Bodylanguage issue 03 spring 2013

2 2:52 PM

A better health care experience altogether

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Issue 03

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2013

How screening can detect breast cancer when it’s most treatable

Straightening crooked teeth will impact your health and wellbeing

Men in good health: wellness guide for your 20s, 30s, 40s+

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Issue 03 | 2013

Making your own recovery the first priority in your life!

contents 4 up close and personal 02

Boodskap van die Uitvoerende Hoof

04

Health bites – Short bits of info to digest while on the go

16

interact 03

Contributors

06

A day in the life of ...

from the experts 08

heart attacks and preventing cardiovascular disease 12

10 things to know about

Breast health – demystifying cancer screening and

Dr Ina de Beer 07

Matters of the heart –

mammographs

Must haves – Great products and give-aways we

32

want you to know about

your health

Intercare events –

23

healthy pregnancy

What happenend over the last few months

your body 16

24

20 30

Cholesterol and when to

Put some teeth in your smile –

Taking men’s health seriously – an age-related guide

Recipe – Yummy Chicken Briyani for the family

Why straightening teath matters 26

First aid – Heading for a fall?

Tips to prevent trips

consider statins 20

All about – Planning for a

26

1

2

BOODSKAP VAN DIE UITVOERENDE HOOF Geagte Pasiënt, Ons stel met trots Urgent Care, die jongste toevoeging tot ons kwaliteit gesondheidsorgdiens, aan u bekend.

Intercare is uniek in die opsig dat ons ‘n breë spektrum van dienste lewer wat nie net fokus op primêre gesondheidsorg (mediese en tandheelkundige sentrums) nie, maar ook wêreldklas daghospitale, sub-akute- en rehabilitasiehospitale bied. As ‘n waardesgedrewe maatskappy soek ons voortdurend innoverende oplossings om in geheel ‘n beter gesondheidservaring te bied. Juis hierdie benadering het gelei tot die nuut gevestigde Urgent Care diens wat op 2 Mei 2013 by Intercare se Mediese en Tandheelkundige Sentrum te Glenfair Boulevard, Lynnwood, Pretoria geloods is. Hierdie diens sal mettertyd ook na ander takke uitgebrei word. Daar is ook groot potensiaal om Urgent Care sentrums as losstaande eenhede in areas met ‘n hoë bevolkingsdigtheid te vestig.

Urgent Care is die vinnigste groeiende gesondheidsorgmodel in die VSA en is ontwerp met pasiënte se

EDITORIAL Publishing editors Christa Grobler christa@health-bytes.co.za Marilize Eygenberger marilize@health-bytes.co.za

besige skedules in gedagte. Hierdie diens bied ongeskeduleerde, instapafsprake asook verlengde diensure.

Dit vul die leemte tussen die twee tradisionele keuses - jou algemene praktisyn óf die trauma-afdeling van die hospitaal.

Urgent Care is daarop gemik om mediese behandeling te bied vir probleme wat binne 24 uur sorg benodig, maar nie lewensbedreigend is nie, met ander woorde, “less than 911”. Tipiese mediese probleme wat behandel word, sluit onder andere asma-aanvalle, allergiese reaksies, steek- en bytwonde, geringe beserings, rug- en nekpyn, vomering, koors, griep en verkoue, migraine, maagpyn, diaree en ontwatering in.

Die diens vervang nie die algemene praktisyn nie, maar is aanvullend daartoe. So kan ‘n pasiënt ook van die Urgent Care diens gebruik maak indien sy/haar gebruiklike praktisyn

Editorial enquiries Unit 11, Bellfour Office Park, Corner of Rodger & Edmar Street, Bellville, Cape Town, 7530 Tel: 021 917 8804 Fax: 021 917 8801 info@health-bytes.co.za

met verlof is of nie ‘n afspraak tydig kan toestaan nie. Geen opvolgafsprake word in die Urgent Care sentrum hanteer nie. Opvolgafsprake vir pasiënte wat aanvanklik deur die Urgent Care sentrum behandel is, word deur die normale afspraakprosedure hanteer.

Die Urgent Care sentrum is 365 dae van die jaar oop en die verlengde diensure (07:00 – 20:00 op weeksdae en 08:00 – 18:00 oor naweke en op vakansiedae) bied ‘n uitstekende alternatief vir hospitale se traumaafdelings.

Ons glo dat die Urgent Care diens vir u as pasiënt ‘n gerieflike en kosteeffektiewe opsie bied, en ons nooi u uit om daarvan gebruik te maak.

Dr Hendrik Hanekom Uitvoerende Hoof Intercare Groep

Design Blinc Design, Bronwen Moys Proofing Marietjie Yelverton Business managers & publishers Christa Grobler & Marilize Eygenberger 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: 021 917 8804, Fax: 021 917 8801, info@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 03 | 2013

3

contributors

Dr Neil Richards, Family Physician at Intercare.

Professor Justus Apffelstaedt (Head of the Breast Clinic, Tygerberg Hospital, Associate Professor University of Stellenbosch and Chairman of the Breast Interest Group of South Africa) has been responsible for the treatment of thousands of women with breast cancer and introduced many new treatments; he has published widely on breast health matters and is an invited expert at many international conferences. He advises governmental and non-governmental organizations at provincial, national and global level.

Prof Johan Hartshorne, General Dental Practitioner, Intercare Medical and Dental Centre, Tyger Valley and Visiting Professor: Department of Periodontics and Oral Medicine, University of Pretoria.

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 actual. We will then be able to make a difference and to “create the better health care experience altogether� on a daily basis.

Please email us at: info@intercare.co.za with any suggestions, ideas and things you would like to see on these pages.

Dr Elna Rudolph, Sexual Health Physician, MySexualHealth.co.za.

In proud partnership with Intercare.

Dr Joe Bodenstein is a cardiologist at Panorama Medi-Clinic since 2001.

He loves his work and has great fun teaching colleagues during continued medical education programmes. He is also involved with presentations to various patient support groups at Panorama Medi-Clinic.

Health Bytes Publishers Christa Grobler (MSc Biochemistry, MBA) and Marilize Eygenberger (BPharm, MBA) have extensive experience in the pharmaceutical industry with regard to patient education, sales, marketing research, scientific knowledge (disease and products) and pharmacy management.

Health bites

4

health bites Short snippets of info to read and digest while on the go ... take heed of the following ...

Surviving cancer with CANSA’s iSurvivor The Cancer Association of South Africa (CANSA) wants to encourage celebrating life with survivors and their families! During June, CANSA launched its new e-online iSurvivor programme, which is the first of its kind in the world, using short, weekly emails to guide cancer survivors along their journey and help survivors cope better.

“We know how scary and stressful a cancer diagnosis can be resulting in a whole new set of questions and challenges. Our iSurvivor programme is a free email-based course written by a cancer survivor to help other survivors cope better.” says Sue Janse van Rensburg, CANSA’s CEO and cancer survivor herself of nearly 30 years.

“Our revised CancerCare Coping Kit (2 audio CDs) is great for anyone recently diagnosed with cancer, as it provides information and practical tips to promote physical, emotional and mental wellbeing before and during treatment - in short, helping you and your loved ones cope with cancer.”

Please visit www.isurvivor.co.za or www.cansa.org.co.za for more information.

5 voorskrifte vir ‘n regte Mediterreense dieet 1. Gebruik olyfolie as die hoofsaaklike bygevoegde vet (ongeveer 60 ml per dag).

2. Eet groente met elke maaltyd (sluit 100g groenblaargroente, 100g tamaties en 200g ander groente per dag in).

3. Sluit ten minste twee maaltye van peulplante (250g porsie) per week in.

4. Eet ten minste twee porsies vis (150-200g) per week, salm en geblikte sardientjies ingesluit.

Geblikte tuna het nie soveel van die belangrike visolie omega-3 nie, maar bly steeds ‘n goeie keuse om by jou visporsies te voeg.

5. Eet kleiner vleisporsies (bees-, vark- en hoendervleis) en ook minder gereeld (nie meer as een of twee keer per week nie).

Snuif roosmaryn: Volgens sommige navorsing kan wakkerheid verhoog word en geheue verbeter word deur snuf in die neus van hierdie aromatiese krui te kry.

Om skerpsinning te bly, probeer om vars roosmaryn of die geur van roosmaryn vlugtige olie voor ‘n toets of vergadering in te asem.

Gesondheidswenk

5

Gesondheidswenk ‘n Goeie trandedal is glo goed vir jou. En net so om te lag. Dit is bewys dat lag helende effekte op ons liggame en gebroke harte het. Studies in Japan dui aan dat lag die immuunstelsel versterk en kan help om allergiese reaksies af te weer.

Tips for ordering healthy sushi Sushi can either be a very poor choice or a very smart choice in terms of nutrition. To choose the latter, order wisely.

If ordering maki, stick with no more than two rolls. Ask for brown rice if it's available – not necessarily for the extra fibre but for the whole grains, which can be heart protective.

Avoid anything tempura, aka extra kilojoules and fat. This battered and deep-fried version, usually prepared with prawn or rock lobster, is not for the health conscious.

Stick to just one spicy tuna roll, which typically has mayonnaise added to it.

For the lowest kilojoule options, choose tuna, prawn (not tempura) or salmon rolls.

Add avocado to only one of your rolls to keep the kilojoules from accumulating.

Add cucumber to any or all rolls for extra flavour and minimal kilojoules.

Order veggie rolls, such as those with spinach, avocado, shiitake mushrooms or even peanuts.

To make sushi more satisfying, start your meal with either miso soup or a mixed green salad with ginger dressing on the side.

Do you have social jetlag?

If your work/study schedule is out of synch with your body clock, your ‘programmed’ wake time is later than when you need to wake up for your daily life, forcing you to cope with less sleep.

A relaxed sleep schedule during the weekend can make you feel as though you’re moving through a two- to three-hour time zone early in the week.

Technology can also cause you to sleep less than the 6.5 to 8.5 hours that adults need to manage life adequately. TV, cellphones and other electronic devices used in the bedroom lead to later bedtimes. The blue light from computer screens suppresses the hormone melatonine, which aids sleepiness. Sleep deprivation impairs your reaction time, problem-solving ability and immune system and can cause long-term health problems.

To reprogramme your body clock:  Expose yourself to bright sunlight shortly after getting up.  Follow a pre-bed wind-down routine (eg enjoy a warm bath/ shower or read).  Try to stick to the same schedule during the week and weekend.

Connecting with parents on social media is good for teens A new study shows that social networking with parents may actually strengthen the parent-child bond, which may in turn lead to more positive results for teens.

The results show that kids who engage with their parents through social media feel more connected and had higher "pro-social behaviour" and lower incidence of aggression and depression.

A surprising finding from the study was that teen social networking done without parental interaction was linked to more negative outcomes, like delinquency, lower feelings of connection and increased aggression in relationships.

The results show that while high levels of social networking may be harmful for some, engaging with parents via social networking sites may be a good way to strengthen the parent-child relationship.

A day in the life of ...

6

10 THINGS

TO KNOW ABOUT ...

Dr Ina De Beer, one of our dedicated staff members, who is a Managing Director and dedicated General Practitioner at Intercare Woodhill.

1.

I grew up … in Empangeni, KwaZulu-Natal. I still prefer a small town environment.

5.

My favourite movie stars are …

Richard Gere (looks!!) and actress …

Cameron Diaz (versatility)

2.

I share my home with ... my husband (Tiaan Stoffberg, an orthopeadic surgeon), two daughters and my son. I also have a married daughter.

6.

I believe in ... God, honesty and hard work.

7.

To be happy is to … have peace, courage and not to be afraid.

My mentor is … my aunt who had polio and still lead a full life.

Despite her physical disability she studied at the University of Chicago and was a professor at the University of North West.

She was living proof that life has much to offer, despite major setbacks.

8.

I would still like to do … mountain biking.

9.

Best medical advice ... prevention.

Vaccinate and go for regular screenings/tests. Many diseases such as cardiovascular problems, hypertension, cholesterol and diabetes can be prevented by early detection and lifestyle changes.

10.

My favourite food … home-cooked

3.

fun facts

4.

I can’t go a day without … my family, especially my husband, my soul mate … my everything!

    

Likes Classical music Reading Rowing Cooking Leisure walks

meals, especially Malaysian curry.

Favorite author is ... Jeffrey Archer Dislikes  People who do not do their part, or who have a negative attitude.

My best places  For holidays ...

Italy and Still Bay (Western Cape)

Life motto: live each day to the fullest, without fear, don’t be intimidated and always stick to your values.

Issue 03 | 2013

To see your products on these pages please email us at: info@health-bytes.co.za

7

Products we love & want you to know about!

MUST HAVES We’re giving away some fabulous goodies! To stand a chance to qualify, SMS the product code (eg LL) and your name and surname to 34298 (R2 per SMS). Competition closes 10 October 2013.

Little Luxury Water Cooler with Vitality Filter

T

GIVEAWAY

o mark breast cancer awareness month Little Luxury has partnered with the Pink Drive to create the limited edition pink Little Luxury Water Cooler with Vitality Filter.

It is the first mini water cooler that offers ice-cold water at 6 degrees Celsius that flows fast from its tap while being energy efficient with an Energy Star Rating and it is environmentally friendly. The water chilling capability of the unit has been optimised while its energy consumption during cooling has been reduced making it very energy efficient. It also has an exceptional filter that’s easy to replace and safely removes potentially dangerous impurities and cancer-causing agents.

We are giving away one Little Luxury Water Cooler with Vitality Filter to the value of R699 to one lucky reader.

Product code for give-away is LL.

Greenlove.co.za

G

reenlove is on a mission to help people live better lives.

It’s a fundamental new way of thinking about life, the environment, what we put into our bodies and our children’s bodies. Greenlove sells only organic and natural goodies. What’s more is that the products they sell:  are not tested on animals;  contain no synthetic ingredients (except those approved for use in certified organic products);  are good for you, your loved ones and the environment.

The products they sell are either all natural, partly organic or certified organic. Product ranges include skin care products, aromatherapy oils, mother and baby products, natural home-care products, organic foods and even fashionable all-in-one cloth nappies. And just in case you were wondering, they definitely sell organic coffee too. Think of Greenlove as your grocery store, except everything is organic and natural and you can shop from the safety and comfort of your own home.

Greenlove is giving away an online shopping voucher to the value of R350.

Product code for give-away is GL.

Ey Spa

E

y Spa is a day wellness spa specialising in traditional authentic Thai massages. The Thai Specialists at Ey Spa are expertly trained and professional.

The spa boasts a sauna, steam room and shower as well as a couples room, 2 Thai aromatherapy rooms and a Thai massage area with 4 Thai beds, imported from Thailand.

Thai massages focus on the entire body and work on the major energy lines in the body, known as ‘Sen’. A massage will enhance circulation and flexibillity while muscles are relaxed and the nervous system stimulated. The therapies will also help prevent rheumatism and arthritis.

A Thai massage with a hot herbal compress aids in eliminating back pain, shoulder pain, migraines, tendinitis, spasms and tension.

Regular Thai massages will do wonders for your health routine, leaving you feeling energised and invigorated. www.eyspa.co.za.

Ey Spa is giving away a traditional Thai massage to the value of R420 to one lucky reader. Product code for give-away is ES.

GIVEAWAY

GIVEAWAY

CONGRATULATIONS!

Congratulations to the following winners from our previous Body Language issue 02: Sweet and Wild: Sune du Plessis; Doctor Duve: Alta Burroughs; 4aKid: Marelise Fourie. We trust they will enjoy their prizes.

Give-away terms and conditions: The winners will be the first correct entries drawn after the closing date. In the event of the judges not being able to get hold of winners on details supplied, alternative winners will be selected. The judges’ decision is final and no correspondence will be entered into. Winners must be prepared to be photographed for publicity purposes. The prize is not transferable and may not be converted into cash. Please note: Give-away prizes/hampers may differ from the images depicted here and they are at the discretion of the sponsor/suppliers who are responsible for delivering the prizes and not Health Bytes Publishers or Intercare.

All about: By Dr WMJ Bodenstein

8

Heart attacks & matters of the heart

Is cardiovascular health really as important as often stated? Is it not just a hype to sell drugs?

C

ardiovascular disease is proven to be the leading cause of death worldwide. This is true both for developed countries and the developing countries. Only Sub-Sahara Africa is different as HIV/AIDS is the most common cause of death there.

Worldwide 1 in every 2,4 deaths are due to cardiovascular disease. People develop heart attacks in a process known as arteriosclerosis (or atherosclerosis), where there is progressive damage to the arteries supplying the heart muscle (coronary arteries).

There can be a slow progressive or sudden blockage of these arteries resulting in vital nutrients and oxygen not reaching the metabolically very active heart muscle and consequently leading to heart muscle injury and death. (See attached picture.)

The symptoms of a heart attack are usually described as a central pressing and burning chest pain, which will often radiate to the left shoulder and arm, and sometimes

to the neck and jaw. Most patients will also perspire. However, these symptoms can easily be confused with indigestion, hence the term heartburn.

The diagnosis of a heart attack is based on the typical history of chest pain in conjunction with certain ECG changes and elevation of cardiac enzymes. This means that the blood test shows elevated biomarkers confirming heart muscle injury, since these markers leak out of the injured heart muscle cells into the blood stream and are specific for heart muscle cells.

If a heart attack is suspected, Aspirin 300 mg should be taken as soon as possible and medical care should be sought immediately. This means going to your general practitioner or closest medical centre or emergency response (ER) service. If needed, an ambulance could be dispatched. If there is one close by, going to a cardiac unit would be best.

Once the doctor has confirmed the diag-

Issue 03 | 2013

The symptoms of a heart attack are usually described as a central pressing and burning chest pain. nosis of a heart attack, the urgency of the treatment is determined by the type of heart attack. Complete occlusion of a coronary artery results in a “STEMI” (ST-elevation myocardial infarction, ST-elevation referring to the raising of a certain portion of an ECG) that requires very urgent and active intervention to undo the blockage. This would take the form of intravenous therapy of a fibrinolytic drug (also referred to as a block-buster) that dissolves the clot that has caused the bloodvessel to close up.

Alternatively the occluded vessel can be opened directly by means of a balloon and stent procedure called cardiac catheterisation.

Especially if implemented early, this invasive technique results in the best outcomes. This procedure can however only be performed in hospitals equipped with a heart unit and catheterisation facilities.

Incomplete occlusion of a coronary artery tends to give rise to a “NSTEMI” (Non-ST elevation myocardial infarction, ie there is no elevation of the ST segment on the ECG tracing), which still requires the patient to be admitted to an ICU or high-care unit, but more time is available to first “cool-down” the patient with further blood thinners prior to transferring them to have coronary angiography performed.

9

Case study: A seminal study published in 2004 by Prof S Yusef, called the “Interheart” study, confirmed that we can predict more than 90% of heart attacks by just looking at nine factors. Six are negative risk factors (ie increasing your risk of having a heart attack) and are in order of importance: 1. High cholesterol 2. Current smoker 3. Psychosocial stress 4. Diabetes 5. High blood pressure 6. Abdominal obesity There were three positive risk factors (ie reducing your risk): 1. Having fruit and vegetable daily 2. Regular exercise 3. Mild to moderate alcohol intake This study did not take family history of premature heart disease into consideration and we know that in the South African context this is a very important predictive risk factor.

We thus have a clear focus of the task at hand:  Stop smoking.  Cholesterol, diabetes and high blood pressure need to be strictly controlled toward guideline values.  Healthy lifestyle choices that include a healthy, varied and balanced diet resulting in weight loss; regular exercise (which is also good to reduce stress); and the great news is that some alcohol is good for you.

Medical Dictionary Arteriosclerosis/atherosclerosis: the buildup of fats and cholesterol in and on your artery walls (plaques), which can restrict blood flow Complete occlusion: completely blocked artery, no blood flow through the artery Incomplete occlusion: partly blocked artery, minimal blood flow through the artery ECG: electrocardiogram, a device that measures the electrical activity of the heart over a period of time, as detected by electrodes attached to the surface of the skin Myocardial infarction: heart attack, caused by the partial interruption of blood supply to a part of the heart muscle, causing the heart cells to be damaged or die STEMI: the elevation of the ST segment on the graph of the ECG NSTEMI: No elevation of the ST segment on the graph of the ECG Coronary angiography: is a visually interpreted test, which resembles an X-ray picture and is performed to recognise blocked arteries Percutaneous procedure: access to inner organs or other tissue done via needle-puncture of the skin

All about

10

Useful info

Stages of Arteriosclerosis

Nowadays approximately 85% of patients with coronary artery disease will be able to be helped with stents and only 15% will still require a bypass operation.

Coronary angiography is performed as a percutaneous procedure, under local anaesthesia and direct pictures of the coronary arteries are obtained. This is minimally invasive with a thin hollow cannulae introduced into the arteries via the groin toward the heart and contrast can be injected directly into the coronary arteries and then “photographed” as a movie by means of X-ray cameras. The extent of disease and the amount of vessels affected determine whether the problem can be fixed with stents (small metal coils or spring) or whether criteria are met that would determine that a CABG (coronary artery bypass grafting) operation is preferable.

Ideally we should not let this disease progress to this level, and the focus should really be in prevention. We have clearly established what risk factors play a major role in the development of atherosclerosis and this is where we should focus our attention and utilise our resources.

It is very important to stress that not all problems can be solved by yet another pill, but that this global problem requires both the health care providers and the patients alike to buy into the principle that the medication prescribed must be complemented by healthy lifestyle choices and habits.

Having said that, the severely elevated cholesterol values often found in our South African population is largely a genetically driven disease and even becoming a vegan would not necessarily result in target values being reached. This is where our pharmaceutical products play a pivotal role and specifically a class of drugs called statins. This is by far the most researched class of medication in the entire pharmaceutical history. A myriad number of studies have confirmed that statins

 This figure is likely to change further in favour of stenting as technology improves. Diabetic patients however tend to have more severe multivessel disease and thus have a greater likelihood of requiring a bypass operation. While the coronary angiogram and the stenting procedure are performed by a cardiologist, the bypass operation is done by a cardiac-thoracic surgeon (heart surgeon).  Since it is the patient with multivessel disease that mostly ends up being referred for surgery, the conventional approach is still a sternotomy (cutting through the sternum or chest bone) and having the operation done while being on “bypass,” that is the heart-lung machine.

A double bypass refers to two grafts being done, a triple to three grafts and so forth. Conduits or veins are usually harvested from the legs and used as a “bypass” from the aorta (main artery) to then supply blood to beyond the blockage in the coronary artery – hence a bypass operation. In spite of what is still a very invasive procedure, the bypass operation remains the best and safest treatment option for certain patients.

Stent Angioplasty

not only reduce the number of heart attacks, but also reduce the risk of strokes and the risk of vascular dementia.

Statins have even shown benefits in patients with chronic obstructive airway disease and in patients lying in ICU and this benefit is mediated by the anti-inflammatory effect that statins possess.

With regard to supplements, the only products to have shown any benefit are products containing Omega-3.

Key points to remember The message is clear: Prevention is better than cure! Make healthy lifestyle choices, establish what your risk factors are (check your cholesterol, sugar and blood pressure) and if risk factors are present, treat them aggressively to guideline target values. Remember, health is not just the absence of disease, but also a sense of wellbeing.

2260 - V

AstraZeneca Pharmaceuticals (Pty) Limited. Reg. No. 1992/005854/07.

Building 2, Northdowns Office Park, 17 Georgian Crescent West, Bryanston, 2191. Private Bag X23, Bryanston, 2021.

Tel: 011 797-6000. Fax: 011 797-6001. www.astrazeneca.co. za.

Expiry date: May 2015. Log no: COR 05/13/018.

2260 - Vimovo Advert Intercare.indd 1

2013/08/05 4:08 PM

In the know: Professor Justus Apffelstaedt, Associate Professor: University of Stellenbosch and Head of the Breast Clinic: Tygerberg Hospital

12

Understanding

breast cancer

screening

The most significant benefit of breast cancer screening, and in particular mammography, is that it changes breast cancer from a deadly disease to a manageable condition.

I

t is important to explain some general principles of screening, and more specific breast cancer screening: The disease screened for must be common. With one out of eight women suffering breast cancer during their lifetime, this is clearly the case. While there are no accurate, recent statistics available for South Africa, our own cancer detection rates indicate that contrary to official statements, breast cancer is as common in our population

Breast health management at all ages Age 20-39:  Know your family history of breast cancer

as in countries with established screening programmes.

The disease must be sufficiently severe to warrant the screening effort. Nobody will dispute this for breast cancer.

A screening test that reliably picks up the signs of the disease must be available.

A screening test must also not generate too many “harms”. Mammography will pick up early signs of breast cancer in about 90 – 95% of cases, fulfilling the first condition. “Harms” means the test

Age 40+:  Know about the latest advance in breast treatments and technologies

must not indicate signs of the disease in too many patients that with further examination turn out to be false alarms.

For mammography it is accepted that less than 10% of women should be called back for further examinations. While false alarms are inevitable, they can be sorted out with a minimum of cost and further harms to the patient. Generally, less than 5% of women should have a biopsy to confirm findings. The vast majority of biopsies should be done as

3-step approach to breast health A lifelong breast-care programme should include:

 Schedule a clinical breast examination by a health care professional every three years

 Arrange for an annual clinical breast examination by a health care professional

1. Breast self-examination: examine your breasts one week after your period ends. It is easy to do and only takes a few minutes.

You will detect changes in your breast more easily.

 Conduct breast selfexaminations monthly

 Conduct breast selfexaminations monthly

2. Clinical breast examination: your breast health care

 Schedule an annual mammogram

professional will check your breasts and can demonstrate the proper self-examination technique to you.

3. Mammography: A mammogram is a lowdose X-ray of your breasts.

It can detect many breast changes that are too small or too deep to feel. Good mammograms are safe, quick and painless.

Issue 03 | 2013

13

Man y wo men who mam undergo mog raph not e y pain. xperience do Wom any en w sensit ith ive b reast very s ma expe y slight rience disco mfort .

office procedures under mammographic or ultrasound guidance; only very rarely should a woman have to go to theatre for diagnosis. If a biopsy is performed, it must yield a diagnosis of cancer in two to five out of 10 cases.

As new cases of the disease arise continuously, the screening test must be repeated at regular intervals. For mammographic screening, most cancer organisations recommend annual screening from age 40 onwards. In most governmental screening programmes, the screening interval is two years, mainly due to financial reasons.

Concerns about the radiation exposure are unfounded, as there is stringent supervision of mammography units by the Radiation Control Board in South Africa.

The screening test must detect the disease so early that it will change the course of the disease. In a well-run screening unit, about one in five cancers will be detected at a pre-invasive stage.

This means that the cancer is curable by surgery alone and does not require intensive treatment such as chemotherapy

FAQs! Can mammograms cause breast cancer?

No. For over 40 years, millions of women have undergone mammography. As with all radiography, it involves exposure to X-rays, but the dosage levels used are very low.

Modern mammographic techniques have also improved greatly over the past years. A full field digital mammography machine uses only 0,1 to 0,2 rad's per X-ray, which is an extremely low dosage of radiation.

The question has been asked whether compression can cause breast cancer? Compression doesn’t affect the breast tissue at all. It’s essential that the breast be compressed if a useful mammogram is to be obtained. Breast tissue is spread out to allow breast structures to be seen. Compression also means that the X-ray dose required can be reduced.

Patients should make sure that they have their mammograms done at a centre where modern mammography units are in use.

I’ve been told that mammograms are very painful. Is this true?

Although the breast is compressed, many women who undergo mammography do not experience any pain.

Women with very sensitive breasts may experience slight discomfort.

I would like to have cosmetic breast surgery. Should I have a breast check-up first?

Prior to having cosmetic surgery, it is always advisable to go for breast cancer screening. Any surgery to the breasts will make future evaluation of the breasts more complicated and surgery therefore increases the chances of missing an existing cancer.

I have breast prostheses. Can I still have a mammogram?

Yes. Breast augmentation does not constitute an increase in glandular tissue; therefore you are not more at risk. It is necessary that an experienced mammographer takes your mammogram as special techniques are needed to demonstrate all breast tissue.

In the know

14

FAQs! or radiotherapy. The pre-invasive and small invasive cancers can be cured in more than 90% of patients. It is well documented that in regularly screened patients, the mortality of breast cancer is up to 50% lower than in those who do not undergo mammographic screening. Here, many misunderstandings arise.

Breast cancer is a slow-growing cancer and effective therapy is available. This means, that the benefit of screening in the form of a reduced mortality becomes apparent only after about 10 years in those who underwent screening.

Summary All the above shows that mammographic screening can change the course of breast cancer. The effectiveness of screening is well recorded in overseas screening programmes where stringent quality controls from regulatory authorities are applied. This is not the case in South Africa. Only a single breast screening unit in South Africa has ever published in peer-reviewed scientific journals its screening results and shown that it can provide screening equal in quality to the best overseas units.

If my breast check-up is fine, why do you recommend that I have a mammogram every year?

Most international cancer society’s recommend annual mammographic screening as the best method of detecting breast cancer early. Early detection greatly increases the chances for survival and greatly decreases the chances of a mastectomy being necessary for treatment.

What is the best time of the month to have a mammogram done? My breasts are tender during menstruation.

We recommend you have a mammogram about a week after menstruation when your breasts are less tender.

A mammogram should only be mildly uncomfortable. However, if you are concerned about the tenderness of your breasts, it is advisable to see a trained breast health physician. In this instance, a clinical evaluation and an ultrasound can be done. If anything suspicious is detected, an immediate mammogram may be required. Please note that an ultrasound does not replace a mammogram, which remains the best equipment for the diagnosis of breast cancer.

It has been noted that 2-3 gram of Evening Primrose Oil per day for two to four weeks reduce breast tenderness.

Can an injury to the breast cause breast cancer?

Breasts are very resistant to injuries. An injury to the breast cannot cause breast cancer.

Severe trauma can cause fat necrosis when tissue dies off. This is felt as a lump and can at times be mistaken for cancer by a mammogram. Fat necrosis is not a form of cancer and does not develop into cancer over time.

What types of signs should I look out for?  Lumps of any size or thickening of the breast tissue.  Changes in the shape of the breast or persistent discomfort.  Discharge from the nipple that is not associated with pregnancy or breast feeding.

Why should I also have ultrasound?

Breast ultrasound can add important information to the results of other tests, such as a mammogram. It also may provide

information that is not found by a mammogram.

A breast ultrasound may be done to:  Find the cause of breast symptoms, such as pain, swelling and redness.  Check a breast lump found on breast selfexamination or physical examination. It is used to see whether a breast lump is fluid-filled (a cyst) or if it is a solid lump. A lump that has no fluid or that has fluid with floating particles may need more tests.  Check abnormal results from a mammogram.  Look at the breasts in younger women because their breast tissue is often more dense and a mammogram may not show as much detail.  Guide the placement of a needle or other tube to drain a collection of fluid (cyst) or pus (abscess), take a sample of breast tissue (biopsy) or guide breast surgery.  Watch for changes in the size of a cyst.  See how far cancer has spread in a breast.  Check your breasts if you have silicone breast implants or dense breasts. In these situations, a mammogram may not be able to detect breast lumps.

We have heard of 3D mammography? Is this superior to full field digital mammography?

Digital breast tomosynthesis (DBT, or 3D-mammography), a three-dimensional derivative of digital mammography (DM), reduces the effect of tissue superimposition and may improve mammographic interpretation.

Trials indicate that 3D mammography is not superior to full field digital mammography plus ultrasound and as the radiation dosage is increased by 162% (to full field digital mammography), there is insufficient evidence to justify a change from full field plus ultrasound to 3D. However, the available data strongly support investment in new large-scale population screening trials.

Is preventative mastectomy recommended in cases where genetic screening indicates a strong predisposition or risk factor?

For women being found to be carriers of a disease-causing BRCA mutation, risk-reduction mastectomy will be considered as one of the management options. As disease-causing BRCA mutations are relatively rare (less than one in a hundred women will carry such a mutation), BRCA- associated breast cancer is relatively rare and counselling, risk management and riskreduction surgery should be limited to specialiced centres.

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Health advice: By Health Bytes

16

StatinS 101: Should you be taking statin

for cholesterol Cholesterol is a soft, waxy, fatty substance in the blood, which plays an important role in cell membranes and hormones. Your liver produces all the cholesterol your body needs, but when you eat too many foods that are high in saturated fats and cholesterol (mostly animal foods) it can make your blood cholesterol levels rise.

A

high blood cholesterol level can slowly build up in the inner walls of arteries. If left unchecked, it can eventually form plaques – a thick hard deposit that can narrow arteries and make them less flexible. This process is called atherosclerosis. If a clot forms and blocks a narrowed artery that feeds the heart or brain, it can result in a heart attack or stroke. High cholesterol is one of the most important risk factors for cardiovascular disease.

What are statins?

Statins are drugs that can lower your cholesterol. Statin drugs work by blocking

What does it mean if you have high cholesterol: If you have high cholesterol, meaning your total cholesterol level is 5.0 millimoles per litre, or mmol/L or higher, or your low-density lipoprotein cholesterol (LDL, or "bad" cholesterol) level is 3.0 mmol/L or higher, your doctor may recommend you begin to take a statin.

If the only risk factor you have is high cholesterol, you may not need medication because your risk of heart attack and stroke could otherwise be low. High cholesterol is only one of a number of risk factors for heart attack and stroke.

the action of the liver enzyme that is responsible for producing cholesterol.

Too much cholesterol in the blood can cause a buildup of plaque on the walls of the arteries. That buildup can eventually cause the arteries to narrow or harden.

Sudden blood clots in these narrowed arteries can cause a heart attack or stroke.

Statins include well-known medications such as atorvastatin (Lipitor), simvastatin (Zocor), rosuvastatin (Crestor) and others.

Lower cost generic versions of many statin medications are available.

Already shown to be effective in lowering cholesterol, statins may have other potential benefits. But doctors are far from knowing everything about statins.

Are they suitable for everybody with high cholesterol? What happens when you take a statin for decades? Can statins help prevent other diseases?

Should you be taking a statin?

Whether you need to be on a statin depends on your cholesterol level along with your other risk factors for cardiovascular disease.

Your doctor can do a simple blood test to determine the amount of cholesterol in your blood. If you have high levels of LDL ("bad�) cholesterol, you have a greater chance of heart disease.

However, it's good to have high levels of HDL ("good") cholesterol. HDL cholesterol prevents plaque buildup in the arteries by transporting the bad (LDL) cholesterol out of the blood to the liver

Issue 03 | 2013

17

High cholesterol is one of the most important risk factors for cardiovascular disease.

where it is eliminated from the body.

For an accurate result, fast (without food, liquids or pills) for at least nine hours before the test. If a total cholesterol level is high, it is important to know what type of cholesterol is high. Aim for a lower LDL (‘bad’ cholesterol) and higher HDL (‘good’ cholesterol) levels.

The target values are: Lipid Levels mmol/l Total cholesterol < 5.0 LDL cholesterol < 3.0 HDL cholesterol (women) > 1.2 HDL cholesterol (men) > 1.0 Triglycerides < 1.7 What other risk factors are there?

Before you're prescribed a statin, your cholesterol level is considered along with other risk factors for cardiovascular disease.

If your doctor decides you should take a statin, you and your doctor will have to decide what dose to take. If your LDL cholesterol isn't as high, you'll likely need a lower dose. Talk to your doctor if

you have concerns about the amount of statins you're taking.

If you're following the recommended lifestyle behaviours but your cholesterol — particularly your low-density lipoprotein (LDL) cholesterol — remains high, statins might be an option for you. Risk factors for heart disease and stroke are:  A family history of high cholesterol or cardiovascular disease  An inactive (sedentary) lifestyle  High blood pressure  Having diabetes  Smoking  Narrowing of the arteries in your neck, arms or legs (peripheral artery disease)  High cholesterol  Being overweight or obese  Heavy alcohol use  Poor stress and anger management  Older age Consider statins as a lifelong commitment You may think that once your

cholesterol goes down, you can stop taking medication. But, if your cholesterol levels have decreased after you take a statin, you'll likely need to stay on it indefinitely. If you stop taking it, your cholesterol levels will probably go back up.

The exception may be if you make significant changes to your diet or lose a lot of weight. Substantial lifestyle changes may help you lower your cholesterol without continuing to take the medication, but don't make any

Health advice

18

If you're following the recommended lifestyle behaviours but your cholesterol — particularly your low-density lipoprotein (LDL) cholesterol — remains high, statins might be an option for you. changes to your lifestyle or medications without talking to your doctor first.

The side effects of statins Although statins are well tolerated by most people and are among the safest and most studied medication available today, they do have side effects, some of which may go away as your body adjusts to the medication.

Common, less serious side effects:  Muscle and joint aches (most common)  Nausea  Diarrhea or constipation Potentially serious side effects:  Liver damage. Occasionally, statin use causes an increase in liver enzymes.

If the increase is only mild, you can continue to take the medication. Rarely, if the increase is severe, you may

need to stop taking it. Although liver problems are rare, your doctor will likely order a liver enzyme test before or shortly after you begin to take a statin.  Muscle problems. Statins may cause muscle pain and tenderness (statin myopathy). The higher the dose of statin you take, the more likely you are to have muscle pains.  Increased blood sugar or type 2 diabetes. It's possible your blood sugar (blood glucose) level may increase when you take a statin, which may lead to developing type 2 diabetes. Despite this possible connection between increased blood sugar and statin use, it's still safe for most people with high cholesterol, including diabetics, to take statins.  Neurological side effects. Some researchers have studied whether statins could be linked to memory loss or amyotrophic lateral sclerosis (ALS), also

TOP TIPS

where any value above 25 indicates that you are overweight.

Lifestyle changes are essential for reducing your risk of heart disease, whether you take a statin or not. Here are the top 10 tips on lowering your cholesterol:

2 Replace saturated (unhealthy) fats in your diet with unsaturated (healthy) fats.

For example, use soft tub margarine, olive, Canola, avocado, grape seed and sunflower oil (amongst other) in food preparation or over salads instead of hard brick margarine/butter/ghee, cream or coconut milk.

1 Attain and maintain a healthy body weight.

Do a simple calculation of your body mass index (BMI) at home: divide your weight (in kilograms) by your height (in meters) squared. A value between 18.5 and 24.9 indicates that you have a healthy weight,

3 Cut down on trans fats.

Although trans fats are found naturally in small amounts in various animal products (eg beef, pork, lamb, milk and butter), they can also be formed in a manufacturing process that is widely used in the food industry to make margarine, shortening

Lifestyle is still key for lowering cholesterol

Sources: www.heartfoundation.co.za; www.mayclinic.com; www.webmd.com

known as Lou Gehrig's disease. These side effects reverse once you stop taking the medication. Talk to your doctor if you experience memory loss or confusion.

Don't stop taking your statin medication before talking to your doctor.

It's important to consider the effects of statins on other organs in your body, especially if you have health problems such as liver or kidney disease. Also, check whether statins interact with any other prescription or over-the-counter medication or supplements you take. Keep in mind that when you begin to take a statin, you'll most likely be on it for the rest of your life. Side effects are often minor, but if you experience them, you may want to talk to your doctor about decreasing your dose or trying a different statin. Don't stop taking a statin without consulting your doctor first.

and commercial cooking oils. It is also found in baked goods (pastries, biscuits and cakes) and other processed foods in the form of partially hydrogenated vegetable oils. Fortunately, in South Africa, products are now required by law to limit trans fats to an acceptable level of 2% or less, providing consumers with healthier choices.

4 Ensure an adequate intake of fibre Eat at least five servings of fruit and vegetables daily. Legumes (beans, peas and lentils) are high in fibre and a good source of protein.

5 Be physically active.

Exercising regularly helps to increase your HDL (good) cholesterol. The Heart and

Issue 03 | 2013

19 KEEP IN MIND THAT WHEN YOU BEGIN TO TAKE A STATIN, YOU'LL MOST LIKELY BE ON IT FOR THE REST OF YOUR LIFE.

Stroke Foundation SA recommends 150 minutes of moderate-intensity exercise every week.

6 Drink alcohol in moderation (if at all).

Alcohol is not essential for health. Should you wish to consume alcohol, stay within the recommended limit of 1 unit per day for women, and up to 2 units per day for men (1 unit is equal to a small glass (120ml) of wine or 340ml beer/cider or 1 tot of spirits).

Opt for red wine, which contains resveratrol and polyphenols (antioxidants) that may assist with raising HDL (good) cholesterol (when consumed in moderation).

7 Practice healthy cooking methods.

Avoid frying foods â&#x20AC;&#x201C; rather use dry-frying, roasting, baking, poaching, boiling,

steaming, grilling and microwave cooking.

Remove all visible fats from meats and the skin from chicken prior to cooking.

Remember that meat dishes can be thickened by using legumes and/or vegetables in combination and cream in recipes can be substituted with low-fat evaporated milk and sour cream or low-fat yoghurt.

8 Incorporate fish that is naturally fatty in your diet every week.

For example, a 100g portion of pilchards, salmon, tuna, mackerel, sardines, trout, herring or snoek at least once a week.

9 Try the plant sterol route!

These naturally occur in small quantities in fruits, grains, nuts, seeds, vegetables and

vegetable oils. The recommended daily intake of plant sterols to assist in reducing cholesterol levels is 2g per day, an amount we typically do not consume in our regular diet.

10 Listen to your medical practitioner.

Any medication should be taken as prescribed and should not be discontinued unless this has been discussed with your doctor.

20

Dental care: Prof Johan Hartshorne General Dental Practitioner, Intercare Medical and Dental Centre, Tyger Valley

Crooked teeth &

bad bites DOES straightening teeth matter?

Most of us are not blessed with perfectly aligned or straight teeth.

Sometimes we can become very conscious as to how our teeth look when we smile.

P

eople judge us on our smiles, whether they do it consciously or not. While it is not fair, people do judge us on our appearance all the time.

A beautiful smile is immediately associated with youth, health, and vitality. A smile can thus be an asset or a distraction. Besides appearance, crooked teeth or bad bites can also cause complications and long-term health problems if they are left untreated.

Crooked, crowded, and poorly occluding teeth are problems that will affect the physical and emotional wellbeing of an

individual at some or other time. The reality is that straight healthy teeth and an attractive smile do matter.

What causes crooked teeth and bad bites?

Most of the time, an over- or underdevelopment of the jaws and having crooked teeth or a large overbite is simply an inherited trait. However, premature loss of baby teeth and harmful habits such as thumb sucking can also cause crooked teeth (misalignment) or

bad bites (malocclusions).

Mouth breathing, incorrect swallowing and tongue position all affect growth and development of the jaw and face. If these habits are not corrected at an early age (7-10 years old), arch development is compromised, the jaw becomes narrower, the teeth become crowded and the face does not develop properly.

When is the best time to treat crooked teeth?

Fortunately, there are solutions for

Issue 03 | 2013

21 A beAutiful smile is immediAtely AssociAted with youth, heAlth, & vitAlity.

both children and adults who are affected by crooked teeth and bad bites. Orthodontic therapy is that branch of dentistry that corrects teeth and jaws that are positioned improperly. With orthodontic treatment dental misalignment defects can be corrected and proper function and aesthetics restored so that patients can enjoy straight, healthy teeth and a more attractive smile.

Ideally, children should have their teeth screened by their dentists for orthodontic problems by the time they reach 7 years, because growth-related problems can be identified then. When a child is 12 years old, 90 percent of his or her face has already developed. If problems are detected early (before the age of 12 years), interceptive orthodontic treatment can be provided to guide jaw and facial development and to make space for the teeth. Such early treatment is often less costly than the care required to treat more serious problems that can occur if left untreated.

WHY? Why is it important to treat crooked teeth or bad bites?

Crooked teeth and bad bites will impact on your overall health and wellbeing if not attended to at the earliest possible stage. The sooner it is diagnosed and taken care of, the less effort in terms of time and money it takes to fix it at a later stage. Crooked teeth or bad bites may affect more than just the appearance of

How do I know whether I need orthodontic treatment?

Orthodontic treatment is usually indicated if there is: (i) a lack of spacing

your smile; they are also associated with the following problems that can affect one’s quality of life:

chipping teeth.  It makes a person feel self-conscious about their appearance and affect their self-esteem.

 It can interfere with proper chewing.  It makes keeping teeth clean more of a challenge, increasing the risk of tooth decay and gum infection.  It can increase the strain on teeth, jaws, and muscles, thus increasing the risk of breaking and

Straightening crooked teeth and correcting a bad bite with orthodontic treatment can also potentially correct speech impediments and breathing problems; improve chewing and eating; and reduce or eliminate grinding and clenching of teeth as well as jaw joint pain.

Ideally, children should have their teeth screened by their dentists for orthodontic problems by the time they reach 7 years, because growth-related problems can be identified then.

(crowding) of baby teeth, also called the primary teeth; (ii) a pronounced overbite or underbite in the primary dentition; (iii) signs of clenching or grinding of teeth; (iv) chronic allergy or airway issues; (v) early or delayed loss of baby teeth; (vi) bad habits such as thumb sucking, cheek biting or using a pacifier past the age of two and a half. Patients should contact their dentist to determine the cause of their condition.

Your dentist or orthodontist will use several diagnostic tools that include a full medical and dental health history, a clinical exam, plaster models of your teeth, and special X-rays and photographs to determine what type of orthodontic treatment is required.

Is orthodontic treatment only for children?

People often think that teeth alignment is always done during adolescence.

Treatment between the ages of 7 to 12 is advantageous because it is possible to influence the growth of the jawbones and to create space for the teeth. However, adults can also enjoy the benefits of cosmetic and functional rehabilitation of orthodontic treatment. In fact, teeth alignment treatments can benefit a 12year old and a 70-year old equally.

Dental care

22

to estimate the cost of your treatment How is treatment carried out? and give you details depending on the In this advanced world of dentistry, severity of your case and the type of there are a variety of teeth-straightening appliance that will be options available to us, used. It is advisable such as orthodontic Besides to discuss the cost braces, teeth veneers, appearance, and payment plans crowns and teethcrooked before treatment and, if straightening surgery. necessary, have the cost teeth or bad Orthodontic treatment confirmed in writing to can be done with bites can avoid any confusion. removable appliances, also cause fixed appliances complications Does wearing braces (commonly known as and longhave risks? braces) or with aligners, term health Orthodontic treatment also called invisible is not without risks. braces. Orthodontic problems if Some risks of wearing braces remain the most they are left braces or orthodontic cost-effective by far; have untreated. treatment include, but the least risk of damaging are not limited to, root teeth and are the most resorption, cavities, tooth decalcification popular choice for straightening teeth. and gum problems. However, with proper oral hygiene, many of the risks How long will treatment take? associated with orthodontic treatment The length of treatment depends on can be minimised.. how severe the problem is. Treatment may take anything from a few months to two and a half years. Most people can be treated in 18 months.

How regularly do I have to see the dentist for adjustments?

Orthodontic appliances usually need adjusting every six to eight weeks. Your dentist or orthodontist will tell you how often your appliance needs adjusting.

What happens when the teeth are in the right position?

When treatment is finished the teeth need to be held in position for a time.

This period is called retention, and the appliances that hold the teeth in place are called retainers. The retainers hold newly straightened teeth in position while the surrounding gum and bone settle.

The retainers can be removable or fixed depending on the original problem.

How much does it cost?

Your dentist or orthodontist will be able

Straightening teeth matters Crooked teeth and bad bites leading to imperfect smiles and poor chewing function can be socially and physically inhibiting.

Advances in orthodontic treatment have leveled the playing field for those of us not fortunate enough to have a perfect smile. Braces can straighten teeth in the vast majority of patients. This means that the benefits of straight teeth are within reach for virtually everyone. The improvement in self-confidence, social development and career advancement as a result of orthodontic therapy are now a reality for those that are willing and seeking to make that change.

Why is early orthodontic treatment required?

Every child should be screened by his or her dentists at the age of seven â&#x20AC;&#x201C; before the permanent teeth have erupted â&#x20AC;&#x201C; to establish whether there is a dental or skeletal development problem present.

Some common problems that can be intercepted are inadequate spacing of teeth, crowding, cross-bites, overbites, midline diastema and incorrect positioning of the lower jaw. Starting treatment at an early stage allows early development of the jaws, thus changing the shape and size of the jaw, to make space for all the teeth. In most cases the jaw is expanded and lengthened to accommodate all of the teeth. This prevents crowding and promotes the eruption and extrusion of the teeth.

Because the jaw is moved rather than the teeth at this stage, the process would be more accurately called dentofacial orthopedics but is commonly referred to as interceptive orthodontics. This process is usually done with removable appliances.

By creating the necessary amount of room for teeth early on, a patientâ&#x20AC;&#x2122;s need for orthodontics later in life can be greatly reduced or completely avoided in some cases and sometimes eliminate the need for braces later on.

Not doing early interceptive treatment may require some of the permanent teeth to be extracted before dental braces can be placed.

The goals of interceptive orthodontics can be described as preventative rather than corrective because it is aimed at preventing problems from developing before they need to be treated later.

What does orthodontic treatment involve?

The most important thing is to have regular examination from an early age to identify problems. When problems are identified this will usually involve taking X-rays and making plaster models of your teeth. Your dentist will discuss what treatment is possible and at what age.

Orthodontic braces are the most conservative option of tooth straightening with the downside of treatment usually taking 18 to 24 months to complete. A further retention period after the removal of braces is also required to maintain the straightened teeth. Good oral hygiene is essential to ensure success of treatment.

Feature: Dr Elna Rudolph, Sexual Health Physician: MySexualHealth.co.za, in proud partnership with Intercare

23

Things to do

BEFORE

you fall pregnant Did you know that there are many things that you can do before you fall pregnant to increase your chances of having a healthy pregnancy and healthy baby?

Here are some of the things you should do: 1 Get a full physical examination and ask your doctor to check your:  Blood pressure and pulse rate  Heart for a murmur  Abdomen  Breasts 2 Your doctor should also do a pelvic examination and take a pap smear.

3

Ask your doctor to check your blood for:  Anaemia and deficiencies (FBC)  Thyroid function  Blood sugar  Blood group  HIV and Syphilis Any other tests that your doctor might want to do, according to your signs and symptoms or medical history

Diphteria and Pertussis) – Pertussis is whooping cough; a major cause of hospitalisation in infants and can be prevented by vaccinating adults who come in contact with children.  Varicellla (chickenpox) – only if you have never had chickenpox.  Flu – all women trying to fall pregnant and all pregnant women further than 12 weeks should get this.  You can have all these vaccinations now, even if you are not planning to fall pregnant soon. They all stay effective for at least 10 years (apart from flu, which needs to be done annually). You have to wait at least a month after your last vaccination before you can fall pregnant.

5

Stop smoking!

6

Get to a healthy weight.

7

Follow a healthy diet and lifestyle.

8

Take a pregnancy multi-vitamin with folic acid to prevent birth defects before you start trying to fall pregnant and all the way through your pregnancy.

4

Ask your doctor for the following vaccinations:  MMR (Measles, Mumps and Rubella) – you should get it, even if you have never had the MMR vaccine as a child. If you have never had it, you will need two dosages, one month apart.  Adacel Quadra (Tetatus, Polio,

You can book an appointment at MySexualHealth.co.za or any Intercare doctor to have your pre-pregnancy consultation.

A few extra tips Stock your fridge with healthy foods You're not eating for two yet, but you should start making nutritious food choices now so that your body will be stocked up with the nutrients you need for a healthy pregnancy.

Try to get at least 2 cups of fruit and 2 1/2 cups of vegetables every day, as well as plenty of whole grains and foods that are high in calcium – like milk, calcium-fortified orange juice, and yogurt. Eat a variety of protein sources, such as beans, nuts, seeds, soy products, poultry, and meats.

Give those cups of joe the heave-ho While there's no consensus on exactly how much caffeine is safe during pregnancy, experts agree that pregnant women and those trying to conceive should avoid consuming large amounts.

Some studies have found an association between high caffeine consumption and decreased fertility. And too much caffeine has also been linked to a risk of miscarriage in some (but not all) studies.

Fact file: By Dr Neil Richards, Family Physician

FACT FILE

When is a fall

MORE than just a trip?

Falls are the leading cause of injury-related hospitalisation in people older than 65 years of age.

A

fall may not be due to an unintended event such as a trip on a pavement, but rather a manifestation of an acute or chronic underlying medical problem.

As such, all falls in the elderly must be thoroughly assessed and managed by your GP or local emergency department. An assessment after a fall will include whether one has had a previous fall. Other areas and factors of review include: 1

Medication: certain types of medication are sedating and can affect coordination, eg sedatives, antidepressants and analgesics or painkillers.

2 Vision: Onset of cataracts or

re-examination of eyesight to determine the need for glasses 3 Impaired balance: Vitamin

D deficiency, vitamin B12 deficiency, medication and onset of neurological illness.

4 Dizziness/Syncope: Blood

pressure changes and possible underlying heart disease.

5 Cognition/Memory 6 Environment: Consideration

of the home environment and safety around the home.

6 tips to prevent falls Fall prevention may not seem like a lively topic, but it's important. As you get older, physical changes and health conditions – and sometimes the medications used to treat those conditions – make falls more likely. Still, fear of falling doesn't need to rule your life.

Instead, consider six simple fall-prevention strategies.

1. Make an appointment with your doctor Begin your fall-prevention plan by making an appointment with your doctor.

2. Keep moving Physical activity can go a long way toward fall prevention.

With your doctor's OK, consider activities such as walking, water workouts or tai chi — a gentle exercise that involves slow and graceful dance-like movements. Such activities reduce the risk of falls by improving strength, balance, coordination and flexibility.

3. Wear sensible shoes Consider changing your footwear as part of your fallprevention plan. High heels,

floppy slippers and shoes with slick soles can make you slip, stumble and fall.

mend using a cane or walker to keep you steady. Other assistive devices can help, too.

4. Remove home hazards Take a look around your home. Your living room, kitchen, bedroom, bathroom, hallways and stairways may be filled with hazards.

If necessary, ask your doctor for a referral to an occupational therapist. They can help you brainstorm other fall-prevention strategies. Some solutions are easily installed and relatively inexpensive. Others may require professional help or a larger investment. If you're concerned about the cost, remember that a fall prevention plan is an investment in your independence.

5. Light up your living space Keep your home brightly lit to avoid tripping on objects that are hard to see.

6. Use assistive devices Your doctor might recom-

REMEMBER: A PROPER ASSESSMENT TO REDUCE FALLS CAN IMPROVE AN OLDER PERSON’S ABILITY TO FUNCTION AND LIVE INDEPENDENTLY AND THUS THEIR QUALITY OF LIFE

Sources: (Reference: Modern Medicine, March 2013).

Sources: www.mayoclinic.com

24

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Feature: By Health Bytes

26

Men’s

health care an overview of every decade Men often shy away from health issues and they will normally only seek medical or health care advice once they contract a disease or are confronted with a serious health issue. However, maintaining a healthy lifestyle at every age is vital.

Lifestyle and exercise Young men are likely to be involved in some form of sport or activity. But if you think a leisurely stroll to the nearest cafe to get your daily pack of cigarettes and takeaways count as exercise, you may be in for a surprise.

You may get away with not being active now but bad habits can be detrimental to your health if you don’t break the pattern while you are young.

Warming up should always form part of an exercise routine, and cardio as well as strength training will ensure a good exercise workout at least four times a week.

20s

Nutrition If you do smoke and drink excessively your body will be depleted from the necessary vitamins and minerals, especially vitamins B and C. Ensure that you eat shellfish, meat, dairy products and wholegrains to supplement your body’s need for these vitamins. Drinkers need to increase their intake of folate by eating beans, pulses, liver and cereal as well as their intake of magnesium found in wholegrains, nuts and seeds. And smokers should include watercress and broccoli in their diets to reduce the risk of lung cancer induced by tobacco.

Checkups and tests An annual physical exam by your

medical practitioner is recommended.

You don’t need to go for many tests at this age, but it is good to have your blood pressure taken and your body mass index (BMI) calculated. You need to be screened for testicular cancer, and you can even do self-exams on a monthly basis. Your cholesterol should be tested every five years. Your doctor may consider certain risk factors relating to your lifestyle and will recommend screening for skin cancer, sexually transmitted diseases, HIV infection and alcohol abuse. Bi-annual dental checkups are also encouraged.

Bear in mind that mental illness can also affect young men and that anxiety and depression can show their first symptoms during this decade.

Issue 03 | 2013

27

You need to be screened for testicular cancer, and you can even do self-exams on a monthly basis. Your cholesterol should be tested every five years.

Your doctor may consider certain risk factors relating to your lifestyle and will recommend screening for skin cancer, sexually transmitted diseases, HIV infection and alcohol abuse.

30s

Lifestyle and exercise It’s time to realise that if you don’t workout, your six pack will turn into a barrel! Due to workload, family commitments and an overall busy lifestyle, it is easy to gradually fall into a routine where exercise is not a priority. You may even be in a comfort zone of just exercising a few times a week, but research has shown that you may lose up to 15% of your aerobic capacity for each decade after the age of 30, and that from 35 onwards your maximal oxygen uptake begins to weaken. It is recommended that you add speed to your aerobic workouts and that you do weight training two to three times a week. And if you do enjoy the odd pint of beer, weight training will assist in regulating body fat storage.

Nutrition If you’re having regular business lunches, chances are that you favour pastas or fatty meals with chips. But to burn calories more efficiently after a busi-

ness lunch it is best to pick a chicken salad or chicken stir-fry from the menu or even steak with salad or vegetables.

To keep your blood pressure in check you can enjoy beans, bananas and raisins. If you find that your sex drive is declining you can boost your testosterone levels by eating a handful of walnuts, peanuts or almonds.

Checkups and tests In your 30s it is also a good idea to visit your medical practitioner annually for blood pressure and BMI checks. You will also still need to get screened for testicular cancer and you should continue with self-examinations on a monthly basis. Your individual circumstances may urge a doctor to check for heart disease, diabetes, liver problems or thyroid disease. Should your doctor consider it necessary due to your individual risk factors, screening will also be done for cancers such as skin and oral cancer and sexually transmitted diseases, including HIV infection. You will also have to test your vision.

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If you find that your sex drive is declining you can boost your testosterone levels by eating a handful of walnuts, peanuts or almonds.

General health care

40s

Lifestyle and exercise Your 40s can be a stressful time in your life. You may be climbing the corporate ladder or establishing yourself as an experienced professional in your career and if you have children they will also demand your time and attention.

High blood pressure and the risk of heart disease are common health problems encountered during this decade. Exercise can increase your energy levels and will help you to cope with stress and anxiety. Avoid working through your lunch hour and ensure that you spend quality time with your family engaging in activities rather than watching television.

You should be cautious of an increased waistline at this age, and also bear in mind that your muscles will start losing elasticity and that you will experience more stiffness, aches and pains. Restore motion and suppleness by stretching and extending your joints regularly.

Nutrition As men age they gradually lose muscle. If youâ&#x20AC;&#x2122;ve worked hard to maintain your physical appearance

when you were younger, you can protect your muscles with a steady intake of food such as tuna that are high in quality protein. To reduce the risk of prostrate cancer you can enjoy a few Brazil nuts and mushrooms can help too. Sweet potatoes and carrots are sources of beta-carotene that can reduce the risk of skin cancer. If you want to prevent your arteries from blocking in order to lower high levels of cholesterol you can enjoy grapes on a daily basis. Red grapes are also antioxidants.

Checkups and tests Your annual physical exam should include blood pressure checks, as well as BMI calculating and testicular cancer screening. You should also continue with your cholesterol checks every five years. You need to be screened for prostrate cancer and once you are 45 you should be tested for diabetes at least every three years. If you have a family history of coronary heart disease your medical practitioner should screen to determine whether you are at risk of the disease. Visit your dentist twice a year and have your vision examined annually.

To ensure a balanced lifestyle throughout every decade of your life, it is essential that you consider your habits, eating patterns and exercise routines from an early age. If you are a smoker, it is best to quit this dependency as soon as possible. Heavy drinkers should realise the impact that alcohol abuse can have on their health. Men that often have different sexual partners should recognize that promiscuity can influence their own health as well as the health of their partners. It is recommended that you seek professional medical advice to help you if you struggle to break free from habits that can be detrimental to your wellbeing.

Although regular visits to your medical practitioner cannot prevent you completely from contracting serious illnesses it will enable you to take precautionary steps to ensure a healthier old age. Because dreaded diseases such as cancer, strokes and heart attacks are potentially real threats to your health, it is important that you donâ&#x20AC;&#x2122;t dismiss advice or recommendations regarding your wellness or health care as marketing attempts to lure you into investing in your future health. Rather take note of the information and guidance provided and you will have peace of mind that you are taking care of your body in the best possible manner from an early age until well into your retirement.

Sources: www.realbuzz.com (Male health through the decades); www.netdoctor.co.uk/menshealth (Health checks - when they are needed); www.bodyandsoul.com.au (The main health risks for men); www. menshealth.com (The Best Foods for Your 20s,30s 40s by Philip Rhodes); www.mensfitness.com/training (Check-Ups Every Guy Needs)

801566

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Recipe: www.heartfoundation.co.za

30

SERVES 8

Chicken BRIYANI Ingredients: marinade  3 chicken breasts on the bone,

skin and all fat removed

Try this delicious recipe for the whole family – they will love it!

Ingredients: rice  2 cups (500 ml) uncooked

brown rice

 1 tsp (5 ml) turmeric

 6 g 1 tsp (5 ml) salt

 2 tsp (10 ml) each of cumin seeds

 1 cinnamon stick

        

and chilli powder 2 cinnamon sticks 3 cardamom pods 45g 3 tbsp (45 ml) lemon juice 64 g 2 tbsp (30 ml) tomato paste 240 g or 2 tomatoes, finely chopped 4g or 2 cloves of garlic, finely chopped 2 tbsp (30 ml) chopped fresh coriander 1 green chilli, chopped (optional) 250 g 1 cup (250 ml) plain low-fat yoghurt or buttermilk

 2 cardamom pods  125 g 1 cup (250 ml) uncooked

brown lentils  330 g 3 potatoes, peeled & cubed  1 tsp (5 ml) turmeric  8 g 2 tsp (10 ml) sunflower oil  375 g 3 onions, thinly sliced  ½ cup (125 ml) boiling water

Directions 1 Marinade: Cut chicken breasts into chunky pieces. Mix all the marinade ingredients together.

Serve

with fresh coriander, a dollop of plain low-fat yoghurt and salad of your choice!

2 Stir chicken into marinade and

refrigerate for 1 hour or overnight.

3 Rice: Place rice, ½ tsp of the salt, cinnamon and cardamom with enough water in a pot. Simmer until the rice is cooked and drain.

4 Meanwhile, cook lentils in a

separate pot with enough water until tender and drain.

5 Boil potatoes with the rest of the

salt and a pinch of the turmeric until tender. Drain.

6 Heat oil in a large pot and fry

onions until tender. Keep half the onions for garnish.

7 Add chicken to onions in the

pot and fry for a few minutes. Add marinade, reduce heat and cover with a lid. Simmer for 15 minutes.

8 Place potatoes in a layer over the

chicken. Spoon the lentils and rice in layers on top.

9 Mix the turmeric with the boiling water and pour over the rice.

10 Spoon the fried onions on top.

Cover with a lid and steam over a very low heat for 15 minutes or until warmed through.

Enjoy with family and friends around a heart-filled table!

39013E

Events: Intercare

32

Intercare events – over the last few months

Above: Summit Rehab team

A kick in the teeth

Launch of Irene Day, Sub-Acute and Rehabilitation Hospital – 17 April 2013

hat does a zebra do when it has problems with its teeth? It goes to the dentist or rather, in this case, the dentist goes to the zebra.

This week, Jurina Le Roux, Enviromental Officer at Koeberg Nature Reserve, called in Wildlife veterinarian Dr JC Botha and dentist Dr Riana Rabe from Intercare Blaauwberg to attend to one of their zebra stallions. During a fight with another zebra stallion, the “patient” sustained injuries to its leg and jaw.

It took almost an hour to reach the zebra cornered, and once Dr Botha darted the animal, it took a mere 5 minutes before the zebra was completely sedated and ready for the team to commence with medical treatment.

While Dr Botha attended to its hind leg, Dr Rabe extracted three broken teeth and pieces of the broken jaw. “The teeth were enormous,” Dr Rabe said, “and it needed a very firm grip and quite a bit of force to remove them.” Dr Botha inserted several sutures to ensure a good wound closure.

After the treatment, the zebra was given a “wake-up” injection and it trotted off, completely unaware of the treatment by the medical team.

t was with great pride that the Irene Day, Sub-Acute and Rehabilitation Hospital were officially opened on 17 April 2013 by Dr Bevan Goqwana, Member of Parliament and Chairperson of the Portfolio Committee on Health.

The Irene Day Hospital offers three operating theatres, 24 beds, high-quality nursing staff and state-of-the-art equipment.

The Sub-Acute and Rehabilitation Hospital with 36 beds is situated on the first floor of the building and offers a highly qualified multidisciplinary team, fully equipped therapeutic gym and assisted showers and bathroom.

W

I

Above left: Department of Health team

Following the opening of the Irene Day, SubAcute and Rehabilitation Hospitals, Dr Goqwana made the following remarks during his budget speech in Parliament (unrevised Hansard version): “I commend the group called Intercare, which is in the private health care industry, and they are investing in primary health care, rehabilitation and day care hospitals. They keep patients for a shorter period to make sure that they go back and contribute to the economy.”

The inauguration of this modern, worldclass facility is yet another example of Intercare’s vision to “Create a better health care experience altogether”.

Above right: Dr Hendrik Hanekom (CEO Intercare Group), Dr Bevan Goqwana (MP and Chairperson of Portfolio Committee on Health), Dr Dumani Kula (Head of the Hospital Portfolio at Discovery Health) and Dr George Veliotes (Managing Director Intercare Group)

Intercare Kempies

I

ntercare Medical and Dental Centre Glen Marais is a proud sponsor of “Kempies” – the 1st rugby team of Kempton Park High School. The level of rugby produced by this team is outstanding. Kempies has, over the years, produced a number of Springboks such as Jannie Breedt, Danie Van Schalkwyk and Werner Kruger. We are proud of the Kempies Rugby team and can only cheer them on to higher heights.

TJDR (CT) 39013/E

THIS IS WHAT IT TAKES TO GET A HEART MARK

First, the product applies for endorsement.

Next, it is thoroughly tested by an independent, accredited lab.

The laboratory results are then examined by a team of dietitians.

Levels of fats, cholesterol, fibre, sodium and sugar are checked to see if nutritional criteria are met.

Now the product is ready to receive our stamp of approval.

But not before its packaging is assessed for nutritional accuracy according to our strict requirements.

It may seem excessive, but it means that every Heart Mark approved product is nutritionally sound.

Look out for the healthy choice you can trust.

39013E Heart Foundation Heart Mark 275x210.indd 1

2012/07/31 9:53 AM