The Nation Newspaper

Tag: tame

  • How to tame the silent killer (2)

    I have had several patients whose blood pressure may be “normal” at home but rose at the care centre. The presence of an authoritative figure such as a doctor or a nurse may cause a blood pressure to be raised. In all these situations that I have mentioned, the blood pressure may be temporarily raised. It does not mean that the individual has a raised blood pressure as an illness.  However, if the pressure is raised to a certain level even on the same day within 60mins, the doctor may decide to offer treatment. I had a client in recent times. He had lost a very close and loving relative. When I was asked to see him because of his distress, amongst other things, I took his blood pressure.  To my greatest surprise, it was the highest blood pressure readings that I have ever seen. Of, course; I had to start treatment immediately.

    Therefore, normal blood pressure is a matter of relative degree, individualised, age and circumstances that are influencing the pressure reading.  Raised blood pressure is a matter of persistence.

    Types of Blood Pressure:  Blood pressure can be divided into two. The first is called essential or primary hypertension. In this case, there is no knowing specific cause for the raised blood pressure although there are certain features that can be identified as contributing to the high blood pressure.  It’s by far the commoner form. The other type is called secondary hypertension. In this case, there is a reason, an identifiable cause for the abnormal blood pressure.  Now let us deal with each category of the raised blood pressure.

    Essential Hypertension:  90% of raised blood pressure belongs in this category. This is the more common form of blood pressure and sadly a deadly disease that is extremely common amongst people of Black African descent wherever they may be on earth. There are certain factors that had been identified as contributing to essential hypertension. These factors include unreasonable consumption of table salt (sodium chloride).  I once had a 30year old patient who came with his wife to see me by reason of infertility. As soon as I measured the blood pressure of the husband, I noticed that for his age, he was reading a pressure as if he was 70year old: very high for his age.  Upon discussion, the wife said, he likes to “lick salt” for no apparent reason. He will ask for extra salt be put in his food. It was therefore not surprising that my patient was having abnormal blood pressure readings. Another common association with high blood pressure is obesity. Being fat may compress the blood vessels and cause the heart to pump blood around the body with extra effort.  High cholesterol that tends to block the passage of blood may also contribute to essential hypertension.  On the other hand, being Black-African is a factor.  Hypertension may run in the family. Father, son, daughter, and grandchildren may inherit essential hypertension.

    Persistent anxiety whatever the cause, depression and sleeplessness may be the unseen cause of high blood pressure in an individual.  Gender plays a part too. Men appear to suffer high blood pressure that women.

    Obviously, just along with obesity and high blood cholesterol, lack of regular, voluntary, physical exercise is a well known association with rising blood pressure.

    Causes of Secondary Hypertension:  As I mentioned earlier, secondarily raised blood pressure is often due to something else. That is, 10% of hypertension is due to another illness.  Amongst the chief and well known causes of secondarily raised blood pressures are: Chronic kidney disease. A long standing impairment of one or both kidneys may lead to increased blood pressure whatever the age and gender or race of the individual. Therefore, kidney disease should be treated with the urgency that it requires.  Persistent sleep apnea associated with obesity, difficulty in breathing during sleep may lead to blood pressure disorders. Abnormal growth of the adrenal gland and diseases of the adrenal gland such as Cushing’s disease may cause high blood pressure.

    Coarctation of the aorta — A narrowing of the aorta (the large blood vessel from the heart) that you are born with that can cause high blood pressure in the arms. Pregnancy: (See hypertension in peculiar situations).  Medications: Some medications such as oral contraceptive pills, antidepressants and antipsychotics may cause high blood pressure as part of their side effects.  Alcohol addiction: In individuals that consume some amount of alcohol over long time may suffer from liver cirrhosis and high blood pressure.

    Treatment: At all times high blood pressure must be controlled and brought to normal level for suitable for the individual. Failing, blood pressure is deadly and a silent killer. The doctor will conduct appropriate investigations and prescribe suitable treatment.

    Exercise is the free, sure-bet that could help bring the blood pressure low.  Before commencing exercise, you should inform your doctor to assess your suitability. Exercise may not be for everyone but may be for most. Exercise will help expel salts from the body, make the blood vessels and heart relax, clear fats from the vessels and body store. To be effective, exercise must be planned, structured and regular involving aerobic, stretching and anaerobic forms of exercises.

    Further, decrease salt intake and eat as much of natural foods and fruits as possible.  If unsure of your status, talk to your doctor or have your blood pressure checked at least every 6 months.

     

  • Food and water poisoning: How to tame the widespread killers

    About few years ago, I had stopped over in one of the fast food chains in Lagos to eat. I had only eaten a meat pie and some gizzards. I was certain I did not consume anything else until the following day when I started vomiting with frequent bowel movements and severe abdominal pain.

    It took a great medical effort to bring my health into normality. I had a repeat of the same experience within the last 36 months when I bought a piece of roast plantain on the roadside.

    A female friend of mine who had just returned from the United Kingdom (UK) three weeks ago had bought some foods from a popular fast-food chain also, only to end up in our hospital facility few days after with severe vomiting, diarrhoea, abdominal pain, reduced appetite, generalised weakness and fever.

    The above is a tip of the iceberg of the experience of Nigerians when it comes to food poisoning. Like malaria, food poisoning is as common, affecting both men and women, children and adult alike. Depending on the lifestyles of the individual, class of the victim may not really be of any barrier against food poisoning. I have come across professionals, bank directors, company CEOs, business owners, politicians and so forth who had suffered from various forms of food poisoning.

    In the following series, I will be writing on causes of food and water poisoning focusing on the common agents such as salmonella typhi that is commonly known as Typhoid disease E.coli and other bacterial contamination of our food and drinks. Cholera is still a menace in Nigeria, breaking out occasionally in different parts of the country. Viruses and chemicals also cause food and water diseases that afflict us severely. We will also be dealing with treatment and preventions of these illnesses. For now, let us take a closer look at origin of food and water poisoning.

     

    Causes of food and water poisoning

    I will rely on World Health Organsation (WHO) for guidance on this. Credit to WHO too.

    As I mentioned earlier, food and water poisoning may be caused by various agents.

     

    Bacteria

    Salmonella, Campylobacter, and Enterohaemorrhagic Escherichia coli are among the most common foodborne pathogens that affect millions of people annually – sometimes with severe and fatal outcomes. Symptoms are fever, headache, nausea, vomiting, abdominal pain and diarrhoea. Examples of foods involved in outbreaks of salmonellosis are eggs, poultry and other products of animal origin.  Salmonellosis are not often reported or experienced in our environment unlike diseases of typhoid.

    Because of its great importance in our environment and the damage it causes us, I will discuss Salmonella typhi and paratyhi (typhoid diseases) separately next week.

    Foodborne cases with Campylobacter are mainly caused by raw milk, raw or undercooked poultry and drinking water. Enterohaemorrhagic Escherichia coli (E.coli) are associated with unpasteurized milk, undercooked meat and fresh fruits and vegetables.

    Listeria infection leads to unplanned abortions in pregnant women or death of newborn babies. Although disease occurrence is relatively low, listeria’s severe and sometimes fatal health consequences, particularly among infants, children and the elderly, count them among the most serious food borne infections. Listeria is found in unpasteurised dairy products and various ready-to-eat foods and can grow at refrigeration temperatures.

    Vibrio cholerae infects people through contaminated water or food. Again, due to the importance of cholera in our environment, I will devote a separate article in this series on Cholera.

    Meanwhile, regarding viruses, the following are the major causes of food and water poisoning.  Norovirus infections are characterized by nausea, explosive vomiting, watery diarrhoea and abdominal pain. Hepatitis A virus can cause long-lasting liver disease and spreads typically through raw or undercooked seafood or contaminated raw produce. Infected food handlers are often the source of food contamination. We will examine issue of hepatitis A further in the series.

     

    Parasites

    Some parasites, such as fish-borne trematodes or worms, are only transmitted through food. Others, for example tapeworms like Echinococcus spp, or Taenia solium, may infect people through food or direct contact with animals. Other parasites, such as Ascaris, Cryptosporidium, Entamoeba histolytica or Giardia (common in our environment), enter the food chain via water or soil and can contaminate fresh produce.

     

    Chemicals

    Of most concern for health are naturally occurring toxins and environmental pollutants.  Naturally occurring toxins include mycotoxins, marine biotoxins, cyanogenic glycosides and toxins occurring in poisonous mushrooms. Staple foods like corn or cereals can contain high levels of mycotoxins, such as aflatoxin and ochratoxin, produced by mould on grain. A long-term exposure can affect the immune system and normal development, or cause cancer. Persistent organic pollutants (POPs) are compounds that accumulate in the environment and human body. Known examples are dioxins and polychlorinated biphenyls (PCBs), which are unwanted by-products of industrial processes and waste incineration. They are found worldwide in the environment and accumulate in animal food chains. Dioxins are highly toxic and can cause reproductive and developmental problems, damage the immune system, interfere with hormones and cause cancer. Heavy metals such as lead, cadmium and mercury cause neurological and kidney damage. Contamination by heavy metal in food occurs mainly through pollution of air, water and soil.

    From next weeks, we shall discuss in detail, illnesses, such as typhoid, cholera, hepatitis A and D.

    Finally, I shall touch on chemicals that poison us in our food and drinks.

  • Hypertension: How to tame the silent killer (3)

    Disorders of hormones such as thyroid disease for example hyperthyroidism (overacting thyroid) may lead to raised blood pressure in individual sufferers.  High blood pressure very often coexists or be part of the disease of diabetes mellitus.

    High Blood Pressure in a Peculiar Situation (Pregnancy and in Children):

    As a junior doctor decades ago, I was witnessing a young lady in labour in a government hospital. She had become unconscious of her environment although she could still respond to conversations with her carers. Suddenly she started telling those of us who were present that she wanted to “fly” and that she should be allowed to fly away in the midst of labour. She got to this stage because of a deadly, brutal form of blood pressure that affects pregnant women. In her case, she was suffering from preeclampsia- a vicious killer of pregnant women.  Depending on the origin, hypertension in pregnant women may be pregnancy-induced hypertension, hypertension-in-pregnancy and both can lead to preeclampsia or eclampsia. The latter two constitute extreme medical  emergency. Therefore, all pregnant women should have their blood pressure measured as soon as possible and same should be kept in check in each antenatal attendance.

    High Blood Pressure in Children: Blood pressure in children is not expected to be raised except in rare circumstances.  Thus, a notice of high blood pressure in children is an indication of an underlying disease. The attending doctor is likely to raise an alarm on this finding and parents should take any raise blood pressure in children extremely seriously.

    Symptoms and signs of High Blood Pressure: Very frequently, there may be no symptom at all until late in the disease. Finding that a person has a raised blood pressure may be an accidental discovery by a doctor or a nurse who is checking for something else or it may be a discovery as part of routine monitoring. There is no blood test or imaging test that will say a person has high blood pressure other than clinical findings, although investigations may follow discovery of raised blood pressure as a step to finding the cause of the hypertension.

    Therefore, in most cases, the blood pressure is slow crawling and silent hence the name, silent killer.  When the pressure has been raised to a certain level that the body, kidney and heart or brain can no longer tolerate, symptoms may begin to appear.   If the symptoms were to appear, it comes in form of headache, visual impairment, dizziness, nausea, shortness of breath, awareness of the beating of the heart or palpitation and vomiting, nose bleed as well as chest pain.  In some complex situations, the legs may be swollen especially if the heart is starting to fail.

    Dangers and complications of High Blood Pressure: The higher the blood pressure, the greater the risk of injury to the heart and blood vessels in major organs of the body such as the heart, the brain and kidneys. Overall, raised blood pressure is the most important preventable cause of heart disease and stroke in the entire world.

    If left untreated, high BP (Blood Pressure) can lead to a heart attack, an enlargement of the heart and ultimately can cause a stroke (blood in the brain or absence of enough blood/oxygen) supply to the brain. Hypertension is also known to cause kidney failure, blindness, and cognitive impairment.

    Treatment of High Blood Pressure: In a lot of cases, notwithstanding the age, raised blood pressure is treatable especially if it is detected early. The challenging part of managing blood pressure especially in Nigeria is the denial of the illness by the patient. This is complicated by religious indoctrination that denies evidence of existence of the disease.  The second problem is compliance with treatment. I have been asked to see a young patient who was brought to me listless and unconscious at the verge of death due to high blood pressure. The fundamental problem is not the fact that she has high blood pressure but of the fact that she denied the illness and refused to comply with the prescribed medications. After her near-death ordeal however, she learnt her lesson to comply with medications, in a hard way.

    That said, there are various medications that exist and are available to treat high blood pressure. Such treatment will be individualised depending on the person’s tolerance and acceptability of the therapy.

  • Can CBN tame the rising inflation?

    SIR: The Buhari-led administration appears to be doing a wonderful job fighting corruption. The last time this monster was tackled head-on in this country, was in 1984, by the same Head of State, Muhammadu Buhari.

    Then as now, the price of crude oil created the havoc. Then, as now, there were discordant views about whether or not the government should devalue the currency or not.

    Meanwhile, as the administration is focusing on the battle against corruption and on external affairs, there is no discernible policy direction of government with regards to the economy and there’s an overwhelming feeling among most informed that the economy is faltering at an alarming rate and a resignation that it might never get better than this without some sort of dramatic change.

    The government may pretend not know it but it is the reality on ground. Pure water sachet is now selling for N10 as against N5 in the North and N20 as against N10 in Lagos and places like Abuja; this is not because there are water shortages in the country, allegedly due to the cost of importing polyethylene, a raw material for making the sachet, which has shot up.

    Already, prices of consumer products and household items like mobile phones, electrical components and electronics have been inflated by over 20 percent, as such products are imported and assembled locally.

    Many economic experts and social commentators have said the current rate of rising inflation requires the CBN’s urgent attention because of its adverse effects on the economic well-being of the citizens.

    As industry observers worry on how long it would take for this inflationary trend to be halted, even a forlorn hope seems like a mirage, because there is no vibrant economic team to tackle these economic challenges and provide clarity and direction of economic policies. All we have is widening team of media foot soldiers who, for now, specializes in sustaining the sermons of melancholy inherited by the regime.

    Given that over-production and excess demand are the major causes of inflationary trends, the challenge before the CBN therefore is to grow the economy by ensuring reasonable growth for the real sector. This can be done with its monetary policy instruments, which experts say is necessary in employment generation, poverty reduction and sustainability of macro-economic growth rates and objectives of any serious government.

    Overall, the apex bank would need to reinforce its technical capacity for the analysis of monetary policy and a comprehensive toolkit for macro-economic projections in order to smoothly transit to a new framework.

    Recall that the Chairman of the US Federal Reserve Bank, equivalent to our CBN Governor, Dr. Arthur Burns, once said that ‘if a nation allowed an untenable economic situation to persist for too long, suddenly, there are no good options left’. Nigeria is slowly but surely approaching a situation where there are no good options left. Even now, the options have been reduced to few. But another delay will spell doom.

     

    • Aminu Imam,

    aminimam@gmail.com

  • Who will tame the tigers of Ugborodo?

    IT was not a new madness. It was something we had all seen but could really not understand. It subsided and we knew it was just a matter of time before it would rear its head again. And on July 27, the signs that brawns, rather than brain,s would soon be on display were glaring. The threat to Ugborodo’s peace needed no special lens to be seen. By the second day, houses, cars and other valuables started going up in flames. And then the third day, discordant tunes started oozing from the mouths of many in the town.

    The fragile peace recently achieved in Ugborodo, one of the host communities of the $16 billion Export Processing Zone (EPZ) in Warri Southwest, Delta State, gave way  to turmoil when some quarters of the community violated the peace pact. Two months ago, the Federal Government, through the peace and security committee, comprising of various security agencies, state government and community representatives, set up the EPZ Interface Committee, leading to the signing of a peace agreement.

    One of the articles of the agreement was the restoration of displaced persons from the various quarters of Ugborodo to their homes, as well as cessation of hostilities by various armed groups. These yet-to-be- resettled  people in the community, first called for the dissolution of the EPZ Interface Committee, citing the continued unrest pervading the community.

    This followed the action of youths of Aruton (Ode-Ugborodo), who allegedly frustrated, for the third time, the Navy’s efforts at resettling the displaced persons.

    Commander, Nigerian Navy Ship (NNS) Delta, Navy Capt Musa Gemu, who led the naval team’s mission to resettle the displaced persons, expressed frustration at the attitude of Aruton youths and leaders, saying there was hardly any indication that the people wanted peace in Ugborodo.

    His lamentation: “I met with leaders of the two sides the day before. They assured that they will be on ground to talk to their people where they are in control to allow all displaced persons return in peace. Now only Isaac Botosan and Ayiri Emami of Thomas Ereyitomi bloc were on hand to lead displaced persons to Ogidigben and Ajudaibo where they are in control.

    “David Tonwe, who gave his word, never showed up to talk to the boys at Aruton to resettle displaced persons there. These same youths at Madangho and Aruton, who refused to allow displaced persons return home, also scared people from leaving to Ogidigben and Ajudaibo.

    “It is not like the Aruton youths can resist me. Applying force now is not the spirit of the peace process. So, I asked my men to pull back. I went in with just two men and interacted with the community elders and youths. Their feeling is that the said displaced persons committed sacrilege against the community and they need to appease the land and atone for their action before being allowed back in the community.

    “They said the only condition for peace is that all the people that have been jailed, even six years back, must be released. Do I know their offences? Were they offences against the state? Also that all those that were killed, they must bring their corpses back for burial, that all those who committed crimes against the community must come back to apologise and that proper punishment would be meted on them by the community.”

    So, it was not a surprise when just the day after the failed effort to bring the displaced back  properties worth hundreds of millions of naira, including houses and cars, were destroyed. The madness that started in January was here again.

    The two camps have come up with counter-claims. Both camps are blaming the other  for the display of brawns.

    A leader in the Ereyitomi camp, Emami, said contrary to speculations that the acts of arson were done by supporters of Ereyitomi, the acts were carried out by angry members of the Tonwe camp who felt they had been used and dumped.

    Whoever is right, the truth remains that this ding-dong can only stop if a compromise is reached. If both parties are not ready to shift grounds, where is room for settlement?