right?" The lady asked, and she nodded.

"Is she the one?" One of the women asked anxiously. Ray only smiled, He turned to the gateman and threw his car key at him.

"over to you!" He said as the man caught the key.

"Let's go in for proper introduction" He said, leading the way still holding her, and the people followed behind.

"Mummy we're hungry o, Hope the food is ready?" Ray asked one of the women.

"Trust me na. I don't waste time" His sister snapped before the woman could say anything.

The music suddenly went off. Chi looked back and saw the gateman doing justice to the yoghurt she was sipping in the car.

Yes! Some gateman are like that

To be continued.

PAINFUL TRIUMPH! A true life story(must read) episode 15

The 5:30 am alarm woke her up. she was determined to wake up early in order not to be late to work. Though, her boss has changed completely and they relate well unlike before, All thanks to Ray. but she didn't want to take advantage of that. She maintained her punctuality to work, except when something serious happened.

She managed to stand up from the bed, yawned and stretched her body. She slept late the previous night following Ray's reaction after telling his story. He felt so bad that at a point she started blaming herself for reopening his injury,nonetheless she enjoyed the story.

She waited until 7 o'clock before going to knock on his door. She quietly pushed the door and went inside after he ordered her to come in.

Ray was surprised when he saw her already dressed up that morning,

"Where are you going so early?" He asked, and she simply told him she's set for work. Ray hissed and beckoned on her to come closer to him. He tapped his hand on the bed indicating she should sit down.

"If it's about the work, forget it" He said trying to get up, while she starred at him in disbelief.

"Yes. Forget it" He repeated, clinging his pillow to his chest.

"Why?" She asked quietly

"I told you we were going to talk about your work and other thing once i return . You can't continue doing that job all your life. You have a bright future and you can't achieve anything by working under someone in such a small shop, you have to go back to school" he advised,

"I love your idea, but you see, I can't see myself through school right now. My family can't help me either. I told you what happened to us" She said sadly.

"Don't worry. I'm here for you. I have sisters older than you, and i can do anything to see they have the best things life can offer, so i can't sit down and allow you suffer. You are more than a friend to me and i will do everything possible to make you comfortable in life, but first, you have to promise me to remain responsible for us" He said looking directly into her eyes,

"I promise!" she shouted excitedly. Almost jumping to her feet.

"...but, Can i go and tell my madam, she might be expecting me", She suggested.

" Don't worry about that. I've concluded everything with her. I told her to look for another girl before i travelled because i can withdraw you at anytime once i return. And today is the day" he said smiling at her,

"thank you very much" She said happily. Her face beaming.

They discussed at length, after asking her what she would like to study, He suggested she starts attending an evening lesson while waiting for Jamb the next year as that year was already coming to an end.

................................................................

Three weeks later, Chi was busy ironing the clothes she washed the previous day when her phone rang, she picked it up to view the caller. It was Ray. He asked her to meet him along the road leading to a catholic church not far away from her house. He couldn't get access to the secretariat because a trailer carrying sand was reported to have fallen on the road leading to her house thereby Making it difficult for other cars to pass.

She quickly unplugged the iron and ran to meet him.

"How're you dear?" he asked, giving her a light hug.

" Sorry i couldn't make out time to see you during the week. I have been so busy" He apologized.

"It's okay, I understand" She replied smiling.

"So, how have you been and how is studies" He asked. And she nodded indicating everything is fine.

He told her they won't be hanging out that Sunday because he would be going to pick his mum at the airport that evening as soon as she arrives.

"I would have love to take you along but i don't know the exact time the plane will land. Last time she came in around 10 pm in the night and i don't want to keep you awake till that time" He said. She just nodded saying nothing.

"Don't worry, next Sunday i will take you to the house to meet her and my dad. I've told them so much about you and they are eager to meet you. Mum in particular won't stop asking after you ever since i told her about you" He said to her.

He opened the trunk and brought out all the things he bought. He handed them over to her, kissed her goodbye and sped off.

To be continued

PAINFUL TRIUMPH! A true life story(must read) episode 14

Since she decided to sleep over, Ray suggested they take dinner, have their bath , so by the time he's done with the story, they would just retire to bed.

She rushed to the room, hastily took her bath and went to sit at the dinning where she waited for Ray. Once he joined her, she gulped down the cup of tea before her, ignoring the bread totally.

"Why didn't you take the bread?" He asked,

"I'm not hungry" she responded, and he smiled. She watched as he sipped his tea gently, she bit her lips severally, wishing she could just force the food down his throat at once.

After the meal, she took the cups to the kitchen and quickly washed them, then went back to the sitting room where Ray was seated watching a program.

"Continue with the story" She said sitting close to him. Ray lowered the volume of the television, cleared his throat and began,

"I left everything i was doing and travelled down to Enugu to see Ada. After telling her what i planned with my mum, Ada bluntly told me she can't marry me because she had her own plans. When i asked her what her plans were, she told me she promised herself not to settle down until she's done with everything concerning school. I tried everything i could to convince her and give her reasons why we needed to settle down all to no avail. When i asked about her plans concerning the pregnancy, she boldly told me to my face that she doesn't want the baby and as such, she's planning to abort it. I suddenly became extremely angry, I nearly slapped daylight out of her but thanks goodness i was able to control myself. I threatened to deal with her should anything happen to the baby, and i stormed out of the place in anger. I went back home feeling sad, for the first time i regretted meeting her. I locked myself up in my room and cried while waiting for my mum to return. Upon her arrival, I told mum everything that transpired between Ada and I. Mum was shocked by what she heard but managed to console me. She asked me to take her to the girl, so, the next day we went to her hostel but first to her house. We met her mum in her shop, I introduced my mum to her and told her the reason for our visit. Ada's mum was equally not happy with what she heard. Though she said she was aware about the pregnancy, Ada never told her but as an elderly woman, she found out and when she learnt it was for me, She didn't bother herself because she knew her daughter was in a safe hand.

We all proceeded to the hostel and was lucky to meet her when she was preparing to go out with her friend. We told her to cancel wherever she wanted going because we needed to talk. Firstly, Her mother started by scolding her for that stupid idea she came up with. When she finished, My mum pleaded with her to marry me so that together we could raise the baby, but Ada remained adamant. She spoke to my mum with disrespect, telling her she won't allow her or anybody to come between her studies and tie her down in the name of marriage. Her mother out of annoyance slapped her before she could even finish what she was saying, and the next thing she got up and left the room. That was the last day i saw Ada. We left her hostel that day feeling so disappointed. Her attitude towards us got me really upset that i stopped calling her but i was worried about my unborn child and so was my mum. She asked me to go back to the camp that she would take care of everything. She promised to go back and see Ada and gradually she might be able to convince her to marry me or keep the baby even if she wasn't ready to settle down. We could still wait for her till anytime she's ready.

I thanked my mum and went back to the north two days after.

I continued calling my mum everyday to know how far she had gone With the case and she told me she always visits her hostel, sometimes with Ada's mum but they neither saw nor heard from her because she switched off her phone. Mum kept assuring me that things would be okay just to make sure i don't worry.

One day, mum called me and told me to start coming back immediately because my grandmother was sick and wanted to see me. It's true i loved my grand parents but I've never been disturbed about anything concerning them. Even when my grandfather, her husband died, Dad refused me going for the burial saying village people are bad and they easily poison people during burial then i was in secondary school. So, that day, i was so surprised when mum called me but i obeyed and took the first bus down to Enugu where i got the shock of my life. Mum didn't even know how to tell me what happened so she quietly drove me to Ada's house. I was confused at first and asked her why she took me there not until i saw Ada's mother crying and running towards me",

"Ada has killed me!" She wailed.

" I turned to ask mum what was going on but i saw my mum crying as well, i managed to console the woman and demanded to know why she was crying. She told me how Ada died after the complications she suffered following the abortion. She said Ada confessed how she was misled by her so called friend not knowing the girl was jealous of her. She asked for my forgiveness and requested to see me but before my mother could get to the hospital, she gave up the ghost.

The ground started spinning around and before I knew what was happening, I lost my balance and landed on the floor. I found myself on the hospital bed later With my mum and sisters crying beside me" Ray said, fighting hard to stop the tears forming in his eyes. Chi wanted to stop him but No, she was enjoying the story. Omo buruku

"Dad kept blaming me for trying to run faster than my shadow according to him. He said I shouldn't have gone fallen in love to the extent of sending a girl to school without their knowledge. He said he's not against me fallen in love but they would have married her for me before sending her to school.

I left Enugu two weeks after her burial and went back to the north frustrated and heart broken" By then, Ray was finding it difficult to control the tears and he allowed them flow. Chi thought it was time to stop him. So, she went and got him a glass of water. She knew he love sipping water when he's sad. He collected the water and thanked her.

"It's okay!" She said, patting his shoulder.

To be continued.

PAINFUL TRIUMPH! A true life story (must read) episode 13

They were still in the garden when it started drizzling, They quickly ran inside the car and he drove off immediately.

"Please, continue the story my ears are itching" Chi said as soon as they entered the car. Ray quietly shook his head indicating he wasn't going to continue for fear of losing control of his mind and colliding with another car. He told her how he collided with a vehicle while driving due to the trauma he suffered as a result of that lady. He promised to continue as soon as they get home.

" I can't wait",She murmured.

"I stayed till dusk, joking and laughing with Ada, When it was time for me to leave, I handed her some money to take care of herself but she refused to collect it. So, I bought a few items in the kiosk, paid her and left. But before leaving, I requested for her number but was told she gave her mother the phone she was using after she lost hers because her mother needed it most. I left that day thinking about all she told me. I could imagine how poor they were. I really felt for them especially when she told me how her mum lost her father when she was pregnant with her. Though, I was still a student then but i promised myself to take care of their welfare. I started visiting the kiosk every weekend, I would go in the morning to stay with her mother and stay until she's back from work then stay with her till she closes around 07:00 to 07:30 in the night. At a point, I started developing strong feelings for her, gradually i changed the kiosk to a big shop, and her mum stopped working as a cleaner and stayed in the shop full time while i enrolled her in school. She didn't go beyond JSS3, she was 24 years then and i felt she was already too big to go back to secondary school, so, I worked her papers out through the help of a friend and she quickly got admission into ESUT, by then i was already a graduate preparing for my youth service. Even after i was posted to the north it didn't stop me from seeing her. I made sure i visit every month. One thing led to another and she became pregnant. When she discovered she was pregnant, she called me and told me to start coming back immediately. I demanded to know the reason why she wanted me back. When i learnt she was pregnant, I told her i would get back to her. I called my mum and told her everything that had happened, mum was so happy because she always wanted a grandchild from me. She wouldn't stop telling me to get married after my service, whether or not i have a job not minding i was just 24 years then.

After speaking with my mum, she asked me to bring the girl home so we could start the marriage plans immediately, we planned it so well that it was agreed she stay with my parents after the marriage and continue with her studies while waiting for me to finish my service so we could move over to the house i was building, that was when this house was still under construction" Ray said pointing to the house in which they sat that night.

"when i called Ada and told her all i discussed and agreed with my mum, She didn't like the idea. She started complaining and giving excuses why she doesn't one to marry then..." He paused when his phone started ringing,

"What did she say?" Chi asked anxiously. Eager to know how the story would end.

"Sorry please, I need to pick my call" Ray said reaching for the phone he kept beside him. When he finished, He checked the time and discovered it was already past nine and it was raining heavily.

"Chi, Are you still going today?" he asked her,

"Yes, but after the story" She responded.

He reminded her it was already getting late. He gave her two options, Either to sleep over and continue listening to the story or he drop her home because it was already late to continue keeping her.

She chose to sleep over because of story.

VAGINAL DISCHARGE by Dr Nwuba(CEO of medik247)

Discharge is the fluid or semi fluid substance that flows out of the body through natural or abnormal openings.

 Discharge is composed of cells and secretions from body organs/ cavities/ linings. When the discharge is of infective origin it would also contain microbial cells, and even neoplastic cells.

Vaginal discharge is the effluent from the vagina. it could be normal or abnormal.

Normal vaginal discharge is produced almost every day of the menstrual cycle (there are dry days), and its characteristics vary with the cycle. The most usual normal discharge  is odourless, colourless-to-whitish, and does not itch. However it turns yellowish when it contacts air, giving the characteristic stain on female underwear. During ovulation it becomes more and like raw egg white, immediately before menstruation it may have a dark reddish tinge. In pregnancy, the vaginal discharge is copious, thick and whitish. It does not itch.

 Abnormal vaginal discharge is produced in response to disease, e.g infection.  Abnormal discharge could have the following characteristics;
*Yellow,
*creamy,
* brown,
* pink,
* watery,
* greenish,
*grayish,
*smelly.

Other symptoms associated with abnormal vaginal discharge include; ##itching,
##burning/soreness especially during urination,
##lower abdominal pain,
## genital ulcers and swellings,
##Painful sexual intercourse,
##fever,
##vomiting,          
##menstrual irregularity,             ##abnormal bleeding.

Causes of abnormal vaginal discharge could be infections or other conditions. Infections could be sexually transmitted (STI) or not. Common STIs include;
gonorrhea, Chlamydia and trichomonas.
Non STIs are candidiasis and bacterial vaginosis. Other causes are allergic reaction to underwear, sanitary pad or tampons, foreign bodies in the genital tract and growths (cancerous and non-cancerous).

Treatment would be according to cause. All cases of abnormal vaginal discharge are best treated early and by a Medical Doctor to avoid complications such as spread of infection, pelvic abscess, painful menstruation or sexual intercourse and infertility/ sub fertility. Avoid chemists or self medication.

VITILIGO. by Dr Nwuba( CEO of medik247)

Vitiligo is an autoimmune disease that affects the skin; here the melanocytes(pigmented cells responsible for dark colour of skin) are seen as foreign and killed by an immune response which results in white patches at the affected areas. The causes are unknown but it is believed to have a few predisposing factors such as; familial (genetic), history of sunburn, presence of other autoimmune diseases....

SIGNS & SYMPTOMS

Signs & symptoms of vitiligo include painless white patches but with emotional and psychological implications.

TREATMENT

For treatment options, psychological support is important while using medical or surgical treatment plans. Medical option involves using ointments to even variations in skin colour & also use of ultra violet rays, surgical skin grafting is sometimes used, cosmetics & dress style modifications to hide the affected areas is also an option.

*There is no known cure.*
Late king of Pop Michael Jackson is rumoured to have battled vitiligo while alive.
Various research works are on going on finding a cure to this disease.

DIABETES MELLITUS by Dr Nwuba( ceo of medik247)

INTRO:
These are a group of diseases in which the body is unable to use up glucose appropriately.

Glucose is the breakdown product of carbohydrates. It is a major source of fuel in the body. It helps to power every body tissue and cell including the brain, muscles and other tissues.

A hormone called insulin, produced in the beta cells of the pancreas helps to aid glucose absorption in the body tissues.

So, diabetes leads to an increased level of glucose in the blood and a decreased utilization of same by the body.
This abnormal blood glucose level and utilization causes serious health problems.

TYPES OF DIABETES AND THEIR CAUSES

There are three major types of diabetes. Namely.

Type 1 diabetes
Type 2 diabetes
Gestational diabetes

1) Type 1 Diabetes:

It was initially referred to as insulin dependent or juvenile onset diabetes.

It usually results from the destruction of the beta cells of the pancreatic islet by the body's immune cells(autoimmunity). These beta cells are the cells that produce insulin. So, their destruction leads to decreased or zero insulin production and therefore decreased glucose use by the body (hence high blood glucose).

It is more common in children and adolescents and progresses fast.

2) Type 2 Diabetes:

This type of diabetes results from the resistance of the body cells to insulin action and the inability of the pancreas to overcome this by producing more insulin. Here, unlike in type 1 diabetes, the blood insulin level is usually high or normal. Obesity is an important cause o

Gestational Diabetes:

Diabetes or glucose intolerance that started or was diagnosed during pregnancy is called gestational diabetes.
It starts mostly in late pregnancy.
It is believed to be caused by certain pregnancy hormones that increase the body's resistance to insulin.
This type of diabetes resolve after pregnancy in most women.

FACTORS THAT PUT ONE AT RISK OF DEVELOPING DIABETES

-Obesity (type 2)
-Lack of exercise (type 2)
-Age>40(type 2)
-High body Cholesterol (Type 2)
-Hypertension (type 2)
-Family history (all)
-Pancreatitis (type 1)
-Pancreatic trauma and cancer(type 1)
-Diet--low vitamin D consumption and early exposure to cow milk; <4months of age(type 1)
-Some drugs
-Some viral infections
-PCOS
-Some hormonal disorders like acromegally, Cushing's syndrome, pheochromocytoma.
-Race--Negroes, Hispanics, American-Indians,.

N.B: the type of diabetes most involved with each predisposing factor is in bracket.

Also note that sugar consumption is not mentioned either as a cause or a predisposing factor.

SIGNS AND SYMPTOMS OF DIABETES

Some people with early type 2 diabetes may no show any symptoms. But in others, the symptoms are:

-Frequent urination
-Increased thirst
-Increased Hunger
-Weight loss
-Tiredness
-Ketotic smell in urine and breath
Other symptoms that may result from complications of diabetes are:

Blurring of vision
Poor healing of wounds
Increased susceptibility to infections.
Numbness of hands and feet.

WHEN TO SEE YOUR DOCTOR

You should see your Doctor as soon as you notice the following;
> Increased thirst for water
> Increased appetite
> Increased urine frequency
> Unexplained weight loss

PREVENTIVE MEASURES

It is very possible to prevent the development of Diabetes Mellitus even when there is a family history of Diabetes. This can be achieved by the following;
> Maintaining healthy body weight
> Regular exercise
> Avoiding sedimentary lifestyle
> Eating healthy diets
> Minimizing consumption of refined sugars e.g soda's
> Ensuring good hydration daily
> Minimizing alcoholic beverages consumption
> Regular blood glucose checks.

COMPLICATIONS

The complications of Diabetes Mellitus are usually as a result of poor blood glucose control and they include;
> Infections
> Diabetic foot ulcers
> Diabetic Ketoacidosis DKA; this is a life threatening condition that needs urgent medical attention or may result to diabetic Coma and eventually death.
> Organ damage e.g Kidney disease
> Diabetic Retinopathy; which is the effects of Diabetes Mellitus on the eyes.
> Stroke