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JANUARY 21, 2011


Resolve to be healthier and leaner this year As with all New Year’s resolutions, we begin the rebirth with a heightened awareness that we have to make changes in our lives and health. It’s not just a matter of living longer, but living betB. CANDACE ter. RAY Coronary Feature Writer/ issues are Photographer number one in that Bermuda’s resident population shows an increasing incidence of the obesity, diabetes and hypertension that are risk factors for cardiac disease. An interview with Dr. Carl Levick, the Bermuda Hospitals Board (BHB) chief of cardiology, discusses the newest partnership between BHB and Lahey Clinic. Cardiac Associates of Bermuda is the product of this collaboration and is moving forward with

enhanced diagnostics and a plan for more wisely used medical resources. Further, we offer an explanation of how cholesterol affects the ‘coronary tree’ from as early as the teen years. Cardiac patients and potential patients should discuss a referral with their primary health care provider to the cardiac nurse support and ‘Heartline’ classes KEMH offers. The Bermuda Heart Foundation’s Simone Barton addresses the topic of how to avoid heart disease. Donaldo Laurenceo of the Sickle Cell Foundation of Bermuda discusses sickle cell disease. Mr. Laurenceo defines the disease, its origin, challenges, affected parties, diagnoses and outlook. And Minister Gwen Smith provides a personal view of someone dealing with the day-to-day logistics of living with sickle cell. Dr. Sarath Anandagoda

enlightens our readers about Seasonal Affective Disorder, or SAD. Commonly called the ‘winter blues’, it affects people in unsuspected ways and at different times of the year. Dr. Anandagoda writes from a consultant psychiatrist point of view. Weight loss is a perennial resolution requiring new resolve, according to Kym Herron Scott. The Athletic Club’s owner talks about how to properly lose weight so you can keep it ‘lost’. Dr. Annabel Carter argues the importance of physiotherapy rehabilitation following an injury. She discusses the progression from pain to recovery of mobility, strength and stability, and the looked-for return to preinjury conditions. Family physician, Dr. George Shaw, offers an overview of the annual physical. He notes its origin, who should have one and why. And he addresses specific, male-female and

family history concerns. Dr. J. J. Soares offers a personal perspective of the mid-season flu shot. He answers the question: is a flu shot worthwhile this late in the season? The Bermuda Health Council includes its comparison of Bermuda’s health care system to that of other jurisdictions. Argus Insurance focuses on everything to do with walking. Its contribution deals with getting active, selecting footwear, stretching, warming up and building distance. And in an article that complements the Argus offering, The Foot & Ankle Clinic provides a summary on circulation and how it affects the legs and feet. The Bermuda Sun hopes you find inspiration in these Health Care Directory pages, and with head up and spirit soaring are stirred to meet your own challenges and climb your own heights. ■

Inside this supplement Round-the-clock cardiac services thanks to partnership Pages 2-3 Agencies provide support for those at risk Page 3 The sickle cell abnormality: symptoms and treatment Pages 4-5 Living every day with sickle cell Page 6 Five steps to help avoid heart disease Pages 8-9 What to do in case of a heart attack Pages 10-11 Bermuda’s health system check up Pages 12-13 Mid season flu shots still beneficial Pages 14-15 Dealing with peripheral arterial disease Page 17 The importance of physiotherapy following an injury Pages 18-19 Should everyone have an annual physical? Pages 20-21 Revere life’s gift: the perfectly flawed human body Pages 22-23, 25 Walk you way to wellness this year Pages 26-27 Gain control of your body and your life Pages 28-29 Dance your way to a magnificent you Pages 30-31 A seasonal mood disorder named SAD Page 32

Bermuda Sun 19 Elliott Street, Hamilton, Bermuda HM 10 Tel 295-3902 Fax 292-5597 E-mail This special supplement is produced and published by Bermuda Sun Limited and printed in Bermuda by Island Press Limited.

Publisher Randy French President Lisa Beauchamp Editorial B. Candace Ray Layout Jack Garstang Advertising Sales Carlita Burgess (Deputy Advertising Manager) Olga French, Diane Gilbert, Claire James

The Bermuda Sun publishes twice weekly and is a subsidiary of MediaHouse Limited. We are members of the Inland Press Association, International Newspaper Marketing Association and the Newspaper Association of America. We are located at: 19 Elliott Street, Hamilton HM 10; P.O. Box HM 1241, Hamilton HM FX Tel: 295-3902 Fax: 292-5597. Visit our website:

Creative Services Gerri Saltus, Christina White, Colby Medeiros, Shay Ford Circulation & Distribution Nick Tavares

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Partnership helps hospital provide BY B. CANDACE RAY

Cardiac disease is Bermuda’s most common cause of death and disability. But thanks to Cardiac Associates of Bermuda, the hospital now has 24-hour cardiac services seven days a week. Cardiac Associates of Bermuda partners Bermuda Hospitals Board (BHB) with the Lahey Clinic to provide inpatient and outpatient consultation, diagnostic testing and urgent care for critically ill patients. “What we have attempted to do is to provide a specialty trained cardiologist to help existing staff manage cardiac emergencies day and night,” said Dr. Carl Levick, BHB’s chief of cardiology. The collaboration between the two facilities is intended to improve Bermuda’s cardiac services generally, and within the walls of the hospital (KEMH), specifically. Of the cardiac providers on the island, Dr. John Doherty would not be expected to commit to around-the-clock availability for in-hospital care in addition to his private practice; and Dr. Shane Marshall does not have active hospital staff privileges, so does not currently perform inpatient consultation. Dr. Levick has conferred with outpatients in his third floor office in the coronary department at KEMH since August, and is engaged in inpatient care in every ward of the hospital. He has been assisted by a ‘locum tenens,’ an alsoboard certified cardiologist here in Bermuda on a shortterm basis. A second, permanent cardiologist, Dr. Sam Mir, will join him in March 2011. “The main activities of my practice are to take patients who have symptoms of cardiac disease, or may have already been diag-


SOUNDINGS: Dr. Carl Levick, cardiologist and Irene Conlon, cardiac sonographer, discuss an ultrasound of a heart. nosed with cardiac disease, and to establish an accurate diagnosis and treatment plan for that particular patient,” Dr. Levick said. Dr. Levick is focused on expanding the range of diagnostics, including stress and other tests to diagnose heart disease. “For people who can’t walk, we use chemicals to speed up the heart rate temporarily and reproduce the heart’s response to exercise,” he said. “Other pharmacologic agents alter the blood flow pattern to the heart muscle without exercise and allow us to diagnose coronary obstruction.” Dr. Levick expected that Cardiac Associates would this month begin using nuclear cardiology to diagnose coronary blockages. He explained that a patient undergoes treadmill stress

testing and a small amount of radioactive material is injected into the circulation through an intravenous infusion. A camera then photographs the amount of radioactivity pooling in the heart muscle. Analysis of the pattern of blood flow to the heart muscle will detect blockage in a coronary artery threatening to cause a future heart attack or causing chest pain symptoms. “These are tests to help us determine the presence and the severity of coronary disease so we can institute the best treatment plan,” Dr. Levick said. “We essentially use our diagnostic tests to determine who may need to be transferred [overseas] for surgical treatments such as coronary angioplasty and stenting or coronary bypass surgery, and which patients

might be best managed locally with medications.” The majority of cardiac problems are treated with medicine, according to Dr. Levick, but where necessary, some surgical procedures can be performed in Bermuda. Such therapies might include electrical cardioversion or pacemaker implantation, both performed with high success rates at KEMH. Electrical cardioversion addresses atrial fibrillation, the most common arrhythmia, by shocking the heart of a patient under anaesthetics to restore it to a regular rhythm. The hope is that the heart rhythm will remain regular following the procedure. Sole provider, Dr. Andrew Spence, has performed pacemaker implantation locally for years. Cardiac Associates want to increase



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around-the-clock cardiac services that service to two doctors, so that service can always be provided. Cardiac catheterization, angioplasty and stenting, coronary bypass surgery, and other large cardiac surgeries are not available on the island, according to Dr. Levick. He said, for example, that less than 75 Bermuda residents a year require open-heart surgery. “This population base is too small to support a complete range of cardiac procedures,” he said, noting the surgeons, staff and equipment that would be required to perform such a complex procedure. “The cost of delivering a programme to a small number of people would be a big concern, as would the quality of a service performed on only a small number of people each year.” “It is possible that with the new hospital and with the development of new techniques in cardiology, other cardiac procedures will be done on the island. “It will be a constantly evolving situation as to what services should be delivered at KEMH.” ■


LIFE ON THE TREADMILL: Dr. Carl Levick is pictured with stress test tools, a treadmill and computerized test results display.

Agencies offer support for people at risk BY B. CANDACE RAY

While the BHB/Lahey Clinic’s Cardiac Associates of Bermuda focuses on coronary care diagnosis and treatments, other agencies — The Bermuda Heart Foundation is one — perform risk factor screening and institute public health measures to try, through education, to reduce the incidence of coronary disease. “Our best efforts to prevent progression of coronary disease involve long-term teaching and lifestyle modification with attention to the risk factors,” Dr. Carl Levick,

Bermuda Hospitals Board (BHB) chief of cardiology said. “Much of coronary disease is the result of our diet and exercise habits.” He noted, for example, Bermuda’s increasing risk of obesity, diabetes and hypertension. Once coronary disease is diagnosed in a patient, modifying the patient’s risk factors may help prevent future cardiac events such as myocardial infarction. Cholesterol starts to build-up in the ‘coronary tree’ in the teenage years. This gradual accumulation in the arteries goes on through life and is called atherosclerosis.

The end result of this gradual process may be a heart attack or myocardial infarction. Certain factors may accelerate the process of atherosclerosis, according to Dr. Levick. Smoking, hypertension, diabetes, high blood cholesterol and family history of coronary disease are referred to as ‘risk factors’ by physicians. According to a BHB spokesperson, “The BHB offers a Cardiac Care Programme (a referral from your doctor is required), managed by a nurse educator, who provides support, counselling and education to cardiac patients and those at risk for cardiac

conditions.” The process involves one-on-one interviews, a full assessment, risk factor profile, goal-setting and class attendance. “‘Heartline’ is a six-week series of classes held three times a year on six consecutive Wednesdays from 10am until noon at KEMH,” the spokesperson said. “It is geared to identify ways to avoid heart disease and instruction on how to live a full life after a heart attack, coronary artery bypass grafting or angiography.” ■

FOR MORE information, call the hospital at 236-2345 and ask for the cardiac nurse educator.

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The sickle cell abnormality: who Donaldo Laurenceo, Sr., chairman of the Sickle Cell Foundation of Bermuda, discusses the sickle cell abnormality with the Bermuda Sun. What is sickle cell? Sickle cell disease is an inherited change in the blood. The protein haemoglobin, which is responsible for the red colour of blood, is made slightly differently in sickle cell disease. Normal adult haemoglobin (HbA) is replaced by the abnormal sickle haemoglobin (HbS).

Haemoglobin is used to carry oxygen in the body but when HbS gives up its oxygen, the units of HbS stick together forming long chains, which change the shape of red blood cells. Normal red blood cells are round and flat like a saucer, but in sickle cell disorder, when the oxygen is removed, the cells become long and pointed like a sickle or scythe.

cell gene from one parent and the gene for normal (HbA) from the other, you have the sickle cell trait. This is harmless and cannot become the disease. If you inherit the HbS gene from both parents, you have homozygous sickle cell disease or SS disease. Other types of sickle cell disease may occur if your parents carry other abnormalities in the blood.

How do you get sickle cell? It is inherited from your parents. You cannot catch it like the flu or measles. If you inherit the sickle

Why does it cause problems? When oxygen is removed from (HbS), it forms fibres, which make the red cell stiff and deforms them into a

sickle shape. These deformed cells cannot travel down blood vessels normally and are destroyed quickly and block flow in blood vessels. Rapid red cell destruction causes anaemia, jaundice, gallstones, and problems from a greatly expanded bone marrow. Blocking blood vessels may cause death of the tissue supplied by those blood vessels resulting in problems which may affect anywhere in the body, but especially the bone, lungs, spleen, skin, and brain. Damage to the bone marrow may cause pain close to the joints, back, and abdomen, usually starting in childhood, and becoming more frequent and severe in adolescence and early adult life, and then improving and often ceasing after the age of 30 years. Attacks may follow getting cold, going swimming, doing strenuous exercise, or suffering from infections, or emotional stress. Does it only affect black people? No, the sickle cell abnormality is widespread. It is very common in Equatorial Africa, and most of the sickle cell disease seen in the Americas, Caribbean, Bermuda and Europe is in persons of African origin. However, the abnormality also occurs in Italy, Greece, Turkey, Saudi Arabia, and Central India. All these areas have a history of malaria and persons with the sickle cell trait have some resistance to malaria. Over the centuries, people with the sickle cell trait have been more likely to survive and pass on their genes, so the sickle cell trait has become more common in malarial areas. The sickle cell trait protects against malaria, but sickle cell disease does not, and malaria is a common cause of illness and death



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it affects and how it is treated among persons with sickle cell disease in Africa. How can you find out if you have it? You must have a blood test called haemoglobin electrophoresis. Can the disease be cured? No, the abnormality is built into the genes and cannot be changed. Can the disease be treated? Certainly, and many of the complications can be avoided or treated more effectively. Most of the early causes of death can be prevented and both survival and the quality of life are improving. Can the disease be prevented? Yes, in several ways. If people with the sickle cell trait avoided having children with others with the sickle cell trait, there would be no more children with sickle cell disease. One approach would be to educate the population on the inheritance of the disorder and offer screening so that everyone would know their genotype. People could then make informed decisions on whether to have children if they knew they were at risk of a child with sickle cell disease. Another approach is antenatal diagnosis early in the pregnancy so that the families know whether the foetus has the disorder and then can decide whether to bring the pregnancy to term. What is the outlook for someone with sickle cell disease? The outlook is a lot better than in the past. Now, with the better treatment and understanding of the disease, persons with the condition are much more likely to survive and enjoy better health. Many survive beyond 5060 years, some into their


DONALDO LAURENCEO, SR., chairman of the Sickle Cell Foundation of Bermuda, offers a copy of a publication from a recent conference. late 70s. It should be remembered that although complications may occur, many ‘sicklers’ are well much of the time. The period of greatest risk is early childhood, and much can be done to prevent mortality, but only if the diagnosis has been made at birth. Early diagnosis is probably the single most important factor in improving survival in sickle cell disease. ■

STATISTICAL AND other information provided by the Sickle Cell Trust, MRC Laboratories, University of the West Indies, Jamaica.


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Living every day of my life with sickle cell As related to the Bermuda Sun by Minister Gwen Smith. Gwen Smith is a substitute para-professional, former special ed student educator and licenced minister in The United Holy Church of Bermuda Inc. She serves there as public relations officer and head of the Christian education department, and is an administrative assistant at her local, Greater St. George’s Holy Church. Minister Gwen is the wife of Pastor Grant Smith. Within this hectic schedule, the minister also lives with sickle cell disorder, which involves severe pain in the joints, bones and chest and sometimes requires hospitalization for blood transfusions, intravenous fluids and oxygen. These painful episodes are called ‘sickle cell crises.’


MINISTER GWEN SMITH lives with sickle cell disorder. Once she has recovered from one, Gwen resumes her hectic lifestyle with a bottle of water, pain medication and warnings from her doctors and husband that she needs to rest more. Gwen has lived with this disorder all her life, but due to the lack of technology

Do you get pain, cramping or discomfort in your legs when you walk ? Do you have diabetes or a family history of diabetes ? Do you have high blood pressure ? Do you have high cholesterol ? Do you have varicose veins ? Do you have swelling in the lower leg / ankle ? Do you smoke, or have you been a smoker in the past ? Are you over 45 years of age ?

If you answered YES to 2 or more of the above questions, you could have reduced blood flow in the legs and feet. Regular monitoring of your foot and leg circulation can provide early warnings of circulation impairment. PLEASE CALL The Foot and Ankle Clinic to arrange an appointment for a lower limb vascular assessment 48 Cedarparkade Cedar Avenue, Hamilton


and equipment when she was an infant, her symptoms were misdiagnosed for rheumatism. Now, technology has improved, and a baby can be tested to determine if they have the disease or sickle cell trait. Sickle cell disease is an inherited change in the red blood cells, which have a component called haemoglobin. Haemoglobin carries oxygen to all the cells and tissues in the body. People with sickle cell anaemia have a type of abnormal haemoglobin called haemoglobin S; normal haemoglobin is called haemoglobin A. The abnormal red cells are sickle shaped. They become stuck in the small blood vessels, causing a blockage which deprives the body of blood and oxygen and leads to painful crisis. The sickle cell trait is the harmless carrier state for the abnormal sickle haemoglobin (HbS) gene, which is inherited when only one parent has the sickle cell trait. That person rarely has pain in the joints. When both parents have the trait, then the child is likely to have the disease or SS disease. Although sickle cell anaemia is found largely among the black population, it also affects populations in the Americas, Greece, Italy, Turkey and Saudi Arabia, along with our own Portuguese population. There was an increase in Bermuda during the 1990s. It paralleled the increase in the integration of people, especially among the young. At that time, Minister Gwen visited the middle schools to educate the youth about the disease. She advised them that if they were going to be sexually active to first get tested for sickle cell and urged them to use ‘precautions’. Having a child with sickle cell is not easy, especially if you are young. It requires great sacrifices, which many are not prepared for

— particularly for the interruption of a lifestyle. Minister Gwen is grateful to her late mother for her dedication and sacrifice in ensuring that Gwen led as normal a life as possible, not only for herself, but also for her younger sister. The minister’s mother was a woman of faith and prayer. She saw to it that Gwen received the best medical treatment, but also taught her to trust in God. She encouraged her to achieve her goals in life. Gwen had and still has a wonderful support system — primary teachers who came to her house, high school friends who carried her books and a devoted husband of 28 years. Thanks to the drug hydroxy-urea, which she has been taking since the mid-1990s, she doesn’t have as many crises today. She has gone from nine or 10 to one or two crises a year. She sometimes has to remind her husband she needs a break, and likewise, he reminds her to rest and not take on too many responsibilities. That makes Gwen feel well, and normal. She enjoys a ‘plain old tired’ feeling, instead of being racked with pain as soon as her body gets active. She is grateful to God for the wisdom he gives her doctors, along with the peace of mind that only He can give. The Sickle Cell Support Group has been very encouraging to her, and to the many others who live with this disorder, by educating and meeting their medical, academic and emotional needs. Minister Gwen tries to encourage parents to be more positive and less fearful about sickle cell. She said: “Educate yourself to empower yourself and let your child live! Modify his or her activities when they go through a painful season. And remember, it is just a season. Like the weather, spring will come again.” ■



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Five steps to help avoid heart disease BY SIMONE J. BARTON Heart disease and high cholesterol were once considered disorders of our senior citizen population. Young folks in their 30s and 40s didn’t even give them a second thought, but not anymore. With the advent of modern technology people are living sedentary lifestyles, sitting in front of their computers all day with little or no exercise, while eating processed high fat laden foods. The number of people who are living with unmanaged high blood pressure, high cholesterol levels, diabetes or obesity is mind-boggling. If we do not effectively tackle the risk factors that lead to heart disease, we will very shortly become overwhelmed by the number of people needing costly medical attention. The fact is that many cases of heart disease and heart attacks could be completely and easily avoided by simply watching what, and how much we eat, and engaging in a regular exercise regime. The risk factors for heart disease are high blood pressure, high cholesterol levels, and obesity, all of which can be combated by regular exercise and body fat loss. When we exercise, our bodies create more HDL (high density lipoproteins), which is the good kind of cholesterol. Think of HDL as the street sweepers of the blood, the more HDL we have, the more LDL (low density lipoproteins) the bad kind of cholesterol is swept to our liver and removed by the body. In addition, as we exercise, we actually work out our heart —the heart is a muscle! Did you know that the average adult heart beats 72 times a minute, 100,000 times a day, 3,600,000 times a year and 2.5 billion times during a lifetime? The heart is an amazing


SUSIE NOEL-SIMMONS, cardiac fitness specialist, talks with a patient at CORE Consult on behalf of the Bermuda Heart Foundation. muscle that needs tender loving care. Heart disease may be the leading cause of death in Bermuda and around the globe, but that doesn't mean you have to go down without a fight. There are some risk factors that you cannot change such as family history, age, gender or ethnic origin, but you can always work towards limiting your risk. Take steps today to avoid heart disease. As Dr. Oz (Oprah’s doctor) always says, “It is easier to prevent than it is to cure.”

1. Prevention pays Heart disease is 95 per cent avoidable. Following a heart-healthy lifestyle doesn't have to be complicated. Find ways to include hearthealthy habits into your lifestyle and you may well enjoy a healthier life for years to come.

2. Don't smoke or use tobacco products. Smoking or using other tobacco products is one of


HEART HEALTHY: This Greek salad pays homage to the Mediterranean diet.



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the most significant risk factors for developing heart disease. When it comes to heart disease prevention, no amount of smoking is safe. Smokeless tobacco and lowtar and low-nicotine cigarettes also are risky, as is exposure to second-hand smoke.

3. Get active Regularly participating in moderately vigorous physical activity can reduce your risk of fatal heart disease. And when you combine physical activity with other lifestyle measures such as maintaining a healthy weight, the payoff is even greater.

4. Eat a heart-healthy diet When you are told that you need to go on a diet, the first thing you automatically think of is all the things you will have to give up. Eating heart-healthy is not a diet; you don’t need to deprive yourself of the foods you love. Enjoy everything in moderation; look for ways to remove 100 empty calories per day and you will make a dramatic difference in your health profile. Drink less soda and more water; keep grapes at your desk for a quick snack, instead of that bag of chips or that chocolate bar. Try to eat as clean as possible, no heavy cream or cheese sauces or things drowning in butter. If you want to follow healthier eating, check out the Mediterranean diet. It is packed full of yummy foods that are tasty as well as heart-healthy. By eating heart-healthy, you will eventually notice clothes fitting looser, your waistline shrinking. Throw away the scale and let your clothes be your guide. You will lose weight holistically.

5. Maintain a healthy weight We are creatures of our genetic gene pool. Some of us were born of parents with great metabolisms. I often do speaking engagements with a local doctor, who is 5ft 5in with a slender build. She says that she is built just like her mother. I,


THE MEDITERRANEAN DIET is rich in breads, pastas, vegetables, fruit and legumes. Olive oil is used in cooking in lieu of butter or other fats. Seafood is emphasized over red meat. on the other hand, have the genetic thighs of my father’s side of the family. Let’s just say I could never wear corduroy. Genetics loads the gun; lifestyle pulls the trigger. Know your Body Mass Index or (BMI). Go on line and look for a BMI calculator, aim for a body weight that will keep you in the healthy range. Get regular health screenings. Heart disease is a silent killer. You could be sitting at your desk one day feeling like you are on top of the

world and the next day be found dead at that same desk. Heart disease is a matter of the heart; it takes into consideration the way you have lived your life, the food you have eaten, the amount of exercise you have performed. Coronary heart disease is the build-up of plaque/fat in your arteries; it is unmanaged high blood pressure and high cholesterol. Left unchecked, it damages your heart with no external signs. Without testing for them, you probably won't know

whether you have these conditions. Regular screening can tell you what your numbers should be, where you are and whether you need to take action. The Bermuda Heart Foundation has recently opened the first cardiac prevention and rehabilitation centre because sometimes we all need a little help. For more information call 232-2673. ■

SIMONE J. Barton is executive director of the Bermuda Heart Foundation.

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AFFAIRS OF THE HEART: A regular exercise regime helps avoid the dreaded heart attack

What to do in case of a heart attack COPY SUPPLIED BY BERMUDA RED CROSS What an amazing organ the heart is. In an average lifetime it will beat more than three billion times. The heart is about the size of a fist and lies in the centre of the chest between the lungs. It pumps blood throughout the body. The ribs, breastbone and spine protect it from injury. The heart is separated

into right and left halves. Blood that contains little or no oxygen enters the right side of the heart and is pumped to the lungs. The blood picks up oxygen in the lungs when you breathe. The oxygen-rich blood then goes to the left side of the heart and is pumped to all parts of the body. The heart’s electrical system sends out signals that tell the heart to pump blood, these signals travel through

the upper chambers of the heart called the atria, to the lower chambers, called the ventricles. When a heart is healthy, electrical signals cause the ventricles to squeeze together, or contract. These contractions, force blood out of the heart; the blood then circulates throughout the body. When the ventricles relax between contractions, blood flows back to the heart. The pause that you notice

between heartbeats when taking a person’s pulse are the pause between contractions. If the heart is damaged, the electrical system can become disrupted. This can lead to abnormal heart rhythm that can stop the proper circulation of blood through the body. When damage to the heart causes it to stop working properly, a person experiences a heart attack or other damage to the heart



Signs of a heart attack can include any of the following signals:


THE HUMAN HEART, with the chambers and ventricles clearly visible. muscle. Heart attacks can cause the heart to beat in an irregular way. This can prevent blood from circulating effectively. When the heart does not beat properly, normal breathing can become disrupted or stop altogether. A heart attack can also cause the heart to stop beating entirely. This condition is called cardiac arrest.

Cardiac arrest The most common abnormal rhythm the heart goes into during sudden cardiac arrest is ventricular fibrillation or V-Fib. During V-Fib, the heart’s electrical system stops making sense. This causes fibrillation or quivering of the ventricles with the result that the heart cannot send enough blood through the body and there are no signs of life. Another abnormal rhythm found during cardiac arrest is ventricular tachycardia or V-tach. With V-tach, the electrical system tells the ventricles to contract too quickly. When this happens, the heart cannot pump blood properly. As with V-fib, during V-tach the person will show no signs of life. In many cases, V-fib and V-tach rhythms can be corrected by an electric shock delivered by an automated external defibrillator (AED). This shock disrupts the abnormal electrical activity of V-fib and V-tach long enough to allow the heart to

■ Persistent chest discomfort lasting more than 3 to 5 minutes. ■ Persistent chest discomfort that goes away and comes back. ■ Discomfort, pain or pressure in either arm, back or stomach. ■ Discomfort pain or pressure that spreads to the shoulder, arm, neck or jaw.

■ Dizziness, light-headedness or loss of consciousness. ■ Trouble breathing including gasping, shortness of breath, or faster than normal breathing. ■ Nausea. ■ Pale or ashy looking skin. ■ Sweating – face may be moist or person may be sweating profusely.

Care for a heart attack Recognize the signals. Call 911 or the local. emergency number immediately for help. ■ ■

JANUARY 21, 2011 ■ 11 ■ Have the person rest in a comfortable position. ■ Obtain additional information abut the person’s condition. ■ Assist with medication if prescribed ■ Monitor the person’s condition. ■ Be prepared to give CPR and if available use AED. ■

ALL INFORMATION in the article above is taken from the First Aid/CPR/AED for Schools and the Community Participants Manual of the American Red Cross pages 67 – 71.

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Bermuda’s health system check-up BY JENNIFER ATTRIDE-STIRLING We’ve all been there before. Sitting in the doctor’s office, explaining the pain in our back, soreness in our throats or the aching in our arm because we cannot figure out why we are not at our optimum. With the doctor’s questions and analysis, however, a solution is found! A country’s health system can also cripple its functioning. In Bermuda it is the fastest growing part of our economy. It was worth $557.7 million in 2009 — and, yet a thorough checkup on Bermuda’s health system has never been done. Until now. For the first time in Bermuda’s history, we at the Bermuda Health Council (BHeC), and the Department of Health have done a full check-up of our health system based on information about the public, health professionals, hospitals and insurers. We have analyzed the available data and compared it to other countries of similar high-income levels — the 30 countries in the Organisation for Economic Cooperation and Development countries (OECD). These include the United States, Canada, Australia, Japan, Norway, and Switzerland, to name a few. The result is our forthcoming report that analyzes 76 indicators on everything from health status and social determinants of health, to the workforce and financing. It is called Healthcare in Review: An International Comparative Analysis of Bermuda Health System Indicators and we will release all of the findings within the coming month. To compile the report, there were a number of questions that needed to be asked. With Bermuda’s healthcare spending growing by 47 per cent (from $378.1 million to $557.7 million) between 2004 and 2009, perhaps the most important


COMPARISONS with OECD countries show that Bermuda’s spending on health is proportionate to its wealth.


JENNIFER ATTRIDESTIRLING of the Bermuda Health Council. were: where was the money going? And was the public happy with the result? With that question posed we found some interesting trends, which I am happy to give you a sneak-peek of right now: ■ Most people feel their healthcare needs are met. Only 11 percent of the population state they have unmet healthcare needs. ■ Lack of insurance coverage was the number one complaint for their needs being unmet. This was usually for those with an income level that was under $50K (see graph page 13).

■ Those with income levels above $100K were less concerned about coverage and more worried about their unmet need for specialists and facilities. ■ The population with an income that fell between these two was divided on their concerns, but was worried about the lack of Government funding. ■ Overall spending on our healthcare system, however, ranks second among the OECD countries, accounting for cost of living. We are surpassed only by the U.S. ■ We spend 40 per cent more than the OECD average and that amounts to 8.5 per cent of the Island’s GDP, which represents nearly 18 per cent of all household spending. ■ When Bermuda is compared to OECD countries, however, the island’s spending is proportionate in relation to its wealth. These numbers led us to ask: why are we spending so much? And, perhaps, more importantly, is the healthcare we have making the public healthier? To answer these questions we pulled together statistics on diseases, deaths and activities that affect Bermuda’s healthcare and, of course, compared them to the OECD countries. The areas we looked at

included everything from AIDS, to diabetes, and road traffic accidents. What we found was that Bermuda has among the highest level of obese and overweight adults compared to the OECD countries. We also have a higher rate of diabetes than all OECD countries. Where we do well, however, is the rate of mortality for cancers. Our overall mortality rate is lower than the OECD average, and for women, is among the lowest of all countries compared. But what might surprise you even more is our level of traffic accidents. Though we might think the Island has too many, when we compare it to all of the OECD countries the numbers are even worse. We have the highest rate of road accidents of any of the OECD countries. I could continue, and the report that will be out soon, does. Our hope at the BHeC and the Department of Health is that now that we know where our trouble spots are we can begin to fix the problems and continue to excel in our strengths. ■

JENNIFER ATTRIDESTIRLING is chief executive officer of the Bermuda Health Council.



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GRAPH OF SELECTED REASONS for unmet health care needs, by income, 2005 (BDA).

14 ■ JANUARY 21, 2011



Mid-season flu shots still beneficial BY DR. J. J. SOARES Symptoms of the dreaded flu include fever (100 degrees plus temperature), muscle aches and chills. The sufferer may or may not experience headache, sore throat, runny nose, nausea, vomiting, diarrhoea and cough. It is interesting to note that most of these unpleasant symptoms are not caused by the invading virus itself, but by the immunological response mounted by the body. The onset of symptoms means that our immune system is fighting back. Immunocompromised individuals may not have any symptoms, as their immune system does not respond in the correct way.

Immune system Healthy individuals with an intact and functioning immune system usually win the fight against the viruses. Compromised individuals may not, although ironically showing fewer symptoms than normal. The incubation period of the flu can range from one to four days. Individuals having contracted the flu may pass it on to others from as early as the day before showing symptoms and up to seven days after they become symptomatic. One can reduce the chance of infecting others with frequent hand washing, covering one’s nose and mouth with their sleeve (not their hands) when they sneeze or cough, trying not to touch one’s nose, mouth or eyes and staying at home — away from work and not socializing — for 24 hours after the fever ends. Once one has the flu, treatment is symptomrelated. Take regular Tylenol/Paracetamol for fever and drink plenty of fluids to compensate for the increased fluid loss that diarrhoea, vomiting and fever bring. In life-threatening infec-


PROTECTION: Dr. J. J. Soares of The Hamilton Medical Center holds up a sample of this season’s flu vaccine. tions, antiviral prescription medicines are an option, but most folks won’t need these to get over the flu. The flu shot is meant to protect us from a number of influenza viruses, which

circulate each year. The flu vaccine is different each year. Although usually containing no live viruses, the flu vaccine exhibits some of the proteins typically found in the strains of flu.

Upon injection of the vaccine, the immune system launches a defence against these proteins by making antibodies against them. Since the proteins in the vaccine are the same ones



found on the surface of the influenza viruses circulating that year, the body, by default, is launching a defence against the flu as well. Administering the vaccine causes the body to produce these useful antibodies in advance. This process takes usually up to a few weeks. Some of these remain in the blood as memory cells so that if the person is exposed to the flu virus in the future, the body can rapidly ramp up production of these antibodies in a matter of hours/days (rather than the days to weeks it would take to mount this response from scratch). These ready-made antibodies neutralize any virus in the bloodstream before it reaches high enough titres (specific value) to cause an infection. In this way, one is said to be immunized against that form of flu. The problem is that flu viruses are continuously mutating to evade the immunological system, and

each year’s flu viruses are different from those of previous years. For this reason it is important to get the latest flu vaccine each year. Last year’s vaccine only protects us from last year’s flu, not the new wave of this year’s mutations.

Flu shot It is good to have the flu shot before the flu season, which runs from October each year and can run as late as up to May. The shots usually arrive here in Bermuda in or around early October. Once given the shot, it can take about two-weeks for the immune system to mount a proper response. One is said to be fully immunized after about two weeks of receiving the shot. If a patient gets the flu before the flu shot has mounted its full effect, their symptoms may be a bit milder than someone who hasn’t received the shot at all. Getting the flu shot after

one has already had the flu is also valuable as remember the shot immunizes us against more than one virus, which we may yet be exposed to. For the most part, the shot should not add to the health problems of a patient who has already had the flu and still offers protection against other strains. A flu shot at any time of the year is better than not receiving one at all. The later one leaves it in the year the less helpful it is, however, as your likelihood of being exposed to one of the flu viruses after ‘the flu season’ is over becomes more remote.

Further protection Can a person do anything other than having the flu shot to protect themselves against the flu? Yes. If there is one basic thing in medicine that never changes it is that healthy living is the best thing one can do for them-

JANUARY 21, 2011 ■ 15

selves to prevent illness. Eating a balanced diet with the proper food groups is the mainstay. Without proper nutrition, the body will not have the building blocks to mount an immune response. A good diet is usually sufficient. One can take vitamin supplements in hopes of boosting the immune system, but it is generally accepted that one needs little supplementation on top of a balanced diet. Of course, regular exercise and sufficient rest are important too. In today’s society, stress can also be detrimental to our bodies. The Hamilton Medical Center offers nominally priced walk-in flu shots to the general public from October till May each year. It is open from 6:45am till 5:30pm during the week, and on Saturday mornings. Appointments are not necessary. ■

DR. J. J. SOARES, is the director of The Hamilton Medical Center Ltd.

16 ■ JANUARY 21, 2011





JANUARY 21, 2011 ■ 17

Dealing with peripheral arterial disease BY DR. NATALIE BENNETT Podiatrist at The Foot & Ankle Clinic

Peripheral arterial disease (PAD) happens when there is a narrowing of the blood vessels outside of your heart. The cause of PAD is atherosclerosis, which happens when plaque, a substance made up of fat and cholesterol, builds up on the walls of the arteries. The most commonly affected arteries are those that supply blood to the legs. The plaque causes the arteries to narrow or become blocked and can reduce or stop blood flow. The main symptom is pain in one or both legs when you walk or exercise and is relieved when you rest for a few minutes. This pain varies between cases and you may feel aching, cramping or tiredness in your legs. This is called intermittent claudication. When you walk, your calf muscles need an extra blood and oxygen supply. The narrowed artery cannot deliver the extra blood and so pain occurs from the oxygen-starved muscles. The pain comes on more rapidly when you walk up a hill or stairs than when on the flat. A person with PAD also has an increased risk of heart attack and stroke. You can often stop or reverse the build-up of plaque in the arteries with dietary changes, exercise, and efforts to lower high cholesterol levels and high blood pressure.

How is peripheral arterial disease diagnosed? The diagnosis is usually made through a series of tests, including the ankle brachial pressure index (ABPI), the toe brachial pressure index (TBPI) and ultrasound assessments of arteries and veins. One of these tests alone cannot determine if PAD is present therefore a comprehensive lower limb vascular


DR. STUART A. MCINTOSH, podiatrist, of The Foot & Ankle Clinic tends the feet of Clarence D. Burgess. assessment is required to determine the presence and extent of PAD. The podiatrists at The Foot and Ankle Clinic recommend that comprehensive lower limb vascular assessments be carried out for any individual who experiences pain, cramping or tiredness in the legs when walking. Vascular assessments are also recommended for anyone with diabetes, high blood pressure, high cholesterol, varicose veins, swelling in the lower leg or ankle or a history of smoking as these can all contribute to or increase your chances of PAD.

Exercise regularly Regular exercise encourages other smaller arteries in the legs to enlarge and improve the blood supply. If

you exercise regularly, there is a good chance that symptoms will improve, and the distance that you can walk before pain develops will increase. Walking is the best exercise if you have PAD, and regular exercise means a walk every day, or on most days. ■ Walk until the pain develops, then rest for a few minutes. ■ Carry on walking when the pain has eased. ■ Keep this up for at least 30 minutes each day and preferably for an hour a day. The pain is not damaging to the muscles. Other exercises such as cycling and swimming will also help you to become fit and are good for the heart, however, these should be done in addition to walking, as walking has been shown

to be the best exercise to improve symptoms of PAD.

Take care of your feet Good foot hygiene is important and should include drying your feet thoroughly after bathing, especially between the toes. Check for any colour change or irritation on the skin of the soles and sides of the feet as well as between the toes. Also check for any difference in temperature from one foot to the other. The Foot & Ankle Clinic has a team of podiatrists available six days a week to provide podiatry consultation and comprehensive lower limb vascular assessments. GP referrals are not essential. ■

FOR MORE information, call 296-1288.

18 ■ JANUARY 21, 2011



The importance of physiotherapy BY DR. ANNABEL CARTER Picture this: you are out on the soccer pitch, or perhaps just taking a walk along the railway trail. A player comes at you from the side as you go for the ball, or perhaps a momentary distraction has you stepping awkwardly in a pothole on the trail; in both cases it takes but a heartbeat for your world to change for the worse. The ankle unexpectedly rolls way over, beyond what seems humanly possible, and you find yourself unceremoniously sitting on the ground, your breath taken away by the sheer intensity of the pain. It takes a few minutes before you gather yourself together and gingerly try a couple of steps on an ankle that is already visibly swollen. Maybe you limp to the Emergency and the staff there X-rays the ankle, telling you it’s “just a sprain” and send you on your way. What now? If the injury is mild, with no significant tear or rupture of stabilizing ligaments, perhaps you’ll be just fine on your own, following the administration of what you’ve read in the books about R.I.C.E (rest/ice/compression/elev ation) over the first few days and then getting going gradually from there. Perhaps you’ll never even injure that ankle again. But you might not be so lucky. The injury may lead to further injuries down the road, more time out from a normal lifestyle, the ankle becoming more unstable with time and possibly even progressing to having secondary arthritis and potential permanent disability as a consequence. This can have ramifications not only for your more vigorous sporting days, but also in the simple pleasures of jogging, walking and one day just plain getting about. This is where physiotherapy steps in. At the very least you can think of your


DR. ANNABEL CARTER, sport and exercise medicine specialist, rotates the leg of patient Claire de Ste Croix in a piriformis stretch. physiotherapist as a guide. Advising you firstly on finetuning the RICE, then guiding you through a rehabilitation programme with gradual and progressive exercises. These typically

centre on restoring normal joint and soft tissue range of motion, muscle strength and general stability. Exercising too hard and too much can be detrimental to an effective injury

recovery, yet not doing enough may be just as bad and set you up for future injury. Depending on the type of injury, some people may benefit from treatment



JANUARY 21, 2011 ■ 19

rehabilitation following an injury modalities, which include therapeutic ultrasound, laser and interferential therapies, as well as manual therapy. Straightforward cases may only require one or two visits to the physiotherapist; the more complex and severe may take several weeks or even months to achieve optimal recovery. The physiotherapist is also in an ideal position monitoring cases with time to judge when those patients who ultimately ‘fail’ physiotherapy may require further investigation or referral on for various other treatment options including injections or surgery. A recent survey by the Football Association in the U.K. reported that more than half the injuries sustained in soccer were without contacting another player, i.e. during activities such as sprinting, landing, and slowing down. Gender differences also prevail in that female soccer players are five times more likely than their male counterparts to rupture the main knee stabilizing ligament, the anterior cruciate ligament (ACL). Recent evidence suggests that this is at least in part due to reduced leg stability and faulty knee alignment particularly in landing from jumps and while turning, which has implications across many sports. Again enter physiotherapy. A good physiotherapy sports injury rehabilitation programme can help athletes and coaches to address the varying aspects of an injury when it occurs and aid in working out prevention strategies. Initial focus is made on flexibility, mobility and strengthening where exercises progressively restore pre-injury conditions. Programmes should be tailored to the individual, working on fitness through alternative training methods and minimizing performance and fitness loss

without stressing the injury. Poor training techniques are common causes of sports injuries and during rehabilitation, exercises can be performed to help correct faulty techniques performed prior to the injury (such as the faulty knee alignment alluded to above), thus working towards future injury prevention. Some injuries, of course, can never be avoided; with or without the best physiotherapy rehabilitation there is on offer. But at least having access to good physiotherapy services can offer one of the best ways possible of minimizing recovery time and getting us back out where we want to be, out there on the railway trail or on the field, enjoying what we want to do, and for as long as possible. ■

DR. ANNABEL Carter specializes in sports and exercise medicine. She can be reached at 292-6901.


AT FULL STRETCH: Dr. Annabel Carter manipulates the leg of Claire de Ste Croix with a hamstring stretch.

20 ■ JANUARY 21, 2011




DR. GEORGE SHAW, family physician, confers with nurse Ellen Baxter at his practice in Sandys.

Should everyone have an annual physical? BY DR. GEORGE SHAW Family Physician

A question that has been debated for many years and still is: should everyone have an annual physical? The origins of the practice, in the early part of the last century, apparently came from physicians doing examinations to see if people were fit enough to be sold life insurance. In 1947, the AMA (American Medical Association) suggested that everyone should have a yearly check up, even when

they were healthy. It then became an accepted practice, which many follow to this day. Studies in the 60s and 70s, however, showed that persons who have annual physicals did not live longer or have less illness than persons who did not have annual physicals. More recently, with the advent of evidence-based medicine, and of financial and time constraints, there has been a move away from the practice. Even so, many people continue to have a yearly check

up. They are reassured by the fact that they do not have anything wrong. So, does every healthy ‘twenty something,’ who has no specific complaint, need a yearly physical? Probably not. I hasten to add that this applies to healthy young people, who have no ongoing chronic medical conditions. Persons who have hypertension, diabetes, asthma or other chronic conditions should see their physicians a minimum of once a year. Do my patients come for

annual physicals? Many do. Interestingly, they are the ones who are already following a healthy lifestyle, doing the right things and looking after themselves. Many who should come, don’t. There are certain tests and procedures that are accepted by the medical community as being important components of preventive medicine. Some screening tests include screening for cervical cancer (PAP smear, or Papanicolau smear), prostate cancer (PSA, or prostate specific antigen



and rectal exam), diabetes, colon cancer (fecal occult blood testing; possibly colonoscopy), mammography, bone densitometry and cholesterol testing. These are done periodically, and the timing of them is based on the age of the patient and the family history. Much of what is included in an annual physical can be done at a regular visit. Many physicians will use a regular visit to ask specific questions and to do a targeted physical examination. So what things are important in an annual visit? For me, enquiring about significant family medical history, and about the traditional risk factors for heart disease and stroke (cardiovascular disease) are a priority. These traditional risk factors include: family history, gender, smoking, hypertension, elevated cholesterol, diabetes, and sedentary lifestyle. Specific questioning will vary by age and gender. If

there is a positive family history of a specific condition, usually screening will be commenced earlier than would be recommended for a person with a negative family history.

Women Women’s health exams include a check for a family history of gynaecologic malignancy, breast cancer or colon cancer, as well as for a history of cardiovascular disease. Screening for cervical cancer (PAP) usually begins at age 18, or three years after becoming sexually active. After two normal yearly exams, frequency can move to every three years. STD (sexually transmitted disease) screening for sexually active women should be yearly. Cervical cancer has been shown to be caused by persistent Human Papilloma Virus (HPV) infection. There are two vaccines available that protect

against the vast majority of troublesome HPV types, and it is recommended that girls age 10 to 12 receive one of these vaccines, which will confer, hopefully, life-long protection. It is noted that these vaccines can be given to women up to age 26. I have no idea why there is not more uptake on this. Perhaps there needs to be more dissemination of information. Breast exams should be done at the time of the gynaecologic exam. Mammography usually starts after age 40, earlier if family history dictates. Colon cancer screening should start at age 50, and can be done by yearly fecal occult blood testing, or colonoscopy every ten years. Again, timing would be influenced by family history. Women are traditionally better at seeking medical attention than men. But there are signs of improvement, probably related to

JANUARY 21, 2011 ■ 21

the heightened awareness of various conditions and advertising campaigns.

Men Men’s screening will involve risk factors for heart disease and stroke, prostate cancer and colon cancer, and these will come into play at different ages. Prostate screening should begin at age 40, and involves a PSA blood test and a digital rectal exam. Colon cancer screening is the same as for women. Other topics to cover include avoidance of risky behaviour, immunizations history, eye health and mental health. In summary, people are much more educated about health matters now and should be part of the process. Making arrangements with your doctor to have a periodic health maintenance exam is a good idea, to be sure that all that can be done to maximize one’s good health is done. ■

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Revere life’s truly perfect gift: the BY LESLIE BARKER GARCIA (MCT)

All too often, we look at our bodies as a white-elephant offering rather than as a treasured gift. We’d happily pass to someone else our varicose veins, oversize nose, frizzy hair, extra-wide feet. We’d swap in a minute our pokey metabolism, our allergies, our bellies that hurt when we eat dairy products. Yet whatever we might think, the body is, indeed, a gift. Hair and skin, blood and bones, crooks of elbows and knees, it is connections and pathways, a puzzle and a patchwork quilt. It is a symphony and a soufflé, a sunrise and sunset. Without each instrument, each ingredient, each interspersing of light and shadow, it falters a little; its magnificence a bit shriller or flatter or darker. Yet with each, it moves and heals; it rests and breathes and grows. Dr. Tom Shires knows more than most about the intricacies and awes of the human body, and day after day he revels in them. He gave up his dream of being a rock star to become a physician. The rhythm of the human pulse has replaced the beat of his beloved string bass and trumpet — ever steady, ever true. Several times each day, in his role as chair of surgery at Texas Health Presbyterian Hospital Dallas, he makes gigantic as well as microscopic cuts into these masterpieces. He removes what shouldn’t be there, and helps strengthen that which belongs. Each time, he balances knowledge with mystery, putting into practice what he has been taught and what he has learned, continually struck again by enigmas that may never be answered. “The body talks to itself,” Shires says, taking a break in one of the hospital’s


LIFE’S GIFT: What a piece of work is the human body: it breathes, it heals, and yet it is flawed. fourth-floor waiting rooms. “I operated on a patient’s 60year-old liver recently. It had grown as he grew, and stopped growing in his adolescence. When it got a little cancer on it, I removed half

of it. “Somehow the ‘on’ switch gets turned back on and it starts growing. How does the body perceive it’s only half there, and when it’s fully grown it stops grow-

ing? Take 80 per cent of the liver out and in a couple of months, it’s back. “It’s God; it’s magic. It makes you religious. Who in creation planned you’d need to grow a liver back?”



JANUARY 21, 2011 ■ 23

perfectly flawed human body Shires talks quickly, in part because his beeper could go off any second and he’d have to leave, yet also because he seems hardly able to contain his excitement. “This is something different every day,” he says. “It’s like fishing in the ocean. You cast your lines, but until you pull it up and look, you don’t know what’s there. What’s real is what we hold in our hands, what we see with our eyes, what we smell. “We’re born and we die, and all things conspire to get us through the journey.” For most of our lives, during much of that jaunt, we tend to take our bodies for granted. We don’t think to stop and marvel, though well we should: a cut that ■ ISTOCK PHOTO

See FLAWED, page 25

A WONDERFUL LIFE: One can only marvel at the perfect creation of a baby’s fingers.

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How do the body’s parts work together to make that happen, or falter to prevent the simplest of movements? Sometimes, it takes a breakdown in this system to draw attention to how wonderful it is. Since the end of August, my father has been in and out of hospitals and rehabilitation centres. At 83, his body has endured congestive heart failure, a broken back; one surgery was to insert a pacemaker, another to remove a melanoma. With age, his skin has become thin — not in the way his sensitive daughter’s is, but quite literally. When I see him, he frequently has a new place on his arm that’s bleeding. Yet neck-and-neck with his health issues is his determination to strike back at what his body is hurling at him. Until he went to rehab, he never understood the appeal of exercise. Yet he looked forward to and excelled at the physical-

Continued from page 25 bled through a paper napkin last week is glasssmooth skin today. A baby is born, each finger and toe a perfect creation. Floss, and you’re less likely to get heart disease. Lose weight, and your body rejoices with a chorus of lowered cholesterol, brighter mood, reduced risk of diabetes. Quit smoking, and almost immediately your lungs are clearer. Get one massage and your immune system becomes more resilient. Snap your fingers. Swim a lap. Sleep. Stand on a street corner and watch marathoners run by. Each moves forward, yet each body is different; each pace, each form, each landing of the feet on concrete. What makes one run faster than another, or a basketball player jump higher, or a piano player’s fingers move in staccato steps?

therapy sessions that still help strengthen his body, and which helped get him home.

Therapy I sat in on some of them, watched a group of people brought together by fate and circumstance: the man with the half-spiral of stitching encircling his shaved head, the young woman in the electric wheelchair, the older woman on oxygen. They held tiny weights no heavier than a box of cereal, made moves however slight. Yet their bodies responded; I could see my dad getting stronger. At the end of each three-hour session, he’d say, “Honey, that felt great.” Dad will never run a marathon; he may never walk more than a block or two. But he does what he can with what he has been given. His accomplishments — manipulating his wheelchair, rolling into bed without twisting his back — are

JANUARY 21, 2011 ■ 25

every bit as successful as my son’s when he hurls a volleyball over the net at nose-breaking speed, or triple-jumps a few inches farther than he did a month ago. We’re entrusted, each of us, to make the most of this gift which we are granted. I will never look as young, weigh as little or be as tall as I might like. My nose won’t be as cute as my best friend’s, my teeth straight as my son’s, my feet small as my mom’s. Truth to tell and for the most part, that’s okay by me. What matters is that I am able to tie my shoes in a double knot, and to pull the warm red cap my father gave me over my ears. I can start running, because even if I don’t go as fast or far as I would like, I will do it, simply because I can. It’s just my way of whispering — once I get started I don’t have much breath for anything else — thank you. For this most precious of gifts. ■

26 ■ JANUARY 21, 2011




WALKING THE WALK: The Argus Group has developed a number of walking routes in the City of Hamilton, ranging from two to four-miles, which will help you start a regular walking regime.

Walk your way to wellness this year BY GERALD SIMONS President, The Argus Group

Getting fit and losing weight are always popular New Year’s resolutions. Starting a new regime or taking your current walking routine to the next level is a good way to start 2011. Walking is the easiest form of exercise, even for some who have a major health problem or disability. It’s flexible enough to suit your schedule and you can even vary your routes by including beaches and parks at the weekend when you have more time. It’s sociable: you can catch up with family, friends and colleagues along the route. It’s

cheap: you don’t need to join an expensive gym — all you need is a good pair of shoes. Walking is a great cardiovascular activity, reducing both blood pressure and cholesterol. It also helps to burn calories, boost energy and increase the metabolic rate. Exercise can help to manage the symptoms of stress by making use of the adrenaline and sugar produced in your body as a result of anxiety, instead of it being left to damage your heart, cause weight gain and poor sleep. Your muscles will get a great workout from walking — especially your calves

and gluteals — which will help to improve your flexibility. Above all, an active lifestyle helps to prevent and manage disease. You don’t have to run a marathon to reap the rewards of exercise. Cancer risk is lowered with increased physical activity, especially by moving from inactivity to moderate activity. The leading cause of heart disease is physical inactivity and research suggests that half an hour of aerobic exercise daily can cut the risk of a fatal heart attack by 60 per cent for those with existing heart disease.

Studies show that low aerobic fitness increases the risk of cardiovascular disease in particular and overall disease and deaths in people with diabetes. Exercise also improves the action of insulin, resulting in improved blood sugar levels. Being physically active can also help protect your bones against osteoporosis, relieve arthritis and back pain, lower the risk of gallstones and impotence, reduce anxiety and depression and help delay the effects of aging. So there are lots of reasons to get up and get moving. Before starting a walking



programme, bear in mind that good footwear is your best protection against injury. You should replace old shoes as they can contribute to injuries such as shin splints, as well as general foot and leg fatigue. Remember, shoe cushioning loses its effectiveness after 500 miles, often long before soles or uppers show wear. You need shoes that fit properly and are correct for your foot type, weight, gender and the distance you plan to cover. Look for uppers made from mesh or with air holes to allow your feet to breathe. Wearing the right socks is also important to ensure your feet stay dry, comfortable and cushioned. Choose a sock that fits snugly on your foot and is made of polyester, polyester blend, or CoolMax fabric as these materials pull moisture away from your skin and reduce the chance of blisters. Wear comfortable clothing. Again, choose polyester

or CoolMax fabrics to draw the moisture away from your skin to the outside of the garment, where it will evaporate more quickly. These fabrics result in less chafing and bacteria production. If you are prone to blisters, apply a lubricant to trouble spots before walks.

Hamilton walks You only need to walk three times a week to obtain a good level of fitness. The Argus Group has developed a number of walking routes in the City of Hamilton, available at, to make it easier to get started with a regular walking regime. We have mapped out two-, three- and four-mile routes, so why not start with the two-mile course and work your way up to four miles. All of the routes begin and end at the new Argus Building at 14 Wesley Street, so they are accessible to those working in Hamilton. If you are walking specifically to lose weight then it

is interesting to note that a study by the University of Massachusetts Medical School found that walking for 45 minutes, four times a week, resulted in an average weight loss of 17 lbs in one year, without any form of dietary changes. Another way of measuring your progress is to use a pedometer to track the number of steps you take each day. A pedometer is a small, inexpensive device that clips onto your waistband. Start by using the pedometer over a three-day period to determine the average number of steps you normally take each day. Then increase it by 1,000 to 2,000 steps for the first week. Each consecutive week, aim to increase your steps by 1,000 to 2,000 until you reach 8,000 to 10,000 steps on at least five days. If you are currently sedentary, 10,000 steps a day may seem like a lot of walking but by gradually increasing your average

JANUARY 21, 2011 ■ 27

number of steps, it becomes a more achievable goal. If you are already active then 10,000 steps may not be enough of a challenge, so set yourself a higher target. If you don’t have a pedometer, 30 minutes of brisk walking equates to approximately 3,000-4,000 steps depending on your height, stride and pace. No matter how fast or far you plan to walk, you need to warm up at an easy pace for the first 10 minutes. Stop and stretch after your warm-up to increase blood flow to the muscles, holding stretches for 15 to 20 seconds, while you continue to breathe. There are lots of small changes you can make to your daily routine to ensure you take more steps. For example, use the stairs rather than an elevator, get up 15 minutes earlier and go for a short walk or park your car further away from stores when you go shopping. Don’t delay; go for a walk today! ■

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28 ■ JANUARY 21, 2011




KEEP GOING: Kym Herron Scott, owner of The Athletic Club (left) watches as Judy Benevides, management team member, works out on the elliptical.

Gain control of your body and your life BY KYM HERRON SCOTT Timothy Ferriss, author of the number one New York Times’ best seller, The 4-Hour Workweek recently released his new book, The 4 Hour Body. He jokes that the major fears of modern man could be boiled down to two things: too much e-mail and getting fat. Upon the arrival of yet another New Year comes — you guessed it — New Year’s resolutions, the most popular of which are a change in exercise and diet. Is it time for an attitude adjustment? If you have the

wrong attitude about fitness, you’ve already set yourself up for failure. Most people think of exercise as punishment, obligation, pain, and as a timeconsuming bore. However, exercise is a break from a stressful day; a way to boost energy, an opportunity to get physical and rest the mind, reward the body for working so hard, ‘me time’, and a way to immediately improve quality of life. As we all make extreme promises from time to time, New Year’s resolutions work the same way.

Let’s look at making realistic goals versus extreme resolutions ■ I will go to the gym three days a week increasing to four days as I get comfortable versus I will go to the gym and work out every day; ■ I will dust off my treadmill and use it a certain number of times per week versus I will train for an ironman triathlon; ■ I will hire a trainer to teach me the best way to weight train versus I will use my dumbbells for something other than paperweights, if I can find them.

You get the idea. Resolutions sound great when you make them, but the reality is often a far cry from what you imagine. What happens when the thrill is gone? What can you do in order to not abandon your resolutions? ■ Results take time. Be patient and consistent. It can take weeks or months to see significant changes. Don’t think you’re doing something wrong and give up before you see these results. ■ Plan ahead. Making permanent changes requires



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planning. Hitting the gym without a clear idea of what to do can lead to frustrations and confusion and for many, quitting. Quality clubs have the expertise to help you reach your goals. Some sessions may be included with your membership, such as an assessment and goal setting session, programme orientation and personal training session just to get you started and then following up within three months. ■ Set realistic goals. Keep them specific, measureable, achievable, trackable and reasonable. Stick with goals that work for your body, your lifestyle and what you are willing to do with your exercise time. ■ Start slowly. It takes time to build strength, power and endurance; allow your body the time to adjust. This is essential for permanent change. Add small challenges each week to progress. ■ Have fun and don’t take yourself too seriously. Getting healthy and losing weight is important, but it doesn’t have to be grim. Get moving with something you enjoy, such as a dance inspired class like Zumba, or punch it out in a martial arts based class like BodyCombat. Change your attitude about fitness and you will be more likely to stick with it.

Kym’s weight control tips ■ Weight training is the key to effective fat burning. The more muscle you carry the more efficiently you will burn fat. ■ Increase your calorie burn by exercising at higher intensities. The fat burning zone (55 to 65 per cent of your maximum heart rate) can be misleading. ■ Quicken your metabolism by eating six small healthy meals a day instead of three larger ones. Eat a portion of protein (chicken, salmon, or egg whites) and carbohydrates (sweet potato, pasta, or oatmeal) with each meal. Add veggies when you can. Use performance shakes or bars to supplement some of your meals if necessary.


CARDIOVASCULAR TRAINING: Kym Herron Scott (right) puts Judy Benevides through her paces on the Cardio Wave. ■ Portion control. I like to use my clenched fist or palm of my hand to represent the size of portion for each of rice, chicken and vegetables, as an example. ■ Plan your grocery list in advance, not when at the store. ■ Water, water, water. Drink at least 10 cups per day. It keeps you hydrated and fills a temporary void if hungry. ■ Give yourself a break

once a week without beating yourself up. Eat what you like and rest your body. ■ When it comes to fat loss what matters most is how many calories you burn as opposed to how many calories you take in. Timothy Ferriss sums it up like this. “Take adherence seriously. Will you actually stick with this change until you hit your goal? “If not, find another

method, even if it’s less effective and less efficient. The decent method you follow is better than the perfect method you quit!” ■

KYM HERRON SCOTT, owner and president of The Athletic Club Bermuda and Turks and Caicos, welcomes your comments. Let her know how you are progressing with your goals. Contact Kym at athleticclub@

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DANCE, DANCE, WHEREVER YOU MAY BE: Dancers give an enthusiastic demonstration of salsa in the street.

Dance your way to a magnificent you BY TERESA WHITTER Sabor Dance School

If you’re searching for a fun, exciting activity to include in your fitness routine, or simply something new to try in the New Year, look no further than the wide variety of social dance classes offered at the Sabor Dance School. Whether you need a new activity to improve your fitness or just to meet new people, social dancing and

dance-inspired fitness classes may be just the ticket. It’s no secret that TV and film have elevated social dancing to epic new heights in recent years, and for good reason: it’s glamorous, sexy, fiery, graceful, expressive…and fun! However, all glitz and glitter aside, dancing has become a source of immense physical, mental, emotional and social benefit. With dance schools,

organizations and events in every corner of the globe, it’s not difficult to reap the many benefits dancing provides.

Physical Dancing lowers the risk of coronary heart disease, lowers blood pressure and cholesterol levels, increases heart and lung efficiency, improves co-ordination and balance, improves flexibility, burns fat (calories burned will vary depending

on age, body composition and gender, but generally you can expect 200 to over 540 calories expended per hour of continuous dance), strengthens muscles and connective tissue (particularly in the core and lower body) and neuromuscular connections, and strengthens bones (dance is a weight-bearing exercise).

Mental Dancing improves kinaesthetic (body movement)



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awareness, improves memory, relieves stress and tension, promotes creativity and the feeling of “letting yourself go”, decreases stressful hormones such as cortisol and increases positive hormones like endorphins, may help lower the risk of dementia and Alzheimer’s, by challenging the brain through learning complex movement and rhythm patterns, and improves quality of sleep.

Emotional Dancing improves mood, promotes freedom of expression, improves selfesteem and self-efficacy (the belief that you can achieve something).

Social Dancing improve communication skills, promotes cooperation, etiquette, respect, team work, and connection with another person. Another incredibly fascinating and relatively recent realization is that dancing promotes “creative intelligence”. According to a 2008 article published by the American Council on Exercise regarding partnered dancing, “the leader and follower are engaged in a constant give and take and must make hundreds of split-second decisions about what to do and where to move next. The person following must interpret signals (through touch, gesture and eye contact), which requires an active, creative intelligence. Dancing with different partners forces the follower to adjust to each one. As for the leader, he must interpret the music in movement terms (her movements, rhythm and which manoeuvres work best for her).” Not sure where to begin? Try Latin dances such as salsa, cha cha, merengue, bachata, Argentine tango, and New York hustle. You can also explore the traditional ballroom dances like waltz, foxtrot, rumba, samba, cha cha, and swing. Sultry yet fun Bollywood (Indian film dance) and zumba (Latin-inspired aero-


LET’S DANCE: Dancing improves fitness and even promotes ‘creative intelligence’. bics classes) are guaranteed to have you sweating by the end! All classes can be found at Sabor Dance School, located in the Berkeley Cultural Centre. Led by a team of passionate, skilled instructors, you’re sure to find something that you enjoy. The price is right, at $100 for a seven-week course (one class per week) and No

partner is necessary! If you’d like to get ahead or practice more, the school offers private, one-on-one lessons. No partner is necessary! All you have to bring are comfortable clothes, non-grip soles and a great attitude! When you’re ready, join your fellow students and instructors and hit the dance floor at SalsaMania

Productions’ two free weekly social dance venues. What better way to spend an evening dancing, playing, exploring and laughing your way to a healthier mind and body. ■

FOR CLASS schedules, upcoming events, and promotions, visit or call 799-6616.

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A seasonal mood disorder named SAD BY DR. SARATH ANANDAGODA Consultant Psychiatrist

If you experience a change in your mood and energy occurring regularly in a particular season every year, you might be having a mood disorder called Seasonal Affective Disorder (SAD). SAD is a better term than the commonly called ‘winter blues’ because in some people this disorder can occur in the summer, when the reverse of feeling blue can occur. Normally, the people who suffer from the disorder notice a change in their level of energy and enthusiasm in the autumn. They become less socially active and tend to sleep more, especially during daytime. They might notice changes in appetite where there might be a craving for carbohydrate foods, and an accompanying gain in weight. Irritability and anxiety are common, too, and if the disorder is more intense, feelings of hopelessness and outright negativity and pessimism can occur. The symptoms might increase as autumn progresses into winter, and gradually diminish and disappear altogether when spring arrives. This cycle should occur for two consecutive years, at least, for a diagnosis of SAD to be made. In some people, the cycle occurs from summer to winter. Others might notice an elevation of activity and over enthusiasm, increased need for social interactions, difficulties with sleep, and loss of appetite seasonally, instead of the lowering of mood and activity. If these changes cause distress and disability to the normal rhythm of life, consider seeking medical treatment as the recurrence of the symptoms annually can be quite disruptive. The exact reason for this


SEASONAL BLUES: Anxiety and irritability as the seasons change are symptoms of SAD. illness is not known, but lack of sunlight during the winter months is thought to effect changes in the activity of the brain chemicals producing the symptoms. This does not explain the illness occurring in the summer months, or the reverse of symptoms manifesting themselves. A genetic predisposition is thought to be the reason in those instances. Treatment depends upon the intensity, and once identified, upon preventative

measures. Obviously, you must get the condition diagnosed by your physician and treatment recommended. ‘Light therapy’ is the proven effective treatment for SAD, and if the disorder is not severe will be sufficient. The objective is to provide the brain with exposure to light that mimics sunlight that, in turn, will affect the brain chemicals. This is done using a light box that is designed to pro-

vide light similar to sunlight. Normal indoor lighting is not effective, and tanning beds with UV light are ineffective, as well as detrimental. It is simply a matter of sitting near a light box and being exposed to the light without actually looking at it. The strength of the light emitted by the light box determines the duration of exposure. The strength of light is measured by a unit called Lux, and a light box that gives 10,000 Lux will need an exposure of 30 minutes. For the necessary strength of light to reach the body, the box will have to be placed two feet away. This is best carried out in the mornings as sleep can be disturbed if done at night. You can get your light therapy in your home or office by placing the box on a desk while you do stationary tasks like using the computer, watching TV or using the phone. Light therapy is best commenced at the onset of the season when the symptoms start and carried out daily till the end of the season. Stopping treatment half way will result in recurrence of the symptoms. Apart from using the light box, exposing yourself to direct sunlight as much as possible, by walking or working outdoors is beneficial. Keeping the house well lit and warm also enhances a sense of wellbeing. If these measures do not give relief, a further evaluation by a physician will be necessary. ■

LIGHT BOXES can be found in Canadian and U.S. pharmacies, according to Dr. Anandagoda, but a brief survey by the Bermuda Sun suggests they are not available in Bermuda. You can research light boxes at or www.lighttherapyproducts. com or Google SAD Light Boxes.

Health Care Directory 2011 Part 1  

Healthcare is big business here and abroad. It concerns everyone, particularly the ever-increasing portion of the population 65 years and ol...

Health Care Directory 2011 Part 1  

Healthcare is big business here and abroad. It concerns everyone, particularly the ever-increasing portion of the population 65 years and ol...