Healthy Times April 2017 Edition

AUTUMN 2017

How she keeps mind, body and soul in shape

HEALTHIER FOOD Takeaway makeovers

VACCINES

Top up your health

WELLNESS AT WORK Posture-perfect Greener buildings Deskercise The new way to work

HEALTHY HOME

Dealing with house dust mite allergies

contents

AUTUMN 2017

52 44 HEALTHY BODY Give your vaccines a boost 47 PAIN MANAGEMENT About fibromyalgia 52 HEALTHY EATING Fast food doesn’t have to be unhealthy

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56 HEALTH AND BEAUTY Getting to the root of hair loss 59 HEALTHY TEETH Gum disease 60 VEINS Help for troublesome veins 63 HEALTH AND BEAUTY Chemical peels

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65 HEALTHY SLEEP Restless legs syndrome

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FROM THE EDITOR

HEALTHY WORK

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COVER STORY Lira feeling good

21 Deskercise: the new way to work

10 HEALTHY AUTUMN Prepare now for winter 15 DIABETES The future of diabetes management 17 HEALTHY FINANCES What you need to know about gap cover

25 How to treat and prevent burnout 29 Ergonomics could change your life 33 Move towards ‘greener’ buildings HEALTHY HOME 37 Dealing with house dust mite allergies 41 Natural cleaning products

68 HEALTHY PREGNANCY Looking after you and your baby 71 HEALTHY PETS Animal behaviourists 72 HEALTHY HOLIDAYS What to pack in your first-aid kit

FS R T ROAMP LT IHNEE EHDEI R TO ER

EDITORIAL

PREPARATION

Art Director: Janine Wait Copy Editor: Joy Capon

Contributors: Louise Ferreira, Lynne Gidish, Caryn Gootkin, Georgina Guedes, Penny Haw, Nia Magoulianiti-McGregor, Zaza Motha, Prevashni Naidu, Nicole Sparrow, Candice Tehini Cover image: Franz Rabe ADVERTISING Project Manager: Roman Ross

romanr@picasso.co.za Tel: 021 469 2498

Sales Team: Jay Deary, Sandile Koni, Marc Plastow Advertising Co-ordinator: Vanessa Payne

Advertisement Design: Nichole Liedeman

he older I get, the more I love these transitional seasons. Autumn comes with its particular beauty, the heat of summer softening into cooler mornings and evenings, the trees changing from bright-green to warm tones of orange, red and rust.

I find myself getting into a kind of preparation mode – I make jam and other preserves for my kitchen cupboard, or stews and soups for the freezer, to be reheated when I need something warm and nourishing. And I start to take the blankets and throws from the linen cupboard, for easy access on the sofa when the night air nips at my neck and arms.

The transition into winter can also be a time of preparation health-wise. Sure, you might not be so inclined to go outside to exercise, and there is always the temptation of too many comfort foods, but it’s a good time for some healthy self-care and nurturing – at home, at work and at play.

With that in mind, this issue of Healthy Times has some new sections – we’re looking at your work health and the health of your home, with articles on green buildings, lessharmful cleaning products and the itchy issue of dust mites. Our reporters have gone out to find the most up-to-date, practical information available to ensure you live your healthiest life this autumn.

We’ve even included some advice on how to make your takeaways a little less harmful, for those nights where you just cannot face cooking. And our health and beauty section will ensure your hair, skin and teeth are not only healthy on the inside, but gorgeous on the outside too.

The transition into winter can also be a time of preparation health-wise.

And if you’re struggling to get to the gym, there are even some easy exercises you can do at work, at your desk, using ordinary office equipment.

Last, but definitely not least, we are thrilled to be able to bring you an interview with our cover star, Lira, who not only glows with good health, but is also beautiful inside and out. Read about her health regime on p6 – it’s a great way to kick off this edition of the magazine.

Mandy Collins Editor

4 l HEALTHY TIMES

Copy Editor Advertisements: Suna Snyman PRODUCTION Production Editor: Shamiela Brenner

Distribution: Shihaam Adams subscriptions@picasso.co.za Tel: 021 469 2523 Printing: Paarl Media Gauteng MANAGEMENT Senior Bookkeeper: Deidre Musha

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Times Media Building Central Park, Black River Park Fir Street, Observatory, 7925 Tel: +27 21 469 2400 Fax: +27 86 682 2926

Disclaimer While every effort has been made to ensure that the information in this publication is sound, it is expressly not designed to diagnose or treat a medical condition or health problem. The information does not constitute medical advice. It is also subject to personal interpretation and may become dated or obsolete. The publisher, editor, authors and their employees or agents, therefore, cannot accept responsibility for the information in this publication or for any errors, omissions or inaccuracies contained therein, whether arising from negligence or otherwise. They are therefore not liable for any direct or indirect effects of the information. Please consult a qualified healthcare practitioner regarding any medical or health issues.

Copyright: Picasso Headline. No portion of this magazine may be reproduced in any form without written consent of the publishers.

The publishers are not responsible for unsolicited material.

Healthy Times is published by Picasso Headline Reg: 59/01754/07.

The opinions expressed are not necessarily those of Picasso Headline.

All advertisements/advertorials and promotions have been paid for and therefore do not carry any endorsement by the publishers.

Image: Cobus Bodenstein

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Time of

Editor: Mandy Collins

ADVERTORIAL

HEALTH PRODUCTS ASSOCIATION

– dedicated to protecting supplements

6 l HEALTHY TIMES

The HPA is dedicated to protecting this industry, and ensuring that everyone has access to the natural health products and practices of their choice. The HPA was founded in 1976 as a non-profit organisation to represent the CAMs industry. It is one of the most respected CAMs authorities in South Africa, with affiliations to overseas bodies. The HPA is committed to developing and maintaining standards that ensure product quality, safety and efficacy. It strives to establish an ethical, credible, relevant and vibrant health products industry in South Africa.

The CAMs industry has been facing major regulatory challenges for some time. In May 2014, the HPA launched legal action against

THE HPA IS COMMITTED TO DEVELOPING AND MAINTAINING STANDARDS THAT ENSURE PRODUCT QUALITY, SAFETY AND EFFICACY. the DoH and the Medicines Control Council (MCC) to protest the proposed draconian regulations published in November 2013. This move succeeded in exerting sufficient pressure on the regulators to encourage them to agree to discussions with CAMs stakeholders regarding modifications to the regulations.

Since then, the HPA has been engaging positively with the MCC to ensure the fate of the CAMs industry is better understood by the regulators. On 27 January 2017, the DoH published new draft regulations, which outline the replacement of the MCC by the new South African Health Products Regulatory Authority (SAHPRA).

SAHPRA is a positive move for the industry, as it allows the regulator to work more effectively and with a wider mandate. Included in these regulations

are more inclusions for health supplements.

HPA director of scientific and regulatory affairs, Wayne Robinson, commented on the regulations, stating: “At this moment, the regulations are still very new, but we welcome the department’s openness to comments by allowing industry a three-month comment period. The HPA is still reviewing these draft regulations in order to comment appropriately during this allotted period.

“The initial feedback from industry has been that we expected more allowances showing the unique differences between allopathic, CAMs and health supplements. It is important to apply appropriate standards and requirements to products based on their risks and claims.

“We were hoping that the previous industry feedback submitted to the Department of Health on the CAMs regulations would be applied here as well. The HPA acknowledges that these new regulations afford the industry a second opportunity to interact with and hopefully persuade the authorities to apply a more practical approach to CAMs and health supplementation regulation.”

While the negotiations continue, the HPA will remain focused, vigilant and proactive in working towards regulations that are beneficial to all CAMs products, paradigms and modalities, to ensure that the health products industry continues to survive and thrive.

For further information, contact Deirdre Allen, Health Products Association, hpasa@hpasa.co.za

Image: ©iStock.com/Hope Connolly

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omplementary and alternative medicines (CAMs) are in danger of vanishing completely.

What are CAMs, you may ask. Quite simply, they are the vitamins, minerals, probiotics and dietary supplements our health-conscious South Africans choose to take daily to support and supplement their wellbeing. Consumers appreciate both the value of dietary supplements and the ability to have the freedom to choose which supplements would be best suited for disease prevention and health maintenance.

Over the last 40 months, new regulations governing the use and sale of CAMs products have begun to be implemented by the regulators in the South African Department of Health (DoH). CAMs products that were previously readily available off the shelf have started to be removed or become more difficult to market.

Many consumers feel their freedom to choose appropriate health products has been taken away.

Supplements as benign as probiotics were placed on the “scheduling hitlist”. A product such as milk thistle (Silybum marianum) was recalled from the market even though it, like others, is a proven safe and effective natural product.

To protect both consumer and industry rights, the Health Products Association (HPA) reacted immediately, working with the DoH to reverse what could have become inappropriate regulations on natural health products. The rescheduling of natural supplements would have seen multiple products being removed from the shelves permanently. This would also result in increased costs across the board, from manufacturing to warehousing and distribution, with the end user paying the price. This could very well put an end to the CAMs industry in South Africa.

su C O pV pe lRe smteOnRtys

feeling good

A healthy body, mind, relationship, and even a healthy home – that’s what keeps Lira’s soul singing, writes Nia Magoulianiti-McGregor

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ward-winning songstress Lira is the picture of grace and calm. To say she seems to sail through studio schedules, press shoots, bouts of intense songwriting, concert tours and coaching singing hopefuls on talent show The Voice is an understatement.

There is no sign of strain or even the odd sniffle as she finds the space to promote her latest album, Born Free, collaborate with global cosmetic house Bobbi Brown as the company’s first SA “influencer”, while also spending quality time with her husband of eight years, Robin Kohl.

Lira just continues to glow with good health and rocks with energy.

As her hit song Feeling Good, from her 2014 album, Rise Again, goes: “I just wanna feel good everyday/I wanna wear a smile upon my face.”

Her secret? She has two: her health-conscious parents, Buyi and Webster Lichaba.

“Always listen to your body. And eat well,” Lira’s mother told her frequently while she was growing up. “And, as far as possible, eat organically.”

“We lived in an RDP house in Daveyton, but we ate organic food she grew in our garden, and drank filtered water,” says Lira.

8 l healthy times

Her father – “an athlete”, says Lira – is a vegetarian. “Not eating meat? That was completely unheard of in our township!”

Webster is also still a keen herbalist. “Whenever anyone in the family felt like they might be coming down with some illness, he would whip up a remedy using herbs and plants from our garden. I can’t remember him ever visiting a doctor.”

Both Webster and Buyi motivated the family into following a health regimen by leading by example, and this included consistent exercise.

“My parents still run to this day – even in their 60s.”

Lira has emulated this fundamental approach to living healthily in her own household. It’s how Lira and husband Robin live and eat – well, all except for the running.

“Okay, I admit I hate running,” she laughs. “I hate gym too. But I’m never static.

I walk, I swim, Robin and I play soccer together in our garden, but, most of all, I love to dance – especially to Nigerian dance music, like P Square’s Shekini. I make special time for physical activity,” she says.

Every morning between 6am and 8am, Lira claims time for herself. “I call it Li-time. I start off with some stretches.

Then I put on music and dance to get my endorphins going. That immediately lifts my mood. It’s such a buzz; it sets the tone for the whole day.”

Lira is aware of the need to look out for her emotional health too.

“Somewhere in those two hours, I practise a very personal spirituality.

Some mornings I watch the sunrise, because it helps to centre me.

“I also frequently write in my journal, just taking stock of my life and staying in touch with everything I have to be grateful for. It’s about being mindful. I believe what you focus on amplifies, so I try to get rid of any negativity that I’ve absorbed.

“I call it de-weeding, taking time out to tend to the garden of my mind – to root out what doesn’t matter, and allow the space for the beautiful stuff to grow.”

It’s not always easy being in the public eye. As one of The Voice mentors, Lira occasionally receives rude mail. “As a rule, I don’t let people’s opinions bother me, but sometimes something ‘catches’ and I feel misunderstood or start to doubt myself. I realised a while ago that if I didn’t deal with that, it would affect everything in my day, from a photo shoot to my general productivity.

“That’s when I remove my phone and other gadgets, and just write in my journal, until I get to the core of why a comment bugged me.

What was it that hooked me? After that, I can distance myself from it. I gently bring myself back to myself.”

Just like her mom, Lira keeps an organic garden in her home in Johannesburg. “Besides vegetables and fruit, I grow three types of lettuce, potatoes, plums. I also grow medicinal herbs such as aloe vera, tea tree, senna and lavender. An organic farmer taught me how to take care of my garden, which is entirely edible and medicinal.

It’s so abundant.”

Diet-wise, Lira starts off her day with a few squeezes of lemon in

Images: Franz Rabe

“Not eating meat? That was completely unheard of in our township!”

warm water. “I believe that diseases struggle to survive in an alkaline environment, and that lemons cleanse the liver and kidneys.” She also believes in the health benefits of ginger, and makes an immune-boosting smoothie every morning.

“Robin says we have become ‘food snobs’, and I think he’s right. I can feel the contrast between when I eat well and eat badly.

Occasionally, I eat slap chips, but afterwards, because I’m attuned to my body, I usually end up thinking, ‘My body didn’t really like that so much...’”

Lira says she’s come to accept that her body likes her to eat fruit, fresh vegetables, and enjoys fine dining. As for Banting? Not a chance.

“I love pasta!”

Touring and staying healthy is not always easily negotiated. “The US was the worst. It was hard to find good food. My whole team put on weight and it took years to shed it.”

In South Africa, if travelling by road, Lira packs a lot of her own food, so she can avoid the fast-food temptation.

Lira and Robin also make a point of maintaining a healthy relationship. “We are kindred spirits. We do everything together. He’s my manager and sound engineer, my photographer and assistant. We lead the same lifestyle. We do what we love for a living.

“We never compete, but we playfully challenge each other. We enjoy our differences and respect these. When I need alone time, he gets it.

We’re both in good shape and make a point of remaining active. Love?

Yes, definitely, but we also really like each other!”

Lira says they are both invested in a healthy home – and a healthy planet. “Our home is well thought out so as to be an indoor/outdoor living space. Robin and I have strong values about not having a negative impact on the planet. All our cleaning products are biodegradable.

There is a beautiful energy in our house. It’s our sanctuary, and full of light. We make an effort to avoid clutter. Our philosophy is ‘own only what you need’.”

As Feel Good continues: “I wanna feel the joys of the day/ I wanna feel alight in every moment/Said I won’t waste time on feeling blue/I won’t waste time on things I cannot change/I’m gonna live these days as best as I can/Doing everything that feels right.”

Lira’s HeaLtH survivaL Kit: • Ginger • Vitamin B • Vitamin C – “to help fight stress, and it’s an immune-booster” • Chamomile tea – “for calmness and easy digestion” healthy times l 9

HEALTHY AUTUMN

PREPARE NOW FOR WINTER

Autumn is a great time to prepare for a healthy winter.

Here are some hints and tips to get you ready

YOUR BEST SHOT: THE FLU SHOT

If you want to give yourself the best chance of avoiding the worst of the flu bugs this winter, you need to get vaccinated now.

Everyone six months and older can – and should – have a flu vaccine every year.

Different flu viruses circulate every year, and flu vaccines are designed to protect against the most common flu viruses of that season. You can’t just rely on the one you had last year, because there will be new bugs to watch out for this year.

There is a common misconception that flu vaccines can give you the flu. They simply can’t, as the virus in the vaccine has been deactivated.

The most common side-effects from a flu shot are soreness, redness and/or swelling at the injection site, fever, and/or muscle aches. But these sideeffects are not the flu.

You can get a flu injection at most big pharmacy chains, as well as your local family pharmacy.

HYGGE FOR GOOD MENTAL HEALTH

AUTUMN SUPERFOODS

Eating seasonally is a good way to stay healthy.

Here are four superfoods to look out for this autumn: • APPLES – they’re the easiest grab-and-go snack in the world.

• BUTTERNUT – purée the cooked flesh and it adds depth of flavour, vitamins and fibre to anything it touches.

• CARROTS – they’re packed with beta-carotene and vitamin A.

• SWEET POTATO – these are a good lower-GI substitute for potatoes.

• LEEKS – easier to prepare than onions, they’re great in soups, stuffing and casseroles.

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WAYS TO GET THE WHOLE FAMILY MOVING Exercise is a vital part of staying healthy, and it has other benefits for toddlers and young children too: it helps them to practise their motor skills, while strengthening their developing heart, lungs and muscles.

Most children should be getting an hour of exercise a day – and it won’t do their parents any harm either. So, here are some easy ways to exercise as a family: 1. Go for pre- or post-dinner walks.

2. Crank up the music and throw an impromptu dance party.

3. Make a game out of household chores.

4. Park as far away as possible, so you walk more.

5. Turn TV ads into get-up-and-move breaks.

6. Have a weekly sports night where you spend some time kicking a ball in the park.

7. Walk or run for charity.

8. Put kids to work in the garden.

9. Walk the dog.

Images: ©iStock.com/DSGpro/FatCamera/Floortje/izusek/spaxiax

There is a new word doing the rounds: hygge (pronounced hue-guh) – a Danish word for a philosophy of cosiness, of indulging guilt-free in the simple pleasures of home. And, given that the Danes are known to be the happiest nation on earth, it’s something the world is starting to pay attention to.

Hygge looks something like this: sitting by a roaring fire on a cold night, wearing a warm jersey and favourite socks, snuggling under a blanket with a good book and a mug of hot chocolate. Is it any wonder the Danes are so happy?

There are a lot of books doing the rounds, but there is no really right or wrong way to do hygge. It’s all about being fully present in the moment, doing one thing at a time – no multitasking, no tapping at your phone while you’re watching TV. It’s gentle and friendly and warm. And that sounds like a great recipe for contentment.

advertorial

diabetes

the future of

diabetes management Caryn Gootkin looks at some of the advances currently being explored in diabetes research

d

iabetes is a chronic disease that occurs when the pancreas either doesn’t produce any insulin or cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar. (World Health Organisation) The vast majority of the roughly 7% of South Africans with diabetes have Type 2 diabetes (high blood sugar levels and impaired insulin metabolism), treated with a combination of medication, lifestyle modification and – sometimes – insulin. Type 1 diabetes is an autoimmune disease that causes the body to destroy cells in the pancreas, leaving it incapable of producing insulin.

A vaccine for Type 1 diabetes would prevent millions of people from developing this serious condition, but decades of global research have yet to yield the perfect result. However, there have been some other advances that are making managing diabetes a little easier.

advances in insulin

Type 1 – and some Type 2 – diabetics must replace the insulin their body can’t produce with daily insulin injections. Scientific advances can improve their quality of life. insulin Constant pharmacological developments result in insulin products that are more

effective, better absorbed and longer-lasting. unfortunately, these are often very expensive.

administering it traditionally, insulin is administered by injection under the skin several times each day. a significant advance has been the advent of portable infusion pumps, but many people with diabetes resent living attached to a device. the pumps and consumables are also very expensive. determining how muCh the key to controlling insulin-dependent diabetes is

Images: Shutterstock

assessing how much insulin the body needs: too much or too little can be fatal. Pricking fingers and dripping blood onto a strip read by a glucometer (a machine that measures blood sugar) was, until recently, the best way to measure blood sugar. the recent local commercial introduction of continuous glucose monitoring devices – such as the guardian Connect from medtronic – that transmit readings by smartphone is potentially revolutionary. But these are expensive and rarely covered by medical schemes. the future may include digital contact lenses that measure blood sugar from tears, and digital tattoos that transmit blood sugar readings wirelessly. “technological advances will make it easier – and hopefully cheaper – to monitor your blood glucose levels and dosages to closer mimic what the body’s natural responses to insulin and glucose levels should be,” says margot mcCumisky, national manager for diabetes south africa.

Other future develOpments there are also some other exciting developments in the pipeline: The US Food and Drug Administration (FDA) has approved a closed-loop insulin delivery system (“artificial pancreas”), an insulin delivery pump integrated automatically to a continuous glucose sensor, which would be life-changing, if affordable.

Islet cell transplants use insulin-producing cells from the pancreas of a dead donor, which are then transplanted into diabetics.

Stem cells may be able to grow new insulin-producing cells to replace those the pancreas has lost.

diabetes educatiOn Whether you have Type 1 or Type 2 diabetes, maintaining a healthy lifestyle is vital. McCumisky says successful diabetes management includes: regular exercise: half an hour, five times a week. a healthy diet: “we advocate reducing your sugar intake, eating a low-fat diet, including monounsaturated fats like olive oil and avocado, and reducing carbohydrates (choose low-GI) to a quarter of your plate. Eat more non-starchy vegetables (about half your plate) and low-fat protein (a quarter of your plate). Include moderate amounts of low-GI fruit daily.” medication: insulin and other drugs as prescribed. education: diabetes sa and diabetes education sisters teach patients and their families to cope with the many implications – psychosocial, physical, lifestyle, mental – of being diabetic. technological advances may make it easier to manage diabetes, but there will never be a substitute for education and support.

h e a l t h y t i m e s l 15

HEALTHY FINANCES

MIND THE gap

Image: ©iStock.com/Squaredpixels

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ap cover is a short-term insurance product designed to cover shortfalls between medical scheme rates and rates charged by private medical professionals, to reduce the need for out-of-pocket payments, explains Bianca Viljoen, Agility Gap & CoPay product owner.

“All medical scheme options have a standard scheme rate at which healthcare expenses are paid. Standard options provide cover at a rate of 100%, while more comprehensive options cover up to 300%. While medical schemes refund claims in accordance with the rates set by the Board of Healthcare Funders, medical professionals’ rates are not regulated, so it’s at their discretion how much they charge for their services.

“Some do charge only 100% of scheme rates, but others may bill their patients as much as 900% or more, so, even if you are signed up to the most comprehensive medical scheme benefit option, it’s very unlikely that you’ll have sufficient cover for highly specialised medical services, and will have to fork out the difference. And this is where gap cover comes in.”

Many people are investing in policies to close the gap when their medical aid doesn’t quite cover expenses. If you’re thinking of going this route, Lynne Gidish outlines what you need to know

WHAT ARE THE BENEFITS?

Most people are unaware of exactly what they are covered for in times of unforeseen medical emergencies or hospital stays. Having to deal with the shock of undergoing unexpected surgery is bad enough, so suddenly having to find the funds to pay the bill adds to the trauma.

According to Viljoen, apart from the standard cover provided for a shortfall in specialists’ rates in hospital, there are additional cover options that can be included in more comprehensive gap products, to soften the financial blow. These include: • Co-pay cover, which provides protection against stated co-payments, as prescribed by the medical scheme. For example, a gastroscopy or colonoscopy may require a procedural co-payment applicable if performed in hospital. This co-payment is usually payable by the member upfront at the hospital. This procedural co-payment can be claimed from your gap cover policy, if this is included in the policy; • Sub-limit cover, to provide limited cover should in-hospital limits be reached and exceeded; • Out-of-hospital specialist cover, which provides limited annual cover for out-ofhospital specialist consultations. For example, if your specialist charges rates in excess of medical scheme rates, a limited amount per consultation may be claimed from the gap cover policy; and • Casualty benefit during the event of trauma or accidents, when urgent care is required. This benefit would provide cover for costs incurred at a trauma facility that are not covered by the medical scheme.

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H E A L T H Y T I M E S l 17

healthy financeS

What’S the doWnSide?

From a medical scheme’s perspective, gap cover insurance products have their merits, but the influence they have had on the South African healthcare landscape has not been altogether advantageous, says Mark arnold, principal officer of Resolution health medical scheme. “this type of short-term insurance, particularly in its current form – that is, prior to 1 April 2017 (see Stop Press) – has been perceived as allowing some healthcare providers to impose tariffs that far exceed medical scheme rates in their billing. Because the tariffs charged by healthcare providers are not yet subject to regulation, highly specialised healthcare providers, in particular, may charge whatever they like for their services.

“Patients in need of specialised medical care are not in a strong position to negotiate with providers, and the medical schemes industry is prohibited from doing so as a collective. so, due to the fact that shortfalls could often be claimed back – in part, if not in full – from gap cover policies, these fees have sometimes been nothing short of extortionate.”

One of Health Minister Aaron Motsoaledi’s biggest bugbears in the past has been that gap cover has given doctors free rein to charge much higher tariffs, as they are not yet subject to regulation. However, says Arnold: “The cap that will shortly be imposed on gap cover payouts could mean that, if such providers persist in charging unreasonable fees for their services, they may well price themselves out of the market.”

Most people are unaware of exactly what they are covered for in times of unforeseen medical emergencies. cloSing the gap

Remember that being a member of a South African medical scheme is a prerequisite for gap cover, says Viljoen, and that, when choosing a gap cover package, you need to consult with an accredited short-term insurance financial advisor. Always consider the following:

Arnold suggests the following if you’re thinking about going the gap cover route: • Weigh up the expense of gap cover, in light of the new regulations, compared with that of upping your medical scheme benefit option; • Speak to an accredited broker about the difference between membership of a medical scheme and being a gap cover policyholder; and • Before signing on the dotted line, read the fine print of any policy carefully, and ensure you understand the benefits, limitations and price of the product.

18 l h e a l t h y t i m e s

is it FoR you?

Arnold believes the new cap on gap cover payout should be something you bear in mind when reviewing your medical scheme benefit options for next year. “The gap cover ‘cushion’ many members factored into their calculations for mitigating possible healthcare costs, particularly for unexpected health events, will be significantly reduced under the new regulations.

“So, while responsible and well-designed gap cover products remain a helpful complement to the cover that medical schemes are able to provide, ultimately investing in a good medical scheme benefit option represents a sound investment for private healthcare consumers, and the greatest peace of mind for your healthcare needs.”

Viljoen concludes: “Even with the new annual limit of R150 000 on gap cover claims coming into effect, gap cover is still an affordable product that offers a good level of protection in the event of unexpected healthcare expenses. Very few of us have that kind of money available at short notice if we’re suddenly confronted with shortfalls on expensive medical bills, so this kind of protection is truly invaluable when the need arises.”

Stop preSS

after four years of uncertainty, the Demarcation Regulations under the longterm and short-term insurance acts will come into effect on 1 april 2017 for all new gap cover policies. existing policies will have to comply with the regulatory changes from 1 January 2018, with an overall annual policy limit of R150 000 per insured now being imposed on all such products.

Image: ©iStock.com/didesign021

• If you’ve had no previous cover, check with your prospective provider whether a waiting period will be imposed, as there may be a three-month general waiting period, during which time no claims can be processed, as well as up to 12 months’ condition-specific waiting periods for defined pre-existing conditions; • Always investigate whether Prescribed Minimum Benefits (PMBs) are covered under the gap cover policy, as some of these conditions may not be included; • Check whether there are any policy-specific exclusions, which means you may not be insured for certain activities and conditions; • Ascertain whether the gap policy provides cover for family members who belong to different medical schemes, as some might provide cover for varying schemes on one policy, while others may require that all of the insured belong to the same medical scheme; and • Remember that the percentage of cover may vary between gap cover providers in the industry, from 200%-500%, and the level of cover required should be considered as part of the decision-making process.

Deskercise

HEALTHY WORK

THE NEW WAY TO WORK If you spend far too many hours seated at your desk, as many of us do, these simple exercises can help you to increase your exercise quotient without having to go to the gym, writes Prevashni Naidu

Images: ©iStock.com/AndreyPopov/endopack

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edical dictionaries have begun to incorporate the term “deskercise” into their latest editions. If you haven’t cottoned on to it yet, it’s time you do. According to the Doctor’s Dictionary, deskercise refers to “exercises performed while seated (or) at the workplace, suited for those whose jobs require them to sit for prolonged periods of time”.

Research indicates that the average adult spends 50% to 70% of their time sitting, if you factor in work, driving in traffic, eating and watching television. That’s almost 15 hours of our day spent in sedentary activity!

The Mayo Clinic recently conducted a research study into the effect of sitting for prolonged periods of time, and showed that all of this sitting is a forerunner to serious health decline in the current generation of office workers. In fact, one of the Mayo study authors, Dr James Levine, refers to sitting as “the new smoking”. Their study links sedentary behaviour, associated with the typical 9-to-5 office worker, to increased risk of heart disease, certain cancers, cardiovascular disease, Type 2 diabetes, obesity and muscle degeneration.

And if you’re lucky enough to escape some of these more traumatic health conditions, other research points to the harmful impact that sitting all day long has on our

muscles. Explains US exercise scientist and trainer Jeff Kuhland: “You work out for an hour at the gym, then shower, eat and head to work.

You’ve passed the 60-minute threshold, so your body has absorbed the majority of the nutrients it’s going to from your meal. It starts to regenerate and heal. If you have poor posture with shoulders forward, a curve in your spine and collapsed hips, your body is literally healing the micro-tears and micro-trauma into this poor position. You are actually healing in a shortened muscular state that remains static, slowly solidifying the new connections your body is making.”

To eliminate these effects, Kuhland recommends taking regular exercise breaks from your desk job. In fact, just getting up and standing for a short while seems to be enough of a stimulus to prevent catabolism (the breakdown of tissue). A 2013 study published in the International Journal of Behavioural Nutrition and Physical Activity recommends five minutes of standing for every 30 minutes of sitting, to stave off the negative effects of poor desk posture.

Standing alone, however, is unlikely to decrease your cardiovascular disease risk. Thankfully, says Laylaa Asmal, personal trainer at the Muscle and Fitness Gym in Musgrave, Durban, you can incorporate a quick exercise session into your daily work day. “Whether you do 30 continuous minutes of exercise each day or two to three smaller

Getting up and standing for a short while seems to be enough of a stimulus to prevent the breakdown of tissue.

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segments of 10-15 minutes each, you’ll get the same benefits. In addition, movement has significant stress-reduction effects. Exercise produces those stress and anxiety-busting chemicals called endorphins, which improve sleep and even aid in improving self-confidence.”

Asmal has devised a quick 15-minute exercise session that you can incorporate into your day, to get your health back on track and reduce stress levels at work. Include a reminder on your calendar or phone to book yourself a block of time dedicated to doing your deskercise daily, and if you’re feeling a bit embarrassed at the thought of colleagues catching you mid-stapler curls, why not seek out an empty conference room during your lunch break so you’re more likely to stick to your routine?

Repeat each exercise in this routine 15 times.

ReseaRch indicates that the aveRage adUlt spends 50% to 70% of theiR time sitting, if yoU factoR in woRk, dRiving in tRaffic, eating and watching television. office equipment energisers

Use these “on tap” office supplies to get your heart going in the office: Most people with desk jobs suffer with shoulder and neck pain.

This can help to relieve it. Stand with a water bottle in each hand at shoulder level, elbows bent. Exhale and push the water bottles up until your arms are extended and reaching straight up towards the ceiling.

Slowly bend your elbows back to the starting position, and repeat.

romanian deadlift with water bottles

Stand with a water bottle in each hand. Bend your knees slightly, keep your back nice and straight, and lower the water bottles until just below your knees. Slowly lift your water bottles up until you’re back to your starting position, and repeat.

standing wall push-up

Place your palms shoulder-width apart on your office wall. Press your body towards the wall, as if you were doing a push-up. Exhale and push back to your starting position.

static lunges

Stand with your hands placed on your hips. Take a big step forward with one leg, but don’t allow your knees to go over your toes. Using your heel, push yourself back up to the starting position.

glute seat squeezes

To start toning, simply squeeze the buttocks, hold for five to 10 seconds, and release. Repeat until the agenda wraps up or the glutes tire. The results will be uplifting in more ways than one.

22 l h e a l t h y t i m e s

• air-punching with water bottles – water bottles can be great exercise equipment. to feel reinvigorated, and get a quick cardio boost in, do a few air jabs with a water bottle in each hand when you’re feeling an energy slump.

• triceps dips using a non-rolling chair – use a sturdy desk or a non-rolling chair. sit at the very edge and place your hands on both sides of the body. plant both feet on the floor and take one to two steps away from the desk or chair. bend your elbows down to a 90-degree angle, hold and straighten up.

• Biceps curls using a stapler – seated or standing, take the stapler in one hand, with the palm facing upwards. starting at the thighs, bend the elbow and curl the arm up towards the chest, just like a regular dumbbell biceps curl. Pause momentarily and then lower the stapler again.

• oblique twists with a swivel chair – have a swivel chair? use its twirl to your advantage with this oblique abs fix. sitting upright and with feet hovering over the floor, hold the edge of your desk with your fingers and thumb. next, use the core to swivel the chair from side to side. swish back and forth for 15 rounds.

• squats using your office desk – push your chair away from your desk. rest your hands very lightly on your desk and slowly lower yourself as though you are about to sit at your desk. stop when your thighs are parallel to the ground and hold this position for 10 seconds, before standing up straight and repeating five more times.

Images: S©iStock.com/AndreyPopov/endopack

shoulder press with water bottles

healthy work

beating

burnout Caryn Gootkin investigates how you can prevent and treat this all-too-common condition

e

“

very day was a struggle.

I used to drag myself to work and my productivity dropped dramatically.”

“It was as if I had lost myself. I didn’t know where I had gone.”

“I was utterly worn out and unable to figure out how to fix the problem, which is very unusual for me. I’m a problem-solver.”

Sound familiar? You or someone you know might be suffering from burnout.

Image: ©iStock.com/Squaredpixels

what is burnout?

the word “burnout” describes fuel reduced to nothing through combustion, or electrical devices that stop working after overheating – both great metaphors for the third meaning of burnout, which the Oxford English Dictionary defines as “physical or mental collapse caused by overwork or stress”. When you suffer from burnout, you feel overwhelmed by and unable to meet the constant demands of your life. “from a psychological point of view, burnout is an emotional, mental and physical exhaustion,” says anat yakuel, a clinical psychologist in private practice in Cape town. “it’s about more than just working too hard and getting exhausted. i see it most often in my practice in professionals in the medical and legal fields, both of which involve dealing with people. it’s not just about bad time management and overworking; the very nature of the job involves giving of and depleting yourself.”

Who is at risk of developing burnout?

“Severe burnout can also result in suicide.”

Despite certain professions carrying a greater risk of burnout, we’re all at risk. “Burnout is an equalopportunity condition,” says Judy Klipin, a Johannesburgbased Martha Beck master life coach and author.

“I see executives and stay-at-home moms, students and retired people. But the one thing they all have in common, which I believe is at the root of all burnout, is an inability – Anat Yakuel to prioritise their own needs and desires, a tendency I refer to as ‘others-centredness’.”

Experts have identified certain characteristics and personality types that make us more likely to reach burnout. Very often, people with burnout feel a strong need to help and rescue others, and spend too much time doing things that are not good for them in order to please others. People who are others-centred pay too much attention to other people’s needs and too little to their own.

“Often burnout is a result of spending too much time doing the things we don’t want to do, things that aren’t good for us,” says Klipin. “We are very good at talking ourselves into things that are wrong for us, and out of things that are good for us.

“Many things in our lives are out of our control – often we don’t have the indulgence of changing a job we’re not satisfied with – but we can control who we spend our free time with and what we do to relax. Burnout is about putting boundaries in place to mindfully, consciously say no to the things that don’t serve you.”

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h e a l t h y t i m e s l 25

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HOW DO I KNOW IF I HAVE BURNOUT? Common signs of burnout can include: • Chronic fatigue; • Palpitations, dizziness, chest pain, headaches; • Feeling constantly stressed and overwhelmed; • Insomnia/waking up exhausted; • Frequent illness and reduced immunity; • Lack of focus/forgetfulness/brain fog; • Loss of appetite; • Anxiety; • Depression and suicidal thoughts; • Irritability/short temper; • Loss of enjoyment/social withdrawal/disinterest; • Craving escape; • Feeling disconnected/detached; • Loss of productivity; • Cravings for carbohydrates/sugar/salty foods; and • Feeling depleted, as if you have nothing left to give.

Yakuel stresses the severity of the condition. “It’s a process that could begin unnoticeably and go on for a long time before the various symptoms present clearly. I’ve seen people on the verge of hospitalisation because of burnout. Severe burnout can also result in suicide.”

“Often burnout is a result of spending too much time doing the things we don’t want to do, things that aren’t good for us.” – Judy Klipin It is sometimes difficult to differentiate burnout from depression, because they manifest very similarly and very often overlap. “Burnout is not yet an official diagnosis in the DSM5 – it does have an ICD-10 code in the World Health Organisation’s coding system – so it can’t be officially diagnosed as a standalone condition,” says Yakuel. “It is, however, increasingly used to explain the reasons behind a depressive disorder.” [Ed’s note: The DSM5 is the Diagnostic and Statistical Manual Disorders Fifth Edition – a classification and diagnostic tool of Mental Disorders, used by psychologists and psychiatrists ICD-10 codes are a comprehensive international classification of diseases, conditions, disorders, signs and symptoms.]

“People often come to me because they feel like their life is falling apart.

When we look deeper, we realise it’s burnout,” adds Klipin.

Burnout develops over a long time, so it takes a while to reverse. Physical symptoms must be treated quickly to avoid further illness.

“As burnout overlaps with depression, anxiety or both, sometimes it’s important for the person to consult a psychiatrist, who’ll prescribe the necessary pharmaceutical interventions, as with cases of severe and debilitating depression,” says Yakuel.

Similarly, those who have other symptoms, such as physical exhaustion, chest pains, palpitations and headaches, need to seek the appropriate medical help. This may include testing for adrenal fatigue, a syndrome that results when the adrenal glands function below the necessary level, often after intense or prolonged stress.

Treatment for burnout should not only focus on adequate time management and behavioural changes; although such modifications are often required, it is important to explore the reason why the person finds themselves in this situation. “We aim to reach an understanding of the underlying psychological motivations that led the person to burnout,” explains Yakuel.

One of the most important mechanisms for recovery from the physical aspects of burnout is rest – lots of it. Klipin coaches her clients to develop strategies that ensure they can rest more and put boundaries in place.

“You have to learn to say no without feeling you have to explain. Pay attention to what drains your energy and what buoys it up, and adjust your life accordingly,” she says. “We tell ourselves these stories about what’s expected of us, and we believe them wholeheartedly, and they’re often untrue.”

One of Klipin’s clients, a writer in her mid-40s, shares what helped her recovery: “I’m very good at flogging myself with a slew of I must/I should tasks. And most aren’t musts or shoulds at all,” she says. “I am also very bad at resting. It makes me grumpy to be unproductive. So, I’ve learned to find ways to rest and relax while doing something enjoyable – reading, sewing, tapestry, that kind of thing. I do them in an unhurried, pleasurable way, with no deadlines attached.”

If you suspect you may have burnout, consult a psychologist or life coach.

26 l H E A L T H Y T I M E S

Images: ©iStock.com/alvarez/GlobalStock/RobertoDavid

HOW TO TREAT AND PREVENT BURNOUT

ergonomically

healthy work

sPeaKing…

Current research shows that more than half of office workers will develop neck or back pain during their lifetime, with some studies putting this figure as high as 70%, writes Lynne Gidish

Image: ©iStock.com/IPGGutenbergUKLtd

b

ecause we live in an information age, in which work is often desk or computer-bound, and social media, mobile devices and TV dominate our free time, we’re sitting more and moving less, says physiotherapist Carolyn Fenwick.

“In recent times, the detrimental health effects of a sedentary lifestyle have come to the fore, with sitting for long hours regarded as the biggest villain. Office or desk-bound workers are in the firing line here, because they sit for most of the day.

Not only is this linked to weight gain and obesity, but it also increases the risk for diabetes, heart disease and early death.

“Since our world today is mainly technology-driven, we need to ensure that the tools we access for work, rest and play are designed for our body’s requirements, which is why so many people are turning to ergonomics to minimise risk of injury or harm.”

what is ergonomics?

ergonomics is the discipline of matching your specific needs, limitations and abilities to the demands of your work situation, be it at a micro-ergonomics (immediate human-machine interaction) or macro-ergonomics level (larger organisational or environmental considerations), explains miriam mattison, a lecturer in the Department of human Kinetics and ergonomics at Rhodes University.

“Compatibility between an individual’s capabilities and work demands results in healthier and more productive workers, leading to more profitable and effective businesses. Back and neck health are current concerns because so many people sit and work at a desk for long hours, mostly with computers.

“When it comes to the setup of office workstations and chair design, in light of these concerns, working posture is a main consideration. Poor workstation layout increases stress on the musculoskeletal system of the neck and back through awkward joint positions and increased muscle tension.”

But while a good chair minimises these stresses, adds hayden searle, a researcher in the Department of human Kinetics and ergonomics at Rhodes University, it’s important to consider other aspects of “While daily exercise your workstation. “For example, your computer monitor, telephone, keyboard and mouse may be positioned in is essential for good a way that encourages poor work postures, despite a health, Wellbeing, mood wonderful chair. moreover, your body was designed to and cognitive function, move, and a major cause of neck and back pain is the it’s not enough to static posture sitting creates, which is why your entire compensate for sitting workstation should be holistically set up, preferably with for hours at a time.” the help of a qualified expert.”

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h e a l t h y t i m e s l 29

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STANDING AND WALKING DESKS

Fixed postures associated with operating a computer often lead to musculoskeletal complaints, says Fenwick. “The major cause of associated headache and neck pain is the forward tilt of your head, which results in an increase in the static loading of the muscles at the back of your neck. The key to comfort and good posture is a well-designed, adjustable workstation.”

Aside from a good chair (see box below), always ensure the following: • Your desk top is at elbow height; • Your feet touch the floor, and you’re able to move your legs in under your desk; • Your arms or hands rest on your desk; • The screen is directly in front of you, 10°-15° below eye level; and • Documents are read at an angle >45°.

Never: • Lean over your desk or work for long periods of time; • Sit too far away from your work; • Lean away from your work while sitting, as you’ll have to bend your neck forward into a stressful position to see; and • Sit with your back unsupported.

CHOOSING THE RIGHT CHAIR

There are many types of ergonomic chairs available for use in the office, and Fenwick suggests that you look out for the following when making your choice:

• Seat height: always ensure your feet are flat on the floor, with thighs horizontal and arms even with the height of your desk; • Seat width and depth: you need to be well supported, with your back against the backrest and approximately 5cm-10cm between the back of your knees and the seat of the chair. The forward or backward tilt of the seat should be adjustable; • Lumbar support: sitting for long periods without support for the natural inward curve of your back tends to lead to slouching.

BENEFITS OF THESE DESKS INCLUDE:

• Better weight management; • Decreased LDL (bad) cholesterol; • Decrease in blood pressure and glucose levels; • Increased alertness; and • Less leg, back and shoulder discomfort.

“These benefits are more pronounced in treadmill desks,” Schmidtke says, “but these do require more floor space, while standing desks are more affordable, and easier to move and transport. And if you decide to change over to either of these,” she continues, “expect an initial period of muscular fatigue.”

BACK TO BASICS

In addition to bad working posture due to poor workstation setup, there are other factors that can contribute to back and neck pain, according to Searle and Mattison. These include negative psychological states (eg. depression and anxiety), poor nutrition, inactive lifestyles and smoking.

They offer the following advice to take back control: • Reduce stress and improve mental wellbeing through social activity, physical exercise, meditation and dealing with work conflict; • Keep moving in the workplace by standing, walking and changing posture while sitting; • Adopt a healthier lifestyle – exercise regularly, and eat a balanced and healthy diet; • Keep hydrated; and • Avoid lifting heavy loads.

USEFUL WEBSITES: International Ergonomics Association: www.iea.cc; Ergonomics Society of South Africa: www.ergonomicssa.com 30 l H E A L T H Y T I M E S

SITTING FOR LONG PERIODS OF TIME INCREASES YOUR RISK FOR CHRONIC DISEASE, EVEN IF YOU LEAD AN ACTIVE LIFESTYLE.

Images: ©iStock.com/GAPS/koosen

WORKSTATION GUIDELINES

Standing and walking (treadmill) desks are workstations that have been modified to accommodate and encourage physical activity during office work, says Nadia Schmidtke, a researcher in the Department of Human Kinetics and Ergonomics at Rhodes University, and should be used in conjunction with periods of sitting and physical rest.

“A standing desk consists of a working surface fastened to a heightadjustable stand or legs,” she explains. “You can get a comparatively long standing desk, which you place on the floor, or a shorter one that you can place on a table. An affordable option is to use a sturdy box to make your own standing desk, but always ensure that your upper arms are relaxed in line with your torso, and your elbows are kept at 90° to prevent stooping or reaching. A treadmill desk consists of an adjustable workstation that is mounted to a treadmill so that you can walk while working.”

Schmidtke adds: “The reasoning behind this is that studies have revealed that sitting for long periods of time increases your risk for chronic disease, even if you lead an active lifestyle. While daily exercise is essential for good health, wellbeing, mood and cognitive function, it’s not enough to compensate for sitting for hours at a time.

These desks offer a good solution and, by positioning your workstation so that you adopt a neutral standing working posture, you’ll reduce your risk of developing back, neck, shoulder and wrist strain too.”

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HEALTHY WORK

SICK OF

work The move towards ‘greener’ buildings may have positive spin-offs for both employees and the environment, writes Louise Ferreira

Images: ©iStock.com/mapodile/Robert Daly

a

re you dreading returning to the office after the weekend? It may be more than just the Monday blues.

The office building of the last few decades, as much as it may have evolved and improved, can make you sick, and affect your mood and performance. But could environmentally friendly buildings help employees too?

Sick building syndrome (SBS) is defined as a collection of symptoms linked to poor workplace conditions, including poor ventilation, lack of exposure to natural light, and office furniture with poor ergonomic support.

“The term is a bit outdated, but symptoms associated with bad buildings certainly occur,” says Prof David Rees, head of occupational medicine and epidemiology at the National Institute for Occupational Health. “The causes are generally a mixture of workplace psychosocial factors, poor ventilation and mixtures of chemicals arising from a number of sources, usually at lowish concentrations. As [Prof] Sherwood Burge said, if people worked in offices with windows they could open, the condition would be less common.” (Burge runs the Occupational Lung Disease Unit at Birmingham Heartlands Hospital in the UK.) This is not to say that specific allergies or conditions such as asthma should be attributed to SBS, which causes more non-specific, irritanttype problems, such as headaches, Rees explains. “If there is a specific identified cause, then it’s not a sick building, but a problem due to that specific agent.”

Still, your building can make you miserable. In a 2012 study on call centre agents in Durban, researchers Devina Oodith and Sanjana Brijball Parumasur present a veritable smorgasbord of nasty symptoms. These include “tired or strained eyes, unusual tiredness, fatigue or drowsiness, headaches, tension, irritability or nervousness, sinus congestion, chest tightness, wheezing, skin dryness and gastrointestinal complaints”.

“SBS occurs in a workspace where a significant number of occupants complain of sickness and/or discomfort,” they point out.

“These symptoms vanish or diminish when they leave the workspace.”

Two of the biggest problems are air quality and the constant use of artificial light. The latter often results in complaints about headaches or eye strain.

Everything from office equipment to cleaning supplies can contribute to the range of synthetic chemicals, moulds and pathogens that are making you sick. Office air conditioners are either too hot or too cold, and dry out the air.

Rees points out that an unhealthy office environment can also negatively affect mental health concerns, such as depression. “They are exacerbated especially if the problem is not attended to properly. If a number of people start believing that the environment is going to make them sick, it can become contagious and spread to other people,” he says. “You get a growing anxiety and frustration building up.”

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INCREASING NATURAL LIGHT AND INTRODUCING GREENERY CAN HAVE A DRAMATIC IMPACT ON EMPLOYEE PRODUCTIVITY.

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GOING GREEN

staff turnover and medical costs,” it states.

The report’s findings are remarkable. A Yet, “green” buildings, which aim to well-ventilated office can double cognitive contribute to sustainability through the use of ability, while workers in offices with windows renewable energy and similar environmental get 46 more minutes of sleep a night than interventions, can improve employee health workers in windowless offices, according to too, believes Gillian Gernetzky, acting the WorldGBC. Almost an hour of extra sleep communications manager at the Green every night can make a significant difference, Building Council South Africa (GBCSA). as every new parent knows.

The GBCSA is an internationally recognised And it’s not just air and light; the interior organisation that champions the cause of temperature, what is referred to as “thermal healthy green buildings through research, comfort”, also plays a role. Your silent war certification and rating tools. with that one co-worker over control of the Gernetzky supplied Healthy Times with a office air conditioner is happening for a report from the World Green Building Council reason: staff performance can fall 6% if offices (WorldGBC) which shows that, when attention are too hot and 4% if they’re too cold. is focused on the environment, building IN ONE CASE, PERFORMANCE IMPROVED Rees agrees. “Importantly, if people occupants will also be healthier and happier.

BY 7%-12% WHEN STAFF HAD A VIEW OF have control of their own environment The report is part of the organisation’s Better NATURE. PLANTS INSIDE THE BUILDING (for example, windows they can open and Places for People campaign.

WILL ALSO HELP TO IMPROVE AIR QUALITY. individual temperature control), it helps.”

“Simple steps such as improving air quality, And yes, the word “green” is meant increasing natural light and introducing literally; in one case, performance improved by 7%-12% when staff greenery ‒ those that typically have environmental benefits, such as had a view of nature. Plants inside the building will also help to using less energy ‒ can also have a dramatic impact on the bottom improve air quality. line by improving employee productivity and reducing absenteeism,

OFFICE LAYOUT IS A FACTOR

34 l H E A L T H Y T I M E S

WHAT ABOUT LUNCH?

When it comes to taking breaks, office culture can be incredibly unhealthy, as anyone who has eaten a takeaway lunch in front of their computer can attest to. When a smoke break is a more acceptable excuse for stepping outside than drinking a cup of coffee, there is a problem.

Oodith and Brijball explain that cafeteria facilities should ideally not be in the same building as the office (or at least not right next to it), because it needs to be a space for employees to rest and relax. The “break room” should include kitchen facilities with a microwave and television, away from the computer.

Images: ©iStock.com/baona/shironosov/Tom Merton

What about that bugbear of cubicle-dwellers everywhere: the openplan office? It should come as no surprise that they do not contribute to employee wellbeing.

“Originally, open-plan offices and cubicles were invented by architects and designers to break down the social walls that divide people; however, research is increasingly finding that open plans cause conflict, high blood pressure and increased staff turnover, and increase the chances of getting ill, feeling stressed and becoming aggressive,” Oodith and Brijball explain. In offices with a high density of employees, airborne diseases such as colds and flu can also spread rapidly.

Given the ironic outcome of good intentions, they recommend “taking cognisance of privacy, concentration and interaction before open-plan offices are designed”.

Of course, it’s not just about privacy. According to the WorldGBC, noise distractions lead to a massive 66% drop in performance and concentration. While it is unlikely that any company would be able to afford a private office for each employee, it could certainly provide them with workspaces more attractive and quiet than identical cubicles with grey partitions.

One of the greatest challenges for human wellbeing in the 21st century will be to focus on the advantage of having a healthy colon and therefore a good immune system – this is where probiotics can play a significant role.

Probiotics are critical for normal digestion and for defence against infection.

Bacteria in the gut are known to: • Stimulate the immune system • Enhance the mucosal barrier • Aid digestion and break down toxins • Inhibit adherence of pathogens

A good probiotic can be beneficial in the following ailments: • Diarrhoea or constipation • Bad breath, gas and bloating • Irritable bowel and lactose intolerance • Gastroenteritis and playschool diseases in young children

HEALTHY HOME

DON’T LET THE

bed bugs bite The thought of creatures living in your mattress or pillow is a little alarming, but it doesn’t mean the coming of an apocalypse.

With some knowledge and tools, the situation is easily manageable, writes Zaza Motha

Images: Shutterstock and ©iStock.com/animatedfunk/humonia/simarik

h

ouse dust mites are microscopic, eightlegged organisms that look like spiders and live in household dust. And chances are, they’re in your house.

Dr Ahmed Ismail Manjra, a paediatrician and allergologist from the Paediatric Allergy & Asthma Centre at Durban’s Westville Hospital, says: “They proliferate in a warm, humid environment, and are therefore abundant along coastal areas of South Africa.”

“They don’t bite and are invisible to the naked eye, being only 0.3mm long,” adds Dr Adrian Morris of the Dr Adrian Morris Allergy Clinic. “The adult lives about six weeks, lays 50 eggs and produces 20 faecal pellets per day, which contain the allergen DerP1 (a digestive enzyme).”

DerP1 is the allergyprovoking particle produced by the house dust mite that penetrates clothing, bedding, carpets and upholstery, and can remain airborne for prolonged periods. This enzyme is harmful and can affect sensitive defence cells in the eyes, nose, lungs and skin.

HOW HOUSE DUST MITES THRIVE

“They inhabit mainly mattresses, carpets, pillows, sofas and soft furnishings.

They feed on human skin scales as well as fungi,” explains Manjra.

According to Morris, mites require 70% humidity, as they extract water vapour from the air to live. “The indoor temperature needs to be about 25°C for them to survive, as they are cold-blooded. They do not survive at high altitudes over 1 500m, in ‘sterile’ hospital environments or in very dry places.”

Mites use the adhesive suckers on their legs to cling to carpets and bedding. “Predator mites (Cheyletus), which in turn eat the common house dust mites, have less adhesive suckers and are preferentially vacuumed up, allowing allergy-provoking mites to proliferate.”

Mites will colonise a new mattress within three months, with up to 10 000 mites making their home there.

SYMPTOMS OF AN ALLERGY TO DUST MITES

Dust mites generally cause symptoms of allergic rhinitis, such as sneezing (as well as a runny, itchy and blocked nose), asthma (wheezing, coughing, tightness of the chest and shortness of breath), allergic conjunctivitis (itchy, watery, red eyes) and eczema (inflamed, itchy skin).

GETTING TESTED FOR AN ALLERGY

A RAST (radioallergosorbent) blood test is most reliable. The skin-prick test is done by applying a drop of a specific allergen to the skin of the forearm. The skin is then gently pricked with a sterile lancet, allowing some allergen to penetrate. The skin reaction is evaluated after 10 to 15 minutes, and a positive test result is indicated by a weal reaction of between 3mm and 10mm in diameter.

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AS THE MAIN FOCUS OF ATTENTION IS THE BEDROOM AND LIVING AREA, DR ADRIAN MORRIS EMPHASISES THE FOLLOWING: • Use only synthetic or non-feather bedding and exchange the pillow with a new one every six months, as mites can even breed in synthetic pillows. This is important, because the average person spends eight hours a night asleep on the pillow.

• Wash duvets, covers and pillows in a hot wash (60°C) at least once a week. Adding eucalyptus oil to the wash helps to kill mites. Hot tumbledrying and ironing of the bed covers will further reduce mite levels.

• Vacuum both sides of the mattress. Make sure you have a vacuum cleaner fitted with an HEPA (high-efficacy particle arresting) or electrostatic micro-filter, plus double-thickness bags, otherwise mite allergens will pass right through the vacuum cleaner and end up resuspended in the air.

• Vacuum floors, curtains, carpets and furniture at least twice a week. “Mite-allergic children should be kept out of the bedroom during cleaning, and for three hours afterwards.

Never allow pets in the bedroom, as they can introduce allergens.”

• Avoid heavy drapes or dust-collecting A DEHUMIDIFIER Venetian blinds; simple roller blinds are CAN HELP TO best. Try to keep furniture to a minimum, and REDUCE THE preferably use wooden or plastic furniture.

HUMIDITY • Limit soft toys and upholstery. Soft toys INDOORS. should be machine-washed once a month and then placed in a plastic bag in the freezer overnight to kill mites.

• Wet-wipe all surfaces with a damp cloth to remove allergens. The cloth should be moistened with household bleach, as this breaks down the mite allergens and kills the mould spores on which mites feed.

• Remove fitted carpeting from the bedroom, if possible, and replace with hard-board flooring, vinyl, or tiles and washable rugs. Fitted carpets harbour mites and act as an allergen reservoir.

• Reduce indoor humidity to less than 45% by airing rooms regularly; a dehumidifier may help. Direct sunshine will kill mites, so, whenever possible, place the bedding and mattress in the sun for a few hours.

Four hours once a week is recommended for killing mites in mattresses.

• Underfloor heating and electric blankets raise the temperature and kill mites by overheating them. Allow as much fresh air as possible to penetrate rooms during daylight hours.

• Certain chemicals kill mites, but faecal pellets and even dead mites cause allergies, so intensive vacuum-cleaning is imperative. Benzyl benzoate effectively kills mites and should be applied every four to six months. Insecticides such as pyrethroids are ineffective and can be toxic for humans. Steam-cleaning of carpets and application of liquid nitrogen sprays are alternative methods of killing mites. Application of tannic acid breaks down the mite allergen by denaturing it.

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WASH DUVETS, COVERS AND PILLOWS IN A HOT WASH AT LEAST ONCE A WEEK.

WHY USE PROTECTIVE COVERS FOR MATTRESSES AND PILLOWS? “Good mattress and pillow protectors create an impenetrable barrier between the sleeper and the mattress and/or pillow. This means that the dust mites living in the fibres of the mattress and pillows are trapped and cannot come out to feed off dead skin cells that we shed every night,” explains Chaya Medalie, MD of Protect-A-Bed. “We can lose up to 500ml of bodily fluids through the night, and without a waterproof mattress protector, these fluids enter the mattress and create the perfect breeding ground for all kinds of parasites.”

Medalie advises considering the following when choosing a protective cover for your mattress or pillows: • Find out about the material used as a protective layer. “It is imperative that the barrier protective layer is waterproof. Some cheaper mattress protectors use PVC, also known as vinyl, as waterproofing. While effective as waterproofing, PVC is noisy to sleep on, and will leave the sleeper hot and sweaty.”

• Look for a mattress protector that “breathes”, which is impenetrable to liquid and dust mites, but not to air. “It acts like human skin to moderate the sleeper’s temperature, creating a comfortable environment for a restful and dry sleep.”

• In addition, the protector should be effective against leaks and combat allergens; it should fit snugly, and be soft enough to sleep on.

Images: Shutterstock and ©iStock.com/FotoDuets/Nastco

KEEPING YOUR EXPOSURE LOW

UNDERSTANDING ALLERGIC SYMPTOMS AND IgE Celebrating the 50 year anniversary of the discovery of Immunoglobulin E

M

ost people are aware that allergic symptoms are caused by the release of powerful signal substances such as histamine that can cause everything from mild reactions such as a runny nose or skin rash to severe symptoms such as asthma, eczema and even systemic shock. But it wasn’t until the 1980s that scientists understood how these symptoms came about – or the central part that IgE antibodies played in the process.

In principle, allergic reactions are misguided inflammatory reactions triggered by normally harmless substances from our day-to-day environment – allergens. An allergen is typically a protein found in for example plant pollens, animal dander and foods such as peanut, egg and milk.

In allergic individuals, one or more of these allergens may be recognised as potentially dangerous. On first exposure, their immune system starts to produce antibodies that can bind to that antigen to protect the individual in the future. In atopic allergy (the most common type of allergy), the antibody formed is IgE. It was discovered that an allergic individual’s ‘memory’ of having first been exposed to an allergen is stored as IgE antibodies attached side-by-side on a special type of white blood cell. These blood cells, known as mast cells, contain the powerful signal substances that on their release create the inflammatory response we call allergy. On second exposure, sensitized individuals may suffer a reaction if the allergen cross-links adjacent IgE antibodies, triggering the release of the inflammatory chemicals from inside the mast cell.

This is why measuring levels of IgE antibodies in blood is a good way of determining the risk of allergic reaction, and why IgE-testing is still a leader in allergy diagnostics.

The rest is history. IgE history.

Visit www.isitallergy.co.za to download your free Allergy Guide e-book

Research in the 80’s demonstrated exactly how IgE binds to other compounds, based on a deeper insight into IgEreceptors, which opened the door to a better understanding of the origin of allergic symptoms.

healthy home

it’s only

natural Image: ©iStock.com/Geo-grafika

n

ow that consumers are becoming more aware of human impact on the environment, they are starting to take action. You can’t end the drought, but you can shower with a bucket and use the contents to water the garden.

One option is to use natural cleaning products as opposed to commercial household cleaners. Of course, this raises questions: What does “natural” mean, exactly? Are natural cleaners always safer? Which chemicals are harmful?

According to Dr Raj Lalloo, chief researcher at the Council for Scientific and Industrial Research (CSIR), there are numerous chemicals that pose a risk to the wellbeing of cleaning staff and people in homes and buildings.

Common substances that pose a risk to the environment include ammonia-based cleaners, disinfectants and antibacterial compounds such as triclosan. Ammonia and phosphate-based cleaners contaminate natural water and lead to eutrophication (a process where oxygen levels drop and destroy natural ecosystems). Some ingredients can render farmland useless, affect the safety of our drinking water and kill aquatic life.

The ingredients in most conventional cleaning products are usually not biodegradable. If that’s not enough, many cleaning chemicals

Commercial household cleaners may often be detrimental to the environment, but are natural cleaning products any better, and do they work as well?

Louise Ferreira investigates

are corrosive, carcinogenic, and can cause skin damage, allergies, breathing problems, and autoimmune diseases such as lupus and rheumatoid arthritis.

Fragranced products are a big problem, says Robyn Smith, founder and director of online store Faithful to Nature. Manufacturers don’t have to disclose the makeup of their scents, which means consumers don’t know which chemicals or irritants the formula contains. These can include phthalates, which are endocrine disruptors. Air-fresheners can trigger migraines and asthma. Ethoxylated alcohols, which are found in virtually everything from laundry detergent to oven cleaner, can cause skin and eye irritations, and induce asthma attacks.

“Biodegradable and biological products have several advantages for wellbeing and the environment,” Lalloo confirms. And they can be just as effective, yet formulated with a better choice of ingredients.

Options range from the homemade (baking soda, vinegar and lemon juice), and “natural” products sold in supermarkets and health stores, to eco-friendly products that are a combination of natural and not, and next-generation biotechnology cleaners.

“Some natural cleaning products do work differently, but their efficacy is no longer an issue,” Smith says. And you don’t have to worry about playing Cinderella on your knees with a scrubbing

Both natural and organic ingredients can be dangerous, cause health issues and also damage the environment.

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HEALTHY HOME

Common substances that pose a risk to the environment include ammonia-based cleaners, disinfectants and antibacterial compounds such as triclosan.

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DO THESE ACTUALLY WORK?

I BOUGHT A PLASTIC SPRAY BOTTLE, AND PUT VINEGAR AND BAKING SODA TO THE TEST.

A quick spray and wipe with vinegar did the trick with the kitchen counter. I mixed baking soda and water, and applied the paste to the greasy parts of the stovetop, then left it for a while. Subsequent spraying with vinegar caused the bicarb to foam and partly dissolve, but the first wipe with a cloth indicated far too much baking soda. I spent several minutes scooping up lumpy white dirt with paper towels, before spraying again and wiping the stovetop clean. I was quite pleased with the result, although I clearly need practice.

The vinegar smell wasn’t nearly as strong as I had anticipated.

Images: ©iStock.com/baona/SolStock

brush. “This perception could be a hangover from the past. Natural cleaning products are very effective, but much more forgiving on the person they are being used by and the surface they are being used on.”

Woolworths sells a wide range of products under its Earth Friendly label, from moisturiser and handwash to dishwashing liquid and toilet cleaner. According to Justin Smith, group head of sustainability, Woolworths Group Marketing, this came about as a result of feedback from customers who are passionate about environmental and animalwelfare concerns.

“We wanted to provide them with a product range that managed these issues responsibly, and still provided the functionality and benefits that they expect from household and personal-care products.”

The products aren’t exclusively “natural”; a quick glance at the ingredients of an Earth Friendly Moisturising Hand Wash shows tea tree leaf oil as well as sodium laureth sulphate.

“We did a lot of research around which chemicals were potentially most harmful, as well as customer research around their expectations on this. We also had to balance the costs of the products to customers, as we didn’t want there to be a significant premium associated with the Earth Friendly range, but rather to make it accessible to as many customers as possible,” he says.

One of the concerns raised by consumers is the lack of regulation in the industry; it is easy to slap “natural” or “eco-friendly” on a label without any substance to the claim.

The CSIR agrees. “In terms of ingredient regulation, it is quite poor for general cleaning products. Our team has worked with the SABS to put together a standard for biological-based eco-friendly cleaning products (SANS 1604). The other standards are mainly around cleaning efficiency or safety for use in the food processing environments. Regarding eco-friendliness and biodegradability, there is no real focus on ingredients from a regulatory perspective.”

Faithful to Nature recommends reading and understanding each product’s ingredients list with the help of its free pocket guide, which “lists the really contentious ingredients found in cleaning products”.

If you’ve determined that all of the ingredients are indeed natural,

does that mean you’re in the clear? Not quite, according to the CSIR. “‘Natural’ is a very grey term. So, too, is ‘organic’. Both natural and organic ingredients can be dangerous, cause health issues and also damage the environment. Contrastingly, some of the synthetics are made to be more biodegradable and are sometimes safer. Our approach is to look at each ingredient in terms of biodegradability, according to EU specification, toxicity, hazard, potential for allergic response, etc. So, it is better to follow a scientific approach to make a good product than to adopt dogmatic categories and fit into them.

“The new technologies are already enabling the use of biologicalbased products. This is where active good bacteria are used to do the cleaning, as they would do in nature.”

The CSIR has itself created a start-up company, OptimusBio, to make high-quality next-generation products accessible to all consumers.

Its offering has also taken into consideration the use of these types of products in rural households, where the health and environmental risks are greatest, especially around ablution and sanitation.

Another emerging area is eco-tourism, where products are specifically designed to cater for septic-tank and greywater systems in remote areas.

More urban households are also becoming conscious of re-using water, and biological products are essential in enabling this change.

RADITHAMA

OCCUPATIONAL HEALTH AND SAFETY TRAINING PTY (LTD)

Radithama OHS offers training in

Audiometry, Spirometry

and Basic Eye Assessment in an occupational setting.

The courses are conducted by nurse educators with experience in occupational setting and facilitation.

Training is conducted during school holidays and universities recess.

Other dates are set according to the client’s request.

Mpho 084 290 4257 Dineo 084 313 3323 Thabo 074 441 8780 E-mail: radithamaohs@gmail.com Website: www.radithama-ohs.co.za

RADITHAMA OHS

s teraal pt h h l iyn be ohdeyr e

GIVe yoUr

vaccines A boosT

s

outh africa’s immunisation programme, as is the case with many other african countries, focuses on infant vaccination. however, global immunisation strategies are now seeing the need to expand immunisation services to adolescents and adults, since these groups are also at significant risk of contracting and transmitting vaccine-preventable diseases.

Vaccines for Africa Initiative (VACFA), at the University of Cape Town, says

ADolesCenCe AnD PreGnAnCy

Topping up on your childhood immunisations may give you the edge against vaccinepreventable diseases as you age, reports Prevashni Naidu

there are a few countries that have organised routine adolescent and adult vaccination programmes. the good news is that south africa is at the early stages of developing its own formal recommendations for adolescent and adult vaccination programmes.

Director of VACFA, Prof Gregory Hussey, explains that immunisation of adolescents and adults is necessary to ensure the boosting of the waning immunity induced by childhood vaccinations.

“South Africa’s immunisation programme has already introduced vaccination against human papillomavirus (HPV) to girls in Grade 4 (aged 9-11 years) in public primary schools,” he says. “The HPV vaccine prevents the development of cervical cancer later in life. Cervical cancer is the commonest type of cancer in the country.”

There are other booster vaccines recommended for adolescents; these include the MMR (mumps, measles and rubella) and Tdap (tetanus, diphtheria and acellular pertussis) vaccines. These vaccines are advised to be given at around 10-12 years of age, and many highincome countries recommend them at that stage.

The MMR vaccine is not recommended for use in pregnant women, since this is a “live attenuated” vaccine, meaning a scientifically modified form of the live virus is administered.

“Therefore, it is important that women of childbearing age be given the MMR or MR vaccine before falling pregnant,” explains Hussey.

ADUlT boosTers reCommenDeD

Vaccines recommended during adulthood include those against influenza (flu) and pneumococcal (pneumonia) diseases.

VACFA advises the entire population to consider annual flu vaccinations. Pregnant women and HIV-infected persons have an increased risk of getting influenza and, therefore, should get the annual flu vaccination. Unfortunately, it is not recommended for children under six months.

“If you’ve never been vaccinated before, older adults, particularly those aged 65 years and above, should get vaccinated against pneumococcal disease through the administration of PCV13 first, and then PPSV23 after at least one year. If previously vaccinated with PPSV23, boosting with PCV13 should be done after at least one year among older adults. These vaccinations protect the older population against diseases such as meningitis and pneumonia,” explains Hussey.

travel much?

Heed tHis warning 44 l h e a l t h y t i m e s

if you are an adolescent or adult and know that you may not have had booster vaccines with mmr, Tdap and PCV13 (for older adults), you could be at risk for some of these diseases and hussey recommends you speak to your family doctor before it is too late.

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Images: Shutterstock

Vaccines against hepatitis a and B viruses are also recommended in adulthood. For hepatitis A, it is advisable to get vaccinated if travelling to hepatitis a virus-endemic regions. “there are recommendations for persons travelling out of the country to consult a travel clinic on vaccination against hepatitis a, as well as other relevant vaccines, such as the one against yellow fever. Vaccination against hepatitis B is recommended to populations at risk of intravenous drug use, as well as those with chronic liver diseases, and hiV-infected persons,” says hussey.

LIVE FREE MOVE FREE DRUG FREE

Did you know?

OSTEOARTHRITIS IS THE MOST COMMON FORM OF ARTHRITIS There are more than 100 different forms of arthritis but osteoarthritis is the most common. Also known as wear-and-tear arthritis, osteoarthritis is a degenerative joint disease that occurs because the cartilage between joints breaks down. Cartilage acts as a shock absorber and lubricating surface for the joint so it can move comfortably, so if the cartilage is worn-down and lubrication is reduced, movement is much more difficult. The increased bone-on-bone friction then results in pain, stiffness and swelling. FLEXISEQÂŽ lubricates the cartilage in joints to relieve pain and stiffness, and improve impaired joint function associated with all stages of osteoarthritis.

THERE’S A TREATMENT FOR OSTEOARTHRITIS THAT COMES IN SIMPLE GEL FORM Pain killers like paracetamol are often used as a first treatment, while non-steroidal anti-inflammatory drugs (NSAIDs) help to reduce pain and inflammation in the joints. However, these drugs may also cause serious side-effects like gastro-intestinal problems, leg swelling and skin rashes.

NSAIDs should not be given to people who have heart issues, or to people with uncontrolled high blood pressure, which makes it difficult for an older population to manage their osteoarthritis pain.

WEIGHT BEARING JOINTS ARE WORST AFFECTED BY OSTEOARTHRITIS Osteoarthritis can affect any joint but is more likely to occur in joints that have been stressed over time like the knees, hips, feet, hands and lower spine.

FLEXISEQ is a topically applied drug-free gel that not only provides pain relief, but also improves joint mobility. Extensive clinical trials have shown that FLEXISEQ is as effective as a commonly prescribed NSAID. There have now been more than 50 million applications of the product and, unlike other oral and topical treatments, there have been no reported incidences of any systemic side effects related to the use of FLEXISEQ. This makes FLEXISEQ safe to use alongside any other therapy. FLEXISEQ should be applied twice daily to the affected joint, usually in the morning and the evening. Use enough gel to evenly cover the soft tissue around the joint and leave to dry for 10 minutes.

OSTEOARTHRITIS IS MORE COMMON AND MORE SEVERE IN WOMEN The World Health Organisation estimates that 9.6% of men and 18% of women aged over 60 years have osteoarthritis.

INSTEAD OF REST, MODERATE EXERCISE IS SUGGESTED FOR PATIENTS Exercise is important to keep the joints moving, even if you have osteoarthritis.

Low-impact activities like cycling and swimming are recommended, but always speak to your healthcare practitioner before getting active.

FLEXISEQ Classic, RSP R280, available from Dischem, Clicks and leading pharmacies.

For more information please contact 0800 098 706 or visit www.flexiseq.co.za

PA I N M A N A G E M E N T

Chronic,

MULTI-SYSTEMIC AND WIDELY MISUNDERSTOOD Although it’s one of the most prevalent types of chronic pain disorders, fibromyalgia remains a complicated illness that is difficult to diagnose, writes Penny Haw

Images: Shutterstock

f

ibromyalgia is characterised by chronic, widespread pain in the muscles, areas of tenderness and general fatigue, all of which last more than three months. But, because it can be difficult to describe and the symptoms differ from person to person, it’s neither easily nor quickly diagnosed.

This is exacerbated by relatively low awareness about fibromyalgia. It’s not that the illness is new; fibromyalgia has been described for centuries. It is believed that the founder of modern nursing, Florence Nightingale, suffered from it in the 1800s.

However, it wasn’t until 1981 that the first scientific study formally confirmed fibromyalgia symptoms and tender points in the body.

Even so, and despite growing bodies of knowledge and better understanding of fibromyalgia – which is now considered one of the most common types of chronic pain disorders – diagnosis remains problematic.

“Some doctors still don’t believe in the condition,” says healthcare consultant and head of Fibromyalgia South Africa, Sharon Levin. “Others are timestrapped and, while they know how to diagnose the illness, only prescribe specific medications. They don’t necessarily do things like assess patients’ clinical nutrition, evaluate their levels of fatigue or ascertain whether or not exercise should be undertaken.”

SEVERAL SYMPTOMS

Individuals with fibromyalgia experience pain in multiple areas simultaneously. For some, it moves around. Pain can also seem to be everywhere at once. The intensity of discomfort can change from day to day.

But, says Dr Kevin White, author of the book Breaking Thru the Fibro Fog: Scientific Proof Fibromyalgia is Real,, many fibromyalgia patients say pain isn’t their worst symptom. They list fatigue, sleeplessness, mental cloudiness, headaches, depression, anxiety and irritable bowels or bladders among their most problematic symptoms. Most say they can’t name the worst symptom because the pains and discomfort are multiple and equally severe.

To make matters worse, says Levin, fibromyalgia symptoms often occur together with other conditions, including myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

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Individuals with fibromyalgia experience pain in multiple areas simultaneously.

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PA I N M A N A G E M E N T

WHAT TO DO?

WHAT IS IT?

Author of the book The Fibro Fix, Dr David Brady describes the illness as follows: “Classic fibromyalgia is a central pain processing disorder. What that means is the problem is in how you process pain and other sensory information coming into the body. In fibromyalgia, it’s not processed correctly. It’s amplified and over-interpreted. Things that would not normally be interpreted as painful are painful, and things that would be mildly painful would be interpreted as significantly painful.”

The classic fibromyalgia patient’s nervous system, he says, is hypervigilant to imminent threat or harm. It’s constantly in fight-or-flight emergency panic mode, which means eventually everything intensifies and becomes calamitous. This is exacerbated by the nervous system’s inability to rest during sleep. Even when they sleep for 14 hours, fibromyalgia patients feel exhausted because their nervous system is neither secure nor restful enough to enter the restorative stages of sleep.

Lack of sleep means profound fatigue and inability to think clearly. The mobility of the bowel is also affected.

The treatment of fibromyalgia, says Levin, does not fall under the banner of traditional medicine, but rather functional medicine.

The distinction is that traditional medicine focuses on treating the symptoms, whereas functional medicine addresses the underlying causes, using a systems-oriented approach to identify and fix imbalances or disorders in the body.

WHAT ARE THE CAUSES?

While the exact cause of fibromyalgia is not yet known, research has found a number of factors might contribute and trigger the disease. That fibromyalgia is hereditary, familial and has pre-existing genetic quotients is undisputed fact, which means family history is important when diagnosing the disease.

Although fibromyalgia can start at any time, research indicates there might be some events that trigger the disease in people who have an increased risk of developing it. Doctors believe fibromyalgia may be triggered by an injury or trauma. Infections including hepatitis C, Epstein-Barr virus, parvovirus and Lyme disease have been linked to fibromyalgia. And, while fibromyalgia is not an autoimmune disorder itself, it has been linked to autoimmune disorders such as rheumatoid arthritis and lupus.

The onset of fibromyalgia is also believed to coincide with certain types of emotional stress. According to a study by chronic support community NewLifeOutlook, almost two-thirds of patients diagnosed with fibromyalgia had also been diagnosed with depression, and more than half with anxiety.

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There is no easy way to confirm whether you have fibromyalgia, and, according to support group FibroCenter, it takes an average of two years to get an accurate diagnosis.

When there is an inkling they might suffer from fibromyalgia, most people are referred to rheumatologists, who know how to identify the muscle tender points found only in the four quadrants of the bodies of fibromyalgia patients, says Levin. Thereafter, completion of a functional medicine questionnaire gives doctors a better overall patient and family history.

Some doctors undertake blood tests to check hormonal levels and thyroid functions, and to eliminate ME/CFS. There is also a blood test that identifies markers produced by immune system blood cells in people with fibromyalgia.

Once diagnosed, the important thing, say both Levin and Brady, is to deal with fibromyalgia on a multitude of fronts, with a multidisciplinary team. Although every patient is different, there is something of a recommended universal approach. This includes addressing hyper-vigilance of the nervous system with things such as meditation, breathing exercises and other calming techniques.

Nutrition is also important. Wholesome, fresh foods are recommended, and processed foods discouraged. Exercise is advocated, depending on each patient’s situation.

Medicating fibromyalgia and the use of supplements also depend on individual cases. The key, says Brady, is to take a comprehensive approach to fibromyalgia, as opposed to medicating it only. Support is also fundamental to the successful treatment of the disease.

“Fibromyalgia is a huge subject,” says Levin. “Patients become sick and tired of being sick and tired, which is why it’s important to establish an empathetic support group. There’s no cure for the disease, but it does go into remission and, with the right approach, this is possible.”

A BIOKINETICIST’S TAKE ON FIBROMYALGIA

Because the symptoms come and go, and flare up in different parts of the body at different times, fibromyalgia can be a difficult condition for exercise specialists to treat, says Johan Kitching, a biokineticist with Dr Lienka Botha & Partners in Cape Town.

“Patient education is at the forefront of any treatment regime, to explain symptoms and the nature of the disorder,” he says.

“Biokineticists can help patients manage their symptoms through a range of stretches and patient-specific exercises.”

While many believe exercise is one of the most effective treatments for fibromyalgia, for some, pain and fatigue can make it seem impossible.

“It is important to take each patient’s pain threshold into account,” says Kitching. “It is advisable to do gentle warm-ups, ease slowly into the routine and avoid high-impact exercises that can aggravate the pain.

Walking on a flat surface for a few minutes a day or water-based exercises are considered good entry points. A gradual build-up of exercise time and intensity, with strengthening exercises performed at a later stage of the conditioning – while avoiding over-training – is effective.”

For more information, go to www.fibromyalgiasa.co.za.

Images: Shutterstock

THE TREATMENT OF FIBROMYALGIA DOES NOT FALL UNDER THE BANNER OF TRADITIONAL MEDICINE, BUT RATHER FUNCTIONAL MEDICINE.

ADVERTORIAL

INFLAMMATION – underrated, but deadly

allergic rhinitis, osteoarthritis, auto-immune diseases and cancer.

Added sugar can lead to higher levels of inflammation, directly linked to insulin resistance and diabetes. You should remove all added sugar – refined sugar, artificial sweeteners, honey and agave – from your diet.

Processed food is likely to contain not only sugar, but harmful fats and preservatives too – also risk factors for inflammation. Your body needs good fats, found in avocado, coconut oil, raw nuts and seeds, fatty wild fish and quality animal protein.

You can further reduce the risk by increasing your intake of foods known to combat inflammation, including tomatoes, olive oil, ginger, rosemary, cloves and turmeric. You could also cut out gluten, a known cause of gut inflammation.

DIET

High levels of stressinduced hormones, such as cortisol, can lead to abnormalities in sugar metabolism and eventual insulin resistance.

Find ways to manage your stress, and get at least eight hours of sleep in per night.

Foods known to combat inflammation include tomatoes, olive oil, ginger, rosemary, cloves and turmeric.

The typical Western diet is the number one root cause of both premature death and disability. Red meat (especially if not pasture-reared) is inflammatory. Animals fattened on grain have an increased amount of omega-6 in their muscles. An imbalance between omega-6 and omega-3 results in inflammation, increasing the incidence of chronic diseases such as eczema, asthma, 50 l H E A L T H Y T I M E S

WEIGHT

EXERCISE

We’ve all been told about the benefits of exercise. You should aim to achieve at least 10 000 steps a day to stay fit and improve circulation.

STRESS

BMI is a good yardstick for the average person to determine healthy weight. Your BMI should be below 25.

SUGGESTED SUPPLEMENTS

Omega-3 – Omega-3 has anti-inflammatory properties and should be taken twice a day.

Ensure that it’s pharmaceutical-grade and free of heavy metals. Fatty fish such as tuna, pilchards, sardine and salmon should be eaten twice a week, while vegetarians can take ground flax seeds or chia seeds.

Origine 8 – Known as a superfood, this green tea extract is rich in polyphenols, powerful antioxidants and anti-inflammatory properties.

Curcumin – The main ingredient in turmeric spice, curcumin is a wonder substance with anti-inflammatory, antioxidant and anti-ageing properties. One of the most powerful natural substances at our disposal, it has also been found to counter inflammation, liver damage, bone loss, cardiovascular disease and weight gain. It is not easily absorbed, so make sure the supplement you use has been researched to improve absorption. Supplements which contain BCM 95 are particularly good, as they use the essential oils of the turmeric root to facilitate absorption. Anti-inflammatory benefits can be felt within the first three days of use.

Probiotics – Many of the inflammatory diseases we suffer from are gut-mediated, but do not actually present as gut issues. Taking a daily probiotic can counteract this silent risk.

Images: Supplied

c

hronic inflammation is an underrated threat that is often difficult to detect. The World Health Organisation has acknowledged that chronic diseases are the leading cause of mortality worldwide, and the best way to address the risk of chronic disease is to reduce chronic inflammation.

Lifestyle is the most influential factor in determining this risk. In the modern world, increasingly high stress levels, overmedication, poor gut health and overreliance on processed, chemically enhanced food have aggravated the problem.

Most inflammatory diseases start in the gut with an immune reaction, progressing into systematic inflammation. This often goes undetected for years, before manifesting as a chronic disease.

So how do we effectively identify this silent killer?

It’s crucial to look at the root of the issue. This could be based on a variety of factors going back as far as 20 to 40 years.

HEALTHY EATING

Fast food DOESN’T HAVE TO BE UNHEALTHY Indulging in a takeaway meal doesn’t necessarily mean you are eating unhealthily. Georgina Guedes helps you to make the right fast-food choices

i

t’s Friday night. You’ve worked late. You haven’t made it to the shops all week, so there is nothing good in your fridge, and you are hungry RIGHT NOW. Is there any way to choose fast food that is not going to scupper your healthy eating plan?

We chatted to Tabitha Hume, a Johannesburg registered dietician, about how to make healthy choices when fast food is your only option.

WHAT DOES “HEALTHY” MEAN, ANYWAY?

According to Hume, the first thing to establish is what constitutes a healthy plate. “A healthy plate should be made up of half vegetables, a quarter protein and a quarter carbohydrates,” she says.

Of course, it’s possible to fill a plate in this way and still eat very unhealthy foods, so Hume explains that the carbohydrates should be of a low glycaemic index (see sidebar), the protein should be from

AVOID THESE!

lean animal meat, with no skin or visible fat, or from protein-rich vegetables such as legumes or nuts, and the vegetables should be well prepared and not swimming in butter, cream or oil.

“Remember that ‘healthy’ means the food should contain lots of nutrients,” says Hume. “And while protein is important, you don’t need it at every meal, so depending on what else you’ve eaten during the day, you can replace the protein quarter with a sauce for your carbs – something like a rich Napoletana.”

Also include – but keep it small – a portion of healthy oils such as olive, avocado, nut or seed oil. (Children and advanced athletes will need more “good” oils.)

Fortunately, many fast-food restaurants have tried to shift their menus towards a healthier spread of options, so it’s certainly easier now than it was 10 or 20 years ago to find an alternative to a cheeseburger and chips.

Foods that are best avoided are high-GI breads, potatoes in any form (but especially chips), stir-fried noodles (even though the vegetables are nutritious), any cheesebased or cream-based dish, fried or battered foods, and too much animal protein, especially that found in red meat.

Try not to have Indian too often, Hume says. “Curries are usually high in quick-release carbohydrates, animal protein and fat – there’s lots of ghee, full-fat cream, and naan and roti are high-GI.” Obviously, there are healthier options within the range of curries, so if you do want to treat yourself, consider these problem ingredients and opt for healthier alternatives.

Hume points out that if you are generally a conscientious eater, indulging in some of the less healthy foods once a week isn’t really going to do much harm. “The best way to spoil yourself is to have a moderate amount of the treat food, combined with a low-GI carb to look after your liver and insulin.”

If you focus on making the right choices at the right time, getting takeaways needn’t mean your health will suffer.

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Images: Shutterstock and ©iStock.com/bergamont/dianazh/Hyrma/Ridofranz/kreinick/vitalssss

THESE ARE YOUR HEALTHY OPTIONS

WRAPS ARE GENERALLY HEALTHIER THAN BURGERS. THEY TEND TO HAVE A LOWER GI AND HAVE MORE SALAD ADDED.

“A great starting point is always a salad – and most fast-food restaurants have some kind of a salad option these days,” says Hume.

She adds that the biggest mistake people make is to have a protein and a salad with no carbs. “Despite the bad rap that carbs are getting, they are a vital food group. If there are no carbs in your diet, your body has to utilise oils and protein to produce glucose, and the more you do that, the fattier your liver gets.”

So you should try to pick a salad with as much variety as possible, to get lots of nutrients – and remember your low-GI carb. “Look for salads with beans, chickpeas, or else get a side of spicy rice. But no croutons!”

If the available salad doesn’t offer any of these options, try to add a side of rye bread or some hummus as a sauce or dip. “And if you can lay your hands on cubed sweet potato or a side of quinoa, that’s great!”

She says sushi, which is available as a takeaway in most areas these days, is a fantastic option that is both healthy and slimming.

“California rolls meet all the requirements of fresh vegetables, a healthy protein and a good carb.”

If you have an Asian takeaway joint nearby, she says edamame beans are good. “They are a low-GI carb, the right kind of protein and they contain good fibre. Stir-fried rice with vegetables is also great. Chinese and Japanese soups are also good options.”

Hume recommends looking out for grilled fish (no batter) with the veggies and rice side – “no chips!” – from a seafood takeaway. Or, if there is an Italian restaurant, a pasta arrabiata or Napoletana is a good choice. “But avoid the cream or meat-based sauces.”

Wraps, she says, are generally healthier than burgers. “They tend to have a lower GI, have more salad added, and don’t automatically come with a side of chips.”

Vegan burgers are healthier than beef burgers. “They are not necessarily slimming, but much more nutritious. When you avoid animal-based protein, you lower your risk of colon cancer and kidney disease. So, vegan burgers have a more positive effect on the body.”

She also advises finishing off your meal with something sweet, such as a piece of fresh fruit (not a chocolate volcano cake!). “Eating well isn’t just about calories. It’s also about ensuring you feel full, so you don’t overeat. Sweet things help to release dopamine and serotonin, which tell your brain that you are satisfied.”

LOW-GI OPTIONS TO LOOK OUT FOR Low glycaemic index (GI) foods cause a steady rise of glucose in the blood, which leads to a small and gentle rise in insulin. High-GI foods cause a rapid rise in blood sugar, triggering an insulin spike that then instructs the body to store fat. Low-GI carbohydrates are an essential part of your diet.

It can, however, sometimes be difficult to tell which foods are low and which are high-GI – and sometimes the way in which the foods are cooked can change their GI. But, as a general rule of thumb, look out for these low-GI options to fill you up and boost your energy: • • • • • • • • • • • • • • • • • • • • • • • • • •

Popcorn (check microwave popcorn for fat content) Low-GI bread Provita Brown rice Wild rice Basmati rice Oatso Easy (plain flavour, cooked with fat-free milk) Oats (cooked with fat-free milk) Futurelife (with fat-free milk) Mealies or sweetcorn on the cob Cold mealie pap 100% durum wheat pasta Pearled barley Bulgur wheat Cold samp Whole/cracked rye products Kidney, butter, cannellini, black, sugar and baked beans Chickpeas Lentils Raw oatbran Pumpernickel bread Special K Bran flakes with plenty of skim milk Pronutro Wholewheat (original and apple bake flavours only) Low-GI muesli Sweet potato

(Courtesy of The GI Foundation, South Africa)

H E A L T H Y T I M E S l 53

HEALTH AND BEAUTY

GETTING TO THE ROOT OF

hair loss

t

he signature song from the 1960s rock musical Hair expresses how most of us feel about our locks: “Give me a head with hair/Long beautiful hair, shining, gleaming, streaming, flaxen, waxen/Give me down to there, hair, shoulder length or longer…” Yet, for many, hair loss seems an inevitable side-effect of ageing.

For some, it begins as they reach puberty and, by early adulthood, the loss is apparent to all. For others, it’s more gradual. Either way, hair loss can be distressing. It’s not only that thick, shiny hair is considered attractive; it’s also an indicator of health, vitality and longevity.

Indeed, hair loss isn’t only about thinning on top; for many, it signifies the end of their youth, and triggers dissatisfaction about their appearance and body image, and low self-esteem.

“The good news,” says the managing director of Dr Alexander’s Hair Loss Clinic in Bedfordview, Dr Kevin Alexander, “is that huge strides have been made in both stopping and reversing the balding process in men and women over the past 20 years. What’s more, technology makes it easier for people to research treatment and clinics.”

Dr Larry Gershowitz of the Medical Hair Restoration Centre in Cape Town concurs. “Some remarkable research and development into different restorative treatments and procedures has taken place in recent years, which greatly advances the options for our patients.”

Innovation, he says, includes a follicular regeneration procedure using the proteinrich platelets from the patient’s own blood to stimulate regrowth. Doctors are also using Janus kinase (JAK) inhibitors to stimulate follicles to move from the resting phase back into the active growth (or anagen) phase.

56 56 ll HH EE AA LLTT HH YY TT II M M EE SS

Right or wrong, society reveres youth, vigour and beauty, and a healthy mop of hair is the cherry on top. These days, there’s hope for hair loss, writes Penny Haw

Another new development is the introduction of a drill-like device to harvest individual follicular units (where bundles or families of hairs naturally group together on the scalp) as painlessly and non-invasively as possible, for transplanting to other parts of the scalp. Deciding on the relevant treatment, however, depends on the nature and cause of hair loss.

WHAT CAUSES HAIR LOSS?

The most common causes of alopecia (the medical term for hair loss) on a normal, unscarred scalp are predetermined genetic factors and the effects of the male hormone dihydrotestosterone (DHT).

This form of hair loss is known as alopecia androgenetica (“androgenic” is the adjectival form of the noun “androgen”, which refers to male hormones) or pattern hair loss.

Deciding on the relevant treatment depends on the nature and cause of hair loss.

Approximately 70% to 80% of men and 8% to 12% of women will experience some form of hair thinning from this condition in their lifetime.

Male-pattern hair loss often begins as a receding hairline. As it progresses, all that remains is a rim of hair at the sides and back of the head. Female-pattern hair loss is primarily seen at the top and front of the scalp, and typically presents as a thinning rather than total hair loss.

Illness, trauma, poor nutrition and hormonal changes can also cause hair loss. Other types of hair loss are alopecia areata, which is produced by the autoimmune destruction of hair follicles in localised areas; traction alopecia, thinning caused by wearing very tight braids or ponytails; trichotillomania, the habit of twisting and/or pulling out your hair; and tinea capitis, a fungal infection. These conditions require specific treatment, but for the purpose of this article (given that it is the most prevalent type), we focus on pattern hair loss.

TREATING HAIR LOSS

Over the ages, men and women have gone to extraordinary lengths to prevent balding and restore their hair. Ancient Greek physician Hippocrates treated his bald head with a mixture of beetroot, horseradish, opium, pigeon droppings and spices.

When the concoction failed and he noted eunuchs never lost their hair, he observed castration might be the ultimate cure for baldness.

More recent attempts to stimulate hair growth include the application of horse shampoo, Bob Martin conditioning tablets for dogs, and bergamot essence, says Alexander. Low-level laser therapy, laser combs and laser domes used alone also have a poor record of inducing

regrowth. Another popular myth is that cutting hair short stimulates growth. Indeed, hope springs eternal where hair springs no more.

“Like the weight-loss industry, the hair-loss market is worth a fortune,” says Gershowitz. “People are desperate to believe there is a way to restore hair, which is why marketers continue promising the impossible and selling ineffective products.”

That is not to say there are no potentially effective ways of treating hair loss. Approved by the US Food and Drug Administration (FDA) and available in South Africa, minoxidil (Rogaine) and finasteride (Propecia) are two of the most widely used non-surgical hair-loss treatments.

Minoxidil is a topical medication that is applied to scalp skin in areas of hair loss. It is, says Alexander, a means of controlling (not curing) hair loss by increasing the levels of prostaglandin E2 (one of a group of compounds with hormone-like effects), which prolongs the anagen phase to encourage thicker, stronger hair.

Finasteride is an oral tablet that inhibits the enzyme that converts testosterone to DHT in the follicle, thus preventing androgenic hair loss when administered over a long time. (Finasteride is also available as a cheaper generic called Finpecia 1MG.) It does not promise regrowth, but slows hair loss in men and women with alopecia androgenetica. The earlier patients begin using finasteride, the better, says Gershowitz, who has used it himself for more than 20 years and has a full head of hair, despite being genetically predisposed to balding.

Regardless of your problem and gender, there is almost certainly something you can do about hair loss.

For further information: www.hairloss.co.za; www.medhair.co.za

Images: ©iStock.com/1905HKN/CatherineL-Prod/VladimirFLoyd

HIGH-TECH RELOCATION

Where professionally undertaken on patients who have hair to transplant and who are dissatisfied with non-surgical treatment, hair-transplantation surgery has become an increasingly effective option. These days, the procedure is performed under local anaesthetic, and – because of improved understanding of the scalp and hair, and refined techniques and instrumentation – the results are natural and undetectable.

“Hair-replacement treatment involves transplanting hair follicles, which can be extracted individually from their original location using a sophisticated new follicular unit extraction (FUE) device, moving them to another area and positioning them so they behave in the same way as they did in their original site,” says Dr Larry Gershowitz of the Medical Hair Restoration Centre. “FUE is a newer, more advanced technique than strip harvesting, which requires sutures to close the skin.”

The advantage of the FUE method, he says, is that it helps to avoid scars, pain and excessive swelling on both the donor and newly grafted areas, expedites recovery, and eliminates unnatural-looking, “pluggy” transplants.

Possibly the most profound hair-loss message of the 21st century is that, regardless of your problem and gender, there is almost certainly something you can do to improve the situation. Hair replacement (that is, hair pieces and wigs) might be an absolute last resort, but, even there, the options are greatly improved. So, hair’s looking at you, kid.

H E A L T H Y T I M E S l 57

BY gum!

H SE UA PL TPHL EY MT E N E TTHS

g

In adults, gum disease is far more common than cavities.

Zaza Motha gets her teeth into the problem

um disease (gingivitis) is considered the most common disease, found in almost 90% of the world’s population. Johannesburg dentist Dr Chelsea Cahi explains that it is caused by an accumulation of plaque around the base of the teeth and the gum line.

Plaque, a sticky colourless film, consists of mucus, food debris and bacteria. It causes the gums to become inflamed and possibly infected if not removed by effective brushing and flossing on a daily basis.

Dr Thulani Qwabe, course co-ordinator, junior lecturer and supervisor at the Oral Rehabilitation Department at Wits Dental School, adds that causes of plaque include poor oral hygiene, not visiting the dentist at least twice a year for check-ups and cleaning, medical problems, hormonal changes in women, diabetes, reduced salivary flow, some medication (which can cause abnormal overgrowth of gums, making it difficult for the gums and teeth to be cleaned), and smoking.

TIPS TO PREVENT GUM DISEASE:

• Brush your teeth thoroughly twice a day, once after breakfast and once before bedtime; • Floss your teeth once a day, at night before you brush; • Use an antibacterial mouthwash occasionally; • Have a professional dental cleaning done at least twice a year; • Avoid a diet high in sugar and starch (the combination of starch and sugar produces an acid which causes dental decay and disease); and • Seek professional help as soon as any of the above signs and symptoms appear.

TREATMENT OF GUM DISEASE:

Images: ©iStock.com/ellobo1/Wavebreak

SYMPTOMS OF GUM DISEASE:

• Painful and tender (or itchy) gums, to the touch and on brushing; • Bleeding gums (usually on brushing, but can occur spontaneously); • Red and inflamed (puffy and swollen) gums; • Bad breath (halitosis); and • Receding gums.

“If plaque is left on our teeth, it hardens into calculus, and, when this happens, ordinary brushing cannot remove the deposits from the teeth. Only a professional scaling by a dentist/oral hygienist can get rid of this hardened plaque.” – Dr Chelsea Cahi

“If gum disease is recognised and diagnosed very early on, it is totally reversible if managed correctly,” Cahi says. “If ignored, the disease progresses into periodontitis. One should avoid reaching this stage at all costs, because periodontitis is irreversible, and often leads to loss of teeth in early adulthood.”

The treatment of gum disease depends on the extent and severity of the condition. “Mild gum disease is treated with a thorough professional cleaning to remove all the hardened plaque and debris. An antiseptic mouthwash is usually then prescribed, together with other medication, if needed,” Cahi explains.

“The most important aspect of treatment is your oral hygiene routine at home. A professional cleaning should be done at least three times a year if gum disease is present.”

For severe gum disease, surgical intervention may be required. Says Qwabe: “In some cases, a laser can be used to remove plaque and tartar. There’s usually less bleeding and pain after this procedure.”

H E A L T H Y T I M E S l 59

VEINS

Varicose and spider veins are unsightly, and, left long enough, varicose veins can be painful and affect your quality of life. However, they are fairly easy to sort out in the hands of a phlebologist, writes Mandy Collins

HELP FOR TROUBLESOME veins

i

t’s one thing to trace the faint blue outline of a vein you can see below your skin. It’s quite another when you get patches of small, red spider veins right near the surface, or, even worse, bulging, twisted varicose veins.

Specialist surgeon Dr Johan Blignaut says the difference between the two is primarily about size. “If the vein is larger than 4mm and raised above the level of the skin, it’s a varicose vein,” he says. “Spider veins are usually less than 1mm - 2mm wide.”

“The first thing people need to realise is that these veins will never kill you,” emphasises Dr Lawrence Retief, a Johannesburg GP. “They are superficial veins lying between the muscles and the skin.

“In 99% of patients, blue veins and spider veins are treated for aesthetic reasons – there is no medical danger and they seldom cause swelling in the legs. But varicose veins often cause discomfort and swelling; medically this is called chronic venous insufficiency (CVI).

“In contrast, deep veins run up your legs, inside the muscles and are where a deep vein thrombosis (DVT) can occur. That’s a life-threatening condition and is treated as a medical emergency. Superficial veins have very little to do with a DVT in the deep veins.”

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WHAT CAUSES THEM?

Varicose veins are caused by failed one-way valves – it’s a pressure-based problem, Blignaut explains. So, there is increased pressure from the deep to the superficial veins in the skin and they bulge out. “Spider veins form the same way, but to a lesser degree,” he adds. “If you’re hit hard with a ball, for example, you might get a patch of veins because a valve has ruptured.”

Women are far more likely to suffer from spider veins than men. “In patients with spider veins, eight or nine out of 10 are women, and it’s just because of normal female hormones.”

Once varicose veins progress to the CVI stage, they are more than just a cosmetic problem; they can cause leg pain, heaviness and swelling, and, ultimately, venous eczema and ulcers. “They take away quality of life and, if left untreated, can often result in permanent skin changes,” Blignaut says.

VARICOSE VEINS ARE CAUSED BY FAILED ONE-WAY VALVES – IT’S A PRESSUREBASED PROBLEM.

Can they be prevented?

NORMAL VEIN

VARICOSE VEIN

there is very little you can do to prevent them. “your most important risk factor is your family history,” Blignaut says. “also, keep your weight in check – if you are overweight and have an abdominal apron, for example, when you sit down it kinks the blood vessel in the groin area, so it affects your circulation. my obese patients really improve their varicose veins by losing weight.” “nature put one-way valves in your veins to prevent gravity from pulling the blood down your legs,” adds retief. “there are hundreds of valves in your leg veins, but they’re designed for a creature that spends 80% of the day sitting on the ground. When you sit in a chair, or stand, the pressure on your valves is high enough to cause leaking valves over time.” if you do struggle with varicose veins, Blignaut advises that you avoid sitting or standing for long periods of time, and take a break every 30 to 60 minutes. you can also do simple calf raises to improve circulation and decrease pooling of the blood in your lower legs. “teachers and nurses – people who stand on their feet all day – can also wear compression stockings, but these are supportive, not preventive,” he stresses.

If you have problems with your veins, it’s best to seek help from a phlebologist who is up-to-date with modern protocols.

Images: Shutterstock and ©iStock.com/DKart/ElenaChervyakova/Staras/Ugreen

treatment oPtions

Both doctors agree that if anyone offers you vein-stripping as a solution to your problem, you should get a second opinion. “First, you need a diagnosis to determine whether you have CVI or not, which is accomplished through a special ultrasound scan of your leg veins,” Blignaut explains.

Patients with CVI will probably have to undergo endovenous ablation under local anaesthetic. This means that the veins are ablated and sealed via radiofrequency or laser energy to cauterise (burn) and close the varicose veins. “The goal is to re-establish normal circulation and close the points where the blood is escaping. The body heals itself by re-absorbing the treated veins, and the chance of recurrence is less than 15%,” he says.

“When we inject the local anaesthetic, we do so in a large volume of fluid, which pushes the healthy muscle and skin tissue away from the vein. The vein is then heated to 120°C; there’s no collateral tissue damage, and thus no pain afterwards. This is as close to ideal surgery as you get.”

If you want treatment for purely cosmetic reasons, the doctors recommend sclerotherapy, which entails injecting a sclerosant (an irritant solution that stops bleeding by hardening the blood or vein into which it is injected) into the vein. This strips out its inner lining, and the vein collapses and is absorbed by the body. It’s done in the doctor’s rooms; you walk in and walk out, and it takes about 30 minutes. Some patients go straight back to work afterwards.

“Between endovenous ablation and sclerotherapy, there are no legs that can’t be sorted out, or at least be dramatically improved. We can also do a lot to improve venous ulcers,” says Retief.

What is a phlebologist?

a phlebologist is a medical specialist in the diagnosis and treatment of disorders that originate in the veins. the american medical association added phlebology to its list of self-designated practice specialties in 2005.

Phlebology developed to enable physicians sharing an interest in venous disease and health to share knowledge and experience, despite being trained in a variety of disciplines, such as dermatology, vascular surgery, haematology or general medicine.

Diagnostic techniques used include the patient’s history and a physical examination, venous imaging techniques and laboratory evaluation related to venous thromboembolism. a significant part of a phlebologist’s work involves the treatment of superficial venous disease, frequently of the leg. Conditions often treated include venous stasis ulcers, varicose veins and spider veins (telangiectasia). if you have problems with your veins, it’s best to seek help from a phlebologist who is up-to-date with modern protocols, and who will not only look at your veins from a cosmetic point of view, but assess you properly to ensure there are no problems with the bigger veins inside your leg as well.

h e a l t h y t i m e s l 61

H E A SL U T HP P&L EBM E AE N U T YS

Peel TO PERFECT

Image: ©iStock.com/Image Source

s

kin is constantly renewing itself from the inside out as new cells make their way up from the deepest layers to the skin’s surface, and are eventually cast off. A young skin replaces itself every 28 days, but eventually this renewal process slows down, and it’s one of the reasons why skin begins to lose that youthful radiance and even tone.

Because no one lives in a bubble, the skin is also subject to factors including sun exposure, hormonal fluctuations, climatic conditions, injuries, shaving and breakouts, and each can contribute to a dull, aged and uneven-toned complexion. A skin peel is a technique where a chemical solution is applied to the skin to reveal new cells underneath, for a more radiant-looking, even-toned skin.

“Chemical peels have been around for many years and have proven an effective treatment to correct skin damage,” says Sonette Donker, professional skincare therapist and owner of Skin iD in Johannesburg. However, she adds that the knock-on effect of this process is that it also enhances cell-to-cell communication and helps to stimulate new cell growth.

There are several types of chemical peels, from superficial “lunchtime” peels through to deep peels for conditions such as acne scarring, but, because peels are a combination of acids that penetrate the skin, all are done under the watchful eye of a trained professional, Donker explains.

Peels are suitable for most skin types, and can be used on both men and women to improve sun damage, dry, rough skin, fine lines, wrinkles, uneven skin tone and acne scarring, to boost overall radiance and glow, and to complement other rejuvenating treatments such as plastic surgery, filler injections and Botox.

What’s more, peels can be done on the face, neck and hands – anywhere where the signs of ageing or skin damage are visible.

They may not be pampering or glamorous, but chemical peels are an effective way of rejuvenating the appearance of a tired, aged or uneven-toned skin, writes Nicole Sparrow

WHAT PEEL DO I NEED?

Not all peels are alike; depending on the concerns, the beauty therapist assessing your skin will advise either an alpha hydroxy acid (AHA) or beta hydroxy acid (BHA) peel. AHA peels are good for ageing skin, loss of firmness, crepey texture, and rough and dry skin. BHA peels work well on oily skin, blackheads, blemishes, enlarged pores and ageing, explains Megan Byleveldt, aesthetic therapist at The Goddess Factor in Johannesburg.

Peels can be done on the face, neck and hands – anywhere where the signs of ageing or skin damage are visible.

WHAT HAPPENS DURING A PEEL?

The week before your appointment, stay out of the sun, and avoid using products containing retinoids (vitamin A), salicylic acid and peroxide, advises Byleveldt.

She normally starts with a mild peel solution, for the skin to adjust.

During an appointment, skin is cleansed and prepared, and product is then applied. Some clients experience tingling and discomfort, in which case a fan helps to soothe and cool, but it’s all monitored by the therapist. After the activation time is complete, the peel is neutralised or removed, and moisturiser with sun protection is applied.

Some peels make the skin flake within hours, some take a few days, and other peels can even take a few weeks. Irrespective of the peel used, Byleveldt emphasises sun protection, as most peels make skin photosensitive.

Depending on what skin concern is being treated, she says, peels might need to be done until the problem is resolved. The best bet is to make an appointment for an initial consultation, during which the therapist will advise which type of peel is best and how many sessions are required.

H E A L T H Y T I M E S l 63

HEALTHY SLEEP

If you’re unable to sleep because you have strange sensations in your legs at night, it’s time to see a sleep specialist, advises Mandy Collins. You may be suffering from restless legs syndrome

CALMING RESTLESS

Images: Shutterstock and ©iStock.com/FatCamera/grinvalds

legs m ost of us, at some time or another, have experienced a bout of insomnia. Often the cause is anxiety, or perhaps your mind is racing. Your afternoon nap may have thrown out your sleep cycle, or you just need to put down that screen and practise better sleep hygiene.

People with restless legs syndrome (RLS), however, have a very different reason for not sleeping: a feeling of discomfort in their legs that is relieved only by movement. And because they have to move their legs to find relief, they can’t sleep.

“Typically, what happens is that people work all day, then they get home and put their feet up, and they go nuts,” says sleep researcher and clinician Dr Alison Bentley. “Their legs are so uncomfortable that they just have to move.”

Most often, she says, they blame the symptoms on their lifestyle, particularly if they have a job where they have to stand a lot. “But it has nothing to do with lifestyle,” she emphasises. “It’s a disorder that happens from 5pm to 1am because the dopamine level in your brain drops.

Bentley describes a patient she saw – a teacher – who was on her feet all day “So she blamed it on that.

And then she retired, and wasn’t on her feet all day anymore, and she still had the same sensation at night.

That’s when she realised there was a problem.”

SIGNS AND SYMPTOMS

Typically, RLS isn’t painful, although there are patients who experience pain.

But it happens only at night, and when it does, many patients think they’re just imagining things, that it’s some kind of psychological problem.

“Typically they describe it as feeling like they have Coca-Cola in their veins, or ants inside their legs,” says Bentley. “And it’s also not like pins and needles, but it is painful sometimes. The relief that movement provides is an important component. As soon as they stop moving, the feeling comes back.”

>

H E A L T H Y T I M E S l 65

healthy sleep

What causes Rls?

There is considerable evidence to suggest that RLS is related to a dysfunction in the brain with regard to dopamine, the neurotransmitter that your body needs to produce smooth, purposeful muscle activity and movement.

When the dopamine pathways are disrupted, the result is involuntary movements. If that sounds similar to what happens when people have Parkinson’s disease, that’s because it is, although it doesn’t mean that if you have RLS, you have Parkinson’s, Bentley stresses.

However, it is true that some patients with Parkinson’s may have RLS. “There is also a familial component,” she adds. “So, if other members of your family have RLS, that increases your risk. We think it may be about iron transport to the brain, because you need iron to manufacture dopamine. If you have an iron deficiency, you may get RLS, but simply supplementing with iron won’t necessarily sort the problem out.

“There’s also no cure. We use a Parkinson’s drug, Pexola (pramipexole), to manage the symptoms, but that won’t cure it.

Patients don’t always need treatment, so generally we treat it when it is having an adverse impact on their lives.”

However, it’s not as simple as seeing a sleep specialist, getting the drugs, and it’s all sorted. There are some side-effects to be aware of. For example, the medication can cause some patients to become compulsive gamblers!

“There is another thing that happens with RLS, called augmentation,” Bentley explains.

“Basically, you chase the RLS with medication – so, as you increase the meds, the RLS gets worse. Usually we will then take the patient off the medication and try a different drug. There are always other options.”

Bentley makes the important point that, when treatment doesn’t work, patients often simply discontinue what has been prescribed, instead of informing the doctor that the treatment is not working – and this applies to all medical treatment, not just RLS. “Don’t get upset if your doctor can’t fix it the first time; go back and she or he will keep trying until they find something that works for you. But they can’t help you if they don’t know that the treatment is not working,” she says. “If your RLS is getting worse with an increased dose, you must go back to the doctor. Pexola, for example, works in only 60% of cases, and you may be in the 40%.”

Some people with restless legs syndrome never seek medical attention, because they worry they won’t be taken seriously. Often their symptoms might be attributed to nervousness, stress, insomnia or muscle cramps. But if you’ve tried to rectify all of those causes, and your legs are still not comfortable at night, it’s worth seeking out a sleep specialist and telling them you suspect you may have RLS – it’s worth it if the result is a good night’s sleep.

“Typically patients describe it as feeling like they have Coca-Cola in their veins, or ants inside their legs.”

– Dr Alison Bentley

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how is Rls diagnosed?

there is no specific test for Rls, but sleep specialists look at four basic criteria:

A sleep study might be required, where your brAin wAves, heArtbeAt, breAthing And leg movements Are monitored for An entire night.

1. a strong and often overwhelming need or urge to move the legs and feet; 2. symptoms that are worse at night, and are absent or negligible in the morning; 3. sensory symptoms that are triggered by rest, relaxation or sleep; and 4. sensory symptoms that are relieved with movement, where the relief persists as long as the movement continues.

sleep specialists will probably focus largely on your descriptions of the symptoms, what triggers them, what relieves them, and what happens to them during the day. they might also conduct a neurological and physical examination, and take a comprehensive medical and family history, in addition to looking at any medications you are currently taking. you might also be asked about the frequency, duration and intensity of your symptoms, as well as your tendency towards daytime sleep patterns and sleepiness, disturbance of sleep, or daytime function. your doctor might perform some laboratory tests to rule out other conditions, and identify iron and vitamin deficiencies, as well as other medical disorders associated with Rls. in some cases, a sleep study might be required, where you go to a sleep laboratory and have your brain waves, heartbeat, breathing and leg movements monitored for an entire night.

HEALTHY PREGNANCY

Eat well and exercise – FOR YOU AND BABY

s

Looking after yourself during pregnancy is vital – for your own sake and for that of your unborn baby, writes Candice Tehini

saturated fat or sugar. Maternal obesity and excess maternal nutrition are associated with a long-term detrimental influence on the risk of disease in childhood and beyond, elaborates Julsing-Strydom.

Eating too little is no good either, especially if you restrict your kilojoules and protein. “Undernutrition during developmental stages reallocates the energy and nutrients to the development of organs critical for immediate survival, like the brain and heart, which occurs at the expense of those organs and systems like the pancreas and kidney, contributing to eventual dysfunctions in adulthood,” she adds.

This is potentially associated with low birth weight, reduced fat mass and lean mass, poor cognition in childhood, increased risk for diabetes, and high blood pressure during adulthood.

During pregnancy, especially in the early months, it’s imperative that you include folate, iron, zinc, calcium, vitamin D and essential fatty acids in your diet.

SO, HOW MUCH WEIGHT SHOULD YOU GAIN?

The right amount of weight to gain during pregnancy depends on your pre-pregnancy body mass index (BMI), explains mom, registered dietician and lactation consultant Deidre Lindeque. If you were underweight before you fell pregnant, you can put on between 12kg and 18kg; if you were at a normal weight, 11kg to 16kg should be your average weight gain. If you were overweight, you could put on between 7kg and 16kg, but if you were obese, you should gain only 5kg to 9kg.

THE RIGHT AMOUNT Bear in mind that the weight you put on is not all body fat.

OF WEIGHT TO GAIN Lindeque outlines: your baby may weigh around 3.5kg; your DURING PREGNANCY placenta, amniotic fluid and breast tissue can weigh anything from DEPENDS ON YOUR 1kg to 1.5kg each; your blood supply is a further 1.8kg; and your PRE-PREGNANCY BODY uterus can weight anything from 1kg to 2kg. Then there is stored fat for delivery and breastfeeding, which weighs around 2.5kg to 4kg.

MASS INDEX (BMI).

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Images: Shutterstock and ©iStock.com/sam74100/SelectStock

ure, some women use pregnancy as an excuse to eat what they want and to avoid exercise, but the experts show just how important it is to follow a well-balanced eating plan and exercise regime.

“The mother’s diet is extremely important, as it will provide key nutrients to promote foetal growth, red blood cell production, enzyme activity, bone development, and brain and central nervous system development,” says registered dietician and mom Claire Julsing-Strydom.

During pregnancy, your metabolism may increase by up to 15%, but that doesn’t mean you can help yourself to an extra slice of chocolate cake. In fact, Julsing-Strydom explains, in your first trimester, no extra kilojoules need to be consumed. In your second trimester, you will need an additional 1 470kJ, which you can get by simply adding a low-fat yoghurt, five nuts and a piece of fruit to your regular diet. Then, in your third trimester, you will need a further 470kJ, which you can get from adding a tin of tuna.

You shouldn’t overeat, especially when you make up those extra kilojoules in the form of

BREAST IS BEST

Advice from the World Health Organisation and the South African government is that women should breastfeed their babies for the first six months. “Healthy eating while breastfeeding is about ensuring your diet is full of a wide variety of nutritious, naturally colourful foods,” says Lindeque. You should focus on getting some iron-rich foods such as eggs and red meat, fruits rich in vitamin C, green leafy vegetables, whole grains, low-mercury omega-3-rich fish, adequate amounts of calcium and protein to give you sustained energy throughout the day.

“It’s important to highlight that you need to get in a minimum of two litres of clean water per day,” Lindeque adds.

PREGGIE FIT

“Exercising during your pregnancy is not only safe; it is advised. As long as you progress slowly, exercise can play a big part in keeping you healthy throughout your pregnancy. The general rule of thumb is maintaining your current workout routine, not increasing it,” says fitness and lifestyle expert, and new mom, Lisa Raleigh.

Proceeding with caution and listening to your body will help you to gauge the effect of certain exercises, and ensure that you are not pushing yourself beyond your limits.

Of course, you need the all-clear from your ob-gyn, and should proceed with caution and under supervision if you have health issues such as diabetes or high blood pressure.

Get started on strengthening your pelvic floor as soon as possible, she advises. With the growing weight of your baby resting on your bladder and pelvic floor, these muscles can weaken over time. Walking, swimming and biking for 30 minutes at low to moderate-intensity levels are great ways to work out while pregnant.

In addition, strength training is highly recommended during pregnancy, to keep muscles strong and adaptive to the many changes that occur as your belly grows. “While you want to avoid exercises performed on your back after the first trimester, core and back exercises are still important. These help with the postural changes that come with a growing baby, as will regular back and neck stretches,” says Raleigh.

Don’t overwork your thigh muscles, as this tends to stress the ligaments surrounding your pelvis as well. Lower your weights and increase your reps as you grow. By the end of your pregnancy, you should be lifting half of what you are used to.

Prenatal yoga and pilates classes offer excellent, adapted and supervised exercises for moms-to-be. Avoid high-impact, contact sports or those that require quick changes of direction, such as soccer and squash. Also avoid those requiring balance, such as biking or skiing, as your centre of gravity changes as you grow. You should also avoid twisting or compressing your abdomen, torso or spine, which means no overhead presses, deep backbends or yoga twists.

HEALTHY EATING WHILE BREASTFEEDING IS ABOUT ENSURING YOUR DIET IS FULL OF A WIDE VARIETY OF NUTRITIOUS, NATURALLY COLOURFUL FOODS.

MEDICINAL MUST-KNOWS

During pregnancy, you may be told that no medicine is safe to take, except Panado. While there is some truth in that, there are a few others that can safely offer suffering momsto-be some relief. According to Gerald Briggs, pharmacist clinical specialist, in an interview on babycentre.com, some medicines are safe to take throughout pregnancy, some pose known risks to a developing baby, and a host of others fall somewhere in between. It’s always advisable to check with your ob-gyn if a medication is safe or not.

Antibiotics: If you’re very sick and an antibiotic is the only thing that will help you to get better, you may need to take it. In some cases, not treating your illness could be more risky for your baby’s health than exposing them to an antibiotic.

Painkillers: While Panado is considered safe during pregnancy, other over-the-counter painkillers are not. Stay away from ibuprofen (Nurofen), and other anti-inflammatory drugs such as aspirin (Disprin).

Colds and flu: You want to avoid decongestants such as pseudoephedrine and phenylephrine, found in Degoran Cold and Flu, Flusin and Corenza C, especially in the first 13 weeks of pregnancy. When it comes to nasal sprays, most are low-risk, but, to be on the safe side, rather use saline solutions.

As long as you progress slowly, exercise can play a big part in keeping you healthy throughout your pregnancy.

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H S UE A P LP TLHE M Y EPNE T S

If Fido or Felix has developed behavioural issues, an animal behaviourist can guide them – and you – back to mental wellness, suggests Georgina Guedes

THE TRUTH ABOUT (THE MINDS OF)

cats and dogs...

a Images: Shutterstock and ©iStock.com/Halfpoint/Valkyan

nimal behaviourists are like psychologists for pets.

When your dog or cat is acting up, that’s who you call. They will take a look at your pet, its environment and its relationship with you, and provide you with a course of action for treating the problematic behaviour.

But how do you know when an animal’s behaviour is problematic enough to warrant calling in an expert? According to Celia McCulla, owner of Happy Pack Dog Training and Pet Sense College, which provides diplomas in dog and cat behaviourism, you need to contact an animal behaviourist if your pet is exhibiting behaviour that is preventing it from living a happy life.

TRICKS AND TIPS FOR ANIMAL PROBLEMS

For dogs, one of the most important steps you can take is to carry out “life enrichment” interventions to alleviate boredom and frustration. In addition to food and water, dogs need social interaction, and mental and physical stimulation. Dogs that are closed in a garden all day, with no company, soon become bored, lonely and destructive.

Animal behaviourist Gordon Banks recommends that, in addition to a daily walk, you provide your dog with chew toys. One idea is to put bits of sausage in an ice cream tub full of water, then freeze it.

Once frozen, give it to your dog so he can try to work out how to get at the frozen sausage pieces by chewing, gnawing and tugging.

With cats urinating in unwanted places, McCulla says sometimes the best solution is the simplest: if you don’t want your cat to soil your bed linen, keep the bedroom door closed until the habit is broken.

“You should reduce access, then you can get pheromones from your vet to help calm the cat down, and finally you can try to modify the behaviour – provide extra litterboxes so the cat has options of preference. You can also confine the cat to a room while the proper behaviour is established, and let it out only when you are able to keep a close eye on it.”

There are also animal behaviourists who specialise in other types of pets, including birds or rodents, but these are harder to come by. Just remember, if your furry friend is stressed, unhappy or aggressive, you can improve its life – and yours – by calling in a professional.

GETTING TO THE ROOT OF THE PROBLEM

McCulla explains that people usually approach behaviourists after a referral from a vet, which is an essential first step, because it is important to eliminate other possibilities for the behaviour, such as some kind of pain or illness.

She says the most common problematic behaviours in dogs are aggression, separation anxiety, destructive behaviour and noise phobias. For cats, common problems are urination indoors or outside of the litterbox, or territorial marking, excessive grooming, compulsive behaviour, tail-chasing or mutilation, and hair-pulling.

While these kinds of behaviours are irritating for the owner, they usually indicate some kind of distress on the part of the pet. According to Banks, who consults to the dog shelter Dogtown, problems such as these are the number one reason why dogs are surrendered to shelters.

“In most cases, the problem can be solved,” he says, “but it takes hard work on the part of the owner – and you have to be willing to do the work.”

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HEALTHY HOLIDAYS

BE

prepared A simple first-aid kit can be a lifesaver if you’re far away from medical facilities, or it’s after hours, writes Mandy Collins

“Local pharmacies are a good first port of call, so use them as a resource.”

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WHAT TO PACK IN YOUR FIRST-AID KIT

It also pays to pack yourself a basic first-aid kit with medications to cover pain, fever, tummy bugs and allergies, as well as any chronic medications you or your family may be taking.

Davis says this kit should contain the following: ●

●

● ●

An anti-inflammatory such as ibuprofen. Aspirin is also an antiinflammatory, but children under 12 shouldn’t have aspirin at all, so it’s strictly for teenagers and adults. ● Paracetamol, which is a good mild painkiller. Take some in tablet form for the grown-ups and syrup for younger children. ● Both an oral antihistamine and a cream, for allergies and insect bites and stings. ● An anti-nausea medication such as cyclizine, which can also be used to ward off travel sickness. ● A good treatment for burns, such as Burn Shield – your pharmacist will be able to advise you here.

Rehydration solution in case of diarrhoea, especially if you have young children, as they dehydrate very easily.

An assortment of plasters, gauze swabs and a bandage or two.

A good pair of tweezers and a clean needle for splinter removal.

It’s also well worth having a tub of aqueous cream in the car, as it works very well as an all-purpose soother, as well as “magic cream” for little bumps and bruises, or arnica cream. Some lip balm is also useful to have, as are wet wipes, for cleaning dirty hands and faces.

“Don’t forget to ensure the whole family is adequately protected from the sun,” says Davis, “and ensure it’s applied daily, regardless of the weather, and reapplied after swimming. Remember that UV rays penetrate clouds, so you can get just as sunburnt when it’s overcast.”

Finally, she says, if you’re uncertain about basic first aid, or what to do in an emergency, it’s a good idea to take a basic first-aid course and learn CPR (cardiopulmonary resuscitation) – it’s a very useful skill for anyone to have.”

Images: Shutterstock

w

hen you’re packing for your holiday, your health needs may be the last thing on your mind – particularly if everyone in the family is in pretty good health. But they are very important – you’re away from your regular first-aid cupboard and your family doctor. Throw in a different climate, different food and water, and possibly some extreme adventures, and you may find yourself in need of either medication or help for bumps and bruises.

“If you can, find out about the doctors and medical services in the area before you go,” suggests Colleen Davis, a primary healthcare professional nurse. “In some towns, you can’t just arrive at an emergency room unless it really is a life-threatening emergency. You may need to be referred by one of the local general practitioners.”

She points out that local pharmacies are a good source of information about local medical facilities. “They will generally know the doctors in the area and have a good sense of how things work. But they are also a good first port of call anyway, so use them as a resource.”