MY BABY IS TURNING TWO

 I wasn’t always sure if I wanted to be a mom. Now that I have a daughter, I am enjoying every minute of it. There are difficult moments here and there. Some nights when we have a sick child and haven't slept the whole night and still show up at work the next day. Weekends are crazy with a toddler, by the time I am up and showered and dressed baby and myself and prepared breakfast, I feel exhausted and still have a long day ahead.  It has been an overwhelming journey for me and my husband, from trying to conceive to pregnancy loss and all the way to having a happy and healthy girl!

She has been amazing through these two years. She is growing well and is above the growth chart for her age. Her milestones have been reasonable. She atrted sitting at around eight months and started walking around 15 months. She follows instructions. She is still not very vocal and only says a few words. It may be due to the bilingual atmosphere in the household. She enjoys watching Cocomelon, stealing our phones and playing with them, running in the open and splashing in the swimming pool, or playing with the other kids and she is starting to show interest in books. Her favourite books are Peppa Pig stories and the ones with pictures of farm animals. I love it when I set up her toys and books and she goes and grabs the book and starts paging through it.

She doesn’t like me and her daddy arguing, she hates separating from mommy, she doesn’t like her legs being covered with a blanket at night and recently she has no interest in food and loves to say no to everything.

She stays with my mother while I am at work. We are in the same complex and I drop her off every morning there is no stress and I pick her up whenever work is finished. I am planning to put her in crèche next year for three days per week. I think she might go through a hard time separating from me and adjusting to the new place, but in the end, it will be worth it because she can play, make friends, be more stimulated, and learn new skills.

 

 

 

 

 

GRATITUDE

 The day-to-day life may seem boring with the same routine of waking up and going to work. The demanding workplace, and the usual problems, the traffic, back home is the cooking dinner, bathing the baby, and putting her to sleep. We might think that we are not making much progress in life, but there are times when I actually have the time to sit back and reflect on my life journey and I realize that I have come a long way. This happened the other day when I was shortlisting doctors for a medical officer post in our hospital. I realized I was in the job hunting position just a few years ago trying to write my exams and get into the specialisation program.

I have come a long way and tried to enjoy the journey and have fun. The job market for doctors has become very competitive. It is hard to believe that thousands of doctors in South Africa struggle to find a government job after they finish their community service. One of them actually made a touching video on social media to make people aware of the doctor unemployment crisis. A couple of our registrars who also finished specializing are going to be without a job until they figure something out.

As humans, our brain tends to drift towards negativity. We tend to spend a lot of time thinking about the things we don’t have and not wanting what we already have. I was listening to a program where Oprah Winfrey was talking about happiness in life. She pointed out that, during challenging times in her life, she often sits down and starts writing in her gratitude journal. And the one time she wrote seventy-two things that she is grateful about.

I know my workplace is not without problems but I am truly grateful that I have a full-time job that is meaningful and I can support my family. I know I still need more experience regarding surgical procedures, or I still want to do a fellowship but I am happy I have come all this far and specialized in the first place! And I love my job!

This is me about 20 years ago when I just started medical school, preparing for one of my exams. the photographer was my brother running around the house with his new digital camera and capturing every moment

 

THE GOLDEN HOUR

 The “Golden hour” is a term used to describe the first hour after birth. This is a crucial time when the mother and baby share their first intimate moments, initiating an emotional bond with significant health benefits. It is during this hour that the first breastfeeding usually occurs. Breastfeeding during the golden hour helps the baby stabilize its heart rate, breathing, and blood sugar. It also keeps the baby warm and helps the mother and baby develop a strong bond. The benefits of breastfeeding extend far beyond the golden hour.

I had a normal vaginal delivery with an epidural, my husband was present as a companion which meant a lot to me and added extra support. The epidural anaesthesia helped me be calm and cooperative during the second stage of labour. The baby was delivered with the assistance of a vacuum because my pushing efforts were not adequate and I’m sure my gynae did not have enough patience to wait for an hour for a primigravida to push this baby out. Everything went well. I was well and the placenta was delivered and I had a few sutures down there. The baby came out vigorous and crying! A paediatrician was also present to make sure the baby was breathing well, happy and pink, and safe to be with the mother.

Pregnancy and breastfeeding are protective against breast cancer in women. according to a report by the World Health Organization, the risk of breast cancer decreases by 6% for each year a woman breastfeeds. The reduction in cancer risk is thought to be due to changes in breast tissue that occur during lactation making the cells more resistant to mutations that lead to cancer.

Breastfeeding lowers the risk of cardiovascular disease and high blood pressure. It reduces the LDL levels which is the body’s bad cholesterol. It also reduces insulin resistance and the risk of diabetes. A study published in JAMA Internal Medicine found that women who breastfed for six months or more had a 47% lower risk of developing type 2 diabetes compared to those who did not breastfeed.

Breastfeeding is not always easy, and everyone will have a different experience. As healthcare professionals, we must provide help and support to mothers choosing to breastfeed their babies.  

 

OBSTETRIC HEAMORRHAGE

 Obstetric Haemorrhage is the leading cause of maternal morbidity and mortality worldwide. It is defined as excessive bleeding during pregnancy, childbirth, or the postpartum period. It is difficult to quantify the volume of blood loss. Still, most references suggest excessive bleeding of more than 500 ml after a vaginal delivery and more than 1000 ml after a caesarean section is significant. It also depends on how the mother has been optimized during the antenatal period to cope with bleeding. Anemia in pregnancy can on its own predispose pregnant women to postpartum haemorrhage.

We have made good progress in terms of training staff concerning the acute management of haemorrhage, maternal resuscitation, and the use of uterotonic agents. We believe that in the twenty-first century, we should not lose any woman with obstetric haemorrhage. Most of us know the tragic story of Mumtaz Mahal in 1631 who gave birth to her fourteenth child. Shah Jahan was devastated by her death and decided to build a magnificent mausoleum in her memory which is named the Taj Mahal in Agra, India. It took 22 years to be completed, and it is considered one of the seven wonders of the modern world. It is a testament to Shah Jahan's and Mumtaz Mahal's eternal love.

In the modern world, we have easy access to birth control. Most births occur in a level of health care facility. In our regional hospital, we still struggle to have access to a blood bank after 4pm, which is not ideal considering it is a mother-and-child hospital with about 1000 births per month. The other day we prioritized an elective caesarean section with a known placenta praevia to be done first thing in the morning while the senior doctors are on duty and the blood bank is available. We started the case with 2 units of blood in theatre and we also had the senior anesthetic consultant available. The fetal medicine unit had not found any ultrasound evidence of the anterior and low-lying placenta being morbidly adherent to the uterus. Intraoperatively the placenta was morbidly adherent and we had an obstetric haemorrhage and proceeded with a caesarean hysterectomy! The mom ended up in the ICU with a massive transfusion.

We try our best every day to decrease the incidence of obstetric haemorrhage and the morbidity and mortality that comes with it. A morbidly adherent placenta or a placenta accrete spectrum is on the rise due to a rise in caesarean section rate. We hope with recent advances in antenatal imaging we will be able to identify such cases and manage them appropriately in a tertiary-level hospital with experienced surgeons and, an anesthesiology team.

 

 

PADEL

 Padel is a sport that combines elements of tennis, squash, and badminton. It is played on a smaller court with solid walls and a net, using paddles and a plastic ball. This sport has recently gained a lot of popularity worldwide. It is fun, social, and fast-paced, and it is easy to learn and play, making it accessible to people of all ages and skill levels.

My husband started playing Padel last year, and when he asked me if I was keen to try I became defensive, saying that my working hours are long and unpredictable to book anything, and have never played any racket sports in my life and I am not interested in trying anything new. On top of that, I have a toddler that I have to look after when I get home. Back then I was working very far from home and the long drive was a big challenge. I got a new job just around the corner from my house and the working hours improved. Winter was over and I was in a more outgoing mood. I met my old friends in the Bryanston sports club. I found new padel courts that night and I watched people play, and I really enjoyed the vibe. That was the time I reached out to my husband to show me the logistics of how to book a court, hire rackets, and play the game.

I loved the first Padel game! It was exciting and competitive! I was running around the court trying to get the ball, sweating and not knowing how the time is passing. It was me and my Serbian friend versus my husband and his friend. We played for one and a half hours. Then we sat down had a drink and enjoyed watching other people playing. 

It is something I would like to continue playing. It improves hand-eye coordination and reaction time which is something I need to work on. It is a good cardiovascular exercise and helps with burning calories. The social interaction is very nice and every padel court has a nice café next to them overlooking the courts. It is something I look forward to the whole week, it is extremely fun and helps with stress relief.

 

 

 

BREAT CANCER AWARENESS MONTH

 October is Breast Cancer Awareness Month. It creates an opportunity to raise awareness and funds for breast cancer research, diagnosis, treatment, and support. It is one of the most common malignancies in women. The survivors experience severe trauma and major health issues. It is scary to know that 1 in 8 women will develop breast cancer in their lifetime. Early detection and treatment improve survival rates.

Most of us have a friend or family member who has been through the breast cancer treatment journey or has surrendered the battle. One of my colleagues whom I met during community service was diagnosed with early stages of breast cancer five years ago. She has been disease-free after her operation and chemo-radiation therapy. Another friend of mine that I met in the meet-up groups is also known to have been through the breast cancer treatment process and has been disease-free for over ten years now.

There are numerous ways to help raise funds, such as participating in different fundraiser events or functions. Wearing pink clothes and accessories shows support and increases awareness for the public. We need to educate women to perform self-breast exams and get mammograms to pick up the disease at an early stage. Pay attention to the family history as well. If there are first-degree relatives who had breast or ovarian cancer before the age of fifty, there might be a need for genetic testing to pick up dangerous genes such as BRCA1 and BRCA 2. About three months ago we lost a fifty-year-old woman with advanced breast carcinoma in our gynae ward. When I spoke to the family, it turned out that the patient’s own mother was a breast cancer survivor, and yet she did not have any screening and did not even present to us as soon as she felt a lump in her breasts.

Several celebrities such as Angelina Jolie and former French First Lady Carla Bruni have helped raise breast cancer awareness. Remember, every small action counts and collective efforts can make a significant difference in the fight against breast cancer!

 

THE CONFLICTS IN THE MIDDLE EAST

 When I started this blog, I was curious about how consistent I would be with my full-time job as an OBGYN and a toddler. I have many ideas about women’s health and many interesting things happen from day to day. I enjoy sitting down and putting my thoughts in writing. It gives a sense of purpose, and peace and brings on new ideas.

One of the current burning topics is the new conflicts in the Middle East. It is a big worry that in the twenty-first century countries are invading each other. As a person who advocates for women's and children’s health, I want to elaborate on the various consequences of a new war in this region.

A new war forces a lot of families to be displaced and flee their homes. Imagine being in that situation, wondering which precious belongings besides your life you can take and go to a safer place. Wondering when will you come back, and if you ever do, will your home still be there! At times family members are forced to be separated, and this leads to emotional trauma long-term psychological effects, and PTSD. I wonder if the new generation  of kids who grow up in these situations will be able to create peace in the world.

War damages and destroys essential social infrastructure such as schools, hospitals, and community centers. The fragile economy of most of the developing countries that are already struggling becomes completely dysfunctional during a war, and this leads to more unemployment and poverty in the society.

A lot of the low and middle-income countries that have been involved in war over the years such as Lebanon, Iraq, Palestine, and Yemen have lost some of their beautiful cultural heritage sites and buildings. The effect of various chemicals and weapons on nature and all the pollution can last for years. my Lebanese friend pointed out to me that their gardens and the olive trees in the South of Lebanon were damaged after the war and they haven’t been able to grow anything on that land.

The social consequences of war can persist for generations, affecting the social fabric of societies and perpetuating cycles of violence. These consequences underscore the importance of preventing war and promoting peaceful conflict resolution. It is crucial to address the root causes of conflicts and work towards a more just and peaceful world.

Below is a photo of me as a war refugee with my mother, grannies, and uncle.  

 

The entrance to Grandma's house where I was born and raised. I absolutely love that place, and it is still standing strong

 

 

 

 

 

HERITAGE DAY

 Heritage Day is a public holiday that is celebrated on the 24^th of September every year. It is a day that celebrates the diverse cultural heritage of South Africa, including its languages, traditions, customs, and history. My favourite part of Heritage Month is people with various cultures wearing their traditional attire and sharing their traditional food. Other activities during this month are different music and dance festivals, food markets, more art and museum visits, and most importantly family and friends getting together and braaiing!

At work, we planned to celebrate Heritage Day and organize a farewell party for one of our colleagues on Friday the 27^th. It was a beautiful day with everyone wearing their traditional clothes to work and bringing a signature dish to share with everyone else. I am from the Middle East and was wondering what food item to bring. The traditional rice dishes are difficult to share. I thought about making chicken kebabs and flatbread, or small portions of the rice pudding with saffron and sprinkled with cinnamon.

We ended up going to the Turkish restaurant for lunch on the 24^th and I bought some Turkish delights as a backup plan in case everything fails. In the end, I brought Turkish delight on the celebration day. We have a lot of different signature traditional dishes, such as vegetable stews, we have crispy rice, lots of soups, and dessert recipes. My husband is not quite a fan of our traditional food and I hardly cook for him. My mom cooks the different vegetable stew dishes and because the portions are big we end up eating them for a couple of days.

A lot of things are different when I compare my conservative Middle Eastern culture to the more modern and open South African culture. I enjoy the diversity of cultures and languages in South Africa. Everyone is very warm and friendly. I have enjoyed my stay in this country for the past 11 years. I am grateful for all the various opportunities this country has offered me in my late twenties.

Heritage Day is an important part of South Africa’s reconciliation process as it promotes understanding, tolerance, and acceptance of the country’s diverse culture and history.

 

 

 

THE LIGHT WE CARRY

 I am a fan of women who have contributed to making a change in society. Michelle Obama was the first woman of colour to become the first lady of the United States of America. She carried out her duties gracefully. I enjoyed her first book “Becoming”. It was a small glimpse into her childhood, adult life, college, meeting Barak, having kids and the election campaign, and finally settling in the White House. I came across her other book "The Light We Carry" in the library and grabbed it excitedly. I read it in less than a month with my full-time job and a toddler at home. It was indeed a very good read.

She touched on the Covid-19 Pandmic. The times of fear and uncertainty and of course lockdown. I was fascinated when Michelle pointed out her knitting journey to battle with stress. “ I am not sure if I would have gotten there without the period of enforced stillness and the steadiness I found inside of knitting. I’d have to go small to think big again. Shaken by the enormity of everything that was happening, I needed my hands to reintroduce me to what was good, simple, and accomplishable. And that turned out to be a lot."

She spoke about her daughters growing up and being independent and the proud feeling every parent has when visiting their children’s house. Seeing their different behaviour compared to the times they stayed with their parents. Also looking at the new generation dating. Addressing the fear she experienced when Barak wanted to run for president, she didn’t want to stop him, knowing she might regret that decision. “How will you meet your soul mate if you don’t go on that date? How will you get ahead if you don’t take that new job, or move to a new city? How will you learn to grow if fear stops you from leaving home to go to college?

She spoke about her mother’s vital role, supporting her young daughters while Michelle and Barak were busy with their day-to-day duties in the white house. Her mother stayed with them for the whole 8 years. She spoke about herself being very self-aware of her physical difference from the other girls her age. Reading this part made me feel better about myself.

I'm tall and that’s a good thing

I'm a woman and that’s a good thing.

I'm black and that’s a good thing.

I am myself and that is a very good thing.

 

She spoke about her political motto of going high. “ When people ask me about going high, I explain that for me, it's about doing what it takes to make your work count and your voice heard, despite the despites. It helps if you're able to stay agile and adapt to change as it comes. And all of that becomes more possible, I've found when you are ready and practiced with a full range of tools. Getting high is not about what happens on a single day or month or outside one election cycle either. It happens over the course of a lifetime, the course of a generation.”

 

TURNING 39

 It was my birthday on the first of September! It is also the first day of spring in South Africa. I have never been a fan of big birthday parties since childhood. In fact, I don’t think I had any major birthday celebration since the age of five. Sweet sixteen, eighteen, twenty, and thirty went by without much of a fuss. This time we had balloons and some friends over and we all celebrated. It was a beautiful day full of laughter, and positive energy!

This is my new year, and it is the time for me to sit back and reflect on my life. I have lived quite a life and this part of the journey will determine what the rest of my life will look like in the future. In this reflection, I am going to look at various departments such as health, family, career, and finances.

Being a healthcare professional I appreciate the gift of health every day. Being able to get yourself out of your bed, take a shower, eat, and get into your car to work is an amazing thing. Dealing with patients who rely on help just to make it to the bathroom from the hospital bed gives me a different perspective on life. Knowing all this, getting a couple of grey hairs or wrinkles on my face is the least of my worries. I look good for my age, and there is no shortcut for this. I eat well, sleep well, and stay away from alcohol, cigarettes, and too much sun. we need consistency for good results. I am a bit heavier than what I used to weigh ten years ago, but I have started to eat cleaner and have increased my physical activity. I even now have a fitness watch. I have been watching my cholesterol, blood pressure and doing my pap smears and HIV tests annually. I have a strong family history of diabetes and I hope I can keep it away for as long as I can.

Family is everything. I feel blessed to have my husband and my daughter in my life. It is not always easy to keep a house running and give everyone the attention they need, but I am doing my best. I want to have a healthy family with good relationships and a happy child who will grow up to be a happy girl! Having Middle Eastern parents who will freak out at every little thing that goes wrong with a lot of tension makes me want to do better.

I love my job! I love the fact that you are not quite sure what your day will look like in labour and delivery when you leave your house. It is diverse, we teach the younger medical students and we learn from our mentors. There is room for academic growth, but I am keeping it slow and mellow. I was in a rush to specialize, but the fellowship can wait for now while I enjoy being a general ob-gyn.

Finances have had its ups and downs. We have had phases of great expenditure and growing debt but now we are in the damage control phase. Finances have never been my strong point. I grew up in a middle-class family. We were savvy with money but as soon as I moved to SA and started making more money I started spending more. I did not understand how credit card interest works and how bank interest rates work. After the pandemic, we have had a rise in interest rates and inflation. We are doing our best to pay the debt and try and save effectively for retirement. 

WEIGHT LOSS

 Conversations regarding weight loss are prevalent in the OBGYN consulting rooms. We encounter many females with obesity who have irregular menstruation and fertility struggles, and they are desperately looking for a quick fix to regulate their hormones. They do not want to hear the advice regarding healthy eating and regular exercise. I recently consulted a girl who managed to regulate her menses by losing 20 kg and came for her viability ultrasound and she was 8 weeks pregnant. She was still obese and we consider this a high-risk pregnancy, but without weight loss, we do not see the desired results. I have also met several patients who were turned away from fertility clinics to do weight loss surgery and then start fertility treatment.

Another category of patients is women in the postpartum period who are trying to lose pregnancy weight. This period has it is own unique challenges. A busy and sleep-deprived mother can hardly find the time and energy to exercise. A lot of women spend the first 6 weeks to four months postpartum period at home and they might turn to high-calorie foods and unhealthy lifestyles. I personally believe that after the COVID-19 pandemic, a lot of women stopped their gym subscriptions and outdoor activities and now prefer to stay at home and order takeaway food. Having support in the postpartum period is important for women to be able to look after themselves and shed pregnancy weight.

The menopausal period is another era where women start feeling uncomfortable with their weight. I had a patient who was in her late forties. She was a flight attendant and they needed to stay in shape for their job. And she started noticing increased central obesity and she was struggling to fit into her work clothes. We had to prescribe some anti-obesity medication for her because she needed results within a short period.

We know that there are several useful anti-obesity medications in the market, however healthy nutrition, physical activity, and behavioral modification remain key pillars of weight management. Women in whom anti-obesity medications may be indicated are those with a BMI of 30 or greater, those with a BMI of at least 27 along with at least one obesity-related comorbidity, such as hypertension, high cholesterol, diabetes, or sleep apnea. The goal of treating obesity with medications is at least a 5%-10% reduction in body weight.

There are three basic categories of anti-obesity medications. The short-term options include phentermine and diethylpropion. Long-term options are Orlistat, phentermine/topiramate ER, naltrexone/bupropion ER and lastly, we have the three GLP-1 receptor agonist drugs, liraglutide, semaglutide, and tirzepatide. The GLP-1 agonists have shown very promising results in clinical trials with most patients losing up to 20% of their body weight. I will dedicate a blog to elaborate on the dosage, regimens, and route of administration of the GLP-1 agonist agents.