U The Caribbean Health Digest - Issue 25

APR JUN 2014

ISSUE 25

TT$35.00 US$5.99

COCONUT OIL Can't beat its traditional value but it is also loaded with many health benefits.

Common Foot Disorders and the role of a Podiatrist.

Portugal A tangy, sweet fruit related to the orange and just as good.

Hand, Foot and Mouth Disease Why it’s not a reason to panic.

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Dr. Claudette Mitchell Maia Hibben David Fenton Lylah Persad Dr. Amanda Jones Andrew Chan Carol Quash Nasser Khan Michelle Ash Dr. David Bratt Stuart Fraser Damian Gill Varesha Ramnath Lorraine Biran Hamish Tarauné iStockPhoto Dr. Neil Singh

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This information is of a general nature only and is not intended as a substitute for professional health advice and no person should act in reliance on any statement contained in the information provided and at all times should obtain s p e c i fi c a d v i c e f ro m a h e a l t h professional. Eidetic Publishing has made reasonable efforts to ensure that the health information contained herein is accurate and up to date. To the extent permitted by law, Eidetic Publishing, their employees, agents and advertisers accept no liability

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WHEN IT COMES TO YOUR HEALTH, the choice is yours.

It’s your health and YOU can choose who takes care of it You have a choice in healthcare. Choose well. Choose Baptist Health, ranked among the best hospitals in the United States by U.S. News & World Report. Comprised of 7 hospitals, Baptist Health is one of the largest U.S. medical organizations attending an international clientele. Our multilingual staff and over 2,000 expert physicians take great pride in delivering personalized, compassionate care, which is covered by most international insurance companies.

To learn more about Baptist Health International, please visit BaptistHealth.net/International, contact International@BaptistHealth.net, or speak to an international representative any time of the day or night at 786-596-2373.

12 Using Dietary Approaches to Help Manage Chronic Diseases

There are many medicines, treatments and surgeries out there to help manage chronic diseases such as high blood pressure and diabetes, but the easiest way to manage them — or not to develop them at all —is right there in our kitchen. Dietician Claudette Mitchell, Ph.D., tells us why healthy food is sometimes the best medicine.

16 Coconut Oil — the Oil of Life

Trinidad and Tobago was once the land of coconuts. But internationally, coconut oil has come under fire for its high saturation levels.

But recently, whole-food advocates have been claiming that the reputation of coconut oil as unhealthy is undeserved. Let’s take a look at the other side of the story.

20 Beat Those Dangers Behind The Wheel

Most of us are sick of driving, but did you know that driving can make you sick? Stress, smog, inactivity, eye strain and bad, on-the-go food choices can all put a strain on your body.

Here’s what to do about it.

24 Bacillus

We grew up believing that all bacteria are bad, but that’s far from the truth. David Fenton’s anecdote about the horrors of battlefield infections during World War I is a window through which we can peek at early discoveries about beneficial bacteria.

28 Dehydration

Thirsty? Better drink up. Dehydration doesn’t just leave you with cotton-mouth. It can have serious consequences for your body.

32 Make Your Birthing Experience Better: Get A Doula

Giving birth may be intimidating, but it is also one of the most treasured moments in a woman’s life...and a doula can help make it so much better. Part coach, part sister, all professional...a doula is all this, and more.

36 Putting Your Best Foot Forward

We treat our feet so badly: squash them into shoes that don’t fit, expose them to infection, and put thousands of pounds of pressure on them as we stomp about our day. Let’s be nicer to our feet...and they, in turn, will be nicer to us.

39 Portugals

Pootegal, Pretty Girls, whatever you like to call them, these citrus fruit seem made to order for peeling and eating on the go. And like all citrus, their goodness and taste are boundless.

40 Do Women’s Menstrual Cycles Synchronize?

It’s a standing joke that a house or office in which more than one woman experience PMS at the same time is a volatile place to be.

But is the synching of menstrual cycles medical fact, or just another old wives’ tale?

42 Hand, Foot and Mouth Disease

It’s a condition that’s greatly feared in primary schools, to the extent that many a child has been sent home at the first sign of a rash.

But Dr. David Bratt tells us that it’s far from a reason to panic.

So, by now you’ve picked up your 25th issue of U The Caribbean Health Digest!

That’s right folks, Issue 25!

It seems only just the other day we were in that sticky situation of tough decisions as to what submissions by our amazing writers would make the cut, only because they were all so informative. We seem to be in the same predicament every quarter, and, as usual, we’ve managed to bring to you some really fun and enlightening articles.

In this issue, we’re going nuts; nuts about coconuts, which we love so much here in the Caribbean, and for so many more reasons than just its refreshing, thirst-quenching water. This time, we zero in on the benefits associated with one of its main by-products, which is being praised the world over for its surprising health benefits: coconut oil.

Complementing our offering this issue are articles chock full of compelling information on some very interesting topics, like Dr. Bratt’s contribution on Hand, Foot and Mouth Disease, and long time friend and writer of U, Carol Quash’s piece on the many types of foot problems and the role of the podiatrist.

And for all of you who, like us, find history intriguing, David Fenton, our BBC Health Correspondent, shares some of his history knowledge with us on how doctors and surgeons dealt with injuries on the battlefields in Europe in the early 1900s.

We hope you enjoy our choices for you this issue; happy reading until next issue!

SHERINE & STUART

FOUNDING EDITORS

NUTRITION

| USING DIETARY APPROACHES TO HELP MANAGE CHRONIC DISEASES IN THE CARIBBEAN REGION

USING DIETARY APPROACHES TO HELP MANAGE CHRONIC DISEASES IN THE CARIBBEAN REGION

WRITTEN BY

| NUTRITION

CLAUDETTE MITCHELL, PH.D., RD

Taking charge of your health is a position which most of us desire to assume.

Good health brings benefits, and choosing to maintain your health through improving dietary practices can possibly help to lower potential risk for chronic diseases. In Trinidad and Tobago, the Health Report Card 2011, Ministry of Health, documented that obesity, elevated blood sugar, cholesterol and blood pressure levels, coupled with unhealthy diet, physical inactivity, tobacco use and alcohol consumption can be labelled as primary contributors to chronic non-communicable diseases.

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NUTRITION

| USING DIETARY APPROACHES TO HELP MANAGE CHRONIC DISEASES IN THE CARIBBEAN REGION

The report emphasized that the leading causes of death due to lifestyle behaviours or practices were cardiovascular disease, cancer, and diabetes mellitus.

Statistically these were 24.6%, 13.7%, and 13.6%, respectively. In the context, addressing the health concerns of the nation is critical.

The Facts…

Regionally, heart disease, stroke, cancer and diabetes can be referred to as the “killers in society,” being regarded as the main causes of death. Diabetes mellitus and hypertension are regarded as the significant contributing factors to heart disease and stroke. Hypertension has been shown to affect the regional populations as follows: 22.6%, 25.8%, and 27% in Jamaica, St. Lucia and Barbados, respectively.

The prevalence rates of diabetes mellitus are increasing, and the condition is documented as being the major cause of hospital admissions, as well as that of kidney failure, blindness and limb amputations (Healthy Caribbean Coalition). This chronic disease tends to affect persons across communities, and for Barbados, Jamaica, and St. Lucia, the figures are approximately 17%, 18%, and 8%, respectively. In Guyana, on the other hand, approximately thirty thousand individuals suffer from diabetes mellitus. In that country it accounts for 400 deaths annually (BBC Caribbean. com). Moreover, obesity and overweight remain a health challenge for most Caribbean countries. Henry (2004) stated that within approximately two decades the number of persons

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Now let us explore some dietary approaches that might be useful in nutrition management of the diseases…

being obese has grown by 400%. Obesity is a predisposing factor for developing many chronic diseases, which eventually result in deformity or death.

So what lifestyle behaviours can we change?

Change can be difficult, but a collaborative approach among community members can be helpful. The availability of more nutritious foods, providing appropriate nutrition information, encouraging community residents to engage in physical activity, such as walking clubs, aerobics class, etc., and sending positive health messages on adopting a healthy lifestyle are powerful tools which none can deny. All of these have been proven to help persons to modify their behaviour.

Whatever the choice, it will be worth it. The modification of dietary patterns can take place through several means, e.g. providing nutrition education to individuals and groups, including healthy meals and snack offerings in the school cafeterias, conducting demonstrations in preparing healthy foods or enhancing the nutritive value of foods, and choosing nutritious foods. The meal manager should aim to incorporate fruits, vegetables, whole grains, lean meats, and low-fat or fat-free dairy choices into the menu.

By adhering to these simple lifestyle practices, the desire to lower one’s potential risk for chronic diseases may probably be achieved.

low-fat diet Low-fat diet – generally is prescribed by the physician to assist persons in decreasing the levels of total cholesterol, LDL cholesterol, and triglycerides. A low-fat diet also helps in weight management. The food choices that you can include are ground provisions, brown rice, grain and grain products, legumes, lean meats, chicken without the skin, fish (for canned fish choose those packed in water), egg whites, low-fat or fat-free milk and milk products, and fruits and vegetables. Avoid high fat meats, pastries, whole milk (full cream milk), and fried foods; eat concentrated sweets (cakes, cookies, and candies) sparingly.

High fibre diet

High fibre diet – may be used to alleviate constipation, but it also can be useful in the management of elevated cholesterol and blood sugar levels. Be sure to consume adequate fluids, e.g. 6 – 8 glasses of water, daily. You may include in your meal plan foods rich in dietary fibre, such as ground provisions, brown rice, starchy fruit (breadfruit, plantain, and green banana), whole wheat products, peas and beans, and vegetables.

For a balanced diet you can also incorporate foods from animals (lean meats, fish, chicken, eggs, and low-fat or non-fat dairy products).

USING DIETARY APPROACHES TO HELP MANAGE CHRONIC DISEASES IN THE CARIBBEAN REGION

| NUTRITION

Carbohydrate Controlled or Diabetic diet

low sodium diet Low sodium diet – referred to as a low salt diet, often prescribed by the doctor to help persons with the management of blood pressure levels. Your healthy meal plan can include good sources of the following nutrients: potassium, e.g. fruits (bananas, oranges, paw paw, etc.), vegetables (spinach, patchoi, dasheen leaves, etc.); magnesium, e.g. dried beans, tofu, peanuts, potatoes, milk, dark green leafy vegetables, ready-to-eat cereals; calcium, e.g. milk and milk products, dried beans, calcium-fortified foods — orange juice, breakfast cereals; protein, e.g. lean meats, fish, eggs, poultry, milk and milk products; and the fibre rich foods previously mentioned in the high fibre diet. Avoid foods high in salt, e.g. salt fish, smoked herring, processed meats, sausages, seasoning salt, olives, capers, salted crackers, soups, etc. Instead choose low salt products, fresh or frozen vegetables, and fresh seasonings and herbs to flavour your meals.

Other helpful hints…

Carbohydrate Controlled or Diabetic diet — is usually prescribed by the doctor for persons diagnosed with diabetes mellitus or impaired glucose tolerance. The goal is to aid in the management of blood sugar levels and to minimize the potential risk for the development of complications. Generally, the focus is on including complex carbohydrates (good sources of dietary fibre, e.g. ground provisions, legumes, brown rice, and other whole grains — oats, barley, whole wheat, etc.), more servings of vegetables, at least two fruits daily, and food from animals such as lean meats, fish, chicken without the skin, low-fat or fat-free milk and milk products. Persons are required to visit with a dietician for nutrition education on carbohydrate counting and the diabetic exchanges. The dietician should work together with the client to develop a sample meal plan, taking into consideration food preferences, medications prescribed by the doctor, and work schedule. Diabetics should aim for consistent mealtimes, and to limit concentrated sweets (cakes, cookies, candies, etc.) and foods high in fat.

Overall, meal preparation should be reviewed. For example, instead of frying, you may choose other methods of cooking, such as baking, roasting, steaming, boiling, and grilling.

1. Irrespective of the diet, ensure that your meals are well balanced.

2. Watch your portion sizes.

3. Choose healthy snacks, e.g. salad, vegetable pieces — baby carrots, cucumber slices; granola bars; low-fat/fat-free yoghurt; whole wheat crackers, etc.

4. Include physical activity in your schedule (talk with your doctor first, and follow their instructions).

5. Use local produce in your meal plan which may be less costly when compared to foreign foods.

6. Include healthy meal and snack offerings in school and workplace cafeterias.

7. Be sure to discuss your progress with your doctor.

Remember:

You can improve your nutritional status and lower your risk for chronic diseases by selecting nutritious foods, adopting a healthy lifestyle, and following the advice of your doctor.

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FEATURE

| COCONUT OIL

COCONUT OIL

| FEATURE

The oil of life WRITTEN BY

MAIA HIBBEN

The coconut (cocos nucifera) provides a nutritious source of meat, juice, milk, and oil that has fed and nourished populations around the world for generations. Nearly 1/3 of the world's population depends on coconuts to some degree for their food and their economy, and among these cultures the coconut has a long and respected history.

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FEATURE

| COCONUT OIL

Mistakenly believed to be unhealthy because of its high saturated fat content... coconut oil possesses many health giving properties While coconut oil has had a lot of negative reports published about it in recent times, there has been growing controversy as opposing opinions have been arising within the natural and whole foods market.

Coconut oil is an edible and nutritional oil derived from the meat of matured coconuts and it has been consumed in tropical places for thousands of years.

According to coconutoil.com, studies done on native diets high in coconut oil consumption show that these populations are generally in good health, and don’t suffer as much from many of the modern diseases of western nations where coconut oil is seldom consumed anymore.

shades. The mid-ribs of the coconut leaf are also traditionally used in T&T to make cocoyea brooms, not just as cleaning tool for the home, but used also by Pundits in rituals to drive away demons and evil spirits. And who could forget in the land of Brian Lara that many a boy’s first cricket bat is made from the branches of a coconut tree (including Lara’s first bat!).

Coconut is highly nutritious and rich in fibre, vitamins, and minerals. It is classified as a ‘functional food’ because it provides many health benefits beyond its nutritional content. Coconut oil is of special interest because it possesses healing properties far beyond that of any other dietary oil and is extensively used in traditional medicine among Asian and Pacific populations. Pacific Islanders consider coconut oil to be the cure for all illness! The coconut palm is so highly valued by them as both a source of food and medicine that it is called "The Tree of Life”. Only recently has modern medical science unlocked the secrets to coconut's amazing healing powers.

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Contrary to popular belief, coconuts are not indigenous to Trinidad and Tobago. It is thought that the first coconuts floated across the ocean from Africa and Asia. However, coconut was an integral part of Indian diet and life, and when indentureship brought many people to Trinidad from the Indian subcontinent, so, too, came the coconut and its culinary and cultural heritage.

The kernel is extracted by Nutrition Facts hand and hand-processed to Serving Size : 100g remove the milk and the oil. It Amount per serving Calories 862 is widely used for cooking and % Daily Value* beauty products, and is Total Fat 100 g 153% Saturated Fat 86 g 430% considered sacred to Hindus, Polyunsaturated fat 1.8 g being offered up to God during Monounsaturated fat 6 g Cholesterol 0 mg 0% pujas. The oil is used for deyas Sodium 0mg 0% during Diwali and within Total Carbohydrates 0 g 0% Dietary fibre 0 g 0% Hindu homes on a daily basis; Sugars 0g the nut itself is used to Protein 0g represent the womb during Vitamin A 0% Vitamin C 0% wedding ceremonies, and the Calcium 0% Iron 0% leaves are widely used in * Percent Daily Values are based on a 2,000 calorie diet.

Your daily values may be higher or lower depending on your calorie needs. religious ceremonies as

DIET

Once mistakenly believed to be unhealthy because of its high saturated fat content, it is now known that the fat in coconut oil is unique and different from almost all other fats, and possesses many health-giving properties. It is finally gaining long overdue recognition as a nutritious health food.

Oils and fats are composed of molecules known as fatty acids.

Coconut oil is predominantly a medium-chain fatty acid (MCFA)

COCONUT OIL

and the effects of this fatty acid are distinctly different from the long-chain fatty acids (LCFA) found in other foods. Why is this relevant? It is important because our bodies respond to and metabolize each fatty acid differently. According to the Coconut Research Center in Colorado Springs, USA, the MCFA found in coconut oil does not have a negative effect on cholesterol. In fact, they believe it to lower the risk of heart disease and atherosclerosis (the thickening of artery walls).

Essential fatty acids are integral to a healthy diet, but like with most foods there are many different options, some of which will provide enhanced nutritional or health benefits. There are only few dietary sources of MCFA, and one of the best sources by far is coconut oil.

Weight Loss - The fatty acids found in coconut oil can speed up metabolism better than other fatty acids, because they are easily digested and converted into energy, therefore effectively promoting weight loss. In fact, a study reported these acids to be three times more effective in raising metabolism than other acids, leading researchers to conclude that effective weight loss can be achieved by replacing long-chain fatty acids with medium-chain fatty acids. Coconut oil is also lower in calories than other fats.

Cooking - Coconut oil is heat stable, making it suitable for cooking at high temperatures. It is slow to oxidize and has a shelf life of approximately two years. It does not form harmful by-products when heated to normal cooking temperatures like other vegetable oils do, so it is an ideal replacement oil for frying, roasting and baking!

HEALTH

Coconut oil provides a nutritional source of quick energy. It boosts energy and endurance, enhancing physical and athletic performance and also improves digestion and absorption of other nutrients, including vitamins, minerals, and amino acids.

It is also a first-class antioxidant, and does not, like other oils, deplete the body’s antioxidant reserves. It conditions and strengthens hair, reducing dandruff and improving other scalp conditions. It is a fabulous skin moisturiser; relieving dryness, preventing wrinkles, sagging skin, and age spots. It also helps to protect the body from the damaging effects of ultraviolet radiation from the sun and harmful free radicals that promote premature aging.

DISEASES

Coconut oil has many health benefits which are attributed to the presence of lauric acid, which, when converted, is highly toxic to viruses, bacteria and funguses. Coconut oil; • Kills fungi and yeasts that cause candidiasis, ringworm, athlete's foot, thrush, diaper rash, and other infections • Eliminates skin conditions such as fungal infections, acne, eczema, psoriasis, keratosis polaris, rosacea and other skin complaints

| FEATURE

• Kills bacteria that cause ulcers, throat infections, urinary tract infections, gum disease and cavities, pneumonia, gonorrhoea, and other diseases • Expels or kills tapeworms, lice, and other parasites • Kills viruses that cause influenza, herpes, measles, hepatitis C, SARS, AIDS, and other illnesses. (Extensive work is currently being undertaken into the use of coconut oil in the treatment of HIV/AIDS due to its strong, non-toxic, anti-viral properties) There are countless other diseases and illness that it can help alleviate symptoms of, or act as a preventative measure against. Coconut oil • Helps relieve symptoms associated with gallbladder disease • Relieves symptoms associated with Crohn's disease, ulcerative colitis, and stomach ulcers • Improves digestion and bowel function • Reduces inflammation • Supports tissue healing and repair • Supports and aids immune system function • Helps protect the body from breast, colon, and other cancers • Helps relieve symptoms associated with chronic fatigue syndrome • Relieves symptoms associated with benign prostatic hyperplasia (prostate enlargement) • Reduces epileptic seizures • Helps protect against kidney disease and bladder infections • Helps prevent liver disease Perhaps most significant is the current medical research into the use and consumption of coconut oil as a preventative and treatment measure in both type 1 and 2 diabetes and Alzheimer’s Disease. As pharmaceutical companies fail to create a successful drug for Alzheimer’s (and other dementias), will nature’s coconut and coconut oil provide the solution to this epidemic of degenerative disease that now affects 44 million people worldwide, and is projected to increase to 76 million by 2030 if no viable cures are found?

Coconut oil is proving to be yet another wonder of nature that holds vast nutritional, health and beauty benefits, far exceeding other oils’ abilities. As more research is conducted on this valuable ‘nut’; its properties and abilities, particularly in the field of disease treatment, will it continue to amaze us? What other secrets does it hold?

Coconut is widely available in T&T, however for use in cooking and on skin it is safer to use an organic, unrefined, cold-pressed coconut oil (this is the oil in its most natural unprocessed form and contains no harmful by-products). It is available in organic and health food stores. The Internet holds vast amounts of literature on the uses of coconut oil and how it can be ingested, applied and used. Please use trusted sources and do your research.

NB: Do not self-diagnose or self-medicate with serious conditions; always seek professional advice.

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STRESS

| BEAT THOSE DANGERS BEHIND THE WHEEL

BEAT THOSE DANGERS BEHIND THE WHEEL

| STRESS

BEAT

THOSE

DANGERS

BEHIND

THE WHEEL WRITTEN BY

ANDREW CHAN

Drivers put themselves at risk every time they get behind the wheel.

The threat of accidents aside, emissions and noise pollution also pose problems.

To make things worse, drivers also encounter physical, emotional, even nutritional stresses that can lead to impaired health and well-being.

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STRESS

| BEAT THOSE DANGERS BEHIND THE WHEEL

STRESSING OUT BEHIND THE WHEEL

position can be compounded into abdominal pain and even musculoskeletal disorders. The most prevalent of these disorders relates to the back and spine, while other affected areas include the neck, shoulders and knees. Eye-related illnesses are made even worse in the night, when drivers are temporarily blinded by the high beams of oncoming vehicles.

Headaches can result from eye fatigue. This fatigue causes an inability to focus, greatly increasing the possibility of an accident.

Driving is supposed to make your schedule easier, but we all know this is not the case. Hours are lost in the commute that could well be used to spend time with family, work harder in the office or just relax. People feel they’re losing control. The combination of these factors can even culminate in road rage.

Drivers are subjected to harmful levels of noise pollution, as they are exposed to noises and vibrations from their own cars as well as those of neighbouring vehicles. One can argue that the rest of the commuting population is drowned out by music, air conditioning and almost soundproof vehicles. The fact remains, however, that simply due to the number of commuters, there are more of them than you.

Consider the stress you face daily simply getting to work. You have to leave at the exact time every day, because five minutes later would result in a further half hour of traffic. Your children are forced to get up early and arrive at school hours before it starts. Of course, you can’t argue with your boss that traffic was bad, so you’re blamed for a situation that’s out of your control.

ROAD RAGE

Road rage can almost be considered a disease. The bug that transmits this disease is irritation, caused by aggressive or careless drivers who use their vehicle almost as a weapon. Aggression is met with aggression, leading to violent retaliations.

Inadequate lanes, inconsiderate drivers, accidents resulting in heavy traffic jams, and the sheer volume of drivers on the road can trigger anger, as well as elevate blood pressure to dangerous levels, putting the body under immense strain.

DRIVING CAN MAKE YOU SICK

Stress behind the wheel can result in gastrointestinal disorders. Because of the effects of high traffic on normal mealtime hours, a driver may grab meals on the go. The body isn’t fed properly, and high levels of caffeine, sugars and salts like MSG result in debilitating side effects such as ulcers. These poor nutritional choices also lend to irritability, which heightens fatigue.

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Even though driving is essentially a sedentary activity, there’s intense physical strain on the joints and body.

Poor posture as a result of sitting in a cramped

GASPING FOR FRESH AIR

Air pollution remains a hazardous side effect of driving. Considering that there are no concrete regulations governing toxic emissions, the levels of carcinogens belched into the atmosphere are deadly.

In a commute into Port-of-Spain, one can clearly see the smog floating over the capital city, affecting the health of drivers and long-suffering pedestrians. It’s no wonder that asthma and other respiratory illnesses are slowly reaching epidemic proportions.

According to the National Resources Defense Council (NDRC), a US-based non-profit organisation with an environmental mandate, exhaust from diesel vehicles are responsible for close to 70% of the cancers directly caused by air pollution. These emissions can also cause numerous other health problems, like cardiovascular diseases such as atherosclerosis (a build up of plaque in the arteries), which can result in heart attacks. Pregnant women and their yet-to-be born children can experience serious health problems, including birth defects, low birth weights and premature birth.

BEAT THOSE DANGERS BEHIND THE WHEEL

| STRESS

HOW TO DEAL WITH ROAD STRESS

Here are some tips to help you to deal with the stresses of being behind the wheel:

STAY POSITIVE

AND CALM Drink lots of water and carry healthy snacks: nuts, grains, vegetables

Keep alert by listening to the radio (bring your own music, as ads can get annoying), playing games (memorising licensing plates etc.)

TAKE YOUR

SUPPLEMENTS:

VITAMINS C AND A,

LYCOPENE OR ZINC FOR

EYE STRENGTH

Even though driving is a stationary task, there are exercises you can do while driving to maintain vigour and release stress on your body. Stephanie Mansour, a body image coach and Chicago-based personal trainer, suggests three exercises we can do in even the most compact of cars:

• Spine Stretching.

Hold onto the steering wheel with your hands at 10 and 2. By pulling on the steering wheel and rounding your back, you’re stretching the area in between the shoulder blades and mid-back. Take a breath here and then release.

• Belly Busting.

Pretend you’re trying to zip closed a tight pair of jeans. Pull your belly button in towards your spine as you try to pull your lower belly away from the waistband of your pants. Hold here, engaging your abs, or, for a more intense workout, breathe out 20 times quickly. As you breathe out, contract your lower abs even harder to pulse your abs in and out.

• Tension Tackling.

While stuck at a red light, tilt your right ear down towards your right shoulder. Relax your shoulders and breathe into the left side of your neck, stretching the left side of your neck. Hold for 10 seconds. At the next light, repeat on the other side.

Here’s to a healthier, safer commute!

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MEDICINE

| BACILLUS

S U L L I C A B WRITTEN BY

DAVID FENTON

As the 100th anniversary of the First World War approaches, our correspondent David Fenton looks back at the difficulties that doctors and surgeons faced in dealing with battlefield injuries, and, in particular, how they treated infection in a time before antibiotics. One surgeon in England saw many wounded soldiers and discovered a strange bacteria which seemed to help the healing process‌

BACILLUS

| MEDICINE

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MEDICINE

| BACILLUS In 1914, at the outbreak of war , a you ng sold ier called Robert Han na went into battle for the first time . He didn’t know it, but he was to become one of the earliest casu alties of the conflict. Dur ing the Bat tle of Ypres, he was hit by a German bullet which pierced his shou lder. It was a serious wou nd — bad enough for him to be eva cua ted from the front line s and eventual ly sent home to England .

This is how he described wha t happened, in a note to one of the nur ses trea ting him .

‘It was on the 21st day of Oct ober that we ran aga inst the German s,’ he said . ‘We were advancing up an open field when they opened fire with shrapnel and bullets. We retu rned the same, but after abo ut 10 minutes of fighting I received a Ger man souvenir (a bullet) which put me out of action and I was sent from Ypres dow n cou ntry to Bou logne where I was for ten days.’

Dur ing the cou rse of the Firs t World War, one and a half mill ion British sold iers were wounded, often dur ing the heat of battle. For many that meant their bod ies — bleeding and dam aged — were exposed to filthy cond ition s in the trenches or in open field s. Not surprisingly, infe ction was rife. Dr Tim Smith is a form er con sultant anaesthetis t and now director of the Berkshire Hos pita l Her itage Museum .

‘The wou nded sold iers cou ld be in No Man’s Land where they cou ld stay for 24 hou rs or 48 hou rs dep end ing on how the fighting was goin g. Gas gan grene was the dre aded complication, where the wou nd gave off gas and went all bub bly and had a certain smell to it and that often mea nt immedia te amputation.’

Tre atment of the wou nds ofte n star ted within a few hundred yard s of the battlefield, but for the mos t serious inju ries, eva cua tion to a field hos pita l or a spe cialist war hos pita l back in England was necessa ry. However, getting the men back from the trenches in Fra nce was not easy. Often it requ ired effort and ingenuity — and ever y kind of tran sport was used: horses, trai ns, bas ic motorised ambulances and even bicycles . One ingeniou s dev ice used on the Wes tern Front involved three bicycles tied toge ther in a tria ngle form ation with a stre tcher betw een them !

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The first place the soldiers wer e taken was a hospital clea ring station.

These were often basic treatme nt centres where surgeon s did what they cou ld to stabilise patients and to stem the bleeding. Dr Zahir Shah is a modern- day surgeon who has served with the British Army in Afghan istan and war zones arou nd the world. He showed me a medical field kit from 100 years ago: exa ctly the sort of thing that wou ld have been used by military surgeon s in France. One dev ice — a long slender piece of metal with a curved holl owed end — he recognised immediately as an instrument used to clean infection from bon e.

BACILLUS

| MEDICINE

‘The edge of this would be sharp and this would be used to scrap e at the bone and remove any infection accumulate d,’ he said. ‘And then it would be left for a day or two to see how much the infection came back and see if the bone was heali ng. And that process of waiti ng a day or two still happ ens — we quite often have second look opera tions just to see how much the infection has healed or come back .’

Those soldiers lucky enou gh to surv ive their initia l wounds — and the journey back from the front lines — woul d be taken home on hospital ships. More than a million men came throu gh the port of South ampton en route to war hospitals in southern Engla nd. One of those hospitals was in the town of Read ing, in Berk shire, and this is where Priva te Hann a came for his opera tion. In those days there was no National Health Serv ice and the hospital charged the Government 3 shilli ngs and 4 pence a day for every soldier they treated — that’s abou t $100 TT in today ’s money.

One of the doctors work ing at the Read ing hospital was a man called Leon ard Joyce. He noticed that some of the soldiers’ wounds were heali ng much more quick ly than other s, and he wondered why. In his notes of one of the cases that he saw, a soldier injured in fighti ng on the Front, he later wrote, ‘The patient lay out in the open for four days before being brought in, then he rema ined at the casua lty clear ing station for 11 days, durin g which time gas gang rene developed and the patie nt became very ill. Two days after drain ing and packi ng the wound with salt bags it had developed a chara cteris tic odou r.’

That unusual smell was a bacteria at work , and it was actua lly clean ing the wounds by reducing pus and septic matt er. It wasn’t an antibiotic, but it was helping. So Joyce and his team inves tigate d and then took the dram atic decision to infect other injured soldiers with it. They hoped it would fight off infections — which often meant ampu tation of limbs. It worked. The soldiers who were given the strange bacte ria recovered more quick ly and their wounds showed better healing. Joyce called his bacteria the Read ing Bacillus and in 1917 he published his results in the medical journ al, the Lancet. They are still there now — if you can get a copy and care to take a look!

No one knows how many soldiers owed their lives to the Read ing Bacil lus, perhaps many hund reds. But in an age before antibiotics, when post-injur y infection could often do more dama ge than the wound itself, medics were constantly on the lookout for anything that migh t help.

Priva te Hann a had his opera tion and left Read ing hospital just before Chris tmas Day, 1914. Like many wounded men, he probably retur ned to his regiment to fight again . We don’t know what became of him after that — but there is one smal l clue. His name does not appe ar in any of the lists of the war dead , so there is a good chance that he mana ged to surv ive not only his injur y from a Germ an bulle t, but also the next four years of that dread ful and never to be forgotten conflict.

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CONDITION

| DEHYDRATION: THE RAPID DECREASE OF FLUIDS IN THE BODY

DEHYDRATION: THE RAPID DECREASE OF FLUIDS IN THE BODY

WRITTEN BY

|

CONDITION

LYLAH PERSAD

I recently spent nine days in the hospital…. I went in with extreme body aches, strong palpitations in my chest, sweating and fever, and I swore I had dengue fever. I didn’t. Turned out that I had a viral infection, and my body was dehydrated.

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CONDITION

| DEHYDRATION: THE RAPID DECREASE OF FLUIDS IN THE BODY

It’s amazing the things you learn in a hospital and how they treat with you and your various illnesses. I was able to gain a new understanding about your health, your body, how it works, and, of course, the importance of water.

Now, we grew up learning that we had to drink lots of water — at least 8 glasses a day — because water is essential for growth, to keep your skin healthy, to give you a good cleanse, to keep the brain functioning well.

We also heard that water makes up the majority of our body, approximately 65%... of course, this will differ with age, because as we get older, the percentage of water in our bodies decreases by approximately 15%, increasing the risk of dehydration.

Also, some medications that are used when we get older to treat symptoms of high blood pressure, chronic diseases, etc., are diuretic, meaning that they increase urination. Finally, elderly people don’t always have the will power or strength to “go grab that glass of water” when they are dehydrated, and sometimes caregivers are not aware of dehydration signs. But the reality is, keeping the body hydrated is more than just keeping the brain functioning, or any of the other body parts for that matter… Hydration is life saving!

Here’s how: First off, water, which is non-caloric, enriches the skin and hydrates the muscles; it removes body waste through urine; it controls body temperature, keeps a normal heart rate and blood pressure while maintaining a healthy metabolism.

Dehydration arises when the amount of body fluids lost, mainly water, is greater than the amount of fluids that the body takes in. Furthermore, a dehydrated body doesn’t only lose water, it loses electrolytes (salts, potassium and sodium) as well.

When your body is dehydrated, it does not have enough water to transport the necessary nutrition and oxygen to tissues.

Fortunately, the human body tries to compensate for the decrease in water. The initial response to dehydration is increased thirst and the restriction of fluid loss in the kidneys, sweat and saliva. After this has failed, the body compensates, resulting in decreased blood pressure, etc.

How do we know how much we should take in?

Firstly, we need to understand that we lose body water every day; either in the form of sweat, passing urine and stool, or in the form of water vapor in the breath we exhale.

Once we are aware of how much we lose, we’ll have an idea of how much needs to be put back in. Of course, we could take into consideration the constant reminders from our parents, teachers, friends, and doctors that 8 glasses of water per day (64 oz.), should suffice.

In addition, the need for water depends on the amount of calories you burn daily; for every calorie you burn, you need just about 1 ml of water. So imagine being high on exercise and burning about 3,000 calories a day; that would mean you need about 3 LITRES of water (approximately 10–15 cups), to compensate for the calorie loss. It is also a good idea to drink 1–2 cups of water at least 15 minutes to half hour before you work out, and have at least one glass of water upon arising in the morning.

Water and your skin Water is your key to immaculate skin. The more water you drink, the more quickly it works on your skin by keeping it hydrated.

Causes of dehydration include • Fever • Too much exercise • Exposure to heat.

• An infection that causes increased urination • Viral infections such as dengue and influenza • Vomiting • Diarrhea

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the need for water depends on the amount of calories you burn daily; for every calorie you burn, you need just about 1 ml of water

Take Note If your urine is a deep shade of yellow and odorous, as opposed to its regular clear or light colour, you could be dehydrated.

DEHYDRATION: THE RAPID DECREASE OF FLUIDS IN THE BODY

To know if you are dehydrated, here are some things to look out for: • Thirst… if you are thirsty, that’s a sign of moderate dehydration.

• Dry mouth and swollen tongue.

(Usually your doctor asks you to stick your tongue out to see how dry it is) • Weakness • Dizziness • Headaches/Migraines • Palpitations • Confusion • Fainting • Inability to sweat • Heat exhaustion • Decreased urine output/inability to pass urine

| CONDITION

Take Note: If your urine is a deep shade of yellow and odorous, as opposed to its regular clear or light colour, you could be dehydrated.

Now, even though water is extremely important in keeping the body hydrated, it does not contain electrolytes. To restore electrolyte and water levels, one should have: • Sport drinks (e.g. Gatorade) • Soups/ broths, which contains sodium • Watermelon • Grapes • Fruit juices • Soft fruits and vegetables that contain potassium

Dehydration has 3 different stages: Mild, Moderate and Severe.

The average adult may lose 2-3% percent of total body water.

In addition to thirst, these symptoms may appear: MILD DEHYDRATION • Headache • Slightly dry mucous membranes • Slightly decreased urine output • Dark yellow urine • Loss of appetite • Tiredness or fatigue • Dry or flushed skin • Chills • Constipation

MODERATE DEHYDRATION

When these symptoms go unnoticed or untreated, it leads to the next stage of dehydration:

• Little to no urine output • Increased heart rate • Decreased ability to sweat • Faster/ heavier breathing • Higher than normal body temperature (approximately 98.6°F / 37°C ) • Muscle cramps • Tingling hands and feet • Nausea

SEVERE DEHYDRATION

When 7-9% of total body fluid is lost, this is the most critical stage of dehydration:

• Rapid pulse • No tears • Low blood pressure • Mottled skin • Shriveled skin • Muscle spasms • Impaired vision • Confusion • Chest or abdominal pain • Seizures (extreme symptoms may lead to coma)

HOW TO TREAT WITH THE DIFFERENT STAGES OF DEHYDRATION: • REHYDRATE — drink lots of fluids including sports drinks, which rehydrate by providing not only fluid, but also electrolytes and salt.

• DO NOT USE coffee, tea, or sodas, because the caffeine in them can be dehydrating.

• You can try to rehydrate by using the same treatment for mild dehydration, but sometimes IV fluids may be needed.

• Get medical assistance immediately

!

EXTRA TIP: If you are having difficulty drinking large amounts of fluid at the same time, take sips at a time. But make sure and replenish the body of its losses to stay hydrated. Now that you know … DRINK UP!

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MATERNITY

| TRY A DOULA

MAKE YOUR BIRTHING EXPERIENCE BETTER:

TRY A DOULA

TRY A DOULA

WRITTEN BY

| MATERNITY

DR. AMANDA JONES

At the end of pregnancy, a woman’s body ushers her precious passenger into the world. Muscular contractions of the uterus soften, thin and ultimately transform the cervix — often called the “mouth of the womb” — into an open gateway through which a tiny human can pass.

Yet, as eager as a woman may be to meet her new baby, she may be dreading labour and birth.

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MATERNITY

| TRY A DOULA

Fortunately, this dread can often be resolved well before birth. For many, the key to overcoming fear is to perceive labour and birth as natural processes that are made easier to work with by positive attitudes and with practical strategies.While the attitude of every mother-to-be is a force influencing whether she faces birthing with confidence or anxiety, including a doula in her birth plans is an excellent strategy.

emergence of the baby through the birth passage.

Mags was completing her training when she attended my son’s birth, yet her impact was so positive I’ve been recommending having a doula ever since.

I remember her being not just well-intentioned, as a friend, father-of-the-baby or mother might be, but also skilled and professional. Years later she holds an important place in our birth memories.

It may have been my midwife who, in 2006, explained to me what a doula was, and recommended the then-very-new doula service to me. I was excited to hear that doula support was associated with shorter labours, less medical intervention and fewer Caesareans. But what exactly is a doula?

Fast forward to 2013. A third pregnancy and another doula — Zara.

The word “doula” is derived from the Greek for “woman servant”, but a doula today is a trained professional, usually a woman, who provides emotional and physical support during labour and/or after pregnancy. The Doula Alliance of Trinidad and Tobago charmingly describes the doula’s role as “mothering the mother.”

My own mother had been a reassuring presence during my first labour. Her back massage and aromatherapy oils had worked wonders. She had been the unofficial doula for my first birth. But she lived abroad and my concern that she might not arrive in Trinidad in time for the birth was a driving force behind my decision to have a doula.

And so, Mags entered our birth story.

In the weeks before our baby’s birth, Mags and I got to know each other and we discussed the natural pain relief strategies she could make available.

Honestly, I was confident about being able to manage the “discomforts of labour”. After all, for my first birth, I’d used certain labouring positions and visualizations from my birth preparation classes, and they had worked. I was simply planning to use them again.

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But in the end, somewhere in the more intense phase of labour, I realised that the strategies I had used the first time round didn’t fit the experience I was going through — and I had no back-up plan. However, Mags did. She presented a birthing ball for me to sit on just when I needed it — and, later, warm compresses for my back. She helped keep me focused at that challenging point in labour just before the actual

This time I was preparing for a homebirth. A few relatives asked me frankly why I should need a doula.

After all, my mother and husband would be available to rub my back, and I wasn’t new to the birth process.

This was a reasonable question.

My answer is that a doula can identify and use more pain relief strategies than a loving family member. She comes with training, regular experience, and she, too, comes with love. The work of a doula involves intimate work with an unknown woman at unpredictable hours for possibly days at a time. The remuneration is humble so the work is vocational, a labour of love.

Importantly too, a doula can support a labouring mum without excluding other relatives or friends. In fact, meeting with my husband to discuss what he felt his involvement in the upcoming birth should be was something Zara did very early in our relationship.

Though today’s man is often expected to be a key labour support person (once the hospital allows him to be present), and some men do embrace this opportunity; others would prefer to stand by or be called in after the birth of their baby. Unfortunately, men can feel socially pressured to be involved beyond their comfort level.

A doula can help take the pressure off baby’s father by helping him identify how he can participate at his comfort level while ensuring that mother has the support she needs.

Thanks to a few planned “chat sessions” with Zara I was better able to focus on mentally preparing for the birth. Zara made gentle suggestions which in the end I used with no regrets. She was keen on hypnotherapy as a tool for a peaceful and natural birthing experience and so loaned me a hypnobirthing book and CD that I used in my preparations for the big day.

TRY A DOULA

| MATERNITY

In the end, knowing that my doula could get to my house (or the hospital) in half-an-hour, that she understood and respected my birth plan and would be able to gently advocate for the written plan to be followed (should I be rendered speechless by contractions), gave me great peace of mind. A woman in labour needs to focus on her task at hand – and arguing rationally with medical personnel is hardly a distraction she can cope with effectively.

Our birthing room this time turned out to be our bedroom. The intense phase of this labour was very brief but Zara was brilliant in helping me to keep calm and reminding me to breathe appropriately.

Some people grumble that no-one needs to be reminded to breathe but I breath-hold unconsciously under stress and some people create a panic cycle by hyperventilating, so simple breathing techniques in labour can be useful.

Zara used a light feathery massage which took the “edge off” the final and most trying surges. Ironically, I had been adamant in our pregnancy discussions that light massage is irritating — but what was amazing is that she knew (intuition or experience?) exactly what I needed at moments when I had no access to words.

Overall, I sought and received peace of mind and help with natural pain relief methods from my doulas.

However, what doulas offer is much broader in scope.

The soothing and coaching to dissolve fear and anxiety, or encouragement provided for a particularly difficult or lengthy labour, can be critical in helping a mother to persevere. I’ve had friends who found doula support priceless for labours that took place in hospital or ended in Caesarean births.

Doulas also extend their services to the period after baby’s birth, helping with breastfeeding in the critical early weeks.

To learn more about accessing doula support in Trinidad and Tobago, do contact the Doula Alliance of Trinidad and Tobago via Facebook, call The Mamatoto Resource and Birth Centre at 621-2368, or email doulaalliancett@gmail.com.

The word “doula” is derived from the Greek for “woman servant”, but a doula today is a trained professional, usually a woman, who provides emotional and physical support during labour and/or after pregnancy.

Birthing and labour memories can be especially wonderful when mothers access the right preparation and support!

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ANATOMY

| PUTTING YOUR BEST FOOT FORWARD

WRITTEN BY

CAROL QUASH

Our feet are among the most overworked parts of our body. From the moment we leave our beds on mornings to the final step we take before we get into our beds at night, our feet are working, constantly supporting our weight as they take us from place to place, sometimes subjected to the rigors of uncomfortable shoes. But do we take care of them in the same way that we do the other parts of our bodies? Are they as pampered as are our faces, hands, legs and hair?

Our feet may be the most neglected parts of our bodies. Unfortunately, neglect of the feet and ill-fitting shoes, oftentimes in the name of fashion, can lead to problems that can affect our day to day life. And while problems such as cracked heels can be alleviated with simple pedicures and home treatments, there are other common problems that may require the intervention of a podiatrist, an allied healthcare professional who looks after the feet.

Some of the more common foot problems include:

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Corns and calluses Corns can form between, or at the top of the toes.

Calluses form at the side of the toes or below the feet.

These painful patches of dead skin cells develop when the bony parts of the feet rub repeatedly against

your shoes. While there are a number of over the counter remedies, it is always safer to have them removed by a podiatrist.

Bunions People with bunions, a joint that protrudes at the base of the big toe, find it painful to wear shoes because of the force it puts on the toe. Although ill-fitting shoes are most often the culprits, other ailments such as arthritis and trauma can also be instrumental in their development. It must be noted too, that bunions can sometimes be hereditary.

Taking pain relievers and wearing soft shoes may help alleviate the pain and discomfort associated with this foot problem, but patients are frequently encouraged to see a specialist because they may require surgical treatment.

PUTTING YOUR BEST FOOT FORWARD

Ingrown toenails Ingrown toenails can be the source of excruciating pain, and can even lead to infections if not treated properly. It develops when the edge of the nail grows into the skin of the big toe. It can be caused by shoes that fit poorly, fungal infections of the nail, and injuries.

Practicing good foot health, including clipping the toenails straight across instead of cutting into the corners of the nails, may help to control ingrown toenails.

However, if the condition is recurring, you should seek professional treatment.

Nail fungus If your toenails have gradually attained an unattractive, discoloured appearance, chances are you may have picked up a toenail fungus.

People who frequent gym showers and pools are especially at risk, because fungi thrive in moist environments. If not treated properly, the nails eventually thicken and become brittle. People with diabetes, poor circulation and who have deficiencies in their immune systems are more susceptible to infections from nail fungus. Treating nail fungus is difficult, as infections tend to recur. If over the counter anti-fungal medicines are ineffective, you may want to schedule an appointment with a doctor.

| ANATOMY

and dry, dusting with foot powder, and wearing clean socks and shoes are the keys to controlling athlete’s foot. While many over the counter anti-fungal treatments are available, people with severe cases are advised to see a doctor, as they may need prescription strength medicine.

Hammer toes If your feet look deformed because your three middle toes are bent inward at the middle toe joints, you may have hammer toes. Ill-fitting shoes, arthritis and genetics are the main causes. People with hammer toes usually develop corns at the top of the joints of the bent toes, making it even more painful to wear shoes. The constantly bent toes also put a painful pressure on the balls of the feet and can cause you to over-balance. There are two types of hammer toes — flexible and rigid. As the name suggests, flexible hammer toes still have the ability to move at the joint. There are several treatment options that can be recommended by a podiatrist.

Rigid hammer toes cannot move at the joint and sometimes can only be treated with surgery.

The 52 bones in your feet make up one quarter of all the bones in your body.

When they are out of There are a number of other ailments alignment, to which our feet may be susceptible as a result of neglect. Like the rest of our so is the bodies, they are entitled to proper care.

They work hard and they deserve a raise, rest of be it in the form of an at-home Epsom salt soak; a massage, or a professional pedicure. your body.

Athlete's foot Like nail fungus, can easily be picked up in gym showers and pools because it is caused by a fungus. The symptoms of this disease are usually found between the toes, and at the bottom of the feet, and manifest as a cracked, flaky, peeling skin. It causes an itching or burning sensation, and sometimes causes the feet to emit a slight odour. Keeping the feet clean

So whether your next step is made wearing a pair of Oxfords, loafers, stilettos, pumps, sneakers, sandals, boots, slippers, socks, or even barefooted, remember to ensure your feet are happy about it.

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PORTUGAL

| FRUIT

(CITRUS RETICULATA) WRITTEN BY

NASSER KHAN

You cannot miss the strong and unmistakable citrus scent of a portugal being peeled and is certainly not a fruit you might think of sneaking into a room for a discreet snack.

How did the portugal get its name? Did it come via Portugal or is it a derivation of ‘pretty girl’ as in ‘purty gal’ which was eventually Trinidadianized to become potigal or pooteegal? The jury is still out. The fruit did, however, originate in the Mediterranean and Indian region and is also known as the Mediterranean mandarin and Willowleaf mandarin.

mandarin species, is easily peeled with the hands to reveal neat semi circular easily segmented ‘pegs’ or sections (usually there are about 7 to 14 ‘pegs’). The juicy aromatic ‘pegs’ can be eaten or squeezed to make juice. Another popular way is to enjoy portugal in the form of a chow (see recipe below) and it also makes a delicious and healthy addition to fruit salads.

Portugal (citrus deliciosa) belongs to one of the species of citrus called the mandarin (citrus reticulata). Mandarin is the largest and most varied group of edible citrus with Portugal, Dancy and Mrs. Wrights (as in Asa Wright) making up the three most popular types in Trinidad and Tobago. Another of their distinct characteristics is their flattened shape (rounded with flattened top and bottom).

Hot tropical days call for refreshing fruit drinks that can act as a reviver after hours in the heat. Try freshly squeezed portugal juice for a sure reviver and uplift. Portugal juice is an excellent source of vitamin C (ascorbic acid) and potassium. It is also a natural source of folic acid (Vitamin B9) and vitamin A.

The trees are small to medium in size, fairly broad in spread and have weepy drooping leaves. The bearing season is from as early as September through to February. The Portugal, as other

According to the information supplied by the Research Division of the Ministry of Food Production at Centeno, Trinidad, the following are the nutritional content of the delicious portugal (values are expressed per 100g):

Nutrition Facts Fresh Fruit

Amount per serving Calcium 14 mg Iron 0.1 mg Potassium 160 mg Sodium 1 mg

Zinc 0.1 mg Vitamin A 92 mg Vitamin C 31 mg Riboflavin 0.02 mg

Niacin 0.2 mg Folacin 20.4 µg Cyano Cobalamin 0.02 mg Thiamin 0.11 mg

Fresh Juice

Amount per serving Calcium 18 mg Iron 0.2 mg Potassium 178 mg Sodium 1 mg

Zinc 0 mg Vitamin A 42 mg Vitamin C 31 mg Riboflavin 0.02 mg

Niacin 0.1 mg Folacin - µg Cyano Cobalamin 0.02 mg Thiamin 0.06 mg

3 portugals, 2 cloves garlic, Some leaves chadon beni, 1/4 cup water (for sauce), Salt to taste, pepper to taste

Method

Ingredients

How to make an easy and delicious portugal snack (Chow): Wash and peel the portugals. Place in a bowl.

Separate the pegs (segments); Add the chopped chadon beni, garlic, pepper and salt to taste.

Add about a 1/4 cup of water for sauce and toss.

The author recognizes the assistance of Alimuddin Juman of the Ministry of Food Production, Trinidad & Tobago,in compiling this article

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THEORY

| MYTH OR FACT?

Do Women’s Menstrual Cycles Synchronize When They Spend a Lot of Time Together?

WRITTEN BY

MICHELLE ASH, M.P.H.

the theory

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It is sometimes observed that women who spend a significant and consistent amount of time around other women eventually start to see their menstrual cycles come into sync with each other. Common situations where this may happen are women who live together within family households, among roommates or college dorms, and also workplaces. Synchrony with menstrual cycles has been documented in many species within the animal kingdom class of mammals including in rats, hamsters, chimpanzees and humans. It has been suggested that the underlying reason for this proposed phenomenon of synchronized menstrual periods has to do with providing mammals with a reproductive advantage. Menstrual synchrony ensures that there are as many opportunities as possible to guarantee continuation of the species in the future.

MYTH OR FACT?

The phenomenon has been dubbed "the McClintock effect", named after the author Dr. Martha McClintock, who documented her observations and published in the scientific journal Nature in 1971. It has been suggested that pheromones are responsible for triggering menstrual synchrony. A pheromone is a chemical substance excreted where the odor of that pheromone gives a subtle message to another member of the same species to elicit changes in body physiology and behaviour.

Therefore, technically speaking, someone else's pheromones can also affect your body and your own hormone production. Thus, women would produce pheromones during their fertile period that could jumpstart other women's bodies into being fertile as well. Women being fertile together can give males a better chance at producing more offspring, since women are only fertile for a few days each month, and can only have one baby a year, whereas males are fertile all the time, and can produce as many offspring as there are available, healthy females. This is believed to be an evolutionary adaptation to ensure the existence of future generations to be propagated.

Evidence from Scientific Investigations Menstrual synchrony has been widely accepted as a fact of human life; however, many psychologists and anthropologists doubt its true existence. Over the years, studies have added weight to the findings but there is considerable debate over whether the hypothesized phenomenon really exists. More than half the studies carried out on this topic have produced findings suggesting that the McClintock effect in humans and also other mammals does not, in fact, exist.

Some studies, such as a popular one conducted in the 1990s by Leonard Weller and Aron Weller, sometimes found signs of synchrony and then other times not, with no explanation why. Two other scientists, Jeffrey Schank and Zhengwei Yang, conducted the largest and longest running study yet on the so-called McClintock effect. Their study was

| THEORY

carried out for a total period of over one year and their results were published in 2006 in the scientific journal Human Nature. They found that women living in groups did not synchronize their cycles, and that in instances where group synchrony seemed to occur, it was mainly due to statistical chance. Many other scientists who examined the numerous studies that were done on the topic — including the original one by McClintock — found that they suffered from flaws in research method design and faulty statistical analysis of results.

There are still many unanswered questions; for example, why do some women seem to not respond to the pheromones of other women? A very interesting alternative theory suggests that avoiding menstrual cycle synchrony is actually advantageous, and places such a female at a better biological position from a reproductive standpoint. An animal study that was published by Schank in 2004 showed that for the females who don’t respond to menstrual synchrony, such females avoided competition by other females and thus increased their chances to mate with males possessing superior genes. So, according to Schank, it is proposed that women who don’t experience menstrual synchrony actually possess a reproductive advantage over other females, in that they will have available to them their choice of males that are of higher “quality”.

However, this is due to be further investigated yet in humans. And, from another perspective, perhaps indeed it may actually be a good thing that women in the workplace or women living in the same household are not all having their own PMS “stress-outs” simultaneously! Furthermore, it might be laughable, but, menstrual synchrony could possibly be a man’s worst nightmare!

So, is it really an old wives’ tale that women who live or work together, menstruate together?

It certainly appears to be, or at least until science is better able to identify the relevant pheromones and also adequately describe their biological pathways, this phenomenon remains a myth.

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PEDIATRICS

| HAND, FOOT AND MOUTH DISEASE

HAND, FOOT AND MOUTH DISEASE

| PEDIATRICS

hand, foot and mouth disease WRITTEN BY

DAVID E. BRATT

Hand, foot and mouth disease (HFMD) is a benign disease, mainly of babies and children. Most adults have had HFMD once or twice already and have immunity. Kids ages 1 to 4 are most prone to the disease; cases are often found in nurseries, preschools, and other places where children congregate. The illness typically lasts 3–5 days and is fairly common in the Caribbean.

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PEDIATRICS

| HAND, FOOT AND MOUTH DISEASE

It’s characterized by sores in the mouth and a rash on the palms of the hands and soles of the feet. It usually begins with a mild fever and poor appetite, the things that children get when they are coming down with a virus. One or two days after the fever begins, red blisters appear in the mouth, which can turn to sores. They are painful and appear on the tongue, gums and inside of the cheeks. Drooling, due to painful swallowing, is common. At the same time, the skin rash develops, usually as red spots or blisters on the palms and soles. They do not itch and may also appear on the buttocks or genitalia and even on the legs and arms.

HFMD has now become a “school disease”, one of those things that upset teachers badly. No one really knows why. But it’s clear that, ever since the international swine flu scare of 2009 (following on the bird flu scare of 2004), which led to a world-wide atmosphere of panic with governments stockpiling the useless anti-flu drug Tamiflu and ordering millions of doses of flu vaccine that were never used (the pandemic never materialized), schools in T&T have been exaggerating the risks of children coming to

incubation

Variations of this clinical picture are common, so at times it may be difficult for a parent to tell if a preverbal child has HFMD. When the picture is clear, an ill, febrile child with a rash in the mouth and on the palms and soles, the diagnosis is easy.

disease! It can easily be confused with “mad cow disease” or “foot and mouth disease”. Mad cow disease is extremely rare, although you would not believe that if you watch a lot of television news.

Foot-and-mouth disease is a disease of cattle, sheep and pigs, only. The names are similar but there is no connection. They are caused by different viruses.

People do not get foot-and-mouth disease! Animals do not get HFMD!

day

fever

sore throat

poor appetite

3-6

HFMD is caused by several different kinds of viruses that live in the body’s digestive tract. The most common is Coxsackievirus A16. This is the virus we have in the Caribbean at present, and the disease it causes is mild and self-limiting. There are other Coxsackievirus A viruses that also cause HFMD, so you can get it more than once.

In the Far East, where the disease is prevalent, the common virus that causes it is the Enterovirus 71 (EV71). Most children also recover quickly from this virus but there have been some deaths associated with EV71. In 1998 an outbreak of approximately 90,000 cases of Enterovirus 71HFMD occurred in Taiwan. About 320 children had to be hospitalized with suspected inflammation of the brain (meningo-encephalitis). There were 55 deaths.

This kind of outbreak has never occurred in the Caribbean, but, of course, the possibility of occurrence is always there.

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Regardless of the virus, HFMD can be an unnerving diagnosis for a parent to hear. Hand, foot and mouth

school with runny noses and rashes and requesting parents to keep their children home at the slightest sign of a snuffle, throat clearing or insect bite (insect bites are often confused with HFMD). In many cases, parents are required to bring in medical certificates of clearance before their children are allowed back.

It is certainly wise to be careful about outbreaks of disease where there are groups of children, but the line between careful and panic is a narrow one.

Children will get sick no matter what parents and teachers do. Sickness is necessary for children to grow up healthy. The only way to prevent illness is to encase the child in a plastic bubble and that itself will cause sickness of the child’s mind. Teachers are seen as authorities and can easily cause guilt or panic among their parents with aggressive statements about hygiene or the lack of it and needless claims about the possibilities of fatal disease.

A little dirt in a child’s environment is a good thing.

Children who grow up with animals around them are always healthier adults than those whose parents

HAND, FOOT AND MOUTH DISEASE

attempt to raise them in so-called sterile conditions.

There is no such thing in real life.

HFMD is rarely serious in the Americas, and I have been diagnosing it in T&T since the early 80s and so far have never had to hospitalize a single case.

Undoubtedly there will be always be cases that are more serious and require hospitalization, not for brain lesions, but for dehydration, which can occur if a baby or child refuses to drink because of the pain in the mouth from the sores.

HFMD is most contagious in the first week of the illness. It is spread from person to person by direct contact with saliva, secretions from their nose and throat or the fluid in the blisters. The virus is also present in the child’s faeces, so inadequate hand washing after toileting or changing a nappy can also cause the virus to be spread. In some healthy children and adults, the virus can remain present in the faeces

| PEDIATRICS

can remain in the body for weeks after the patient’s symptoms have gone away. This means that the infected child can still pass the infection to others even though they may appear well. Also, some children, and most adults, who are infected and excreting the virus may not have any symptoms at all. Exclusion is recommended if children have blisters in their mouths and drool, or have weeping lesions on their extremities, or are to ill to participate in daily nursery or school activities.

There is no specific treatment for hand, foot and mouth disease. There are no antibiotics or antiviral agents that work. Treatment is entirely symptomatic: • Paracetamol or ibuprofen can be given to console a child who is achy or irritable, or to ease painful mouth sores or discomfort associated with fever.

• There are mouthwashes or sprays that numb mouth pain in older children.

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lack of energy

skin rash

road to recovery day 10

for several weeks. Because of this, it is almost impossible to prevent the spread of HFMD. Once infection with the HFMD virus has occurred, the time until symptoms appear (the incubation period) is usually between three and six days.

There is no vaccine against HFMD, and it is very difficult to do anything to stop active, sociable children from getting HFMD if there is an outbreak in a nursery or school, but the risk can be lowered by • Plenty of hand-washing with soap and water, especially after changing diapers and using the toilet. As usual, hand washing is the best protection!

• Cleaning and disinfecting frequently touched surfaces and soiled items, including toys.

• Avoiding close contact such as kissing, hugging, or sharing eating utensils or cups with people with hand, foot, and mouth disease.

Exclusion of sick children or persons may not prevent additional cases since the viruses that cause HFMD

• Kids with blisters on their hands or feet should keep the areas clean (wash with lukewarm soap and water, pat dry) and uncovered. If a blister pops, keep it clean with soap and water.

• The major problem is if a child has mouth sores, and refuses to drink or swallow because of the pain.

Dehydration may occur and hospitalization needed for intravenous rehydration. Gently encourage the child to eat and drink whatever she likes. Cold foods like ice cream and popsicles ease pain by numbing the area, and will be a welcome treat for those who have difficulty swallowing (and even those who don't!).

• Of course, contact your doctor if your child remains very uncomfortable or can't be consoled or is lethargic and especially if she has signs of dehydration such as dry tongue, sunken eyes, or decreased urine output; or if symptoms worsen.

It may help if you think of HFMD as a sort of modern but milder form of an old time childhood disease, chickenpox, which most of us over thirty have had, not as common, not as contagious, and certainly, at this time, not as serious.

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