Tuesday, 13 May 2025

13th May 2025. Packed Day



 Today was such a packed day . I have been with a sickness which in my big-headed medical personality , I decided to manage conservatively quietly because it wasn’t causing much issues . Shit hit the fan last week . I had such bad pain on a Tuesday night but me being me , I kept it low to avoid alarming my household , gobbled down some painkillers and drove over 30Kms to work and ran a full clinic and even did a procedure.  I sneaked into our radiology department in between and asked for some thorough sonography; it picked my usual ka-disease but couldn’t explain the severe stabbing pain I was having .  I continued on painkillers but the Friday night attack was the worst ; I have never felt so much pain . I couldn’t sleep, breath , lie down or stand; rolling on the floor didn’t help either. Painkillers weren’t working and I vomited them all . I had to be rushed to the E.R at 4am ; God bless a clinician called K* . He put me on proper pain meds and listened to me when I insisted on particular tests and a CT-Scan (ujuaji ya patients who are doctors; another clinician would have kicked me out but turns out that my predictions were point on). The problem was picked ; my little ka-disease was somehow complicating and putting me in danger . I quickly saw a senior and he referred me pronto to the Nairobi Hospital . I argued with him if I could please first attend a compulsory work meeting scheduled for 15/5/2025 and if I could do some booked surgeries ; he reminded me that my well-being should come first before anything and a small problem could worsen due to postponing unnecessarily. He further told me that work/patients/the world moves on whether we are there or not so to prioritize myself at all times. 

The particular Nairobi Hospital clinic was fully booked for the week but after listening to what I had and for being a colleague , the professor  squeezed me in for Tuesday 13th May - in 3 days time  . I had a very important online interview on the same day and I had to choose my well being or the interview or both and I chose both . I had to prepare a full research concept paper for it and man , I prepared it fully from scratch on my sick-bed over the weekend and combed through 10 research papers in detail. I didn’t even have an idea on what I wanted to write about but Alhamdulilah I managed.  I chose to work on the Monday of 12th despite some little pain and even preponed my surgical cases for later in the week to that day 12th. I was in some pain but neither my patients or colleagues noticed ( nurse Cate noticed because she had to give me a few painkiller shots) . Staying at home would only worsen my feeling of pain and create anxiety  so I chose to take pain killers and do what I love ; my professional duties as an ObsGyn . Working wasn’t going to affect my anyway ongoing disease process. The day went quick and my mental well being was on check ; there is a euphoria that comes with knowing that you have helped others(and made some buck) even in our own pain. 

Tuesday 13/5/2025 - I had the doctor’s appointment all the way in Nairobi at 12.00noon, I had the interview at 4.20pm and yet I was in Meru. Driving was out of the picture because I was still in pain and prone to some bad attacks ; my husband had to be left behind because of my kid’s school and my insistence ; I didn’t want them to be left alone for days with the nanny and not see atleast one of us  - they are so small and I also didn’t want my son to miss school for a prolonged period ; so travelling as a family was out of the picture.   I opted to jump onto the 5am shuttle and have my mum , siz and bro wait for me off Thika Road  and take me to hospital : talk of splitting tasks m. I hadn’t been in a Meru-Nairobi matatu for over a decade but this was my most convenient means for the day. I made it on time and was sitted in Nairobi Hospital at noon sharp . I requested the secretary to slot me in such a way that I wouldn’t miss my interview but medical secretaries are funny people ; they will either be super nice because you are a doctor or decide to humble you because you are in their domain - I remained humble throughout and called her ‘madam’ all through but can’t tell how she chose to treat me at this moment and even made one patient who came late skip me on the queue despite my reminders. I couldn’t complain because remember this was such a precious booking  . My slotted time to see the prof doc delayed and so I waited , my interview coincided to the dot with my ongoing doctor review when I walked in and I was torn so I requested to continue seeing the doctor because he would leave for a procedure.  I requested the panelists for a delay in the interview by 15 minutes but they were strict and so I narrowly missed my ‘possible-life-changing’ interview just like that. Its funny that after this I had a whole idle 3 hours being processed for hospital admissions;l was angry. Why did they slot the interviews at such odd late office hours ? Too many questions.

I got admitted to hospital for an immediate procedure- had I missed the doctor slot I would have had to battle with pain , worsening complications and no solution for another few nights . I chose me in those critical 15 minutes . The Prof doc attending  to me saw me shed a tear for missing the interview but haidhuru. I apologized profusely to the panel on text and email but will they understand that I’m just a very strong focused  girl who even dared to read for the interview in the doctors waiting room and be very optimistic to attend and pass ? I was all set with the clinic wifi on my laptop and had warned the patients next to me that I was about to take an exam there and then if called upon - they joked that I was too calm for someone with an ‘exam’ . Am I joker to have chosen to be seen and not miss a rare Doctor’s slot ? They gladly decided to reschedule me. I could however feel the disappointment in their replies  ; they should know how determined I was against all odds. I hope my career trajectory doesn’t take a lifelong twist because of these precious 15 minutes.

I’m typing this from my hospital bed , unable to sleep , thinking of my babies and very hopeful that my midnight imaging and procedure tomorrow morning goes well. I’m just a very strong willed girl with such big dreams and a very big heart (sometimes I wonder if I ever receive back the so much I give to the world and those around me) .I remember the many times I move up patients when they need to be elsewhere urgently ; why didn’t the same happen to me today? I realize that this is among the rare times when I’m all alone without being called ‘mama’ a million times by my precious little ones and so my mind is in a wandering mode. 

Sometimes being too strong can make our loved ones to overlook if we ever have times of need. I just hang up the phone on a relative who called to ask for directions for something minor; I reminded him that I’m sick , in hospital, alone and in pain . Please allow us to be vulnerable for once ; this very strong will and concern for others but myself has made those around me to never know when I’m breaking inside , afraid and just in need of some attention, space and pampering. I told my mum that had she not come  and if I had had to admit myself  alone with my big safari bag and interview laptop/gadgets ningejihurumia sana; I would break down. ( It reminds when as little girl who had never gone to a different town let alone a different country, had to travel overseas solo at age 19 and find her way around alone in new continent/country 😎; long story for another day - I have always been super strong 💪). 

I won’t advertise this post , it shall be seen later by my binge readers when I bounce back and post my many fantastic clinical stories . 

I’m now blubbering, time to rest for the few hours before my midnight imaging . 

Update - my subsequent days in hospital were very dramatic. One major procedure and one major surgery later  . I got very very sick but gladly pulled through . I ended up staying in for more than 10 days . I’m well now and so thankful for recovery . 


Tuesday, 6 May 2025

EMERGENCY CONTRACEPTION - NOT JUST P2; THERE ARE BETTER METHODS

 


Rael * 23 year old final year university student walks into my clinic . She is anticipating her final exams and soon thereafter start plans for a wedding with her fiancé Daniel*. They have been very careful with their safe days and using protection but last evening , they had an unprotected moment and she is ovulating today. She comes in because she wants advice on the best emergency contraception that is very efficient  and without complications. She is not ready for a baby now and would like to focus on finishing school , getting high grades  , getting a job and starting the tedious dowry/wedding preparations with Daniel. Her cycle has been very regular to the dot and she is sure that she has a very big chance of conceiving from the previous night’s encounter .


I’m surprised that we have younger ladies who are very armed with information and I congratulate her for seeking care timely and wanting to take control of her life . She says that my blog ( whose link was shared to her by a classmate)on not fearing contraception before marriage opened her eyes.  


Emergency contraception according to WHO refers to methods of contraception that can be used to prevent pregnancy after sexual intercourse. These are recommended for use within 5 days of intercourse but are more effective the sooner they are used after the act of intercourse.


Emergency contraceptive pills prevent pregnancy by preventing or delaying ovulation and they do not induce an abortion. In case ovulation has already occurred, methods like the copper-bearing IUD prevents fertilization by causing a chemical change in the uterus and fallopian tubes that is toxic to sperms before they can reach the egg for fertilization. The copper-bearing IUD therefore acts as a spermicide, killing or impairing sperm so they cannot reach the egg. Copper IUDs do not contain any hormones, but release copper ions, which are toxic to sperm. They also cause the uterus and fallopian tubes to produce a fluid that contains white blood cells, copper ions, enzymes, and prostaglandins  which is also toxic to sperm.The very high effectiveness of copper-containing IUDs as emergency contraceptives implies they may also act by preventing implantation.


Emergency contraception cannot interrupt an established pregnancy or harm a developing embryo; therefore doesn’t induce abortion and so it’s legally allowed.


Emergency contraception can be used in a number of situations following sexual intercourse. These include:

  • When no contraceptive has been used or was forgotten e.g in patients on the daily pill  .
  • Sexual assault when the woman is to be protected against conception 
  • When there is concern of possible contraceptive failure such as a condom burst or slippage
  • Miscalculation of the  safe window or when not sure how to calculate
  • Patients with sudden expulsion of an intrauterine contraceptive device (IUD) during or immediately after intercourse 


So back to Rael , we get talking and the two main methods  available locally are discussed which are as follows

  • The high dose progesterone pills (150mg of levonorgestrel) popularly known as the P2  which should be taken within 72 hours of sexual intercourse  (these pills can also be taken in 2 doses of 75mg each, 12 hours apart). This should not be abused and it’s recommended to be used infrequently and mainly during the fertile window.
  • The copper IUCD which should be inserted within 120 hours (5 days)of unprotected intercourse 


The pill will have same side effects like the oral contraception pills and if vomiting occurs immediately on taking the pills then it should be repeated immediately. The P2 has a failure rate of around 2% and the resultant pregnancy might be an ectopic pregnancy but this is rare. The P2 pill is also associated with irregularities of subsequent menses . 


The copper IUD (Copper-T) is 99.2% effective as an emergency contraception if put within 120 hours . The downside is that it has to be put  by a professional and may be unreachable by most especially younger students who may shy away from fertility clinics . The less than 1% that conceive would also most likely have an ectopic pregnancy but this is very rare . The advantage is that the woman can keep it as a continued effective contraception method and can last for upto 10 years . Removal is easy in the clinic and can be done by any medical cadre as long as the strings are visible .





The IUCD is also non-hormonal so no hormonal side effects like weight changes , menstrual irregularities are encountered . The return to fertility on removal is instant. 


Rael opted for the IUCD . Luckily I had a a sterile insertion set and piece ready in the office and I was able to insert it for her immediately after confirming that her pregnancy test was negative (we have been conned by patients before so we always want to confirm). She was glad that she took medical consultation and saw a professional . Her next menses came on time and she is busy preparing for her exams . 


I hope this is well understood. Take charge of your life ; do not let an oops moment change the trajectory of your life .