Why can’t I haveregular stool? Why can’t I have regular stool?Dear Doctor;I take what is relatively a healthy diet. I neither drink, nor smoke. However, sometimes I suddenly find myself taking like up to three days without excreting. During such times, my stomach would always feel full, forcing me to eat less. I also eat lots of fruits regularly. What could be causing these digestive problems? Niyitegeka, 26, Butare.Dear Niyitegeka, You are having chronic constipation. Although intermittent now, it can augment if not corrected. If one does a desk work sitting for long hours continuously, there can be constipation. Inadequate intake of water, fiber in the food, intake of more carbohydrates, mental stress, etc, these factors also contribute to constipation.Drink more water, take hot water before sleeping or first thing in morning, take more green vegetables, fresh fruits particularly papaya. This will be helpful. In addition do regular physical exercise. Walking, jogging, yoga, any of these can be done as per convenience and shall help in controlling constipation.Is Injectaplan safe as a contraceptive?Dear Doctor;I recently started using Injectaplan but I bleed a lot. The nurse from who gave me the shot said the bleeding was normal and that it would stop. It eventually did after about three days. Throughout the dosage period of three months, my periods would be heavy. When I went back for the second injection last month, the bleeding returned and it is much heavier this time. What could be the problem since the nurse insists Injectaplan is okay? Marie-Anne, 24.Dear Anne-Marie, Injectaplan has many advantages as a contraceptive. There is said to be initially bleeding for about two to six weeks after starting using it but eventually it stops. It  protects against cancer of reproductive parts, provides contraception for three months and even longer if one does not take next injection on scheduled time. However, being a hormonal contraceptive it can cause heavy bleeding, delayed fertility, etc. If bleeding is persistent, you can change to another contraceptive on advice of your doctor.How can I know it’s time to start on ARVs?Dear Doctor;I have heard that the World Health Organisation wants ARVs to be started much earlier than before. But what are CD4 cells and how can I know that I have reached the count to start on medication? Concerned HIV-positive, 40.Dear Concerned HIV-positive, I understand your anxiety very much. Yes, nowadays anti-retroviral drugs are started much earlier as compared to before. CD4 cells are part of lymphocytes, a type of cells responsible for helping fight disease germs in body.  The HIV virus has affinity for CD4 cells, attaches to it and multiplies affecting other cells. It has been observed by studies that even with good CD4 counts a person can have malignancy and opportunistic infections and starting ARV early can prevent this. Hence, this decision is made  to start ARV early when Cd4 counts become 350; WHO now recommends 500. As an affected person, you can get CD4 count done in any health facility (it is freely available) every six months or so. If it is falling, the healthcare giver will guide you to start ARV therapy.Are there signs of cancer I can watch out for?Dear Doctor;Are there signs and symptoms of some types of cancer such as of the cervix or the breast that I can watch for when I have limited opportunities for cancer screening? Marion, 37.Dear Marion, It is good to be vigilant about cancers. The common tell tale signs of any cancer are gradual unexplained anorexia and weight loss in absence of any infection or conclusive results. Regarding breast cancer, a painless lump felt in any part of the breast or armpit, abnormal or bloody discharge from nipple, are some of the features suggestive of it.

About cancer of the cervix, bleeding vaginal occurring six months after menopause, vaginal discharge in elderly women, persistent genital ulcer, are features which should alert one to possibility of carcinoma cervix. Doing a simple Pap’s smear shall confirm the diagnosis.