APRIL 2014
HEALTH CARE
DIRECTORY2014
Part 2
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healthcare directory a special advertising Supplement of the bermuda sun APRIL 4, 2014 page 1
Inside this supplement Bermuda men: Live fast, die young Pages 2-3 Cancers and men: What you need to know Pages 4-5 Why retirement can be a difficult time for men Page 7 Nail separation common ailment at spa Page 8 Drinking: How much is too much alcohol? Page 9
Bermuda Sun 19 Elliott Street, Hamilton, Bermuda HM 10
Prostate cancer is a major concern for men Page 10
Tel 295-3902 Fax 292-5597 E-mail feedback@bermudasun.bm
Lifestyle and diet, factors in increasing risk Page 11 Grilled or fried? Check your obesity genes Pages 12-13 Work out the kinks with a sports massage Page 14 Healthy lifestyle myths debunked Page 15 ‘Scratchie’ reflects on 72 years of barbering Page 16
The Bermuda Sun publishes twice weekly and is a subsidiary of MediaHouse Limited. We are members of the Inland Press Association, International Newspaper Marketing Association and the Newspaper Association of America. We are located at: 19 Elliott Street, Hamilton HM 10; P.O. Box HM 1241, Hamilton HM FX Tel: 295-3902 Fax: 292-5597. Visit our website: www.bermudasun.bm
This special supplement is produced and published by Bermuda Sun Limited and printed in Bermuda by Island Press Limited.
Publisher Randy French President Lisa Beauchamp Editorial Robyn Bardgett Editorial Layout Jack Garstang Advertising Sales Carlita Burgess (Deputy Advertising Manager), Diane Gilbert, Claire James, Larissa French, Trikeita Outerbridge Creative Services Christina White, Colby Medeiros, Calae Steede Circulation & Distribution Michelle Furbert
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HEALTHCARE DIRECTORY: a special advertising supplement
THE BERMUDA SUN
Bermuda men: Live fast, die young By Jennifer AttrideStirling,
Women and men’s health behaviours
CEO Bermuda Health Council
Bermuda’s men are optimistic about their health and well-being. So how do their health statistics match that perception? The Bermuda Health Council (BHeC) and the Department of Health publish reports on population trends with respect to health outcomes, healthcare access, health-related behaviours and health expenditure. For example, the 2011 Health Survey of Adults, the 2011 Health in Review report and the 2013 Health Disparities Report help us to understand health trends on the island, in order to identify problem areas and find workable solutions. The trend for Bermuda’s men? Overall, men are just as happy with their health as women, but they are less likely to access healthcare or to practise some healthy behaviours. According to these reports, 84 per cent of men
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said they were in excellent, very good or good health (same as women), and they were more likely to report being well every day than women — 69 per cent versus 62 per cent. These statistics are encouraging, but on average, life expectancy for Bermuda’s men at birth is 77 versus women’s 82 years. This is a global pattern, but the local context is also important. So while a posi-
‘Overall, men are just as happy with their health as women, but they are less likely to access healthcare or to practise some healthy behaviours.’ tive outlook is a wonderful thing, it has to be weighed against the danger of masking potential or current health problems. Men were less likely to eat fruit than women — 14 per cent versus 25 per cent ate three or more servings a day, and were less likely to eat breakfast than women — 68 per cent versus 78 per cent. Men and women were similar in their vegetable and fast food consumption, but neither had a great record in these areas — only one in five eat three servings of vegetables daily, but one in five eat fast food three times a week.
More active than women
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CAN I TEMPT YOU? Health surveys indicate that men were less likely to eat fruit than women.
However, men are more likely than women to participate in vigorous physical activity — 23 per cent versus 19 per cent, three times a week. However, 72 per cent of men are overweight or
obese, which is higher than the overall population rate (67 per cent). And men are smoking! That’s right, folks; men smoke more than women (20 per cent versus 9 per cent) and are more likely to have more than one sex partner than women (34 per cent versus 12 per cent). Men are also more likely to have been in a road accident (10 per cent versus 5 per cent); and were less likely to wear a seat belt than women (21 per cent versus 12 per cent). However, both sexes have similar binge-drinking habits, which are not a statistic to be proud of — one in three had engaged in ‘binge drinking’ at least once in the previous month. Nearly all men and women had a routine checkup within the previous year or two; only 2 per cent had not. Well done, Bermuda! But men were less likely to go to a GP or dentist — 35
THE BERMUDA SUN
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and leave a good-looking corpse per cent men versus 20 per cent women had not seen a GP in a year. Despite this, however, most men did have a prostate screening — four in five men aged over 55 had a screening within five years — and one in three men had a seasonal flu shot, exactly the same as women.
Women and men’s access to healthcare
Hospital admission In addition, men may be more conservative users of hospital services. For example, men were less likely than women to be admitted to the hospital for asthma and have seen a steeper decline in their admission rates for chronic obstructive pulmonary diseases (COPD) than women. So there’s good news but also room for improvement in men’s health.
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As the old adage goes: “an apple a day keeps the doctor away”; men are staying true to the latter part in terms of their GP visits, but would do well to eat that apple, and a few vegetables too, to really live up to the old saying. Ultimately, there
must be a commitment by both men and women to link men’s positive health outlook with positive health outcomes. A great place to start is knowing the information about our habits, so that Bermuda’s health system
stakeholders can work together to turn these trends around. n
For more information and access to BHeC’s reports, please visit our website: www.bhec.bm
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THE BERMUDA SUN
Cancers and men: What you need to know Deborah Titterton Narraway Marketing and Fundraising Manager Bermuda Cancer and Health Centre
Bermuda has some rather alarming cancer statistics considering the reporting of cancer in Bermuda is not mandatory. The Bermuda National Tumour Registry reports the following based on the number of registered cancer cases that have been reported: n Over 330 people are told “you have cancer” each year, approximately 52 per cent are male. n Approximately 80 people lose their battle with cancer each year in Bermuda. n Bermuda’s incidence rate of melanoma in the adult population is 12 per cent higher than reported by the National Cancer Institute for the US. The most common type of cancer women and men both can have is basal or squamous cell skin cancer. Although these skin cancers tend not to be fatal, a percentage of those persons will also develop the more deadly type –– melanoma. According to the American Cancer Society (and in line with statistics from the Bermuda Tumor Registry), after skin cancer, the top three cancers in men are: 1. Prostate cancer. 2. Lung cancer. 3. Colon and rectum cancer (colorectal). Prostate Cancer is the most common cancer in men. See articles by Dr Paul Coty, Consultant Oncologist at King Edward VII Memorial Hospital, and Brenda Dale, assistant vice president and project manager at the Argus Group (pages 10-11).
Lung cancer Lung Cancer is the leading cause of cancer death in both men and women, and smoking is the most important risk factor for lung cancer. According to the
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SMOKING RISK: The American Cancer Society reports the chance that a man will develop lung cancer in his lifetime is about 1 in 13, with smokers at a higher risk. American Cancer Society, the chance that a man will develop lung cancer in his lifetime is about 1 in 13; this number includes both smokers and non-smokers. For smokers, the risk is much higher while for nonsmokers the risk is lower. And black men are about 20 per cent more likely to develop lung cancer than white men. What puts one person more at risk than another? n People who smoke. n People exposed to secondhand smoke. n People exposed to indoor and outdoor air pollution. n People exposed to certain toxic substances, such as arsenic, radon or asbestos. n People whose jobs expose them to radiation. n People with personal or family histories of lung cancer. The most common cause of lung cancer is long-term exposure to tobacco smoke from smoking. Lung cancer in non-smokers — approximately 15 per cent of cases –– is usually attributed to genetic factors, asbestos and other air pollution including secondhand
smoke. Symptoms that suggest lung cancer include: n Dyspnoea (shortness of breath). n Haemoptysis (coughing up blood). n Chronic coughing or change in regular coughing pattern . n Wheezing. n Chest pain or pain in the abdomen. n Cachexia (weight loss), fatigue, and loss of appetite. n Dysphonia (hoarse voice). n Clubbing of the fingernails (uncommon). n Dysphagia (difficulty swallowing). Lung cancer may be diagnosed early, usually because it has been found by accident on a chest X-ray and computed tomography (CT) scan while scanning for another medical condition. Testing is not recommended for people who are at average risk. However, there are screening guidelines for individuals who are at high risk of lung cancer due to cigarette smoking. n If you are a long-term smoker with a history of 30 pack-years or greater (for example, a person who has
smoked at least a pack a day for 30 years) and meet the following criteria, then you might be a candidate for screening: n 55 to 74 years of age. n In fairly good health.
Colon and rectum cancer Colorectal cancer is cancer of the colon or rectum. With certain types of screening, this cancer can be prevented by removing polyps (grape-like growths on the wall of the intestine) before they become cancerous. Several screening tests detect colorectal cancer early, when it can be more easily and successfully treated. Colon and rectal cancers are often lumped together as “colorectal cancer”. Rectal cancers arise in the final six inches of the digestive tract. Cancers that occur above the rectum are called colon cancers. Colorectal cancers generally begin as a small polyp, and while most polyps will be benign, some will be precancerous. Colorectal cancer risk factors: n People age 50 and older. n People who smoke.
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APRIL 4, 2014 n 5
n People who are overweight or obese, especially those who carry fat around their waists. n People who are not physically active. n People who drink alcohol in excess, especially men. n People who eat a lot of red meat (such as beef, pork or lamb) or processed meat (such as bacon, sausage, hot dogs or cold cuts). n People with personal or family histories of colorectal cancer or benign (not cancerous) colorectal polyps. n People with personal histories of inflammatory bowel disease (such as ulcerative colitis or Crohn’s disease). n People with family histories of inherited colorectal cancer or inherited colorectal problems. Colonoscopy screening should begin at age 50 and then every five years or as advised by your physician. During the colonoscopy, the surgeon will remove polyps and send to the lab for further analysis. Other screening tests include faecal occult blood test (FOBT) that tests for blood in the stool, and sigmoidoscopy, which examines the last portion of the colon (from the anus to the sigmoid) only. Many people with colorectal cancer experience no symptoms in the early stages of the disease. When symptoms do occur, they will vary depending on the cancer’s size and location in the intestine. See your doctor if you experience any of the following: n A change in your bowel habits, including diarrhoea or constipation or a change in the consistency of your stool for more than a couple of weeks. n Rectal bleeding or blood in your stool. n Persistent abdominal discomfort, such as cramps, gas or pain. n Abdominal pain with a bowel movement. n A feeling that your bowel does not empty completely. n Weakness or fatigue. n Unexplained weight loss. Do not ignore blood in
your stool. While this may occur with haemorrhoids, proper follow-up is necessary to ensure the cause is not cancer. Screening is available and highly recommended: n Beginning at age 50, both men and women should follow one of these testing schedules: n Faecal occult blood (stool) test every year* or n Flexible sigmoidoscopy every 5 years (not commonly done in Bermuda) n Colonoscopy every 10 years n CT colonography (virtual colonoscopy) every
five years (recommended only for those persons with pre-existing bowel disease and who are at high risk for complications). A diagnosis of cancer can be frightening, but where there is hope there is healing, not just for the cancer patient, or the survivor, but also for their family, caregivers and friends. Speaking with your doctor and discussing concerns should always be your first option. However, family members and others may have difficulty in finding relevant current health information.
Cancer Information Service By calling 232-2247 you will be connected with a trained and knowledgeable cancer information specialist, who will provide you with personal and confidential information. n
Bermuda Cancer and Health Centre is a registered charity engaged in the prevention, detection and support of cancer and other health concerns in the local community. For more information visit their website www.chc.bm or call 236-1001.
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HEALTHCARE DIRECTORY: a special advertising supplement
THE BERMUDA SUN
RETHINKING DRINKING….
ALCOHOL AND YOUR HEALTH Submitted by the Research Unit, Department for National Drug Control People drink to socialise, celebrate, and relax. If you are someone who drinks alcohol it is likely that you have experienced first-hand at least some of its short-term health effects, be it a hangover or a bad night’s sleep. The longer term health effects of alcohol, on the other hand, are what people often only experience once it is too late. According to the National Institute on Alcohol Abuse and Alcoholism in the United States, people who drink too much on a single occasion or over a long period of time may experience alcohol’s longer-term effects, which can include: alcohol dependence, health problems, and increased risk for certain cancers such as cancer of the mouth, esophagus, throat, liver, and breast. Results of the 2013 National Household Survey on Drug Use and Health indicate that many of Bermuda’s residents understand the health risk involved with drinking alcohol; however, many continue to engage in such behaviour.
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People who admitted current use of alcohol were more likely to engage in other risky behaviours such as smoking cigarettes (81.1%) or smoking marijuana (65.2%). Current alcohol drinkers: • Admitted to having problems with a partner because of alcohol (8.2%) when compared to non-alcohol drinkers; • Were more likely to have lost friends or partners because of alcohol (10.9%); • Felt like decreasing the amount of alcohol they consumed (27.3%); • Said they drink more than they wanted to without noticing (7.8%); and • Woke in the morning after having drunk the night before and did not remember part of what happened (28.4%).
Drinking too much on a single occasion or over time can take a serious toll on your health. Options for reducing alcohol-related risks include: staying within low-risk drinking limits; taking steps to be safe when you drink; and quitting drinking altogether. If you or a loved one needs help or more information call the Department for National Drug Control.
The Survey highlighted the following findings: • On a whole, alcohol has remained the substance of choice among Bermuda’s adults, currently being consumed equally by both males (28.5%) and females (28.4%). • When asked about the frequency of alcohol use, most participants admitted to using alcohol mostly on weekends (14.3%). • Males were more likely to consume five or more standard drinks in one sitting (binge drinking) when compared to females. • Participants of this survey understood that drinking alcohol sometimes (78.3%) and often (67.4%) or becoming drunk presented some level of risk and when it came to other substance using behaviours, participants felt that drinking alcohol was most harmful even more so than smoking marijuana. • A person is more likely to use alcohol if he/she has family members or friends who get drunk. According to survey respondents, 26.1% of participants said that they had about one to five friends or family members who get drunk and over one third admitted to being current alcohol Suite 304 Melbourne House | 11 Parliament St. | Hamilton | HM 12 drinkers (36.3%). Tel: 292-3049 | Fax: 295-2066 | www.dndc.gov.bm
Think Health…not drugs.
THE BERMUDA SUN
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APRIL 4, 2014 n 7
Retirement can be a difficult time for men Past generations of men signalled retirement as the end of life, not merely the end of working life. As sole bread earners in the family, many men dreaded their retirement and regarded it MICHELLE as an end to who they SMITH were in the Guest Columnist public eye and suffered emotional and mental turmoil as a result. I asked men that I know what they would do after they retired. Many of them had no idea and no hobbies per se; but had every intention to either get into better shape or find something that would keep them busy. If they take their own advice they will probably live longer than those who camp out on the sofa. Retirement is a time when some honest self-examination is essential. The fastest-growing age group in this decade comprises those 65 and older and those who will be entering that 50 plus age or presenior status as it is so often now referred. People spend more years in retirement than they do in childhood and adolescence combined and how to spend that time has become a very real concern, especially for men whose life span is shorter than women’s and who typically take less care of themselves. Surveys suggest that some men want to travel more, read more, play more golf, or even volunteer or maintain a standing on a particular board to keep them active in the business community. Staying employed is another growing trend for men over 65. There are many reasons for not retiring; some can’t afford to and others are simply in their element and enjoying it too much. Instead of fully retiring,
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KEEP STIMULATED: Studies have shown that retirees who are active and develop hobbies and interests live longer and have fewer health problems. they retire from a 40-hour work week to a shorter schedule. If you enjoy your job, why not keep doing it? Many men consult on a regular basis. They enjoy using their skills and experience in assisting businesses — as long as they can do it on their terms.
Staying sharp According to “The Art of Manliness” website: “Hobbies can bring you joy, increase your eye for detail, keep your mind sharp, expand your creativity, and help you meet friends and learn valuable skills. “They add interest to your life and help you become a more well rounded man. If you’ve been feeling depressed, restless or apathetic, the problem may be the lack of having something in your life you feel passionate about, something that brings you needed fulfilment.” One of the best aspects of retirement is finally having time to do all those things you always dreamed of doing, like reading more, completing a coin collection, building wood working skills or playing a musical instrument. Didn't have hobbies before? Retirement is the
‘I have known many men who have picked up a chisel only to find hidden talent with a piece of wood.’ opportunity to find some. book clubs, writing clubs and gardening are all top choices and staying active in Bermuda is year round. I have known many men who have picked up a chisel only to find hidden talent with a piece of wood. There is no shortage of men’s groups you can join, Freemasonry to mentoring young men, to martial arts or community college classes.
Make a start All you need to do is start, but that’s where the problem lies, in starting something. If in doubt as to where to start, volunteer. Of all those people who volunteer, about a third of them are elderly. Apart from having more free time, retirees have discovered that volunteering provides an excellent outlet for the skills and passions they've spent a lifetime developing.
Staying connected to others your own age also helps fight depression especially if a widower. Let your hobbies blossom. Stay physically active, as studies have shown, people who keep their bodies moving after retirement — by gardening, playing golf or going to the gym a few days a week — live longer and have fewer health problems than those who opt for more sedentary lifestyles. One of my favourite groups in Bermuda is Age Concern. This is a fantastic organization where men can assist with their skills whether it be helping with taxes, carpentry or plumbing. Many seniors could use the help, and who better than an experienced man looking for something to do. n.
Michele Smith is the managing director with OBMi Bermuda office.
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THE BERMUDA SUN
Nail separation common ailment at spa Submitted by Orchid Nail Spa At Orchid Nail Spa we take every effort to educate our customers while they are receiving their services or via social media. The most common problem we see at Orchid Nail Spa is onycholysis. It is currently averaged to harbour in one in every six customers that walk through our doors. It is the most common and neglected nail hindrance due to the following factors: n Bermuda’s humidity. n Customers’ continuous perspiration. n Customers’ tendency to fashion longer nails and toenails. n Immediate rush to cover feet after bathing, thus harbouring moisture.
Facts Onycholysis is the separation of the nail plate from the nail bed. It is a common condition that results in a white appearance of the affected part of the nail. Fingernail or toenail separation can have numerous causes but is typically related to trauma or a fungal infection of the nails. Nail separation can sometimes be associated with other abnormalities of the nails, including nail pitting, flaking and crumbling, or other damage to or changes in the nail. Toenail or fingernail separation is generally painless and may occur gradually, without the affected individual being aware of a distinct cause. In some instances, onycholysis can be related to systemic conditions, including connective tissue disorders or hyperthyroidism. A number of factors can give rise to onycholysis.
Some of the common onycholysis symptoms causes are: n Trauma. Improper manicuring of the nails is often seen as a cause of onycholysis. Over-trimming of the nails may expose the nail bed, and may also result in lifting of the nail plate. In onycholysis, trauma of the nails is often the main cause. n Pressure. Wearing very tightfitting shoes makes the feet sweat, and puts the toenails under stress for a long time. This can lead to onycholysis in toenails. n Hyperactive thyroid. Oversecretion of the thyroid glands can also result in onycholysis. n Iron deficiency. Deficiency of iron
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Onycholysis, the separation of the nail plate from the nail bed, affects one in every six clients seen at the Orchid Nail Spa. in the body can sometimes give rise to onycholysis. n Skin ailments. Skin problems like eczema, and psoriasis, can also act as causative factors of onycholysis. The skin around the nail and cuticle turns dry and flaky in such cases. n Irritation. Exposure of the skin to an irritating substance can also give rise to onycholysis problems in the nail. Certain chemicals in nail polish can be allergenic for the skin and produce harsh symptoms, causing the nail to separate from the skin. n Moistening. In onycholysis, separation of the nail and nail bed can occur due to long exposure of the surrounding skin to water. n Medication. Onycholysis can also arise as a side effect of certain medications. Tiny, white marks may appear on the nail as a result. In onycholysis, chemotherapy medications, Tetraycline drugs, and medicines containing vitamin A are often found to be causative factors.
n Psoriasis. In onycholysis, psoriasis is often a main cause. Psoriasis is a chronic skin disorder. When the disease affects skin of the fingers and toes, the nails can be seriously affected. In advanced stages, the entire nail can come off from the bed. Onycholysis in psoriatic fingernails can be quite difficult to treat. The best treatment is to trim the nail short, polish if you want to hide the discoloration, apply a fungal treatment, and wait two to six months for healthy results. Results will vary based on the severity of the nail infection. We, as Bermudians, have a tendency to believe that some conditions are the norm until it is too late. If you have any questions or concerns in regards to your nail health, please do not hesitate to call us on 2968696 or pop in for a quick free consultation at Orchid Nail Spa. n
Visit our website www.orchidspabda. com or like us on Facebook: orchidbda.
ULTIMATE IMAGING (HEALTH SUPP).pdf
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HEALTHCARE DIRECTORY: a special advertising supplement
APRIL 4, 2014 n 9
Drinking: How much is too much alcohol? How much is too much when it comes to consuming alcohol? Surely, being a ‘social drinker’ or enjoying a glass of wine with a nice meal can’t be harmful? While there really is no level Dr Simmons of drinking alcohol that can be guaranteed to be completely ‘safe’ or ‘have no risk’, the following guidelines, developed by the US National Institute of Health and National Institute for Alcohol Abuse and Alcoholism, indicate how healthy adults can decrease their risk of short and longterm medical complications. For healthy adult men up to age 65, drinking no more than four standard drinks on any day and no more than 14 drinks per week reduces your lifetime risk of harm from alcohol-related disease or injury. For healthy adult women and healthy men over age 65, drinking no more than three standard drinks per day or seven drinks per week reduces your lifetime risk from alcohol-related disease or injury.
How much is a standard drink? A US standard drink is any drink that contains approximately 14 grams of alcohol. A standard drink will vary based upon the specific beverage. Approximate equivalents of one standard drink are: n 12oz of beer. n 5 oz of table wine — 12 per cent alcohol. n 1.5oz of spirits — 40 per cent alcohol. Research has indicated that for those who never exceed the daily or weekly alcohol limits, the risk of developing an alcohol-use disorder is less than 1 per cent. However, for those who exceed both the daily and weekly limits, the risk
of developing an alcohol-use disorder is nearly 50 per cent. Heavy alcohol use can increase one’s risk of high blood pressure, gastrointestinal bleeding, liver cirrhosis, specific cancers and depression. On a single occasion, women may reach higher blood alcohol levels than men who have consumed an equivalent amount of alcohol. However, men are more likely to incur an injury because in general they are more likely to engage in risk-taking behaviour when drinking.
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By Dr. Chantelle Simmons
Minimize risk While adhering to these guidelines may minimize your risk of harm, but if you are supervising children or engaged in activities like driving, operating machinery or water sports, you should take special care when it comes to using alcohol. There really are no safe levels of alcohol consumption under these circumstances. Young adults (aged 18–25) are particularly susceptible to the effects of drinking alcohol. The risk of accidents, injuries, violence and selfharm is high among drinkers under 18 years of age. Young people who drink tend to be more prone to risky behaviour than older drinkers. Older adults taking medication and individuals who have physical or mental health problems should seek advice from a healthcare professional about the use of alcohol. Mixing alcohol with certain medications can cause significant prob-
lems. If you are taking medication, either prescribed or bought over the counter (including herbal preparations), ask your doctor or pharmacist about whether combining them with alcohol could be harmful. A potential concern when alcohol is combined with sedative medications is the risk of respiratory depression. Alcohol use can increase the risk of falls for the elderly or those with gait challenges.
Cocktail Another serious concern regarding alcohol consumption is mixing illicit drugs such as cannabis, heroin, cocaine, methamphetamine or ecstasy, with alcohol. This can have dangerous or potentially lethal
consequences, for example combining alcohol with sedative drugs such as heroin. People who are depressed, anxious or have other mental health problems sometimes drink with the goal of improving their mood. Using alcohol as a way to resolve personal problems does not address the underlying issues and may potentially result in additional challenges. If you are using alcohol to self-medicate, consider talking with a mental healthcare professional. Being provided with tools for addressing emotional or psychological challenges is much more productive than turning to alcohol as a coping strategy. If you are pregnant, thinking of becoming pregnant or a breastfeeding mother, no lower limit can be guaranteed to be completely safe for your baby. Heavy daily drinking or binge episodes of drinking have the most risk and are potentially associated with foetal alcohol syndrome. However, because alcohol may harm your baby, the safest thing is to stop drinking altogether while you are pregnant and while you are breastfeeding. If you find it difficult to decrease or stop drinking alcohol, speak to your healthcare practitioner for support and advice. So can you have that glass of wine with dinner or that cocktail at a party? The answer is probably yes, as long as you manage your drinking and stay within the guidelines outlined above. For further information or if you would like to seek assistance in cutting down or maintaining abstinence from alcohol use, please contact our Turning Point Substance Treatment Programme at 236-3770, ext 3426. n
Dr Chantelle Simmons, Bermuda Hospitals Board’s chief of psychiatry.
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THE BERMUDA SUN
What men need to know about prostate cancer outside the prostate, it is dangerous and this aggressive type of cancer can occur at any age. Although the disease tends to progress slowly, it can be fatal if it spreads beyond the prostate gland itself. While cancer that has spread beyond the prostate is not curable, it may be controlled for many years. Because of the many advances in available treatments, the majority of men whose prostate cancer becomes widespread can expect to live five years or more.
By Dr Paul Coty Consultant Oncologist at King Edward VII Memorial Hospital
Prostate cancer is a major health concern for men and while the disease is rare before age 50, many elderly men have at least traces of it. Most men will not experience symptoms in the early phases and because prostate tumours are often slow growing, men with this condition are more likely to die of other causes. Prostate cancer in its early stages, when confined to the prostate gland, can be effectively treated, with very good outcomes for survival,. Fortunately, most men with prostate cancer are diagnosed in an early stage of the disease. Prostate cancer affects mainly older men, with four out of five cases diagnosed in men over 65 and less than 1 per cent in men under 50 in the USA. Though rare, prostate cancer can be seen in men in their 30s and 40s. Men with a family history of prostate cancer are at higher risk of developing the disease than the general population. For reasons not fully understood, men of African descent have a higher incidence of prostate cancer and a higher death rate from the disease. Two initial tests are commonly used to look for prostate cancer in the absence of any symptoms. One is a digital rectal exam and the other is a blood test used to detect a substance made by the prostate called “prostate-specific
Options
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SOURCE: The Mayo Clinic, Rutgers University, American Cancer Society. antigen” (PSA). When used together, these tests can detect abnormalities that might suggest prostate cancer. A PSA test can also help determine if prostate cancer has recurred. While there
‘If men notice any change in their pattern of urinating, they need to inform their doctor. Early detection makes a significant difference in treatment outcomes.’
are no warning signs or symptoms of early prostate cancer, once a malignant tumour causes the prostate gland to swell significantly, men may experience difficulty with urination, including a frequent need to urinate, especially at night. It is important for men, starting at the age of 40, to have a check-up with their physician and to discuss their risk factors for prostate cancer. If men notice any change in their pattern of urinating, they need to inform their doctor. Early detection makes a significant difference in treatment outcomes. If prostate cancer begins to grow rapidly or spreads
There are three basic options for early stage prostate cancer. Two active treatment options include surgery or radiation. A third option is expectant management or watchful waiting. Men with intermediaterisk or high-risk disease need surgery or radiation to achieve a high likelihood of cure or disease control. Expectant management or watchful waiting, a form of close patient management, is only used for elderly men who have early-stage, lowrisk prostate cancer. More recently, hormone therapy has been used in combination with radiation therapy, in addition to treatment of more advanced disease. I encourage all men 40 and older in Bermuda to have a conversation with their general practitioner about prostate cancer screening. While experts don’t agree about the benefits of prostate cancer screening in the general population, many oncologists like myself encourage high risk groups (men of African descent and those with a family history of prostate cancer) to get screened. n
For more information about men’s health, check the BHB website’s Health and Wellness page at http:// www.bermudahospitals.bm/ health-wellness/index.asp
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Lifestyle and diet choices a factor in increasing risk By Brenda Dale Prostate cancer is the second most diagnosed cancer in men after skin cancer and the second deadliest cancer in men after lung cancer. Men out there, listen up. To begin, what is the prostate? The prostate is a walnut-sized gland that is found below the bladder in men. It is part of the male reproductive system that adds nutrients and fluid to sperm. One in six men will be diagnosed with prostate cancer in their lifetime. Age is the most important factor in prostate cancer. Although it can be detected in younger men, the chance of being diagnosed with prostate cancer increases significantly after the age of 50, with the highest frequency of diagnoses in men who are 65 or older. Men with one close relative, such as a father or brother, having had prostate cancer, are at greater risk, and chances increase if more than one relative has had it. Those with African ancestry are 60 per cent more
likely than Caucasians to be diagnosed with prostate cancer, and Asian men are significantly less likely to get prostate cancer. The cause of these differences is unknown.
Early detection The good news is that survival rates with early detection are high. Ninety per cent of prostate cancers that are discovered early and have not spread beyond the prostate have an almost 100 per cent chance of survival for five years. So detection is important and, in Bermuda, men are encouraged to begin screening for prostate cancer after their 40th birthday. Symptoms are not always present in early cases, when the cancer is most treatable, so regular screening is a must. There is no known way to prevent prostate cancer; however, several lifestyle and diet choices do seem to play a factor. Diet can increase risk, particularly those low in fibre or high in saturated fat. A high Body Mass Index can increase your chances of getting
prostate cancer and those who are overweight should aim to lose weight. All men, regardless of age, should eat a healthy diet low in fat and full of fruits and vegetables. Try to add at least one serving of fruits or vegetables to every meal and eat them as snacks as much as possible. Dairy is a possible factor, so it is recommended to reduce dairy consumption and choose non-dairy or low-fat versions. Limit other fats such as those from oil and eat lean meats in small portions. Fatty fish such as salmon, sardines, tuna and trout are a good choice because they contain Omega-3, which has proven health benefits.
Antioxidants Other foods to consider adding to your diet are those high in isoflavones, antioxidants found in products like tofu, kidney beans, chickpeas, and lentils. Lycopene, another antioxidant, is also recommended and is found in tomatoes, watermelons and grapefruits. Drink lots of water and
limit alcohol consumption. If you like a hot drink, try green tea, which might decrease inflammation that can be associated with prostate cancer growth. In addition to a healthy diet, exercise is important. A minimum of 30 minutes, three times a week should be a starting point. If you don’t already exercise regularly, consult your doctor for advice on getting started. And visit the Wellness section at www.argus.bm/ wellness for some great fitness ideas and walking routes. A healthy lifestyle with a balanced diet and plenty of exercise will make you feel better, give you more energy and reduce the risk of other diseases. So men, what more reason do you need? For more information visit the Argus Wellness Programme at www.argus. bm/wellness. n
Brenda Dale is an assistant vice president and project manager at the Argus Group, with responsibility for managing the Wellness Programme.
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HEALTHCARE DIRECTORY: a special advertising supplement
THE BERMUDA SUN
Grilled or fried? First let me check my By Melissa Healy In a brave new world in which we've all had our whole genomes analyzed and know about our genetic predisposition to certain diseases, here's a helpful finding: Don't eat a lot of fried food if you happen to carry several of the genetic variations linked to obesity. And here's some more good advice: Don't eat a lot of fried food even if you carry few or none of the single nucleotide polymorphisms (or SNPs) that confer a higher risk of obesity. Why? Well, because people who eat a lot of fried food— especially away from home, where fried foods tend to be deep-fried — are highly likely to pack on weight, a new study finds. The same study finds, however, that people who carry many of the 32 known obesity SNPs in their DNA and frequently eat fried foods tend to pack on more weight than do the big friedfood consumers with less genetic propensity toward obesity. So avoiding fried foods makes good sense, really. Even in a world in which we have not all had our genomes scanned. The new research, published last month (March 19, 2014) in the journal BMJ, comes from a collection of researchers from Boston University and Harvard University's schools of medicine and of public health. In October 2012, they published the finding — in the New England Journal of Medicine — that frequent consumption of sugar-sweetened beverages results in greater weight gain among those with higher genetic predisposition to obesity than it does among those whose genetic vulnerability is less pronounced. The studies' findings are not as obvious as they may seem. Both aim to explore how genes and behaviour interact to drive obesity in large populations. And both
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Los Angeles Times (MCT)
suggest that while obesogenic behaviours (such as eating too much and exercising too little) make people fat, they have a magnified effect on those whose genes programme them to burn calories more efficiently, to accumulate and store extra calories as fat, and to consume more food when it's available.
Fried food and sugar That magnifying effect isn't huge. But spread across vast populations — all of which are eating more fried foods and drinking more sugar-sweetened beverages — it can become very huge indeed, and with it come increased rates of Type 2 diabetes, heart attacks and strokes, and certain cancers. In the more than 37,000 men and women of European ancestry who made up the population of the current study, those who ate fried foods four or more times a week on average weighed more than did those who indulged least
frequently — less often than once a week. (Frequent consumers of fried foods were also more likely to smoke, watched more television, drank more sugarsweetened beverages and less alcohol and engaged in less physical activity than less-frequent consumers of fried foods. But the researchers adjusted for those behavioural differences, and still saw significant differences.) But here's the bottom line: The BMI difference between light and heavy fried-food consumers was bigger — as much as twice as big — when those consumers were at highest genetic risk for obesity than when they were at low risk. On a scale of zero to 64, a calculation of genetic obesity risk placed all the study's subjects between 13 and 43. And among those whose genetic predisposition to obesity was on the low end, the difference in body mass index between frequent fried-food consumers and infrequent consumers of
fried food was less than half a point. Among those with the highest genetic risk of obesity, a difference of between 0.7 and one full BMI point separated the least frequent fried-food consumers from the most frequent. Two obesity experts from Imperial College London said the findings were unlikely to change the way that physicians counsel patients and treat obesity.
Lifestyle That's mainly because having even several of the SNPs that predispose to obesity appears to be far less influential in whether one becomes obese than more obvious factors, such as overeating and a sedentary lifestyle. But it would be "a great shame", wrote Alexandra I.F. Blakemore and Jessica L. Buxton, "to assume that genetics can be ignored in the management of obesity". For starters, they wrote, there are genetic contributors to obesity that are not
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obesity genes and get back to you nearly as subtle as the 32 SNPs measured in this study, and a mutation in just one of those genes, called MC4R, is thought to cause 1 in 20 cases of severe child obesity. Beyond that, wrote Blakemore and Buxton, a physician might be guided toward more personalized treatment of an obese patient if armed with the knowledge that the patient carries a heavy genetic vulnerability to the condition. As knowledge of genes' role in obesity advances, some genetic variations may be found to, say, disrupt the brain's appetite control system at the molecular level. In such cases, a physician might conclude that calling for more self-restraint, or a reversible measure such as lap-band surgery, are unlikely to work. n
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SELF-RESTRAINT REQUIRED: A deep-fried croissant-doughnut hybrid, known as the ‘cronut’, is not the best choice if you are genetically disposed to obesity.
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Work out the kinks with a sports massage Like a car needs an oil change, our bodies need to be maintained By Robyn Bardgett rbardgett@bermudasun.bm
“You hold a lot of stress in your shoulders and I can see you suffer from back pain,” observed Greg Ozarowski, a sports and remedial massage therapist at Bala Sports & Remedial Massage Clinic, when I sat down to interview him for the Healthcare Directory. He was spot on. I’m constantly trying to readjust my body when I’m at work and always notice that my shoulders are somewhere near my ears when I’m deep in concentration staring at the computer screen. I have lower back pain and tightness in my shoulders that affects my sleep.
Target But when you walk in for your first treatment with Mr Ozarowski he will begin with a postural assessment that can help pinpoint exactly where you are hurting and then create a programme to work on relieving you from your pain by both teaching you skills to correct your posture and using massage techniques to target your problem areas. Like a car that needs maintenance and oil changes, our bodies also need to be maintained to always be at our best. A massage may sound like a nice luxury, but Mr Ozarowski says it is an important part of a healthy lifestyle. “A massage is as important to your body as brushing your teeth is a part of your life,” he says. A good massage can obviously be a great relaxing tool, but for a real holistic experience, relaxing may not be the best word to describe a sports massage that can help with detoxifying and releasing tension. There’s a lot of pressure that some may say is painful, but worth it, and somewhat awkward positioning
‘We work on making postural changes, which can help you feel more refreshed and focused.’ of limbs in order to get the best pain relief from sports injuries as well as the everyday stresses that we put on our bodies. “I have knowledge of body mechanics, which is what sets sports massage apart from a regular massage. A massage at a spa is relaxing but the therapist may not have the right skills and they may not be able to treat the cause of the pain,” says Mr Ozarowski. The postural assessment also helps Mr Ozarowski work on his clients posture and helps him formulate a plan to help minimize aches and pains. The way we position ourselves throughout the day puts a lot of pressure on our bodies, says Mr Ozarowski. “We work on making postural changes, which can help you feel more refreshed and focused,” he adds.
Strength At Bala Clinic –– Bala means strength in Sanskrit –– there are also stretching classes, where clients are taught effective stretches and self massage techniques. Active stretching takes the average stretch and goes much deeper to help improve circulation and elongate muscles. Mr Ozarowski gives detailed explanations to get a better and more effective stretch.
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Pressure: Greg Ozarowski works out the aches and pains in a client’s back. And while Mr Ozarowski works with athletes, both here and internationally, he also has helped many people just looking to release tension and improve their posture. “There is a perception that you have to be a certain type of person to get a massage and some people may feel uncomfortable about getting a massage, but I don’t care how someone looks, I just want to help them and I want to help them discover the core of their problem,” he says. Bala Clinic also has two other therapists available –– Imani Chapman and
Megan Rumbelow. The massage services are covered by insurance, and Mr Ozarowski gets referrals from doctors to help with pain complaints from their clients. But Mr Ozarowski says, “Don’t wait until there is pain to come to me. It is very important to keep the body maintained. Prevention is very important.” n
Bala Sports and Remedial Massage Clinic is located in the International Centre, 26 Bermudiana Rd. For more information, call 292-4433.
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APRIL 4, 2014 n 15
Healthy lifestyle misconceptions debunked By Leslie Barker The Dallas Morning News (MCT)
Every die-hard fitness fanatic cheers the benefits of eating right and exercising: Reduced risk of disease! Increased energy! A better sense of mental, physical, emotional self! But there is a caveat to all that rah-rah: You can overdo it. While that won't necessarily negate what you're doing, it can make your lifestyle less effective than you might think. To help you stop, we asked a couple of experts for specifics on how too much of a good thing can be bad for you. Megan Lyons recently opened a health-coaching company in Dallas. Kathy Dieringer is a board member of the Dallasbased National Athletic Trainers' Association.
Myth 1: Working out hard every day The reason: "Our bodies need rest," Ms Lyons says, "and performing high-intensity exercise every single day does not allow adequate time for muscle repair and recovery". Adds Ms Dieringer: "Rest between exercising is just as important as the exercise itself. If you don't allow your body to rest and recover between bouts, it will break down eventually." The solution: If you must do something every day, make sure it's lower intensity, like a non-power walk or stretching, Ms Lyons says. Vary the intensity of your workouts, says Ms Dieringer, owner of D&D Sports Med in Texas. Take a few days off if you show such signs of overtraining as insomnia, restlessness, continued soreness, burnout or irritability. If you're injured, take time to heal. "Moderation is tough, especially in those individuals who are high achievers and believe they must work out every day," Ms Dieringer says. "I'd encourage everyone to keep a training log so they can
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Boredom: Sticking to the same workout routine may increase risk of overuse injury. look back on what they've been doing and objectively analyze their workout regimen."
Myth 2: Swearing by only one exercise routine The reason: In addition to the boredom factor, doing the same workout over and over increases your risk of overuse injury, Ms Lyons says. Additionally, "you'll neglect other muscles. This often leads to muscle imbalances, which can cause or exacerbate injuries." The solution: Try a new class, or exercise with a friend who does a workout you don't.
Myth 3: Believing that pain equals gain The reason: Being sore is one thing; pain is another. Pain often signals an injury, which means you'll have to stop working out for a while. The solution: Your body lets you know when it's time to rest and time to move, Ms Dieringer says, so listen to it. "Pushing through soreness is okay, as long as we're sure that's what it is, but you should not try to push through pain," she
says. "Any type of soreness or discomfort that doesn't go away with rest and proper care after a few days should not be pushed through." At that point, seek professional help, she says.
Myth 4: Loading up on sports drinks The reason: You probably don't need these, which are geared for athletes exercising "under intense conditions for prolonged time periods", Ms Lyons says. They contain excess sugar that can quickly add up and even counteract the workout. In other words, you may be eating more than you're burning off. The solution: Refuel with carb-heavy gels and drinks only when your workout lasts longer than an hour, or 30 minutes "in incredibly hot conditions," she says. Your best bet for a beverage? Water.
Myth 5: Thinking glutenfree is a panacea The reason: Gluten-free items are trendy but fall prey to what Ms Lyons calls the "halo effect". That is, "causing us to assume anything labelled gluten-free is automatically healthy".
In many instances, they have "fewer nutrients, more calories and more sugar than the real thing", she says. The solution: Unless your body has a true intolerance for gluten, you're better off choosing whole grains and whole-grain products without that gluten-free label, she says.
Myth 6: Overdoing diet products The reason: Many are overly processed and contain additives and preservatives our bodies don't recognize as food, Ms Lyons says. "Even when a product is marketed as healthy or diet, the calories still add up," she says. Unfortunately, many of us think of these as "free food". The solution: Choose a whole-food option such as a piece of fruit or a vegetablebased salad, she says.
Myth 7: Sticking with triedand-true The reason: Doing what we've always done or what we were taught as young athletes isn't necessarily valid, Ms Dieringer says. The solution: Do your research; seek advice from experts, not from fads. n
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What ‘Scratchie’ has learned in 72 years of cutting hair By Danny McDonald Franklin Delano Roosevelt was the American president. World War II was raging; the Japanese had occupied parts of the Philippines. Ted Williams won the Triple Crown. And Earlston “Scratchie” Lawrence opened his barbershop in the back of town in Hamilton. The year was 1942. Much has changed in the intervening decades, but Scratchie’s remains. What started out with him hanging around barbershops as a kid has become his vocation. Now 90, Mr Lawrence still cuts hair. After 72 years of cutting hair, sweeping the floor and joining in the barbershop debates and arguments, he still loves the gig and listens attentively. “You learn a lot here,” he said. I ask him about the nickname. He embarks on a story that I don’t quite follow. He was much younger, working in a grocery store. There is a part of the tale involving chicken scratch. Someone at the store started calling him Scratchie. I suppose that’s all I need to know. The name stuck. Decades later, the name still adorns the outside of his barbershop, right above the old school swinging doors that blow in whenever a gust picks up. He acknowledges his mind is not as sharp as it once was and he stopped doing shaves a little while ago; he doesn’t trust his hands anymore.
Close shave He leaves that to Theodosia Lambert. She goes through the ritual of the straight razor shave as she has for the last four plus decades. May will mark her 47th year at the shop. She trims the beard with a small clipper, then applies the shaving cream, which she moistened with hot water. She scrapes with the razor along the cheeks. She is specific with her movements around the mouth
n Photo by Danny McDonald
HAIRCUT OR SHAVE? Theodosia Lambert, 47 years at the shop, and Earlston ‘Scratchie’ Lawrence take a break between customers at the iconic barbershop at the back of town. and nose. “It’s all in the wrists,” she will say afterward. She wipes the blade occasionally. After the shave, there’s the hot towel — which is just shy of scalding — and the aftershave. “You awake now?” she asks. I go back to trying to coax stories from Scratchie. There were lots of arguments about sports and politics, he says. Mondays were particularly lively. People would discuss the sporting events of the weekend. This Monday morning is slow; I’m the only one in the shop presently. No, he says, he’s never had to kick anyone out. “I stop it before it gets to that point. I’ll say ‘That’s far enough’.” Yes, he’s seen styles change drastically over the years. No, he’s never refused to do a haircut, no matter how foolish. “If someone wants something, we try and do it,” says Theodosia. Asked about changes in Bermuda over his nine decades, Scratchie mentions the theatre boycotts in
the late 1950s as a seminal moment. Changes in the neighbourhood? He allows, “Buildings have changed to suit the times.” We talk sports: He says he is a fan of Arsenal, but doesn’t mind Liverpool, either. In fact, way back in the day, he originally liked the Reds. I don’t press the matter. Locally, he supports Devonshire Cougars. Newspaper clippings of sporting feats and football photographs adorn the walls. There is one black and white photo of a younger Scratchie cutting a man’s hair. He is the oldest of 13 children, father of two, grandfather of two and great grandfather of five. He used to work night jobs as a bartender and a maître-d in one of the hotels.
Keeps his own counsel He says there is more gang violence nowadays. He says he has his own thoughts about why, but doesn’t usually share them with the young people who come in.
Ever cut the hair of anyone famous? “I’d rather not touch that one.” He’s equally as evasive on politics. He doesn’t mention which party he supports. He says politically, he’s in the middle. “I’m for progress, I’ll say that much.” When the subject comes to people, what he has learned about people and information and the way people share information, he lightens up.
Reading people He says he has learned over the years how to read people now. Body language. Tone of voice. That sort of thing. He knows when people’s mouths work faster than their minds. “You’d be surprised at how many people say things that they don’t really believe,” he says. “Or they haven’t really thought about it. Or they just repeat what they read in the paper.” So he must get all the news that doesn’t make the papers? “I’d like to think so.” n
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