Seeing blood in your urine is not a good sign

Body fluids are contained in their own departments and ideally do not mix. For example, blood is in the blood vessels and does not mix with saliva or urine. Blood in saliva could be that you bit yourself as often happens when food tastes great. Or perhaps you were sucker punched by the bus conductor. Otherwise seeing blood in your urine, stool, brain fluid or saliva is not normal and should set alarm bells ringing.

Blood in brain fluid

Bleeding into the brain fluid occurs commonly following a head injury or after a stroke. Of course, if due to stroke it can kill and so needs urgent investigation with a CT brain scan and management as required. It causes a massive headache and patients sometimes describe it as the worst headache of their lives. It often feels like someone set off a bomb inside your skull.

Headache due to head injury, which may be as trivial as banging your head on the car door, can cause problems and should be checked out early. Headaches accompanied by dizziness, nausea and vomiting, fainting attacks and just general ill health demands attention by your general practitioner in the first instance. But, please do not call it Malaria or Typhoid. Have a proper doctor examine and treat you as appropriate.

Blood in saliva or cough

Blood should not appear in your saliva or cough. In cough especially, it could signify an infection such as pneumonia or God forbid, cancer. Now, the commonest cause is chest infection and the cough is painful, racking and distressful. The cough will be speckled with blood and not a frank fresh blood. If you see fresh blood, that is a bad sign and you must go to a hospital immediately. Cancer is the most obvious cause to be concerned about.

Blood in the chest is also a killer since it can interfere with breathing. The management must therefore be immediate and taken seriously. Please do not be fobbed off and insist on proper firm diagnosis with CT or MRI scan of the chest. The management may also require a camera put into the air passage to actually see what is going on (bronchoscopy). A specialist can even stop the bleeding there and then.

Blood in your vomit

If you vomit fresh blood or even dark foul smelling vomit please endeavour to have someone look at you seriously. Fresh blood in the vomit could be pretty dangerous as a sign of a bleeding stomach ulcer. It can also lead to very black tarry stool. In the presence of previous history of stomach ulcer and severe pain in the centre of the chest, bloody vomit is an ominous sign of a torn blood vessel.

It can then appear in the stool (making it black) after being affected by the acid in the stomach. Long-term use or high doses of anti-inflammatory drugs such as aspirin, ibuprofen, and naproxen can also cause ulcers. Regardless of the cause, an urgent transfer to hospital is critical and must be done without delay.

Blood in urine

Urine should be normal and dark, foul, tea coloured or frankly bloody urine demands review. Sometimes, what appears to be blood in urine is actually red pigment from other sources such as food dyes, certain medications, or an excessive amount of beets. This can occur in some people who eat beetroot.

The commonest cause of bleeding into urine is an infection. If there is blood in urine, an infection in the kidneys or bladder could be responsible. It can occur also following an operation where we have placed a tube into the bladder to remove urine.

In adults, bladder infections usually cause burning or pain with urination. Infants with bladder infections may have fever, be irritable, and feed poorly. Older children may have fever, pain and burning while urinating, urgency, and lower belly pain. Infection in the kidneys could also cause bleeding into the urine and are also associated with ill health, pain in the flanks and fever. In elderly patients, a bladder cancer is important to rule out. Send a sample to the diagnostic laboratory for review.

Blood in stool

Fresh blood in the stool could be due to trauma following cleaning after using the toilet. However other things such as haemorrhoids (piles) can cause bleeding which can be severe on occasions. I once had a patient who nearly bled to death from a bleeding pile. A small cut or tear in the tissue lining the anus (anal fissure) similar to the cracks that occur in chapped lips can also cause bleeding. Fissures are often caused by passing a large, hard stool and can be painful.

The bleeding we are more concerned is fresh blood in the stool but bleeding that happens higher up in the digestive tract may make stool appear black and tarry and could also be of real concern too. Polyps or cancer can cause bleeding. Polyps are benign growths that can grow, bleed, and become cancerous. Colorectal cancer is common and often causes bleeding that is not noticeable with the naked eye. Send a sample of stool to the diagnostic centre if you are concerned.

So all in all, if you are seeing blood, see a doctor.

The Abuja Healthcare Directory

 

This is the online copy of the 2012 Abuja Healthcare Directory. Your repository of information about specialist doctors and hospitals in Abuja. 

The directory is due for a major revamp and we will be asking QUALIFIED, REGISTERED doctors and REGISTERED hospitals in Abuja to participate in the new edition scheduled for publication before the end of 2014.

The new directory will be distributed FREE of charge to the general public in Abuja so placing VITAL information about you and your practice in the hands of people who need to know. 

Nigerians need help and this is a critical resource to ensure information about GOOD healthcare facilities and health care providers are easily available.

Please contact me as follows:

Dr Biodun Ogungbo
Consultant Neurosurgeon
SFIA: SPINE FIXED IN ABUJA
Tel: 07082350074
Email: Ogungbo@icloud.com

Let us work together!

How do we improve radiology reports?

Radiology reports are appalling in Nigeria and it underscores the paucity of training for radiologists. Some of the radiologists who report MRI and CT scan of the brain and spine are untrained in neuroradiology. They dabble, moonlighting in the many diagnostic centres, reporting on scans they know nothing or very little about.

There is a radiologist in Abuja who is so bad as to be criminal. His reports are so abysmal you wonder if he needs glasses or suffers from glaucoma. His brain and eyes are certainly not connected. This one is particularly horrible he should be certified as fit for a lobotomy. I cannot remember the last time he got the diagnosis right and someone should put him out of his misery. But, his health is actually not the problem. It is the profound risk he puts ordinary Nigerians to that is important.

The fact is that doctors rely on the reports to make a diagnosis and guide treatment. We rely on the reports to know if the patient should be referred to a specialist or not. In essence, the reports can be the difference between life and death for the patient. MRI and CT scans are so expensive that the quality of the report is equally as important as the quality of the imaging. Since, many imaging centres utilise poor quality equipment, the radiologist has to be particularly astute. To have bad equipment and a bad radiologist therefore compounds the problem.

Take for example; arthritis of the spine can lead to pressure on the nerves in the back. The nerves supplying the legs, private parts, bladder and the anus can be under pressure. MRI scan showing such pressure must be correctly diagnosed and indeed flagged as an EMERGENCY problem that requires urgent treatment by a spine surgeon. Delay in diagnosis and treatment can lead to permanent damage to the nerves making the patient incontinent of urine and faeces. It can affect sexual function, cause untold pain and even paralysis of the legs.

The radiologist must correctly diagnose this. Therefore, for a radiologist to not even see that nerves are under pressure is a big problem. For a radiologist to not highlight the severity of the condition is a bigger problem. Finally, for a radiologist to misdiagnose it as infection and therefore send the doctors down the wrong treatment path is the biggest problem of all.

There are pertinent issues of course that bedevils medical practice in Nigeria. There are also special problems related to the practice of radiology through our diagnostic centres. Some of these issues are as below:

Information

One problem is that radiology requests are often deficient in information that will help the radiologist. Many do not state the correct age of the patient preferring to write ‘ADULT’ in the column for age. Yet, many diseases are age related. Secondly, full history and suspected diagnosis are often missing, so without adequate information, the radiologist sometimes needs a crystal ball or the services of a clairvoyant to make the right diagnosis. Garbage in, garbage out!

Communication

There is disconnection between the radiologist and the radiographer. In many centres, the radiographers do the imaging and send the patient away. The radiologist then comes later to report on what may be inadequate or incomplete imaging. Other types of images that may have helped are then nigh impossible since the patient has already left the building. Of course, fresh imaging often means additional costs that may be unaffordable for the patient. So, radiologists make do with inadequate examination to the detriment of their reputation and the patient.

Secondly, of course and more important is the recognition of urgent cases and diagnosis. The radiographer and the radiologist need to be able to recognise cases that are emergencies and flag this up immediately. Conditions such as pneumothorax (air in the chest cavity outside the lungs), massive stroke and bleeding into the brain sometimes require immediate attention. There is therefore a duty of the radiology personnel to highlight these conditions with despatch. Delays often lead to loss of limbs and life.

Collaboration

It is rare for radiologists to phone the referring doctor to ask for more information. It is also rare in private practice especially for them to ask for feedback from the surgeon. This is sad, does not improve learning and perpetuates ‘quackery’ in radiology. Feedback from the surgeon and more important from the pathologists should be integral parts of the process for making the right diagnosis for the patient. Many teaching hospitals encourage radiology meetings between departments just to facilitate this level of collaboration and learning. It is vitally important but sorely lacking in private diagnostic facilities.

What are we to do?

How do we improve radiology reporting and share expertise, experience in a way that stimulates and improves quality of care for the majority of our patients? How can specialists provide feedback for radiologists and help improve their practice? How do we do this without bruising some over inflated egos? Especially in those without perception!

What are we to do in order to save lives?

Dangerous barbers and the dandruff scam

I went to the barbing saloon recently to get a haircut. Usually, when I go, I take my own shaving kit with me and so avoid any risk of catching head lice or even Hepatitis. God forbid! Anyway, that is not the story I want to relate to you. The hair cut was performed efficiently but after the barber succeeded in making me handsome (to my amusement), he did the following:

First, the barber got a hot wet towel from a small oven in the shop. He then proceeded to slap this hot towel on my head without warning. It was hot enough to make me jump up, slap his hand away and exclaim. Seriously, what has barbing become? Why do I have go to the shop to get a burn on my head? There was no communication at all and he did not even check if the temperature was suitable for me. I supposed he used his own calloused hands to judge the temperature!

He still used it to clean my head, wiping off the bits of hair and then he proceeded to perform a hand massage of my scalp and neck. I thought that was good and I almost fell asleep with the pleasure of it. That was until he put one hand on my head and another under my chin. He was about to twist my neck before I shouted. I was so mad! How dare a barber try to twist my neck (unsolicited) and without prior warning, as part of the simple act of shaving my head? I admonished him severely and warned him never to do this again. It is certainly not part of hair cutting and does not take into cognizance the huge risks involved.

For example, I may have a bad neck with cervical spondylosis, or a previous neck operation or even just a weak neck. And apart from being a surgeon who operates on necks, I watch movies where peoples’ necks are twisted leading to their demise. It is believable that the barber could one day, perform this neck twisting act and render his client paralysed or dead. A N500 hair cut should not send you to the emergency room or to the morgue.

This brings me to another point in the hair-cutting industry and this relates to the dandruff scam perpetrated by hair dressers and barbers. Dandruff is not a disease but simply dry scalp. It is dry skin that flakes off the head and is not really a problem. It is also not curable. Since it is not a disease, in the first place!

According to Wikipedia, Dandruff is a common scalp disorder affecting almost half of the population at the post-pubertal age and of any gender and ethnicity. It often causes itching. The severity of dandruff may fluctuate with season as it often worsens in dry weather. Those affected by dandruff find that it can cause social or self-esteem problems, indicating treatment for both psychological and physiological reasons. Most cases of dandruff can be easily treated with specialized shampoos. There is, however, no true cure.

No cure for Dandruff

This is the basis of the scam! When barbers and hair dressers say that you have dandruff and ask if they could treat it for you, they make is sound as if they can make it go away. That the exorbitant price you pay to have your hair washed with shampoo and creamed is justified. As if once they have done the treatment, it won’t reappear the very next day!

Dry scalp like dry in other part of the body is part of life and happens to a lot of people. People who use soap a lot and especially in the hot weather we have in Nigeria suffer from dandruff and dry skins. Those who suffer from eczema and allergies perhaps suffer the more. It is no reason to spend your hard earned money on the scam perpetuated by big business selling shampoos, lotions and potions purported to cure dandruff.

You may have seen the image of that gorgeous woman on the billboards all over the country selling shampoo for dandruff. No matter how pretty you think she is, remember what she is selling is not a cure for dandruff and all part of the scam. Shampoos, soaps, creams and moisturizers are temporary treatment and not cure for dandruff. It is part of your makeup and not a condition to worry about at all.

Finally, please be careful at the barbers shop and even at hairdressers. People have been maimed and injured in these places mostly by this trial and error behaviour and barbers especially doing things they feel add quality to the service. But, which may be fairly harmful. Burns, allergic reactions, cuts, rash and transmission of deadly infections are all possible at the hairdressers.

Be careful.

NB: Please share your bad or good experiences at the barbers with me. Simply write in to the discussion column and let us share the information and advice widely.

So you need a back operation?

Patients who have severe back and leg pains due to arthritis of the spine may be offered back operation. Spine operations are more commonly used to treat lower back pain resulting from a damaged or degenerate intervertebral disc (the shock absorber between the bones), or spondylolisthesis (slip of one bone on the other). The goal here is to stabilise the spine so that pain (and sometimes deformity) is reduced. Operations are also used to treat lower leg pain resulting from pressure on a nerve or nerves in the back. The goal then is to free the nerves from pressure and so stop pain, numbness and weakness in the legs.

Surgery is usually recommended when all reasonable conservative measures (pain medications, nerve injections, physical therapies, braces etc.) have failed. It is often the last resort unless there are special circumstances like severe nerve injury that makes it the number one priority. Operations on the spine can be performed from the back or the front. We more commonly do it from the back. Operations from the front entails going through the abdomen and may be required in some special circumstances. More often than not, it is combined with a second operation from the back as well.

The goals:

Reduction of back pain

Stabilisation of an unstable spine

Reduction in amount of drugs used for pain

Prevention of deterioration in your condition

Improved lower back and leg function

Improved work, walking and recreational capacity

Improved quality of life

There are risks in back surgery as with any operation. The chance of a minor complication is around 4 or 5%, and the risk of a major complication is 2 or 3%. Generally, surgery is fairly safe and major complications are uncommon. Over 90% of patients should come through their surgery without complications. Our review in 2012 demonstrated good outcome in the majority of patients.

The specific risks:

Failure to benefit or to prevent deterioration

Worsening of pain

Infection

Bleeding and a need for Blood transfusion

Nerve damage (weakness, numbness, pain) occurs in less than 1%

Cerebrospinal fluid (brain fluid) leak: this risk is much higher in revision (re-operation) surgery

Surgery at incorrect level (this is rare, as X-rays are used during surgery to confirm the level)

Major neurological problems are very rare, but include paralysis, damage to a nerve, problems passing urine or stool and loss of erection.

Chronic pain (may require further surgery)

You must tell your surgeon:

About blood clotting or bleeding problems

If you have ever had blood clots in your legs (DVT or deep venous thrombosis) or lungs (pulmonary emboli)

Are taking aspirin, clopidogrel, warfarin, or anything else (even some herbal supplements) that might thin your blood

About high blood pressure

About any allergies to drugs or following previous operations

Any other health problems even if it seems unimportant

Before Surgery:

Please bring all your regular medications with you to hospital.

Consult with your surgeon if you are taking blood-thinning medications.

You may continue to take your routine medications (for example, heart and blood pressure medications), on the morning of surgery with a sip of water (unless otherwise directed).

You may not eat anything after midnight, the night before surgery and must cease drinking clear fluids (water, apple juice, black tea) 2 hours prior to your admission time (unless otherwise instructed.)

Please shower on the morning of admission. Do not use powder, apply perfume, makeup or nail polish and wear cotton underwear if possible.

Please be sure to take the following to the hospital for the operation; MRI/Xray/C.T Scans and all previous medical reports and results. Before your surgery it is imperative that you stop smoking, and you should not smoke for at least 12 months after. Smoking impairs the healing process and leads to worse outcomes following spinal surgery.

The operation:

A general anaesthetic will be administered to put you to sleep. A breathing tube (‘endotracheal tube’) will be inserted into your throat and antibiotics and steroids given (to prevent infection and post-operative nausea). A catheter will be inserted into your bladder to prevent bladder distension during surgery and to monitor urine output. You will be placed face-up or face-down on the operating table depending on the type of surgery you are having. An x-ray is often performed to confirm that the surgeon is at the correct level for your operation. The team then performs the operation and finish when the surgeon is happy the aims of the operation have been achieved. A final X-ray is taken and the wound is closed with sutures or with staples.

You are then transferred back to the ward to commence your recovery from the anaesthesia and the operation. Once you are fully awake and well, we start making plans for your discharge home within a few days and subsequent visits to the clinic for post operative care.

So if you need a back operation:

The operations are being performed safely in Nigeria, everyday, and many patients are benefiting from the procedures. Be clear in your mind that you have exhausted all other reasonable treatments such as weight loss, regular exercise, medication and even meditation. Be prayerful and trust in your surgeon for a successful outcome. Have no fear and trust in God to heal you.

  1, Nice normal MRI scan, 2, MRI with pressure on the nerves, 3, MRI showing destruction of the bones and prolapsed disc causing pressure on the nerves.

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