Why is the second child so hard to conceive?

Dear Doctor
While I am a man, I write to ask this on behalf of my wife and any expectant woman who is in the dark like me. Why is the syphilis test part of the prenatal tests that an expectant mother has to go through?

The second question is: Why is it normally hard for a second born to come by after one gets the first child? Could there be any reason for this?

Mutenyo N

Dear Mutenyo,

The screening assessments done during pregnancy look for potential risks to the unborn baby and the mother, to allow for early intervention if need be. Some assessments are done for all mothers, others are done depending on the disease risks in the region, while others are done based on availability of resources, and there are those done based on the individual’s health risks.

Syphilis testing during pregnancy is mandatory in our country and in many other countries around the world. Syphilis is easily tested and there is safe treatment available, yet it poses a great risk to an unborn child, since it can cause a stillbirth bone deformities, impairment of the neurological system or death of babies in the first few weeks of life. Testing and treating for it potentially saves lives and prevents complications.

On your second question, you are actually more likely to have a successful second pregnancy after a first delivery. However, it is possible to experience a delay in conceiving a second time or experience secondary infertility due to a number of reasons including breastfeeding; use of contraceptives that do not have an immediate return to fertility; advancing age of the mother, especially if is she is over 35; having a previous history of difficulty conceiving the first time; being overweight; low sperm count; medication; excessive alcohol consumption or smoking. Sometimes the exact cause of delay in conceiving is not identified. After a year of trying to conceive without success, it is advisable to visit a gynaecologist for review and assessment. If there was previous difficulty in getting pregnant, then you need to see the doctor as soon as you decide to get another baby since it is likely the diagnosis from before is still present.

Dear Doc,
What causes the human tongue to have a white layer on the upper side? When I brush, it comes out like a stain, and this happens daily. Please advise. Is there any medication I need to take?

Dear Frank,

On the surface of the tongue, there are small projections called papillae, which can become enlarged or inflamed. The white coating happens when bacteria, dead cells and food remnants collect between the papillae. The papillae may become enlarged or inflamed because of poor oral hygiene, not taking enough water, not having enough roughage, mouth breathing, tobacco use or smoking, excessive use of alcohol, having a tooth, dentures, or braces with sharp edges that irritate the tongue.

The white coating may also be associated with bad breath, bad taste in the mouth and redness of the tongue. This usually happens daily and can be easily cleaned with a toothbrush or a tongue scrapper, in addition to brushing the teeth at least twice a day, taking adequate water, fruits and vegetables, and avoiding tobacco and alcohol. 

Sometimes the white tongue is as a result of other health conditions that require treatment such as fungal infection, syphilis, having a geographical tongue, oral lichen planus or leukoplakia. If there is pain, difficulty eating/swallowing, bleeding, excessive redness or the white coating is not easily cleaned off, see a doctor for evaluation and treatment.

Currently, a number of young people, including children, suffer from diabetes, even though this is a disease majorly linked to age. What is the cause?

Dear reader,
Diabetes mellitus is a chronic metabolic disease where the body is not able to use sugar properly, resulting in high blood sugar levels. The pancreas makes the hormone insulin, which helps to move sugar from the blood streams into the cells, where it is used to provide energy. In diabetes, either the pancreas does not make enough insulin, or the insulin made is not able to work properly. There are several types of diabetes:

Type 1 diabetes, which commonly starts in childhood or young adulthood. This is an autoimmune disease where someone’s immune system attacks its own pancreatic cells where insulin is made, and insulin production goes down and eventually stops. There is no specific known cause of this, though it may be related to genetics or it may follow a viral infection. Someone who has type 1 diabetes requires daily insulin injections.

Type 2 diabetes, which commonly starts later in life. It occurs when someone’s body becomes resistant to insulin, so the insulin is not able to effectively get sugar inside the cells, leading to high blood sugar levels. This type of diabetes is associated with genetics, diet, obesity, excessive alcohol consumption and lack of exercise. Treatment usually begins with tablet medications, though injections may also be used.

Gestational diabetes, which happens during pregnancy. Hormones produced during the pregnancy interfere with how insulin works, leading to high blood sugar levels

Type 1 diabetes has no known cause and therefore cannot be prevented. Type 2 diabetes may be delayed or prevented by maintaining a healthy weight, exercising, maintaining a healthy diet, avoiding excessive alcohol consumption and controlling any other illnesses such as high blood pressure and high cholesterol levels.

Send your health questions to [email protected]