​NEONATAL JAUNDICE

Congratulations to all new mums and dads! 
So, your baby was born, looking all fresh, pink and healthy. However, on your arrival at home, having been discharged from the hospital, you found that he is as yellow as saffron. “Oh Dear! What’s wrong with my cutie pie”, you’re worried. Should you be worried? 

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Jaundice is defined as the yellowish discoloration of the skin and sclera (white of the eyes) due to excessive amount of a pigment called BILIRUBIN. 
Bilirubin is produced normally, following the recycling and breakdown of red blood cells. It is excreted in the urine and faeces, to maintain a tight balance and normal concentration in the body. Therefore, anything that increases the rate of breakdown of the red cells, or impedes the excretion of bilirubin, will result in jaundice. 

In fetal life, red cells are much more than in adults. Once the baby is born, he sheds this excess red cells as they are no longer needed. This results in a mild form of jaundice known as PHYSIOLOGICAL JAUNDICE. This form of jaundice is transient and self-limiting. If you worry, it will go. If you don’t worry, it will go! 
There are two things you can do to speed up the clearance of physiological jaundice :

1. Breastfeeding 

2. Exposure to sunlight 

Of the numerous benefits of human breast milk is that it helps to prevent and treat jaundice. There’s a tendency to think that breast milk is the cause of physiological jaundice because it is commoner in breastfed infants. But the truth is, breastfeeding provides a better chance at recovery from jaundice than not breastfeeding. 
Once you have checked with your paediatrician, and they tell you that the jaundice is mild or physiological,   try to expose him to early morning sunlight until the jaundice clears. A plus to this practice is that your baby also gets loads of vitamin D *winks. 

Remember to cover his eyes and genitals before exposure (too much UV rays can damage those organs), and do not expose to midday sunlight (to avoid sunburn)… 

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So, we have talked about physiological jaundice. What about pathological jaundice? Basically, neonatal jaundice is physiological until proven otherwise. Pathological jaundice is just an extension of physiological jaundice, ie. when the latter fails to go away or when there are superimposed factors complicating the former. 

Now, let’s break it down. As mentioned earlier, jaundice can be caused by excessive breakdown of red cells or decreased clearance of bilirubin from the blood due to – 
*Haemolytic anaemias (immune and non immune) 

*Polycythaemia (pathologically high red cell count) 

*Extravasation of blood during delivery (eg. Cephal haematoma) 

*Bruising during delivery 

*Genetic/Familial anomalies in the enzymes required for red haemoglobin and bilirubin metabolisms (eg. G6PD deficiency) 

*Infections (congenital or acquired) eg. Malaria, pneumonia, etc. 

*Some drugs, if taken in late pregnancy or given to the infant (especially sulfur-containing drugs, eg. Fansidar) 

*Congenital malformations of the liver and biliary tract

***In a Nigerian study, 13% of babies with clinical jaundice tested positive for G6PD deficiency. 

 

This list is not exhaustive; it’s just a rough overview. 
Let’s zoom in a little on Haemolytic anaemias. The commonest causes include blood group incompatibility (ABO & RHESUS) and infections (sepsis). Rhesus incompatibility is particularly important. When a baby’s blood group is different from that of the mother (mother Rhesus negative, baby positive), the mother produces some substances called ANTIBODIES. These antibodies may not affect the triggering baby, but subsequent babies are affected. 
These antibodies travel from the mother’s blood, through the placenta and attack the baby’s red blood cells which are seen as “aliens”. The cells break down at a faster rate than the baby’s liver can clear. The resultant hyperbilirubinaemia manifests as jaundice. In severe cases, anaemia or death may occur even before the baby is born (stillbirth) 

There are two components of bilirubin: the conjugated (coupled with a plasma protein) and the unconjugated. When the unconjugated bilirubin exceeds a threshold level, it crosses the blood-brain barrier resulting in a condition called KERNICTERUS. Early signs include muscle weakness, failure to feed and convulsions. This is a neurological disorder that can result in severe intellectual disability or death.

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So that I don’t bore you with too much details, let’s discuss the clinical features and management of neonatal jaundice. 
Of course, jaundice itself is a symptom, but in subtle cases, parents may not be able to detect it easily. It starts with a yellowish tinge in the sclera (white of the eye). You need to be very observant to detect a jaundiced eye because the neonatal eyes consists of more dark than white; plus, they usually sleep for the most part of the day! 

As bilirubin level rises, the skin gradually becomes yellow. In dark-skinned babies, you need to indent the skin gently to see the yellowness. You may also notice changes in the colour of the urine and faeces. 
Other signs and symptoms are related to the underlying cause and resultant effect (complications) of jaundice…

*fever

*irritability (excessive crying) 

*inability to feed

*failure to thrive (loss of weight or failure to gain weight) 

*vomiting 

*muscle weakness

*convulsions

*sudden death

The best way to manage jaundice successfully is to detect it early. As mentioned earlier, unattended jaundice can lead to permanent brain injury and severe handicap or death. Parents should be able to recognise red flags and know when to seek help. Never underrate any sign and never resort to self-medication. 
Treatment modalities include:

1. PHOTOTHERAPY – The baby is placed under a specialised kind of light. This light converts bilirubin into a form that can be easily excreted from the body. The eyes and genitals are protected while extra breastmilk or iv drips are given to replace the fluid loss due to heat. 

2. INTRAVENOUS IMMUNOGLOBULIN – In hemolytic jaundice due to blood group incompatibility, maternal antibodies can be wiped out of the baby’s blood by infusion of IVIG. This therapy is highly effective, faster and more preferable to other invasive treatments. However, IVIG is very expensive and often unavailable in developing countries. 

3. EXCHANGE BLOOD TRANSFUSION – This is a form of blood transfusion that involves gradual withdrawal of the “jaundiced” blood and replacement with normal, compatible, screened blood. The procedure is performed in the special baby care unit and there are potential risks such as infection and transfusion reactions. 

4. ADJUNCT MANAGEMENT – The cause should be determined and treated as appropriate. Breastfeeding should be continued as tolerated. Serial bilirubin levels are checked until normal. Psychosocial support should be offered to parents as they are often in distress due to the prolonged hospital stay. 

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​THE MID-CYCLE CHASE

 

One of the most FAQ’s from young women who are either trying to conceive or trying to delay pregnancy (while avoiding modern contraceptives) is:

“How can I know the ovulation day?”

Knowing the length and dynamics of your cycle will guide you in planning conception and contraception, as well as early detection of abnormalities in your menstrual cycle in general. Ovulation is the process of release of the egg from the ovary and transfer into the fallopian tube where it will be available for fertilization, in the presence of viable sperms. It normally occurs once in a monthly cycle and the egg (in rare cases more than one egg can be released at a time) remains valid for only less than 24 hours. This is why couples are advised to have intercourse at least 3-4days in a week if they want to “catch up” with the ovulation window. 
Here are some tips… 

1. Note the length of your cycle. This is the interval between the FIRST day of one menses and the FIRST day of the next. eg. If you start your menstruation on January 1st  (this is called the last menstrual period –  LMP) and then the next on January 29th, that’s a 28-day cycle. Your ovulation should occur on the 14th of January. This is the average duration but it can be as short as 21 days, and as long as 32 days.

2. It’s quite straightforward for a regular 28-day cycle. But if yours is shorter or longer, just count 14 days backwards from the first day of the next expected menses. These last 14 days after ovulation are always constant. For example, if your cycle is 3o days and your LMP is January 1st, then you’re going to ovulate on the 16th. 

3. Target this day. Add 4 days before and 2 days after. All other factors being normal, ovulation, hence fertilisation should occur somewhere around these days. If you’re avoiding pregnancy, you should avoid sex around these days too (up to a week) or, use a backup contraceptive such as condom. 

4. If the cycle is irregular, this might be difficult to calculate. You may need to see a doctor who may give you some medications to “regulate” your cycle. Ovulation can also be unpredictable at extremes of reproductive age: first 5 years after puberty and before the onset of menopause. 

5. Other options include:

A) Checking the vaginal fluid. It becomes more sticky, stretchy and copious around ovulation period (not accurate) 
B) Checking your body temperature. It rises about 1 degree Celsius around ovulation (not reliable) 
C) Ovulation tracking using ultrasound and blood tests (cumbersome) 
D) Use of ovulation prediction kits, eg. Predicte™ (available in pharmacies)
E) The ovulation pain. Certain inflammatory enzymes mediate the process of ovulation. This subtle inflammation can cause mild lower abdominal pain but, again, you can’t rely on this as many people don’t feel the pain as such.

THANK YOU… 

Dear husband, 
Calm down! This is not a rant. I’m not here to complain about anything. This is a letter of appreciation. I just want to say THANK YOU… 

Thank you for loving me. Thank you for being my Godsent protector and sustainer. Thank you for crowning me as the Queen of your heart. Thank you for trusting me enough to make me the manager of your home. Thank you for believing in my dreams and helping me achieve them. 



Thank you for the basic provisions and the bonuses. Thank you for hustling in the midday sun while I bask in my air-conditioned room. Thank you for going through the bustles of the city to bring me food and clothing. Thank you for risking your life so that I can enjoy mine. 

Thank you for putting up with my mood swings and periodic nagging. Thank you for your understanding during the times I was weak or sick. 
Thank you for the little things you didn’t even remember you did – like fixing the light bulbs and replacing the clock batteries! 

Thank you for the things I didn’t expect you to do but you did anyway. Thank you for the surprise gifts and occasional treats. 
Thank you for your kindness towards my parents and siblings.

Thank you for assisting me to keep my duties towards Allaah. Thank you for waking me up for tahajjud and enjoining me to pray on time. Thank you for reminding me to recite the Qur’an and daily adhkaar.

Thank you for everything I forgot to thank you for. Thank you for the little things I didn’t notice. Thank you in advance for the good things you’re planning to do. Thank you for the things you intend to do but you don’t have the means yet. 

JazaakaLlaah khairan! 

Signed

A grateful wife. 

“70 WAYS TO LOVE YOUR SPOUSE”

The first five years were the bomb.  The intimacy was great. The food was always ready in time. Behaviour was top notch. Looks were flawless. Everything was on point. The best word to describe this phase is: PARADISE. 
By the end of that phase, the theme begins to change. The fertile couple starts experiencing the reality of parenthood while the subfertile ones become extremely tense.  There is a paradigm shift from “my husband/wife” to “my children’s father/mother”. Show of affection becomes a seasonal affair. The bedroom becomes just a place to sleep and snore. Communication is reduced to “please buy diapers on your way home, thanks”…. 
Oops! Sorry, wrong title! I’m not here to give you a list of ways to love your spouse. You will have to find out by yourself. As a general guide, find out what works for you and stick to it. What works for couple A might not work for couple B. What are the things you used to do during the honeymoon that you’re no longer doing? Which of those things can you start doing again? What do you need to do differently now? These are the questions you need to discuss with your spouse over and over, and work out the answers, together. 
No one can teach you how to love your spouse better than your spouse. Ask them what they want and how they want it; however, be realistic and reasonable. Pay attention to the fine details. From time to time, arrange dates and outings; away from the interruptions and tantrums of the kids. 
Monotony kills love in marriage. Up your game! Update your wardrobe according to your means. Upgrade your bedmatic skills. Try out new recipes. Read books to sharpen your mind. Mix with older couples and learn from their success strories (but avoid comparing; each couple is unique). 
Most importantly, search within yourself and strive to bring out a better version of you. You will have to make a lot of sacrifices, but these things pay off eventually. Patience is an essential ingredient; it breeds love, happiness and peace of mind.

​MARRIAGE IS NOT AN ACHIEVEMENT?


I think marriage is an achievement and I’ll explain why. When Adam was created, he had everything. (Now, how do I explain this to an atheist who thinks he evolved from a chimp?!) He lived in a beautiful garden with all his desires fulfilled on demand. But something was obviously missing. He was a full-grown man with testosterone flowing through his veins. He needed companionship. He needed a wife and Allaah granted him a perfect match – Eve. It was the same for Eve.  She was happy. She was loved. She had everything, too. 
Marriage is based on love, compassion and mercy. Allaah said in Qur’an chapter 30 verse 21,

“And among His Signs is this, that He created for you wives from among yourselves, that you may find repose in them, and He has put between you affection and mercy. Verily, in that are indeed signs for a people who reflect.”
It’s fine if you choose to live a celibate life, but don’t impose it on our girls. If you prefer to service your honeypot with sextoys and bring forth children through unknown sperm donors, again, it’s your choice. Just don’t corrupt our girls. Let them feel free to love and be loved. We’re here to guide and bless them – so help us God. I can’t help you if Allaah has removed compassion and affection from your heart. It’s like the feeling of analgesia after a jab of morphine; I pray you recover soon! 
My Prophet taught me that marriage is half of faith. He encouraged us to hasten towards completion of this “half”. He said, “O young people! Whoever among you can marry, should marry, because it helps him lower his gaze and guard his modesty” (Bukhaari). This is because we have no other option of satisfying our desires. This is because sexual pervasiveness is not part of Islam. 
Keep your messy feminism to yourself and stop brainwashing our girls. And yes, we do pay attention to their education and empowerment. We do honour our wives and obey our mothers. Marriage is not the only achievement we prepare our girls for, but when a girl gets happily married, we celebrate her as much as we celebrate any of her other achievements. 

​ORAL SEX : A MEDICO-ISLAMIC ANALYSIS

 
Disclaimer! Adults only. Reader’s discretion is advised. 
There is no clear-cut medical verdict on oral sex. There are benefits and there are risks. Studies have shown that oral sex enhances the overall sexual health in some couples. Sexual therapists do recommend it when managing cases of desire and arousal dysfunctions. Unfortunately, the risk of transmission of STDs is enough to scare anyone. Genital and oral herpes, syphilis, HIV and HPV are among the most notable. 
People who engage in oral sex have been shown to be at higher risk of developing oropharyngeal cancer (secondary to HPV infection). The risk is higher for those who have multiple sexual partners, and in the presence of a breach in the genital (or oral) skin and mucosa (bruises, cuts, etc) 
The vagina contains a cocktail of several bacteria. A high level of personal hygiene is required of a woman who wishes to enjoy cunnilingus. It is more advisable to use a ‘female condom’ or ‘vulval diaphragm’ to shield that area and prevent the husband from picking up infections from down there. 
The husband could also use a condom. This will rule out the chances of the woman swallowing semen and transferring pathogens between the phallus and the mouth. 
In Islam, the basic principle in issues of daily life is that everything is permissible unless there is an explicit ruling that forbids it. On this basis, some schools of thought opine that oral sex is permissible because there is no evidence to rule that it is haraam. 
Allaah says:
“Your wives are a tilth for you, so go to your tilth when or how you will, and send before you for your ownselves. And fear Allah, and know that you are to meet Him, and give good tidings to the believers.” (Qur’an chapter 2 verse 223)
In explaining this ayah, scholars of tafseer say that couples can enjoy sexual pleasure with each other using any style. The only exception to this permissiveness is ANAL SEX which is explicitly prohibited in the shari’ah as seen in several authentic ahadeeth. 
 It was narrated from Abu Hurayrah (RA) that the Messenger of Allaah (SAW) said: “The one who has intercourse with his wife in her back passage has disavowed himself of that which was revealed to Muhammad (SAW).” Narrated by Abu Dawood (3904); classed as saheeh by al-Albaani in Saheeh Abi Dawood. 
However, another school of thought believes that oral sex should be discouraged as it resembles what obtains among lower animals (especially dogs), and it is inappropriate for humans to imitate animals. They argue that the same tongue that would be used to glorify Allaah should not be seen around filthiness; such as the pre-ejaculatory fluid in men (al-madhiyy) and the vaginal discharge in women. 
Overall, we have no evidence to say that oral sex is haraam. Considering the fact that some couples have trouble achieving sexual satisfaction via penetrative intercourse alone, should they be denied the opportunity to explore other options? Should we categorize this under the “umuurun mushtabihaat” (doubtful affairs) and steer clear so as to be on the safer side? Well, there are more questions than answers on this topic…
My submission: 

Couples who decide to explore other methods of satisfying each other may, by mutual agreement, include oral sex. They should maintain a high standard of genital and oral health, and try not to ingest the genital fluids. 
WAllaahu Ta’aala A’alam.

​WHAT PEOPLE DO FOR LOVE… 


Shirk (associating partners with Allaah) comes in different shades and forms. I’m not here to go into the academic discussion of its divisions, but I’ll like to call our attention to the things people do all in the name of love and sex, thereby falling into one category of shirk or the other. 
In those days, our scholars travelled from  East to west in search of a single hadith. Despite the overwhelming amount of knowledge and information available to us today for free, it’s quite appalling that we still wallow in abject ignorance, and do things without searching for the authenticity and acceptability. 
When you fall in love with a woman, do istikhaara and walk up to her or her waliyy. The worst answer you can get is a “no”. They can’t kill you for pursuing your desire. They can’t crucify you for trying to satisfy your natural instinct in a halaal way. Rejection of a proposal is not the end of the world. When you go overboard and make use of amulets and talisman, it means:

1. You have committed shirk

2. You have refused to accept fate and predestination as a major article of faith 

3. You have failed to put your trust in Allaah
 It was narrated from Zaynab the wife of ‘Abd-Allaah ibn Mas’ood from ‘Abd-Allaah who said: “I heard the Messenger of Allaah (saw) say, ‘Indeed, spells (ruqah), amulets and love-charms are shirk…” (Aboo Dawood, Ibn Maajah, Classed saheeh by Albaanee). 
In trying to achieve contraception without the knowledge of their husbands, some women use rings, wrist bands and waist beads on which magical spells have been cast. These magicians, alfas or pastors employ the services of jinns, but they lie to them that they’ve only recited some verses of the Qur’an. How about convincing your husband to accompany you to the family planning clinic, get counselling and opt for an appropriate method that can suit your needs? 
I heard that some cultures prepare certain love potions for new brides on their wedding nights. They want them to look beautiful and irresistible. They want to be the favourite among the wives in polygamous marriages. They want to satisfy their husbands in bed forever and make their private parts as good as new. Why? When did marriage become a competition? When did sex become oxygen that you can’t live without? When did few minutes of pleasure become more important than your faith and hereafter? 
The worst set of people are those who break marital bonds in order to step in and hijack the wife from her husband or vice versa. They have morbid greed for other people’s spouses. It’s a craving they can’t help until they capture their preys. In Qur’an chapter 2 verse 102, Allaah mentioned that one of the main purposes for which magic was used in the time of Prophet Sulaiman (AS) was  to cause discord between couples. 
Don’t be surprised that some conscious muslims have been victims as well as culprits in this matter. The good news is that Allaah is oft-forgiving, All-Merciful. You can still repent today. Shirk is a grave sin. You can’t afford to die in that state. 
No man or woman is indispensable. Don’t lose your sanity in the quest for love. Don’t trade your faith for a transient feeling of ecstasy. Don’t trade the eternity of paradise for a few years of spellbound union. Fear Allaah! 
“… and the life of this world is only a deceiving enjoyment.” (Qur’an chapter 57 verse 20)