JANUARY 2013
HEALTH CARE DIRECTORY2013
Part 1
HEALTHCARE DIRECTORY A SPECIAL ADVERTISING SUPPLEMENT OF THE BERMUDA SUN JANUARY 18, 2013 PAGE 1
Inside this supplement What you can do to combat tooth decay Pages 2-3 Abused women speak of their trauma Pages 4-5 Signs, symptoms and prevention of stroke Page 6 Dietary advice to protect your heart Page 7 Hypnosis can help you quit smoking Page 9 Problem of cost containment in healthcare Page 10 What you can do about colds and flu Page 11
Bermuda Sun 19 Elliott Street, Hamilton, Bermuda HM 10 Tel 295-3902 Fax 292-5597 E-mail feedback@bermudasun.bm This special supplement is produced and published by Bermuda Sun Limited and printed in Bermuda by Island Press Limited.
Pointers to designing your home gym Pages 13-14 Over 50s susceptible to osteoporosis Page 16
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■ FEBRUARY IS ORAL HEALTH MONTH
What you can do to combat tooth decay BY CELIA MUSSON-NZABALINDA Department of Health
Over the years I have often heard people say that they were born with soft teeth, or that everyone in their family has tooth problems. Enamel is the hardest structure in the human body and teeth are designed to last from the cradle to the grave; but even the hardest structure in the body cannot stand up to a daily acid bath. Very few people truly inherit soft teeth, so why do you see families who demonstrate a family tendency toward decay? The answer is found in the habits each family practices. Even before a child is born many parents do not realize that they are setting that child up for a lifetime of dental disease. Decay and periodontal (gum) disease are contagious. If parents and caregivers have decay, the child they care for is likely to have decay as well.
Bacteria The bacteria which cause dental diseases are passed from the mouth of the parent to the mouth of the child. These bacteria are found in abundance in the mouths of those with dental disease, but few bacteria are found in the mouths of those who are disease-free. There are three components which are necessary for the development of dental disease — bacteria, plaque and sugar. Controlling these three components is the key to preventing the disease process. Bacteria reside in plaque, which builds up in the mouth every day. Removing the plaque minimizes the bacteria. This is done by brushing twice daily for two minutes, flossing once a day, and using a tongue scraper once a day. Sugar is found in refined and natural forms in many
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CULTIVATE GOOD HABITS: As young people grow, controlling plaque, bacteria and sugar exposures continue to be important.
‘The bacteria which cause dental diseases are passed from the mouth of the parent to the mouth of the child.’ foods, including healthy food. The fact is we need a certain amount of carbohydrates to supply the energy needs of the human body. Teeth are detrimentally affected by sugar when the exposures come too frequently. Bacteria use the natural or refined sugars in the diet to supply their nutritional needs. They break down the sugar and produce acid, which they then excrete into the plaque on the teeth.
The acid exposure lasts about 20 minutes and begins to break down the enamel on the teeth. The saliva in the mouth gradually neutralizes the acid and the mouth returns to its normal alkali pH. Minimizing acid exposure helps to minimize the chances of decay. But if you snack between meals you increase the number of sugar exposures and you increase the chances of developing decay. Baby teeth are more sus-
ceptible to decay than permanent teeth. The enamel is significantly thinner and it does not take as long for decay to penetrate through the enamel into the dentin, where it spreads. Therefore, when children are fed food or liquids frequently, they are very likely to develop decay. Research shows that if a child has more than seven sugar exposures per day, the chances of decay increase significantly. We advocate exclusive breast-feeding for at least the first six months. This means that no other foods or beverages are introduced. With exclusive breastfeeding the chances of decay are less. Once other foods are introduced to a baby, the likelihood of decay increases significantly if there are
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greater than seven feedings. If a child has a sippy cup or bottle and sips a little now and then, then each time the child drinks, there is another sugar exposure. Similarly, the child who goes to bed with a bottle will usually fall asleep with a little milk in the mouth, and the teeth are then bathed in this for hours.
erupts. As young people grow, controlling plaque, bacteria and sugar exposures continue to be important. It is common for children in middle and high school to increase their beverage intake. This increases the chance of tooth decay in the adolescent and youth population.
Enamel
Brushing and flossing
First the enamel is softened and white patches appear. Once the decay breaks through the enamel, brown spots are evident. By this time the decay is already quite large. Controlling the frequency of food and beverage intake will help to train a child to develop proper feeding habits, as well as reduce the chances of decay. It is the recommendation of the American and Canadian Dental Associations that a child’s first dental visit should be at the age of one, or six months after the first tooth
Continuing a regimen of brushing twice daily for two minutes, flossing, and using a tongue scraper continues to be critical to the prevention process throughout life. Brushing should be done with a soft brush with good bristles. Brushes with bent bristles should be replaced. In general it is good practice to replace a toothbrush every three months. Brushing for two minutes without any method can lead to unsatisfactory results. It is important not to bounce around the mouth. Right-handed people
JANUARY 18, 2013 ■ 3
start brushing in the outer surfaces of the teeth in the upper-right molar area and work around to the left side. Then do the same thing on the surfaces next to the palate. Finally, brush the biting surfaces. Then use the same methodical approach on the bottom teeth. People who are left-handed may be more comfortable starting on the upper-left teeth. Flossing can be done once per day, either in the morning or the evening. Using a tongue scraper can remove build-up and bacteria from the tongue and can dramatically improve the smell of the breath. This simple routine will result in less decay and periodontal disease, and teeth that can last a lifetime.
Health benefits A healthy mouth will also improve the course of diabetes and heart disease. The mouth can be a source of constant infection, which causes the blood
sugars to be out of control, and it can also increase the build-up of blockages in the blood vessels (including the blood vessels in heart muscle). It is never too late to start taking care of your mouth. Once decay is taken care of, the number of bacteria in the mouth will decrease. A dental cleaning and daily care will improve the outcome of periodontal disease, while anti-bacterial mouth rinses can help get this condition under control. By taking care of your own teeth you are also helping to take care of the rest of your family. ■
DR CELIA MUSSONNZABALINDA DDS is the senior dental officer for the Department of Health. For more information see www. gov.bm, e-mail dentalclinics@gov.bm. Hamilton Health Centre 278-6440, St George’s Health Centre 2971932, Somerset Health Centre 234-0239.
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Abused women’s trauma and how they SUPPLIED BY THE CENTRE AGAINST ABUSE Domestic abuse affects one in three women in Bermuda, according to the Government’s Health Survey. But help is at hand. The Centre Against Abuse is a registered charity which provides services to rehabilitate both the victims and perpetrators of domestic abuse. It also has a safe house for women and children escaping violence. Most abusers are men and the Centre Against Abuse offers a Batterers’ Intervention Programme to deter this kind of behaviour. The charity also works to build up awareness of domestic violence and abuse, going to schools, companies and the community, to educate the public. Abuse knows no boundaries — whether geographic, social, demographic or economic. It also impacts a person’s physical, mental and emotional health. Below is the story of Maria (name changed to protect the woman’s identity), who suffered for years in a relationship with an abusive man. She sought help from the Centre Against Abuse and obtained a Domestic Violence Protection Order. She also received counselling to help her get her life back together.
Maria’s experience This is Maria’s account of the final moments of her relationship: “I was at a party by myself. I went to the bar and got a drink. I noticed my abuser but ignored him. Then I went to the dance floor and started to dance. “My abuser came to me and said, ‘Let’s go, our son is in the car’. I said, ‘Cool, don’t race me’. “When I looked at my abuser, I knew he was mad, so I went after him. As soon as I got out the door, my abuser was there waiting
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PUT A STOP TO IT: The Centre Against Abuse can help if you are in an abusive relationship. for me. He started to yell at me saying, ‘How could you embarrass me, dancing with a guy? You want to act like a whore; I’m going to treat you like one.’ “While saying that he was trying to pull off my clothes. I tried to stop him by holding my top up. I threw my drink on him to stop him. Then he started pulling and dragging me along the ground.
Screaming “The next thing I knew, he was standing over me assaulting me. I heard my son screaming and crying from the car ‘Momma!’ I tried to get up but couldn’t. My abuser picked me up and put me in his car. “I was screaming and crying, ‘I hate you!’ I repeated myself over and over. My abuser was saying, ‘I am sorry. I love you. I am sorry.
I didn’t hit you.’ A friend gave me some ice, someone else gave me water and I tried to get the blood off of my face. “I was still crying, I was escorted by my friend to another car and was taken to the police station to file charges. The police took my statement and told me to go to the hospital and the Centre Against Abuse. “I had a broken hand, stitches on my lip, several chipped front teeth, road rash on my face and back, and my foot was badly bruised.”
Survivor’s tale Below is an account of how domestic violence can affect your health and wellbeing, written by an abuse survivor. “The types of abuses I was enduring in my marriage took their toll on my physi-
cal and mental health. “I had developed various types of chronic ailments: asthma, acute allergies, skin conditions, teeth grinding, nervousness, insomnia, circulation problems, inflamed joints, gynaecological concerns, and hypertension. “This also led to poor mental health, including increased alcohol use. Fortunately for me, I didn’t lean on to the other substances. I already suffered from sinus problems, migraines, sensitive skin, and sensitivity to prescribed antibiotics and allergies. “During my marriage my allergies were amplified to the point where I experienced anaphylactic shock and an acute food allergen; and both incidents required emergency medicine intervention. “I underwent a
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eventually got their lives back on track sleep study and was fitted with a CPAP (continuous positive airway pressure) to assist my breathing disorders. “I had to visit the allergy specialist and that became an emergency situation. My partner was called to the doctor’s office as I was not asymptotic, and nearly died.
Medication “I was gaining weight, despite the combined change of diet and exercise. I wasn’t getting better; the medicine cabinet was lined with all types of medicines to assist with the ailments. “I became a walking pharmacy before I was 40; and was growing tired of the doctor’s visits. I decided to take another approach. I ventured into the nonmedicinal arena, acupuncture, to assist with my health issues. Initially, the
change started to make me feel better. The relationship would have an unwanted flare-up and so would my health ailments.
Link “Not once did I consider linking the relationship abuses to my health challenges. I was still able to function professionally; but personally I was barely coping. “Immediately, after my 40th birthday I was very ill for about three weeks, as it was one aliment after another. I just couldn’t shake the flu bug and the stress bug had its hooks on my mind and body with a vengeance. “Once I left my partner I noticed some subtle changes. My weight reduced, I was drinking less alcohol, and my sleep patterns were improving. I was less irritable with my home life and
the people in my space. My thoughts were not all over the place; I was becoming more stable and focused. “As I was healing my mind and broken spirit; unbeknown to me, I was also improving my health. My weight came off, I ate healthier, my eyes were brighter, I was smiling and laughing and living again.
Health changes “Just recently, I experienced some dizziness, blurred vision and feeling faint. I shared with my physician what I was experiencing. Much to my surprise it was my hypertension. “I was advised to stop the medication and to monitor my [blood] pressure. With simple lifestyle changes — leaving an abusive relationship and losing weight, I could control my hypertension through my diet again.
I was absolutely elated by my personal commitment and discipline to myself, to restore my health. “I feel empowered by the passion of my own potential and my transformation through self-discipline. “As a survivor of domestic violence I have restored my mental and physical health without supplements or prescribed drugs, and with the support of my family, friends and the extended family of the Centre Against Abuse.” The Centre Against Abuse helps up to 100 victims each year, and scores of abusers. ■
TO MAKE a donation via HSBC Bank Bermuda, reference the Centre Against Abuse and account No. 010 284 636 001, or send a cheque to: Centre Against Abuse, 3 Brooklyn Lane, Hamilton.
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■ FEBRUARY IS HEART MONTH
Signs, symptoms and prevention of stroke SUPPLIED BY BERMUDA HOSPITALS BOARD (BHB) A stroke occurs when a clot blocks the blood supply to part of the brain or when a blood vessel in or around the brain bursts. In either case, parts of the brain become damaged or die. “It is critically important that you call 911 immediately if you notice signs or symptoms of a stroke,” says Dr. Keith Chiappa, Chief of Neurology for Bermuda Hospitals Board. “The chance that you will survive and recover from a stroke is higher if you get emergency treatment right away. “The most common type of stroke is caused by a blockage of a blood vessel. Many patients are candidates for medicines that can reopen the blocked blood vessel but these medicines only work within the first three hours after a stroke and the earlier the better. “There is no room for delaying getting to the hospital. Every minute counts!” The five most common signs and symptoms of a stroke are: ■ Sudden numbness or weakness of the face, arm, or leg. ■ Sudden confusion or trouble speaking or understanding others. ■ Sudden trouble seeing in one or both eyes. ■ Sudden dizziness, trouble walking, or loss of balance or coordination. ■ Sudden severe headache with no known cause (“the worst headache you’ve ever had”). Signs of a stroke always come on suddenly. If your symptoms go away after a few minutes, you may have had a ‘mini-stroke’, also called a transient ischemic attack (TIA). “TIAs may not cause permanent damage but can be a warning sign of a full stroke and if you notice the symptoms, you should still get help immediately,” adds Dr. Chiappa. Several conditions and
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LOSE WEIGHT: Being overweight or obese can increase your risk for stroke. certain lifestyle choices can put people at higher risk for stroke. The most important risk factors are: ■ High blood pressure. ■ Heart disease. ■ Diabetes. ■ Cigarette smoking. ■ Prior stroke. “Everyone can take steps to lower the risk for stroke,” Dr. Chiappa explains. “Most importantly, you can do a lot to help prevent stroke by managing any medical conditions you might have and making healthy choices. Living a healthy lifestyle will greatly reduce your risk for stroke.” Here are simple tips for reducing your risk of a stroke: ■ Choose healthful meal and snack options. Be sure to eat plenty of fresh fruits and vegetables. ■ Eat foods low in saturated fat and cholesterol and high in fiber. Limiting salt or sodium in your diet can also lower your blood pressure.
■ Maintain a healthy weight. Being overweight or obese can increase your risk for stroke. To determine whether your weight is in a healthy range, doctors often calculate a number called the body mass index (BMI). Doctors sometimes also use waist and hip measurements to measure a person's excess body fat. If you know your weight and height, you can calculate your BMI at this web link. ■ Be active. Physical activity can help you maintain a healthy weight and lower cholesterol and blood pressure, and promote blood vessel and circulation health. It is recommended that adults engage in moderate-intensity exercise for at least 30 minutes on most days of the week. ■ Don't smoke. Cigarette smoking greatly increases your risk for stroke. So, if you don't smoke, don't start. If you do smoke, quitting will lower your risk. Your doctor can suggest ways to help you quit.
■ Limit alcohol use. Avoid drinking too much alcohol, which causes high blood pressure. If you have high cholesterol, high blood pressure, diabetes, or heart disease, here are steps you can take to lower your risk for stroke: ■ Have your cholesterol checked. Your healthcare provider should test your cholesterol levels at least once every five years. Talk with your doctor about this simple blood test. ■ Monitor your blood pressure. High blood pressure has no symptoms, so be sure to have it checked on a regular basis and treated vigorously if elevated. This is also very important for avoiding kidney disease. ■ Manage your diabetes. If you have diabetes, closely monitor your blood sugar levels. Talk with your health care provider about treatment options. ■ Take your medicine. If you're taking medication to treat high cholesterol, high blood pressure, or diabetes, follow your doctor's instructions carefully. Always ask questions if you don't understand something and do not stop taking the medications without physician guidance. ■ Talk with your healthcare provider. You and your doctor can work together to prevent or treat the medical conditions that lead to heart disease. Discuss your treatment plan regularly and bring a list of questions to your appointments. “While stroke can cause death or significant disability, such as paralysis, speech difficulties and emotional problems,” concludes Dr. Chiappa, “the good news is you can greatly reduce your risk through lifestyle changes although medication is necessary is many patients. “Remaining fit and healthy is often as simple as choosing to eat well, maintaining an appropriate weight, incorporating exercise, avoiding tobacco and cutting back on alcohol.” ■
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Dietary advice to protect your heart BY DR CARL LEVICK
Dietary suggestions
Bermuda Hospitals Board
Patients frequently consult their physicians for dietary advice regarding the prevention of cardiovascular disease. Given that 65 per cent of adult Bermudians are either overweight or obese, there is little doubt that a heart healthy lifestyle will mean reducing caloric intake for many people. For gradual weight loss, cutting just 100 calories a day from your current diet will produce results. Depending upon what you regularly eat, this could be as simple as eliminating one sugary drink a day. Doing this consistently over the course of a year will result in about a 10 pound weight loss. If you prefer more rapid results, cutting 500 calories per day will result in the loss of about one pound a week. But what should your diet be comprised of? It is generally accepted that saturated fat intake should be reduced for the prevention of cardiovascular disease. The main sources of saturated fat are from animal products: red meat and whole-milk dairy products, including cheese, sour cream, ice cream and butter. Plant-based sources of saturated fat, such as palm kernel oil, often crop up in commercially prepared products, like non-dairy whipped toppings, coffee creamers, cookies, cakes and other processed food items. The “Dietary Approaches to Stop Hypertension” (DASH) diet replaces saturated fat with carbohydrates, emphasizing the intake of fruits, vegetables and low-fat dairy products. While this diet has been shown to lower blood pressure and LDL cholesterol, which is associated with plaque build-up in the arteries, it also lowers HDL cho-
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1,000 STEPS: Buy a pedometer and count your steps, and aim for 10,000 steps per day. lesterol, sometimes referred to as ‘good’ cholesterol. Higher HDL levels are associated with cardiovascular health. To determine which dietary approach would best impact cardiovascular health, studies were conducted at Johns Hopkins and Brigham and Women’s Hospital. Patients followed three different healthful diets and their blood pressure results were then compared. One diet reduced the amount of saturated fat with carbohydrates, as the DASH diet does. The other two replaced saturated fats with either proteins or unsaturated fat. While each diet resulted in lower blood pressure and improved LDL cholesterol levels, the protein and unsaturated fat diets were clearly superior in terms of lowering blood pressure. Unsaturated fats are derived from vegetables and plants and include olive, peanut and canola oils and nuts and avocados, which tend to lower LDL (bad) cholesterol and maintain HDL (good) cholesterol. Other sources include safflower, sesame, corn, cottonseed and soybean oils. While these also tend to
lower LDL levels, consuming large quantities of these oils can lower your HDL cholesterol as well. Examples of low-fat, protein-rich foods include lean cuts of meat, skinless chicken breast, fish and seafood. Beans and soy products, like tofu and soy milk are good sources of lean vegetable protein. The protein diet reduced the 10-year risk of cardiovascular disease by 21 per cent. The unsaturated diet came in next at 19.6 per cent and the carbohydrate diet reduced the 10-year risk by 16 per cent. Clearly, replacing saturated fats in your diet with protein or unsaturated fat can further lower your blood pressure, improve lipid risk factors and reduce cardiovascular disease. Another important factor in maintaining heart health is to incorporate exercise. Our bodies are made to move and you can reap substantial health benefits even with minor adjustments to your routine. Here are some practical suggestions for modifying your diet to achieve a heart healthy regime, along with tips for incorporating more movement in your daily life.
■ Eat breakfast — people who consistently eat breakfast are leaner. ■ Choose an unsweetened whole grain cereal topped with fruit and 1 per cent skim milk. ■ Eliminate cream in coffee or tea — use low fat milk instead. ■ Use a sugar substitute. ■ Switch to low fat versions of all dairy products. ■ Choose low-fat, proteinrich foods like lean cuts of beef, skinless chicken breast and fish. ■ Minimize cheese consumption. ■ Consume three or more servings of vegetables per day (avoid starchy vegetables such as peas, corn and lima beans). ■ Replace refined grains/ simple sugars with whole grains. ■ Limit dining out to once a week. ■ Switch from regular soda to sugar-free soda or water.
Exercise suggestions ■ Purchase a pedometer and aim to walk 10,000 steps a day. ■ Move any chance you get: walk around the house during TV commercial breaks or when you talk on the phone. ■ Park as far away from your destination as possible and walk the rest of the way. ■ Walk on your lunch break. ■ Join a gym. ■ Exercise with a friend. ■ Go dancing. ■ Skip rope. ■ Play outside with your kids. s■ Join a basketball, baseball, soccer, cricket or rugby team. ■ Run or walk on the beach or go swimming. ■ Take up golf, tennis or another social sport. ■
DR CARL LEVICK, MD FACC, is a cardiologist with Cardiology Associates, Bermuda Hospitals Board.
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Hypnosis can help you quit smoking Subconscious mind needs reprogramming to change bad habits The time for resolutions and change is traditionally at the beginning of a new year. How wonderful to gain control over smoking and live a longer, healthier and happier life, starting right now. Why is MONICA stopping so DOBBIE difficult? Guest Columnist Because, although smokers consciously understand the long-term risks of smoking, they have shortterm emotional connections to smoking. They associate smoking with pleasure, the perception of being grown-up or sophisticated, and they often have a fear of not being able to stop. Stopping smoking means breaking the addiction to nicotine, which is a deadly poison. A way to address this addiction is to break the habit of lighting up. Like any habit, it can be changed if you are committed to making the change.
Going it alone Some smokers try to quit on their own, but they usually need several attempts before they are successful. One way to quit on your own is to identify the times that you smoke (for example, with a cup of coffee, after a meal, with a drink) and pick one of these times to stop smoking. Then pick another time. In that way the ‘need’ to smoke diminishes. Smokers often have internal conflicts. ‘Part’ of the smoker wants to stop — the health conscious part (adult), but another part still enjoys smoking (child). Automatically reaching for the pack of cigarettes when stressed, when bored, when having that cup of coffee, when driving, at the end of the day, or after a meal — all so regular and
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WANT TO STOP? If you have tried to stop on your own and failed then hypnosis may help you quit smoking. without thought. Logically it makes no sense to feel pleasure as you inhale poison into your body, but then smoking is not logical. If you do something often enough (smoke after a meal) the behaviour shifts from a conscious behaviour to an automatic response. Then, no matter how much you try to change the behaviour consciously, your subconscious mind reminds you to have a cigarette. The only way to make a permanent change in your behaviour is to change your programmed subconscious mind.
Hypnotherapy An effective way of doing this is with hypnotherapy. The reason that hypnosis works so well is that bad habits and undesirable behaviours are rooted in the subconscious mind. Although they once served a purpose (such as comforting you or making
you feel grown-up), they are patterns that have stuck and because they are so entrenched, it usually takes communication with the subconscious mind — through the relaxed, focused state of hypnosis — to help you reprogramme yourself to unlearn bad habits and replace them with lasting healthier habits.
Stress reduction One of the chief side-benefits of hypnosis is relaxation and the reduction of stress of both body and mind. While in a pleasant state of hypnosis, you focus and imagine achieving your desired goal whether it is to reach your ideal weight, stop smoking, exercise or become a better, more confident speaker. Hypnosis is the natural ability that we all have to focus our attention and subconscious thoughts on what we wish to achieve, instead of being at the mercy of old programming. It is a fast,
effective and pleasant way to overcome nicotine withdrawal symptoms without gaining weight or starting any other compensating ‘bad’ habit.
Decide You have the power of your own mind to help you to become a comfortable non-smoker. Make the decision today to break free from smoking and be in control of your healthy life starting now. You can stick to your new year’s resolutions to stop smoking, achieve your ideal weight, stop procrastinating, change habits, obtain more prosperity and reach your goals. Whatever your new year’s resolutions are, hypnosis can help you succeed. ■
MONICA DOBBIE, certified hypnotherapist, can be reached at 505 7531 or e-mail change@hypnosisbermuda.com and www. HypnosisBermuda.com
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Money, money, everywhere; but not a drop to cut BY JENNIFER ATTRIDE-STIRLING In healthcare, cost-containment has been the hot topic for some time. But with health fees and premiums rising faster than people’s pay cheques, the issue has become increasingly urgent. This message has been heard loud and clear. The problem is that costcontainment is not easy to do. Let me correct that: it is theoretically easy to do. There are many ways to cut costs, and these are well documented in the literature with countless books, studies and scholarly articles providing innumerable ideas, backed by evidence of how to contain healthcare costs. So the theory is sound. The problem is implementation. Because there the devil resides, and the bottom line is that there are only two ways to reduce health costs: to use less health services, and/or pay less for them. The reason is simple: healthcare costs are high because we spend a lot of money on healthcare — money that goes into someone’s pocket. So if we want health costs to go down (or, at least, not go up so much) it means that we have to put less money into someone’s pocket. That much seems easy — everyone likes to have a scapegoat. But, in fact,
to put less money into “someone’s” pocket usually requires that “someone” to do less. In healthcare that means less testing, less procedures and less volume. As a renowned health economist friend likes to say: “cost reduction for one party generally means revenue loss for another.” I like to add that it also means activity reduction in the health system... but this is clearly less catchy.
Number of MRI exams per 1,000 population, 2007 (or latest year available) United States
91.2 70.5
Bermuda ◊ Iceland
64.7
Luxembourg
63.3 48.0
Belgium OECD11
Excesses Looking at Bermuda’s health spending we can see there are some areas where we use too much of the wrong types of healthcare. For example: overuse of the emergency room to avoid co-pays or because it’s the only healthcare accessible; patients who don’t need to be in a hospital bed, but can’t be discharged because services or funds are not available in more appropriate settings; and our penchant for diagnostic tests, where we have among the highest rates in the world (see graph). These are some of the excesses driving our health costs. To reduce them, we will need to target misuse. Nevertheless, there is good news; very good news, in my view. First, there is a terrific amount of buy-in across the health sector for cost-containment.
■ ISTOCK PHOTO
HEALTH COSTS: Bermuda’s health spending needs examining as we use too much of the wrong types of healthcare.
41.3
Spain
32.9 31.2
Canada United Kingdom
28.8
Hungary
27.9 24.5
Czech Republic France*
21.8
Australia*
20.2 0
20
40
60
80
100
Exams per per 1,000 population OECD is the Organization for Economic Cooperation and Development ◊ Data for Bermuda only reflects exams at KEMH; excludes exams outside the hospital and overseas. * Only include exams for out-patients and private in-patients (excluding exams in public hospitals).
SOURCE: Health in Review 2011 Every stakeholder from the hospital, to GPs to insurers is on-board, and all agree that we have to work together to achieve it. Second, healthcare quality is not at stake and won’t be compromised. It’s clear from the evidence that our use of health services is so bloated in certain areas, that there is much scope to decrease use without sacrificing quality one bit. Appropriate, medically necessary care should never be compromised. And, lastly, the benefits of cost-containment are within our reach and, if we do things right, should see real improvements. So the future is bright. But we
will need to hold tight for now because devising these changes and bringing them about will most certainly rock the boat. Hence the title of this article — a take on the wellknown poem with the line: “water, water, everywhere, nor any a drop to drink”. In health, we are spending on more services than we need. To spend less we will have to look seriously at which ones we really do need. Money, money everywhere... is there a drop we are prepared to cut? ■
JENNIFER ATTRIDESTIRLING is CEO of Bermuda Health Council.
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What you can do about colds and flu BY STEPHANIE SIMONS Cold and flu season typically runs from November to March when we spend more time indoors and are in close contact with one another, increasing the chances that viruses will spread from person to person. While there are some similarities between colds and flu, they are not identical.
Colds A cold is caused by a virus and, according to the National Institute of Allergy and Infectious Diseases in the US, there are about 200 different viruses known to cause the symptoms of the common cold. Symptoms usually begin two to three days after infection and often include stuffy nose, swelling of the sinuses, sneezing, sore or scratchy throat, cough and headaches. Cold symptoms can last anywhere from two to 14 days, with the average duration being about a week. If your cold lasts longer than this with no improvement, or worsens, you should see your doctor. Cold infections are transmitted in several ways: touching your skin or other surfaces that have germs on them and then touching your eyes or nose; or inhaling drops of mucus full of cold germs from the air. While there is no cure for the common cold, you can get relief from symptoms by getting plenty of rest, drinking fluids, gargling with salt in warm water or using throat sprays or sore throat lozenges, putting Vaseline on a sore and tender nose, and taking a pain reliever for headaches or fever. Non-prescription cold remedies may relieve some of your cold symptoms but will not prevent or even shorten the length of a cold. Many of these medications have side effects such as drowsiness, upset stomach or insomnia, so you should take them with care. If you have a cold, talk to your pharmacist about what might work for you. Importantly, your pharmacist can also give you advice about the ways in which cold remedies may interact with prescription drugs that you may be taking.
Flu Influenza, or the flu, is a respiratory infection caused by a variety of flu viruses. Flu outbreaks begin suddenly
and spread through the community quickly. Children are two to three times more likely than adults to get sick with the flu. How do people catch the flu? Well, as with a cold, you can catch the flu if someone around you who has the flu coughs or sneezes, or if you touch surfaces that have been contaminated by someone with the flu.
including lots of rest, drinking plenty of liquids, and using over-the-counter medications. However, if you or your child develops a high or prolonged fever, has difficulty breathing or experiences shortness of breath, feels pressure in the chest, experiences shaking chills, is confused, or experiences severe or persistent vomiting, see a doctor right away. This may be a sign of a more serious infection requiring immediate medical attention. So what can you do to avoid catching a cold or getting the flu? First, avoid close contact with people you know are sick, and wash your hands often. Avoid touching your eyes, nose or mouth, since germs are often spread when you touch something that is contaminated and then touch your eyes, mouth or nose. Eat a healthy diet, full of vegetables and fruit. Garlic boosts your immune system, increasing resistance to infection and stress, so add garlic to your food when you cook. Cheese and other dairy products contain conjugated linoleic acid, a natural component of dairy fat that has boosted immune response in animal studies. Vitamin C, found in citrus fruits and juices, and Echinacea also help boost the body’s immune system. Zinc, found in chicken, meat, peanuts and peanut butter, ■ MCT IMAGE plays an important role in the Flu viruses pass through the air proper functioning of the immune sysand can enter your body through the tem in the body. nose or mouth. Flu symptoms vary If you or your child does get sick, from cold symptoms. In addition to you should stay home from work or sore throat and headaches, symptoms keep your child home from school include fever, extreme tiredness, dry to help prevent others from catching cough, nasal congestion and body the illness. aches. Cover your mouth and nose with According to the Food and Drug a tissue when coughing or sneezing. Administration in the US, you can Remember to wash your hands often. help prevent against the flu by getting Try eating fresh ginger root to help the flu vaccine each autumn. decrease nausea. Chicken soups and Children, pregnant women, seniors, warm beverages are another good and anyone living in a nursing home, idea, since they increase the flow of working in a health profession, or nasal secretions, helping alleviate cold suffering from other health problems symptoms. like asthma, diabetes or heart disease, This cold and flu season, let’s hope should receive the vaccine. Bermuda residents stay healthy. ■ See your own doctor or go to the government health clinic to receive it. STEPHANIE SIMONS is head pharIf you do get the flu, treatments are macist at Lindo’s Pharmacy in similar to those for the common cold, Devonshire.
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Pointers to designing your home gym While function matters most in an exercise room, a well-designed room makes exercising more enjoyable. Good design includes making a space right for its use and user. Many of the decorative elements MICHELE that make SMITH your exerGuest Columnist cise room look better also make it safer and more serviceable.
Walls Colour can be very motivating.Paint the walls of your exercise space to suit the type of exercise you plan on doing there. Choosing a colour that induces the right mood for your exercise routine will
help you to stay focused and want to be there. If you're a yoga enthusiast or simply want a spa-like effect, consider calming colours like sage green, lilac, silvery aqua or sky blue. If you need all the help you can get to stay on that treadmill for the allotted time, choose a warm, energizing colour, such as yellow, orange or red. Warm colours, especially brights, make a space feel smaller and warmer. If your room is small or if you have west-facing windows, tone it down by using lemony yellow, coral or a blue-based red. You are going to be spending some quality time in this room so make it enjoyable by having pleasant surroundings. Consider adding floor-toceiling mirrors on one of your walls. They'll bounce
light around, make the room look larger and allow you to make sure your form is correct.
Floors Exercise room floors need to give and absorb shock. Avoid exercising directly on hard tile or concrete. Hardwood floors are fine if they're not installed directly on concrete. Carpet and rubber flooring will give some shock absorption. If you do not want to redo the complete floor apply large interlocking thick foam tiles that look like jig saw puzzle pieces. Styles are available in many toy stores and will cover a fairly large area of the floor and give good shock absorption.
Furnishings In addition to any exercise equipment you're using, you'll need storage
for other items, such as towels and rolled-up mats. For an exercise room without closet space, consider adding a freestanding or wall-mounted shelving system. If you exercise to videos, mount a flat-panel television on a wall mount with a swivel so that you can reposition the television as needed. Add wall-mounted speakers and a music player if a lively beat helps you move. Even if you have a closet in your exercise room consider having a wall-mounted shelf for you put your water bottle on in order to reduce accidental water spills.
Space planning A floor plan highlighting your equipment will be important prior to setting up your room. Measure See HOME GYM, page 14
ARCHITECTURE ‡ INTERIOR DESIGN ‡ LANDSCAPE ARCHITECTURE
obm international ‡ 7 ‡ PVPLWK#REPL FRP ‡ REPL FRP
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HOME GYM
appropriate with your exercise equipment. An overhead chandelier strung with baubles doesn't work. Install cooler bulbs such as compact fluorescent or LED lights. If you will be using your room for cardio as well as yoga or stretching consider using a dimmer switch to change the mood of the room as your workout changes. Hugger ceiling fans also are a great idea to keep the air circulating.
Continued from page 13 your exercise equipment in the fully extended position in all directions. This includes the height of the equipment to be sure that it fits. Make grid-paper templates for each piece and arrange them on the floor plan. Allow three feet of walking space for major traffic patterns and at least two feet between each piece of equipment such as a treadmill or stationary bike. Place any large pieces of equipment close to the walls and leave an open space in the centre of the room for exercising on mats. If any equipment is to be wall-mounted make sure there is sufficient blocking within the wall cavity unless it is directly installed on concrete block.
Lighting Install clean-lined lighting fixtures — overhead, sconce and recessed — that look
Safety Your home gym should be a safe place. Small children should not have access to this space unless they are supervised. Use zip ties to bundle any extra cords or cord covers to tuck them out of the way. Put a floor cover strip over any cords that have to cross the room. A phone in your home gym is also a good idea in case you need to make an emergency call. Always keep water nearby to help you stay hydrated while you exercise.
Keep track Use a bulletin board to hang informational posters that describe common exercises, number of calories burned per workout, and other data related to your fitness goals. Also, display an outline of your workout regimen. For example, fill in a large calendar with specific workout goals for each day. Add the long-term results you hope to achieve, such as the number of pounds you want to lose. Write a note each day to keep track of your progress. After a while, you'll get a long-term view of your workout's effectiveness, allowing you to fine-tune your regimen to achieve your fitness goals.
Spend carefully Avoid buyer's remorse. Purchase equipment that you know you will enjoy using. Otherwise, your expensive purchase will gather dust. If you plan on having a treadmill or other large
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piece of exercise equipment, consider buying used equipment if possible. Check garage and yard sales for low-priced fitness equipment. If friends or family members have fitness equipment they don't use, make an offer. Inspect all prospective purchases carefully to ensure they are in proper working condition. Perhaps when starting out, keep it simple at first and add more equipment later. Initial pieces of equipment could be resistance bands and tubes, a stability ball, balance board, yoga matt and weights. Always be careful when using any exercise equipment. We exercise to stay healthy, strong and young but improper use can cause injuries. ■
MICHELE SMITH is managing director for OBM International Limited, Bermuda. She is a senior interior designer with expertise in solutions for seniors.
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Over 50s susceptible to osteoporosis BY DR ANNABEL FOUNTAIN Osteoporosis is a major public health issue but tends to be under-recognized and under-treated. According to figures from the US, nearly 50 per cent of women and 20 per cent of men over 50 will suffer a fracture due to osteoporosis. So what is osteoporosis? It is a condition which makes your bones weak, leading them to break more easily. People with the condition sometimes break a bone just by falling at home. But this can be serious, especially if they break a hip. Some people only learn they have osteoporosis after they break a bone during a fall or mild impact, or if they lose height as a result of bones in their spine collapsing. Healthy bones should not break easily, and so these injuries are called ‘fragility fractures’. Some people have an increased risk of osteoporosis. They include: smokers; post-menopausal women, people who have taken steroids or other medications for prolonged periods (some anti-epileptic drugs, Heparin, Prednisone, Vitamin A); those underweight or malnourished; people with endocrine disorders such as an overactive thyroid or over-replacement with the thyroid hormone; and men with testosterone deficiency. You can’t change some risk factors such as age, sex, race and family history, but to reduce risk of fracture, diagnosis and early treatment is key. You can be tested for osteoporosis with a special X-ray, the DXA scan, which measures bone density You can also keep your bones as healthy as possible by following a diet with enough calcium and vitamin D, which are essential for bone formation and maintenance. Men and pre-menopausal women should have at least 1,000 milligrams of calcium per day (from foods, beverages or supplements). Post-
menopausal women need more and should have 1,200 milligrams of calcium per day. Sources of calcium include: milk, yoghurt, orange juice, tofu; cheese, cottage cheese, ice cream/ frozen yoghurt, soy milk; beans; dark, leafy vegetables, almonds, and oranges. The Institute of Medicine recommends that men over 70 and post-menopausal women need 800 IU of vitamin D each day. Children and healthy adults should have 600 IU per day, up to age 70. Vitamin D is manufactured by our skin when it is exposed to sunlight, or eaten as part of our diet. If you sit in the midday sun for 15 to 20 minutes a day, you will make 1,000 IU of vitamin D. In the winter, particularly in the northern hemisphere, vitamin D supplements are an alternative. The pigments in darker skin act as a sunscreen, so this skin makes less vitamin D.
Vitamin D deficient Even though we are in sunny Bermuda, people who do not tend to spend time outside, such as the elderly, or who wear high factor sunscreen may be vitamin D deficient. A 2010 study in Nutrition Journal found that 42 per cent of adults in the US were Vitamin D deficient. The highest rates were among African Americans and Hispanics. Exercise also improves bone mass in younger women and will maintain bone density and increase its strength after menopause. Physical activity also reduces the risk of falling and hip fracture in older women. You should exercise for at least 30 minutes, three times a week. The National Osteoporosis Foundation (NOF) recommends medication to treat post-menopausal women and men over 50 with a history of hip or
vertebral fracture. Drug therapy may also be recommended if you have an estimated 10-year risk of hip fracture greater than 3 per cent, or osteoporosisrelated fracture greater than 20 per cent. Your physician can calculate the absolute risk of fracture using the World Health Organization FRAX calculator, at www.shef. ac.uk/FRAX.
Treatment Osteoporosis medications reduce bone loss, increase/ maintain bone density and reduce the chance you will break a bone. You also need to take calcium and vitamin D for the medicines to work. Most people being treated for osteoporosis take bisphosphonates first. They slow the breakdown of bone and come in pill or a shot form. To avoid throat or stomach irritation, if you take them orally then take the pill in the morning on an empty stomach with eight ounces of water. Do not eat or drink anything else for at least 30 minutes. Avoid lying down for 30 minutes after taking it. Raloxifene (Evista) and Tamoxifen are Selective Estrogen Receptor Modulators (SERMs). SERMs have oestrogen-like effects on the bone and protect against post-menopausal bone loss. They also decrease the risk of breast cancer in high-risk women. They may not be as effective as bisphosphonates or HRT and are not recommended for pre-menopausal women. Hormone replacement therapy (HRT) is taken by some women to replace estrogen and progesterone, which are lost through menopause and which protect against osteoporosis. HRT is also useful for women who cannot take other osteoporosis medicine. It is a useful prevention for younger women with premature menopause (due to surgeries, cancer
treatment or other causes). Overall, HRT is not recommended for osteoporosis in post-menopausal women, but some women with persistent menopausal symptoms and those who cannot tolerate other types of osteoporosis treatment still use it. Another treatment is synthetic calcitonin — a hormone which regulates calcium in the body and which is good for pain relief for vertebral fractures. Parathyroid hormone (PTH) is from the parathyroid glands and high doses of the synthetic hormone (Forteo) stimulate the body to make new bone. It is not recommended for pre-menopausal women. Denosumab (Prolia) is a new medicine, given as an injection every six months. It is currently reserved for individuals who cannot take other osteoporosis medications, or who have severe osteoporosis which the usual medications fail to work on. Osteoporosis causes bones to become abnormally weak and easily broken. It can be treated and prevented with diet, exercise, not smoking, regular exercise and calcium and vitamin D supplements. If you’re not getting enough calcium and vitamin D from your diet, it is recommended that you take supplements. There are several medications that help to prevent osteoporosis in women after menopause. Bisphosphonates are the most recommended therapies. There are other options for patients who are intolerant of or unresponsive to bisphosphonates. Your doctor may arrange follow-up tests to monitor how the bones respond to your osteoporosis treatment. This may include a bone density scan (DXA) or laboratory tests. ■
DR ANNABEL FOUNTAIN is director of endocrinology, Bermuda Hospitals Board.
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