Paradise in Sickness

Body & Spirit Body & Spirit

Just a few weeks ago, a family friend ended her own life.

She was young, vivacious, attractive and very talented.

She had some health problems which were manageable and she would probably have made a full recovery.

She had apparently spoken about suicide several times, although no one thought that she would actually do it.

Suicide is more common that you might think. Most people that you speak to know someone who has lost a friend or a relative to suicide. Suicide is the leading cause of death for

Australians aged between 15 and 44, with around 3,000 people dying by suicide every year. That’s an average of eight people every day.

In Indonesia, in particular Bali, suicide rates are relatively high, at approximately 150 deaths per year on the Island - although these figures are likely drastically less than the true figures, due to under reporting and the fact that suicide is a taboo subject amongst the local people.

For every suicide, there are tragic ripple effects for friends, families, colleagues and the broader community.

“When people kill themselves, they think they’re ending the pain, but all they’re doing is passing it on to those they leave behind.”

If someone you know seems to be struggling, reach out and connect with them. Showing that you care could make a huge difference in their life. If you are struggling yourself, you might feel better if you reach out for support, get treatment and start taking steps towards recovery.

Common warning signs

Someone who is thinking about suicide will usually give some clues or signs to people around them, though these may be subtle. Suicide prevention starts with recognising the warning signs and taking them seriously

Suicide warning signs

• A sense of hopelessness or no hope for the future. • Isolation or feeling alone - “No one understands me”. • Aggressiveness and irritability - “Leave me alone”. • Possessing lethal means - medication, weapons. • Negative view of self - “I am worthless”. • Drastic changes in mood and behaviour. • Frequently talking about death - “If I died would you miss me?”. • Self-harming behaviours like cutting. • Engaging in ‘risky’ behaviours - “I’ll try anything, I’m not afraid to die”. • Making funeral arrangements. • Giving things away (clothes, expensive gifts) - “When I am gone, I want you to have this”. • Substance abuse. • Feeling like a burden to others - “You would be better off without me”. • Making suicide threats - “Sometimes I feel like I just want to die”.

Responding to warning signs

Fortunately most threats of suicide are not genuine. It is usually a desperate cry for help. However, no suicide threat should be taken lightly. Suicidal intent can be very subtle, and even those whom you may think have every reason to live, can be very serious about taking their own life. Who would have thought that a man like Robin Williams would even dream of it? Talking to someone about suicidal thoughts can be challenging but if you are unsure whether someone is suicidal, the best way to find out is to ask.

ARE YOU SUICIDAL? Talking to someone about your suicidal feelings

Having suicidal thoughts can be scary. You may have never had them before, or perhaps the thoughts have been there for a while and you are not sure what to do. You may be

SUICIDE.....The Big “WHY??” ashamed to talk about it or worry that people will judge you or not take you seriously and just tell you to “Get over it”.

At this point in time we are popping more vitamins, herbs and other supplements than ever before. The supplement industry is the new Big-Farma. Australians alone are now spending over 8 million dollars a year on supplements that are questionably necessary.

It’s true, if you take a vitamin supplement as well as supplemented food such as orange juice, or fortified milk which comes with calcium and vitamin D. Energy bars, meal-replacement drinks, protein shakes, cereal bars, cereal itself - which claim lots of vitamins and minerals, up to 100% of the recommended daily allowance (RDA), you could end up getting up to 500% of the RDA, maybe more, in one day - up to five times what your body needs. But are we toting up toxic levels of vitamins? And throwing our money away?

The Fat Soluble Vitamins A,D, E & K

Fat soluble vitamins are stored in the body for longer than water soluble ones are, which generally poses a greater risk for toxicity that water soluble vitamins. The upper tolerable limit for adults is 10,000 IU for vitamin A. You get it from animal foods, fish, and dairy products. Also, beta-carotene (from orange and yellow veggies) gets converted to vitamin A in the body. If you’re taking a multivitamin that contains 5,000 IU, plus getting A-fortified foods in your diet, plus eating foods that contain vitamin A, you’re OK, but it’s the super-A supplements we worry about. It’s easy to overdo it with pills which is of particular concern for pregnant women. Vitamin D is tricky because we need some, and as we get older we need more. Too much can actually cause calcium to leach out of your bones, causing weak bones as well as high levels of calcium in the blood which will cause another set of serious problems. Vitamin D is found in some calcium supplements, and multi vitamins. If you do drink dairy, as well as take calcium with D, AND a multi you could be getting close to the limit. There is focus on vitamin E to prevent Alzheimer’s, heart disease, macular degeneration, cancer etc. The upper tolerable level is 1,000 milligrams (1,500 IU); the RDA is 30 IU, and even higher doses seem to be well tolerated. In an Alzheimer’s study, people took 2,000 IU for four years and did’t have any adverse effects. In another study, people took 800 IU for six years, with no adverse effects.

The Water Soluble Vitamin C & B’s

Most people think it’s fine to take as much Vit C as they want, I know people who take 10,000 mg a day. However, the upper tolerable limit is 2,000 mg a day. The risk for kidney stones can increase with very high doses and other people may get diarrhea. The B’s are generally well tolerated, however very high doses of B3 & B6 can have serious side effects.B supplements may be beneficial for pregnant women, the over 50, those that suffer from anxiety or depression, or people with certain medical conditions that prevent B absorption.

The Minerals

Like calcium, overloading on potassium supplements is potentially problematic for your ticker. This mineral has a function in regulating your heartbeat, and taking too much of it can cause heart problems. iron and zinc can both easily accumulate in your body and cause various issues, Digestive issues are typically the first sign that something is off, but people can also experience nausea, vomiting, seizures, or a rapid heartbeat.

The Herbs

Herbs can be very dangerous, particularly for your liver. Herbal and dietary supplements are now are responsible for about 20 percent of liver injury. An “all-natural” herbal product might sound like it’s good for your health, but some common ones, like green tea extract and comfrey tea, can cause injury to your liver - the organ that breaks down medications. Because of the potential risks, it’s important to take precautions if you decide to use a herbal product. Keep these tips in mind: 1. Beware of the big liver offenders. Green tea extract, anabolic steroids, pyrrolizidine alkaloids, and flavocoxid (a herb sold to treat arthritis) are among the top substances that can cause liver injury. If you love green tea, rest assured: Drinking up to 10 cups a day is safe. It’s the high doses of green tea extract usually found in weight-loss supplements that cause damage. Certain herbs used in traditional Chinese medicine have also been found to pose some risks. Researchers have identified 28 traditional Chinese medicine herbs and herbal mixtures that have been reported to cause liver toxicity. Meanwhile, comfrey - which is sold as a tea, powder, and capsule - contains several pyrrolizidine alkaloids that may cause liver injury. Chaparral, kava, and skullcap can also damage your liver. 2. Know what’s in it. Some herbal products, such as milk thistle, are known to be safe. But others contain additional ingredients: Green tea extract, for example, is added to many herbal products. And in some cases, supplements don’t list the ingredients at all but make claims that they will flush your liver

PARADISE...

IN SICKNESS & IN HEALTH

SUPPLEMENTS How many is too many? WHO has warned that the over prescription of antibiot- 3. Check the LiverTox website. The LiverTox website ics will lead to a global resistance to pathogenic contains valuable information on hundreds of drugs that microbes (infection causing bacteria & viruses). While have been found to damage the liver, including herbal many developed countries have strict guidelines on products.

the prescription of antibiotics, third world countries

are much more relaxed on the issue, often considering 4. Don’t always trust the label. To make matters worse, the profits, incentives and commissions to be made labels of herbal medications can’t always be trusted. Black rather than the wellbeing of the patient and the global cohosh, which is often taken for menopause symptoms, is community at large. considered safe. But products labelled as black cohosh have been linked to more than 50 cases of liver injury. In For example, women that give birth in Indonesia are all several cases, scientists found herbs from the Chinese given a course of Amoxicillin after birth “just in case” infection actaea species in the supplement rather than black develops. With many doctors in Asia on low incomes, cohosh. Heavy metals, pesticides, and bacteria have also commissions from drug sales are often where they make their been found in supplements.money. Self medication is also a huge problem in this society. Antibiotics (or any “prescription” drugs for that matter) are easily purchased at most pharmacies without any prescription at all. Even more shocking is that some backstreet “warungs” also stock a supply of antibiotics, usually selling to the “gentlemen” who have visited the local whorehouses. “Antimicrobial resistance (AMR) causes an estimated 700,000 deaths annually worldwide, and every country is potentially affected. If not properly addressed, the number could grow to 10 million per year by 2050”.

What are antibiotics?

Antibiotics, through various actions, destroy or inhibit the growth of bacteria. The antibiotic may be specific, and targeted at a small group of bacteria, or it may be a broad-spectrum antibiotic, which means it will be effective against a large group of organisms. Most antibiotics are absorbed well through the gut, and are sold as tablets or syrups, but some do have to be injected.

Do antibiotics cure all infections?

No they do not. Antibiotics have no effect at all on infections caused by viruses, or fungi. Viruses cause all types of flu and colds, and most coughs and sore throats. Recovery from viral infections will happen in the same number of days with or without antibiotics. In some cases antibiotics will be prescribed for someone suffering a heavy viral infection to prevent bacterial overgrowth. Antibiotics will aggravate the condition of someone suffering a fungal infection. Many “healthy bacteria” that normally live around our bodies actually assist us in our wellbeing. These friendly bacteria are killed when broad-spectrum antibiotics are prescribed. This then leaves an open arena for pathogens like certain fungi (e.g. Candida), to take over. Interestingly enough, recovery from some bacterial infections will happen in the same number of days with or without antibiotics. Our bodies do have the ability to heal themselves in most circumstances.

What is “Antibiotic Resistance”?

When antibiotics are used to kill a certain group of bacteria, some of those bacteria may adapt, grow and multiply with a new found strength that is able to resist the antibiotic that was once effective in killing it. Each time an antibiotic is used, the chance of resistance increases. The resistance to any antibiotic is not limited to one person but affects the entire community in general. For example if Fred takes antibiotics (eg Amoxicillin) for every minor infection that he has, the bacteria will soon become resistant to that antibiotic. If John is then infected by a bacteria that has been passed on to him by Fred, it will be of no use for John to take Amoxicillin. The bacteria is already resistant. This has been proven in communities worldwide. Penicillin, the very first antibiotic to be marketed, is now useless against most infections. Certain strains of antibiotic resistant Staphylococcus (Golden Staph.) have colonized in hospitals all over the globe. Malaria is resistant to Chloroquine in almost all high-risk Malaria regions (although strictly speaking Malaria is not a bacteria, but the same principle applies).

Five Strains of Bacteria that are Now Resistant

Antibiotic resistance risks returning us to an age where even simple cuts and scrapes can become deadly. For a glimpse of what could be commonplace in our future, here are five of the scariest antibiotic resistant bacteria from the last five years.

1. Extensively drug-resistant Salmonella typhi

This highly contagious bacterium causes typhoid fever, a life-threatening infection that affects about 21 million people around the world every year. About 1% of those affected, or 223,000 people, will die. In November 2016, a strain of Salmonella typhi emerged in Pakistan. It was resistant to five antibiotics, leaving only one oral antibiotic (azithromycin) able to treat it.

2. Extensively drug-resistant Mycobacterium tuberculosis

Mycobacterium tuberculosis is the world’s leading infectious killer, causing more than 1.7 million deaths every year. It’s estimated up to 13% of all new tuberculosis cases are multidrug-resistant, with Europe, including Russia, seeing the highest number of these cases.

3. Pandrug-resistant Klebsiella pneumoniae

Klebsiella pneumoniae is a common bacterium found in the skin, intestines and soil. It causes a range of potentially deadly infections in people with compromised immune systems. As this bacterium is particularly prevalent in hospitals, it’s one of the most critical drug-resistant threats to public health. In 2013 there were 8,000 reports of multidrug-resistant Klebsiella pneumoniae in the United States alone, with a death rate of 50% for people with bloodstream infections.

4. Pandrug-resistant Pseudomonas aeruginosa

Like Klebsiella pneumoniae, Pseudomonas aeruginosa is a commonly found bacterium that causes infections in people with compromised immune systems. Like Klebsiella pneumoniae, it’s particularly prevalent in hospitals. In the past five years, 29 cases of pandrug-resistant Pseudomonas aeruginosa infection have been reported in hospitals in England.

5. Extensively drug-resistant Neisseria gonorrhoeae

There are an estimated 78 million global cases of Neisseria gonorrhea, which causes gonorrhea, a sexually transmitted infection affecting men and women. Although usually not deadly, serious and permanent health problems including infertility can result if the disease goes untreated. Around

PARADISE... IN SICKNESS & IN HEALTH Just a few weeks ago, a family friend ended her own life. She was young, vivacious, attractive and very talented. She had some health problems which were manageable

TOO MANY ANTIBIOTICS … and she would probably have made a full recovery. Over-prescription of Antibiotics a Major Problem - WHO

one-third of all Neisseria gonorrhea infections are resistant to at least one antibiotic. More worryingly, a new extensively drug-resistant “super gonorrhea”, resistant to all but one antibiotic, has been discovered.

Steps to reduce use of antibiotics

Try to avoid infections in the first place. If you do get one, use antibiotics correctly. The following steps can help: Wash your hands often • Use plain soap and water. • Wash before preparing or eating food. • Wash after using the bathroom, changing a diaper, She had apparently spoken about suicide several times, sneezing, coughing, handling garbage and coming although no one thought that she would actually do it. home from public places. • Wash before and after treating a cut or wound or being Suicide is more common that you might think. Most people near a sick person. that you speak to know someone who has lost a friend or a At home • Don’t share personal items like towels, razors, tweezers relative to suicide. Suicide is the leading cause of death for and nail clippers. Australians aged between 15 and 44, with around 3,000 • Keep kitchen and bathrooms clean. You can clean surfaces with soap and water. Try to avoid products people dying by suicide every year. That’s an average of with added anti-bacterials. eight people every day. • Don’t put purses, diaper bags, or gym bags on the kitchen table or counter. • Wash wounds with regular soap and water. Use over-the-counter antibiotic products such as In Indonesia, in particular Bali, suicide rates are relatively neomycin (Neosporin and generic) or bacitracin only for high, at approximately 150 deaths per year on the Island - cuts that look dirty. Work with your doctoralthough these figures are likely drastically less than the • Don’t push for antibiotics with your doctor. If you don’t true figures, due to under reporting and the fact that suicide have a bacterial infection, ask how to relieve symptoms. Consumer demand is one of the major factors in the is a taboo subject amongst the local people. over-use of antibiotics. • Fight it off. If symptoms are mild and complications unlikely, ask if you can delay treatment for a few days. For every suicide, there are tragic ripple effects for friends, • Maintain a healthy lifestyle & diet. families, colleagues and the broader community. • Take antibiotics as prescribed. Don’t skip doses or stop the medicine early. • Don’t use leftover antibiotics to treat an infection. “When people kill themselves, they think they’re ending the Taking the wrong medicine allows bacteria to multiply. pain, but all they’re doing is passing it on to those they If the household or personal product (cleaning solutions, leave behind.” soap, shampoo etc) says antibacterial, leave it on the shelf. Use vinegar, soap, or bicarb soda instead. If someone you know seems to be struggling, reach out Bacterial resistance cannot be stopped; it is part of evolution itself. However it’s development and spread can be and connect with them. Showing that you care could make minimized by: a huge difference in their life. If you are struggling yourself, • Only using antibiotics when absolutely necessary. • Knowing what sort of illnesses respond to antibiotics. you might feel better if you reach out for support, get • Understanding that recovery from many illnesses will treatment and start taking steps towards recovery. occur in the same time frame, with or without antibiotics.

Common warning signs

Someone who is thinking about suicide will usually give some clues or signs to people around them, though these may be subtle. Suicide prevention starts with recognising the warning signs and taking them seriously

Suicide warning signs

• A sense of hopelessness or no hope for the future. • Isolation or feeling alone - “No one understands me”. • Aggressiveness and irritability - “Leave me alone”. • Possessing lethal means - medication, weapons. • Negative view of self - “I am worthless”. • Drastic changes in mood and behaviour. • Frequently talking about death - “If I died would you miss me?”. • Self-harming behaviours like cutting. • Engaging in ‘risky’ behaviours - “I’ll try anything, I’m not afraid to die”. • Making funeral arrangements. • Giving things away (clothes, expensive gifts) - “When I am gone, I want you to have this”. • Substance abuse. • Feeling like a burden to others - “You would be better off without me”. • Making suicide threats - “Sometimes I feel like I just want to die”.

Responding to warning signs

Fortunately most threats of suicide are not genuine. It is usually a desperate cry for help. However, no suicide threat should be taken lightly. Suicidal intent can be very subtle, and even those whom you may think have every reason to live, can be very serious about taking their own life. Who would have thought that a man like Robin Williams would even dream of it? Talking to someone about suicidal thoughts can be challenging but if you are unsure whether someone is suicidal, the best way to find out is to ask.

ARE YOU SUICIDAL? Talking to someone about your suicidal feelings

Having suicidal thoughts can be scary. You may have never had them before, or perhaps the thoughts have been there for a while and you are not sure what to do. You may be

SUICIDE.....The Big “WHY??” ashamed to talk about it or worry that people will judge you or not take you seriously and just tell you to “Get over it”.

At this point in time we are popping more vitamins, herbs and other supplements than ever before. The supplement industry is the new Big-Farma. Australians alone are now spending over 8 million dollars a year on supplements that are questionably necessary.

It’s true, if you take a vitamin supplement as well as supplemented food such as orange juice, or fortified milk which comes with calcium and vitamin D. Energy bars, meal-replacement drinks, protein shakes, cereal bars, cereal itself - which claim lots of vitamins and minerals, up to 100% of the recommended daily allowance (RDA), you could end up getting up to 500% of the RDA, maybe more, in one day - up to five times what your body needs. But are we toting up toxic levels of vitamins? And throwing our money away?

The Fat Soluble Vitamins A,D, E & K

Fat soluble vitamins are stored in the body for longer than water soluble ones are, which generally poses a greater risk for toxicity that water soluble vitamins. The upper tolerable limit for adults is 10,000 IU for vitamin A. You get it from animal foods, fish, and dairy products. Also, beta-carotene (from orange and yellow veggies) gets converted to vitamin A in the body. If you’re taking a multivitamin that contains 5,000 IU, plus getting A-fortified foods in your diet, plus eating foods that contain vitamin A, you’re OK, but it’s the super-A supplements we worry about. It’s easy to overdo it with pills which is of particular concern for pregnant women. Vitamin D is tricky because we need some, and as we get older we need more. Too much can actually cause calcium to leach out of your bones, causing weak bones as well as high levels of calcium in the blood which will cause another set of serious problems. Vitamin D is found in some calcium supplements, and multi vitamins. If you do drink dairy, as well as take calcium with D, AND a multi you could be getting close to the limit. There is focus on vitamin E to prevent Alzheimer’s, heart disease, macular degeneration, cancer etc. The upper tolerable level is 1,000 milligrams (1,500 IU); the RDA is 30 IU, and even higher doses seem to be well tolerated. In an Alzheimer’s study, people took 2,000 IU for four years and did’t have any adverse effects. In another study, people took 800 IU for six years, with no adverse effects.

The Water Soluble Vitamin C & B’s

Most people think it’s fine to take as much Vit C as they want, I know people who take 10,000 mg a day. However, the upper tolerable limit is 2,000 mg a day. The risk for kidney stones can increase with very high doses and other people may get diarrhea. The B’s are generally well tolerated, however very high doses of B3 & B6 can have serious side effects.B supplements may be beneficial for pregnant women, the over 50, those that suffer from anxiety or depression, or people with certain medical conditions that prevent B absorption.

The Minerals

Like calcium, overloading on potassium supplements is potentially problematic for your ticker. This mineral has a function in regulating your heartbeat, and taking too much of it can cause heart problems. iron and zinc can both easily accumulate in your body and cause various issues, Digestive issues are typically the first sign that something is off, but people can also experience nausea, vomiting, seizures, or a rapid heartbeat.

The Herbs

Herbs can be very dangerous, particularly for your liver. Herbal and dietary supplements are now are responsible for about 20 percent of liver injury. An “all-natural” herbal product might sound like it’s good for your health, but some common ones, like green tea extract and comfrey tea, can cause injury to your liver - the organ that breaks down medications. Because of the potential risks, it’s important to take precautions if you decide to use a herbal product. Keep these tips in mind: 1. Beware of the big liver offenders. Green tea extract, anabolic steroids, pyrrolizidine alkaloids, and flavocoxid (a herb sold to treat arthritis) are among the top substances that can cause liver injury. If you love green tea, rest assured: Drinking up to 10 cups a day is safe. It’s the high doses of green tea extract usually found in weight-loss supplements that cause damage. Certain herbs used in traditional Chinese medicine have also been found to pose some risks. Researchers have identified 28 traditional Chinese medicine herbs and herbal mixtures that have been reported to cause liver toxicity. Meanwhile, comfrey - which is sold as a tea, powder, and capsule - contains several pyrrolizidine alkaloids that may cause liver injury. Chaparral, kava, and skullcap can also damage your liver. 2. Know what’s in it. Some herbal products, such as milk thistle, are known to be safe. But others contain additional ingredients: Green tea extract, for example, is added to many herbal products. And in some cases, supplements don’t list the ingredients at all but make claims that they will flush your liver

PARADISE...

IN SICKNESS & IN HEALTH

SUPPLEMENTS How many is too many? WHO has warned that the over prescription of antibiot- 3. Check the LiverTox website. The LiverTox website ics will lead to a global resistance to pathogenic contains valuable information on hundreds of drugs that microbes (infection causing bacteria & viruses). While have been found to damage the liver, including herbal many developed countries have strict guidelines on products.

the prescription of antibiotics, third world countries

are much more relaxed on the issue, often considering 4. Don’t always trust the label. To make matters worse, the profits, incentives and commissions to be made labels of herbal medications can’t always be trusted. Black rather than the wellbeing of the patient and the global cohosh, which is often taken for menopause symptoms, is community at large. considered safe. But products labelled as black cohosh have been linked to more than 50 cases of liver injury. In For example, women that give birth in Indonesia are all several cases, scientists found herbs from the Chinese given a course of Amoxicillin after birth “just in case” infection actaea species in the supplement rather than black develops. With many doctors in Asia on low incomes, cohosh. Heavy metals, pesticides, and bacteria have also commissions from drug sales are often where they make their been found in supplements.money. Self medication is also a huge problem in this society. Antibiotics (or any “prescription” drugs for that matter) are easily purchased at most pharmacies without any prescription at all. Even more shocking is that some backstreet “warungs” also stock a supply of antibiotics, usually selling to the “gentlemen” who have visited the local whorehouses. “Antimicrobial resistance (AMR) causes an estimated 700,000 deaths annually worldwide, and every country is potentially affected. If not properly addressed, the number could grow to 10 million per year by 2050”.

What are antibiotics?

Antibiotics, through various actions, destroy or inhibit the growth of bacteria. The antibiotic may be specific, and targeted at a small group of bacteria, or it may be a broad-spectrum antibiotic, which means it will be effective against a large group of organisms. Most antibiotics are absorbed well through the gut, and are sold as tablets or syrups, but some do have to be injected.

Do antibiotics cure all infections?

No they do not. Antibiotics have no effect at all on infections caused by viruses, or fungi. Viruses cause all types of flu and colds, and most coughs and sore throats. Recovery from viral infections will happen in the same number of days with or without antibiotics. In some cases antibiotics will be prescribed for someone suffering a heavy viral infection to prevent bacterial overgrowth. Antibiotics will aggravate the condition of someone suffering a fungal infection. Many “healthy bacteria” that normally live around our bodies actually assist us in our wellbeing. These friendly bacteria are killed when broad-spectrum antibiotics are prescribed. This then leaves an open arena for pathogens like certain fungi (e.g. Candida), to take over. Interestingly enough, recovery from some bacterial infections will happen in the same number of days with or without antibiotics. Our bodies do have the ability to heal themselves in most circumstances.

What is “Antibiotic Resistance”?

When antibiotics are used to kill a certain group of bacteria, some of those bacteria may adapt, grow and multiply with a new found strength that is able to resist the antibiotic that was once effective in killing it. Each time an antibiotic is used, the chance of resistance increases. The resistance to any antibiotic is not limited to one person but affects the entire community in general. For example if Fred takes antibiotics (eg Amoxicillin) for every minor infection that he has, the bacteria will soon become resistant to that antibiotic. If John is then infected by a bacteria that has been passed on to him by Fred, it will be of no use for John to take Amoxicillin. The bacteria is already resistant. This has been proven in communities worldwide. Penicillin, the very first antibiotic to be marketed, is now useless against most infections. Certain strains of antibiotic resistant Staphylococcus (Golden Staph.) have colonized in hospitals all over the globe. Malaria is resistant to Chloroquine in almost all high-risk Malaria regions (although strictly speaking Malaria is not a bacteria, but the same principle applies).

Five Strains of Bacteria that are Now Resistant

Antibiotic resistance risks returning us to an age where even simple cuts and scrapes can become deadly. For a glimpse of what could be commonplace in our future, here are five of the scariest antibiotic resistant bacteria from the last five years.

1. Extensively drug-resistant Salmonella typhi

This highly contagious bacterium causes typhoid fever, a life-threatening infection that affects about 21 million people around the world every year. About 1% of those affected, or 223,000 people, will die. In November 2016, a strain of Salmonella typhi emerged in Pakistan. It was resistant to five antibiotics, leaving only one oral antibiotic (azithromycin) able to treat it.

2. Extensively drug-resistant Mycobacterium tuberculosis

Mycobacterium tuberculosis is the world’s leading infectious killer, causing more than 1.7 million deaths every year. It’s estimated up to 13% of all new tuberculosis cases are multidrug-resistant, with Europe, including Russia, seeing the highest number of these cases.

3. Pandrug-resistant Klebsiella pneumoniae

Klebsiella pneumoniae is a common bacterium found in the skin, intestines and soil. It causes a range of potentially deadly infections in people with compromised immune systems. As this bacterium is particularly prevalent in hospitals, it’s one of the most critical drug-resistant threats to public health. In 2013 there were 8,000 reports of multidrug-resistant Klebsiella pneumoniae in the United States alone, with a death rate of 50% for people with bloodstream infections.

4. Pandrug-resistant Pseudomonas aeruginosa

Like Klebsiella pneumoniae, Pseudomonas aeruginosa is a commonly found bacterium that causes infections in people with compromised immune systems. Like Klebsiella pneumoniae, it’s particularly prevalent in hospitals. In the past five years, 29 cases of pandrug-resistant Pseudomonas aeruginosa infection have been reported in hospitals in England.

5. Extensively drug-resistant Neisseria gonorrhoeae

There are an estimated 78 million global cases of Neisseria gonorrhea, which causes gonorrhea, a sexually transmitted infection affecting men and women. Although usually not deadly, serious and permanent health problems including infertility can result if the disease goes untreated. Around

PARADISE... IN SICKNESS & IN HEALTH

TOO MANY ANTIBIOTICS …

Over-prescription of Antibiotics a Major Problem - WHO

How Important is Vitamin D? In many parts of the world,

one-third of all Neisseria gonorrhea infections are resistant the winter can be cold with short, dark days. This season to at least one antibiotic. More worryingly, a new extensively often raises concerns about vitamin D, which is some- drug-resistant “super gonorrhea”, resistant to all but one times called the sunshine vitamin. antibiotic, has been discovered.

Steps to reduce use of antibiotics

Try to avoid infections in the first place. If you do get one, use antibiotics correctly. The following steps can help: Wash your hands often • Use plain soap and water. • Wash before preparing or eating food. • Wash after using the bathroom, changing a diaper, sneezing, coughing, handling garbage and coming home from public places. • Wash before and after treating a cut or wound or being near a sick person. At home • Don’t share personal items like towels, razors, tweezers and nail clippers. • Keep kitchen and bathrooms clean. You can clean surfaces with soap and water. Try to avoid products with added anti-bacterials. • Don’t put purses, diaper bags, or gym bags on the kitchen table or counter. • Wash wounds with regular soap and water. Use over-the-counter antibiotic products such as neomycin (Neosporin and generic) or bacitracin only for cuts that look dirty. But why should we be concerned in Bali where we have Work with your doctor • Don’t push for antibiotics with your doctor. If you don’t enough sunshine pretty much all year round? Vitamin D have a bacterial infection, ask how to relieve symptoms. levels have become a concern even in sunny parts of the Consumer demand is one of the major factors in the over-use of antibiotics. globe due to our “cover-up” lifestyles. Our windows in cars and • Fight it off. If symptoms are mild and complications homes have UV light screens, we protect our skin from sunlight unlikely, ask if you can delay treatment for a few days. • Maintain a healthy lifestyle & diet. to avoid the risk of skin cancer, we spend long hours in front of • Take antibiotics as prescribed. Don’t skip doses or stop computers in our offi ces and homes away from natural light. the medicine early. • Don’t use leftover antibiotics to treat an infection. Some cultures & religions also require (especially women) Taking the wrong medicine allows bacteria to multiply. to cover-up. If the household or personal product (cleaning solutions, soap, shampoo etc) says antibacterial, leave it on the shelf. What is Vitamin D? Use vinegar, soap, or bicarb soda instead. Vitamin D is technically not a vitamin because humans have Bacterial resistance cannot be stopped; it is part of evolution the capacity to produce it themselves through exposure to itself. However it’s development and spread can be sunlight. Vitamin D is biologically inert and must undergo two minimized by: • Only using antibiotics when absolutely necessary. chemical processes in the body for activation. The fi rst occurs • Knowing what sort of illnesses respond to antibiotics. in the liver and converts vitamin D to a prehormone called • Understanding that recovery from many illnesses will occur in the same time frame, with or without antibiotics. calcidiol. The second occurs primarily in the kidney and forms the physiologically active hormone calcitriol. Consequently, when we don’t get enough vitamin D, we will not have enough calcitriol inside our tissues (e.g. prostate, breast, colon etc.), and not having enough of a hormone can be very bad news. Vitamin D is important in prevention and treatment of a range of conditions including asthma, heart failure, and autoimmune diseases, such as multiple sclerosis and infl ammatory bowel diseases. Vitamin D is important for bone health. For example, vitamin D defi ciency causes rickets in children and osteomalacia or osteoporosis in adults. Further, vitamin D does have many nonbone functions in the body. Indeed, evidence is accumulating that vitamin D is important in prevention and treatment of a range of conditions including asthma, heart failure, and autoimmune diseases, such as multiple sclerosis and infl ammatory bowel disease (Crohn’s disease, ulcerative colitis).

How Do We Get Vitamin D?

Vitamin D is rare in standard human diets, as there are very few natural dietary sources. One major natural source is oily fi sh (salmon, sardines, etc.), but to get enough vitamin D from oily fi sh alone, you would need to eat two or more large servings every single day! In some countries, it is mandatory to fortify milk with vitamin D. However, fortifi ed dairy generally contains very low levels of vitamin D. Some other products can contain added vitamin D but this varies depending on the region and even the food supplier. Mushrooms are one of the few natural plant-based sources of vitamin D, but only when they have been exposed to sunshine (or ultraviolet B). Even then, the amount they contain will be low. Sunshine is the major source of vitamin D for most humans on the planet. When the ultraviolet (UV) light from the sun penetrates human skin, it triggers a chemical reaction that generates vitamin D. If a person with fair skin goes out in the sun for about 20 minutes wearing a bathing suit, 20,000IU (International Units) of vitamin D can be produced. For comparison, a large fatty piece of fi sh might contain about 1,000IU. Importantly, persons with darker skin will also generate vitamin D from sun exposure, but not as effi ciently due to the fact that darker skin contains more UV blocking melanin. This is a main reason why vitamin D defi ciency can be more severe among people of color. People also lose some of their ability to produce vitamin D from sunshine as they age, putting the elderly at a greater risk for defi ciency as well.

Insuffi cient Sun Exposure

The major factor for vitamin D defi ciency is insuffi cient sun exposure. Geographical location, specifi cally latitude (distance from the equator) has a major infl uence on vitamin D levels. The further we are from the equator, the lower the strength of the sun and the lower our potential to produce vitamin D.

PARADISE...

IN SICKNESS & IN HEALTH

VITAMIN D - How Important is it Really? Season is also important. In the summer, the sun is higher in the sky, which means less UV radiation is fi ltered by the atmosphere, and the daytimes are longer.

Let someone know

Let someone know Share how you feel with someone you trust and feel comfortable with, a family member, teacher, doctor or other health professional. Try and think about it as any other conversation. You can describe what has happened, how you feel and what help you need. It’s best to be direct so that they understand how you feel. Be prepared for their reaction. Often people who learn that someone is suicidal can be quite confused and emotional at first. Just keep talking and together you can find a way through it. Ask your friends/ family member to help you find support in person, online, over the phone. Understand that others do care. It is important to have support from your friends but if you tell them about your suicidal thoughts you cannot expect them to keep it a secret. They want to be able to help you stay safe and that usually means calling in extra help. There are few if any support centres for expatriates suffering from mental health issues in Indonesia or Bali. While there are some excellent counsellor now resident on the Island, their services are reasonably expensive. Help lines overseas are plentiful, so sourcing support on line from your country of origin may be the best option for some people. Support for local people can be sourced at the SURYANI Institute http://www.suryani-institute.com/ or the department of Mental Health at Sanglah Hospital.

Share how you feel with someone you trust and feel comfortable with, a family member, teacher, doctor or other health professional. Try and think about it as any other conversation. You can describe what has happened, how you feel and what help you need. It’s best to be direct so Does Sunscreen Use Lead to Vitamin D Defi ciency? High-SPF sunscreens are designed to fi lter out most of the that they understand how you feel. Be prepared for their sun’s UVB radiation, since UVB damage is the major cause reaction. of sunburn and can lead to skin cancers. UVB wavelengths happen to be the specifi c wavelengths that trigger vitamin D Often people who learn that someone is suicidal can be production in the skin. Nonetheless, clinical studies have quite confused and emotional at first. Just keep talking and never found that everyday sunscreen use leads to vitamin D together you can find a way through it. Ask your friends/ 5. Tell your doctor what herbal products you’re using. insuffi ciency. In fact, the prevailing studies show that people family member to help you find support in person, online, over the phone. Understand that others do care. It is important to have support from your friends but if you tell 5. Tell your doctor what herbal products you’re using. Giving your doctor a full list of what you’re taking, including herbal teas or supplements, is extremely important. Giving your doctor a full list of what you’re taking, including herbal teas or supplements, is extremely important. 6. Look for drug contraindications. Another reason to report any supplements you’re taking to your doctor: They who use sunscreen daily can maintain their vitamin D levels. One of the explanations for this may be that no matter how much sunscreen you use or how high the SPF, some of the them about your suicidal thoughts you cannot expect them to keep it a secret. They want to be able to help you stay safe and that usually means calling in extra help. 6. Look for drug contraindications. Another reason to report any supplements you’re taking to your doctor: They could be working against your prescription medications. St. John’s wort, for example, should be avoided by anyone taking the contraceptive pills or hepatitis C medications. could be working against your prescription medications. St. John’s wort, for example, should be avoided by anyone taking the contraceptive pills or hepatitis C medications. 7. Limit the number of herbal products you take. The ingredients could overlap, and you could end up with a higher sun’s UV rays reach your skin. Should You Supplement Vitamin D? Vitamin D defi ciency affects around 1 billion people, making it There are few if any support centres for expatriates suffering from mental health issues in Indonesia or Bali. While there are some excellent counsellor now resident on the Island, their services are reasonably expensive. Help lines overseas 7. Limit the number of herbal products you take. The ingredients could overlap, and you could end up with a higher dose of something that’s potentially toxic. In general, the fewer drugs you take - including those derived from herbs - the better. dose of something that’s potentially toxic. In general, the fewer drugs you take - including those derived from herbs - the better. Despite our best efforts many people still aren’t getting the right vitamins, either through lack of diet variation or one of the biggest nutritional issues worldwide. A vitamin D blood level of around 30ng/ml (75nmol/L) is optimal (the blood test is called 25-hydroxyvitamin D or 25(OH)D - which is available at Prodia lab albeit rather costly). To obtain this blood are plentiful, so sourcing support on line from your country Despite our best efforts many people still aren’t getting the destruction of nutrients through cooking etc. level, evidence supports moderate and regular sun exposure of origin may be the best option for some people. right vitamins, either through lack of diet variation or destruction of nutrients through cooking etc. If you’re taking medicine that interferes with nutrient absorption, if you’re an older person whose calorie intake is for most humans. If the sun is strong enough exposure every other day for 10-20 minutes of will be suffi cient. Darker skin will Support for local people can be sourced at the SURYANI Institute http://www.suryani-institute.com/ or the department If you’re taking medicine that interferes with nutrient absorption, if you’re an older person whose calorie intake is low, if you’re an athlete, or if you’re pregnant my advice low, if you’re an athlete, or if you’re pregnant my advice would be to take a multivitamin as insurance. Take a calcium supplement, if you don’t drink much milk. generally need longer. However, this may not be possible if you live far from the equator and it’s winter. This also may not be of Mental Health at Sanglah Hospital. would be to take a multivitamin as insurance. Take a calcium supplement, if you don’t drink much milk. Rather than taking a supplement you’re not sure about, first learn all you can about it, talk with your doctor, and improve practical if your schedule and lifestyle makes it diffi cult for you to get outside. In these scenarios, a vitamin D supplement is PARADISE... IN SICKNESS & IN HEALTH Rather than taking a supplement you’re not sure about, first learn all you can about it, talk with your doctor, and improve your health by considering herbal products in a safe way. A nutritionist can evaluate your diet for deficiencies. Also, some online programs provide the same service. If you are seeing a naturopath or herbalist make sure that they are qualified and experienced. And remember, NATURAL is not necessarily SAFE. The PARADISE... IN SICKNESS & IN HEALTH Kim Patra is a qualified Midwife & Nurse Practioner who has been living and working in your health by considering herbal products in a safe way. A nutritionist can evaluate your diet for deficiencies. Also, some online programs provide the same service. If you are seeing a naturopath or herbalist make sure that they are qualified and experienced. And remember, NATURAL is not necessarily SAFE. The OLEANDER flower is a natural beauty – but it will KILL you. worth considering. Menopausal women, and the elderly should also consider a supplement. In conclusion, vitamin D is not a cure all magic bullet, but it is important. Aim for moderate sun exposure when possible and consider vitamin D supplementation when it is not. OLEANDER flower is a natural beauty – but it will KILL you. Bali for over 30 years. She now runs her own Kim Patra is a qualified Midwife & Nurse Practioner who has

Kim Patra is a qualified Midwife & Nurse Private Practice & Mothers & Babies center at been living and working in Bali for over 30 years. She now runs Kim Patra is a qualified Midwife & Nurse Practioner who has

Practioner who has been living and working in her Community Health Care office in Sanur. her own Private Practice & Mothers & Babies center at her been living and working in Bali for over 30 years. She now runs

Bali for over 30 years. She now runs her own Kim Patra is a qualified Midwife & Nurse Practioner who has Community Health Care office in Sanur. her own Private Practice & Mothers & Babies center at her Private Practice & Mothers & Babies center at been living and working in Bali for over 30 years. She now runs Kim Patra is a qualified Midwife & Nurse Practioner who has Kim is happy to discuss any health concerns that Community Health Care office in Sanur. Kim Patra is a qualifi ed Midwife & Nurse Practioner who has her Community Health Care office in Sanur. her own Private Practice & Mothers & Babies center at her been living and working in Bali for over 30 years. She now runs you have and may be contacted via email at Kim is happy to discuss any health concerns that you have and been living and working in Bali for over 30 years. She now runs Community Health Care office in Sanur. her own Private Practice & Mothers & Babies center at her balikim2000@gmail.com, or office phone may be contacted via email at balikim2000@gmail.com, or office Kim is happy to discuss any health concerns that you have and her own Private Practice & Mothers & Babies center at her Copyright © 2017 Kim Patra You can read all past articles of Paradise...in Sickness & in Health at www.BaliAdvertiser.biz Kim is happy to discuss any health concerns that you have and may be contacted via email at balikim2000@gmail.com, or office phone 085105-775666 or https://www.facebook.com/ CHC Bali Copyright © 2019 Kim Patra You can read all past articles of Paradise...in Sickness & in Health at www.BaliAdvertiser.biz Kim is happy to discuss any health concerns that you have and may be contacted via email at balikim2000@gmail.com, or office phone 085105-775666 or https://www.facebook.com/CHCBali Copyright © 2019 Kim Patra You can read all past articles of Paradise...in Sickness & in Health at www.BaliAdvertiser.biz Community Health Care office in Sanur. Kim is happy to discuss any health concerns that you have and may be contacted via email at balikim2000@gmail.com, or office phone 085105-775666 or https://www.facebook.com/CHCBali Copyright © 2017 Kim Patra You can read all past articles of Paradise...in Sickness & in Health at www.BaliAdvertiser.biz 085105-775666 or https://www.facebook.com/ CHC Bali Copyright © 2019 Kim Patra You can read all past articles of Paradise...in Sickness & in Health at www.BaliAdvertiser.biz phone 085105-775666 or https://www.facebook.com/CHCBali Copyright © 2019 Kim Patra You can read all past articles of Paradise...in Sickness & in Health at www.BaliAdvertiser.biz may be contacted via email at balikim2000@gmail.com, or office phone 085105-775666 or https://www.facebook.com/CHCBali Copyright © 2019 Kim Patra You can read all past articles of Paradise...in Sickness & in Health at www.BaliAdvertiser.biz Community Health Care offi ce in Sanur. Kim is happy to discuss any health concerns that you have and may be contacted via email at balikim2000@gmail.com, or offi ce phone 085105-775666 or https://www.facebook.com/CHCBali