Bodylanguage issue 08 autumn 2015 by Health-Bytes

A better health care experience altogether

Issue 08

Autumn 2015

FREE COPY

KNOW

your numbers - do yours add up?

MIGRAINES

a work(able) problem

DIABETES & YOUR EYES Juicing FAD OR FAB? MMMMM... Carrot & Coconut Soup

12 Top 10

Winter Getaways

HOW TO FIGHT FLU An apple a day might keep flu at bayâ&#x20AC;Ś

Issue 08 | 2015

contents up close and personal

your body 15 Know it all –

Message from the CEO

8 Health bites – Snippets of the latest health news to read

21 Feature – ADHD

interact

from the expert 12 Winter Health Strategy –

Diabetes & Your Eyes

Fighting Flu

Contributors 18 All about – Migraines

4 Intercare Branch News What happened over

24 Health Strategy – Juicing

the last few months

Intercare Tygervalley

your health

New innovative technology

10 In pictures – Know your numbers

A day in the life of ...

Fad or Fab?

30 First Aid – Mental Health

12 things to know about 32 HealthIQ – Depression

Dr Charline Kemp

as a disease

26 TravelGround

33 Recipe – Carrot & coconut soup

Top 12 Winter Getaways

From the CEO

CEO MESSAGE A t Intercare, we understand that health care is evolving and we want to keep improving our service – not only to meet our patients’ needs, but also to exceed expectations. We believe that health-care services should be shaped by what matters most to patients. That is why Intercare is committed to provide health care that places our patients at the heart of everything we do.

For this reason, we are introducing the Patient Experience initiative where we are embarking on a journey to understand our patients’ needs. We believe that this initiative will provide us with the information we need to equip the Intercare team with concrete tools and a roadmap for the integration of best practice into existing processes, thereby providing the best possible care to you – our patient.

Critical to the success of our approach, is to understand how our patients perceive and experience our services.

We aim to create a patient-centred culture throughout our Medical & Dental centres as well as our Day Hospitals and Sub-Acute Hospitals.

We would like to invite you to join us on this exciting journey. Tell us about your experience at our facilities by sending a mail to myexperience@intercare.co.za. Your feedback will enable us to understand what matters most to you. Enjoy this issue of our magazine as we are excited to provide interesting, knowledgeable and fun information to you.. Warmest regards Dr Hendrik Hanekom CEO Intercare Group

EDITORIAL

Editorial enquiries

Design Health-Bytes: Bernette Becker

Publishing editor

Health-Bytes Publishing

Content editor Itha Kieser

Christa Grobler

Tel: 021 913 0504

Proofing Albert Buhr

christa@health-bytes.co.za

Printing CTP Print

INDEMNITY: The information contained in Body Language is intended for general informational and educational purposes only and not to replace professional medical advice. Persons requiring any medical advice or treatment should consult their relevant qualified health-care professional. The publisher cannot accept any responsibility for any act, omission, loss, damage or the consequences thereof caused

ADVERTISING: Body Language is published quarterly. FREE copies are distributed at Intercare Medical and Dental Centres. To advertise, please contact our advertising department at: Tel: 021 913 0504 christa@health-bytes.co.za

by reliance by any person upon the information contained in the publication. The information included in Body Language is subject to copyright and all rights are reserved. The information may not be sold, resold, transmitted or otherwise made available or disseminated in any manner via any media to third parties unless the prior written consent of the publisher has been obtained.

Issue 08 | 2015

contributors

3 Roseanna McBain is a writer for TravelGround.com. In her down-time, she enjoys reading, writing and acting in shows at the Muizenberg Masque Theatre. On the weekends you'll find her and her husband seeking out hidden nooks and lesser-known spots within the Western Cape, or relaxing with friends in Cape Town. Dr Marcel C Niemandt is an ophthalmologist (medical doctor that specialises in diseases and other conditions of the eye) and has his own practice in Hazeldean, Silver Lakes. His practice aims to provide a general ophthalmological service, with a special interest in cataract surgery as well as corneal and refractive surgeries. Health Bytes publisher Christa Grobler (MSc Biochemistry, MBA) has extensive experience in the pharmaceutical industry with regard to patient education, sales, marketing research, scientific knowledge (disease and products) and pharmacy management. Catherine Govender, registered clinical psychologist. Currently: PhD candidate in psychology, MA Clinical Psychology, MSc Human Physiology Jaqueline Harvey, consultant Currently: MA in Psychological Research. BSocSci Honours Psychology, BSc Honours Physiology with specialisation in neurophysiology Dr Jean Blom is a psychiatrist with a lifetime of experience. He was born in Heidelberg (Gauteng province), studied medicine at Tukkies, and did General Practice in Southern Suburbs, Johannesburg. He specialised in psychiatry at the University of the Orange Free State. From 1998 till 2012 he practiced as specialist psychiatrist in Lloydminster, Alberta, on the prairies of Canada. He and his wife returned to South Africa to be with their children. His special interest is the psychiatry of addiction, and his hobby is music.

We want to hear from you . . . We would like to invite all patients and customers to air their views and provide us with input regarding this magazine. In doing so, we can remain relevant and will then be able to make a difference and â&#x20AC;&#x153;create the better health-care experience altogetherâ&#x20AC;? on a daily basis. Please email us at info@intercare.co.za with any suggestions, ideas and topics you would like to read about.

TOGETHERATE WE CAN CREEALTH BETTER HE CAR

Branch News

Intercare branch news: events over the last few months

Annual Bobbies Road Race

eam Intercare participated in the annual Bobbies Road Race. On Saturday, 14 March, at first light, members of Intercare Wonderboom Dental Department hit the road as participants in the annual Bobbies road race that was hosted at Wonderboom Junction. All finished the race in good time and received a welldeserved medal. Well done! Back row left to right: Annetjie du Raan, Dr Richard Jones, Lizelle Jacobs, Jonathan Gordon. Front row left to right: Magda de Bruto, Maria Ntobela, Dr Colette Leonard

Intercare Tygervalley – Proud Partner of Team Vitality

ntercare is the proud health care partner of Discovery’s Team Vitality – a running and cycling club. During the Argus Cycle race on 8 March, the physiotherapists of Intercare Medical & Dental Centre Tyger Valley treated Team Vitality cyclists with a post-event massage to relieve sore muscles. Thanks to the excellent arrangements by Anneret Wolfaardt (co-ordinator for the Cape region) and her dedicated team, it was a huge success. Make sure to look out for our health care practitioners at upcoming sporting events.

Fltr: Catherine Moult , Inneke Hoffman, Anneret Wolfaardt (co-ordinator) & Lisma Galloway

Intercare Irene open their hearts to the Mooiplaas Community

ednesdays are quite challenging, yet fulfilling for doctors Gerhard van Niekerk and Henry du Plooy, both general practitioners at Intercare Irene. This is when they open their hearts to render medical services free of charge to between 30 and 50 children at Ditshego – an outreach for the community of the Mooiplaas informal settlement. The settlement was formed around one of the major household refuse dumping sites in Centurion, and the community has no access to basic services like running water, electricity and sanitation. It is under these circumstances that doctors Van Niekerk and Du Plooy render a weekly medical service to the children of the community. Services include primary health care, immunisations, a baby clinic and the dispensing of medicine – under the licence of the Department of Health’s Community Clinic in Ladium. They are assisted by Andrea de Wet (nursing sister), Elsie Mashaba (care worker, Intercare Irene), Emmah Mthombeni (Ditshego staff member), Ana Labaschagne, Nicky Herbst and Mandy Williams (volunteers). Once every six months, an audiology service is also offered by Hearsay Speech Therapy & Audiology, also situated in the Intercare Irene Medical & Dental Centre. Ditshego was originally founded to provide care for vulnerable, orphaned and abandoned children. From these humble beginnings, Ditshego has since expanded its scope to include the medical clinic, early childhood development, community support through home-based caring and feeding schemes and the re-integration of older children back into the formal school system. It is now a registered non-profit organisation aiming to bring about meaningful change in the lives of the community.

New Innovative Technology Provides Biofuel for Healing

latelet-Rich Fibrin (PRF), an innovative biomaterial, used widely in the

medical and dental field to enhance healing of tissues, is now available at the Intercare Dental Centre of Excellence in Tyger Valley. PRF is a complex fibrin matrix containing platelets and leucocytes that are essential for healing of soft and hard tissues.

How is it obtained? A small sample of the patientâ&#x20AC;&#x2122;s own blood is taken and placed in a special centrifuge for 8 minutes. At the end of the spin, a fibrin clot, called Platelet-Rich Fibrin, containing the majority of the platelets and white blood cells, is obtained. How does it work? The Platelet-Rich Fibrin clot or membrane placed in the surgical site or defect will gradually release growth factors and cytokine messenger molecules that stimulate and guide the movement of cells towards sites of surgery, trauma, inflammation and infection to accelerate the healing of soft and hard tissues. PRF membranes can be used, but not limited to, treatment of soft tissue and bone defects, extraction sockets, sinus and alveolar ridge augmentation during implant placement. Additional advantages of PRF are that it also has a supportive effect on the immune system and helps control bleeding and is a simple, quick and cost-effective process. Patients receiving implant therapy can now expect to receive this biomaterial as an added value to their treatment where indicated.

Dr Johan Hartshorne - Intercare Tyger Valley

A day in the life of...

THINGS TO KNOW ABOUT ... Dr Charline Kemp, one of our dedicated colleagues, is a general practitioner at Intercare Woodhill. 1.

Where did you grow up? In Bothaville – the “mielie” capital of South Africa.

What do you value most in your life? My relationship with Jesus Christ.

What are you best at doing? I am best at being a key bearer helping those who feel trapped to find their way.

What is your greatest regret? I have a few but I have learned to forgive myself and move on.

Who are you closest to? My two children: JP, my 21-yearold son who is doing computer engineering at TUKS, and my daughter Justine, a first-year LLB student also at TUKS. They are part of the reason I moved to Pretoria.

e Favourit Food?

pecially s E ! s le p p A s from Pink Ladie . Harrismith

12 .

Relaxation is ...? Watching a good movie.

My role model is my mother. In the 81 years that I was privileged to know her, her whole life was an example for me to live by.

Perfect happiness is? Doing God's will.

Hobbies? Walks in nature, especially the Drakensburg.

10.

Favourite TV show? Wimbledon and Suits.

11.

Do you have any furry friends? A Jack Russel and a golden retriever.

eing a "I am best at b lping those key bearer he ed to find who feel trapp their way."

Health bites

health bites

Snippets of the latest health news to read while on the go...

IS CANCER JUST BAD LUCK? Most cancers are caused by lifestyle and environmental factors and not “bad luck” as a recent report suggests. A study, published in the Journal of Science at the beginning of the year, suggested that two-thirds of cancers were caused by chance and therefore could not be prevented. But international cancer bodies and scientists have slammed the report, saying it is misleading and potentially harmful as it may deter people from making lifestyle choices proven to prevent cancer.

WAKING AT NIGHT? HERE'S HELP There’s nothing more aggravating than waking in the middle of the night, and being unable to fall back asleep. Tom Mayer, Registered Polysomnographic Technologist (RPSGT) at St. Anthony’s Sleep Disorders Center, offers this advice: Get out of bed. Staying in bed while awake and thinking about one’s sleeplessness promotes more wakefulness, in most cases. Limit the light, and the electronics. Reading the old-fashioned way tires the eyes and has long been a favourite distraction from insomnia. But the computer and the new electronic reading devices can give off a type of light that stimulates wakefulness. Television is another favourite, but again, the light that comes from the TV can be counterproductive. Use sleep aids with caution. Prescription sleep meds should be monitored carefully by a physician, as there are underlying causes for some issues of poor sleep that can be worsened if sleep is forced through the use of medication. Over-the-counter remedies are usually safe, but should be used according to label directions. Mayer cautions that if wakefulness is a nightly issue that occurs every 1.5 to 2 hours during the night, it can be a sign of more serious issues that require medical attention.

Dr Carl Albrecht, head of research for the Cancer Association of South Africa (CANSA), said numerous studies clearly show the impact of environmental and lifestyle factors on the different types of cancer affecting different populations. “The past five decades of international epidemiological research have shown that most cancers that are frequent in one population are relatively rare in another and that these patterns vary over time,” according to the International Agency for Research on Cancer (IARC), the World Health Organisation’s specialised cancer agency. “For example, oesophageal cancer is common among men in East Africa but rare in West Africa … these observations are characteristic of many common cancers and are consistent with a major contribution of environmental and lifestyle exposures, as opposed to chance,” said the IARC, which also rejected the “bad luck” report findings. The controversial article by researchers from the US Johns Hopkins University in Baltimore studied the stem cell division (a natural process of cell renewal) of tissue samples from 31 areas in the body, for example, oesophagus, stomach, bone, brain, etc. Two-thirds of the tissue showed high rates of division and random mutations (irregular cell division that may lead to the formation of cancerous cells) leading the researchers to conclude that the same ratio of cancers occur randomly, or as they described it, due to “bad luck”. IARC does not dispute the fact that the number of cell division increases the risk of cancer, but maintains that most cancers occurring worldwide are strongly related to environmental and lifestyle exposure. “Therefore, these cancers are preventable; based on current knowledge, nearly half of all cancers worldwide can be prevented,” reads IARC’s report. Albrecht reiterates this. “CANSA will not be changing its philosophy that 90 percent of cancers are caused by environmental carcinogens and lifestyle. Chance may be involved in less than 10 percent of cancers being diagnosed, but that remains to be seen,” says Albrecht. – Health-e News.

Issue 08 | 2015

THINK YOU MIGHT HAVE MISOPHONIA? You are not alone... A doctor recently made an unusual confession in the New York Times: Dr Barron H. Lerner, admitted that some of the sounds his patients make, like loud yawns and sniffling, bug him. A lot.

PASS THE BUTTER, PLEASE... A warning against eating foods high in cholesterol is no longer included in the US government's draft dietary guidelines for Americans. Until now, the Dietary Guidelines for Americans recommended that cholesterol intake be limited to 300mg per day, the amount in about one stick of butter, or two small eggs, or a 300g steak.

Steinbaum, preventive cardiologist at Lenox Hill Hospital in New York. The committee "clearly is trying to dispel the idea that cholesterol matters."

Medical experts used to believe that eating too much cholesterol could raise the risk of heart attack and stroke by contributing to plaque buildup in the arteries.

In fact, experts recommend that Americans eat less than before. Kilojoules from saturated fat should make up about 8% of a person's daily kilojoule intake, compared to the 2010 guidelines that advised 10%.

But the 2015 version of the guidelines will no longer place an upper limit on cholesterol "because available evidence shows no appreciable relationship between consumption of dietary cholesterol and serum cholesterol," the US Department of Agriculture said in a statement. "We have seen this controversy, especially surrounding the consumption of eggs, which are very high in cholesterol yet filled with beneficial nutrients," said Suzanne

SATURATED FAT While cholesterol may be getting a free pass, the saturated fat that usually accompanies it is not.

For an average person, eating 8,000 kilojoules per day, the new guidelines would mean the limit of saturated fat could be achieved with a few spoonfuls of butter, or a dozen eggs – since eggs are naturally low in saturated fat – or a 200g steak.

He writes that “one of the most frustrating aspects of misophonia is what I call the ‘incredulity factor.’ For years, I could not believe that my friends and relatives were not getting as upset at what I considered rude behaviours. They were getting frustrated with me for focusing on sounds they did not really hear.” I imagine noise-sensitive folks around the country were nodding in relief as they read Dr. Lerner’s essay and discovered they weren’t alone. In the comments section, hundreds shared their own misophonic grievances, from the crinkling of a bag of chips to the grating scrape of a fork against a plate. The response led the Times to poll its readers on the most cringe-worthy sounds of all. The top five are: 5 Knuckle cracking (8% of the vote) 4 Nail clipping (10% of the vote) 3 Nose sniffling (17% of the vote)

Saturated fat is still a nutrient of concern for overconsumption, particularly for those older than the age of 50.

IGTIG!

WEES VERS

He has misophonia – the “hatred of sound” – a condition that causes people to feel irritated, or even enraged or disgusted when they hear specific noises. The most common culprits are eating sounds (think lip smacking), hand sounds (such as pen clicking), and breathing sounds (including any activity in the nostrils). Scientists don’t fully understand why these noises cause angst for misophonia sufferers, but early research suggests a hyperconnectivity between the auditory system and the limbic system, a part of the brain that deals with emotions, explains Dr Lerner, a professor of medicine and population health at the NYU Langone Medical Center.

l en al nie isyne is gehee wysings en ed m k an b n o o n Oor-die-t eds die aa haastig en Jy moet nogste risiko-vry nie. ukeurig deurlees, selfs al is jy . no waarskuwings afgelei deur hoe sleg jy voel

2 Gum chewing (18%) of the vote) 1 Soup slurping (25% of the vote)

In pictures

Do you know your numbers?

MAGIC NUMBERS Take a look to see whether yours add up to a healthy you...

24.9

Maximum percentage of daily fat intake

The healthy range for body mass index or BMI is 18.5 to 24.9. The BMI measures your weight in relation to your height. People with a BMI over 25 are overweight. If you have a BMI of 18.5 or below you are considered underweight.

Your daily fat intake should be less than 30% of your total kilojoule intake, with less than 10% coming from saturated fats. Check food labels, and stick to monosaturated and polyunsaturated fats, found in plant oils, including olives and avocados.

Maximum body mass index (BMI)

Maximum number of centimetres your waist should be, if you’re a woman More than that and you’ll up your risk of heart disease. (For men, the maximum measurement is 102cm.) Excess abdominal fat can contribute to high blood pressure and cholesterol.

Maximum number of hours you should wait between workouts Researchers at the University of Missouri in Columbia found that when you’re inactive longer than two days, the kilojoules normally burnt during exercise start to be stored as fat. Fat cells in lab rats can increase in size by 25% after 48 hours of missed workouts.

Minimum number of kilograms of pressure you should be able to squeeze with one hand

A healthy grip strength is between 25 and 30kg. This is a key indicator of your overall muscle strength and may be a sign of how likely you are to develop osteoporosis. To measure your grip strength, squeeze a device called a hand dynamometer, available at some gyms. To improve your grip strength eat more calcium.

Issue 08 | 2015

11 Maximum total cholesterol level (mg/dl ) Total cholesterol levels (the amount of fat in your blood) should be below 200mg per decilitre. If your level is too high (240mg/dl and above) you are at a greater risk of having a heart attack or stroke.

200 120/80 Normal blood pressure A normal blood pressure is 120/80 or below. The first number measures the pressure in your arteries when your heart contracts. The second number indicates the number when your heart is relaxing. High blood pressure is anything above 120/80! Having too high a blood pressure puts you at a greater risk of developing heart disease.

Minimum number of years you should maintain a steady weight A 2004 study in The Journal of the American Dietetic Association suggests that women who keep a consistent weight have stronger immune systems.

5 60-80 Number of times per minute your heart should beat at rest Extremely fit athletes may have a lower rate, but anything under 60 beats per minute (especially if accompanied by dizziness) can indicate an irregular heartbeat or a thyroid disorder. A rate above 100 is a sign of poor fitness. Take your pulse while resting (count the beats for 10 seconds and multiply by six).

100

Maximum blood glucose level (mg/dl) A fasting blood sugar level of less than 100mg/dl is healthy. At between 100 and 125mg/dl youâ&#x20AC;&#x2122;d have borderline diabetes, and an increased risk of heart disease. A level of 126mg/dl or higher, measured on two different days, indicates diabetes with a risk of damage to the eyes, kidneys, blood vessels, heart and nerves as well as dementia.

Winter health strategy: By Health Bytes

Fighting

FLU

An apple a day might keep flu at bay…

hether young or old, for many, the prospect of the looming cold brings about a fear of winter’s worst “side-effects” – seasonal influenza. GP practices are being inundated with questions on how to prevent contracting “the flu” and avoid the endless sniffles, muscle aches and fatigue that comes along with it.

What is influenza? Influenza (flu) is an illness caused by the influenza virus.. There are three types of seasonal influenza viruses – A, B and C. Type A influenza viruses are further classified into subtypes according to the combinations of various virus surface proteins. Among many subtypes of influ-

enza A viruses, influenza A(H1N1) and A(H3N2) subtypes are currently circulating among humans. Influenza viruses circulate in all parts of the world. Type C influenza cases occur much less frequently than A and B. That is why only influenza A and B viruses are included in seasonal influenza vaccines. Person to person transmission occurs through droplets created when someone with the infection sneezes or coughs. Touching surfaces where the virus has been deposited can also put you at risk. Symptoms include fever, cough, rhinorrhoea (runny nose), muscle aches, headaches and extreme fatigue. The illness usually lasts between two to ten days and most people recover completely. However, at times, complications develop,

Issue 08 | 2015

 B acteria can become resistant to

certain antibiotics if they are used incorrectly. Which means the antibiotic might not be effective when needed.

Tips to prevent influenza 1 LATHER UP Contaminated hands spread an estimated 80 percent of infectious diseases. Thorough hand washing is the single most effective way to prevent the spread of communicable diseases. Our hands touch so many publicly used items every day like doorknobs, shopping carts and work desktops, it's best to get in the habit of washing your hands regularly. Children should also wash their hands after playing with toys shared with other children.

Fruits conta in the neces sary f ib vitam re, ins, m inerals and a ntioxid ants to boo s t your im mun system e .

such as pneumonia, and this is more common in young babies, pregnant women, people with lowered immune systems and those with underlying disease (especially heart or lung disease).

Antibiotic misconception Influenza is caused by a virus, as are many common infections of the nose, throat, sinuses, ears and chest. Your immune system is generally good at fighting off many types of viral infections. Hence an antibiotic is not needed if a virus is causing an infection, for the following reasons:  A ntibiotics do not kill viruses.  A ntibiotics may cause side-effects such as diarrhoea, rashes, etc.

Good handwashing technique  R emove all rings or jewellery and wet

Herbal first-aid in a bottle Swedish bitters is a combination of 20 herbs that stimulate the digestive system - thus assisting with the elimination of water products. The elixir can be taken daily as a supplement for chronic conditions. a rack so that it doesn’t sit in water.  R ub your hands together for at least

15 seconds and lather up. Be sure to scrub between your fingers, under your fingernails and the backs of your hands.

your hands with running water.  Rinse your hands with clean running  P ut a small amount of liquid soap in

the palm of one hand. Bar soaps are not as hygienic as liquid soaps as they stay moist and attract germs. If bar soap is the only option, store it on

water for at least 10 seconds. Close the taps with paper towels.  Dry your hands with a dry, clean or

disposable towel.

Health strategy: By Health Bytes | Sources: www.who.int

Help boost your immune system by loading your plate with extra fruits and vegetables. 2 AN APPLE A DAY… Help boost your immune system by loading your plate with extra fruits and vegetables. Colourful varieties are not only appealing to the eye, but these fruits contain the necessary fibre, vitamins, minerals and antioxidants to boost your immune system. 3 SNOOZE SO YOU DON’T LOSE Given the current high demands of daily living, to many a good night’s sleep is considered a luxury and a good old “40 winker” has become the norm. Getting enough sleep is an essential component to your overall health and a key component in disease prevention. 4 EXERCISE: YOU DON’T HAVE TIME NOT TO During winter months the only exercise we do is lifting that snug duvet to cover ourselves. Regular exercise can radically reduce stress, improve our immunity and general well-being and gives our bodies that much-needed energy to fight off unwanted germs. 5 CALL THE SHOTS… According to the WHO (World Health Organisation) flu vaccines are the most effective way to prevent influenza. Unfortunately they do not prevent you from contracting other viral infections which

can cause coughs and colds. The misconception that getting the flu vaccine will give you the flu is not true. But you might develop flu-like symptoms for a variety of reasons such as:  Reaction to the vaccine – general muscle aches and fever develops a day or two after receiving the flu shot. This is most likely as a result of your body producing protective antibodies.  Two-week window – it takes approximately two weeks for the flu shot to take full effect. So if you are exposed to the flu virus shortly before or during this time period, you might get the flu.  Mismatched strains – because the influenza virus evolves so rapidly the virus used for the vaccine might be different to the viral strain circulating in the region.  Other illnesses – many other diseases also produce flu-like symptoms. So you may think you have the flu when you actually don’t. The WHO recommends annual vaccination* for (in order of priority):  nursing-home residents (the elderly or disabled)  elderly individuals  people with chronic medical conditions (HIV/AIDS, asthma or other lung conditions, kidney or liver

KEY FACTS

TRY THIS AT HOME + Place a few drops of eucalyptus or peppermint oil in burning water and inhale. This should help clear sinuses. + Add some tea tree, lavender, rosemary or grapefruit aromatherapy oil to your bath for soothing and relaxation. + Drink plenty of fluids, like water, fruit juice and watery soup. + Stock up on garlic. It acts as a natural antibiotic, helping to fight germs and gently drying mucosal linings. + While you’re ill, steer clear of sugar, which feeds infection, and milk, which produces phlegm. disease, diabetes, diseases of the nervous system)  other groups such as pregnant women, health care workers, those with essential functions in society, as well as children from ages six months to two years. *The arrival of influenza vaccines in South Africa was delayed in 2015 compared to previous years, due to changes in two of the three strains contained in the vaccine, to better match the currently circulating influenza strains.

 Seasonal influenza is an acute viral infection that spreads easily from person to person.  Seasonal influenza viruses circulate worldwide and can affect anybody in any age group.  Seasonal influenza viruses cause annual epidemics that peak during winter in temperate regions.  Seasonal influenza is a serious public health problem that causes severe illness and death in highrisk populations.  An influenza epidemic can take an economic toll through lost workforce productivity and strain health services.  Influenza vaccination is the most effective way to prevent infection.  Antiviral drugs are available for treatment, however influenza viruses can develop resistance to the drugs.

Know it all: By Dr Marcel Niemandt, MBChB (Pret), FCOphth (SA), Opthalmologist, SIlver Lakes

Issue 08 | 2015

DIABETES

and your eyes Diabetes can cause many complications which affect different parts of your body, including your eyes. With increased high blood sugar (glucose) levels, you might be at risk of eye problems. In fact, diabetes is the leading cause of blindness in adults. Dr Marcel from Intercare Silver Lakes explains.

Know it all

hat is the connection? Diabetes can affect almost any part of the eye, and is one of the leading causes of blindness worldwide. The most common ways of affecting the vision is when diabetes causes cataracts, but even more devastating is when diabetes affects the posterior segment of the eye, which is termed diabetic retinopathy / maculopathy. The risk of developing diabetic retinopathy increases with the length of the illness, and affects up to two-thirds of all diabetics after 15 years. Almost 90% of diabetics will have some degree of retinopathy after 40 years. Even though the risk increases with the length of the disease, it has been shown that tight glycaemic control decreases the risk of progression as well as the need for laser intervention. Therefore it is of utmost importance to all diabetics to make sure that their blood sugar is well controlled, and that their HbA1C levels are checked by their attending health care providers. All diabetics should also have annual dilated eye examinations by an eye specialist

All diabetics should also have annual dilated eye examinations by an eye specialist in order to detect any abnormalities early, and to initiate early treatment appropriately.

in order to detect any abnormalities early, and to initiate early treatment appropriately. What exactly is diabetic retinopathy? The complete pathophysiological mechanism is very complex, but in general terms, diabetes causes changes and damage to the blood vessels in the eye, which are responsible for nourishing the retina (light sensitive cells lining the back of the eye). Over the years the damage to the vessels causes decreased blood flow to certain parts of the retina and leakage, and can even lead to the formation of new vessels that can also leak and cause bleeding inside the eye.

PATHY

DIABETIC RETINO

Patient with Proliferative Diabetic Retinopathy and Diabetic Macular Oedema

What are the symptoms of diabetic retinopathy? In patients with early diabetic retinopathy (non-proliferative diabetic retinopathy), there are mostly no symptoms except a mild deterioration of their vision. If the damage becomes more severe (proliferative diabetic retinopathy), and the blood vessels start leaking or bleeding inside the eye, then the vision can become blurred. Some people even experience floaters (please see next page: â&#x20AC;&#x153;A word on floatersâ&#x20AC;?). These floaters can be caused by the blood in the back of the eye (vitreous haemorrhage) or may indicate that there is traction on the retina, which can lead to a retinal detachment. Some patients have no bleeding but still very poor vision. This can be caused by accumulation of fluid in and around the macula (central part of the retina). This is called macular oedema. How can diabetic retinopathy be treated? Proliferative diabetic retinopathy can be treated by the use of a powerful laser that thins out the retina and increases the blood supply to the viable retina.

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17 Macular oedema can also be treated by a different type of laser that increases the reuptake of the fluid that has leaked. Another treatment option includes the use of a specific type of agent that is injected into the eye to decrease the amount of swelling at the macula, and is usually followed by laser therapy. All these treatment options can mostly halt the progression of damage to the retinal cells, if detected early. It is therefore crucial that any form of diabetic retinopathy be followed up more regularly by the eye specialist in order to monitor progression and response to treatment. In very severe cases, when vitreous haemorrhage (bleeding inside the eye) does not clear, or if a retinal detachment occurs, surgical intervention is required in the form of a vitrectomy. During this type of surgery, the gel inside the eye is removed, the retina repaired and the gel replaced by either a specialised type of gas or silicone oil. This procedure must be done by a surgeon experienced in these type of surgeries (vitreo-retinal specialist).

A word on floaters and flashes in the eyes: Floaters (or vitreous floaters) are formed when parts of the gel inside the eye becomes condensed, moves around inside the eye and is observed by a patient as rapidly moving particles, especially visible in bright light or when looking at a white background. These floaters are usually ignored by the brain but in some patients, can be very distressing and can lead to the vision being blurred at times. Someone who experiences floaters accompanied by the following symptoms should consult an eye specialist as soon as possible:

1. Floaters accompanied by light flashes with or without a sudden decrease in vision

2. Floaters accompanied by any type of decreased vision

3. Floaters that are constantly blocking the normal path of light into the eye and thereby causing the vision to be constantly blurred

Treatment of floaters can be discussed with the eye specialist and should be taken seriously. Options can include laser treatment but this is usually temporary and may even require repeat treatments which may not always be successful. The definitive treatment of floaters that constantly causes the vision to be blurred requires surgical removal of the vitreous gel (called a floaterectomy) inside the eye and replacement of the gel with gas in some cases. The risk-benefit ratio of this type of procedure should always be carefully considered and should always be discussed with the eye specialist prior to making the decision to perform such a surgery. Please feel free to contact Dr MC Niemandt at 012 809 6027 to make an appointment with any queries regarding your eye condition, and to discuss any of the treatment options.

All about: Catherine Govender, PhD candidate in psychology, MA Clinical Psychology, MSc Human Physiology & Jaqueline Harvey, MA in Psychological Research, BSocSci Honours Psychology, BSc Honours Physiology with specialisation in neurophysiology

MIGRAINES:

A WORK(ABLE) PROBLEM

Catherine Govender and Jaqueline Harvey are researchers in the Department of Psychology at the University of South Africa. They are currently running a study on migraine in Gauteng and invite all adults in the province to complete the survey at https://unisair.qualtrics.com/SE/?SID=SV_bO9NEznHpfb9qqV All references on request.

Everybody has headaches, right? So what makes migraines so intense that “migraineurs” often spend multiple days off work? And how do you open a conversation about something like this in the workplace?

igraine is a type of headache that causes moderate to severe pain lasting 4-72 hours. There are two subtypes, namely migraine with aura and migraine without aura. The aura type can be accompanied by various neurological symptoms, including seeing flashing lights and smelling interesting (euphemism for pretty awful) odours. Although estimates are that 15% of the world’s population suffer from migraine, statistics for South Africa are not clear. According to the Headache Clinic, approximately 9 million South Africans suffered from headache disorders, including migraine, in 2011.

Migraine pain can be excruciating, frustrating, debilitating, and isolating. Sounds dramatic, doesn’t it? The reality is though, that the headache pain resulting from a migraine often reduces your ability to perform tasks, leading to a decreased quality of life. Imagine needing to proofread a report, but being in too much pain to open your eyes or move your head. The emotional fallout of migraine should not be underestimated either. Headache pain is often associated with depression and anxiety, not to mention the general sadness, anger, guilt and hopelessness that can become a feature of daily life.

Issue 08 | 2015

An article by Sondra McElhinney puts a different spin on the consequences of migraine. McElhinney talks about spouses, parents, family and friends as the “other victims of migraine”. Migraine can affect relationships, straining them to the point of breaking as each person in the system deals with the physical, emotional, and economic burdens of the headache. Collegial relationships are not exempted from these effects. There may be some ambivalence around discussing your migraines in the workplace. There is no doubt that opening up about your health leaves you vulnerable to questions about how well you maintain boundaries in the workplace or to negative peer perceptions. You may be accused of pulling a sickie and taking too many “Benylin” days and end up being labelled as ulova or the office sluiper. Migraine sufferers talk about the guilt that they experience around missing work, and the struggle to cope on days where they attend work despite an active headache. They also mention the difficulties they experience around relating the facts about their condition to their colleagues and bosses. Attempting to explain the intangible to people who are relying on you for daily outcomes (including a salary) is tricky. However difficult the conversation is though, it does need to take place. At the very least you will start to form a picture of how long you can stick it out in that particular employment. Best case scenario? You actually end up gaining understanding from people who can support you in making a success of your job. Communication is vital for a number of reasons. One reason is to try reduce discrimination in the workplace. The Migraine Trust, a UK organisation, reported in 2012 that 46.3% of the migraine sufferers participating in their survey had been treated unfairly over their absences. At least 30% had disciplinary action against them due to migraine-related issues. Countries

The reality is though, that the headache pain resulting from a migraine often reduces your ability to perform tasks, leading to a decreased quality of life. such as the UK and the USA have gone so far as to enact legislation to protect migraine sufferers from such discrimination by including them under various policies for people with disabilities. Vanderbilt University’s Neuroscience Center encourages migraine sufferers to educate their co-workers, discuss modification of the work environment with managers, and – possibly most importantly – urges them to be open and honest about the pain they are experiencing. But how receptive are employers and coworkers to hearing about your problems? According to the Migraine Trust, not very. Approximately 60% of surveyed “migraineurs” felt that their employers failed to accommodate adjustments which would make it easier for them to continue their work successfully. One of the first things you need to establish in your own mind as a migraine sufferer is what you are asking for from your manager or employer. The two of you will have to negotiate whether these requests are reasonable and respectful to the working environment. Accommodations could include an explicit understanding that you will not be discriminated against for absenteeism; ways to prevent you from becoming the subject of malicious behaviours such as gossip; or even physical changes to the work space. For example, a migraine sufferer may need access to a single office where they would be able to turn down the lights and block out other trigger stimuli. As a manager you may be tempted to place the responsibility solely on the shoulders of the migraine sufferer, but this is likely to have a devastating

19 effect on your employer-employee relationship. In addition, you will probably contribute (actively or passively) to the bad vibes in the office over the subject. Let’s face it, none of that is going to improve morale and productivity. It may be tempting to go into the situation with either a blamingand-shaming attitude, or with a martyr stance. Neither of these will improve the situation, though. Do some homework and establish some workable guidelines for both you and your employee, keeping in mind the direct and indirect costs of absenteeism and presenteeism on your business. As a migraine sufferer, it might be useful for you to imagine how awkward such accommodations could make relationships with colleagues – before you get upset with those that do not seem to understand your pain. These requests, if not handled with sensitivity, could appear to be favouritism. Not including your colleagues in the conversations about your migraines is likely to increase any resentment and irritation that may already be festering because others feel forced to take up any slack when you are absent. Yes, there will be those that will think you are trying to have a pity party by advertising your pain, but generally people in the workplace would prefer a heads-up about what they are dealing with, what plans they will have to put in place in case you need to be absent at a critical point, etc. Respectful and honest communication about your headaches allows colleagues the opportunity to express their concerns and needs too. You may find that they have expectations for your productivity when you are well in order to feel that work distribution is equitable. Having these conversations early on in the working relationship can go a long way to decreasing, or even preventing, irritation or frustration and misplaced expectations. At the very least it will make it clear what you are capable of and when, so that those around you do not feel like victims of your migraine.

Fact File

IS IT A

MIGRAINE OR A HEADACHE

From time to time nearly everyone suffers from mild to moderate headaches that develop gradually and clear up after a few hours, leaving no after effects. However, not all headaches are transitory – some can develop into a severe migraine. The symptoms can sometimes be confusing.

TAKE YOUR ANSWERS THAT MATCH YOUR SYMPTOMS AND ADD UP YOUR FINAL SCORE. The pain is… Sharp (+1) Throbbing (+2) Dull (0)

Do you feel sensitive to light or sound? Yes (+2) No (0)

An hour or so before the headache starts, I feel… Fine (0) Tired, stressed (+1) Disorientated/unable to see normally / vision is blurred (+2)

Does your headache respond to paracetamol or ibuprofen? Yes, very well (0) Yes, if taken in time (+1) No (+2)

Do you feel nauseous during a headache? A little (+1) Yes, I sometimes vomit (+2) No (0)

SCOR

When I get a headache, the pain is… On one side of my head (+2) At the front of my head or around the eye socket (+1) All over (0)

If I do physical activity (while having a headache) it gets worse. Yes (+2) Sometimes (+1) No (0) When I get a headache, it lasts for several days and sometimes I have to stay in bed. Yes (+2) Only sometimes (+1) No, it doesn’t last that long at all (0).

Tension headaches are the most common type of headache resulting from emotional stress, tension and overwork. They cause a build-up of tension in the head, neck AND shoulders.

0–4

It’s likely that you suffer from tension headaches. Over-the-counter painkillers should help, but if the headaches persist, see your GP.

4–6 You may have migraine or cluster headaches. If your vision is fine and you don’t feel sick, it’s unlikely to be a migraine.

6+ The more points you scored, the more likely it is that you suffer from migraines. Consult your GP for advice and medication.

Feature

SIX COMMON

ADHD MYTHS & FACTS

Public perceptions of attention-deficit hyperactivity disorder (ADHD) are replete with myths, misconceptions and misinformation about the nature, course and treatment of the disorder.

opular misconceptions assert that ADHD is not a disorder, or at minimum, is a benign one that is over-diagnosed. Critics often claim that children are needlessly medicated by parents who have not properly managed their unruly, unmotivated or underachieving children, or who are looking for an academic advantage in competitive, high-stakes educational environments. Health Bytes will summarise and attempt to dispel some of the common misconceptions about ADHD.

MYTH #1:

MYTH #2:

ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD) IS A "PHANTOM DISORDER" AND DOES NOT REALLY EXIST.

FACT:

The existence of a neurobiological disorder is not an issue to be decided by the media through public debate, but rather as a matter of scientific research. Scientific research spanning 95 years tells us ADHD is a biologically-based disorder that includes inattention, impulsiveness, and sometimes hyperactivity. While the causes of ADHD are not fully understood, recent research suggests that ADHD tends to run in families and therefore can be inherited. An imbalance of neurotransmitters – chemicals used by the brain to control behaviour – also plays a significant role in the manifestations of this disease. Overwhelming evidence suggests that ADHD is a real medical disorder with serious consequences and needs proper diagnosis and multi-disciplinary treatment– medical and psychological. Before a patient is diagnosed with ADHD, other possible causes of his or her behaviour have to be ruled out.

ATTENTION DEFICIT DISORDER IS THE RESULT OF POOR PARENTING AND LACK OF DISCIPLINE.

FACT:

This myth is related to the myth that ADHD is not a real medical disorder. Since the causes of ADHD are genetic and biological, the parents cannot cause ADHD by being too strict or too lenient. However, family instability, poor parent-child relationship and mental disorders in the parents may influence the child's ability to control his or her ADHD behaviour. Most parents of ADHD children are extremely conscientious and involved in trying to help their child succeed. These parents have often developed highly advanced parenting skills out of the necessity of dealing with their child's behaviour and school issues.

MYTH #3:

CHILDREN WILL OUTGROW ADHD WHEN THEY REACH PUBERTY AND THEIR TEEN YEARS.

Feature

FACT:

ADHD is not found just in children. In fact, ADHD is believed to continue throughout a person's lifetime. However, in many teens and adults, the symptoms of ADHD may appear to change or abate as the child matures, simply because the teen or adult learns better management techniques to improve his or her focus, time management and organisational skills. Thus, ADHD is a lifelong disorder that requires a developmental framework for appropriate diagnosis and treatment.

MYTH #4:

ALL CHILDREN WITH ADHD ARE HYPERACTIVE AND HAVE LEARNING DISABILITIES.

FACT: Before children are

considered to have ADHD, they must show symptoms that demonstrate consistent behaviour (for longer than six months) that is greatly different from what is expected for children of their age and background. They start to show the behaviours characteristic of ADHD between ages three and seven, including fidgeting; restlessness; difficulty remaining seated; being easily distracted; difficulty waiting their turn; blurting out answers; difficulty obeying instructions; difficulty paying attention; shifting from one uncompleted activity to another; difficulty playing quietly; talking excessively; interrupting; not listening; often losing things; and not considering the consequences of their actions. Not all

Most parents of ADHD children are extremely conscientious and involved in trying to help their child succeed.

children with ADHD are hyperactive and constantly in motion. The hyperactivity does not cause the biggest impact in a child's, teen's or adult's poor school, career or social performance. Rather, it is the less visible aspects of inattention and poor impulse control that harm overall performance. While 10 to 33 percent of children with ADHD also have learning disabilities, the two disorders cause different problems for children. ADHD primarily affects the behaviour of the child – causing inattention and impulsivity – while learning disabilities primarily affect the child's ability to learn – mainly in processing information. The management of ADHD will be most successful when all three primary aspects (hyperactivity, inattention, impulsivity) are addressed by medical and psychological/behavioural intervention.

MYTH # 5:

GIRLS HAVE LOWER RATES AND LESS SEVERE ADHD THAN BOYS.

FACT:

In general, studies have concluded that ADHD is more common in boys (1 out of 10 boys versus 1 out of 30 girls), but that it can also affect a lesser number of girls. The more subtle finding has been in the differences in how attention deficit problems are manifested in boys vs. girls. Boys with the hyperactivity component of ADHD are often very visible in

their classroom environment and will quickly be identified for interventions and assistance. However, girls far more often display the inattentive variation of ADHD. Rather than bouncing off the walls in the classroom like many boys, they are sitting quietly at their desks daydreaming, unfocused and missing out on the teacher's curriculum. This will result in their poor school performance, but without the rapid identification of their condition and with a delay in providing such girls with needed interventions and assistance.

MYTH # 6: MEDICATION CAN CURE ADHD.

FACT:

Medicine cannot cure ADHD but children, adolescents, and adults with ADHD benefit from therapeutic treatment with stimulant and non-stimulant medications, which has been used safely and studied for more than 50 years. Stimulant medication (e.g. Ritalin, Concerta) and non-stimulant medication is effective in 70% of the children who take it. In those cases, medication causes children to exhibit a clear and immediate short-term increase in attention, control, concentration, and goal-directed effort. Medication also reduces disruptive behaviours, aggression, and hyperactivity. While medication can be incorporated into other treatment strategies, parents and teachers should not use medication as the sole method of helping the child.

Issue 08 | 2015

Rock the ROUTINE: Rules for ADHD-Friendly Schedules PSYCHOLOGICAL AND BEHAVIOURAL THERAPY AND CONTINUED PARENTAL SUPPORT SHOULD FORM AN INTEGRAL PART OF THE TREATMENT OF A CHILD WITH ADHD. A reliable daily routine – at school and at home – is essential to your child's success. WHY STRUCTURE IS KEY Many children with ADHD also have a hard time organising materials to complete homework or a project, figuring out how much time a task will take, setting deadlines and time management. Creating a daily routine, at school and at home, provides external organisation, gives your children the chance to focus on one task at a time, stay focused, and succeed.

baths or reading in bed before falling asleep, put this into your routine. Take your child’s needs and personality into account when creating the routine. 2. AT-HOME SCHEDULE If you haven’t used a schedule or routine at home, it may be easier to start adding one item at a time rather than to schedule the entire day. Start taking 15 minutes before bedtime to pick up toys and put them away. Once this has become a habit, add another item to the schedule.

1. ADAPT ROUTINES TO YOUR CHILD Your routine should reflect your child’s personality, your family values, and your child’s needs. If your child needs down time when coming home from school instead of immediately beginning homework, work this into your schedule. If your child enjoys long

3. GET-UP-AND-GO MORNINGS Getting up and ready for school is often a struggle for children with ADHD. Write down a morning schedule, beginning with waking up. Outline every step, such as eating breakfast, taking medication, brushing teeth, washing her face, getting dressed, checking her backpack for items needed for the day. Put all the steps into a checklist your child can follow each morning.

MEDICAL DICTIONARY

4. BACK TO SCHOOL Your child follows a certain routine in school. From the time he arrives at school until he leaves at the end of the day, he is expected to know where to go and what to do. In the early grades, teachers often have the day’s schedule hanging in the classroom. But older children still need to understand the routine. Ask your child’s teacher for a copy of the daily schedule. Reviewing the schedule at home will help reinforce it.

ADD: Attention Deficit Disorder – An inability to control behaviour due to difficulty in processing neural stimuli. ADHD: Attention Deficit Hyperactivity Disorder – A family of related chronic neurobiological disorders that interfere with an individual's capacity to: regulate activity level (hyperactivity), inhibit behaviour (impulsivity), and attend to tasks (inattention) in developmentally appropriate ways. Behavioural intervention or therapy: A treatment programme that involves substituting desirable behaviour responses for undesirable ones. Hyperactivity: A higher-than-normal level of activity. Behaviour can be hyperactive. An organ can also be described as hyperactive if it is more active than usual.

5. ONE STEP AT A TIME Write down all of the tasks your child completes in a day. Include getting ready for school, after school and homework time, chores, free time, dinner, and preparing for bed. Break down each time frame into steps. There may be activities and other conflicts that make your schedule complicated – dance lessons on Wednesdays and rugby practice on Thursday – but try to make every day as consistent as possible. 6. FUN RULES! As much as a routine is important, kids deserve to have free time and fun. Schedules should include time for your children to explore their interests, play outside, and spend

time with friends. Studies show that exercise and physical activity increase attention and reduce impulsivity. Your daily schedule should include time for outside activities or, on days when the weather is bad, active play indoors. 7. BE FLEXIBLE Life doesn’t always follow the schedule you set. If homework time usually begins at 4:30 and, at 4:20, you are stuck in traffic – 20 minutes away from your house – your routine for the rest of the day is going to be off. Be prepared to make adjustments when needed and use this as an opportunity to teach your child that everyone needs to be flexible from time to time. 8. ONE-STOP ROUTINE Once you create a routine for your child, keep a copy of it in a central location, like the kitchen or living room. For younger children, use pictures as well as text. You, your partner, caregivers, and your child can reference it to make sure every day is consistent and everyone is following the schedule. If you laminate the routine, your child can use a dry-erase marker to cross out tasks he has completed. 9. ROCK THE ROUTINE A written schedule is great, but don’t stop there. Use other tools to make sure your family follows the routine every day.  A kitchen timer helps your child stay on schedule.  Calendars on smartphones allow you to set reminders.  Behaviour charts can be used to reward your child for following the schedule. Keep the routine as simple as possible; elaborate routines often get tossed after a few weeks. 10. REVIEW, REVISE, REDO Your routine should be consistent, but that doesn’t mean it isn’t ever going to change. Your child’s needs may change, an afterschool activity might be added or have ended, your work schedule may change, or you may have miscalculated how long a task takes, such as getting ready for bed. You can review the routine once a month, or sooner, and make adjustments to fit the facts.

Health strategy

G N I C I JU

? b a F r o d Fa

Looking to detoxify, lose weight or just get healthy? Consumers are scrambling to try "juicing" – the latest diet trend.

ome juicing proponents suggest that a juice fast – drinking only juice for several days to months – can reverse chronic disease, jump start weight loss and "detox" the body. Some also recommend supplementing a regular diet with juices. Does the research support these claims? Should you try juicing?

A LOOK AT THE EVIDENCE A juicing machine removes the pulp of fresh fruit and vegetables. This extracts the juice. Juice recipes often use fruits and vegetables together in various combinations. DRINKING FRESH JUICES YOU'VE MADE AT HOME CAN HELP YOU:  Squeeze more fresh fruits

and vegetables into your diet. Fewer than one-third of adults eat the recommended five servings a day.  Use up leftover produce and

save money on groceries.  Increase your intake of

healthy antioxidants, soluble fibre, vitamins and minerals.

25 More research is needed to identify the health benefits and safety of juicing.

Juicing removes the skin and insoluble fiber of fruits and vegetables. The juice itself has a different nutritive value and may not have the same health benefits as whole fruits and vegetables.

On the other hand, decades of research have shown that a balanced diet rich in fruits and vegetables protects us from chronic diseases, such as cancer and heart disease. In addition, a study found that increasing intake of whole green leafy vegetables by one serving was associated with a lower risk of developing type 2 diabetes in adults. Juicing removes the skin and insoluble fiber of fruits and vegetables. The juice itself has a different nutritive value and may not have the same health benefits as whole fruits and vegetables.

CONSIDER THIS:  The vitamin, mineral and

antioxidant content of a whole fruit, like an apple, is decreased significantly when you peel the skin.  One extra serving a day of

In the past five years, some studies have found a potential link between certain juices and health:

fruit juice may be associated with an increased risk of developing type 2 diabetes.

improve lipid levels, such as cholesterol, which affect your risk of heart disease.

which keeps us full and helps maintain muscle mass.  Insoluble fibre can pro-

 CARROT JUICE may

reduce oxidative stress in cells in women treated for breast cancer. Oxidative stress creates free radicals that cause cell damage.  CITRUS-BASED

JUICES and carrot juice may reduce the risk of heart disease.

mote bowel regularity, lower cholesterol, stabilize blood sugars and promote satiety (a sense of fullness) to maintain a healthy weight. Insoluble fibre, however, is lost in the juicing process.  Excessive intake of juice

may cause weight gain and

that works perfectly well in a healthy body work better.  Research has

Aside from the nutritional considerations, juicing raises other concerns. For example:  Expense – Juicers range from R700 to R6000.  Risk of bacterial growth –

Unpasteurised juices can have harmful bacteria that cause serious infections.  Potential side effects –

Juice fast diets to get rid of toxins in the body can cause diarrhoea, fatigue and irritability.

"DETOX" FACTS & FICTION  Environmental toxins

can build up in the body (especially the intestines). FICTION. If toxins did build up in a way your body couldn’t excrete, you’d likely be dead or in need of serious medical intervention. The healthy body has kidneys, a liver, skin, even lungs that are detoxifying as we speak.  A "detox" diet is gener-

 Juices don't have protein,  KALE JUICE may

be dangerous for people with diabetes because juice is a concentrated source of kilojoules and sugar.

ally low in kilojoules and can result in initial weight loss. FACT. That has nothing to do with toxins - it’s because you would have starved yourself for a week.  A "detox" diet is required

to cleanse the intestines and body of waste products for good health. FICTION. There is no way – certainly not through detox treatments – to make something

confirmed the safety of prolonged juice fasts and detoxification diets. FICTION. Your body comes equipped with a natural detoxification system in the form of the kidneys and liver. A healthy liver and kidneys filter the blood, expel toxins and cleanse the body continuously. The intestines are also capable of daily "detox" with the help of fibre-rich whole grains, fruits, vegetables and plenty of water. This is a safe way to naturally detoxify your body.

THE BOTTOM LINE No published research currently supports the safety or efficacy of juice cleanses or fasts. Some juices are associated with health benefits, but more research is needed to determine cause and effect. The literature says that drinking vegetable juice is a healthy way to increase your intake of vegetables. However, it should not replace fresh, whole vegetables in the diet. Whole fruits and vegetables have a higher nutritive value and can help the body to naturally detoxify itself. Not filling up half of your plate with fruits and vegetables and considering juicing? Ask a dietitian if this diet is safe for you. Supplementing your diet with fruit and vegetable juices may help to fill in the gaps for a healthier life. The ultimate lifestyle detox is not smoking, exercising and enjoying a healthy balanced diet.

1 2 TOP TravelGround: Roseanna McBain – www.travelground.com

WINTER GETAWAYS IN SOUTH AFRICA

Cool days and winter rains usher in a restful, relaxed pace of life with activities like hiking and swimming considerably restricted due to rain and snow. This year, when you choose your winter wonderland vacation, consider the following cosy cottages, lodges and farms; they come highly recommended for their crackling log fires, activities like star-gazing and game walks, as well as their warm hospitality.

FABULOUS FARMS 1

Ardmore Guest Farm, Drakensberg, KwaZulu-Natal

Kambro Kind Middelfontein Farm, Sutherland, Northern Cape

Best for: Families, friends, luxury

Best for: Outdoor lovers, relaxation Average Price: R420 per person (all units) Kambro Kind Middelfontein Farm, set in the heart of Sutherland, is an ideal winter getaway for everyone who enjoys a farm-styled stay. The hearty daily breakfasts ensure guests start their day right, before visiting nearby attractions such as Louw museum and the world's youngest active volcano: Salpeterkop. Accommodation consists of a cosy guest house in town, with a main house and several cosy cottages outside of town in the picturesque Aenettes, electric blankets and private and communal log fireplaces. The rustic atmosphere is tailored for relaxation with guided star gazing being ideal on those crisp winter nights, while self-guided walking trails are available year-round.

Average Price: R695 per person (2-sleeper unit) Ardmore Guest Farm is set in the Champagne valley of the Drakensberg Mountain range and offers a picturesque setting for fun with friends and family. Not only do accommodation choices include queen-size beds, fireplaces, heated en-suite bathrooms, and a seating area, but the on-site chef caters for meals all day and provides decadent 4-course dinners coupled with complimentary wine. Tea and coffee are served before the fireplace in the communal lounge after supper, where guests can mingle and enjoy the warm ambiance. There is a children’s playground, trails for visitors to go mountain biking and hiking on, and you can fish at the dam all year round – though the colder months are preferable. Popular activities in the area include golf courses, canopy tours, and game viewing on horseback at Spioenkop Game Reserve.

The duBoirs Boutique Lodge, Kloof, KwaZulu-Natal Best for: Business, couples, romance Average Price: R625 per person sharing

BEAUTIFUL BUSH STAYS 4

Found just outside of Durban, The duBois Boutique Lodge is a haven for those after a restful retreat that’s far from the maddening crowd, but only a short drive from area attractions like the botanical garden, golf courses, and the Krantzkloof Nature Reserve. The luxurious rooms are decorated with wooden furnishings and have modern facilities like air-conditioning and heating, as well as soft ambient lighting. The spacious garden is ideal for picnics, which can be provided by prior arrangement.

Marula Bush Lodge, Hoedspruit, Limpopo

La Kruger Lifestyle Lodge, Marloth Park, Mpumalanga Best for: Couples, luxury, game viewing Average Price: R595 per person (2-sleeper unit)

For those after an adventurous winter getaway, your best bet is to visit the 4-star La Kruger Lifestyle Lodge in Marloth Park for the affordable rates and mild winter temperatures. The spacious wooden deck takes advantage of the lush scenery and is a great place to spot wildlife, as gentle zebra and giraffe are very easily seen from here, though the option to go on a Big 5 safari to the nearby Kruger National Park is always a dream come true for those who’d like to see some of Africa’s predators. Rooms are opulent, with intricately carved wooden headboards, en-suite bathrooms, desks, and luxurious woven rugs. The hospitality is friendly, but unobtrusive, ensuring you have a private couple’s getaway.

A HEAVENLY HOTEL 6

Best for: Family, friends, luxury, game viewing Average Price: R500 per person (8-sleeper unit) Found in the Hoedspruit Wildlife Estate, Marula Bush Lodge is a prime example of modern conveniences meeting adventurous experiences, and is an ideal central base to explore area activities such as the Khamai Reptile Park. Wildlife freely wanders the estate and horse riding safaris are a great way to experience something new on your vacation. Birdlife is abundant and the waterhole – opposite the deck and splash pool – is an ideal cocktail spot, as you relax and sip on a sundowner, watching the fading golden rays. The house offers a king-size bed, queen-size bed, and twin beds; a shady veranda with a gas braai, spacious lounge, and equipped kitchenette complete the bushveld experience.

The French-styled Mont D’Or Hotel, Spa & Conferencing lies within the artistic haven of Claren which is renowned for its beautiful scenery, unique artists meander, hiking trails you can do in winter (wrap up warmly), Mont D’Or Hotel, Spa & Conand breweries and restaurants. When the surrounding ferencing, Clarens, Free State mountains don white caps of snow and frost hardens the ground, the hotel takes on a cosy atmosphere Best for: Couples, busi- where guests can relax in the communal lounges ness, luxury and dine at the restaurant. It’s also the perfect time to Average Price: surround yourself with scented candles and hot towels when you indulge in a massage at the spa, or retire to R650 per person shartheir spacious rooms to unwind before the television. All ing (2-sleeper rooms offer bathrobes, fireplaces, heaters, televisions, room) fridges, air-conditioning, and daily housekeeping.

TravelGround

COSY COUNTRY COTTAGES 7

Maple Grove, Hogsback, Eastern Cape

Tierhoek Farm, Langeberg Mountains, Western Cape

Best for: Friends, family, luxury

Best for: Couples, luxury Average Price: R800 per unit (2-sleeper) Tierhoek Farm, found just outside of Robertson, offers a variety of cottages equipped to withstand the winter frosts. Theyâ&#x20AC;&#x2122;re a favourite amongst couples for the comfortable sitting areas, luxurious bedrooms and beautiful mountain and valley views, with amenities that include fireplaces, gas stoves, and Victorian-styled baths. The nearby winelands in Robertson and Montagu are well worth a visit, and if the weather isnâ&#x20AC;&#x2122;t too cold, a river cruise complete with a picnic basket are ideal for a relaxing afternoon.

Average Price: R350 per person (4- and 3-sleeper units) Maple Grove is a bona fide winter paradise with an annual dusting of snow that settles over the chalets and cottages, and ample gardens where children can build snowmen and create snow angels. The cosy and luxurious accommodation offers fireplaces, woven rugs, thick duvets, extra blankets, and en-suite bathrooms with showers and baths. The rooms have lovely views of the snow-capped mountain peaks in the distance, and the peaceful atmosphere is ideal for a vacation of rest and playing family games like Monopoly and 30 Seconds.

Pennygum Country Cottages, Underberg, KwaZulu-Natal Best for: Friends, family, couples, home comforts Average Price: R300 per person (all units) Pennygum Country Cottages are an ideal yearround spot with units that offer a crackling fire in the lounge, top-notch self-catering facilities and private gardens with braai and seating areas. There are also incredible views of the Giants Cup in the Drakensberg mountain range. In winter, snowfall transforms the gardens into a wonderland where children can safely play before the inevitable snowball fight breaks out.

Port Wine Guest House, Calitzdorp, Western Cape Best for: Couples, yesteryear atmosphere, luxury Average Price: R425 per person sharing (2-sleeper units)

RESTFUL RETREATS 11

Port Wine Guest House provides a perfect blend of home comforts and luxuries combined with vineyard and mountain views. They offer hearty, organic meals and have a prime location within walking distance of nearby restaurants and shops. The stunning Karoo sunsets bathe the area in warm light each evening, which is an ideal time to enjoy a warming glass of the complimentary port. Each room has a four-poster canopy bed, sitting area, heater, complimentary bottle of port, and an en-suite bathroom. Take a leisurely drive into the nearby winelands to indulge in wine tastings as a great way to warm up on chilly afternoons.

Heronmoor Retreat, Central Drakensberg, KwaZulu-Natal

Ravanna Mountain Retreat, Montagu, Western Cape

Best for: Couples, families, romance, relaxation

Best for: Couples, families, friends, relaxation

Average Price: R300 per person (2-sleeper unit)

Average Price: R410 per person (4-sleeper unit)

Heronmoor Retreat is set in the Kamberg region of Central Drakensberg and offers country-style cottages set within the 300 hectare property. Communal facilities include a gym and meditation room. Trout fishing is ideal in winter and mountain biking trails and bird watching are available. Accommodation is offered in cosy cottages with private patios, mountain views, kitchens, lounges, and televisions. The 100-year-old Settlers Cottage offers gas, electric, and solar power amenities, and is a great back-tobasics stay. The farmhouse comes with a spacious lounge and fireplace, though their bathroom with a Jacuzzi is the best spot around, as you can spend a leisurely afternoon soaking your cares away.

Ravanna Mountain Retreat, found midway between Montagu and Barrydale, offers a luxury country stay designed to capture visitorsâ&#x20AC;&#x2122; hearts and souls with a mix of warm hospitality, quiet serenity, beautiful views, and cosy quarters. Guests should be aware that the property comes with several visits from the manager's friendly pets who love to follow guests around the various hiking trails â&#x20AC;&#x201C; they will also keep a close watch on those who decide to light a braai fire. The cottage and log-cabin styled units have luxurious amenities and come with kitchenettes, mosquito nets, heaters, fans, dining areas, sitting areas, en-suite bathrooms, and cosy bedrooms.

First aid

YOUR GUIDE TO

MENTAL HEALTH

Traditional first aid courses are all about the body. Yet we‘re more likely to encounter someone with a mental health problem than someone needing CPR.

hat should you do if you encounter someone having a panic attack, behaving aggressively (perhaps because of alcohol or drugs), or appearing suicidal? Mental health problems are very common, if not more common than a lot of the physical health problems people learn how to give help to. And there are wonderful things that can help. Once you know that, you really need to not just stand by.

How to help: some basics  If you notice changes in a person's mood, behaviour, energy, habits or personality, you should consider a mental illness being a possible reason for these changes. L et the person know you are concerned about them and are willing to help. U se “I” statements such as “I have noticed and feel concerned” rather than “you” statements. What doesn't help? T elling them to “snap out of it” or “get over it” B eing hostile or sarcastic B eing over-involved or over-protective N agging T rivialising a person's experience by pressuring them to “put a smile on their face”, to “get their act together” etc.

Sources: www.mhfasa.co.za/about.htm

B elittling or dismissing the person's

feelings by saying things like “You don‘t seem that bad to me”. S peaking in a patronising tone of voice T rying to cure the person or come up with answers to their problems Dealing with a crisis Mental health first aid doesn't aim to teach people how to be counsellors or mental health professionals, but rather, like traditional first aid, how to keep others safe in some common crisis situations – either until professional help can be found or until the crisis is resolved. Scenarios covered include what to do when someone:  may be having a panic attack  is severely affected by alcohol or drugs  is in a severely psychotic state (has severe disturbances in thinking, emotion and behaviour)  has had a traumatic event, such as being involved in an accident, assault, robbery or family violence  is acting aggressively  is having suicidal thoughts and behaviours  is injuring themselves in a nonsuicidal way The guidelines taught for each scenario are developed by expert panels of professionals and consumer advocates, based on a rigorous analysis of

research, and are regularly updated. Reducing the burden Research shows fewer than 50% of people with mental health problems seek professional help. And of those that do, often it's only because someone else suggested it to them. So mental health first aid has the potential to significantly reduce the burden of mental illness on society. Research suggests the training is having an impact – improving people's knowledge and attitudes to mental health problems as well as the likelihood they would step in and offer help to someone in need. Remembering what to do In any first aid course, participants learn an action plan for the best way to help. In first aid for physical illness and injury, the mnemonic is DR ABC(D) – which stands for Danger, Response, Airway, Breathing and Compressions (Defibrillation). If the first aider determines the person is not fully conscious, the subsequent actions of ABC(D) need to be performed in that order. But these are principles to remember, not steps to be followed in a fixed order. The helper needs to be flexible about the order and relevance of these actions (although assisting with a crisis should be the highest priority). Listening non-judgmentally is an action that occurs throughout the giving of first aid.

Issue 08 | 2015

FIRST AID

MENTAL HEALTH ACTION PLAN Mental Health First Aid has the acronym ALGEE to remind people of the action plan for someone in a mental health crisis or developing a mental health problem. A pproach, assess and assist with any crisis the person is experiencing. When helping a person going through a mental health crisis, it is important to look for signs of suicidal thoughts and behaviours, non-suicidal self-injury, or other harm. Some warning signs of suicide include:  Threatening to hurt or kill oneself  Seeking access or the means to hurt or kill oneself  Talking or writing about death, dying, or suicide  Feeling hopeless  Acting recklessly or engaging in risky activities  Increased use of alcohol or drugs  Withdrawing from family, friends, or society  Appearing agitated or angry  Having a dramatic change in mood

L isten non-judgementally It may seem simple, but the ability to listen and have a meaningful conversation requires skill and patience. Listening is critical in helping an individual feel respected, accepted, and understood. G ive support and information It is important to recognise that mental illnesses and addictions are real, treatable illnesses from which people can and do recover. When talking to someone you believe may be experiencing symptoms of a mental illness, approach the conversation with respect and dignity and don’t blame the individual for his or her symptoms.

1 in 3 a dult will suff s er from a mental hea disorde lth r their life in time.

E ncourage the person to get professional help. There are many professionals who can offer help when someone is in crisis or may be experiencing the signs and symptoms of a mental illness or addiction. Types of professionals:  Doctors (primary care physicians or psychiatrists)  Social workers, counselors, and other mental health professionals  Certified peer specialists Types of professional help:  "Talk” therapies  Medication  Other professional supports E ncourage other supports such as self-help strategies Individuals with mental illness can contribute to their own recovery and wellness through:  Exercise  Relaxation and meditation  Participating in peer support groups  Self-help books based on cognitive behavioural therapy  Engaging with family, friends, faith, and other social networks

HealthIQ: Dr Jean Blom – Psychiatrist at Intercare Silver Lakes

DEPRESSION Clinical depression goes by many names – depression, "the blues," biological depression, major depression. But it all refers to the same thing: feeling sad and depressed for weeks or months on end (not just a passing blue mood). This feeling is most often accompanied by feelings of hopelessness, a lack of energy (or feeling "weighed down"), and taking little or no pleasure in things that gave you joy in the past. A person who's depressed just "can't get moving" and feels completely unmotivated to do just about anything. Even simple things – like getting dressed in the morning or eating – become large obstacles in daily life. Sadness because a loved one passed away is appropriate. It fits the situation. Depression becomes a disease when those feelings linger on and on, become deeper and go hand in hand with loss of energy, motivation, interest and the ability to feel pleasure.

AS A DISEASE

The depressed person feels hopeless, helpless, useless, and even guilty, while he or she is neither a hopeless nor a useless person. The negative thoughts become worse, and suicidal ideas start forming. Those ideas change into planning suicide and that may end in committing suicide. Anxiety is a frequent accompaniment of depression and makes the suicide risk much more real. Depression has many variations and may be a family disease, because of the way a particular family’s genes are programmed. Things that happen in life, such as physical disease, prescription drugs, illegal drug abuse, loss of a loved one and any other trauma that causes stress, may precipitate disease symptoms. The same stress may make the symptoms linger on and on. People differ immensely in how they handle stress, so that a negative, depressed mood could reign superior in some unfortunate families.

KEY SIGNS Constantly feeling down or hopeless Having little interest or pleasure in doing things you used to enjoy

POSSIBLE SIGNS Irritability or restlessness, feeling tired all the time, or general loss of energy Feelings of emptiness or loneliness No longer interested in favourite activities Sleep problems – too much, or too little Weight loss or gain Low self-esteem Problems with concentration Reduced sex drive Thinking about death a lot

Add the unwelcome company of anxiety, which is a disease on its own and we begin to understand some of the reasons for family dysfunction. The most valuable warning that a depression may be on its way, is a loss of energy. The sooner one makes this your doctor’s problem, the better. Treatment is effective and antidepressants are not addictive. It should be taken precisely as prescribed, and the doctor who prescribes it must tell you everything about the side effects and the influence it has on other medications that you take. If you are concerned about the way the medicine makes you feel, tell your doctor immediately. While medication plays its role in the more robust chemistry, psychotherapy addresses the refined chemistry of human interaction. These two treatments together, serve the individual as a whole person.

ANXIETY Often people with depression also find they worry about things more than usual. This is known as anxiety. It can cause physical symptoms like pain, a pounding heart or stomach cramps and for some people these physical symptoms are their main concern. Anxiety may be constant, or it may come and go in certain circumstances. Either way it’s important to recognise anxiety when it occurs, and to seek help.

Recipe: source â&#x20AC;&#x201C; www.bbcgoodfood.com

Carrot & coconut A satisfying soup which is delicately spiced and works well as a rustic starter INGREDIENTS + 1 tbsp vegetable oil + 1 onion, finely chopped + 1 garlic clove, chopped + knob of fresh root ginger, grated + 1 red chilli, deseeded and chopped + 1 tsp mild curry powder, plus extra + 1kg carrots, trimmed and sliced + 2 lemongrass stalks, bashed + 2 strips orange zest + 400g can coconut milk + 700ml vegetable stock

soup

SERVES 6

METHOD 1 Heat the oil in a large pan with a lid. Tip in the onion, garlic, ginger

and chilli, then cook for 3-5 minutes until soft. Stir in the curry powder, followed by the carrots, lemongrass and zest, then cover and cook over a low heat for 10 minutes more. 2 Give the coconut milk can a shake, then pour most of it into the pan

along with the vegetable stock. Bring to the boil, then turn down and simmer for 15 minutes until the carrots are really soft. Remove the lemongrass and orange zest, then use a stick blender or food processor to whizz until smooth. Ladle into bowls and top with a swirl of reserved coconut milk and an extra sprinkling of curry powder, if you like.

Difficulty: Easy Preparation Time: 10 min Cooking Time: 25 min Variations: You can add butternut or pumpkin.