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How Hard Is It To Ask, ‘‘Are You Okay?’’

How hard is it to ask, ‘are you okay?’

Suicide is one of the most common causes of premature deaths amongst people who have a mental illness. Every year approximately 703,000 people take their own life and a more significant number attempt suicide. Here, we tackle some questions regarding this difficult subject, which we hope will help you or a loved one:

  • What do we know about suicide? 
  • What are some myths about suicide?
  • Does one signal warnings before committing suicide? 
  • How to recognise if someone you know is struggling with thoughts of suicide, and how to help them? 
  • How critical is the situation?
What drives so many people to take their lives?
 

For those who haven’t experienced depression and despair, it’s sometimes challenging to understand what leads to suicidal thoughts. It’s usually an attempt to escape unbearable suffering or pain. 

Often, the people who are led to suicide are blinded by hopelessness, loneliness, self-loathing, without any form of escape outside of death.

What are the Myths and Facts about committing suicide?

Myth: There is no way of stopping someone determined to commit suicide.

Fact: People don’t attempt suicide because they want to die but because they want the pain to stop. 

Suicide is preventable. Even if someone is severely depressed or in pain, their thoughts about ending their life do change. Hence, immediate practical help like staying with the person, providing them assurance and comfort, encouraging them and making future plans can divert their intention from attempting to take their life.

“They’re doing great. Life is wonderful. How could they even contemplate suicide?’ But you don’t know what’s going on inside of someone?”

Myth: Suicidal talk is childish and most often just to seek attention.

Fact: Any suicidal talk or behaviour has to be taken seriously.

It is not just a warning sign that someone could be thinking about suicide.  It could be a cry for help.

The following actions could be signs that someone is contemplating suicide: 

  • Talking about suicide
  • Self-destructive behaviour 
  • Hopelessness towards the future
  • Acting anxious, agitated, or reckless
  • Talking about feeling trapped or being in unbearable pain
  • Increasing the use of alcohol or drugs

The best way to help prevent suicide is by noticing these signs and acting upon them immediately.

Myth: Reaching out to ask if someone is okay when going through a difficult period may not be helpful, especially if they won’t respond.

Fact: It’s okay to ask, “are you okay” and not know what to say after that.

Providing advice and solutions to a person who is contemplating suicide is not always the answer. Most often, all they need is someone to listen to them. Listening is very powerful, and it validates the emotions that someone is feeling. 

Myth: Non-experts should not help suicidal people.

Fact: One doesn’t have to be an expert to ask if someone is okay.

In fact, there is no need to treat the problem at all. All that’s required from a friend or loved one is to be present and then guide them to someone who can help.

If you are or know of someone who may be contemplating suicide, it may be helpful to guide them to speak with a mental health professional on oDoc. They then have the flexibility of speaking from the comfort & privacy of their home. To consult, please download the oDoc app here. For additional resources, please visit http://www.suicide.org/hotlines/international/sri-lanka-suicide-hotlines.html 

Know that secrets can kill.

If someone confides in you about their plans of suicide and requests confidentiality, please note you may need to break this confidentiality to help save their life. 

It is always better to have your loved ones alive yet angry with you than keeping their secret safe, leading to them taking their lives.

 “Suicide doesn’t end the chances of life getting worse; it eliminates the possibility of it ever getting any better.”

 

Sources

  1. Suicide prevention, HelpGuide (2020)
  2. Suicide and Suicide Prevention: Understanding the risk factors, prevention, and how you can help yourself or someone who is struggling right now, Psycom (2021)
  3. 7 common suicide myths—debunked, Aetna (2021)
  4. The Myths and Facts of Youth Suicide, Nevada Division of Public and Behavioral Health (DPBH) Office of Suicide Prevention
  5. Warning signs of suicide, Save (2021)
  6. Suicide, World Health Organisation (2021)
  7. Fears that stop the question ‘are you okay?’, Sane Australia (2017)
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Children, COVID19 and Multisystem Inflammatory Syndrome – The What’s What

Children, COVID19 and Multisystem Inflammatory Syndrome - The What’s What

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Parents around the world, including Sri Lanka, have been concerned about Multisystem Inflammatory Syndrome or MIS-C appearing in children who have been diagnosed with COVID19. In this article, we break down what’s known, what remains unknown and the steps to take if you suspect your child could be suffering from MIS-C.

What is MIS-C?

MIS-C is a condition where different parts of the body can become inflamed including the heart, lungs, brain, eyes, kidneys or gastrointestinal tract. 

It appears in children who have had or been around someone who has been diagnosed with COVID19. It’s considered to be a potentially serious condition, developing as a delayed complication of COVID19. Data shows that it usually develops two to six weeks after children have recovered from the virus. It can even develop in those children who were asymptomatic to COVID19. 

What are the symptoms of MIS-C?

Call your regular paediatrician or an on-demand paediatrician or family doctor at anytime on the oDoc app if your child is experiencing:

  • A fever and any of the following symptoms:
    • Abdominal pain
    • Bloodshot eyes
    • Chest tightness/pain
    • Diarrhoea
    • Extra fatigue or feeling unusually weak or dizzy
    • Headache
    • Low blood pressure
    • Neck pain
    • Rash 
    • Vomiting

If your child is showing any of the following signs, please seek emergency care immediately. 

  • Difficulty in breathing
  • Continuous pain or pressure in the chest
  • Inability to stay awake or alert
  • Pale, grey or blue coloured skin, lips or nail bed

This is not an exhaustive list of symptoms, please call a medical professional immediately if any other signs or symptoms appear that are severe or concerning to you. 

Please call 1990 for the Suwa Seriya ambulance service.

Can MIS-C be treated?

Doctors will conduct diagnostics tests on your child to look for inflammation and other signs of disease. Once diagnosed, doctors will closely monitor your child and use a variety of medications to reduce inflammation and protect the affected organs. 

It is vital to seek medical care at the earliest indication of MIS-C. 

What are the unknowns?

There are still a lot of questions out there such as why do some recovered children develop MIS-C and others do not? What health factors could contribute to MIS-C? 

Scientists are working hard to answer these questions and we will update this blog as and when new research is published. 

And finally…

The best way to protect your child from MIS-C is to protect your household from COVID19, this includes:

  • Getting all adults in the household vaccinated at the first opportunity to do so
  • Continuing to mask when interacting with others from different households
  • Washing hands often with soap and water
  • Conducting play dates within a social bubble and in an outdoor environment

If you are concerned about COVID19 or MIS-C and would like medical advice, please consult a pediatrician or family doctor on the oDoc app. Click here to download the app.

Sources

  1. For Parents: Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19, CDC.gov website (2021)

  2. Multisystem Inflammatory Syndrome in Children (MIS-C), Boston Children’s Hospital (2021)

  3. MIS-C and COVID-19: Rare Inflammatory Syndrome in Kids and Teens, Johns Hopkins Medicine (2021)

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Long COVID: What we know so far

Long COVID: What we know so far

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Since May 1st, over 300,000 cases of COVID-19 been diagnosed in Sri Lanka. We are mostly familiar with the short term symptoms of the disease (e.g. fever, cough, sore throat, runny nose to name a few). Most have recovered but ca. 8,700 persons have died at the time of writing. Some have seen symptoms persist for a longer period, a condition globally known as long COVID. In this article, we break down what we know so far about long COVID.

What is long COVID?

The UK’s National Health Service describes long COVID as having symptoms that continue for more than 12 weeks after initial diagnosis which cannot be attributed to another illness.

The UK COVID Symptom study found that 1 in 7 adults experienced symptoms for longer than 4 weeks and 1 in 20 adults experienced symptoms beyond the 8 week mark.

long COVID

What are the common symptoms of long COVID?

There are over 200 symptoms that have been reported that affect various organs in the body from the brain to the skin. Symptoms vary from person to person.

Most common symptoms include:

  • Extreme fatigue
  • Brain fog (problems with memory or concentration)
  • Joint pain
  • Changes to taste or smell
  • Shortness of breath, heart palpitations and chest tightness

Other symptoms range from hallucinations, insomnia, hearing and sight changes, gastrointestinal problems to changes in periods and skin conditions².

Those that experience long COVID have described it as “a storm. One day you can have zero symptoms … then it will just go crazy and as quickly as it hits you it can go.”³

What makes some people prone to long COVID whilst others recover quickly?

The science is still out on exactly why some people suffer for longer. Persons experiencing long COVID are not thought to be infectious but one theory is that the body continues to respond to small amounts of the virus that remains in the body & become reactivated. Another theory is that the infection causes some people’s bodies to go into overdrive, attacking its own tissues.

The COVID symptom study¹ had also found that those who experienced a milder version of COVID19 are more prone to long COVID over an extended period of time.

There is evidence that the following categories of people may be more prone than others:

  • Women
  • Older adults
  • People with pre-existing asthma
  • People who had a wider range of symptoms during their initial illness

Can children get long COVID?

A recent study by King’s College London found that for most children, COVID tends to be a mild, short illness. The 1,500 subject study reported that the average duration of symptoms for a child is six days and fewer than 1 in 50 children are unwell after eight weeks.

How long does it take to recover from long COVID?

Recovery estimates vary but most people with long-COVID are able to live life as relatively normal. However, It is important to get healthcare advice from a trusted professional, listen to your body and rest as much as possible when symptoms flare up.

Are there any treatments available?

Large studies are underway to better understand the nature of this secondary condition. As the 216m persons infected with COVID around the world recover, their experiences help shed light on the disease.

Whilst there are no specific treatments available, the focus is on managing symptoms and enabling a slow return to normal activity.

Nutrient rich foods rich with vitamins & minerals that support the immune system are deemed beneficial and experts encourage patients to eat a holistic, well rounded diet.

Worried you may be suffering from long COVID?

If you are experiencing any new or worsening symptoms, especially 4-8 weeks post your initial COVID-19 diagnosis, speak to a doctor on oDoc. Your doctor will discuss your symptoms and if necessary, order clinical tests to rule out other causes. They will provide guidance on how to best manage your symptoms.

If you are worried or anxious about COVID19 or long COVID, speak to a mental health professional on oDoc.

Click here to download the oDoc app to your mobile device.

Sources:

  • COVID Symptom Study, 2020 How long does COVID-19 last? ZOE COVID Study, UK
  • Davis, H et al., (2021) Characterizing long COVID in an international cohort: 7 months of symptoms and their impact. The Lancet
  • Guardian, UK., 2020, Lingering and painful: the long and unclear road to coronavirus recovery.
  • COVID Symptom Study, (2020) Do children get long COVID? ZOE Covid Study, UK
  • Molteni et al., (2021).,Illness duration and symptom profile in symptomatic UK school-aged children tested for SARS-CoV-2., The Lancet
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The harsh truth: Children are getting COVID

The harsh truth: Children are getting COVID

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As of 9th August 2021, 45,000 children have contracted COVID-19 in Sri Lanka, with around 20,000 under 10 years of age. Some children have had high fever and other severe symptoms that require treatment at hospitals, with Lady Ridgeway Children’s Hospital stating that they have run out of capacity treating COVID infected children.

If you’re a parent or anyone who has young nieces, nephews or cousins, the last thing you want to think about is having these little ones in hospitals, struggling in any sort of way.


What are the long-term effects of children contracting COVID?

Even if children do contract COVID and have healthy enough immune systems to fight off the virus, the long-term effects post-COVID, known as long COVID, should not be taken lightly. Similar to adults with long COVID, children can suffer devastating neurological, physical and psychological issues that can disrupt their schooling, sleep, extracurricular activities and other aspects of life. Symptoms such as fatigue, headaches, brain fog, memory and concentration difficulties, sleep disturbances, ongoing change in smell and taste can creep up even after the child has recovered from COVID.

“The potential impact is huge,” said Dr. Avindra Nath, chief of infections of the nervous system at the National Institute of Neurological Disorders and Stroke who spoke to The New York Times. “I mean, they’re in their formative years. Once you start falling behind, it’s very hard because the kids lose their own self-confidence too. It’s a downward spiral.”

How can you protect the children in your household?

The problem is that young children or teens cannot be vaccinated at this moment. The best solution right now to keep them safe is to get yourself and everyone in your household vaccinated right now if eligible.

Children are at home these days so there is no chance they are contracting the virus from other children. They are most likely getting the virus from their parents or grandparents and others in their household. With the extremely contagious and transmissible Delta variant, if one person in the household contracts COVID, it is highly likely that everyone else in that household, including the children, will get the virus as well.

Studies have shown that vaccinating older adults has decreased the number of COVID-19 cases in young children. A clear example of this was in Israel, where COVID-19 cases in children declined rapidly when adults got vaccinated in large numbers earlier this year.

But don’t vaccinated adults still pass on the virus?

Yes, but vaccinated people are much less likely to get infected with COVID-19, therefore are less likely to pass on the virus to others. Even if they do get infected, vaccinated people clear the virus much faster with a significantly shorter infectious period than the unvaccinated, hence making them much less contagious.


What more can you do to protect the children in your household?

Teach your children the importance of wearing masks over nose & mouth, good hygiene and physical distancing whenever outside the home. It’s a sad reality to subject our kids to this new world but with all these precautions in place, hopefully we can move onto a newer world where our kids can go back to schools and be with their friends safely!

If you have questions about the vaccines and are still on the fence on getting a vaccine, please consult with a doctor on oDoc today.

Sources:

  • The Best Way to Keep Your Kids Safe From Delta, The Atlantic
  • Kids Struggle With Long COVID, The New York Times
  • Lady Ridgeway Runs Out of Capacity, Daily Mirror
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Family planning? Know your available contraception methods

Family planning? Know your available contraception methods

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Almost all women who are sexually active would have Googled contraception methods. Figuring out which method of contraception is the best for you and your partner can be frustrating. It isn’t spoken about freely and it can be difficult to find out what methods are available to you.  Below we’ve collected all the important information you need to know. We have also explored the pros and cons of each contraceptive method to help you compare your options easily. 

So, here we go.

Firstly, what is contraception?

Contraception, also known as birth control, is the use of artificial methods and techniques to prevent pregnancy.

Birth control – the different types 

There are 5 general types of birth control methods and each works in a different way. Some are temporary and some are more permanent. Some prevent the sperm from meeting the egg whilst some prevent the egg from releasing. Either way, the goal of all the contraception methods is to prevent unwanted and unplanned pregnancies.

It is also important to note that birth control and contraception is not the same as prevention of sexually transmitted infections (STI). Condoms are the only method that prevents the spread and transmission of STI’s so it is advised that you combine the use of condoms with other types of contraception. 

1. Short-acting hormonal contraception

Short-acting hormonal contraception methods adjust the hormone level in the woman’s body making pregnancy much less likely to happen. Some of the commonly used short-acting hormonal contraception methods are the daily use birth control pill and the hormonal injection. Both of these methods require a prescription from your doctor. 

The birth control pill 

There are 2 types of birth control pills available: the progestin-only pill and the combination pill (which contain both progestin and estrogen). 

The hormones released by the pill prevent the release of the egg, the thickening of the uterus and the cervical muscle making it harder for the sperm to enter the uterus. By taking the pill at the same time every day, you maintain a steady level of the hormones in your body, making it a very effective form of pregnancy prevention. 

With perfect use, it’s over 99% effective.

control-pill

Pros

  • Easy to use
  • Highly effective if taken regularly 
  • Doesn’t interfere with sexual activity 
  • Helps with heavy and painful periods

Cons

  • Mood swings, headaches and other similar physical side effects 
  • Effectiveness is time-sensitive, you have to take it regularly at the same time every day for maximum effectiveness
  • Does not protect against STIs

The Hormonal Shot

The hormonal injection is administered by the doctor every 1 or 3 months to the woman. Like the birth control pill, this too prevents the release of the egg and thickens the cervical muscle making it difficult for the sperm to enter the uterus. 

Pros

  • Easy to use
  • Highly effective if taken regularly 
  • Doesn’t interfere with sexual activity 
  • Helps with heavy and painful periods

Cons

  • Mood swings, headaches and other similar physical side effects 
  • Once off the shot, it may take up to a year for your menstruation to return to normalcy
  • Does not protect against STIs 

2. Long-term contraception 

This is a good option if you want lasting contraception with little maintenance. Available options include an implant inserted into your arm or an intrauterine device (IUD) inserted into your uterus. These methods are 99% effective at preventing pregnancy. They’ll work for 3–10 years, depending on the particular method you choose. 

Implant

The doctor will place 1 or 2 silicone rods under the skin in the arm of the woman. The rods will release the hormone, progestogen into your bloodstream that prevents the release of egg into your uterus. The hormone also thickens the cervical muscle thus stopping the sperm from entering the uterus. Further, It thins the muscle of your womb making implantation of the egg less likely. 

Pros

  • The most effective type of contraception 
  • Long-term, can be kept for 3-5 years
  • Does not affect sexual activity 
  • Not time sensitive 
  • A good option for women who can’t take oestrogen pills

Cons

  • Requires medical attention to insert and remove
  • Does not protect against STIs
  • May have side effects such as headaches and breast tenderness
  • Your periods may be irregular or stop

Intrauterine Device (IUD) 

The IUD is a T-shaped copper device which is inserted into your womb by your doctor. There are 2 kinds of IUD you can get implanted, the hormonal IUD or the non-hormonal version. 

The hormonal version releases the hormone progestin, which prevents sperm from fertilizing an egg. It also thins the uterine lining making implantation of the fertilised egg less likely and thickens the layer of mucus over the cervix to help block sperm from entering in the first place. 

The non-hormonal device releases copper ions which has similar effects to progestin. The ion immobilises the sperm making it difficult for them to swim to the egg. 

Pros

  • One of the most effective methods to prevent pregnancy 
  • Requires no effort from you 
  • Long term, can be kept in for 5-10 years
  • Does not affect sexual activity

Cons

  • Requires medical attention to insert and remove
  • Does not protect against STIs

3. Single use barrier contraception 

Male and female condoms, spermicides and cervical caps are all types of single use barrier contraceptives. As the name suggests, they act as a barrier between the sperm and the egg, preventing the sperm from fertilising the egg.

Condoms

Condoms are a sheath-shaped barrier device made of latex or polyurethane. The male condom is placed over the erect penis and when ejaculation occurs the semen is collected in the condom acting as a barrier preventing the sperm from entering the uterus. The female condom is inserted into the vagina preventing the sperm from reaching the egg. Condoms when used properly are the only form of contraception that effectively prevents pregnancy and STI transmissions. 

Pros

  • They are hormone-free
  • Protects against STIs
  • Has no effect with other medications 

Cons 

  • Interfere with sexual activity and pleasure 
  • Chances of tearing during sex 

Permanent contraception 

If you plan on never having kids you can opt for the permanent contraception methods of Tubal ligation (for women) or vasectomy (for men). They are both simple procedures and they’re almost 100% effective at preventing pregnancy. Recovery time from these procedures usually takes only a few days and have close to no impact on your sex drive and sexual functions. 

During a tubal ligation, both the fallopian tubes are blocked or cut off and during a vasectomy, surgery cuts are made in the vas deferens ( a tube that transports sperms) preventing the sperm from reaching the semen in the testes. Women will still continue to have their periods every month after tubal ligation and men after vasectomy,  will continue to release semen during ejaculation but it will not contain any sperm. 

Pros

  • Permanent contraception 
  • Does not affect sexual activity

Cons

  • Both surgeries are reversible but does not guaranty fertility 
  • Does not prevent STIs

Emergency contraception 

Emergency contraception can help you prevent pregnancy if you have unprotected sex or your birth control fails. There are 2 kinds of emergency contraception pills you can take in Sri Lanka. Please note that emergency pills should not be used as a substitute for contraception.  

Postinor-1 

Postinor One (morning after pill) is a single dose oral emergency contraceptive pill that should be taken within 72 hours of unprotected sexual intercourse. The sooner you take the pill, the higher the effectiveness. Postinor-1 has releases levonorgestrel which delays ovulation and in turn, reduces the chances of fertilisation occurring. Several studies claim that Postinor-1 has the potential to stop 85% of anticipated pregnancies. The tablet is safe to take and does not alter fertility. 

This pill does not have any abortive effect, so if you are already pregnant it will not impact it. 

Postinor-2 

Postinor-2 is a double dose pill. Both the tablets can be taken at once or separately with a 12-hour gap between each. It works the same as Postinor-1. 

It should be noted that the emergency pill will not cause abortion and should not be used as a contraceptive method.

Wondering what the best contraceptive method for you is?

Well, that depends on you and your goal. Speak to your partner and your doctor to decide on the most convenient and most suited method for you. Also, remember there is no 1 method that suits all. Feel free to experiment with each method till you find one that suits your liking. 

If you want more information or would like to speak to a Gynaecologist on the best form of contraception you do so via the oDoc app. 

Sources

  1. FPA Sri Lanka. (2017, January 6). Contraception | Family Planning Association of Sri Lanka. http://www.fpasrilanka.org/content/contraception
  2. Tesch, D. (2021, July 23). 5 types of birth control options: which is best for you? HealthPartners Blog. https://www.healthpartners.com/blog/how-to-figure-out-which-type-of-birth-control-is-right-for-you/
  3. WebMD. (2016, November 18). FDA Explains Pros, Cons of Permanent Birth Control. https://www.webmd.com/sex/birth-control/news/20161118/fda-explains-pros-cons-of-permanent-birth-control
  4. Vasectomy: Treatment & Information – Urology Care Foundation. (202–12-01). Urology Health. https://www.urologyhealth.org/urology-a-z/v/vasectomy
  5. Johns Hopkins Medicine. (n.d.). Tubal Ligation. Retrieved August 3, 2021, from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/tubal-ligation
  6. WHO. (2020, June 22). Family planning/contraception methods. https://www.who.int/news-room/fact-sheets/detail/family-planning-contraception
  7. NHS website. (2021, March 12). Contraceptive implant. Nhs.Uk. https://www.nhs.uk/conditions/contraception/contraceptive-implant/
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