Paradise in Sickness The Frugal Balinist 23 Rotary News 20The Frugal Balinist 23 Rotary News 20

14Body & 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 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”. 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. SUICIDE.....The Big “WHY??” PARADISE... IN SICKNESS & IN HEALTH Copyright © 2017 Kim Patra You can read all past articles of Paradise...in Sickness & in Health at www.BaliAdvertiser.biz Kim Patra is a qualified Midwife & Nurse Practioner who has been living and working in Bali for over 30 years. She now runs her own Private Practice & Mothers & Babies center at her 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/ CHC Bali 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 3. Check the LiverTox website. The LiverTox website contains valuable information on hundreds of drugs that have been found to damage the liver, including herbal products. 4. Don’t always trust the label. To make matters worse, labels of herbal medications can’t always be trusted. Black cohosh, which is often taken for menopause symptoms, is considered safe. But products labelled as black cohosh have been linked to more than 50 cases of liver injury. In several cases, scientists found herbs from the Chinese actaea species in the supplement rather than black cohosh. Heavy metals, pesticides, and bacteria have also been found in supplements. 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. 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. 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. Despite our best efforts many people still aren’t getting the 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 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. 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 OLEANDER flower is a natural beauty – but it will KILL you. SUPPLEMENTS How many is too many? PARADISE... IN SICKNESS & IN HEALTH Copyright © 2019 Kim Patra You can read all past articles of Paradise...in Sickness & in Health at www.BaliAdvertiser.biz Kim Patra is a qualified Midwife & Nurse Practioner who has been living and working in Bali for over 30 years. She now runs her own Private Practice & Mothers & Babies center at her 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 WHO has warned that the over prescription of antibiotics will lead to a global resistance to pathogenic microbes (infection causing bacteria & viruses). While many developed countries have strict guidelines on the prescription of antibiotics, third world countries are much more relaxed on the issue, often considering the profits, incentives and commissions to be made rather than the wellbeing of the patient and the global community at large. For example, women that give birth in Indonesia are all given a course of Amoxicillin after birth “just in case” infection develops. With many doctors in Asia on low incomes, commissions from drug sales are often where they make their 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 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, 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. Work with your doctor • Don’t push for antibiotics with your doctor. If you don’t have a bacterial infection, ask how to relieve symptoms. Consumer demand is one of the major factors in the over-use of antibiotics. • Fight it off. If symptoms are mild and complications unlikely, ask if you can delay treatment for a few days. • Maintain a healthy lifestyle & diet. • Take antibiotics as prescribed. Don’t skip doses or stop the medicine early. • Don’t use leftover antibiotics to treat an infection. Taking the wrong medicine allows bacteria to multiply. If the household or personal product (cleaning solutions, soap, shampoo etc) says antibacterial, leave it on the shelf. Use vinegar, soap, or bicarb soda instead. Bacterial resistance cannot be stopped; it is part of evolution itself. However it’s development and spread can be minimized by: • Only using antibiotics when absolutely necessary. • Knowing what sort of illnesses respond to antibiotics. • Understanding that recovery from many illnesses will occur in the same time frame, with or without antibiotics. TOO MANY ANTIBIOTICS … Over-prescription of Antibiotics a Major Problem - WHO PARADISE... IN SICKNESS & IN HEALTH Copyright © 2019 Kim Patra You can read all past articles of Paradise...in Sickness & in Health at www.BaliAdvertiser.biz Kim Patra is a qualified Midwife & Nurse Practioner who has been living and working in Bali for over 30 years. She now runs her own Private Practice & Mothers & Babies center at her 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 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 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”. 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. SUICIDE.....The Big “WHY??” PARADISE... IN SICKNESS & IN HEALTH Copyright © 2017 Kim Patra You can read all past articles of Paradise...in Sickness & in Health at www.BaliAdvertiser.biz Kim Patra is a qualified Midwife & Nurse Practioner who has been living and working in Bali for over 30 years. She now runs her own Private Practice & Mothers & Babies center at her 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/ CHC Bali 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 3. Check the LiverTox website. The LiverTox website contains valuable information on hundreds of drugs that have been found to damage the liver, including herbal products. 4. Don’t always trust the label. To make matters worse, labels of herbal medications can’t always be trusted. Black cohosh, which is often taken for menopause symptoms, is considered safe. But products labelled as black cohosh have been linked to more than 50 cases of liver injury. In several cases, scientists found herbs from the Chinese actaea species in the supplement rather than black cohosh. Heavy metals, pesticides, and bacteria have also been found in supplements. 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. 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. 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. Despite our best efforts many people still aren’t getting the 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 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. 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 OLEANDER flower is a natural beauty – but it will KILL you. SUPPLEMENTS How many is too many? PARADISE... IN SICKNESS & IN HEALTH Copyright © 2019 Kim Patra You can read all past articles of Paradise...in Sickness & in Health at www.BaliAdvertiser.biz Kim Patra is a qualified Midwife & Nurse Practioner who has been living and working in Bali for over 30 years. She now runs her own Private Practice & Mothers & Babies center at her 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 WHO has warned that the over prescription of antibiotics will lead to a global resistance to pathogenic microbes (infection causing bacteria & viruses). While many developed countries have strict guidelines on the prescription of antibiotics, third world countries are much more relaxed on the issue, often considering the profits, incentives and commissions to be made rather than the wellbeing of the patient and the global community at large. For example, women that give birth in Indonesia are all given a course of Amoxicillin after birth “just in case” infection develops. With many doctors in Asia on low incomes, commissions from drug sales are often where they make their 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 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, 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. Work with your doctor • Don’t push for antibiotics with your doctor. If you don’t have a bacterial infection, ask how to relieve symptoms. Consumer demand is one of the major factors in the over-use of antibiotics. • Fight it off. If symptoms are mild and complications unlikely, ask if you can delay treatment for a few days. • Maintain a healthy lifestyle & diet. • Take antibiotics as prescribed. Don’t skip doses or stop the medicine early. • Don’t use leftover antibiotics to treat an infection. Taking the wrong medicine allows bacteria to multiply. If the household or personal product (cleaning solutions, soap, shampoo etc) says antibacterial, leave it on the shelf. Use vinegar, soap, or bicarb soda instead. Bacterial resistance cannot be stopped; it is part of evolution itself. However it’s development and spread can be minimized by: • Only using antibiotics when absolutely necessary. • Knowing what sort of illnesses respond to antibiotics. • Understanding that recovery from many illnesses will occur in the same time frame, with or without antibiotics. TOO MANY ANTIBIOTICS … Over-prescription of Antibiotics a Major Problem - WHO PARADISE... IN SICKNESS & IN HEALTH Copyright © 2019 Kim Patra You can read all past articles of Paradise...in Sickness & in Health at www.BaliAdvertiser.biz Kim Patra is a qualified Midwife & Nurse Practioner who has been living and working in Bali for over 30 years. She now runs her own Private Practice & Mothers & Babies center at her 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 It’s the end of the year, as well as the summer (or winter) holidays…depending on where you call home, so long flights and holidays are on the cards. Taking a few simple measure before, during and after the flight will make the trip a lot more comfortable. 1. Keep moving Keeping circulation flowing during a long trip is crucial so make sure to stretch your thighs however you can so the energy can move out and down through your legs, and do some deep breathing exercises regularly. Walk up and down the cabin during the waking hours to avoid DVT (Deep Vein Thrombosis), a common travel ailment. 2. Eat well & Stay hydrated Go for the healthier options on the menu (if there is one) and when the drink cart rolls by, make sure to stay away from coffee, alcohol or even tea as these can all contribute even more to dehydration. 3. Relax Use some aromatherapy and download some meditation or hypnosis apps on your phone for when you need to relax. Listening to music is a great way to relax the brain. Music has the power to shift consciousness and change the brain chemical activity. Bring along some noise cancelling headphones, to enhance your experience and cut out the noise from your neighbor, who could be chatting loudly or snoring even louder. 4. Pack layers The air conditioning on board may seem like a lifesaver if you’re just leaving a tropical climate, but the change in temperature is tough on the body. If you’re in your summer clothes - tank top, shorts and flip-flops for example - make sure to pack a light sweater, light scarf and some socks. If your neck, shoulders and feet are warm, you should be OK. Heat is very important to maintaining healthy immunity, especially when traveling. 5. Keep your body’s clock ticking When heading across time zones, “jetlag” is caused by a disruption to the body’s clock. While the shift is inevitable, you can avoid mental and physical fatigue by trying to stick as closely as possible to your usual routine. If you’re taking medications or supplements, try to adapt to the new time zone for the time you’re away and take at the equivalent of the same time each day if possible. Try to eat at similar times during the day. And while you may want to lie down on your plush hotel bed or doze off on the beach upon arrival, It would be wiser to stay awake for as long as possible in your new time zone then going to sleep early. 6. Comfort & hygiene A small pillow is a staple carry-on item for all long-distance travelers. Every airport on the planet will sell travel pillows, however I would shop around and research which in-flight pillows actually work best before the flight. An eye mask is especially useful if you’re flying during the day. Bring toiletries in your carry-on and make sure to brush your teeth, throw on some deodorant, or even change your clothes. Mint candies or breath fresheners are a must on long flights, for you and the guy net to you! 7. Avoid getting a blood clot Blood clots are a risk for certain people on long haul flights. Here are some simple steps that can be taken to reduce the risk of developing a DVT (Deep Vein Thrombosis): • Try to keep your thighs clear of the edge of your seat by keeping your feet up on the leg rests at the highest elevation or resting your feet on your hand luggage. • Exercise during the flight by moving around the aircraft cabin or by using a leg exerciser. • Drink plenty of water to avoid dehydration. Avoid too much alcohol. • Wear elastic flight socks or support stockings (this is particularly important for passengers with varicose veins). Make sure they are not tight around the knees, this will actually increase the risk of a clot forming. • Walk briskly for at least half an hour before takeoff & during transit stops. 8. Avoid Ear / Head Pain “Airplane ear” is the stress exerted on your eardrum and other middle ear tissues when the air pressure in your middle ear and the air pressure in the environment are out of balance. You may experience airplane ear at the beginning of a flight when the airplane is climbing or at the end of a flight when the airplane is descending. These fast changes in altitude cause air pressure changes and can trigger airplane ear. Ear or sinus pain can be anything from mildly uncomfortable, to feeling like your head is going to explode! This can be especially distressing for young children whose ear tubes are very narrow. Follow these tips to avoid airplane ear : • Yawn and swallow during ascent and descent. Yawning and swallowing activate the muscles that open your eustachian tubes. You can suck on candy or chew gum to help you swallow. • Use the Valsalva maneuver during ascent & descent. Gently blow, as if blowing your nose, while pinching your nostrils and keeping your mouth closed. Repeat several times, especially during descent, to equalize the pressure between your ears and the airplane cabin. • Don’t sleep during takeoffs and landings. If you’re awake during ascents and descents, you can do the necessar self-care techniques when you feel pressure on your ears. • Reconsider travel plans. If possible, don’t fly when you have a cold, sinus infection, nasal congestion or ear infection. If you’ve recently had ear surgery, talk to your doctor about when it’s safe to travel. • Use filtered earplugs. These earplugs slowly equalize the pressure against your eardrum during ascents and descents, (not regular earplugs) one brand is called “Earplanes”. I have never seen these in Bali. • Use an over-the-counter decongestant nasal spray. If you have nasal congestion, use a nasal decongestant about 30 minutes to an hour before takeoff and landing. Avoid overuse, however, because nasal decongestants taken over several days can increase congestion. • Use oral decongestant pills cautiously. Oral decongestants may be helpful if taken 30 minutes to an hour before an airplane flight. However, if you have heart disease, a heart rhythm disorder or high blood pressure, or if you’ve experienced possible medication interactions, avoid taking an oral decongestant unless your doctor approves. • Take allergy medication. If you have allergies, take your medication about an hour before your flight. And from my desk it’s a Very Happy New Years to you all. Stay Happy, Stay Healthy & Stay Happy ☺ The Long Haul…. How to Survive That Long FlightPARADISE... IN SICKNESS & IN HEALTH Copyright © 2019 Kim Patra You can read all past articles of Paradise...in Sickness & in Health at www.BaliAdvertiser.biz Kim Patra is a qualified Midwife & Nurse Practioner who has been living and working in Bali for over 30 years. She now runs her own Private Practice & Mothers & Babies center at her 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 By Kim PatraI was shocked when I read the WHO report on current global trends in diabetes. Diabetes is now the world’s fastest growing disease. Alarmingly, about 50 percent of people with diabetes are not aware they have it. Recent studies have shown that some people suffer from diabetes for up to 7 years without being aware that they have it. Diabetes is the seventh leading cause of death in developed countries and type II diabetes (mature onset) represents about 85 to 90 percent of all cases of diabetes. Early detection and management allows people living with diabetes to enjoy a healthy life. Here are some key facts: • The number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014 & has been rising more rapidly in middle- and low-income countries. • The global prevalence of diabetes among adults over 18 years of age has risen from 4.7% in 1980 to 8.5% in 2014. • Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation. • In 2015, an estimated 1.6 million deaths were directly caused by diabetes. Another 2.2 million deaths were attributable to high blood glucose in 2012. What is diabetes? Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar. Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body’s systems, especially the nerves and blood vessels. Type 1 diabetes Type 1 diabetes (previously known as insulin-dependent, juvenile or childhood-onset) is characterized by deficient insulin production and requires daily administration of insulin. The cause of type 1 diabetes is not known and it is not preventable with current knowledge. Symptoms include excessive excretion of urine (polyuria), thirst (polydipsia), constant hunger, weight loss, vision changes, and fatigue. These symptoms may occur suddenly. Type 2 diabetes Type 2 diabetes (formerly called non-insulin-dependent, or adult-onset) results from the body’s ineffective use of insulin. Type 2 diabetes comprises the majority of people with diabetes around the world, and is largely the result of excess body weight and physical inactivity. Symptoms may be similar to those of type 1 diabetes, but are often less marked. As a result, the disease may be diagnosed several years after onset, once complications have already arisen. Until recently, this type of diabetes was seen only in adults but it is now also occurring increasingly frequently in children. Gestational diabetes Gestational diabetes is hyperglycaemia with blood glucose values above normal but below those diagnostic of diabetes, occurring during pregnancy. Women with gestational diabetes are at an increased risk of complications during pregnancy and at delivery. Gestational diabetes usually goes away once the baby is born however; they and their children are also at increased risk of type 2 diabetes in the future. Gestational diabetes is diagnosed through prenatal screening (a simple glucose screening at 26 weeks), rather than through reported symptoms. Impaired glucose tolerance and impaired fasting glycaemia. Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) are intermediate conditions in the transition between normality and diabetes. People with IGT or IFG are at high risk of progressing to type 2 diabetes, although this is not inevitable. What are common consequences of diabetes? Over time, diabetes can damage the heart, blood vessels, eyes, kidneys, and nerves. • Adults with diabetes have a two- to three-fold increased risk of heart attacks and strokes. • Combined with reduced blood flow, neuropathy (nerve damage) in the feet increases the chance of foot ulcers, infection and eventual need for limb amputation. • Diabetic retinopathy is an important cause of blindness, and occurs as a result of long-term accumulated damage to the small blood vessels in the retina. 2.6% of global blindness can be attributed to diabetes (3). • Diabetes is among the leading causes of kidney failure (4). How can the burden of diabetes be reduced? Prevention Simple lifestyle measures have been shown to be effective in preventing or delaying the onset of type 2 diabetes. To help prevent type 2 diabetes and its complications, people should: • Achieve and maintain healthy body weight; • Be physically active - at least 30 minutes of regular, moderate-intensity activity on most days. More activity is required for weight control; • Eat a healthy diet, avoiding sugar and saturated fats intake; and • Avoid tobacco use - smoking increases the risk of diabetes and cardiovascular diseases. Diagnosis and treatment Early diagnosis can be accomplished through relatively inexpensive testing of blood sugar. A simple visit to your local doctor or Prodia lab is all it takes. Interventions that are both cost-saving and feasible in developing countries include: • Blood glucose control, particularly in type 1 diabetes. People with type 1 diabetes require insulin, people with type 2 diabetes can be treated with oral medication, but may also require insulin, blood pressure control & foot care. Other cost saving interventions include: • Screening and treatment for retinopathy (which causes blindness), blood lipid control (to regulate cholesterol levels), screening for early signs of kidney disease. As with so many other things, diabetes can easily be treated and managed IF YOU KNOW THAT YOU HAVE IT. If you ignore the signs, it can ultimately be fatal. DIABETES…..THE MODERN EPIDEMIC Diabetes……Think you’re not at risk? Read on! Copyright © 2018 Kim Patra You can read all past articles of Paradise...in Sickness & in Health at www.BaliAdvertiser.biz PARADISE... IN SICKNESS & IN HEALTH Kim Patra is a qualified Midwife & Nurse Practioner who has been living and working in Bali for over 30 years. She now runs her own Private Practice & Mothers & Babies center at her 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/ CHC Bali