Why are my toes turning dark?

Dear Doctor: I have noticed my last three toes are turning black and hurting a little. What disease could this be?

Kato Suleman

Dear Kato: Darkening of the toes that hurt could result from compromised blood supply to those toes, leading to a condition called gangrene.

Gangrene may occur after an injury or infection, or in people suffering from any chronic health problems, affecting blood circulation such as diabetes.
It also often occurs in the toes and feet of elderly patients due to arteriosclerosis, a condition also known as senile gangrene. Arteriosclerosis occurs when the blood vessels that carry oxygen and nutrients from a particular area become thick and stiff, many times ending up restricting blood flow, in this case to the toes.

Also, over a long period of time, people such as those with diabetes may have a buildup of fats, cholesterol and other substances in the arteries which may restrict blood flow.
What you call black is usually due to death of tissue that requires a doctors’s quick attention, including cutting off the affected toes to prevent the condition from spreading and endangering your life.

Dear Doctor: I am now approaching 40, but I want to settle down, get pregnant and have a baby. Do you think I am fertile?

Sheilah Kiboneka
Dear Sheilah: As women reach their 30’s, they experience a decline in fertility. Furthermore, complications during pregnancy are more common when women reach 35.

Age-related decline in infertility may be due, in part, to a decrease in the number and health of the ovulated eggs. The increasing presence of other medical and gynaecologic conditions such as endometriosis, or fibroids which may also interfere with conception may further decrease fertility.
Diseases such as diabetes or hypertension, which commonly show up around your age bracket may make it even more difficult to carry a baby to term. It is true also, that abnormalities in babies such as Down’s Syndrome may increase for women around your age and this is not helped by the fact that at this age, you are likely to have a man much older than you.

Older men produce more gene mutations in the children they father, boosting their risk of schizophrenia, autism and possibly other diseases.

You need to visit your gynaecologist for expert advise about how to easily get pregnant and deliver a healthy baby maiming or endangering your life.

Dear Doctor: I am pregnant at the moment. Can I continue breastfeeding my four-month-old baby? They say it is bad to breastfeed while pregnant but my baby is young and I do not want to abort.

Serena Atwooki

Dear Serena: Breastfeeding while pregnant in Uganda is deemed inappropriate and thought to poison the breastfeeding baby, leading to diarrhoea and vomiting, common in children under five years. Also, this is blamed for any future conflicts between the affected two children, hence many women will wean the baby at any hint of pregnancy or even try to abort.
Breastfeeding in pregnancy poses no serious medical problem to the mother or breastfeeding baby, or even the unborn foetus. In some communities, mothers may continue to do so through pregnancy, ending up breastfeeding two children at ago, who are not twins (Tandem nursing).

Apart from leading to tender nipples in some women making breastfeeding a painful venture, pregnancy hormones may dry or even change the taste and flavour of the milk (as milk in the middle months of pregnancy turns into a type called colostrum), prompting some babies to feed less, with others eventually self-weaning.
Mothers who are already overburdened by morning sickness in the early months of pregnancy, may however find carrying out breastfeeding while pregnant a serious emotional and physical drain on the body.

In many circles, breastfeeding while pregnant is feared to increase the risk of miscarriages. When a baby suckles, the brain produces a hormone, oxytocin, in what is known as milk let down reflex. Oxytocin, apart from helping avail milk leads to contraction of the womb, which may be feared to lead to miscarriages.

Fortunately, before 24 weeks of pregnancy, the womb is less sensitive to oxytocin and therefore will not contract the womb significantly enough to cause a miscarriage.
However, a woman at risk of miscarriages (like one with history of miscarriages or one who experiences on and off bleeding during pregnancy) should avoid breastfeeding while pregnant.

It is likely that you did not attend antenatal or even postnatal clinics to advise you about family planning after delivery, which could help you better space your children.
Breastfeeding is a good method of family planning, but for it to be effective, requires being done exclusively without giving other foods at least every three hours.

Dear Doctor: I have suffered from endless mucus in my nose for over a year now. And this goes to extent of emitting a bad smell. I do not know what could be the cause and how I can handle it. Please help.

John Okello

Dear John: Though there could be other causes, mucus in the nose for over a year is likely to indicate that there is something you breathe in, together with air, which your nose may be reacting to. Unfortunately, this may not be visible to the eye to know what it may be so that you can easily avoid it.

Called an allergy, this is very common these days, especially in urban centres due in part to increased levels of pollution.

Allergy management requires identifying the cause and eliminating it but where the cause cannot be identified, then medical treatment can be given. After one year of suffering, you may have got nasal allergy complications which a doctor of the ear, nose and throat can sort out but if this is not possible please visit any medical worker but avoid self-prescription.

One complication that can lead to a bad smell (breath odour) is sinusitis. Also, accumulation of mucus in the nose over a long period can attract nasal bacteria to feed on the mucus and produce substances that may smell.