U The Caribbean Health Digest - Issue 20

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THE CARIBBEAN HEALTH DIGEST JAN MAR 2013

| ISSUE 20

KNOCKING THE WIND OUT OF

ASTHMA WITH PROPER TREATMENT AND MANAGEMENT, ASTHMA SUFFERERS CAN LIVE NORMAL AND ACTIVE LIVES. ALCOHOL AND HEART DISEASE. THE MANY CARDIOVASCULAR RISKS ASSOCIATED WITH CONSUMING TOO MUCH ALCOHOL. 10 MENTAL ILLNESS. THE DEVASTATING IMPACT OF ABUSE ON MENTAL HEALTH...A PROLIFIC PROBLEM IN T&T. 22 COCOA A SWEET TREAT EVEN BEFORE IT BECOMES CHOCOLATE! 38 uhealthdigest.com

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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 f i 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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U The Caribbean Health Digest is published 4 times a year by Eidetic Publishing, Gaston Court, Gaston Street, Lange Park, Chaguanas, Trinidad & Tobago. Distribution is handled by Eidetic Limited.

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Reproduction in part or whole is prohibited. Eidetic Publishing is in no way affiliated with companies or products covered in U. Produced and printed in Trinidad & Tobago.

10 Holiday Heart Syndrome Here in the Caribbean we know a thing or two about overindulgence and having fun especially when it comes to alcohol consumption. This article discusses thenotso-fun aspect of too much alcohol and the health effects it can have on your heart.

14 Breast Surgery For any woman losing her breasts to cancer, it can be a traumatic ordeal, but with technological and scientific advancements, women now have the option to stay sexy or be even sexier after surgery. Mr. Rampaul, Consultant Breast Surgeon, shares his experience with our writer.

18 Asthma One of the most common chronic inflammatory diseases. Learn more about this condition, its causes and treatment options, in this article written by Carol Quash.

22 Mental Illness Many people in societies across the Caribbean suffer from some form of mental illness. There can be a great number of underlying causes for this; Maya Hibben explores some of them in this thought-provoking piece.

26 Diet Do’s & Dont’s For more reasons than one, many of us make our own decisions to “go on a diet” sometimes without much consideration for what’s best for our bodies. Truth be told, there are some do’s and don’t s when it comes to dieting. Dietitian Michelle Ash discusses them with us in this article.

30 Sleep Smart Here are some ideas on how you can do a self-evaluation on your sleep pattern, and tips on how you can maximize on the sleep you do get.

34 Neuroscience More and more people suffer from issues relating to their spine, and in many cases, they result in surgery. This true story tells about a woman who placed her trust in the hands of the specialist surgeons at the Baptist Health’s Neuroscience Centre in Florida who had her on her feet in no time.

38 Loco For Cocoa “Chocoholic” has to be one of the most popular self-admitted addictions of our time, but many of us never stop to consider the source of this decadent treat, the Cocoa. Lucky for us in the Caribbean, we have the luxury of cocoa trees in our own back yard, and guess what? They are packed with nutritional goodness!

40 Periodization or Instinctive Training?

Here are some ways to shake up your routine gym training. Robert Taylor shares some thoughts and insights on Periodization and Instinctive Training which some of you will certainly find quite useful.

46 Youth & Theatre There are many people who commit themselves to helping others, contributing to their mental and emotional well being through the use of many different techniques. While this story is not entirely about health in its traditional form, we wanted to acknowledge the work of one such individual, Steven Edwards, for his contribution to the young people of our society.

48 Paediatrics - Coughing Dr. David Brat explains that coughing suggests there may or may not be something wrong with our child’s respiratory tract. Learn how to tell the difference, and the treatment options.

What an exciting year for us all! We made it past December 2012 despite the many popular apocalyptical interpretations for the end of the world; we are still here. What better time to embrace the concept of a new beginning and celebrate our existence on this amazing planet, and there’s no better way than taking care of our gifted bodies.

As we continue to bring to you, our readers, current and credible information on the health issues that affect us, we hope that we can help to steer you in a direction that will encourage you to make the best and healthiest choices that will enhance the quality of your own lives.

In this issue of U, our professional team of writers, as always, thoughtfully create articles that educate readers at all levels. Our feature story discusses Asthma, one of the most common chronic inflammatory diseases.

Mezaan Beljic writes about the consequences of overindulgence in her article Holiday Heart Syndrome, how too much alcohol can affect your hear. Another must-read!

In his regular feature, pediatrician, Dr. David Bratt focuses on coughing. He discusses the different types of coughs that children may have and what signs parents look for.

Mental illness is prevalent and on the rise in many societies in the Caribbean, but there can be a myriad of causes and reasons behind each scenario. Maia Hibben shares her knowledge with us in this very telling article. And let us close on a much sweeter note; writer Carol Quash brings her story on the health benefits of chocolate in its raw form, the Cocoa.

With these and much more we have no doubt you’ll enjoy our offering this issue. See details inside on our 3rd Annual Health and Wellness Exposition, carded for May 27th -29th. See you there, and have a great 2013!

SHERINE & STUART

FOUNDING EDITORS

DISEASE

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HO L IDAY HE AR T SY NDR OME

Holiday Heart Syndrome: a consequence of overindulgence.

WRITTEN BY MEZAAN

BELJIC

Drink. Laugh. Eat (maybe).

Repeat. Chant “Happy New Year!”

Maybe dance, sing, and drink a little more.

If this pattern sounds familiar and that drink happens to be an alcoholic beverage, you may eventually notice your heart beating irregularly, possibly rapidly. Feeling faint with associated chest tightness and shortness of breath may lead you to proclaim “I think I overdid it...” A trip to the emergency room that night or an urgent visit to the doctor the next day is likely to reveal you have “holiday heart syndrome,” a term which commonly refers to the relationship of heavy alcohol consumption and rhythm disturbances of the heart.

HOLIDAY HEART SYNDROME

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DISEASE

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HOLIDAY HEART SYNDROME

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DISEASE

Recurrent heavy drinking also leads to high blood pressure, high triglyceride levels, alcoholic cardiomyopathy (an enlarged, weakened heart) and congestive heart failure. Binge drinking characteristic of holiday heart syndrome is associated more with atrial arrhythmias and tends to be self-limiting; whereas recurrent, heavy alcohol use and abuse that ultimately results in alcoholic cardiomyopathy, is associated more with lethal, ventricular arrhythmias and increased risk of sudden death.

As far as what constitutes binge drinking, Dr. Pandya acknowledges “There is no consensus on what exactly is defined as binge drinking.

In the U.S., one standard definition is consuming 5 or more standard drinks for a male and 4 or more for a female on one occasion. This is known as the "5/4 definition." The National Institute of Alcohol Abuse and Alcoholism (NIAAA) defines it as a blood alcohol content of 0.08% or higher.”

The bottom line Excessive alcohol and your heart don’t mix!

You may have read that consuming alcohol has heart-related health benefits such as increasing your HDL level or “good” cholesterol; however, any suggested benefits are better achieved with a healthy, non-alcoholic diet, exercise, and maintaining appropriate weight for height and body type.

If you don’t already drink alcohol, most doctors will tell you not to start drinking alcohol. If you do drink alcohol, do so in moderation, noting that what constitutes “moderation” for one may be “heavy” for another, depending on gender, stature, age, and comorbidities.

Moreover, holiday heart syndrome is primarily associated with alcohol intake but similar symptoms can occur after consuming too much caffeine, any amount of illicit drugs, or a combination of the three. So, the next time you sit down and watch the Windies win another T20 World Cup, go easy on the rum and Red Bull.

There is no consensus on what exactly is defined as binge drinking. In the U.S., one standard definition is consuming 5 or more standard drinks for a male and 4 or more for a female on one occasion.

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DISEASE

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HO L IDAY HE AR T SY NDR OME

A fun term, but not so fun condition Holiday heart syndrome was first described in the late 1970s.

Patients generally have normal hearts otherwise.

It usually relates to excessive drinking over a short period of time.

To tell us more about holiday heart syndrome, I interviewed a cardiologist, Vipul Pandya, M.D., who quickly clarified that “despite what the name implies, the heart is under quite a bit of duress during the rhythm disturbance. It is certainly not taking a “rest” [or holiday].

Holiday heart syndrome was first described in the late 1970s. Patients generally have normal hearts otherwise. It usually relates to excessive drinking over a short period of time. Often this is noted during holiday season, during vacation or during sporting events.

Patients can be asymptomatic but often will feel palpitations. The heart rhythms are rapid and irregular, causing fatigue and even chest pain. Additional symptoms include lightheadedness, dizziness or sometimes fainting spells.”

“Holiday heart syndrome,” he adds, “can involve a range of heart rhythms, but, most commonly, a specific rhythm called atrial fibrillation is noted. The rhythm disturbance is usually limited and will convert back to normal within 24 hours with abstinence from alcohol use. The specific mechanism of how alcohol causes arrhythmias is unclear; however, alcohol is thought to affect the transport of sodium within cardiac cells. Sodium, along with potassium, is vital to normal cardiac function.”

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With regards to recurrent holiday heart syndrome and long term consequences, Dr. Pandya states, “Generally, patients will not have any long-term effects. However, if recurrent episodes occur due to continued alcohol abuse, long-term damage to the heart muscle can occur. This damage includes not only a weakening of the heart muscle, but also the development of persistent arrhythmias. In this situation, special medications are required to restore normal rhythm.

Rarely, cardioversion, a procedure to “shock” the heart back to normal, may be performed. Persistent atrial fibrillation can lead to the formation of blood clots within the heart, which can subsequently increase the risk of a debilitating stroke. To reduce the risk of this complication, “blood thinning medications” may be prescribed.” It is important to realize that the risk for stroke is present with paroxysms of atrial fibrillation as well. Do not hesitate to seek medical attention for concerning intermittent or persistent symptoms.

BREAST SURGERY

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S TAY ING S E X Y A FTE R S U R G E RY

STAY I N G SE X Y A F T E R SURGE R Y

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BREAST SURGERY

TREASURED REASURE

CHEST

STAYING SEXY AFTER SURGERY WRITTEN BY STAFF

WRITER

A diagnosis of breast cancer can bring a woman’s world to a grinding halt. Regardless of creed, race, class or level of education, we are more frightened by this disease than almost any other, including many which are, in reality, a greater threat.

This is largely due to our culture and upbringing. Caribbean people have nurtured our fear of cancer into near-paranoia, fostered by the memories of aunts and grandmothers discussing, in hushed whispers, something they only dared refer to as “C”.

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BREAST SURGERY

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S TAY ING S E X Y A FTE R S U R G E RY

CANCER IS NO LONGER A HORROR STORY But Mr. Rajendra Rampaul, Consultant Oncoplastic Breast Surgeon, maintains that our fears, though understandable, are greater than they should be. With more advanced diagnostic and predictive testing, and more efficient and aggressive treatment, women today are not only more likely to detect breast cancer earlier, but to treat it more successfully.

Herein lies the rub. In many cases, the most effective treatment for women with breast cancer is the surgical removal of the lump, including a portion of or even the entire breast. And as happy as we are to have triumphed over this dreaded disease, we are left to face life with scarring or disfigurement to one of our most quintessentially feminine body parts. “It’s a devastating thing,” says Mr. Rampaul. “The ideal is to be able to save the breast in its entirety, but it’s often impossible.”

STAYING SEXY AFTER SURGERY

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Once again, we have the gods of p rog r e s s a n d s c i e n t i fi c development to thank for the many options that are now open to us after breast cancer surgery. “We can offer women reconstruction, so that when she goes to the beach, nobody can tell. A woman doesn’t just survive beyond breast cancer; she can be whole again.”

Mr. Rampaul explains that the breast can be reconstructed using implants, or even fat and skin grafts from other sites about the body, such as the butt or thighs.

In the greatest two-for-one deal ever, he can also remove fat from a woman’s tummy, give her a tummy tuck while he’s at it, and use the fat to enhance the breast.

“They love that,” he says. “Every woman wants to know that breast cancer is not a death sentence.

There’s a certain sexiness about reconstruction.

Most women don’t know that this is what medicine can help them with as well. It’s the lighter side of a difficult situation.”

When Christian discovered an uncomfortable hardness in his nipple, he was worried, but he was sure about one thing: it couldn’t be cancer, because ‘men didn’t get breast cancer’.

The emotional boost that new, beautiful breasts can give a woman can’t be measured. The days of becoming a recluse, hiding scarred or missing breasts under mountains of clothing in this sweltering climate, or even shuttering ourselves away from public eyes entirely, are gone for good.

Thanks to the skill of oncoplastic breast surgeons, not only can we look and feel normal, but our breasts can even be the kind of breasts we’ve always wanted.

Bigger? No problem. Smaller?

Why not. More shapely? Sure.

Sexier? Check, check, and check.

SAVING RELATIONSHIPS Trini men aren’t the most communicative, and often, being faced with a partner who has a scary disease, and who comes out physically scarred, is like a depth charge going off in a man’s life. Sadly, Mr. Rampaul tells us, this often leads to the breakdown of the relationship.

This is one more good reason to opt for reconstructive breast surgery. The woman feels sexy again in the eyes of her partner, and he, in turn, sees her as the same attractive, vibrant, feminine woman he fell in love with.

BREAST CANCER ISN’T ONLY FOR WOMEN When Christian discovered an uncomfortable hardness in his nipple, he was worried, but he was sure about one thing: it couldn’t be cancer, because ‘men didn’t get breast cancer’.

Imagine his shock when a biopsy ordered by Mr. Rampaul came back indicating that he had Stage 2 breast cancer. “I felt as if my life was over. My perspective was that once you got cancer, that was it.”

STAY I N G SE X Y A F T E R SURGE R Y

Rampaul says that out of 100 diagnosed cases, about 1 is male.

Men like Christian struggle to understand their condition, as most of the available literature is addressed to women. Also, in our macho society, the concept of a man having a ‘woman’s disease’ can raise sniggers and taunts even from his closest friends.

A diagnosis in a man can also raise paranoia in his mate: she can also find herself worrying that she, too, will fall victim.

This consists of a temporary expander, which will soon be replaced by an implant similar to those used by women, to make both sides of his chest seem even. Months after his surgery, he hasn’t felt comfortable enough with his scar to go bare at the beach, but on the other hand, doesn’t feel the need to have a nipple tattooed over the area. “What do I need that for? In the end, I am just grateful for life.”

The blow to self-esteem after breast cancer surgery is no less in men, Mr. Rampaul tells us, and they can benefit equally from reconstruction. As a matter of fact, it’s probably a little more obvious in men, as we are a beach-loving society, and while a woman can wear a swimsuit top to cover any scars, going bare-chested is the norm for men. This is not to say, however, that all patients place reconstruction on an equally high level of priority.

THERE IS BEAUTY AFTER BREAST CANCER

Knowing that reconstruction was available actually made it easier for me to decide to have a double mastectomy Christian agreed to reconstructive surgery immediately upon the removal of his nipple and the surrounding lymph nodes.

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BREAST SURGERY

Kaitlin (name changed), is no less than delighted by the results of her surgery. In 2012, she was diagnosed with Stage 1 cancer in one breast, and, because of her family history of cancer, opted to have both breasts removed.

“Knowing that reconstruction was available actually made it easier for me to decide to have a double mastectomy,” she said.

She thinks that women who find themselves in her situation should always consider reconstruction.

“Yes, what you’re going through is horrible, but there’s not a visual reminder. It’s bad enough to have cancer, but to look down and see you are minus a breast....

Reconstructive surgery helps with coping. I didn’t feel less of a woman. It makes it easier to move forward and resume your life. You can still put on a bikini or a V-neck.

You can still feel whole. You can still feel beautiful.”

Mr. Rampaul, Consultant Oncoplastic Breast Surgeon, can be reached at rampaul@thebreastcentrett.com.

The Breast Centre website can be found at pinkhibiscustt.com.

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DISORDER

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KNO CKING THE W IND OU T OF A S THM A

KNOCKING THE

WIND OUT OF

WRITTEN BY CAROL

Eight-year-old Christian can't keep up the pace while playing with his friends.

Twenty-year-old Justin used to mistake the frequent tightening of his chest for a heart attack. Thirty–six-year-old Julia coughs persistently at night.

QUASH

KN O C KI N G T H E W I N D O UT O F A ST H M A

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DISORDER

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DISORDER

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KNO CKING THE W IND OU T OF A S THM A

Asthma, a disease that affects the airways to and from the lungs, can strike at any age, but usually starts in childhood.

Wheezing, shortness of breath, tightness or pain in the chest, and chronic coughing at night and in the early morning are among the most common symptoms. Parents should pay particular attention to infants who have difficulty feeding, and grunt during meal times, as this too may be a symptom of the bronchial disease.

There are two types of asthma: extrinsic and intrinsic. Extrinsic asthma attacks are mostly triggered by exposure to allergens like pollen, mold, dust mites, cockroaches and pet dander, while intrinsic asthma attacks are triggered by non-allergens such as smoke and pollution, household cleaners, cold air, changes in the weather, exercise, and emotional factors such as laughter and stress.

Asthma attacks can vary from mild, moderate and severe to very severe.

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And, according to a report published in the American Journal of Respiratory and Critical Care Medicine (November 2012 issue) the respiratory system of women, asthmatics included, gets worse between the tenth and twenty-second day of her menstrual cycle.

"In a cohort of nearly 4,000 women, we found large and consistent changes in respiratory symptoms according to menstrual cycle phase, and, in addition, these patterns varied according to body mass index, asthma, and smoking status," head researcher, Ferenc Macsali, MD, said.

It must be noted that a person with a family history of asthma is prone to developing the disease.

During an asthma attack the muscles around the patient's airways tighten, causing the airways to narrow. As a result less air flows through the passage, which are always inflamed, and causes further narrowing. In addition, the airway produces more mucus, further restricting the flow of air.

Asthma attacks can vary from mild, moderate, severe and very severe. At the onset of an attack, enough oxygen may get into the lungs but the carbon dioxide may not be exhaled fast enough. A build up of the poisonous gas in the lungs lowers the amount of oxygen that gets into the bloodstream. In severe attacks the blocked airways prevent oxygen from entering the lungs, starving the body's vital organs. If not treated urgently, this type of attack can be fatal.

Asthma is diagnosed by an allergist or immunologist, who will conduct a thorough medical history and a series of breathing tests to determine the severity of the condition and the treatment required. It must be noted that a person with a family history of asthma is prone to developing the disease.

KN O C KI N G T H E W I N D O UT O F A ST H M A

When being tested for asthma, it is important to take note of the patterns your symptoms follow in order to assist your doctor in determining the type of asthma you have and to prescribe the best treatment for you. Answers to questions such as — do the symptoms occur at night or in the early morning, during or after exercising? Are your symptoms triggered at a particular time of the year and in a particular geographical location? — will be helpful in helping your doctor make a diagnosis.

While there is yet no cure for asthma, a person with the disease can live a normal active life with treatment and proper management. Treatment will depend on the severity of the case.

Like any other type of medicine, asthma medicines may have side effects.

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DISORDER

Like any other type of medicine, asthma medicines may have side effects, which you should discuss with your doctor before you start treatment.

Keeping asthma under control may take some getting used to, especially when trying to avoid known attack triggers. Devising an action plan with your doctor and support network and sticking to it will yield positive results.

The written plan highlights: • When, what and how much medication to take

• How to recognize if your

symptoms are getting worse

• What to do if symptoms get worse • When to seek medical assistance Everyone involved in caring for an asthmatic person should be privy to the action plan.

And because your level of asthma severity may change with time, remember it is important to regularly review your action plan with your doctor.

Asthma medicines include relievers, preventers, symptom controllers and combination medications. Relievers are fast acting and open up the airways for immediate relief. Preventers reduce inflammation and swelling of the airways. Symptom controllers open up the airways for up to twelve hours.

Combination medications comprise preventers and symptom controllers in one inhaler.

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DISORDER

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MENTAL IL L NE SS

MENTAL ILLNESS

WRITTEN BY MAIA

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DISORDER

HIBBEN

How many times have you witnessed a man or woman behaving strangely in public? Looking dishevelled, unkempt, talking to themselves, rummaging in bins, staring at objects or people that you or I cannot see? And you think to yourself “That man is mad!” How often have you heard someone make the comment, “He needs to go St. Ann’s", or, "He just got out of St. Ann’s?”

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DISORDER

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MENTAL IL L NE SS

Perhaps you have a friend, family member or colleague who is often very down or has lost all pleasure in their usual interests; or someone who is frequently anxious, agitated and worried; or perhaps someone who displays unusual behaviours you find erratic and worrying?

Mental illness is ever-present in our society; we see it on the streets in the homeless mentally ill, we read about it in the papers; we all probably know someone suffering from a mental health issue. We talk about St. Ann’s Psychiatric Hospital in an almost comical way. But yet, how much do we really know about the reality of mental illness in Trinidad and Tobago?

Mental illness can broadly be defined as 'a disease or condition that influences the way a person thinks, feels, behaves and relates to others and his or her surroundings'. The exact cause of mental illness is unknown, but most recent research suggests that it is often a complex combination of genetic, biological, psychological and environmental factors that influence these diseases.

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When we hear the term ‘mental illness’ or ‘mental disorder’, perhaps there is a tendency to automatically think of acute illnesses such as schizophrenia.

But there is a large and diverse range of disorders, from depression to anorexia, from OCD to schizoaffective disorder, and they are far more common than you may think. In fact, considerable research indicates that mental disorders are more common than cancer, heart disease and diabetes.

In the US, the National Institute of Mental Health estimate that around 25% of adults (over 18 years) and 13% of children (8-15 years) are diagnosed with a mental illness in any given year.

CATEGORY

DISORDERS

Anxiety Disorder

Phobias, Generalized Anxiety Disorder, Panic Disorder, Agoraphobia, OCD (obsessive compulsive disorder), PTSD (post traumatic stress disorder)

Mood Disorders

Depression, Bipolar, Mania

Eating Disorders

Anorexia, Bulimia

Psychotic Disorders

Schizophrenia; Schizoaffective Disorder, Delusional Disorder, Substance-Induced Psychotic Disorder

Personality Disorders

Paranoid Personality Disorder, Narcissistic Personality Disorder, Borderline Personality Disorder, Antisocial Personality

Dissociative Disorders

Dissociative Identity Disorder

The World Health Organisation (WHO) reported that over '1/3 of people in most countries report problems at some time in their life which would meet criteria for diagnosis of one or more of the common types of mental disorders' This is a vast number of people. The WHO also states that the global burden of psychiatric disorders is substantial, (that is, the number of years of disability due to disease, together with years of life lost due to disease), accounting for 13% of the global burden of disease. In fact, the four leading causes of disability in developed countries are mental illnesses: major depression, bipolar, schizophrenia and OCD. But despite the huge burden of mental illness, few human and financial resources are directed towards mental health care. On average, mental health accounts for a very small percentage of national health budgets, in many countries under 1%. In Trinidad and Tobago only 4% is allocated to Psychiatry and Mental Health, 94% of which is directed to St. Ann's Hospital.

Mental illness is a subject still shrouded in myth and widely misunderstood, yet an important issue that no society can ignore or escape from. In Trinidad and Tobago there is little public awareness, and, sadly, deeply embedded stigma, and this only fuels the misunderstanding and taboo nature of these problems. One of the reasons for this lack of social understanding around mental illness is the lack of thorough local and regional research

MENTAL ILLNESS

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DISORDER

into the wide range of illnesses that fall under the title of ‘mental illness’. The majority of research on mental illness, particularly acute illnesses like schizophrenia, is based in the UK, US, Europe and Australia, and so it is argued that the findings may not be relevant to this country, or this region.

This being such an ethnically and religiously diverse country, there are many avenues that people may take to seek help and healing, and it is crucial to understand these paths in order to be able to effectively treat and manage mental illness in Trinidad and Tobago. The researchers are now identifying cases of undiagnosed psychosis and Research from the WHO on other ‘emerging’ or doing in-depth evaluations and analysis to gain a ‘developing’ countries now suggests that the nature comprehensive knowledge of the journey of and rate of mental illness differs greatly according these people and their illness. to place, social group and culture. And thus, it would be of great benefit to Trinidad and Tobago We all have a responsibility to be aware of, and to understand mental illness and the issues that look after, our mental health and understand that surround it in the context of its unique culture. anyone can be susceptible to mental health Having this understanding would allow us to better problems. Stress is sadly a frequent part of educate ourselves so we can improve and protect modern living and often we do not fully acknowlour own mental health. We would also be able to edge the impact that stressful lifestyles can have provide better help and support to those currently on our minds and bodies. Take a moment to suffering, and also help their families who at assess the health of your mind, in this fast-paced present have extremely limited support services in world and perhaps give renewed thought to those coping with, and caring for, those with mental who are suffering. health problems.

Mental health problems affect society as a whole, This 'need for knowledge' is not only a poignant not just a small, isolated segment. They are issue for T&T but also for numerous other therefore a major challenge to global developcountries, and it has inspired the creation of an ment. It strikes indiscriminately, irrespective of international, cross-cultural research project which age, class, gender or ethnicity; no group is aims to increase knowledge and understanding immune. For all individuals, mental, physical and about mental illnesses in different cultures. social health are closely interwoven, vital strands INTREPID: India, Nigeria, Trinidad REsearching of life. As our understanding of this interdepenPsychosis in Diverse Settings, is made up of dent relationship grows, it becomes ever more multiple groups of dedicated researchers from apparent that mental health is crucial to the India, Nigeria, UK, US and here in Trinidad. The overall well-being of individuals, societies and team in Trinidad is based in the University of the countries.

West Indies (UWI), Psychiatry Unit at EWMSC, Mt. Hope, and is headed by Professor Gerard As a nation there is a great need to re-educate Hutchinson. The project is currently a pilot study, ourselves about mental illness; to remove the veil focusing on the Tunapuna/Piarco region of of discrimination and stigma which has hidden Trinidad, but, once successful, will be expanded to the reality of mental illness for too long; it is time a nationwide project which will generate in-depth to break down the myth and truly understand the knowledge of mental health issues in T&T, togeth- issues. It is hoped that the INTREPID project will er with India and Nigeria. go some way in allowing us to begin this re-education and make our nation more knowledgeable.

Researchers have carefully mapped all people and With knowledge comes power, and with power we institutions that citizens may seek help from, have the ability to create change. whether it be hospitals, psychiatrists, psychologists, social workers, clinics, and GPs, all the way to If you are concerned about your mental health or spiritual leaders, faith healers and complementary the mental health of a family member, please visit and alternative therapists. your GP or local health facility.

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NUTRITION

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DI ET DO’S A ND DIE T DON’TS

Diet do’s &don’ts.

WRITTEN BY MICHELLE

ASH, REGISTERED DIETITIAN, MPH, RD, DIP.

Exploring poor nutrition choices.

Poor Choice #1 Eliminating Entire Food Groups In the quest to become more health conscious, many people often eliminate entire food groups.

Animal-derived foods are a major group that many persons believe should be eliminated from the human diet. Examples of Foods from Animals include dairy products and animal flesh/meat.

DAMAGE DONE Dairy products such as milk, cheese and yoghurt are very good sources of the mineral calcium, which is essential for building and maintaining healthy bones and teeth. Therefore, cutting out dairy products may be detrimental to bone health. In addition, removing meat from your diet without including other types of iron-rich foods can trigger the development of other medical conditions, such as anaemia. While there are many good sources of calcium, as well as iron, in plant-based foods, the average person does not usually consume nearly as much vegetables as are needed to meet their nutritional requirements of these minerals.

Poor Choice #2 Skipping fruits and vegetables

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There are many nutrition myths that prevent people from consuming the amount of fruits and

vegetables they should. Additionally, expense, accessibility and hectic schedules are reasons people often give for not being able to consume them every day.

DAMAGE DONE Fruits and vegetables contain high amounts of antioxidants that serve to ward off many chronic illnesses. If you don’t eat fruits and vegetables every day, you are increasing your risk of cancer, heart disease and obesity, because you're not filling up on these naturally nutritious, low-calorie and low-fat foods. Furthermore, eating more fruits and vegetables often helps improve energy levels, skin condition and weight loss.

Poor Choice #3 Confusing food groups If you happen to skip eating green and other coloured vegetables, but instead you prefer to enjoy eating a lot of other types of vegetables, such as starchy root vegetables and ground provisions such as potatoes, cassava and yam, these actually do not ‘count’ towards your vegetable intake. Such items are in the Staples food group.

DIET DO’S AND DIET DON’TS

Foods classed in the Staples group contain very high amounts of carbohydrates in the form of starch that eventually breaks down into simple sugars when it is digested.

DAMAGE DONE Foods in the Staples food group have a higher energy content than foods classed in the vegetables food group. As a result, you may end up eating beyond your daily energy needs if you swap your green and other coloured vegetables for your very tasty and filling starchy foods. On another note, persons with diabetes need to be particularly aware of their portions as it pertains to the Staples food group since they may experience difficulty with controlling their blood sugars when too much starchy food is eaten.

Poor Choice #4 Including too many ‘non-food group’ items in your regular diet Example: salt, sugar and alcoholic beverages. It is very important to pay attention to food labels for information about sodium and sugar content.

* Salt DAMAGE DONE Excess salt and sodium can raise your blood pressure, which in turn may eventually negatively affect many organs of the body.

The majority of salt that we consume in the Caribbean comes from many of our favourite local foods such as pigtails, salted meats and salted fish, smoked herrings, smoked fish and pork bones, smoked meats, canned meat and canned peas/beans and canned vegetable products such as canned peas and carrots, tinned corned beef, luncheon meats and tinned sausages.

* SUGAR

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NUTRITION

and other foods can cause you to easily exceed your daily energy needs. If you do not do enough physical activity, then the extra energy that you consumed from eating or drinking too many sugary items will be stored as body fat. For persons with diabetes, excess dietary sugar can lead to blood sugars soaring above recommended limits and will give rise to other medical complications.

* ALCOHOL A standard drink delivers ½ oz of pure alcohol. It refers to either of the following: • • • • •

4 to 5 oz of wine (12% alcohol) 3 ½ oz of rum or rum cream 10 oz of wine cooler, stout, strong ale 12 oz beer (5% alcohol) 1 ½ oz distilled liquor (80 proof, 40% alcohol: whisky, vodka, scotch, rum)

In general, drinking alcohol may be risky for anyone taking medication, persons with alcohol dependency and persons diagnosed with mental health conditions.

Drinking (more than 3 units per day for women, and more than 4 units per day for men) impairs mental abilities while you're under the influence.

DAMAGE DONE A few years of such a regular pattern of drinking can cause degenerative liver disease. Many times, liver disease causes permanent damage. Regular alcohol consumption is also associated with the development of certain types of cancers.

The healthiest option: Moderation is key!

Healthy eating is all about variety and moderation.

After all, as the old adage says, “too much of anything is good for nothing”, and despite all the diet trends, everyone needs a balance of all the major nutrients every day from each of the six food groups to maintain a healthy body.

DAMAGE DONE Excess sugar is a sure recipe for weight gain. Many of the items purchased at the grocery stores already contain added sugars. Adding extra sugar to these

Feel free to email the author at michelle.ash.tt@gmail.com with your nutrition questions and concerns and they will be answered in the next issue.

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surgery success rate

for Caribbean Heart Care Medcorp.

Heart disease continues to claim lives and tear families apart the world over, as diets deteriorate and stress becomes malignant. In the Caribbean, there is the fear that cardiac patients may not be afforded the same level of health care as those living in more developed countries, as we are faced with a flailing health care system that struggles to cope.

I

t is because of the many chinks in the In the words of co-founder, past Chief Surgeon and existing system that visionary medical current Clinical Head of the CHCM team, Professor Dr. Gianni Angelini, “These results are providers such as Professor the culmination of 20 years of hard Gianni Angelini created work and dedication from a team of services with expertise, professionals striving towards making experience and equipment Trinidad and Tobago one of the safest that allow them to rival those offered places to undergo heart surgery.” anywhere in the Western world.

One such service is Caribbean Heart Care Medcorp (CHCM), which is located at the Eric Williams Medical Sciences Complex.

In operation since 1993, the CHCM has treated over 3,000 cases, foreign, regional and local. The team, from surgical to medical to anesthetic to support specialists, is led by Italian Chief Surgeon, Giovanni Teodori, and is now comprised almost exclusively of Trinidad and Tobago nationals, after years of extensive training and recruitment.

IN OPERATION SINCE 1993, CARIBBEAN HEART CARE MEDCORP HAS TREATED OVER 3,000 CASES, FOREIGN, REGIONAL AND LOCAL.

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The successes of the interventions performed by this team speak for themselves. In 2012, the CHCM achieved a 0% mortality rate, out of 250 adult open heart surgeries performed at the EWMSC, a success rate that stands even higher than that of similar hospitals in the UK and the US, where mortality rates average 4.4%.

As it continues to focus on maintaining its excellent performance rating and keeping the well-deserved trust of its patients, partners and stakeholders, the CHCM team continues to take a zero tolerance approach to patient safety. It provides 24-hour emergency care and round-the clock follow-up on all its cases, while always respecting the need of the families for constant updates and information. The CHCM, unlike many other similar centres, does not select its patients; rather, it is willing to accept patients who have even been refused care by other providers.

Over the last twenty years, CHCM has also facilitated public and private sector networking, which prompted improvement in standards and ethics in medical support systems. Together with the Ministry of Health, CHCM has built themselves into a Caribbean team which, as of 2012, can boast 100% success rate in open heart surgery.

SLEEP

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SL EEP SMAR T

smart!

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AS THE NEW YEAR BRINGS A SLEW OF RESOLUTIONS AND LIFESTYLE CHANGE PROMISES, WE’VE OPTED TO KEEP MOST OF THIS ARTICLE’S CONTENT LIGHT AND EASY TO READ… OUR INTENTION IS THAT YOU TAKE SOME OF THESE TIPS TO HEART AND MAKE POSITIVE CHANGES TO YOUR LIFESTYLE/ROUTINE.

As a follow-up to our previous article (Issue #17) we discussed the most common sleep disorder, Obstructive Sleep Apnoea (OSA), and highlighted the signs and symptoms of OSA. Left untreated, your sleep apnea may be a risk factor for: • Type 2 Diabetes — more than 7 out of 10 people with Type 2 Diabetes have sleep apnoea.

• High blood pressure — more than 3 out of 10 people with sleep apnoea have high blood pressure.

• Stroke — 7 out of 10 people who have had a stroke have sleep apnoea.

• Heart failure — up to 7 out of 10 people with chronic heart failure have sleep apnoea.

SLEEP SMART

Should you evaluate your sleep?

To determine whether you might benefit from a sleep evaluation, ask yourself the following questions: • Do you regularly have difficulty getting to sleep or staying asleep?

• Do people tell you that you snore? Has anyone ever told you that you have pauses in breathing or that you gasp for breath when you sleep?

• Are your legs “active” at night? Do you experience tingling, creeping, itching, pulling, aching or other strange feelings in your legs while sitting or lying down, which cause a strong urge to move, walk or kick your legs for relief ?

• Are you so tired when you wake up in the morning that you cannot function normally during the day?

• Does sleepiness and fatigue persist for more than two to three weeks?

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SLEEP

Step 1: Watch what goes into your mouth.

Food and drink play a significant role in keeping you awake — or helping you sleep.

Make the right choices Choose nutritious food such as fresh fruit and vegetables over junk foods or fast foods, especially for dinner. The right food provides healthy nutrients, assists in weight reduction and improves the overall quality of your health, which in turn helps improve the quality of your sleep.

Eat early Give your stomach at least a few hours to digest the food before your head hits the pillow. Don't eat late into the evening.

Eat a balanced meal in the evening Don't over-eat or under-eat. Neither a full stomach nor an empty one is the best way to a restful sleep.

Make sure your evening meal is balanced and not too large, so your digestive system does not have to over-work when it should be at rest.

Avoid stimulating drinks Caffeine is a stimulant that can keep you awake.

Avoid caffeinated beverages for a few hours before bedtime. Tea, coffee, cola, even that cup of hot If you answered yes to any of these questions, then chocolate, can ruin the quality of your sleep. a complete sleep evaluation should be considered Say "no" to alcohol and discussed with your physician. If you would like more information, please contact U Health and Avoid alcoholic drinks for at least two hours before bedtime. Alcohol could have a sedating effect on they would be happy to assist you. your muscles, including those in the upper airway.

The loss of muscle tone may lead to more snoring, and more severe events of sleep-disordered breathing.

How to be “sleep-smart”

• Have you been, or are you currently being treated for high blood pressure?

Everyone needs to be "sleep-smart", regardless of whether or not they suffer from any sleep disorders.

Here are a series of tips on how to get a good night's sleep. Some are pure common sense, and some are well known, tried-and-tested techniques that seem to work for many people. We hope you can adapt the relevant ones to suit your needs.

Before making any major changes to your lifestyle or your daily habits, it is always advisable to consult with your physician.

Cut out the cigarettes Smoking can also provide unnecessary stimulation and prevent good sleep. Don't smoke for at least two hours before bedtime. (Preferably, don’t smoke at all!)

Turn away from spicy foods Foods that are extremely spicy can aggravate the digestive system of some people, especially if you have problems with reflux. Avoiding such foods in the late evenings might help reduce the associated symptoms of heartburn and the need to wake up in the middle of the night to take antacids.

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SLEEP

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SL EEP SMAR T

YOU MAY NOT BE WILLING OR ABLE TO ADOPT ALL OF THESE CHANGES, BUT PICK ONE OR TWO AND GIVE THEM A TRY; YOU MAY FIND YOURSELF BEING MUCH MORE RECEPTIVE TO A GOOD NIGHT’S SLEEP. Step 2: De-stress. Stay calm: A peaceful mind is a vital ingredient for a restful sleep.

Manage your stress Stress can build up inside you like a time bomb. Take some time to learn and practice relaxation and stress management techniques, which can provide a safe release for stress. Going to the gym or performing some physical activity keeps you fit and helps to expel tension. Go visit the beach on a weekday!

Take a soothing bath Soak in a bath with relaxing essential oils or take a really long shower.

Turn on the music… …Soft, not loud! If it's soothing to the ears, it could well be relaxing for the mind.

Specific relaxation music, such as "ocean sounds" or "rainforest tranquility", is very effective. You might also try listening to relaxation tapes/CDs specifically produced for this purpose.

Turn a few pages Reading a book at bedtime can help to take your mind off the day’s activities. Try reading on your couch, not your bed!

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Watch television It helps most people unwind. Avoid movies and other shows that might stimulate your imagination.

Find a hobby Work on a hobby for a while each night—it's more productive than counting sheep, and helps take your mind off work activities that might be bothering you.

Play cards (with your partner or simply Solitaire), do a crossword, build a model plane.

Get a massage Massage helps remove any built-up tension, neck and back pains. This really helps you to relax. Get one from your partner or from a professional masseuse. Your body knows how to pick up the right signals to relax.

You may not be willing or able to adopt all of these changes, but pick one or two and give them a try; you may find yourself being much more receptive to a good night’s sleep.

ResMed - the global leader in the diagnosis, treatment and management of Sleep and Respiratory Disorders, with a focus on sleep-disordered breathing, non-invasive and invasive ventilation.

Through North Eleven, ResMed is dedicated to working with the Caribbean’s medical, corporate, NGO communities and Government ministries to identify and treat sleep disorders and sleep apnea patients. We recognize that all are vital to effective patient care and play a critical role in the identification, diagnosis and management of sleep disorder in patients.

“Obstructive sleep apnea may be associated with asthma and obesity. The relationship between asthma and obesity is not completely understood yet. However, OSA is associated with upper and systemic airway inflammation, and thus, could complicate asthma management.”

SLEEP and

1O THINGS TO TALK ABOUT

Ignorance is our biggest competitor.

One out of five adults suffers from sleep apnoea

Anything less than five minutes to fall asleep at night means you're sleep deprived. The ideal is between 10 and 15 minutes, meaning you're still tired enough to sleep deeply, but not so exhausted you feel sleepy by day.

Experts say one of the most alluring sleep distractions is the 24-hour accessibility of the Internet.

A new baby typically results in 400-750 hours lost sleep for parents in the first year.

The continuous brain recordings that led to the discovery of REM (rapid eye-movement) sleep were not done until 1953, partly because the scientists involved were concerned about wasting paper.

Dreams may not serve any purpose at all but be merely a meaningless byproduct of two evolutionary adaptations - sleep and consciousness.

Ten per cent of snorers have sleep apnoea, a disorder which causes sufferers to stop breathing up to 300 times a night and significantly increases the risk of suffering a heart attack or stroke.

One of the best predictors of insomnia later in life is the development of bad habits from having sleep disturbed by young children.

You may be asleep but your brain never stops working. It stays busy, constantly instructing your systems to keep functioning—breathing, digesting, pumping blood and all the other tasks that keep you alive while you sleep.

As a leading developer of medical equipment to diagnose, treat and manage sleep apnoea and sleep disordered breathing, our most critical challenge comes not from a competing company, but from the lack of awareness about the serious consequences of untreated sleep apnoea.

Untreated sleep apnoea is a known cause of high blood pressure, and is strongly associated with heart disease, diabetes and obesity. Treating sleep apnoea has been shown to lower blood pressure, improve heart function and glucose control, and improve the symptoms of sleepiness and fatigue that sleep apnoea sufferers feel.

ResMed, along with North Eleven in the Caribbean, is dedicated to educating physicians and the public about the health risks of untreated sleep apnoea and how to effectively diagnose and treat sleep apnoea sufferers. Our mission is to deliver the best therapy equipment on the market to help sleep apnoea sufferers enjoy better sleep, better health and a better quality of life.

Researchers report that the signal that causes them to wake up when they want to is triggered by release of the stress hormone adrenocorticotrophin, in an unconscious anticipation of the stress of waking up.

Most of what we know about sleep we’ve learned in the past 25 years. www.resmed.com

www.northelevenlife.com

SURGERY

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NEURO S C IE NC E

NEUROSCIENCE When Victoria Hall-Humpherson made a quick and strenuous movement to lift her disabled mom, she knew immediately something was wrong. The 58-year-old nurse felt a sharp pain in her back that radiated down her legs. Over time the pain worsened and she experienced difficultly walking and had numbness in her left leg.

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Ms. Hall-Humpherson found help through Baptist Health's Neuroscience Center in Miami, Florida. Ronald Tolchin, D.O., medical director of the Baptist Center for Spine Care, and Sergio Gonzalez-Arias, M.D., Ph.D., medical director of the Neuroscience Center, diagnosed a herniated disc in her back — an injury to the small, spongy cushion between the bones in the spine. Her bulging disc was pressing on nerve roots, causing numbness, weakness and loss of mobility. She needed surgery to relieve the pain and prevent nerve damage.

NEUROSCIENCE

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SURGERY

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SURGERY

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NEURO S C IE NC E

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"I was scared. I never really had a medical issue," she said. "I am active. I hike, fish and travel. I had an upcoming vacation to Yellowstone National Park that I had been planning for one year. I worried that my lifestyle would have to change."

Using minimally invasive techniques, Dr. Gonzalez-Arias reached the damaged disc through a single tiny incision. In an hour-long procedure, he

To build strength and promote healing, Dr. Gonzalez-Arias gave her specific exercises to do at home.

A month after the surgery, Ms. Hall-Humpherson and her husband went to Yellowstone to hike, enjoy the outdoors and photograph the animals.

"I really have no aftereffects of the injury or surgery," she said.

"I feel as good as new."

The minimally invasive approach makes the procedure

TO BUILD STRENGTH AND PROMOTE HEALING, DR. GONZALEZ-ARIAS GAVE HER SPECIFIC EXERCISES TO DO AT HOME. A MONTH AFTER THE SURGERY, MS. HALL-HUMPHERSON AND HER HUSBAND WENT TO YELLOWSTONE TO HIKE, ENJOY THE OUTDOORS AND PHOTOGRAPH THE ANIMALS. repaired the disc and relieved the pressure on her nerve. She returned home the same day.

"It was amazing," Ms. Hall-Humpherson said. "You hear about all the problems with back surgery, and I think I was more apprehensive because I am a nurse. But it could not have gone better. I felt improvement immediately."

much easier for patients. Because Dr. Gonzalez-Arias uses a tiny incision and navigates the affected area with micro instruments, less tissue is damaged.

"The technical advantage of the surgery is tremendous," he said. "We work through a hole that is less than one inch in diameter, so this minimizes the trauma to the

spine. Patients have less pain and a quicker recovery."

Dr. Gonzalez-Arias has been performing minimally invasive procedures for 15 years. At Baptist Health's Neuroscience Center, he averages seven to 10 spine surgeries a week.

Some patients need more complex open surgery that requires a recovery of several weeks.

In addition to treating conditions of the spine, D r. G o n z a l e z - A r i a s a n d physicians at the Neuroscience Center diagnose and treat problems of the brain and nervous system, including tumors, aneurysms, epilepsy, strokes, brain injuries, Parkinson's disease, multiple sclerosis and chronic pain. The Center's neurologists, neurosurgeons, neuroradiologists, interventional neuroradiologists and rehabilitation specialists work together to individualize patient care.

They use the latest technologies and clinical research to provide the most effective treatments in the least invasive manner.

"Our Center strives to stay on the cutting edge of medical care," said Dr. Gonzalez-Arias.

"We offer the highest-quality services backed by science, experience and passion."

To learn more about the Baptist Health Neuroscience Center, visit BaptistHealth.net and look for Neuroscience under the Health Services tab.

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For physician referrals, coordination of medical appointments or other medical inquiries, contact : 786-596-2373, email international@baptisthealth.net or visit baptisthealth.net/international.

FRUIT

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LO CO FO R COC OA

LOCOforCOCOA WE'VE ALL BEEN LURED INTO INDULGING NG IN THE TASTE OF SMOOTH, DARK CHOCOLATE, LATE ALLOWED THE TEMPTING AROMA OF A CUP OF COCOA TEA (HOT CHOCOLATE) TO TAKE US TO A BLISSFUL PLACE, AND HAVE AT LEAST ONCE BEEN REFERRED TO THE SOOTHING AND HEALING POWER OF COCOA BUTTER. BUT HAVE WE EVER STOPPED TO CONSIDER THE SOURCE OF THESE LUXURIES AND THE CHALLENGES FACED BY THIS PRESTIGIOUS FRUIT?

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Trinidad and Tobago is part of the nine cocoa-producing countries that make up the cocoa industry in the Caribbean. The others are Belize, the Commonwealth of Dominica, Cuba, Dominican Republic, Grenada, Haiti, Jamaica, and St. Lucia.

Cocoa was once one of the major sources of revenue for the twin islands decades ago. In fact, in the 1930s Trinidad and Tobago was the third largest exporter of fine cocoa beans in the world. The period between 1870 and 1920 was known as the King Cocoa era, as cocoa gained recognition as the country's leading agricultural product, ahead of sugar cane. It’s an accolade the government hopes to restore to the now struggling industry, which was dealt a crushing blow in the 1970s and 80s with the growth of the energy sector and the migration of labour to that sector.

Despite some hiccups, though, the industry has taken some steps in the direction of being restored to its glory days. Last year the country was awarded first prize in the Spicy category at the Salut du Chocolat in Paris, France — one of the world's largest competitions for professionals in the chocolate-making industry and countries that produce cocoa — and was among the three cocoa samples nominated for final recognition at the International Cocoa Awards Edition 2011.

WRITTEN BY CAROL

QUASH

LOCO FOR COCOA

I

In addition, Trinidad and Tobago cocoa has maintained its place among the finest in the world and continues to be sought after by prestigious European confectioners and chocolatiers.

The cocoa tree, also called cacao tree, is native to the Americas. The fruit, or pod, has a rough, leathery outer shell, which varies in color. A cocoa pod contains 30 to 50 seeds, covered with white, sweet pulp, which, some may not know, makes a lashing chow.

Whether in its natural or processed state, cocoa possesses numerous health benefits. Its by-products can be very nutritious if produced free of large quantities of sugar and calories.

Chocolate is reputed to be the richest source of the mineral magnesium, which is essential for good mental health and the healthy functioning of the heart, and cocoa is rich in copper, sulphur and Vitamin C. In addition to the promotion of cardio-vascular health, cocoa is reputed to reduce LDL cholesterol and increase HDL cholesterol. The tryptophan found in chocolate acts as an anti-depressant, while the theobromine found in the pod stimulates the brain.

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FRUIT

C

Cocoa is a rich source of flavonoids, antioxidants that have been linked to reductions in risk factors for diabetes, by acting as a resistance to the hormone insulin, and regulates blood sugar. A study by Harvard researchers also revealed that cocoa consumption aided in decreasing blood pressure, improving the health of blood vessels.

Meanwhile, studies have shown that the consumption of large quantities of chocolates and cocoa beverages can have aphrodisiac effects. Hundreds of years ago the Aztecs regarded their special brew, called Xocoatl, as a potent aphrodisiac and stimulating tonic. The emperors were said to drink generous helpings before entering their royal harems, and the drink was a prominent feature at marriage ceremonies. Even today, chocolate remains one of the top romantic gifts.

It is no secret that cocoa butter helps with the removal of scars and stretch marks because it is rich in Vitamin E. And because it has a natural resistance to rancidity, it is used in cosmetics and soaps for that soothing effect.

So, the next time you sink your teeth into a decadent bar of dark chocolate, sip on a steaming cup of hot chocolate, or gently rub some cocoa butter over that fading scar, remember where it all began and commit to doing your part to revive an industry that does so much for you.

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FITNESS

| PERIODIZATION OR INSTINCTIVE TRAINING?

Periodization or instinctive training?

WRITTEN BY ROBERT

TAYLOR

RECENTLY AT MY GYM, A GUY APPROACHED ME AND SAID, “I’M NO ATHLETE. SO WHY SHOULD A REGULAR GUY LIKE ME ORGANIZE MY TRAINING PROGRAM DURING THE YEAR?” He continued, “Right now, I sort of train instinctively. I’m not a novice – I do have a general idea of what to do when I come to the gym. When I train, I try to connect with my muscles to see if I can do that extra rep or not. I make sure not to over-train a particular body part, and if I’m feeling sore I’ll rest that day.”

All of this led up to the real burning question he had: “Is periodization still my best option?”

For him, a seasoned gym-regular with no real athletic goal in mind, the idea of a regimented program may seem silly. Could he be right?

Is ‘periodization’ – a regimented program structured around various training cycles – only for competitive athletes?

PERIODIZATION OR INSTINCTIVE TRAINING?

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FITNESS

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FITNESS

| PERIODIZATION OR INSTINCTIVE TRAINING?

Periodization.

According to Fred Hatfield, co-founder and president of the International Sports Sciences Association, periodization can be defined as the organization and division of a training program into smaller, progressive cycles during a specific period of time in order to achieve peak results.

The components of periodization can be broken down into three training cycles: Macrocycles, Mesocycles and Microcycles, aptly named to reflect their respective timeframes. The Macrocycle refers to an entire training period, which is usually from six months to a year or longer based on the individual’s goals.

The Macrocycle is made up of Mesocycles and Microcycles. The Mesocycle is a period in the Macrocycle, usually lasting months or weeks, where goals are mapped out to fit into the larger scope of the Macrocycle for optimal performance in a specific event. Mesocycles must blend together seamlessly for optimum results. Thus, foundational training must be done in such a way as to make the individual transition smoothly into sport-specific training.

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The Microcycle is the shortest training cycle, typically lasting a week or two within the Macrocycle, where specific goals are worked on in training. Once one goal is reached, the individual should move on to the next one until all goals are achieved for duration of the Macrocycle.

For Hatfield, who is also a world champion powerlifter, this type of periodization is key to achieving peak performance.

Athletes preparing for competitions will benefit the most from a regimented approach to keep their focus.

However, anyone can benefit from periodization. Breaking down all of the important parts of a training program into simple, measurable tasks enables both the professional athlete and the novice to conceptualize and realize his/her progress over time.

Instinctive training.

On the other hand, there is also significant merit to what can be termed ‘instinctive training’. As described in the scenario of the guy at my gym, working with your instincts may seem most applicable for those who do not have a specific athletic goal or timeframe.

Joe Weider, co-founder of the International Federation of Bodybuilders (IFBB), refers to this school of thought as the Instinctive Training Principle. This involves constructing diets, routines, cycles, intensity levels, reps and sets that work best for an individual based on his or her experience. Quite simply put, it means that you train based on how your muscles ‘feel’, rather than in accordance with some regimen or guideline.

The greatest benefit of this type of approach is that, for a seasoned gym regular (whether an athlete or not), ‘listening’ to your body means that you can adapt at any given time to get the results you know to expect from experience.

For instance, it can be helpful when one trains according to their energy level on that day – using high-energy days to push harder, and low-energy days to do lighter exercises. In this instance, if one were sticking to a regimen, it may result in pushing too hard at the gym when their body really isn’t up to it, which can result in injuries.

However, it is important to note that instinct of this nature comes from one’s own intuition, which ultimately comes from learning and experience.

Not every person who purports to be ‘going to the gym for some time’ and ‘knowing what to do’ is actually as in tune with their bodies as they may believe.

Ultimately, leaving it up to the individual to ‘do what their muscles feel like’ can result in injuries if he/she does not truly understand how each muscle connects to the other, or feels mentally psyched up to train when his/her body may not be quite as ready. Even experienced athletes who have been doing ‘instinctive training’ for years can one day make a dangerous miscalculation when pushing that extra mile.

PERIODIZATION OR INSTINCTIVE TRAINING?

Periodization vs instinctive.

So... what to tell the guy seeking advice in my gym?

Having an understanding of both principles and how well they can work together, I eventually explained that even for ‘regular guys’, structure is needed where physical fitness is concerned; yet conversely, there are times where we must part from that set structure and use our instincts.

The most important aspect of physical fitness is the psychological component. Breaking down all of the important parts of a training program into simple, measurable tasks enables both the professional athlete and the ‘regular guy’ to mark consistent progress or note errors that can be corrected along the way as the particular cycle unfolds.

Generally, periodization prepares the individual psychologically for training at any level. Notably, even retired athletes who may no longer ‘need’ to periodize, often still do – even though their years of experience have rendered them extremely in tune with their bodies and more than capable of training instinctively.

That said, periodization may become necessary for the ‘regular guy’.

It may in fact be crucial for certain life events. For instance, if you are getting married in July and it is now January, and you want to lose 40lbs to look svelte in your tuxedo

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FITNESS

Instinctive periodization (particularly since your bride-to-be will no doubt be starving herself till her zip can barely close!), then depending on ‘instinctive training’ to shed the extra spare tyre around your middle may not be feasible, even if you are a gym regular.

A PERIODIZED REGIMENTED PROGRAM CAN BE COMPLEMENTED

BY THE PRINCIPLE OF INSTINCTIVE TRAINING – BUT INSTINCTIVE TRAINING SHOULD NOT BE USED IN ISOLATION. If you are, however, serious and realistic about your goal and the timeframe, it will be much more achievable if you break it down into shorter timeframes and focus on a plan for each cycle of periodization. Ultimately, this may not only bring you closer to your goal but may result in a much more thorough approach to the sculpting of your body as you desire – whereas instinctive training without a clear plan may over-emphasize one body part to the detriment of another (this, folks, is how we get the Johnny Bravo lookalikes!).

With this particular ‘regular guy’ at my gym, I urged him to try combining both ways of thinking, as it is possible to be both relaxed and focused where his physical fitness regimen is concerned.

A periodized regimented program can be complemented by the principle of instinctive training – but instinctive training should not be used in isolation. It is a principle developed so that the individual can get the best possible result – not an excuse to be lazy and do your own thing!

While you can train instinctively, the knowledge of some basic training periodization principles can make your training more productive. For instance, training instinctively can be erroneously considered to be training ‘hard’ all the time – knowledge of periodization will enable the individual to mix in ‘light’, ‘medium’ and ‘hard’ workouts to achieve the best results.

The key thing to be noted when adopting a principle based on instinct is that one must first understand that the relationship between training and instinct is one that is developed over time, which may be highly subjective in most cases. Acquiring that connection with your body may take a good few years of training under the belt. But for the more advanced, instinctive training can be your best friend.

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EMOTIONS

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YO UTH & THE ATR E

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YOUTH THEATRE AN EMOTIONALLY HEALTHY YOUTH GIVES RISE TO AN EMOTIONALLY HEALTHY NATION WRITTEN BY STAFF

For the most part, U The Caribbean Health Digest brings you fresh and helpful information about your own health and well-being. In this issue, we’d like to look at the health and well-being of our nation, particularly the youth, who are labouring under unimaginable stress and anxiety that not only impacts on their mental and emotional health, but also brings anguish and hardship to our society as a whole.

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Among the few brave and committed souls who have dedicated their lives to saving the next generation of Trinidadians and Tobagonians is writer, producer and dramatist, Steven Edwards. Through his non-profit organisation, Steven Edwards Productions, he uses theatre culture and technology to rehabilitate, nurture and inspire at-risk youth in many high-stress, impoverished communities throughout the country.

WRITER

His programmes don’t just get the youth off the dangerous streets of their neighbourhood and give them something to do for a few hours; instead, it teaches them viable, marketable skills that can help them create their own income-generating opportunities. “It’s a training ground. It’s not so much what they do, but why they do what they do.”

Those who aren’t keen on being on-stage are trained in technical fields, including PC and phone repairs.

“A lot of them join gangs for financial reasons,” Edwards explains. “You can’t just say, ‘Don’t sell weed because weed is bad’, because the question comes up: ‘How am I going to eat?’ Most of the times it is the elder one selling drugs to send the others to school.

You have to replace that revenue generating ability with something positive. Something they are genius at.”

Edwards has always loved the theatre and enjoyed sharing that love of the stage with the youth of his church. “There was young man in particular, 17, who always came out to practice. Then one day they took him out of his house, put him to kneel, and shot him in the head. That was the genesis of the programme.

We realised that this programme could literally save their lives, give them the ability to make better choices when you are not there.”

Edwards writes, produces and directs, and performs in his own scripts, supported by his wife and a handful of volunteers. Most of the content is easily identifiable by local audiences, featuring our own forest creatures and local characters. Over the past few years, they have put on presentations to enthusiastic audiences, and even post footage on YouTube on the StevenEdwardsPro channel.

His programme, Transformation Through Theatre and Technology, shows them a new way of life, a way to use their talents and God-given abilities to transform their reality.

He is also working on a documentary called Life in Laventille, which he intends to market extensively overseas. “It will help you see what these young people are living, and understand the choices they make.”

YOUTH & THEATRE

Another programme Edwards is eying for this year is Transformation Behind Bars, which he plans to kick off at the Youth Training Centre and the Women’s Prison. Of particular concern are young girls currently incarcerated through circumstances arising out of incest and sexual abuse. He also stands prepared to help young inmates find their way in the world upon their release. “Once you come out of prison,” he says, “there’s always a place for you at Steven Edwards Productions.”

“Since I came back I haven’t gotten myself into trouble.” He’s seeing an improvement in his work, and values the relationships he forged with other campers. “I really want to go back.”

Ultimately, he’d like to see a centre that the kids can come to to receive training. That’s dreaming big, but he’s sure that with the rising reputation of his company, that funding will come to pass.

“I didn’t expect to actually enjoy it.” In fact, he didn’t seem to think he’d done anything to merit being singled out, but admits that there had been accusations of bullying made against him by fellow students.

The sponsors are interested, and so are the awards committees of several organisations. Among the awards he has received, Edwards cites his Ideas to Innovation award and the Trinidad and Tobago Coalition of Service Industries (TTCSI) award for Best Recent Service.

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EMOTIONS

Like Shakeem, 16-year-old Adrian was finding himself in trouble, although he was attending a highly respected prestige school in Port of Spain. After coming out of a two-week suspension, he was sent by his school counsellor to one of Edward’s camps.

He quickly discovered that the programme was rich with activities, including folk dance, games, Trinidad and Tobago and world history, especially about slavery. “It was abolished, but I learned we are still living in a slave style.”

Six months after graduating from the programme, he is a changed person. “The camp taught you about your ways, how to control yourself, anger management and so on.”

The proof of the pudding, of course, is in the eating, and it’s not hard to see that in as little as two weeks, graduates of the programmes have experienced real and lasting change in their lives.

The most valuable lesson he left with was leadership.

“It changed my life, considering how I used to live before, to follow my friends to do bad things. I’m performing better in school.” Adrian’s exams are coming up, and he sees business school in his future.

Young Shakeem, who was sent to one of Edward’s All this, he credits to Edwards and his programme. camps in Success Laventille Secondary School on the recommendation of his principal, wasn’t sure why he “You get to socialise with people who are going had been chosen. But he sheepishly confesses, “I through harder times than you, teach how you have had problems with anger management before. I get to change, how not to go down the wrong road.” vex, I get angry quick, and if somebody get me vex, I would lash them, and get myself in trouble.”

And if Edwards ever needed proof that his labours are paying off, that’s probably it.

Six months after graduating from the programme, he is a changed person. “The camp taught you about To volunteer or sponsor, contact Steven Edwards your ways, how to control yourself, anger manage- by emailing rayvenbusinesses@gmail.com or calling 304-9159. ment and so on,” he says.

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PAEDIATRICS

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CO U G HING

COUGHING

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PAEDIATRICS

ANY SIGNS OF ILLNESS IN THEIR CHILDREN MAKE PARENTS UNHAPPY BUT THERE IS SOMETHING PARTICULARLY ALARMING ABOUT HEARING YOUR CHILD COUGH, ESPECIALLY IF THE CHILD COUGHS AT NIGHT. WHEN THAT HAPPENS THE MOTHER DOESN'T SLEEP EVEN IF THE CHILD AND THE FATHER DO.

IF THE CHILD WAKES UP, THEN NOBODY SLEEPS.

WRITTEN BY DR.

DAVID BRATT, MD. MPH. CMT

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50 | u

PAEDIATRICS

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CO U G HING

Generally, coughing is a sign that there is something wrong with the respiratory tract, which extends from the tip of the nose through the nasal cavity into the back of the throat and down the larynx (voicebox or Adam's apple) into the trachea (windpipe) and the two main bronchial tubes, which lead into the lung tissue itself. Each bronchial tube endlessly divides and subdivides, like the branches of a mango tree, and terminates in the lung alveoli or air-sacs, where environmental oxygen is exchanged for the carbon dioxide the body naturally produces. From the moment a newborn baby takes its first breath, surely one of the great miracles of life, to the last dying gasp, there is a continuous movement of oxygen into the respiratory tract and carbon dioxide out.

is an obstruction or inflammation or infection. Coughing is the attempt by the organism to get rid of the obstruction, whether caused by excess mucus or something else. Cough is to the respiratory tract as diarrhea is to the intestinal system.

Anything that interferes with this movement of gases causes coughing.

Usually, it is an obstruction of some sort, something that the baby may be born with or acquires later on in life, like a swelling or spasm of the bronchial tubes or inhaling and retaining a foreign body, like a piece of a peanut. Complicating these blockages is mucus production, which is the way the respiratory tract reacts to irritation of any sort, whether it

Cough that lasts less than two weeks is due mainly to the common cold.

It is not a good idea to try to suppress cough unless the cough is causing tiredness or weakness, something that does not happen in the great majority of children.

What is important is to get to the cause of the cough and treat that.

So, what causes children to cough? The common causes are the same regardless of where you live in the world.

There are two main types of cough: those that last less than two weeks and those that last more than two weeks.

Children have so many more colds and ear infections nowadays compared to long ago. All over the world, colds and ear infections are on the rise. We are not talking 20 years ago but about the time when the present group of grandmothers were young mothers, i.e., in the forties and fifties. A

time when there was less population, less pollution and more space in which to run about. The streets were safer and mothers had more time to spend with their children.

Family was present to help out with bringing up the kids and everyone in your street looked after everybody else's children.

Perhaps the "golden period" for children to live in the Caribbean.

There are three reasons why children get more colds and their main complication, middle ear infections, today. One is breastfeeding...or, rather, the lack of it. The second is pollution, and not only of the atmosphere but of our body.

And the third is lifestyle, or, rather, the lack of stylish living.

In fact, all of these factors are related to our lifestyle.

Since the mid-fifties, we have been living in a bottle-feeding culture, with cow’s milk being poured down baby's throats in astonishing amounts.

The world's largest supplier of milk today, sells 45 billion US dollars a year of milk, to parents of young children who do not need it. Feeding babies cow’s milk is the most expensive nutritional experiment ever carried out anywhere, anytime, and parents have to pay for this experiment,

COUGHING

not only in dollars and cents but in terms of their children's health. In the last twenty years we have begun to document the results of this experiment, i.e. what we are doing to our babies by making them drink a product created by nature for another young mammal, whilst avoiding our natural product. The result: a whole range of illnesses, from more frequent colds and ear infections to more frequent cancers. The answer to why babies fed formula get sick more frequently than breastfed babies is because formula doesn't have anywhere near the thousands of ingredients that human milk has, and which help prevent these illnesses, like cold and ear infections.

The second factor is pollution.

Pollution begins inside the mother's body, when the baby is in the womb. We used to think that the baby was well protected inside there, just an inert growing thing. We now know that there is a dynamic relationship between the mother and the baby and that anything that affects the mother affects her unborn baby and vice versa. The main pollutants again seem to be certain foods, and once again milk is high on the list of toxins.

That's because the protein in cow’s milk is the most allergenic of all substances known to man.

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When the mother drinks milk, this protein gets into her blood stream and is passed into the baby. It seems that the milk protein, together with other substances, sets up an allergic reaction inside the unborn child and makes it more susceptible to allergies once the child is born.

other children are bad habits and colds. In the nursery they pass around all their viruses at an age when their immune systems are not mature enough to competently handle so many infections.

So they get all the complications of these colds, the most common being middle ear infections.

Outside of the mother, the baby comes in contact with all the atmospheric pollution: vehicle exhaust fumes; industrial estate wastes; lead particles; cigarette smoke; pollens; cockroach particles, etc. In the home, all of this comes well trapped in the ubiquitous carpet of the new culture. On this carpet, the child is proudly placed. Result: more allergies, mainly manifested by runny noses and coughing.

The end result of formula feeding, cigarette smoke and other pollutants and a nursery lifestyle, is a child who "lives with a cold", and frequently gets ear infections. Yes, Granny, it is true that young children are getting more colds and allergies than when you were a mother. In the next edition we will talk about some of those allergic illnesses.

Finally, after a diet of milk and pollution, the child is deposited in a nursery with plenty of other children so that he can learn to "socialize". What an excuse for keeping up with the Joneses!

Children do not learn to socialize in a busy nursery.

Children learn to socialize one on one. One child to one adult.

Not one care-taker to six or seven babies. Human children love adults. Especially a particular adult. All babies want to form an intimate bond with one particular adult at a time. That's how they learn. All they get from

Dr. David Bratt is the author of The Book of Brats: Bringing up Children in the Caribbean.

PAEDIATRICS

Until then, stay healthy.

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THE NEXT U April to June 2013

HPV VACCINE SHOULD YOU GET IT? HERE ARE SOME ANSWERS TO YOUR QUESTIONS.

Safety and Genetically Modified Soy Part of the food chain for over 15 years.

Coconuts The natural goodness of this fruit, packed with antioxidant properties

Urticaria More commonly known as Hives; learn about the symptoms, causes and treatment options.

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