A TODDLER'S WORLD

 It truly takes a village to raise a child. Being a parent truly humbles a human. After having children life completely changes especially for working moms. There has to be a balance between work, partner, and children. It took me a while to be able to dedicate some self-care time to myself. The baby was about nine months old when I joined the gym. Despite finishing work late I would try to gym twice a week. I instantly felt the rise in mood and energy levels. On Sundays, I used to go for a five-kilometer walk, and it fell away because I felt bad not spending time with the baby. The other Sunday I decided to take her outside with me, while I exercised. She enjoyed the outing a lot. I had a chance to move my body get some fresh air, and spend quality time with her.

A toddler’s world is a fascinating place! Children learn and explore their surroundings at this stage with curiosity and wonder. Play is their primary language. She thought it was a new game when I was jumping up and down and squatting, and she enjoyed imitating me. She was constantly exploring and touching everything she saw like the grass, the cars in the parking, the plants, and the soil.

My daughter is about twenty months old, and if I leave her sight she panics and cries for me even if it is for a few minutes. She is still learning to manage her emotions and often expresses herself through tantrums and meltdowns. She is starting to develop social skills. She enjoys being around other children, she is learning to share the toys and cooperate with them. Her language is slowly developing and she greets the kids, the delivery bikes, and the gardener.

She is used to her morning and evening routines. After I fetch her from my mother’s place, she follows me around the house while I tidy the kitchen and do the dishes. Then bath time starts and we try to make it fun, we use different toys and bubbles, and lastly we have a bottle of milk and cuddles.

Her love and attachment to me melt my heart. And I feel very proud every time I see her learn something new and watch her grow. Every child is unique, what works for one toddler may not work for another. By understanding and embracing their world we can better support and nurture their growth and development.

 

 

MY CROCHET JOURNEY

 Looking back, It is quite mind-blowing that I have been doing crochet for almost over 10 years. I always enjoyed doing arts and crafts such as drawing and painting from a young age. I remember at the age of 5 my uncle brought me a Lego set from Japan and I was very serious about what I was building with them and loved the end product. My brother was just a toddler and my mom would ask me to allow my brother to play and destroy my Lego construction to entertain him during feeding times.

I made it to medical school and the medical curriculum, different hospital rotations and exams took most of my time. I was still doing watercolour and oil on canvas paintings. My mother and brother were already in South Africa and after spending dinner time with grandparents I would go upstairs to our old flat and do paintings and listen to music until late at night. The internship started and work became busier with the night shifts. I was either spending the 24-hour shift in the hospital or catching up on my nap time.  I missed my old creative life.

I decided to start doing crochet. Back then there were no YouTube tutorial videos. I started with grandma and some crochet instruction books. Later on, I learned some more patterns from my grandma’s best friend. I went to her house and she would show me a pattern and I would follow her steps and do it. Gradually I figured out how most of the different patterns, single crochet, and double crochet, worked. I started with simple round doilies, granny square patterns, and scarves. The biggest thing knitted was a big colourful blanket made from small round patterns. I would crochet them in my community service accommodation, bring them home, and knit them together.

I find knitting and crocheting to fill the little free time I have here and there and reduce anxiety. I am not the only one who enjoys this. I found a lot of younger generations crocheting and making various crafts on social media. From baby clothes and boots to blankets and various stuffed toys. There is scientific evidence that crocheting and knitting are effective tools in maintaining dexterity and cognitive health as we age. The repetition of stitching absorbs part of our attention while still allowing us to think deeply about other things, therefore it allows us to process grief and other challenging emotions.

I often get criticized and mocked by my close family and friends that crocheting is for the elderly and grannies. I really feel that this is helping with my mental well-being. It is truly an antidote to depression, it helps me pull out of negative thoughts and focus on things that give me a sense of achievement.

 

 

 

 

JULY IS FIBROID AWARENESS MONTH

 Uterine fibroids are a common and yet misunderstood condition that affects many women. They are noncancerous muscle and fibrous growths in the uterus that can cause heavy bleeding, pelvic pain, and urination problems. They are more common in women over 30 and in African women. There is uncertainty as to why certain women are more prone to developing fibroids. According to the Fibroid Institute Texas, 61% of women are not aware of treatment options for fibroids! This highlights the importance of spreading awareness, especially considering that around 2 in 3 women will develop at least one fibroid at some point in their lives according to NHS.

Taking a good history of women presenting to gynaecology clinics is very important. Whether they are experiencing heavy menstrual bleeding, pelvic pain, or infertility. Another category of women is the ones who find out about the uterine fibroids as an accidental finding on a pelvic ultrasound and seek gynaecology advice, in which if they are asymptomatic they can benefit from conservative management.

Another important step in assessing the fibroids is to do an ultrasound and locate their position (subserosal, submucosal, or intramural), size, and number. The subserosal fibroids grow on the outside of the uterus and the submucosal types are the least common they grow inside the uterine cavity, and are associated more with infertility and heavy menstrual bleeding. An MRI can provide more accurate information to map the fibroids. Once the diagnosis is confirmed we can offer women various treatment options.

The treatment options vary from conservative management in asymptomatic women. Medical management to control heavy menstrual bleeding such as NSAIDs and iron supplements to prevent anemia. Hormonal treatment to control the heavy menstrual bleeding in women who are eligible and do not desire fertility. HIFU (high-frequency focused ultrasound) is a minimally invasive medical procedure that uses ultrasound waves to treat uterine fibroids. We have a HIFU unit in Bara Hospital.

Surgical treatment such as myomectomy is reserved for women who still desire fertility. Counseling is essential in such cases so women are aware that the chances of pregnancy after a myomectomy are not 100%, the fibroids may grow within a few years and there are risks of bleeding, infection, blood transfusion, and even life-saving hysterectomy with surgical intervention.

 Women who have completed their families and do not desire fertility may benefit from a hysterectomy or a uterine artery embolization. The latter is a procedure performed by interventional radiologists by embolizing the uterine arteries through catheterization, and this leads to a significant decrease in fibroid size and bleeding.

The key to successful treatment of women is good history taking, accurate location and sizes of the fibroids, and counseling women in terms of all the treatment options.

 

Below is the photo of me doing a hysterectomy for a large 30-week fibroid uterus

MENOPAUSE

 The average age of menopause is about 50 years, with women having a life expectancy of about 80 years, they will spend a significant time of their lives during menopause. A lot of women forget about gynae check-ups once they have completed their families and perhaps done a tubal ligation. A lot of women may have a smooth transition to menopause with minimal hot flashes and no abnormal uterine bleeding or mood swings. That was my mother who is currently 64 years old and she experienced minimal symptoms.

Premature ovarian failure is defined as cessation of menses before the age of 40. It can be idiopathic but can be seen in women who had chemotherapy or radiation, previous pelvic surgery, or hysterectomy.

The perimenopausal stage is where the Estrogen levels are declining and women sense a change in their body with weight gain, decrease in libido, decrease in bone density, and mood swings. It is important to emphasize that the changes are not merely physical but many mental changes. It can mostly manifest with sleep disturbances and low mood. At times if the healthy diet, relaxation, and exercise don’t help a trial of antidepressants can be helpful.

Menopause hormone therapy significantly improves the hot flashes and improves the bone density. The products come in different forms such as oral tablets, transdermal gel, and patches. Ideally, they should be started within five years after the cessation of menses. It is vital for women who have a uterus to use both estrogen and progesterone to prevent endometrial hyperplasia. There is a small risk of an increase in breast cancer and thromboembolic disease in women on hormone therapy. It is advised for women to do regular mammograms and self-breast examinations. The aim to is to try and taper the hormones within a couple of years so women can cope better with the symptoms. I have encountered several women in their 70s who had the uterus and ovaries removed in their 40s and were refusing to even taper the hormones.

Calcium and vitamin D supplementation, weight-bearing exercises, and smoking cessation improve bone density and prevent pathological fractures.

A decrease in estrogen levels causes vaginal dryness, urinary frequency, or even dysuria which is now known as the genitourinary syndrome of menopause (GSM) and along with decreased libido, it may negatively affect the sex life of many women in this age. The use of vaginal estrogen creams and lubricants can help. The regular use of vaginal estrogen can prevent severe vaginal atrophy in later years.

Women should continue with regular gynae check-ups although the majority of women are managed by their general practitioners and family medicine doctors. We can stop doing pap smears in women over 65 if the previous smears have been normal. I try to explain all the aspects of menopause to women in their gynae visits, so they understand better what is happening to their bodies. The take-home message is that women must continue being active and lively and enjoy this new phase of life. I want to do better than my grandmother and my mother when I get to that age.

This is three generations in one photo