ALMIGHTY STOMACH PAIN

If you ask most the description of a drug addict, you probably will be painted a most compelling graphic picture. ‘Anxious, unkempt, half naked, foul smelling, eating from a huge waste dump’

It’s so worrisome because this is something very common and seen in medical practice

The NDLEA   has organised a lot of drug and substance abuse programmes for the youth

In many cases however, the signs are subtle and not as gross as is generally assumed.

I was sitting in my clinic when a female adult patient hugging a baby to her bosom walked in. She was brought by a male relative of hers. She was dressed in traditional blouse and wrapper, with a shawl draping her head, shoulders and hands. The baby was about 4months old and the patient was a breastfeeding mother.

The patient, baby and male relative all looked healthy to me.

I enquired ‘how can I help you’?

‘My sister is sick’, he said

Hmmn, I thought as I studied the patient who consented to her brother being present during the consultation

‘She is on hard drugs’, he said

‘Is that true?’ I asked. Refusing to catch my gaze, she did not reply

Empathetic, wanting to reassure her I tapped her on her hand which was covered by her shawl only to feel a hard and hollow surface. On pushing up her shawl, i saw a large, deep, ugly, painless chronic sore extending from the skin of her wrist to that of her elbow with traces of her bones shining through. Alarmed, I asked if she was bitten by an animal.

‘No, there is another one on the other hand’ the male relative answered

There was I gazing at chronic contaminated wounds on both her forearms

The story began to unfold:

She lived in a distant village and 4months ago, she began to experience severe stomach ache after she delivered the baby she was carrying. A brother of hers took her to a patent medicine store dealer (called ‘chemist’ by laymen). The chemist administered an injection to her which gave her instant relief. She never had the ‘stomach pain’ after the shot but she went back to the chemist to ask for more. She never went to any primary healthcare centre

The drug happened to be very cheap and subsequently, she started buying syringes and the injection and began to self administer the medication on demand via her hands

 The medication is popularly called ‘penta’ here in Nigeria. It is medically known as pentazocine. Pentazocine  is an opoid analgesic for treating moderate to severe pain. It causes euphoria, which was probably what got the patient going back for more and causes dependence with prolonged use. When administered just under the skin repeatedly, it causes tissue breakdown which was the result of the sores she came in with.

All these led to her many problems as she started stealing to buy more ‘drugs’. She stopped caring for her baby. However, she was still breastfeeding and this was also dangerous to the baby.

In Kano state Nigeria, the Governor Musa Rabiu Kwankwaso has banned the sale of codeine containing cough syrup

Drug and substance abuse presents in many forms, but we should be keen to observe when our loved ones are deviating from their norm and render to them the help they need.

Dr Dileem
The Likita Bokanturai
Kano Nigeria

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A CASE OF EMPTY SACS

A frantic mother came into my consulting room looking worried and agitated. Her two sons; a set of identical twins walked in after her.

‘It is alright madam’, I calmly said

‘How can I be of help to you? I asked

‘My boys’ sacks are empty’ she sniffed

The twins were about 10yrs old and they were holding no bags, neither were they dragging along any sacs

‘Madam, take it easy’ I said in an attempt to calm her

She did not stop until she was done undressing both of them.

They looked normal to me until my gaze fell on their genitals and then I immediately understood her worry.

‘They were born like this; they have no balls in their manhood bags’ she said

On proper examination of these identical set of twins, I found out their scrotal sacs were empty. They both had no testes in their scrotum!!

The woman delivered at home under the supervision of a fellow neighbour. The mother noticed the empty sacs and commenced the set of twins on traditional medications all those years. She never attempted going to at least a primary health care centre. I then proceeded to tell her what the condition was.

It’s called ‘undescended testes’ and it means that the testes don’t move downward from the abdomen into the scrotum and are therefore trapped in the abdomen during development. It could affect just one testis or the two testes.

All mothers especially those who deliver at home without medical check up and follow up have a responsibility to check their babies for any obvious abnormality.

Undescended testes can be associated with some other abnormalities at birth, but often times the babies are otherwise normal.

Corrective surgery for undescended testes should be done before the age of  2 years.... with a good reproductive outcome.

Undescended testes can predispose to...cancer, subfertility if not corrected as at when due.

This lady brought her sons who were already 10yrs old...could it be too late?

In our society, who knows how many male children born with undescended testes have been overlooked and then later turn out to be sub fertile during their reproductive years just because their parents did not know that corrective surgery for the condition  could be done at an early age

Dr Dileem
The Likita Bokanturai
Kano Nigeria

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