Alcoholism among post-menopausal women
It would surprise you to note that many of my 'above-50' female patients are chronic alcoholics. I'm following quite a number for Liver Cirrhosis secondary to alcoholism. I see their daughters cry when they open up to me about their mothers drinking behaviour and how they had tried to no avail to help them quit drinking. I have also admitted quite a number in alcoholic coma; drinking till someone passes out completely.
All these women have many things in common. All are above the age of 50, all are widows and only started drinking after the passing of their husbands, all have inherited quite a lot of property and land, all have extremely responsible and well behaved daughters who bring them to hospital and wash them when they pick them from the streets(meaning they were extremely responsible mothers during their productive age).
So what makes them develop this disturbing behaviour? Is it the freedom that suddenly comes with the passing of their husbands? Is it the unlimited control of inherited property? Is it in course of countering the stress that comes with body changes in menopause? Is it the increased loneliness that comes with losing their spouses?Or is it just a mid-50 crisis among women?
I researched on this online to satisfy my curiosity and also to understand my patients better.
The hormonal changes occurring during menopause may lead to uncomfortable emotions. The woman may also have many concerns and fears about what is happening to them such as:
* It is common for women to feel sad because their child bearing years are coming to an end. For many women this will have been an important aspect of their identity
* Menopause is a reminder to women that they are getting older
* The woman can feel less attractive because of the things happening in their body
* They may worry that their low libido due to menopausal changes is going to be permanent
* It is common for women to become easily irritated
* They may feel excessively nostalgic for their younger days and younger bodies
* Women can feel anxious because their body is doing things out of their control like hot flashes and temper fits
* They may experience an identity crisis
Woman use different strategies to help them cope with the emotions of menopause. Unfortunately, some women may turn to negative coping strategies such as alcohol abuse.
So how does one deal with the change that come with menopause.
* Techniques such as meditation are great for helping people cope with stress and anxieties and it can also make it easier to sleep at night.
* Hormone replacement therapy (HRT) mainly estrogen can make a difference for people who are struggling with the symptoms of menopause.
* Night sedatives like Piriton may help people sleep better at night
* Some women may need to begin taking antidepressants if their symptoms are too disruptive. They will need to speak to their psychiatrist or psychologist for this.
* Regular exercise and walking can improve mental and physical symptoms.
* Avoiding spicy food and hot beverages may lead to a reduced incidence of hot flashes.
* Having support groups with their agemates going through the same phase can be a good coping mechanism .
I hope this post helps to highlight a common problem in our society that we have not been keen on. I hope it will help a struggling postmenopausal lady or help the rest of us in the future when our golden years come. Let me know what you think!!!
Tuesday 26 May 2015
Wednesday 20 May 2015
WHAT WOULD YOU DO???? DILEMMA!!!!!
WHAT WOULD YOU DO?
I know that I have been away for a while but I was away in my own world in a journey of self-actualisation, career concentration and personal development.
I have been through a tirade of scenarios while dealing with my patients that have put me in a dilemma and made me wish not to ever be personally in such situations. Mostly we take life for granted and presume many things. There comes a time when you find yourself at crossroads and unable to choose what path to follow.
1). THE AZOSPERMIC PARTNER. Azoospermia is a medical condition in which a man has no spermatozoa at all in his ejaculate fluid. It is mostly irreversible and is a cause of male infertility . I handle such cases atleast once fortnightly. What would you do if found yourself in such a situation? Do you involve the young wife in breaking the news? If you do so, don't you risk having her disrespect her husband and tell everyone in the society putting the man in emotional turmoil?(Remember this is Africa). Isn't it her right to know what is causing infertility in the union and save her from the mean pointing fingers of in-laws? Do you tell the wife and hide it from the husband so that she can secretly look for a child elsewhere and save the marriage?(this only happens in Nigerian movies and is unethical). I have heard cases of men committing suicide due to the stress they go through when their wives 'spread the news.' This is a very tricky situation and I have always tried to handle it with utmost wisdom, privacy and maturity. I let the man do the honors of breaking the news to the wife but I'm sure many of them end up not telling them. A young lady followed me the other day and demanded answers on why I had told her to leave the office and talked to the husband alone. What would you do, as a doctor and as the patient?
2). CANCER IN PREGNANCY. What do you do if you get a patient who has been looking for a child for many years and when she finally gets pregnant she also realizes that she has cancer. Does she carry her pregnancy to term and postpone cancer treatment or does she disregard the pregnancy and carry on with surgery and treatment. If she disregards the treatment, won't the disease be too advanced in 8 months? If she carries on with treatment, what if she doesn't get another pregnancy? WHAT WOULD YOU DO?
3) PRE-CANCEROUS CERVIX AT 30 YEARS
A lady comes in,quite young with an abnormal pap-smear result for pre-cancerous condition . Recently married with only on child. What do you do? Do you do cone-excision of the cervix or remove entire uterus and cervix. She is scared of the condition converting to full blown cervical cancer and insists on Hysterectomy( removal of uterus). However, as a doctor you remind her that she is very young and might need other children or may get re-married later in life. Dilemma! Do you go ahead and do the surgery and risk her regretting in the future? Secondly what if you deny her the surgery and she ends up with cancer later on?
4).THE HUGE GOITRE The patient who comes in with a very big Goitre causing moderate obstruction symptoms. If you don't do surgery, she might end up with severe obstruction of airway later in life. If you do the surgery, she might never wake up from the surgery due to expected collapse of the trachea. What do you do?
5). CANCER IN THE ELDERLY I have seen relatives coming in and insisting on referrals for chemo-radiotherapy for their elderly relatives. How will chemotherapy change the life of a 95year old man with prostate cancer? Won't the effects of the chemotherapy affect the patient gravely more than the cancer itself based on their age and frail bodies? If you don't refer them, the relatives will forever blame you. But this is easy, you refer and shift the burden of blame to the oncologist.
I hope you now appreciate what we go through. The burden of being a decision maker in matters health as well as social. The profession can really get to you. Who said that doctors are not community leaders? Have a nice week ahead. I promise more posts sooner.
1). THE AZOSPERMIC PARTNER. Azoospermia is a medical condition in which a man has no spermatozoa at all in his ejaculate fluid. It is mostly irreversible and is a cause of male infertility . I handle such cases atleast once fortnightly. What would you do if found yourself in such a situation? Do you involve the young wife in breaking the news? If you do so, don't you risk having her disrespect her husband and tell everyone in the society putting the man in emotional turmoil?(Remember this is Africa). Isn't it her right to know what is causing infertility in the union and save her from the mean pointing fingers of in-laws? Do you tell the wife and hide it from the husband so that she can secretly look for a child elsewhere and save the marriage?(this only happens in Nigerian movies and is unethical). I have heard cases of men committing suicide due to the stress they go through when their wives 'spread the news.' This is a very tricky situation and I have always tried to handle it with utmost wisdom, privacy and maturity. I let the man do the honors of breaking the news to the wife but I'm sure many of them end up not telling them. A young lady followed me the other day and demanded answers on why I had told her to leave the office and talked to the husband alone. What would you do, as a doctor and as the patient?
2). CANCER IN PREGNANCY. What do you do if you get a patient who has been looking for a child for many years and when she finally gets pregnant she also realizes that she has cancer. Does she carry her pregnancy to term and postpone cancer treatment or does she disregard the pregnancy and carry on with surgery and treatment. If she disregards the treatment, won't the disease be too advanced in 8 months? If she carries on with treatment, what if she doesn't get another pregnancy? WHAT WOULD YOU DO?
3) PRE-CANCEROUS CERVIX AT 30 YEARS
A lady comes in,quite young with an abnormal pap-smear result for pre-cancerous condition . Recently married with only on child. What do you do? Do you do cone-excision of the cervix or remove entire uterus and cervix. She is scared of the condition converting to full blown cervical cancer and insists on Hysterectomy( removal of uterus). However, as a doctor you remind her that she is very young and might need other children or may get re-married later in life. Dilemma! Do you go ahead and do the surgery and risk her regretting in the future? Secondly what if you deny her the surgery and she ends up with cancer later on?
4).THE HUGE GOITRE The patient who comes in with a very big Goitre causing moderate obstruction symptoms. If you don't do surgery, she might end up with severe obstruction of airway later in life. If you do the surgery, she might never wake up from the surgery due to expected collapse of the trachea. What do you do?
5). CANCER IN THE ELDERLY I have seen relatives coming in and insisting on referrals for chemo-radiotherapy for their elderly relatives. How will chemotherapy change the life of a 95year old man with prostate cancer? Won't the effects of the chemotherapy affect the patient gravely more than the cancer itself based on their age and frail bodies? If you don't refer them, the relatives will forever blame you. But this is easy, you refer and shift the burden of blame to the oncologist.
I hope you now appreciate what we go through. The burden of being a decision maker in matters health as well as social. The profession can really get to you. Who said that doctors are not community leaders? Have a nice week ahead. I promise more posts sooner.
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