Bodylanguage issue 09 summer 2015

A better healthcare experience altogether

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Issue 09

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December 2015

FREE

ROOIBOS TEA PUNCH

TRAVEL HEALTH A safe summer holiday

Watermelon

FRENZY!

SUGAR:

The bitter truth

COPY

FIRST AID

First at the scene

Dangerous

OTC DRUGS

SPECTACULAR

HOLIDAY STAYS

Celebrate in style

Issue 09 | 2015

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contents up close and personal

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Message from the CEO

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Contributors

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A day in the life of ...

Dr Solly Nkhumeleni

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interact 4 Intercare Branch News News & Events 6 Health bites – Snippets of the latest health news to read 12 TravelGround

Spectacular Holiday Stays

from the experts

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10 Summer Health –

Top Ten Tips 16 Travel Health –

Tips for a Fun, Safe Holiday

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20 All About –

Back and Neck Pain

your body 24 Know It All –

OTC Drug Addiction 28 Diagnosis – Gallstones 30 First Aid – First at the Scene

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your health

8 Infographic –

Sugar: The bitter truth 27 Health Treats –

Watermelon Frenzy 32 Recipe – Rooibos Tea Punch

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CEO MESSAGE I am very proud of what the Intercare Group has achieved this year.

By actively developing new solutions, encouraging new ways of thinking and f inding new ways of working, we are dramatically improving health care for our patients. As a result of our ongoing commitment to provide innovative solutions, we’ve been able to achieve yet another signif icant accomplishment with the opening of the Intercare Medical Centre and Day Hospital Century City in Cape Town. Further to our successes for 2015, our Day Hospitals and Sub-Acute & Rehabilitation Hospitals have seen a record number of patients.

At Intercare we are passionate about improving people’s lives and that has always been at the heart of everything we do. We recognise the need to make a positive difference and are embracing the philosophy of giving back.

As part of our social responsibility programme, we were involved in various charity projects such as the City of Tshwane Child Welfare Programme, the It ’s a Girls Thing Fun Walk for abused women and children, and the Teddy Bear Project for children in poverty-stricken areas.

We also offered 48 free cataract removal surgeries at our Day Hospitals in Hazeldean and Sandton for those who needed the surgery but cannot afford it.

Our successes would not have been possible without the hard work and dedication of our health professionals, employees and care partners, and I am truly appreciative of their efforts. Our achievements clearly show that our focus remains on our vision: “Creating a Great Healthcare Experience Altogether”.

I look forward to 2016 in anticipation of continued success. As you gather with your families this holiday season, I wish you a safe, healthy, happy and joyous celebration.

Warmest Regards, Dr Hendrik Hanekom Chief Executive Off icer – Intercare Group

Advertising and Editorial Enquiries

Publishing editor Christa Grobler

Advertising: Body Language is published

Health-Bytes Publishing

Design Health-Bytes: Bernette Becker

quarterly. FREE copies are distributed at Intercare

Tel: 021 913 0504

Proofing Albert Buhr

Medical and Dental Centres. To advertise, please

christa@health-bytes.co.za

Printing CTP Print

contact our advertising department.

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 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.

contributors

Issue 09 | 2015

Riette Landman completed a BSc degree in 1993. She went on to study BPhysT at the University of Pretoria and received this qualification in 1997, after which she started her own practice in 1998. She has been in private practice for 17 years. Riëtte has a special interest in sports-related, back and neck injuries, but also treats sinus and chest conditions.

After completing post-graduate, specialised courses in spinal and sports injuries, she became the founder of The Spine School, seven years ago.

Dr Owen Wiese was formally trained in medicine and science at Stellenbosch University. He completed a BSc in human life sciences in 2005 and received his MBChB qualification in 2012.

He completed his medical internship in Bethlehem in the Free State, after which he concluded his Medical Community Service in the Western Cape in 2014. He likes writing and travelling in his free time and his other interests include drama, film and music.

Roseanna McBain is a writer for TravelGround.com. In her downtime, she enjoys reading, writing and acting in shows at the Muizenberg Masque Theatre.

On weekends you'll find her and her husband seeking out hidden nooks and lesser-known spots within the Western Cape, or relaxing with friends in Cape Town.

Dr Chris Opperman obtained his MBChB at the University of Pretoria and is qualified in aviation, space and travel medicine.

He also has a master's degree in theology. He has a private pilot’s licence and in his free time he enjoys flying, motorbiking and being outdoors.

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

We want to hear from you . . .

We would like to invite all patients and customers to air their views and provide us with input regarding this magazine.

In doing so, we can remain relevant and will then be able to make a difference and “create the better healthcare experience altogether” on a daily basis.

togethe we can crerate better health care

Please email us at info@intercare.co.za with any suggestions, ideas and topics you would like to read about.

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Branch News

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Intercare news & events

Intercare opens new Medical Centre and Day Hospital

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ntercare Medical Centre and Day Hospital Century City opened its doors on 7 July in Cape Town. The Day Hospital is now home to leading health professionals specialising in a variety of surgical procedures.

The Medical Centre consists of general practitioners, a Dis-Chem pharmacy and a whole host of health disciplines. These include pathology, radiology, biokineticists, dieticians, and physiotherapists.

Cupcakes for Hope

I

ntercare Silver Lakes hosted a “Party of Hope 4 Kids with Cancer”.

Doctors and staff baked cupcakes to help raise money for Cupcakes of Hope – a non-profit organisation that aims to create awareness and raise funds for children with lifethreatening diseases.

Heritage Day 2015

Intercare Parow Cares

n Heritage Day, Intercare Head Office employees celebrated our rich heritage with a proudly South African braai. Almost everyone showed their patriotism by wearing the colours of our national flag. Intercare Woodhill reflected upon the uniqueness of our rainbow nation with a “Celebrate Diversity” themed function where staff portrayed a variety of cultures.

he Intercare Cares project was initiated by the Parow Dental Centre.

They aimed to collect as many teddy bears as possible from staff, patients and anyone who is willing to give. The teddy bears and some food were delivered to a local children’s home and a few street children.

O

T

A day in the life of...

15 THINGS TO

KNOW ABOUT...

Dr Solly Nkhumeleni He is South Africa's first black orthodontist,

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practicing at our Dental Centres at Intercare Irene, Glen Marais and Wonderboom.

1.

When are you at your happiest?

When I am helping other people.

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What makes you unhappy?

Lack of ambition by others close to me.

2.

What do you value most in life?

My family and my work.

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What is on your computer screensaver?

An “I want passive income” image.

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What are your greatest fears?

Failure and redundancy.

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What are your hobbies?

Travel.

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What is your most treasured possession?

My profession.

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What is at the top of your bucket list?

I want to be useful to anyone I come across.

What is your greatest achievement?

I started a library in a rural school in Limpopo.

12.

Who would you invite to your dream dinner party?

Nelson Mandela.

6.

How do you relax?

Mmm… I will be dead for a long time.

13.

What is the most important lesson life has taught you?

It is okay to fail.

7.

Who are your roles models?

Warren Buffet and Steve Jobs.

14.

What is your favourite food?

Chicken and vegetables.

to be "I would like as a solutionremembered n who cares seeking perso ut others." genuinely abo

(Photo Credit: Alet Pretorius)

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health

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

What makes South Africans' blood boil?

More than 1 300 South Africans were polled by the country’s leading heart and stroke treatment provider, Pharma Dynamics, to reveal the everyday things that most make them see red.

With 6.3 million South Africans living with high blood pressure, SA has one of the highest rates of hypertension in the world. Stressful situations can cause your blood pressure to spike temporarily, but too much stress could lead to high blood pressure in the longrun. Doing activities that can help you manage your stress and improve your health can make a long-term difference in lowering blood pressure.

SA’s top 30 annoyances according to the survey are: 1. Taxi drivers 2. Queue jumpers 3. People who think rules don’t apply 4.

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to them Bad manners Load-shedding Rudeness in general

TIP HEALTH

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Having to go through lots of automated phone options and then being kept on hold Traffic jams Smoking around children Spitting in public Motorists and/or cyclists who jump red traffic lights Anti-social behaviour, e.g. when someone pays more attention to their electronic device(s) than to you Backstabbers Using cellphones while driving People eating loudly and sloppily Petrol price increases Laziness People who swear all the time People who can’t spell or use correct grammar Paying a fee for withdrawing money from an ATM Pop-up adverts on the internet Paying tax Office suck-ups Paying for parking when you only intend to pop in to the shops quick

25. Drivers speeding through housing estates

26. Your neighbour mowing the lawn or 27.

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drilling at 7am on the weekend Drivers ignoring zebra crossings Tardiness Tissues in the washing machine Busses or trains being cancelled

Twenty percent of respondents experience daily stress and aggravation from everyday irritations and frustrations, and almost 40% admitted that these usually cause them stress long after the incident. Mariska van Aswegen, spokesperson for Pharma Dynamics, recommends the following: “Try to take short breaks during times of the day that tend to be very stressful.

Identify what specifically makes you angry and think of possible solutions.

Humour can also help to diffuse tension.

Practise relaxation skills, especially when your temper flares, and exercise too is a great way to help reduce stress and Source: Pharma Dynamics feelings of frustration.”

Is chocolate good for your heart?

Fifty grams of good quality dark chocolate can lower your blood pressure by several points. But it's not a reason to start eating it in large amounts.

Why do women ditch cancer screening?

CANSA stresses the importance of regular cancer screening to promote early detection and improve treatment outcomes. Women who avoid screening are putting their lives at risk.

These women are urged to educate themselves and bust cancer myths; make the time to be examined; investigate options for affordable screening; and to overcome fear by taking control of their health and responsibility for their bodies; to be guided by their inner voice and not be concerned with what others may think; to choose slight discomfort over a diagnosis of advanced cancer.  Ignorance: Women who are not

sexually active think that screening isn’t necessary. Many young women mistakenly believe that only older women get cancer and that going for screening can be postponed as a result. Other women are ignorant of factors which may cause cancer, the need for screening and how it may reduce their cancer risk.  Convenience: Some women say they don’t have the time or fear the potential discomfort, or embarrassment they may experience.  Finances

: Others say they do not have the funds to afford screening.  Fear: Sometimes women fear what examination results may confirm or have had an unpleasant experience during a prior examination. In certain communities women shun examinations due to cultural taboos or because they fear the stigma often mistakenly associated with a diagnosis of gynaecological cancer and subsequent judgement by their loved Source: CANSA ones and community.

H B

Y A D I L O ING

H C N RU

Late nights and sleeping in during the holidays usually leads to a brunch or a lo-o-o-ng lunch. If you’re a fan of the holiday brunch you probably already know that this meal is an easy one to indulge. After all, you’re on holiday!

It’s tempting to have champers and an indulgent entree, plus other treats you wouldn’t normally have. But if you’re health- conscious, use these tips to navigate the brunch menu the healthy way.

1 Don’t drink your sugar Steer clear of cocktails – these liquid calories can add up fast. Try to stick to ordering just one alcoholic drink for the duration of your meal, and sip plenty of water as well. Bellinis, Bloody Marys, and other drinks made with pre-made mixes are an easy way to tack on loads of sugar to your meal.

Remember that fruit juices are also very high in sugar.

2 Create your own omeletTE An omelette is a great way to get in other food groups, including vegetables and dairy. Omelettes are usually made with 3 whole eggs, but you can also ask for 1 whole egg and 2 egg whites. Smart ingredient picks include spinach, mushrooms, peppers, tomatoes, onions, cheese, roasted vegetables, bacon, sausages and smoked salmon.

3 Sauces and Condiments…

Less is More Speaking of eggs, do keep in mind that fancier egg dishes, like the brunch menu staples of eggs Benedict drenched in Hollandaise sauce, tend to pack on the kilojoules and fat. Condiments like tomato

sauce are also loaded with added sugar.

4 Choose your side If you are on a low-carb diet, stay away from french fries, hashbrowns or toast. Otherwise you end up with too many carbs on the plate. Ask for sliced tomatoes, a side salad, or a side of fruit to add some low-kilojoule, high-nutrition value to your meal.

Many restaurants offer seasonal vegetables prepared different ways, so look for something you like that’s prepared by steaming, grilling, or roasting.

5 Sugar-light Oatmeal or granola may seem like a prudent pick on the brunch menu, but be careful. Home-made granola sounds wholesome, but it may be loaded up with sugar. The same is true for “brûléed” oatmeal, which is oatmeal topped with a couple of tablespoons of brown sugar that is then melted. It’s better to order the plain oatmeal and add your own sugar – less than a tablespoon – and fresh fruit.

6 Better BurgeR Leaning toward the “lunch” side of brunch? If a burger is sounding tempting, there are ways to make sure it’s still a health-conscious meal.

First step: add some veggies.

Choose sliced or mashed avocado in place of cheese, and add tomato and onion on top to “veggify“ the burger. Replace fries with a side salad. You could also order your burger bunless to cut back on carbs, or try a veggie burger or salmon burger if offered. Source: everydayhealth.com

Infographic

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Summer Health: Dr Owen Wiese, General Practitioner, Intercare Tyger Valley

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Summer Health

TOP TEN TIPS Summer is synonymous with sun, sea and lazy days with a cocktail on standby.

Taking good care of your health is just as important as soaking up the sun.

Here's how!

SUNBLOCK, 1 SUNBLOCK, SUNBLOCK South Africa is blessed with long, hot days, and nothing beats a day on the beach. Taking care of your skin is vital.

The incidence of skin cancer is on the rise worldwide, and using sunscreen is essential. Opt for waterproof sunscreen with an SPF of at least 30. Limit your time in the sun between the danger hours of 10am and 4pm.

2 KEEP WELL HYDRATED Being more active means more perspiration. Warm days also take their toll on the hydration status of the body.

Make sure ample cold water is available to your family. Healthy fruit shakes, juices and iced-teas are also great options to keep your family well hydrated.

Good choices:  Freshly squeezed fruit juices  Home-made lemonade  Fruit and yoghurt smoothies  Fresh water with mint leaves

3 EAT LIGHT AND FRESH Make use of the season's fresh produce to prepare healthy meals for your family.

Children prefer light meals to heavy set meals. Being more active, they will

Issue 09 | 2015

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Relaxation in its ultimate form is not spending time on electronic devices, but rather engaging in some me-time. Read a book or visit a botanical garden instead.

7 STAY SAFE

Rech your b arge at and m teries sure y ake o well re u are s make ted to 20 best y 16 the ea your li r of fe.

often raid the fridge. Ensure light snacks are available. A bowl of fruit is always a winner.

Good choices:  Crackers with cream cheese  Light, toasted sandwiches  Fruit salad  Salad and grilled fish

4 GET ACTIVE Strolling on the beach or an early evening stroll around the neighbourhood is a great way to keep your muscles working. Turn excursions into activities by walking to the beach or park instead of taking the car.

5 REMEMBER TO SLEEP Longer days mean that we tend to stay up later. Although this is okay, best is still to stick to your normal sleep cycle. Your body is used to a certain number of hours of sleep. Suddenly depriving yourself of sleep might make you feel tired and restless. Sleeping in is also fine, but getting out of bed at noon will sure make you feel more tired later in the day.

6 TURN OFF TECHNOLOGY Take a break from "electronic pollution" and turn off your cellphone, tablet and laptop, even if it is only for a day or two.

Swim in areas where lifeguards are on duty, wear a helmet while cycling and don't allow your child to play unsupervised – even in play parks. Ensuring the safety of you and your family is important.

Remember to keep a list of emergency contact numbers on hand, so you can take immediate action.

8 FIRST-AID KITS You never know when accidents might happen. Keeping a well-stocked first-aid kit on hand is important. Plasters, disinfectants, splints, eye patches, gauzes and bandages are essential. Also stock creams for insect stings and bites, pain and fever medication and after-sun ointment.

9 DON'T OVERINDULGE Nothing beats a cool summer evening cocktail. But beware not to overindulge only to wake up with a terrible hangover the next day. Alternate alcoholic drinks with water to ensure you keep well hydrated. The misery of a hangover on a hot summer day is incomprehensible.

10 UNWIND, REWIND After a busy year, spend ample time to relax and unwind. Recharge your batteries and make sure you are well rested to make 2016 the best year of your life.

TravelGround: Roseanna McBain - www.travelground.co.za

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Celebrate the holidays in style at these

SPECTACULAR STAYS

This year make the festive season your own when you dust off your glitzy and glamourous items and pick a stay where you can celebrate the holidays in style; be it with civilised dinners and dress-up at a hotel, or barefoot and dancing around a fire at a luxury self-catering lodge.

OCEan-Inspired Luxury

Beachside Relaxation

Lagoon Beach Hotel, Milnerton

Makarios on Sea, Herold’s Bay

Best for: Hotel living, seaside pampering

Best for: Direct beach access

Average price: R3024 per 4-sleeper unit

Average price: R3040 per 6-sleeper unit

Combining coastal chic with slick style, Lagoon Beach Hotel is a perfect fit for small families after a luxury experience. Pampering at the spa, lazing beside the swimming pool, fun and games at the kids club and a choice of dining areas cater to all styles. Not to mention the enviable view of Table Mountain, proximity to the city and beachside access are unbeatable in Cape Town.

Whale Suite at Makarios on Sea is our pick for the laidback family or group of friends that wants to stay together in December. The direct beach access, crashing waves and cosy-cottage feel ensure this 6-sleeper unit will remain a family-favourite for years. All bedrooms are en suite and equipped with fans, and the braai area takes advantage of the beach-side views.

INCREDIBLE SEA-VIEWS Blue Horizon, Tsitsikamma Best for: Luxury seaside experience Average price: R1050 per person

Have that nautical experience you’ve always dreamed of when you book in at Blue Horizon, an ocean-side log cabin that’s equipped for up to eight guests. Tailored for luxury self-catering, this incredible property is perched directly above the crashing waves and all bedrooms offer private balconies to make the most of the view.

Nearby rock pools beg to be explored, and beach walks and fishing are common pastimes.

TravelGround

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Luxury Game Lodge

Game Viewing

Motswari Private Game Reserve, Hoedspruit

Tau@Kruger, Marloth Park

Best for: Exclusive luxury and private stays

Best for: Wildlife viewing

Average price: R4305 per person a night

Average price: R2500 per 10-sleeper unit

For unsurpassed elegance and luxury, you’ll be hard pressed to find a game lodge that provides the same exclusive feel, and wildlife viewing opportunities, that Motswari does. With only 15 suites available, the sense of serenity and timeless class of Motswari will stay with you for years after you’ve left. Don’t miss out on the morning and evening game walks and wildlife drives, though wildlife spotting can also be done directly from the dining areas and swimming pool – seasonally dependent.

Treat your family to a wildlife experience this festive season at Tau@Kruger, an air-conditioned 10-sleeper self-catering chalet with a prime spot on the banks of the Crocodile River. From the patio it’s common to spot elephants at play in the river, as well as wild dogs, lions and buffalo coming to drink. Take time out in nature when you go on a guided or self-drive game drive and don’t forget to bring along that bottle of bubbly to celebrate the festive season.

Country Chic

Adventurers

The French Cottage, Clarens

Misty Peaks Villa, Bergview

Best for: A Provencal-style stay

Best for: Adventurers

Average price: R2400 per 6-sleeper unit

Average price: R4450 for 10 persons

The sandstone-built French Cottage is set only a few minutes outside of the artistic town of Clarens in the Free State, and true to its name provides a country-styled stay with plenty of Provencal appeal. Able to cater for up to six persons, the property offers a beautiful and quaint setting that is as ideal for a Champagne-fuelled soiree in the country, as it is for a week of family bonding.

On the cusp of the uKhalamba-Drakensberg World Heritage Site, and close to Cathkin Park, Misty Peaks Villa is a 6 to10-sleeper Tuscan-styled property, ideally situated for those who wish to adventure and enjoy the outdoors.

Boating and cruises, horse riding and putt-putt, river rafting, quad biking, microlight flights, canopy tours and more are all available only a short drive away.

Bushveld Bonanza

Set in a secluded wildlife estate, Nicole’s Bush Lodge has all you’d require for a perfect family vacation, especially if you have plans to ring in the New Year around a braai fire. The flow of indoor-outdoor open-plan living encompasses a splash pool and braai area, living and dining room, four bedrooms, and a well-equipped kitchen, and there’s plenty of space for children to play.

Nicole’s Bush Lodge, Hoedspruit Best for: Private stays close to town Average price: R5000 per 8-sleeper unit

Travel Health: Dr Chris Opperman, General Practitioner, Intercare Glenfair

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your guide to

TRAVEL HEALTH Tips for a Fun, Safe Holiday T

ravelling is a rewarding and enriching experience and it does not matter whether the road leads us to the other end of the cosmos, or if it is to the local library.

The most rewarding part of travelling is invariably the pretravel planning and anticipation, because that is where the dream develops and grows into an expectation of personal gratif ication. It is during this pretravel phase of planning that we tend to plan for the expected but not to plan for the unexpected.

It is good and well if the unexpected turns out to be a pleasant surprise, but it can so easily be a harbinger of misfortune and an early end to a fairytale vacation!

Every travel planned is unique, and no number of tips will ever cater for every individual need, so this article is meant to aid in remembering the bits and pieces that are so easily forgotten. Let ’s then consider the following topics that tend to present themselves in the consultation room either as a question or sometimes even as a demand from the übertraveller:

Malaria prophylaxis Flying and deep vein thrombosis Antibiotics to take with What medicines to carry along The first aid kit Immunisations: Too much and too little  To sun or not to sun  Care for the long-range driver      

Malaria prophylaxis Do not ever forget that malaria kills.

The old wives' tale that it is better not to take the prescribed medicines because they mask the symptoms and therefore make it more difficult for the doctor to diagnose malaria, is not true.

Issue 09 | 2015

17 There are a multitude of websites dedicated to malaria prophylaxis, but be sure that the site you choose to Google is reputable and, even better, search for the American CDC’s site. Because of variances in malaria risk geographically and seasonally, it is wise to find info related to the place and time you intend visiting. Be very wary of local wisdom, because locals usually do not take any pharmaceutical prophylaxis for good reason, but that does not apply to the in-and-out traveller.

Be advised that the only effective drugs are prescription drugs. That said, it is not always mandatory or even advisable to take pills. It is, however, always wise to create physical barriers protecting you and the loved ones from becoming the next mosquito meal. The spray on/ smear on, netting and other deterrent devices are all good, but only effective when applied correctly.

FLYING AND DEEP VEIN THROMBOSIS (dvt): Let’s first of all state clearly that the risk of deep vein thrombosis (a clot in the calf) is not a risk of flying. It is a risk of moving primarily for extended periods, like in all modes of travel; even travelling on the couch (as in couch potato!).

There are different opinions regarding the duration of immobility and the true onset of DVT risk. Some authors indicate 2 hours, some 4 hours and some others say it is only after 8 hours of being immobile. However, it is prudent to heed the shortest period, so no one should be absolutely stationary for longer than 2 hours. Good advice would be to have a good stretch, tensing and movement of the calves every half hour, and then to stand up and walk a couple of paces every 2 hours.

Do you need medicines or injections

for prevention of DVT? If you have a history of previous clotting risks, then yes you do. There is really no proof that any of these preventative measures actually prevent clotting. There are two basic reasons for that. Firstly, to research it is prohibitively expensive. Secondly, clotting can take place quite a while after the flight, and current medicines taken as a single dose just do not cover a long-enough period. And no, there is no proof that aspirin helps. Actually, we know that aspirin works on the arterial side of the blood flow and we need to target the venous side to prevent DVT. The good news is that although this topic gets repeated media attention, the real risk to develop this specific kind of thrombosis is actually very small. So what to do? Do the exercise, avoid alcohol, do not wear tight clothes restricting blood flow in the groin and knee flexures, have your varicose vein stockings if you so wish, but exercise!

ANTIBIOTICS TO TAKE WITH: Except if you are on a very extensive travel into the very serious nowhere, then nothing! The wrong antibiotic for the wrong reason at the wrong time will cause more problems than solving anything.

For some reason everyone wants antibiotics to be part of his/her parcel when going somewhere, and then use it because it is there. There are exceptions to the rule, but those exceptions will be based on prior problems like heart valve pathology, having organ transplants, etc. So you want to take medicines with; quite rightly. What should then be in your medicine basket?

Vacatio n is an ad ing venture and me a recharg nt to e those interna ls. Keep it safe an d the jo y follows.

Then what medicines to carry along?

For very obvious reasons it is best to have a reminder or note on the fridge door to remember all of your normal everyday chronic prescription medicines.

It is quite surprising to note how often people forget their pills at home!

Depending on where you go, the extras should be added as needed, but the following can be handy and even vital to have in the basket.

1. A general pain, fever and antiinflammatory tablet/capsule that is effective for the unforeseen headache, bumped toe and sunburn pains.

2. Sunscreen. Nowadays the aim is to have a protection factor of more than 50.

3. Celestamine. A much maligned drug by medical aids, but a life saver when needed. From the usual cold to the odd bee sting and the more serious allergic reaction, this combined antihistamine and corticosteroid takes little space but does a lot. Diabetics should be wary though.

4. Diarrhoea is one of the common pleasantries of travel. Antibiotics containing anti-diarrhoeal preparations are seldom really needed, and most of gastro-enteritis tends to be selflimiting. The main focus should be the prevention of dehydration and electrolyte depletion, and there are nicely packed electrolyte sachets available for this purpose.

Travel Health

18 5. An anti-emetic is another must.

Cyclizine is a centrally acting anti-emetic and is useful for the odd gastro-enteritis as well as for all the motion sicknesses.

   

Sterile saline tubes/sachets Antiseptic solution Stop itch cream First aid booklet.

6. There are many conditions where other medications may be of use, but generally speaking the less you have to carry the better. The best solution is to discuss this with your doctor who knows you and can assist you to a degree that no one else can. Allow him/her to guide you and not the other way around.

7. Be mindful that every person is unique and there is no such thing in medicine as a one-size-fits-all remedy.

The potential side effects or allergies must be discussed for you to know what to do if such a malady strikes when using any of the tag-along medicines.

All medicines are potentially harmful and the use of them must be done with a good measure of responsibility.

Once you have assembled a basic first aid kit, you can customise it according to its intended use. For example, if it is: 

For use at home, add extra items according to the number of people in your home and their age, such as thick crepe bandages if you have older children who play sport or for use as a pressure immobilisation bandage

The first aid kit



This is probably the most important part of the article, and usually also the most neglected when we pack for that dream trip. A common mistake is to pack the kit with very fancy and very useless "important” things. Here, the old adage is good to follow: keep it simple...

For the car or caravan, add a highly reflective (day/night) safety triangle and vest as you may be near a road and traffic

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For camping and boating, add heavy crepe bandages, instant cold packs, disposable poncho, plastic bags, whistle, compass, torch, glow stick and some vinegar for stings (especially marine stingers)

A basic first aid kit checklist might include:            

At least 2 crepe bandages: 50mm and 100mm Hypoallergenic (skin) tape 1 triangular bandage Adhesive dressing strips Gauze swabs (also to double up as dressing pads) Sterile eye pad Alcohol swabs Scissors (sharp/blunt) 12.5cm Disposable gloves Tweezers Shock (thermal) blanket Safety pins

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For babies, add extra items such as a digital thermometer, basic pain reliever medications and a plastic syringe for accurate dosing



For mountaineering, have the kit roped. You may need to lower it to a ledge!

Make sure that the bag is instantly recognisable as a first aid kit: You may just be the one who needs the attention and someone else must be able to identify it as such.

Immunisations: Too much and too little Make sure that your immunisations are up to schedule. All over the world there are periodic outbreaks of different diseases. Again the CDC web pages are of high value.

The immunisation that is probably the most important is also the least remembered: the anti-tetanus jab.

There are many places that are too far away from decent medical care, or places where the injection is not available. Keep your tetanus immunity high, because you can get infected anywhere; even at home.

Do not fall into the trap of insisting on having every immunisation in the book.

Every injection carries with it its own risk, and having immunisations that do not add value to your immune system is pointless. On the other hand, do not underestimate the appropriate value of having the proper immunisations in good time.

To sun or not to sun: Vitamin D and Melanoma Sunning the skin is cosmetically beautiful for a couple of days but disastrous a couple of decades later.

Astonishingly, with all of the mediabased warnings, the excessive roasting of the flesh continues unabated.

Heed those warnings! The end result is often malignant melanoma; a very serious and frequently fatal skin cancer.

There is however a caveat to the overavoidance of sunlight.

More and more studies are showing us that a significant proportion of the South African population is vitamin D deficient, and this is in part related to

Issue 09 | 2015

19 not getting enough consistent exposure to sunlight, and living and working in airconditioned artificial environments. The common-sense deduction is that we need a balanced approach to sun exposure.

Have a sunblock of choice, but make sure that the SPF is 50 or more. Have your proper hat on and protect your arms and legs. Sunburn is always too much!

Caring for the driver Fatigue is the unavoidable consequence of prolonged concentration and exertion.

It is insidious and very often fatal when driving. Fatigue is fortunately a manageable effect and a couple of simple rules will help to keep the journey safe.

1. Wear loose-fitting, comfortable clothes.

2. Have plenty of water.

3. Have 2-hourly driving breaks for at least 10 minutes at a time.

4. Have 100km markers to keep interest in the road.

5. Have alternating drivers.

6. Have proper cool air flow over the arms and facial areas.

7. Have a good conversation.

8. Avoid all alcohol, sugars and large meals.

9. Avoid excessive volume when listening to music. Auditory stress is highly fatiguing.

10. Avoid having all passengers sleeping.

It is the best inducement for the driver falling into a trancelike sleep.

11. Avoid fixation on the road.

Continuously scan the road ahead, behind, to the sides and the vehicle's instruments. This is a good indicator of approaching fatigue. The moment the continuity of the scanning breaks off; STOP! You gave yourself a reliable first warning of being unfit to drive.

Vacationing is an adventure and meant to recharge those internals. Keep it safe and the joy follows.

All About: Spine School, Woodhill Intercare Physiotherapy Department

20

Back and Neck pain

Taking the "ouch!" out of your pocket

“Ouch! My back hurts… again!”

It is said that 80% of people will experience back pain at some point during their lives.

Back and neck pain is a common cause for many employees to be absent from work.

Issue 09 | 2015

21

T

he result being thousands of rands spent each year by medical aids, compensation funds and patients themselves. This pain can often go away within a short time by itself, but if it lasts longer than three days or is a result of an injury, rather see a medical practitioner or physiotherapist. Pain that lasts longer than three months is described as chronic and severe: chronic pain can make you feel depressed, useless and tired.

We are taught in schools how to prepare for our future jobs, our elders teach us life skills, but very few of us know how to take care of

our spines and move in the correct way.

Therefore many people end up with back or neck pain, sometimes to such an extent where surgery is necessary to relieve pain… again and again.

South African physiotherapists aim to make people more aware of back injuries, treatment and prevention by means of the correct care.

With initial back pain, try to use ice, heat and over-the-counter medication. If this does not take the pain away, contact your general practitioner or physiotherapist.

With conservative treatment your doctor will aim to get rid of the pain with muscle relaxants, anti-inflammatories and pain medication. After assessing your pain, the physiotherapist will aim to reduce the

pain with different modalities, for example taping, electrotherapeutic intervention, soft-tissue treatment and vertebral mobilisation or manipulation, and in some cases, dry needling. If you do not react appropriately to the treatment, they will refer you for X-rays, if not earlier.

Many people experience terrible pain although their X-rays do not show any pathology. Other people’s X-rays show severe-looking conditions, but they do not experience any pain. Certain problems cannot be identified on X-rays and they might need to have other specialised diagnostic tests done. MRI and CT-scans show conditions like prolapsed discs or narrowing of the spinal canal. Some conditions are not picked up by any of these tests, for example local segmental weakness of stabilising muscle groups.

Your pain may be caused by stiffness of different specific areas of your spine that can again result in too much movement at another level of your spine.

In one person, different conditions may cause different kinds of pain with different movements. Many people might have the same pain in the same area, but it might not be due to the same pathology.

Therefore the same kind of treatmen may cause similar pain in different people to become worse.

KEY FACTS: 

Pain that lasts longer than three months is described as chronic and severe.



Sometimes you can feel worse after a physiotherapy session.

Your feedback is very important to the treatment.



If you apply the principles of ergonomics, movement patterns and correct exercises, you can stay pain free and can prevent pain and/or surgery.

The physiotherapist and biokineticist will work together to prevent the pain from recurring by teaching the patient correct ergonomics, movement patterns and exercises. It is important to know that you can exercise yourself into pain, or out of it.

The principle of “no pain, no gain” mostly does not apply to your spine. If you experience pain during or after your gym or home exercise session, a few small adjustments to the exercises will help you to become pain free.

With proper assessment, physiotherapists who completed a post-graduate specialised course in spinal problems will often be able to identify the cause of your pain. X-rays, MRI and CT-scans may support that diagnosis. Although these tests sometimes show specific pathology, the pathology might not necessarily be the reason for a patient’s pain at that specific moment in time. It is crucial that this proper assessment is done for the therapist to be able to give the correct advice, treatment and exercises.

Knowledge of ergonomics regarding how to sit, stand and even sleep correctly can play a huge part in becoming pain free during night and day. Picking up your children, washing the dog and understanding how to carry your backpack the correct way can mean pain or no pain during your leisure times. Adapting your computer work station and many other working habits may lead to more productivity at work and less hours off to seek medical help.

Remember that you can sometimes feel worse after a physiotherapy session.

The feedback from you, the patient, is very important for the physiotherapist to explain the result of the treatment and to adjust the treatment accordingly.

If you apply the principles of ergonomics, movement patterns and correct exercises, you can stay pain free. If you apply those same principles before surgery, you might prevent pain from ever starting or even prevent surgery.

All About

22 Stress can aggravate any underlying pathology’s symptoms from the spine.

If you go through stressful periods, you might experience that even a small lesion in the spine can wreak havoc on your muscles. Therefore, seeing a psychologist to help you handle stress in your situation or learning how to relax in spite of circumstances will give you much better results while being treated by the other medical professionals.

If you know that you can benefit from losing a few extra kilograms, also realise that it will benefit your back and that in the process of losing weight, the chances are that you might “lose” your back pain.

Consult a dietician if you need help with this matter. Even with the best medical intervention, whether it be exercises prescribed by a biokineticist, physiotherapy or even surgery, the result can only be as good as the patientpractitioner teamwork.

If underlying pathology is present and the patient stops applying what they are taught, the pain often comes back. With good treatment, the medical team aims to get you pain free and helps you to stay pain free.

All these medical processes can become very costly. To have some more insight in your spinal pain, you might consider visiting a physiotherapist who can spend time on a proper evaluation and teach you how to take care of the condition in order to live as pain free as possible, even without spending a lot of money on different kinds of treatments. Some conditions, however, might need you to go for physiotherapy from time to time or will end in surgery regardless.

At Woodhill Intercare, Pretoria, the presentation of the Spine School may give you insight into your pain and how you can become the controller of your

pain, instead of the pain controlling your life. This presentation consists of a once-off lecture on the basic anatomy, possible pathologies, the symptoms thereof, possible medical treatment as well as ergonomic tips for home, office and leisure times on how to take care of your spine.

If you empower yourself with knowledge on taking care of your spine, staying pain free need not cost you an arm and a leg.

The Spine School doesn’t teach you to live with your pain, but to live pain free in spite of the problem. This lecture can also be presented at your company.

Bookings for the Spine School can be made at the Woodhill Intercare physiotherapy department on 012 998 0425.

Advertorial

Gum disease, Pregnancy AND YOUR BABY Bad oral hygiene can affect your bABY Surprised?

Expecting? Don’t neglect your teeth. If you're planning to become pregnant or suspect you're already pregnant, it's important that you see a dentist right away.

Pregnancy can lead to dental problems in some women, including gum disease and increased risk of tooth decay. During pregnancy, the gum problems that occur are not due to increased plaque, but a worse response to plaque (the layer of bacteria on your teeth) as a result of increased hormone levels.

How does plaque build-up affect me?

When plaque isn't removed, it can cause gingivitis – red, swollen, tender gums that are more likely to bleed when you brush. So-called "pregnancy gingivitis" affects most pregnant women to some degree and generally begins to surface as early as the second month of pregnancy.

Gingivitis occurs in 60% to 75% of pregnant women.

If you already have gingivitis, the condition is likely to worsen during pregnancy. Untreated gingivitis can lead to periodontitis, a more serious form of gum disease that includes bone loss.

How does gingivitis affect my baby's health?

Research has found a link between gum disease and three possible problems:  Having a baby with a low weight at birth.  Giving birth too early in the pregnancy.  Having dangerously high blood pressure (pre-eclampsia) during pregnancy.

Estimates suggest that about 18 out

of every 100 premature births may be triggered by periodontal disease, which is a chronic infection of the gums. Excessive bacteria can enter the bloodstream through your gums; then can travel to the uterus, triggering the production of chemicals called prostaglandins, which are suspected to induce premature labour. Pregnant women who receive treatment for their periodontal disease can reduce the risk of premature birth by more than 80% according to one study.

How can I prevent gingivitis?

You can prevent gingivitis by keeping your teeth clean, especially near the gum line. You should brush with fluoride toothpaste at least twice a day and after each meal when possible. You also should floss each day. If you suffer from morning sickness, repeatedly rinse your mouth with water and brush your teeth as often as possible to neutralise the acid caused by vomiting. If brushing your teeth causes morning sickness, rinse your mouth with water, brush without toothpaste and follow with anti-plaque fluoride mouthwash. Good nutrition keeps the oral cavity healthy and strong; in particular, you should get plenty of Vitamin C and B12.

Your dentists can help in controlling plaque and preventing periodontal disease by creating a treatment plan that is safe, effective, and essential for combating the adverse effects of oral disease during pregnancy. They will be able to assess your oral condition and map out a dental plan for the remainder of your pregnancy.

Remember, the healthier your mouth is, the healthier and happier your pregnancy and baby will be.

DON'T DELAY TEST TODAY! Micro-IDent Test: Provides information about kind and load of bacteria in your gum pockets.

DNA Test: Determination of your susceptibility to inflammation to develop gum disease.

Covered by most medical aids

Contact details: Hain Lifescience SA (Pty) Ltd Email: marcelle@hain-lifescience.co.za Web: www.hain-lifescience.co.za Tel: 011 314 8623

Know It All

24

G U R D C OT N O I T C I ADD tion to ic d d a t n e il s e h T dicines e m " y a d ry e v e "

Is your medicine cabinet a source for a family member’s legal “high”?

Because a doctor’s prescription is not needed, many mistakenly believe that over-the-counter (OTC) medicines are safer than prescription medicines and illegal street drugs.

T

hey are in fact safe and effective when taken as directed, but even OTC medicines – including herbal medicines or homeopathic preparations – can cause serious and potentially fatal side effects when abused.

Abuse of OTC medicines is most common among teens between the ages of 13 and 16. In fact, prescription and OTC drugs are, after marijuana (and alcohol), the most commonly abused substances by Americans 14 and older. Adults also abuse OTC medicines, particularly in combination with other medicines, alcohol, and illegal drugs, which increases the risks.

The list that follows includes some of the medicines currently abused by teens and adults. 

Codeine is used in pain relief and for the suppression of coughs. Since codeine is a member of the opiate drug class, it has similar morphinelike effects on the body, including an impaired emotional response to pain and longterm impacts on the way the nervous system functions.

Codeine has many side effects that can impact an abuser in several ways, including but not

limited to their physical well-being, mental health, and relationships. Codeine, if taken regularly over a period of time, can produce physical dependence that will result in withdrawal symptoms if ceased. In addition it is possible to create a psychological dependence, for example when the drug is seen as a coping strategy to lower anxiety. A characteristic of addiction is that the awareness of the excessive and continued use actually increases anxiety. Codeine is the most abused OTC drug in South Africa and patients are required to provide their personal details including ID numbers, when they purchase a range of popular over-the-counter medications containing codeine. It is difficult to regulate codeine as no national database exists. 

Dextromethorphan (DXM) is the active ingredient and cough suppresant in more than a hundred OTC cough and cold medicines. Large doses can cause euphoria, distortions of colour and sound, and “out of body” hallucinations that last up to 6 hours. Other dangerous side effects include impaired judgment, vomiting, loss of muscle movement, seizures, blurred vision, drowsiness, shallow breathing, and a fast heart rate.

When combined with alcohol or other drugs, a large dose can lead to death.

DXM is also addictive and

can cause withdrawal symptoms, including depression and difficulty processing thoughts, when the abuse stops. Teens are most likely to abuse cough and cold medicine, the cough syrups or the higherdose tablets containing DXM. 

Pain killers like acetaminophen and ibuprofen are taken in doses higher than recommended to ensure that the medicine works faster. Liver failure can happen with large doses of acetaminophen, and stomach bleeding, kidney failure, and cardiac risks are heightened when taking large doses of ibuprofen.



Caffeine medicines and energy drinks have all been abused for the buzz or “jolt of energy” they seem to impart. Large doses of caffeine can cause serious dehydration, gastric reflux, panic attacks, and heart irregularities that have occasionally been linked to accidental deaths, particularly in those with an underlying heart condition.



Diet pills in large doses can create a mild buzz.

Abuse of diet pills often starts with trying just a few in order to lose weight.

But these OTC medicines can be highly addictive.

Ephedrine is one of the dangerous stimulants that can be found in diet pills. Many other diet pill ingredients cause digestive problems, hair loss, insomnia, anxiety, irritability, extreme paranoia, blurred vision, kidney problems, menstrual cycle disturbances and dehydration. Furthermore, even the most “natural” diet

preparations can have serious side effects when misused. 

Laxatives and herbal diuretics (water pills) are also abused, to lose weight. Laxatives and herbal diuretics can cause serious dehydration and life-threatening loss of important minerals and salts that regulate the amount of water in the body, acidity of the blood, and muscle function. This can lead to kidney damage.



Motion sickness pills that contain dimenhydrinate or diphenhydramine taken in large doses can cause one to feel high and have hallucinations similar to street drugs. The dose needed to cause these symptoms varies widely according to body weight and tolerance. Extremely high doses have caused dangerous irregular heartbeats, coma, heart attacks, and death. Longterm abuse can cause depression, liver and kidney damage, memory loss, eye pain, itchy skin, urine retention, and abdominal pain.





Sexual performance medicines, often purchased online, are sometimes abused by teens and adults who are drinking to counteract the negative effects of alcohol on sexual performance. These medicines can cause heart problems, especially when combined with alcohol or when taken in large doses.

Pseudoephedrine is a nasal decongestant and stimulant found in many

25

One of the greatest difficulties with preventing OTC drug use is that few teens and adults realise the danger.

Teens and young adults who learn about the risks of drugs at home are up to 50% less likely to abuse drugs. cold medicines.

The medicine has also been taken as a stimulant to cause an excitable, hyperactive feeling. Dangerous side effects include heart palpitations, irregular heartbeats, and heart attacks.

When combined with other drugs, such as narcotics, pseudoephedrine may trigger episodes of paranoid psychosis. 

Herbal products are increasingly being abused for their stimulant, hallucinogenic, and euphoric effects.

Since OTC drugs are legal and easy to find it makes it easy to abuse. Like any medicine, it can have benefits when taken as directed and in moderation.

But there is always the danger of taking too much, mixing it with other drugs and even overdosing.

Treatment for OTC Medication Abuse or Addiction Treatment for drug abuse or addiction to OTC medications depends upon several factors, including the type of overthe-counter medication or medications being abused, the age and gender of the patient, the length and severity of the patient’s drug problems, and the presence of any co-occurring disorders.

Treatment may include the following therapies and techniques:       

Individual therapy Group therapy Family therapy 12-Step education Relapse-prevention instruction Cognitive Behavioural Therapy (CBT) Dialectical Behavioural Therapy (DBT)

e sick h If you'r coug eed a n cold n d n a binatio or com ine, get only ic d and med u nee o y t a hat's wh se of w 're dispo u o en y left wh better. feeling

One of the greatest difficulties with preventing OTC drug use is that few teens and adults realise the danger. Unlike the risks associated with illegal street drugs like cocaine and heroin, the risks associated with OTC drug abuse are given little thought and attention. Teens and young adults who learn about the risks of drugs at home are up to 50% less likely to abuse drugs.

A Checklist for Parents Teen abuse of cough and cold medicines is a widespread and serious issue. As a parent, you may not have any idea how you can prevent it. Here's hands-on advice for what you should do, starting right now.

1 Know which drugs are being abused. The biggest problem is with medicines that contain dextromethorphan and codeine, which are found in over-the-counter medicines sold to treat the symptoms of cough and colds.

2 Learn the slang. Find out what teens are calling these drugs. DXM goes by many names – tussin, skittles, robo, CCC, triple C, dex syrup, and red devils, to name a few.

If you didn’t know that, your kids

could be talking about cough medicine abuse while you drive them home in the carpool, and you'd have no idea.

Monitor their behaviour, be aware if they tend to go to the local pharmacy or supermarket prior to going out with friends, and look for empty bottles of cough syrup or cough and cold pill packs.

3 Look in your medicine cabinet. No parent wants to be a drug supplier for his or her children. Treat your medicine cabinet like your liquor cabinet: know what's in it and keep track.

Just like you did when your child was a baby, you may need to remove some medications to a place where your kids won't be able to get them.

4 Get rid of medicines you don’t use. Don’t keep them around just in case – many are probably expired, anyway. If you're sick and need a cough or combination cold medicine, get only what you need and dispose of what's left when you're feeling better.

5 Talk to other parents.

Share what you know about cough medicine abuse with other parents, particularly the parents of your teen's friends.

Coordinate your efforts. If you're cleaning out your medicine cabinet, get the parents of your teen's friends to do the same. By making it a community effort, you'll help keep everyone safer.

6 Model good behaviour.

You may be careless with how you use medication yourself. If your headache is really bad, you may double the recommended dose. If your back goes out, you might bum a few narcotic painkillers from a friend who had them left over after dental surgery. These medications have real risks when not taken appropriately. What's more, your kids are watching.

If you don't treat these medicines with respect – and only use them as recommended – why should you assume your teens will?

7 Talk to your teen.

When parents talk to their children a lot about drug abuse, it reduces the risk that they will use drugs. So, don't beat around the bush. Talk to your kids directly about the risks of drug abuse, and mention cough medicine abuse specifically. Just because medicines come from a pharmacist doesn't mean they are risk-free.

Sources: WebMD, everydayhealth.com. philly.com

Health Treats

WATERMELON

27

F R E N Z Y Watermelon Whole Fruit Popsicles

One Ingredient Watermelon Sorbet

Watermelon, Feta and Mint Skewers

MAKES: 12 (depending on mould size)

MAKES: 8 cups (depending on the size of the watermelon)

MAKES: 12–24 skewers (depending on the bite size)

    

About 1/4 to 1/2 a watermelon (peeled and cubed) 1/2 cup fresh blueberries 1/2 cup chopped fresh strawberries 1 kiwi, peeled and sliced 1 peach or nectarine, diced small Handful fresh cherries, pitted and chopped



1 Seedless watermelon (peeled and cubed)

1. Arrange the watermelon cubes in an even layer on a baking sheet. Transfer the baking sheet to the freezer and freeze until the watermelon is solid, about 2 hours.

1. Cut the watermelon into chunks and puree it in a blender until smooth.

2. Working in batches, transfer the watermelon cubes to a blender or food processor and puree until smooth.

2. Fill each of your popsicle moulds with chopped fresh fruit. Pour in the watermelon puree until each mould is full to the top. Place a popsicle stick into each one. Place them into your freezer and freeze for about 6 to 8 hours.

3. Divide the puree among two loaf pans, or pour the puree in one deep baking dish, packing it down as you add more on top.

TIP: Any fresh organic fruit can be used.

Try to use contrasting colours.

5. To serve, scoop the sorbet into dishes and eat immediately.

Recipe: www.purewow.com

4. Transfer the pans to the freezer. Freeze until the sorbet is scoopable, 1 to 2 hours more.

Recipe: www.nourishingmeals.com, Photo Credit: Liz Andrew

3. When ready to serve, run the popsicle moulds under warm water for a few seconds to easily pull them out.

    

1/2 cup feta cheese, in a block 1/4 of a large watermelon Mint leaves Skewers Balsamic vinegar for drizzling

1. Cube the watermelon into bite-sized pieces.

2. Cube the feta into the same sizes.

3. To assemble, stack the feta and watermelon with a mint leaf in between.

4. Using a skewer or toothpick, skewer the stack.

5. For added flavour, use a reduced balsamic vinegar drizzle.

TIP: For the drizzle, add 1/2 cup balsamic vinegar to a small saucepan and reduce for 3–5 minutes until thickened.

Drizzle over the skewers.

Recipe: www.bitesofbri.com



Diagnosis Gallstones (cholelithiasis) is a very common problem and about 90% of people with gallstones will have no symptoms and will never even know it.

About one in four women and one in eight men develop gallstones at some stage in their life. Gallstones are more common in women, especially during a woman’s fertile years and during pregnancy. This is because cholesterol is a component of oestrogen, and at these times fluctuating levels of oestrogen need to be broken down to cholesterol and excreted in bile. Although gallstones are most common among overweight, middleaged women, the elderly and men are more likely to experience more serious complications from gallstones.

28

What Causes Gallstones?

Gallstones occur when one of the substances that make up bile (usually cholesterol or bilirubin) becomes too concentrated and forms a hard stone or pellet. According to Harvard Health Publications, 80% of gallstones are made of cholesterol. The other 20% of gallstones are made of calcium salts and bilirubin. These are known as pigment stones.

GALLSTONES The gallbladder isn't an organ that gets a lot of attention – unless it's causing you pain…

T

he gallbladder is a small, pear-shaped sac that stores bile from the liver, and it's tucked just under your liver, below the right rib cage.

After meals, the gallbladder contracts and releases bile, a yellow-green fluid via the cystic duct, into the small intestine to help break down the foods you eat – particularly fatty foods.

Bile contains water, cholesterol, phospholipids and chemicals to aid digestion, as well as waste products for excretion via the bowel, such as bilirubin (a pigment from broken-down red blood cells). Typically the gallbladder doesn't cause too many problems or much concern, but if something slows or blocks the flow of bile from the gallbladder, a number of problems can result.

Gallstones can also form when the flow of bile is reduced. This may occur due to:  damage to the liver (cirrhosis) or damage to the biliary tract which affects the secretion and flow of bile.  long periods of fasting during which there is less requirement for bile, leading to bile stasis (decreased flow of bile).

Gallstones range in size. They can be as tiny as the head of a pin or as large as a golf ball.  Although it is common to have many smaller stones, a single larger stone or any combination of sizes is possible.  If stones are very small, they may form a sludge or slurry.

Who Is at Risk for Gallstones?

While your body produces cholesterol naturally, you can also take in excess cholesterol through your diet. Many risk factors for gallstones are related to diet.

These include:  A family history of gallstones  Being overweight or obese  Eating a diet that’s high in fat or cholesterol  Rapid weight loss within a short period of time  Eating a diet that is low in fibre  Having diabetes

Other symptoms include:  Fever with chills  A yellowish tint in your skin or eyes, which can indicate jaundice  Nausea or vomiting  Clay-coloured stools  Pain that strikes after eating a fatty meal  Indigestion, bloating, and gas  Appetite loss

Other risk factors include:  Being female  Being pregnant  Being 40 or older  Having cirrhosis of the liver  Taking certain medications for lowering cholesterol levels  Taking medications that have a high oestrogen content (birth control pills or hormone/oestrogen therapy)

If you have any of these symptoms, it’s possible that gallstones may be to blame.

Rather head to your doctor for an exam and to get started on treatment.

What Are the Symptoms of Gallstones?

Gallstones may cause pain known as biliary colic, but about 90% of people with gallstones will have no symptoms. These are called “silent” gallstones. They are often found by accident when the abdomen is being X-rayed for some other reason.

In some people the stones begin to cause trouble by blocking the flow of bile and causing inflammation.

The most common symptom of gallstones is pain in the right upper part of your abdomen. The pain often radiates to your back or right shoulder or shoulder blade.

How Are Gallstones Diagnosed?

Your doctor will perform a physical examination. A yellowish tint in your skin or eyes may be signs of jaundice.

Too much bilirubin in your body causes jaundice. The examination may involve using diagnostic testing to see inside your body. These tests include: Ultrasound Ultrasound tests produce images of your abdomen. This is the preferred imaging method to initially confirm that you have gallstone disease.

Abdominal CT Scan This is an imaging test that takes pictures of your liver and abdominal region.

Blood Tests Your doctor may order blood tests that measure the amount of bilirubin in your blood. The tests also help determine how well your liver is functioning.

How Are Gallstones Treated?

Your doctor may use any of several treatment options to remove stones or improve your condition.

Surgery Surgery is often the first option if you have significant symptoms. Your doctor may need to perform a laparoscopic gallbladder removal, which is a common surgery. Tiny incisions are made, recovery is quick, and you may not even have to spend the night in the hospital following surgery. During this procedure, the bile is redirected so

Questions to ask Your doctor  Is oestrogen replacement therapy during and after menopause likely to bring on gallstones even though I have not had problems in the past?  If there is a family history of gallstones, should I avoid oral contraceptives?  Is my high-fat low-carb diet putting me at risk for gallstones? that it flows directly from the liver to the intestines.

Lithotripsy Forceful sound waves are aimed directly at the gallstones to break them into tiny fragments, usually followed by medications to dissolve these pieces.

Painkillers These may be recommended to control pain during an acute attack of cholecystitis.

Medications Drugs that dissolve gallstones caused by cholesterol are an option if you cannot undergo surgery. These medications may take several years to eliminate the gallstones.

Lifestyle Changes After Gallbladder Removal Much like an appendix, a gallbladder isn’t necessary for a person to live a full and healthy life. However, you may have loose or watery stools after gallbladder removal.

This diarrhoea occurs because removing a gallbladder involves rerouting the bile from the liver to the small intestine. Bile no longer goes through the gallbladder after surgery and it becomes less concentrated.

The result is a laxative effect that causes diarrhoea. If you eat a diet lower in fats, less bile will be released. A low-fat, lowcholesterol diet can prevent symptoms of gallstones but cannot prevent formation of stones. It is not known why some people form stones and others do not.

Sources: www.britishlivertrust.org.uk, everydayhealth.com, emedicinehealth.com

First Aid

30

FIRST AID

! fe a S y ta S – lm a C y ta S

First at The scene What to Do at a road accident It just might be that one day you are the first, or only, person to arrive at the scene of an accident, or you may be involved in an accident but uninjured. Would you know what to do? Time is crucial and your actions can make a difference.

What to do when you are first aT AN accident SCENE:

Give the following Information to the Emergency services:

Warn others: + Pull your vehicle off the road (ideally facing approaching traffic) and turn on hazard lights and headlights of all vehicles on the scene. + Place a warning triangle in the road. + If there are other people who can help, send them back along the road to wave traffic in order to slow it down. Take care on fast-moving roads – other drivers might not understand what you are trying to do.

Secure the scene: + Look out for dangers (chemicals, damaged power lines or spilt fuel).

The most important person to keep safe is yourself. + Turn off engines and apply handbrakes. + Impose a no-smoking ban. + Keep children at a safe distance. + Find all casualties.

+ Your name and telephone number (if you are cut off, the emergency service will be able to contact you). + The number of victims and the degree of injuries sustained. + The exact location of the incident: road names or numbers, landmarks, GPS coordinates. + Description of the incident, for example, “Taxi hit a motorcyclist – the motorcyclist is not moving" Assessing and assisting The injured: The quiet casualties are probably the worst injured. Confirm whether the injured persons are conscious or unconscious. If you are not trained in first aid: + Stay calm and reassure all casualties that you have called emergency services. Talk to victims. Be encouraging.

+ If the casualty is conscious, hold their hand. Ask them where they feel pain.

Find out what you can about them – name and address and that of their partner or parents, their GP’s details, whether they are on any medication or suffer from any allergies. + Don’t move the injured or attempt to remove them from the vehicle unless there is immediate danger. Always suspect spinal injuries. + If the person is unconscious, open the mouth and check for any obstructions.

If there is something obstructing the airway, use your index and middle finger to clear the airway. + For heavy bleeding, take any material, e.g. T-shirt, and place over the wound.

Apply direct pressure. + Don’t touch blood without latex gloves. + Cover accident victims with a blanket or a jacket to keep them warm and to prevent shock. + Don't give casualties anything to eat or drink: this can lead to the patient choking or cause complications for medics and delay life-saving treatment.

Issue 09 | 2015

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...keep in mind that your primary job is to help protect the victims until professional help arrives – not treat their injuries.

If you are trained in First aid: + Do the ABCs: Airway, Breathing and Circulation. If the person is not breathing, begin rescue breathing or CPR as necessary. + Don’t move the injured if you suspect a head, back or neck injury, unless there is imminent danger. + Deal with blocked airways and excessive bleeding first. + If an injured motorcyclist is breathing normally, leave the helmet on.

The only time it should be removed is if the airway is blocked and cannot be cleared with the helmet on or if it is necessary to perform CPR.

Keep in your car: + A small notebook and pens + A small LED torch + A reflective vest and a first-aid kit

Attend a first-aid course to learn the basics of first aid. It's easy to save lives with simple skills that can be learned in just a few hours.

Legal and other advice: If you are involved in a collision that causes damage or injury to any other person, vehicle, animal or property, you MUST: + Stop + Give your own and the vehicle owner's name and address, and the registration number of the vehicle, to anyone having reasonable grounds for requiring them + If you do not give your name and address at the time of the collision, report it to the police as soon as reasonably practicable, and in any case within 24 hours.

re s ensu Alway e v a uh that yo ess to cc easy a ency emerg lth t n ta r o imp d hea ers an for numb ation inform diate imme . action

Sources: www.roadandtravel.com, www.smartdriving.co.uk, www.survivetheride.org

Traffic accidents can be traumatic for victims and bystanders alike. But if you ever have to "take charge" at the scene of an accident, keep in mind that your primary job is to help protect the victims until professional help arrives – not treat their injuries.

It takes only 4 minutes for a road accident victim with no serious injuries to die from a blocked airway. It can take up to 10 minutes for an ambulance to arrive at the scene of an accident.

Recipe: SA Rooibos Council: www.sarooibos.org.za

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PERFECT SUMMER COOLER

ROOIBOS

tea punch A Rooibos cocktail movement has taken over bars across the world’s cocktail capitals of London, New York and Cape Town, and has been dubbed by mixologists as this season’s favourite party mixer.

According to experts, bartenders are moving away from overly complex mixes and are creating interesting flavours with a few key ingredients, such as Rooibos. While most cocktails are often packed with just as many calories as a doughnut, swapping calorie-rich ingredients for Rooibos – which contains no fat or carbohydrates – offers not only a great slimming alternative, but also contains disease-preventing antioxidants, which protects against cancer, heart disease, and stroke.

Ingredients

 500ml strong Rooibos

tea, cooled 500ml peach juice At least 100ml vodka 1 lemon, thinly sliced Handful fresh mint leaves  2 peaches, thinly sliced    

Method

 Combine all the

ingredients in a large jug and stir well.  Serve over ice.  Garnish with slices of pineapple and kiwi and add fruit like cherries.

Photo credit: Jan Theron Photography

SUSPENSION & TABLETS

REMEMBER TO DEWORM EVERY 6 MONTHS

S1 Reg. No. 30/12/0245

S1 Reg. No. 32/12/0538

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