Bounce Winter/Spring 2011

Can you afford not to know your cholesterol levels?

Get your cholesterol tested now.

Ask your healthcare professional.

Lowering your cholesterol

When lifestyle changes aren’t enough

Lowering high cholesterol is important for adults, no matter what their age or health. You can’t do anything to change some of the factors that may affect your cholesterol level, such as your age, gender or family history.

For some people, changes to diet and exercise routines are not enough to lower cholesterol to safe levels. If diet and exercise aren’t enough for you, your doctor may decide that you need a medicine in addition to your diet and exercise plan. But it’s important to remember that medicine can’t do the job all by itself. You will still need to eat a healthy diet and exercise regularly to achieve your cholesterol goals.

But there are some things you can do to help lower your cholesterol levels, such as changing your diet, losing weight, increasing your level of physical activity, stop smoking and having regular medical check-ups.

This information should not take the place of talking to your doctor or healthcare professional about how to manage and treat your high cholesterol.

Brought to you by AstraZeneca, in the interest of patient education.

For more information, visit our website www.yes2life.co.za AstraZeneca Pharmaceuticals (Pty) Ltd. Reg. No. 1992/005854/07 5 Leeuwkop Road, Sunninghill, 2157. Tel: (011) 797-6000. Fax: (011) 797-6001

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2011/08/03 11:43 AM

A new approach to quitting Forget nicotine patches and chewing gums. New research suggests that receiving supportive and motivational text messages (SMS's) might be an effective solution for helping smokers kick the habit. A study in the UK, called txt2stop, recruited 5 800 smokers and assigned them into two groups: those who received daily supportive messages for the first five weeks of trying to quit, followed by three a week for the next 26 weeks; and a control group who only received fortnightly texts thanking them for taking part in the trial.

‘Cravings last less than 5 minutes on average. To help distract yourself, try sipping a drink slowly until the craving is over’ is an example of one of the supportive messages.

Participants receiving the messages could also get one in times of need,

by texting the word ‘crave’ or ‘lapse’.

The results after six months?

Chemical tests verified that 10.7 percent of the txt2stop group had managed to quit successfully, versus only 4.9 percent in the control group. Until a programme like this is implemented locally, why not ask friends and family to help you quit by sending their messages of encouragement?

Colds and flu spread rapidly in the winter and spring months, and this is largely due to poor hygiene. Washing your hands properly can play a major role in avoiding contamination. This is how you do it: Wet your hands with clean, running water – if possible, at a comfortably warm temperature.

Apply soap to your hands, lather well and rub vigorously together. Don’t forget to wash between your fingers, under your nails, the backs of your hands and your wrists.

This should take you at least 20 seconds (or the time it takes

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to sing ‘Happy birthday’ from beginning to end, twice).

Rinse your hands well under running water.

Use a clean towel or disposable paper towels to dry your hands completely. If

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possible, use a paper towel to turn off the tap, and then throw this away.

Hand sanitisers can be used in situations where soap and water are not readily available, for example, in the bus.

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How to wash your hands

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Q

I’m a regular blood donor, but the last time I went to donate I was turned away after an iron test showed that I am anaemic.

I was given some information on foods I can eat to increase my iron levels but I would like to know what could have caused the anaemia in the first place. I don’t

feel sick or tired, so is it something that I should be worried about?

A

Some of the factors that can lead to iron-deficiency, and thus anaemia, include a diet lacking sufficient iron (this can be especially pertinent if you are vegetarian); pregnancy, which increases the body’s demand for iron; and significant

blood loss, which could be caused by heavy menstrual periods, a bleeding ulcer or traumatic injury. In many cases, iron-deficiency anaemia can be corrected by treating the underlying cause and taking an iron supplement.

Eating iron-rich foods, especially lean red meats and dark green vegetables, is also advised. The fact that you’re feeling otherwise well is certainly a good thing but it’s still important to see your GP in order to explore what could be behind it and to look at the best way to treat it before you start experiencing any symptoms. Typical symptoms of iron-deficiency anaemia include tiredness, weakness, shortness of breath, poor concentration and, sometimes, a fast heartbeat.

Q A

Drowsiness is a common side effect associated with first-generation antihistamines, which are usually readily available over the counter.

This side effect is due to the fact that these drugs act on the central nervous system (CNS).

However, newer, secondgeneration antihistamines do not affect the CNS, so are much less likely to cause this unwelcome side effect. Rather than buying any OTC antihistamine, speak to your general practitioner about prescribing a second-generation antihistamine that’s right for you.

Another option you can look at is using a steroid-containing nasal spray.

These are very effective in treating allergic rhinitis (hay fever) but it may take up to two weeks of use before you see the full effects. Nasal sprays

need to be used regularly and consistently in order for the allergy sufferer to reap the full benefits. Again, speak to your GP about the best nasal spray for your needs and only use it exactly as prescribed.

DO YOU HAVE A QUESTION? Send your questions to bounce@bankmed.co.za. We regret that letters cannot be answered personally. For further information on your benefits, refer to your plans and benefits for 2011, available at www.bankmed.co.za.

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Every spring I get terrible hay fever and sinus infections, but taking antihistamine tablets makes me so sleepy, which affects my work. Do you have any other suggestions for dealing with seasonal allergies?

Check out your options SELF-EXAMINATION Examine your breasts at the same time each month during ovulation, seven to 10 days after your period – this is how more than 80 percent of lumps are found.

First stand in front of a mirror and inspect your breasts for warning signs (see ‘Spot the signs’). Lift each arm overhead in turn, and examine the opposite breast with your free hand.

Then put your hands on your hips and press hard to flex your chest muscles.

‘Doing this can help you to look for asymmetry,’ explains CANSA’s clinical specialist, Magdalene Seguin.

Next, lie on your back with a pillow under your right shoulder and your right arm behind your head. Keeping the fingers of your left hand flat, gently press your right breast using small circular movements, and working in a circular pattern until you’ve covered the whole breast.

Squeeze the nipple to check for discharge or lumps, then repeat on the other breast. If you find anything, it’s important to see your general practitioner – but don’t panic, as most lumps are not cancerous (see ‘Benign breast conditions’ overleaf).

MAMMOGRAM CANSA suggests that after the age of 40, depending on your risk factors, you may want to speak to your doctor about annual mammograms. ‘If you have a family history of breast cancer, start your screening 10 years before your youngest relative developed breast cancer, and have breast MRI scans,’ advises Dr Carol-Ann Benn, a specialist surgeon at Netcare’s Breast Care Centre for Excellence. An ultrasound is often used in addition to the mammogram for dense breast tissue as it produces sharp, high-

SPOT THE SIGNS ■ a change in shape or size of your breast ■ unusual asymmetry or ‘lopsidedness’ of your breasts ■ dimpling or puckering (similar to an orange peel) ■ any lump or thickening in your breast or under your arm ■ retraction of your nipple ■ unexplained discharge from a nipple ■ a change in colour, roughness or a rash on your breast or nipple ■ any swelling, redness or feeling of heat in your breast.

Even just one of these symptoms is enough to warrant an immediate check-up at your general practitioner.

Mammograms for scheme members who are 40 and older fall under the Bankmed wellness and preventative care benefits.

For more information, consult your 2011 benefit handbook or contact the Bankmed customer call centre on 0800BANKMED (0800-226-5633).

contrast images, says Seguin. Digital mammography is now available, and uses less radiation than conventional mammography, but costs more.

GENE TESTS In five to 10 percent of cases, breast cancer is genetically inherited and, in these families, about 50 percent of close relatives are at risk of early-onset breast cancer due to a mutation in one of the major cancer-causing genes, BRCA 1 or 2, says Professor Maritha Kotze, head of Gknowmix, a research-based company and counselling service in Cape Town. ‘Once the gene defect causing breast or ovarian cancer in a family has been identified, other relatives can be tested with 100 percent accuracy.’

A blood or saliva sample is sent for analysis at a suitable lab after genetic counselling has been done, and if you test positive you can take preventative measures. Breast specialists will monitor you with scans so that if cancer develops it can be dealt with early, or you can opt for a risk-reducing mastectomy. ‘This can cut your risk for breast cancer by more than 95 percent,’ says Dr Benn.

After extensive counselling, you’re given a skin-sparing mastectomy and an immediate reconstruction. ‘This isn’t an emergency procedure, and you should see a psychologist and speak to other women who’ve been through it,’ she advises.

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back positive for cancer, I actually argued the competency of the oncologist. How could it be? I ate well, I exercised, I didn’t smoke, I had no family history of cancer. And, of course, I was so young.’

The most recent statistics available indicate that breast cancer strikes one in 29 South African women. ‘And it has no respect for age or other variables, although genes and environmental factors can affect your risk,’ says Lucy Balona, a spokesperson for the Cancer Association of South Africa (CANSA).

‘It’s vital for each and every woman to self-examine and go for screening, because if breast cancer is diagnosed in the early stages, you have a very good chance of making a full recovery,’ she emphasises.

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No woman is entirely protected from breast cancer, but you can lower your risk by making sensible lifestyle changes: Stop smoking and cut back on alcohol. Studies suggest that about four percent of the breast cancers in developed countries are attributable to alcohol, says Seguin.

Exercise regularly – inactivity is now recognised as a cancer risk. Just 30 to 60 minutes of exercise a day has been shown to reduce cancer risk, apparently independently of changes in body weight.

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Eat sensibly. Follow a low-fat, high-fibre diet to maintain a healthy weight.

Fresh fruit and vegetables, especially cruciferous ones, also help protect you with antioxidants. Dr Benn advises taking additional zinc, B12, folate and B6.

Avoid exposure to pesticides or other chemicals, and excessive radiation.

Be aware of other minor cancer risk factors: take special care if you started menstruating young, had your first child after the age of 32 or have no children, or if you didn’t breast-feed – although Dr Benn says that more than 50 percent of women presenting with breast cancer will have had none of these risk factors.

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Oncologists will also advise you on possible changes in your lifestyle, as environmental factors can help to counter the genetic ones and make you less susceptible to cancer, or help you fight it.

BIOPSY If screening reveals a suspicious breast growth, part or all of it is removed and examined. This is done by sucking it out with a fine needle, or removing it surgically. If it is cancerous, you may have several treatment options. ‘It’s possible to chemically shrink even larger tumours and remove them with a lumpectomy, and studies show no difference in survival rates between this and a mastectomy,’ says Dr Benn. Question your doctor and fully explore all options. ‘Above all, don’t panic,’ she says. ‘The average doubling time of a breast cancer cell is 40 days. Take time to make decisions – it’s your body.

Consider going to a specialist breast unit that offers a multi-disciplinary approach. This means that all options

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STAY SAFER

are discussed with many specialists in the field and you’re getting a form of medical peer review.’

When Cenessa was diagnosed, she opted for a lumpectomy and chemotherapy, but four years later the cancer returned aggressively.

‘I had a double mastectomy and reconstructive surgery, but septicaemia set in and I lost my entire right breast and nearly my life,’ she explains. Back in South Africa, a Durban surgeon reconstructed both breasts, but the cancer returned in surrounding tissue, and she needed further surgeries and chemotherapy.

‘The last scare was this February but when they removed the lump, they – thankfully – found it was benign.’

Today Cenessa lives in St Lucia, where she works as a newspaper

correspondent, gives inspirational talks for CANSA and still goes running daily. Last year she was named ‘International Hero of Hope’ for participating in South Africa’s CANSA Relay For Life and raising funds and awareness. ‘If I can get women to do only one thing,’ she says with feeling, ‘it’s to regularly check their boobs!’

■ If you have questions about breast cancer, call CANSA tollfree on 080022-66-22 or the Netcare Breast Care Centre tollfree on 0860-23-32-33.

■ For more about genetic counselling and testing, email counseling@ gknowmix.com or visit www.gknowmix.com.

■ 1 October is National Breast Cancer Day with awareness and fundraising events countrywide. For details visit www.cansa.org.za.

Bankmed’s Special Care Oncology Programme Bankmed offers support to members and dependants diagnosed with cancer through our Special Care Oncology Programme, which aims to help you deal with cancer in a positive and confident way. For more information visit www.bankmed.co.za, email treatment@bankmed.co.za or call Bankmed’s customer call centre on 0800-BANKMED (0800-226-5633).

BENIGN BREAST CONDITIONS Most breast changes have benign causes, but because many symptoms are the same as for breast cancer, your doctor needs to do tests.

■ LUMPS Nine out of 10 breast lumps are not cancerous, but some can increase your risk of breast cancer. Most lumps are caused by cysts (benign fluidfilled sacs), fibroadenoma (benign solid tumours), fibrocystic changes, blocked ducts, atypical hyperplasia (rapidly growing abnormal cells), calcifications (especially in older women), and non-invasive cancers.

■ PAIN This is mostly related to your menstrual cycle, occurring about a week before your period, or to fibrocystic changes from fluctuating hormone levels and, in some cases, mastitis (breast infection). It’s only in rare cases, like Cenessa’s, that cancer-related lumps cause pain.

■ NIPPLE DISCHARGE This is usually caused by benign conditions such as fibrocystic changes, intraductal papilloma or duct ectasia, and may be the result of anything from a hormone imbalance to the use of certain drugs.

Although often harmless, all of these breast complaints warrant a check-up to rule out anything serious.

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IF SCREENING REVEALS A SUSPICIOUS BREAST GROWTH, PART OR ALL OF IT IS REMOVED AND EXAMINED

IF YOU’VE ALREADY SUFFERED AN ATTACK, THERE’S NO BETTER TIME TO REASSESS WHAT YOU’VE BEEN EATING may be beneficial. Aim to lose that stubborn weight that gathers around your belly as studies have shown a correlation between an increased waist-to-hip ratio and cardiovascular disease risk. You should also consider consulting a dietitian.

■ Avoid stimulants, such as caffeine, and alcohol.

Foods to avoid include cholesterolrich foods, like fatty red meat and butter, which contribute to atherosclerosis (the build-up of fatty deposits in the blood vessels); trans fats (often in fried or commercially baked goods) which decrease the ‘good’ cholesterol in your blood and

increase the ‘bad’; saturated fats found in animal products like red meat, lard, butter and cream; and sodium, as a high intake of salt increases blood pressure, which puts heart disease patients more at risk. According to a HSFSA study, South Africans consume more than the recommended maximum of 5g salt a day, putting the nation’s heart health at risk. Do include plenty of fresh fruit and vegetables in your diet. High in antioxidants, these will promote a healthier body overall and help contribute to weight loss.

MEDICATION Dr Le Feuvre says, ‘A good cardiologist will put you on the 17

BANKMED BOUNCE Your World of Wellbeing Winter/Spring 2011

necessary so that food can be eaten with more ease.

■ Avoid your stomach becoming distended by sticking to smaller meals.

■ Because after a heart attack you will initially be doing little exercise, you might develop constipation. Eat enough fibre-rich foods and drink enough water.

■ If you are overweight, weight loss

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right medication to both help your heart muscle heal, as well as decrease future risk of another attack.

Often medication will target other problems, like high blood pressure, high cholesterol or diabetes.’ But don’t be afraid to ask questions of your health specialist, she says.

Find out why you’re taking whatever you’re prescribed, as it will motivate you to keep up with taking it. ‘Some medication may have some odd side effects,’ cautions Dr Le Feuvre, ‘so give your doctor feedback so that, if needed, they can switch you to another medication.’

Heart attack survivors need to be extra vigilant with over-the-counter medications. Talk to your doctor about what substances to avoid, and be careful when it comes to taking decongestants or flu remedies, which 18

EXERCISE Since a sedentary lifestyle – a life of minimal physical activity – is a large factor in causing heart disease, cutting out all physical exercise is by no means a wise move – but you shouldn’t plunge yourself into a demanding workout routine straight away either. The HSFSA offers the following advice: ‘With your doctor’s approval and advice, begin light exercise as soon as possible.

Start walking outside on a flat surface at a steady medium pace. Increase the length of your walk as you feel able. Each individual is different and you must progress at your own rate.

Listen to your body. Don’t overstress yourself. If you feel shortness of breath, dizziness, weakness, or chest pain, contact your doctor immediately.’

It can take the heart muscle six to eight weeks to recover from a heart attack: aim for moderate physical activity, like walking, swimming or cycling, and gradually build up the intensity.

LIFESTYLE CHANGES If you haven’t already done it, stop smoking. Smoking and stress are two of the leading contributors to cardiac problems.

Instead of turning to cigarettes, take up stress-

reducing activities like meditation and yoga, which will benefit your body and mind.

MENTAL HEALTH ‘Depression is not uncommon after a heart attack,’ says Dr Le Feuvre. ‘The sudden reality check that you’re not invincible can be a real blow for many.’ Depending on the severity of the strain on your heart, the recovery period can stretch from weeks to months, affecting your ability to work and participate in everyday activities. A solid support system of family and friends is key to getting through this difficult period and, on the flip side, will also help those closest to the patient feel connected and useful in the recovery.

Take it to heart Perhaps one of the most important things to remember after a heart attack is to be smart. If you start having any chest pains after your heart attack or you notice unusual breathlessness, inform your doctor immediately. According to a report by the Women’s Heart Foundation, women take an alarming two to four hours longer to respond to the symptoms of a heart attack. If you’re at risk of having a heart attack, do whatever you can to limit that possibility: don’t wait for a heart attack to happen before you see the signs.

Bankmed is there for your heart The Bankmed hyperlipidaemia and hypertension Special Care Programmes can help assist members or their dependants with high cholesterol levels or high blood pressure. A case manager will assist you in learning more about these conditions, as well as offer invaluable support and advice, so helping you to reduce your risk of cardiovascular disease and other related health issues. For more information, contact the Bankmed customer call centre on 0800BANKMED (0800-226-5633) or email specialcare@bankmed.co.za.

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usually contain stimulants and can create increased stress on your heart.

Practical tips: ■ Always wash your hands before feeding your baby.

■ Start on alternate breasts and use both breasts at each feed, ensuring that one breast is emptied.

■ Prevent engorgement by gently expressing any remaining milk after the baby has had their fill.

■ Burp the baby after every feed.

■ Take in enough fluids.

■ Leave a small amount of breast milk on each nipple to keep them soft.

■ Bathe your breasts in water only, and massage nipples with a little aqueous cream daily.

What goes in, must come out In the first two days after birth, babies produce a black, sticky substance called meconium, after

which they start producing normal stools. These may be yellow, orange or green, and pasty, watery or mucousy – all of which is normal.

‘A baby’s stool output will depend on their feeds,’ explains Dr Liezel Jacobs, a community paediatric doctor from Cape Town. ‘Breast-fed babies may produce stools eight times a day, or only every eight days! Formula-fed babies normally pass stools daily.’ It’s 21

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MOST PARENTS WILL TELL YOU THAT NO AMOUNT OF PREPARATION IS GOING TO FULLY READY YOU FOR THIS NEW ROLE

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Forget about just popping down to the shops. Leaving the house with a newborn takes planning. Attach this checklist to your baby bag and run through it quickly before going out with your baby.

■ Nappies ■ Baby wipes ■ A plastic bag for nappy disposal ■ A towel for burping ■ Aqueous cream ■ Breast pads and nipple cream ■ A small bottle of waterless hand cleanser to ‘wash’ your hands ■ Pacifier ■ Extra blanket for winter ■ Change of clothes for baby and for mom ■ Changing mat ■ Clinic card

✂ ‘Is this normal?’

One of the most difficult parts of being a first-time parent is the anxiety that comes with inexperience. While in many instances there is no cause for concern, there are situations that should raise the alarm.

Don’t worry!

Maternal oestrogens have a number of effects on the newborn that will resolve in a few weeks: do not be concerned if your newborn has a white vaginal discharge or breast tissue. Also common is for your baby to have tiny white spots around their nose – these are called

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rare for breast-fed babies to become constipated, but formula-fed infants may need a glycerine suppository if they haven’t had a bowel movement in three days, she adds. As for urine, babies normally pass it at birth or within the first day. They have little output for the first three days, after which they may urinate up to 20 times a day for the first few weeks, so stock up on those nappies!

Practical tips: ■ Change the nappy as soon as possible after a bowel movement to prevent irritation to the baby’s skin.

■ After changing the nappy, gently wipe your baby’s bottom with some water – from front to back for girls.

■ Apply aqueous cream or zinc oxide cream to the nappy area after changing to prevent nappy rash.

Sweet dreams You’re probably wondering, between all these feeds and nappy changes, when does my baby ever sleep?

‘Babies will actually only stay awake

milia and disappear on their own. Some babies are born with blue patches on their backs and buttocks – this is also harmless and disappears by around four years old. If your baby was born vaginally, they may have small, red pinpoint haemorrhages in the eyes, which also resolve spontaneously. Another common cause of parental nerves is their baby’s weight gain. It is totally normal for a baby to lose up to 10 percent of their birth weight in the first few days – this is normally regained by day seven.

After that, babies normally gain about 200 grams a week for the first three months.

for 15 to 45 minutes at a time during the first few weeks,’ says Dr Jacobs.

The newborn naps for 16 to 20 hours every day, only waking for feeds.

From the beginning, try to establish night time as sleep time, ensuring that evening feeds are brief, and that there is no undue extra stimulation.

Conditioning your infant in this way from early on will help to ensure that they settle into a regular sleeping pattern as they get older.

Bath time and cord care Most newborns are covered in a waxy white coating on their skin called

Time to see the paediatrician ‘An infant who was previously feeding well but now does not want to feed is cause for concern,’ says Dr Lucy Linley, a consultant neonatologist.

‘Another symptom which warrants investigation is bilestained vomiting,’ she says.

It’s not unusual for babies to swallow some air while feeding, which can result in them bringing up a small amount of milk when winded, but persistent or yellow-green stained vomits are not normal and may suggest an underlying gastrointestinal abnormality.

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✂

DR NELSON’S BABY BAG ESSENTIALS

Practical tips ■ Clean the cord stump with surgical spirits twice daily.

■ Redness around the cord suggests infection and may require antibiotics.

■ Wash baby with warm water only as soaps can dry out their delicate skin.

Bonding The first few days of your baby’s life are an especially wonderful time when Mom and Dad get acquainted with their new baby. Allow plenty of time for skin-to-skin contact with your baby, letting the baby sleep on your chest rather than in a cot, which will promote bonding and also keep the baby snug and warm. Newborns respond to the sight of their parents’ faces, and also to sounds, such as cooing and singing.

It’s also important to ask for help and to get enough rest. As Aqueela says, ‘I’ve had a lot of support from my family. All I can say to first-time moms is that having a baby really is a lifechanging event.’

BABY-AND-ME Baby-and-Me is Bankmed’s Special Care Programme to inform and empower expectant moms and dads during pregnancy.

Register now to access additional insured benefits during your pregnancy. You can request an application form to register by sending an email to babyandme@bankmed. co.za. You can also visit www.bankmed.co.za or contact the Bankmed customer call centre on 0800-BANKMED (0800-226-5633).

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vernix, which has useful antibacterial properties and doesn’t need to be wiped off immediately. ‘For the first few months of baby’s life, all that is needed is “topping and tailing”,’ says Dr Nelson. Using water and cotton wool rounds, the baby’s face, head and hands are gently cleaned (top) followed by a gentle cleaning of the baby’s bottom and genital area (tail).

Focus specifically on cleaning around the eyes, behind the ears (but not inside them), and in the creases of the neck. ‘The best cream to use on a baby’s skin is unscented aqueous cream,’ adds Dr Nelson. As for the umbilical cord stump, this will turn from yellow to black and should fall off in the second week.

hallucinations, disconnected thoughts, reckless behaviour, and delusions. In most cases, hospitalisation is required during the manic episodes.

In the case of bipolar 2, says Dr Chait, there is also a history of depression, but the mania is considered milder – for example, no delusions are experienced. This type of manic episode is referred to as hypomania, and consists of an elevated mood that does not impair functioning to the same degree as in the case of bipolar 1.

WHILE MUCH REMAINS UNKNOWN ABOUT THE EXACT CAUSE OF THE ILLNESS, IT APPEARS TO BE A COMBINATION OF BIOCHEMICAL, GENETIC AND PSYCHOLOGICAL FACTORS Another form or sub-type of bipolar is called cyclothymia, which is characterised by mood changes that alternate between hypomania and mild depression. While not as severe as bipolar 1 or 2, cyclothymia is still a chronic condition and can become fullblown bipolar at a later stage.

Managing bipolar While the illness cannot be cured, it can be treated. And with the appropriate medication, professional counselling and a strong support system, the prognosis for the majority of bipolar patients is good.

According to Dr Chait, a modern psychological approach to treating mental illness is the use of cognitive therapy, which emphasises emotions and thought processes, helping the patient to deal with thoughts that contribute to stress, anxiety and depression. Learning to deal with stress is key for bipolar patients, as stress is a major trigger for relapse. In terms of medication, mood stabilisers are used to help keep the patient’s mood level. In the case of mania, tranquilisers may be required, while anti-depressants may be prescribed to treat depression.

The psychological impact of the illness on the bipolar patient is huge.

For this reason, support is vital.

Support from family and friends can go a long way to helping the bipolar sufferer feel loved and accepted, while a support group can help both the bipolar sufferer and their loved ones to come to terms with the illness.

Dr Chait says it’s hugely encouraging to note that there is far more interest

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rom feeling on top of the world and invincible one day to descending into the darkest pit of despair the next; these are the extremes that make managing moods a daily challenge for sufferers of bipolar disorder. According to the South African Bipolar website (which can be found at www.bipolar.co.za), bipolar disorder is a mental illness characterised by severe mood swings, from the highest of highs (mania) to the lowest of lows (depression). These mood swings are out of proportion and often completely unrelated to what is going on in the sufferers’ lives.

Also commonly referred to as manic depression, bipolar affects men and women equally, and tends to come to the fore between the ages of 20 and 30, although this may vary. While much remains unknown about the exact cause of the illness, it appears to be a combination of biochemical, genetic and psychological factors.

Dr David Chait, a psychiatrist at Milnerton Medi-Clinic in Cape Town with a special interest in bipolar disorder, says that there are two main types of bipolar disorder. Bipolar 1 is characterised by alternating episodes of major depression and mania, during which the patient’s level of functioning is significantly impaired.

The symptoms of a depressive episode generally include feelings of intense sadness; loss of interest in work, hobbies and people; demotivation; extreme low energy; low selfconfidence, preoccupation with failure or inadequacy; reduced appetite; sleep disturbances and possible suicidal thoughts. On the opposite end of the spectrum, a patient in the early stages of mania may be more active, sociable, talkative, self-confident, perceptive and creative than usual, however these symptoms tend to heighten rapidly, culminating in extreme euphoria or extreme irritability, hyperactivity, rapid speech, paranoia, insomnia,

I HAVE SEARCHED FOR MEANING IN MY ILLNESS AND MY SPIRITUAL GROWTH HAS BEEN HUGE. I’VE REALISED THAT THERE IS NOTHING WRONG WITH BEING DIFFERENT AND THINKING DIFFERENTLY and awareness in bipolar now than ever before. There is also less stigma attached to the diagnosis, and doctors are seeing better results thanks to profound advances in medication and the use of psychotherapy.

Living with bipolar Gavin had his first psychotic episode at 17. He got into such a state that he ran straight in front of a moving car. As he was in the military at the time, he was taken directly to a military hospital.

While the experience was a huge shock and very frightening for him, he thought it was an isolated incident, and went off his medication after the episode.

He was only officially diagnosed with bipolar seven years later, when he 26

was in a heightened state of mania. ‘I’d had numerous jobs in the period since my first psychotic episode, and had advanced well in my career,’ he says.

‘At that point I was working hard, as well as studying, and doing lots of extra reading after hours. I was only sleeping around three hours a night. I was also competing in triathlons, and would train during my lunch break and after work again before going out with friends.

It was crazy – I would participate in a triathlon and then train again that same evening! While I was aware that I had all this extra energy, I had no idea that it was bipolar, having rejected the earlier diagnosis. This meant that I was essentially in an elevated mood for almost seven years, especially in the

two years prior to my diagnosis.’

Gavin had another major psychotic episode at 25, when he was officially diagnosed with bipolar disorder. So began a cycle of spending time in and out of hospitals, and the long journey of coming to terms with and fighting his illness. ‘Learning to fight back gives you confidence. I’ve had a lot to deal with,’ says Gavin, ‘But I have searched for meaning in my illness and my spiritual growth has been huge. I’ve realised that there is nothing wrong with being different and thinking differently. You can turn that difference into something special if you believe that you are special, that you’re valid and that you have a purpose.’

Admittedly, says Gavin, getting to this point has not been easy, and he has got into trouble along the way, including a few run-ins with the law.

But he has not given up, and says that meeting Wendy, now his wife, was a huge turning point in his life.

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Life with a bipolar partner Wendy first met Gavin at a party and says, ‘I liked him from the start because he was so refreshing and open. I took his number and we became good friends, but I only saw him again about three months later when he was hospitalised. Then we spoke almost every day on the phone, and I visited him often. He eventually moved in and a few months later I asked him to marry me.’

One of the most difficult aspects of living with someone who has bipolar, says Wendy, is that you can’t ever totally relax. ‘Since we’ve been married, Gavin has been hospitalised much less, but we both still have to keep an eye on his mood, which means keeping a routine, not too much stimulation for

prolonged periods of time, good sleep and exercise.’

She says that it’s always difficult when Gavin’s mood spikes quickly, and he starts becoming manic. In almost all cases he needs to be hospitalised.

‘Since we’ve been married, he’s been to hospital five times – twice his mood was too far gone for me to be able to persuade him to go to hospital.

On these occasions I had to call the police to assist me, which is hard for me because I feel like I’ve betrayed him at the time.’ Wendy explains that Gavin also has high blood pressure and diabetes, so it’s not just about elevated mood – there is also a real threat to his health. ‘Calling the police is extreme, but necessary in the long term.’

As far as advice for other caregivers goes, Wendy says it’s important to have a support structure. Hers takes the form of supportive friends and family.

She has also found that being as open as possible about Gavin’s illness has really helped. ‘Some of the things he has done when manic, like inviting people wandering down the road in for lunch and giving his duvet away to a needy man, are quite amusing, and I’ll often relay these stories to friends and family. Gavin laughs about this as well, so I know he doesn’t mind.’

Joining a support group online and in person also helps, says Wendy. It’s all too easy to feel alone or overwhelmed but a support group is a wonderful

The Bankmed Special Care Programme for bipolar mood disorder offers support to members and their dependents diagnosed with bipolar disorder. Participation in the programme is free and voluntary. A Bankmed case manager will be assigned to offer advice and support, as well as to help you understand and manage this condition as effectively as possible.

For more information, call the Bankmed customer call centre on 0800-BANKMED (0800-2265633), fax 021-480-2736, or email specialcare@bankmed.co.za.

way to learn from others as you share stories and coping mechanisms.

Gavin and Wendy’s relationship is built on trust. ‘Trust comes from consistency of behaviour, and being responsible. Gavin is always consistent when he’s stable. He promised he’d always take his medication, and always has. I’m so proud of him. Meeting and marrying him was probably the most significant event in my life,’ says Wendy.

‘Aside from being in love and loving someone, which is wonderful, he has taught me to value every aspect of my life – family, friends and work. For me the bipolar is part of him, and I love him for it, not despite it.’

USEFUL CONTACTS For further information, advice and details of support groups, visit www.bipolar. co.za, or contact the South African Depression and Anxiety Group (SADAG) mental health line on 011-262-6396.

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BANKMED BOUNCE Your World of Wellbeing Winter/Spring 2011

Support is critical, and the role a partner and caregiver plays cannot be underestimated, he says.

One of the most challenging aspects of the illness for him is not being able to work. ‘You must find little things that are important to you to keep going,’ he says. ‘A balanced lifestyle is key in managing the illness, and structure in your daily routine is vital if you don’t work.’ Medication is also a vital component of managing the illness.

Gavin takes mood stabilisers and powerful anti-psychotic medication to prevent psychotic episodes.

physicalwellbeing

in the early stages of the infected person’s illness, and should be given preventative antibiotic therapy within 24 hours of the diagnosis – this should provide protection for up to 14 days.

The classmates, co-workers and healthcare workers involved in caring for a patient with meningitis are not defined as close contacts and generally do not require preventative antibiotic treatment. It is also not necessary for the healthy siblings of an infected child to be kept home from school, and the sick child may return to school as soon as they are feeling well and have completed their course of antibiotic treatment.

Is there a vaccine?

‘Unfortunately the mortality rate of untreated meningococcal disease approaches 100 percent, and therefore it’s exceptionally important not to delay administering treatment,’ says Dr Jocelyn Hellig, a medical officer working in a busy casualty in Cape Town. ‘It’s not always possible to distinguish between viral and

OUTBREAK The last documented outbreak of meningitis in South Africa was that of a viral meningitis in Mpumalanga province in February 2011. A total of 87 probable cases – 10 of which were confirmed – were reported. Viral meningitis is fortunately a milder disease, and no complications or deaths occurred.

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bacterial meningitis clinically, so we often err on the side of caution when treating a suspected meningitis case. Antibiotic therapy is usually given after a sample of cerebrospinal fluid (CSF) is obtained via lumbar puncture,’ she explains.

In confirmed cases of meningococcal disease, a prolonged course of antibiotics is required.

Viral meningitis is far more benign and runs a self-limiting course.

‘In this case, the patient is treated supportively with intravenous fluids, painkillers and bed rest,’ says Dr Hellig.

What measures are taken to protect close contacts?

Close contacts include anyone who lives in the same accommodation, sharing a bedroom or bathroom and kitchen utensils, as well as partners who are exposed to respiratory secretions through kissing and intimate contact. Dr Hellig explains that these contacts are at greatest risk of contracting the disease too

Get vaccinated if: • you are travelling to an endemic area.

The African meningitis belt extends from Senegal to Ethiopia, but those on pilgrimage to Saudi Arabia are also required to get vaccinated 10 days before their arrival • you work in the police force or in the military • you suffer from functional or anatomical asplenia • you work in a laboratory that routinely handles N meningitidis • you have been a close contact of a meningitis patient (the vaccine should then be given in addition to preventative therapy).

IMAGE: SHUTTERSTOCK

What treatment is available?

Vaccines protecting against four types (serogroups) of meningococcal meningitis (A, C, Y and W-135) are available locally, but are not on the routine vaccination schedule. These vaccines are not effective in children under the age of two years old, and do not protect against serogroup B, which is more common in the Western Cape. Routine vaccination is not recommended in South Africa, but is rather targeted at specific highrisk groups.

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Wondering whether you should see on optometrist or an ophthalmologist? An optometrist tests your vision, prescribes appropriate eyewear, and is

blink rate goes down,’ explains Dr Harrison. Add to that environmental factors, air conditioning, frequent flying and so on, and it’s no wonder that almost all of us will suffer from dry and strained eyes at some point. Living in South Africa, with our high levels of UV light and our outdoor lifestyles, can have a negative impact on our eye health too.

Dr Harrison recommends using an artificial tear lubricant as often as necessary to prevent dry eye. Ask for this specifically, and avoid using eye-whitening agents as these only treat redness without addressing the underlying causes.

Presbyopia Around the age of 45, the eyes lose their natural ability to ‘accommodate’, 34

trained to detect conditions that affect the visual system. An ophthalmologist is a medical doctor specialising in managing diseases of the eye.

or automatically adjust when you look far and near. This loss of focus can happen suddenly and is a normal, albeit unfortunate, part of ageing. ‘This is a good time to go and have your first eye check to screen for age-related ocular disease,’ suggests Dr Harrison.

There isn’t much we can do to prevent presbyopia; it afflicts everyone (the journal Archives of Ophthalmology reported that one billion people worldwide suffer from presbyopia), and most people find they simply need reading glasses.

There is an enormous amount of research and development in the area of presbyopia (it’s seen as the final frontier of surgical correction) and it’s not out of the question that corrective procedures will be available sometime in the future.

DIABETIC EYE CARE People with diabetes are particularly prone to retinal damage and blindness (diabetic retinopathy) because the small blood vessels of the retina are damaged by high glucose levels. If you have diabetes, you should have annual screenings for diabetic retinopathy – if your eyes are healthy it’s a good indication that the rest of your body is in good shape too.

Glaucoma is one of 25 chronic conditions covered by your prescribed minimum benefits (PMBs). For more information about PMBs and your plan’s optometry benefits, contact the Bankmed customer call centre on 0800-BANKMED (0800-226-533).

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KNOW YOUR EYE HEALTHCARE PROVIDER

IMAGES: SHUTTERSTOCK

of cells – that contribute to lifestyle diseases such as cardiovascular disease and cancer.’ If you must have ‘fast food’, make your own healthier versions at home instead. Keep an eye on portion sizes and make healthy substitutions wherever possible (for example, a baked potato or salad instead of chips). Remember, if you have excess weight to lose, you need to burn more energy than you consume.

Think yourself younger Happy people tend to live longer than those who have a negative outlook.

Chronic stress has been found to accelerate the ageing process because it increases your risk of having an 37

BANKMED BOUNCE Your World of Wellbeing Winter/Spring 2011

known to cause ill health and decrease life span, for example trans fatty acids and hydrogenated fats.

Fast foods and processed foods can also contribute to weight gain, and as Ketterer explains, ‘Carrying excess weight is bad for your health and, if you’re carrying it around your abdomen, it can increase your risk of heart disease. Maintaining a healthy weight reduces your risk of cardiovascular disease (heart disease and stroke) and its risk factors (including high blood pressure and type 2 diabetes).’

Pentz-Kluyts adds, ‘Excess weight produces free radicals – reactive by-products of the normal activity

healthyliving

Exercise yourself younger ‘According to the American College of Sports Medicine, although ageing is inevitable, both the rate and magnitude of decline in physiological function may be amenable to exercise intervention – 38

and even reversible,’ says Andre Kotze, a biokineticist at Jaco van Onselen Biokineticists at the Renaissance Body Science Institute.

Cape Town biokineticist, Mandy Banks, agrees. ‘I think it is possible to live longer through exercise, because exercise helps keep your heart healthy, can help manage blood pressure, cholesterol, and diabetes, as well as help to prevent obesity. Exercise can

also help to reduce stress.’ She adds that it is well known that a sedentary lifestyle speeds up the ageing process.

‘Exercise is one of the cornerstones of living a long, healthy life and every little bit helps: walking for half an hour a day will help to keep your bones, blood pressure, waistline, joints, energy, arteries and attitude young.’ Aim for at least 30 minutes of physical activity most days of the week.

WHAT’S THEIR SECRET? Peter Cleave, 73, retired engineer Peter enjoys good health and doesn’t look his age.

‘I gave up red meat 10 years ago; not strictly because it would make me healthier, but so that I might live longer by not getting mad-cow disease,’ he laughs. ‘Otherwise my diet is reasonably well balanced: not too much fatty food, plenty of yoghurt, salads, and fruit and vegetables. At least six or seven hours of solid sleep a night is also advised. I stay fit by playing golf, doing DIY jobs around the house, including tiling and painting and decorating, and going for regular walks.’

Shona Findlay, 69, retired nurse Shona’s trim physique and youthful approach to life belies her age. ‘I keep involved with folks of all ages, not just my peers. I set myself regular

mental and physical exercises, but don’t fret if I miss a few days. I don’t take medication unless absolutely necessary and prefer natural remedies. I’ve cut back on the amount of red meat I eat, and I consciously eat more low-fat dairy and a variety of fruit and vegetables every day.

Indulgences are only now and then! I’ve learned to accept it’s harder to cross the monkey bars than it used to be and I don’t win many physical challenges with my grandchildren – but I’m enjoying life!’

Marland Holderness, 70, retired pharmacist Marland attributes ageing well to her positive attitude to life.

‘I believe in thinking happy thoughts, avoiding routines and doing everything in moderation – I don’t do extremes. I also enjoy walking for fun: I take it slowly and spend time looking at and photographing plants.

But my most important healthy living practice is: have happy friends – they keep you young.’

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accident and makes you more susceptible to infections. Clinical psychologist, Graham Alexander, says: ‘When we experience ongoing and chronic levels of stress, our bodies actually decay in the face of the ongoing strain. It is well established that stress leads to hypertension (raised blood pressure), cardiac complications, headaches, skin conditions (like eczema) and profoundly lowered immunity levels.’

Managing stress is as important as a healthy diet and exercise when it comes to slowing the ageing process.

‘Being conscious of maintaining a lifestyle of moderation is the wise way of limiting the damaging effects of stress,’ says Alexander. ‘Having the ability to be resilient and flexible in difficult situations helps us deal favourably with the dangers we face every day. Healthy nutrition, laughter, moderate exercise, and holiday breaks are a few examples of the antidotes we need to remain stable and satisfied.’

If you often find yourself on edge, unhappy, unable to sleep well and in a state of high anxiety, you’re probably experiencing too much stress. Try to restore the balance by switching off your cellphone, ignoring the computer over the weekend and making a point of getting some fresh air several times a week. ‘We need to recognise that rest, sleep and relaxation play as functional and important a role as the hustle and bustle of our working lives,’ notes Alexander. Having strong ties with friends and family has been shown to act as a buffer against stress, so make the time to keep in touch with those who are important to you.

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Take action The first step is to speak to your child about what has been going on. ‘Sit calmly with your child and assess the situation,’ says Cape Town-based social worker, Anne Cawood. Then, speak to the parents of the child who was bullied and let them know you are going to get to the bottom of the issue.

‘Initially, I wouldn’t recommend that the parents talk to the bullied child directly,’ says Elise Fourie, a counselling psychologist based in Pretoria. ‘Parents can become very emotional and protective and this might create conflict if either parent feels threatened, or if a parent feels that their child is being unfairly victimised or criticised.’

Cawood says, ‘If the problem continues, make an appointment to discuss it with their teacher or principal. Most schools have a very definite policy regarding bullying and

CHILDREN NEED TO LEARN THAT IT IS OKAY TO HAVE STRONG FEELINGS, BUT THAT IT IS NOT ACCEPTABLE TO USE BULLYING TO EXPRESS THESE FEELINGS will attempt to deal with it effectively and positively.’ When you to speak to your child’s teacher or principal, explain that you’d like to come up with a plan of action. On the home front, you can have an immediate consequence for the bullying incident and make it clear that you expect your child to change their behaviour. It’s probably a good idea to get some professional advice and for both you and your child to see a counsellor or psychologist.

Tread lightly Talking to your child about their bullying behaviour won’t be easy.

Cawood suggests avoiding direct questions, as children tend to shrink away from these. ‘It is better to encourage open sharing by saying something along the lines of, “It seems that there has been some nastiness at school”. Your child may then try to blame the other child. This will give you the opportunity to discuss better ways to deal with conflict and aggression.

Children need to learn that it is okay to have strong feelings, but that it is not acceptable to use bullying to express these feelings.’

‘It’s important for the parents to stay calm and to work together as a team,’ says Fourie. ‘The child should not feel attacked in any way – remember a bully is, more often than not, a deeply hurt child, a child who feels vulnerable or a child who feels angry, for whatever reason. The

parents should remember, no matter how embarrassed, aggrieved or despondent they feel, their child feels even more so, and at this point only has them to step in for him or her.’ She recommends that parents first get as much information as possible, for example what does their child do that can be seen as bullying behaviour?

Where and when does it take place?

Who reported it? Was it observed by a teacher or other responsible parent?

How does the school deal with bullying behaviour? The reason for this is to get information which will enable the parents to decide on an appropriate course of action. ‘It is also important to determine whether the complaints are genuine, and that they are not just an attempt by another child to create problems for the child in question or that the child is not being made a scapegoat,’ adds Fourie.

Why does a child become a bully?

Cawood, who has run workshops on the subject bullying, says the children attending these workshops had the following reasons to offer for their bullying: ■ Because they are bullied at home.

■ Because they are angry and take it out on others.

■ They like power and control.

■ They have low self-esteem and being nasty to others gives them a feeling of being powerful.

■ They regularly see their parents fighting and being nasty to each other at home.

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his teacher who confirmed that he had a bit of a reputation as a bully.’

If someone tells you that your child is a bully you may feel a range of emotions, including guilt, powerlessness, shock, and a sense of responsibility; or you may be tempted to go into denial, telling yourself that the other child is just over-sensitive or over-reacting. However, denial isn’t going to help anyone – neither your child nor the one who is being bullied.

You need to find out what’s at the root of this behaviour and work out how to deal with the problem.

Unfortunately, bullying becomes a habit, built up over a period of time and because of this, changing the behaviour may only happen over a sustained length of time too. Seeing the incident as a once-off episode isn’t realistic – if the episode was big enough for you to hear about it, from either another parent or your child’s school, it’s unlikely to go away without some intervention.

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home, and lastly, some model the behaviour of a parent who doesn’t act in a respectful manner towards other people, or physically abuses a parent or child.’

‘There is no doubt that children learn to behave in aggressive ways because they see adults behaving unacceptably,’ says Cawood, adding that temperament also plays a part.

‘Some children have the innate tendency to be controlling and exert pressure over their peers. Others are genetically wired to more easily adopt a victim mentality. Whatever the temperament, it is definitely up to the adults in the child’s life to help the child manage their behavioural choices positively,’ she cautions.

Fourie agrees that there is no simple answer as to why a child becomes a bully, but says that there are often some underlying reasons why a child might display bullying behaviour: ‘Firstly, children who have suffered some kind of trauma (divorce, sexual 44

SOME CHILDREN HAVE THE INNATE TENDENCY TO BE CONTROLLING AND EXERT PRESSURE OVER THEIR PEERS abuse, exposure to crime) often react with anger due to unhappiness, helplessness and a desire to retaliate,’ says Fourie. ‘When children are exposed to uncertain and unstable circumstances, it creates uncertainty, which can also cause them to act out in uncertain circumstances, such as on the playground at school. Many children are impulsive and react impulsively to feeling provoked or victimised. Some children with low self-esteem feel jealous or victimised, some feel neglected or unloved at

Fourie suggests that parents adopt several of the following strategies to curb their child’s nasty behaviour: ■ Determine the possible underlying reason for the anger.

■ Suggest coping mechanisms for difficult situations.

■ Practise self-assertive, non-aggressive behaviour in role-play situations with the child.

■ Repeatedly educate the child about appropriate behaviour when confronted with frustration and angerprovoking situations. Use examples from your own life, like when you’re stuck in traffic and someone jumps the queue.

■ Let the child understand that even though their behaviour is not acceptable, they are still loved, accepted and important.

■ Spend more time with the child.

■ Create a stable, more predictable environment for the child.

Cawood stresses that it is very important for parents and teachers to be positive role models. ‘Using harsh, punitive methods means that children will imitate these ways of coping with anger and frustration. Help children to find acceptable ways to channel these negative feelings. Make it very clear that they will have consequences imposed if they choose to break the rules of good conduct. For example, say: “It is okay to feel frustrated, but when you feel that way you may not hurt anyone. If you hit her again, you will have to miss your TV programme on Friday”.’ This applies to sibling bullying too. Parents need to make it very clear that, while siblings may annoy each other, it is never acceptable to use bullying to deal with this.

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WHAT’S YOUR BANKMED STORY? Tell us how Bankmed has helped you or been a part of your life. Send a brief outline of your story to: The Editor, PO Box 15054, Vlaeberg, 8018, or email: bounce@bankmed.co.za. Please remember to include your name as well as your contact details. this year, taking her very last breath while lying in her mother’s arms. ‘The difficulties she experienced during her short life were not responsible for her death,’ Raihaan confides. ‘Her death certificate attributes it to “natural causes” and we cannot question the will of God.’ The family was, understandably, inconsolable. Zaynub had taken her daughter to the doctor because she realised she wasn’t well and was told that Layyah needed a drip as she was a little dehydrated.

By the time they got home, Layyah was non-responsive and passed away moments later. Despite the limited time they were blessed with her presence in their lives, Layyah remains

an incredible gift to her loving family.

‘The pain of losing her can’t erase the love we feel for her in our hearts,’ says her father. ‘Even in the midst of all the pain and sorrow, I would choose her over and over again as I can’t imagine not having known and loved her.’

During the 58 short weeks that spanned Layyah’s life, Bankmed paid all the bills and provided invaluable assistance to the Nawaz family, for which they remain extremely grateful.

‘I have no idea what I would have done if I didn’t have Bankmed at my side,’ admits Raihaan. ‘Thanks to Bankmed, Layyah was given the best medical care possible and the best treatment available by the top neurosurgeon in the country. There’s no doubt in my mind that if I hadn’t had medical aid coverage, her journey would have been very different and certainly would have been over very soon after her birth.

Bankmed gave her a fighting chance – what more could any parent want?

I remember having a get-together at work when Layyah was about 10 months old and my colleagues asked me to share my story. Someone wanted to know how much her treatment had cost and everyone was stunned to hear that it was well over R1 million by that stage. That was Bankmed’s gift to us – who has that kind of money lying around age 27? Or at any age, come to think of it? I clearly recall the very first bill that came through from the doctors – for R500 000 – and Bankmed paid it in one shot, no questions asked. That single phone call on the day Layyah was born made a huge difference to our lives.’

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BANKMED BOUNCE Your World of Wellbeing Winter/Spring 2011

Two weeks after her discharge she contracted measles, which meant another readmission. When the measles cleared, the doctors decided to insert a shunt to drain the fluid from her brain, with great success. But after just one month at home, the little girl developed meningitis, which caused severe complications and infected the shunt, causing a blockage. Long-term antibiotics cleared the meningitis and the shunt was removed, only to be reinserted three months later. ‘Through all of this, the special gift who was my daughter was somehow, miraculously, still around,’ says Raihaan. The times of sheer elation were sharply contrasted by the devastating lows that had become part and parcel of their lives with Layyah. The family coped by making the most of every single minute they had with their little girl as they had no idea what would happen next.

Sadly, despite her ongoing fight, Layyah passed away on 25 May

IMAGES: SHUTTERSTOCK

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emotionalwellbeing

IF WE DON’T HAVE A GOOD RELATIONSHIP MODEL, OR ARE ABANDONED OR HURT BY THE PEOPLE WE ARE CLOSEST TO, WE PUT UP A WALL TO PROTECT OURSELVES FROM EXPERIENCING THAT PAIN AGAIN property, which represents far too serious a commitment.

■ They may change jobs frequently or set up an independent work life that gives them plenty of flexibility.

What’s behind fear of commitment?

We first learn about relationships at an early age – before we’re even involved in them. If we are raised by adults who demonstrate their care and respect for each other, we learn how to do the relationship dance.

We witness communication and coping skills, we pick up techniques for resolving conflict and we see partnership in action. But if we don’t have a good relationship model, or are abandoned or hurt by the people we are closest to, we put up a wall to protect ourselves from experiencing that pain again.

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major life choice will be very stressful for someone who can’t commit. While some people don’t feel secure unless they have a firm commitment from their partner, certain personalities prefer to approach the world and relationships with all their options open, as the idea of permanence makes them feel caged or trapped.’

Sometimes fear of the unknown territory they are entering is at the root of their hesitation.

If family upheaval and dysfunctional relationships are a person’s only reference, how do they know if they are doing the right thing

or if they have what it takes to make it work? What does commitment entail? What expectations will there be? These questions can be so overwhelming that escape might seem like the only option.

How you can help You can’t force the other person to change, says Boon, but talking about possible underlying issues in a non-threatening, non-blaming way can help both parties to explore what is happening. ‘And the rule here (for both) is to listen in order to understand – not to fix. In this way, couples can obtain clarity about the meaning of commitment for each person. Building trust in the relationship through consistently honest words and actions is essential.’

Resorting to emotional blackmail doesn’t help; neither does accusing a commitment phobic partner of not really loving you. The more clingy and demanding you get, the further and faster they will run, so give them some space to think things through.

Sometimes, taking the pressure off does the trick, but if it doesn’t, you will have to consider whether it’s realistic to hope for commitment from this kind of person. You could wait forever and get your heart broken anyway. Perhaps it’s best to accept that you will be better off as friends.

If you always seem to attract commitment-phobes, ask yourself whether, deep down, you aren’t fearful of commitment too. It takes two to be in a relationship, and you are in charge of your half of the equation.

If you would really like to do it differently next time, look out for the warning signs and don’t rush into a love affair too quickly.

Keep your

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‘Past experience of whole-hearted commitment ending in abandonment leaves people with a deep mistrust of others,’ says Randburg life coach, Christine Boon. ‘It’s a case of once bitten, twice shy.’

Fear of commitment may also be due to low self-esteem, she says. On a subconscious level, the person may feel undeserving of a relationship.

They may have thoughts such as, ‘I’m not good enough, I’ll never be able to make it work’ or, ‘If she really gets to know me, she won’t like me.’

Difficulty making decisions also plays a part. ‘A commitment is a decision,’ explains Boon. ‘It’s a conscious choice that closes down other options. Buying a house, changing career or making any other

What they can do to get over their fear ‘It’s helpful for a commitment-phobic person to reflect on their past and identify times when commitment led to disappointment, failure or abandonment,’ says Boon. ‘They should talk about these events with someone they trust; someone who can help them compare past experiences with the current situation and acknowledge where there are differences and similarities.’ It’s important that they see you’re not the parent, ex-wife or whoever it was who hurt them; you’re someone with whom they can start afresh, if they’ll just give you a chance.

Clear communication is one of the cornerstones of a good relationship,

IT’S IMPORTANT THAT THEY SEE YOU’RE NOT THE PARENT, EX-WIFE OR WHOEVER IT WAS WHO HURT THEM; YOU’RE SOMEONE WITH WHOM THEY CAN START AFRESH so discussing any fears and concerns will strengthen the connection and cut out some of the potential for misunderstanding and hurt feelings. If it’s hard for your partner to talk about their emotions, encourage them to try writing their thoughts in a journal or a letter. Once the issues are on the page, they may seem easier to deal with.

The more aware they are of the ways in which their past experiences have made them hyper-sensitive, the less likely they will be to project this history on to a new relationship. But to get that right, they will need to do

a lot of emotional and spiritual work, preferably with a counsellor who can guide them gently through the process of developing insight and releasing pent-up resentment and anxiety. After doing all that, they may decide that they really don’t want a long-term relationship – at least not now. If that’s the case, they need to be clear and up-front about this choice not to commit. The other partner can then decide whether they are willing to get involved on those terms or not.

Finally, the reluctance to commit could also be wise advice from a person’s intuitive guidance system.

Maybe this is not a relationship with potential; maybe it’s better to move on.

‘Trust your gut,’ says Boon. ‘Sometimes your intuition is sending you a powerful message.’ Ultimately, though, it is through our relationships that we learn about ourselves. Sooner or later, we have to take a chance and make a choice, knowing that, whatever the outcome, we’ll be wiser for it.

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BANKMED BOUNCE Your World of Wellbeing Winter/Spring 2011

other friendships strong; they will be there for you if the next partner takes off. If your partner tries to monopolise your time and isolate you from friends, beware: they’re not right for you.

Children and teens Given the rise in childhood obesity, it’s essential for exercise to be entrenched as a lifestyle habit – even at this early age. For that to happen, it has to be fun, says Schoeman. The American College of Sports Medicine (ACSM) suggests that, for young children, there should be an emphasis on active play (instead of exercise). In older children, 20 to 30 minutes of vigorous exercise at least three days a week is recommended.

Benefits In children, exercise improves muscle strength, motor skills, coordination, posture and balance. Activities that place compressive and tensile (twisting) forces on bones can also help to maximise bone density.

In addition to the physical payoffs, active children are generally less stressed and have good concentration, confidence, self-esteem, and better sleeping patterns, says Schoeman.

Another advantage of participating in sports, especially team sports, is improved social and interpersonal skills.

And, not only are active children healthy children, but they are likely to have less body fat, a healthy heart, and healthy lungs, arteries and bones in adulthood too. There’s also a decreased risk of developing lifestyle diseases such as heart disease, osteoporosis and high blood pressure.

Twenties to forties One thing that certainly doesn’t change from childhood to adulthood is that,

in order to make exercise sustainable, you should choose a form of exercise that you enjoy. You also need to take your health status, and personal goals and abilities into account. The ACSM recommends that all adults should accumulate 30 minutes or more of moderate-intensity physical activity on most, preferably all, days of the week.

Ideal exercise Schoeman advises a warm-up period of five to 10 minutes, which could consist of low intensity activities such as walking or cycling. Once your muscles are warmed up, you can move into the conditioning phase (20 to 60 minutes), which should involve cardiovascular, resistance and flexibility training.

■ For cardiovascular fitness, try jogging, skipping, cycling, swimming, stair climbing, hiking, dancing, boxing or body conditioning classes. If an injury prevents you from performing activities that stress the joints,

choose swimming, aqua classes or stationary cycling instead.

■ Exercises that place compressive force on bones help to increase bone mineral density, so running or step classes, for example, are great for preventing osteoporosis.

■ Resistance training should exercise the major muscles of the hips, thighs, legs, back, chest, shoulders, arms and abdomen. Examples, that can be adapted to suit your abilities, include: • squats and lunges (hips, thighs and legs) • bent over rowing, back extensions, one-arm rows, pull-ups (back) • chest press, bench press, pushups (chest) • shoulder press, frontal and lateral raises (shoulders) • bicep curls, tricep extensions (upper arms) • sit-ups, reverse crunches, plank position, and oblique crunches (core).

■ Flexibility involves maintaining a good range of motion 57

BANKMED BOUNCE Your World of Wellbeing Winter/Spring 2011

Ideal exercise ■ Sports, such as swimming and cycling. Encourage your children to participate in sports at school.

■ Jumping, skipping, dancing and running games.

■ Supervised resistance training (for teens), with the emphasis on correct form and technique rather than the amount of weight lifted. (This improves muscle strength.)

healthyliving

Benefits Health benefits include improved physical fitness, associated with lower death rates from coronary artery disease; increased HDL ‘good’ cholesterol and decreased LDL ‘bad’ cholesterol; reduced total and abdominal fat; reduced blood pressure; increased muscular strength, endurance and enhanced strength of connective tissue; enhanced performance 58

(at work, during recreational and sport activities); reduced risk of osteoporosis and lower back pain; and decreased incidence of anxiety and depression.

Fifties to eighties Despite a person’s advancing age, the most important thing for this age group is not to give up on exercise – it is still hugely beneficial. The key to staying physically active lies in finding activities that you enjoy which, while still challenging, can be done with comfort and relative ease.

With age, bones can become fragile because of a decrease in bone mineral density, and muscles and joints lose strength and flexibility, so it’s essential, that exercise doesn’t place excessive stress on joints or aggravate existing orthopaedic problems. Schoeman cautions that if you suffer from a medical condition, you should increase your exercise intensity very slowly.

Ideal exercise ■ Aquatic exercise, stationary cycling, walking, and tai chi.

■ Low-intensity conditioning. As a general guideline, Schoeman suggests doing one set of eight to 10 exercises (10 to 15 repetitions per exercise) that use all the major muscle groups.

Examples include:

Benefits Increased strength and endurance, as well as the improved balance and agility as the result of regular exercise, can prevent falls and fractures (the risks of which increase with advancing age). There’s a reduction in blood pressure and cholesterol, as well as body fat and – as a welcome spin-off of exercise at any age – enhanced feelings of wellbeing.

Discovery Vitality offers a variety of fantastic fitness benefits to suit every age, from reduced rates on gym memberships to Vitality points for certain activities.

For more information on Vitality’s fitness benefits or to join Vitality, call 0860-110-833. To enrol in a Bankmed Special Care Programme, call 0800-BANKMED (0800-226-5633) or email specialcare@bankmed.co.za.

IMAGES: SHUTTERSTOCK

in all joints. Stretching helps to achieve this. Include it as part of your warm-up and cool-down before and after a training session, or take up pilates or yoga. Kathy Wolstenholme, founder of the Nia Technique (a dance and martial arts fusion), recommends integrating stretching into your daily activities wherever possible – for example, reaching for items on high shelves.

■ Make time for leisure activities that incorporate a physical element, such as golf, bowling or gardening, or recreational sports such as tennis, squash or soccer.

• sit to stand (legs and glutes) • straight leg raise (front of the thigh) • lying ball squeezes (inner thigh) • bridging or hip lifts (hips, glutes and back) • alternate arm and leg raises (lower back and core) • modified crunches (abdominals) • standing push-ups against a wall (chest and arms) • frontal and lateral raises (shoulders) • bicep curls (upper arms) • tricep kickbacks (back of upper arms)

TEA WORTH THE WAIT

Say goodbye to wilted lettuce leaves, stale cereal and crunchless crisps with new freshSTIX from Tevo. freshSTIX are a convenient and neat way of sealing any bag in seconds, which means food stays fresh for longer – not to mention no more leftovers leaking all over the fridge. How do they work?

Simply fold the bag, slide the freshSTIX rod through the fold and seal.

Packaged in four different colour-coded sizes suited to different applications, freshSTIX are available from Pick n Pay, Game, Makro and Builders Warehouse at R49.95 for a set of 10 pieces. For more information, visit www.tevo.co.za.

ADDTOTASTE.BLOGSPOT.COM, WWW.SCIENCEDAILY.COM, WWW.HEALTH24.COM IMAGES: SHUTTERSTOCK, SUPPLIED

giveaway

To stand in line to win a set of freshSTIX, SMS the words Bankmed/freshSTIX, with your full name, postal address and daytime phone number to 34509 by 31 October 2011.

DON'T PLAY WITH YOUR FOOD...

Play with your napkin instead. These origami napkins from Mantality are sure to be a talking point – not to mention, fun activity – at any dinner table, party or picnic. Choose from four designs printed on the napkins to create your origami masterpiece. But, if chess is more your kind of game, look out for these King and Queen salt and pepper mills from Mantality instead.

This quirky set will add a sense of fun to any table setting.

For more information and playful products, visit www.mantality.co.za.

A great deal of thought and research has been put into how to make the ‘perfect cup of tea’, which is not really surprising seeing as tea is the second most consumed beverage in the world, second only to water. A new study from researchers at the University of Northumbria's School of Life Sciences claims to have found the secret ingredient to the perfect cuppa: patience. They say that the key to the tastiest brew is adding boiling water to a teabag in a mug, letting is sit for two minutes, removing the teabag and adding the milk, and then letting it sit for a further six minutes before drinking. Apparently this is how long it takes for the tea to reach its optimal temperature of 60 degrees Celsius, which – according to 180 hours of testing and a panel of volunteers – provides for the best flavour and sensory experience. Beware of leaving your tea too long though: if the temperature drops below 45 degrees, the flavour will be less than ideal. The researchers added that the addition on 10 ml of milk helped to balance out the bitterness of the tea.

giveaway

To stand in line to win a Mantality hamper consisting of King & Queen salt and pepper mills and a pack of origami napkins, SMS the words Bankmed/Mantality, with your full name, postal address and daytime phone number to 34509 by 31 October 2011.

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BANKMED BOUNCE Your World of Wellbeing Winter/Spring 2011

FRESHEN UP

blood sugar levels, helping to reduce irritability and hunger, so eating oats for breakast will give you sustained energy to get through the day. In fact, most grains and pulses (like brown rice, lentils, barley and chickpeas) help to steady blood sugar levels – so no sugar- or mood crashes.

■ DARK CHOCOLATE Indulging in a few blocks of dark chocolate may be the sweetest way to reduce stress.

Research published in the Journal of Proteome Research has shown that eating dark chocolate when you’re feeling on edge can help soothe frazzled nerves. The stressed-out study participants who ate a little dark chocolate every day for two weeks exhibited reduced levels of

stress hormones. Chocolate causes an endorphin release, which heightens feelings of wellbeing and reduces pain. Chocolate with a high cocoa content also contains more flavanols – antioxidants that improve blood flow in the brain. Moderation is key though.

■ WALNUTS Apart from fish, walnuts are another good source of omega-3 fatty acids which are needed for brain cells and mood-lifting neurotransmitters to function properly.

■ SPINACH This leafy food has high levels of folic acid and magnesium, both of which are linked to mood.

A deficiency of either may cause depression and anxiety.

These foods won’t cure clinical depression – a disorder requiring professional attention – but can help keep a smile on your dial.

Three feel-good meals GRILLED SALMON AND ZUCCHINI WITH RED PEPPER SAUCE (Serves 4)

Ingredients 4 portions salmon fillet 4 medium zucchinis, halved lengthwise a little canola or olive oil freshly ground black pepper 1 tsp chopped fresh parsley, to garnish For the sauce: ⅓ cup sliced almonds, toasted 2 roasted red peppers, seeds removed 1 cup halved cherry tomatoes 1 clove garlic 1 tbsp olive oil 1 tbsp red wine vinegar 1 tsp paprika

Method 1. Preheat your grill to medium.

2. Mix almonds, peppers, tomatoes,

garlic, oil, vinegar, and paprika in a food processor or blender until smooth. Season to taste and set aside.

3. Coat the salmon and zucchini on both sides with a little olive oil and season with salt and freshly ground black pepper. Grill, turning once, until the salmon is just cooked through and the squash is soft and browned, about three minutes per side.

4. Transfer the zucchini to a clean cutting board. When cool enough to handle, slice into 1 cm pieces and toss with the sauce. Top each piece of salmon with the sauce, garnish with parsley (if desired), and serve.

Nutritional analysis per serving ■ Kilojoules: 1 176 kJ ■ Fat: 13 g ■ Carbohydrates: 8 g ■ Protein: 32 g ■ Fibre: 2 g 63

BANKMED BOUNCE Your World of Wellbeing Winter/Spring 2011

mental illness – specifically, depression and anxiety,’ says Durban-based dietitian, Genevieve Jardine. ‘Conversely, a typical “western” diet high in refined or processed foods and saturated fats may increase the risk of depression.’

While eating a well-balanced diet and not skipping meals is best practice, the following foods are known for their mood-boosting properties, so add them to your trolley regularly: ■ SEAFOOD Selenium is a trace mineral (meaning you don’t need much each day) found in seafood, and has been linked to mental decline, anxiety and depression when not enough is consumed. Oily fish, such as sardines, mackerel and salmon, also contains the essential oil omega-3, which enhances serotonin levels. ‘Studies show that a deficiency in these fatty acids may lead to, or worsen, depression or anxiety conditions. Aim for two to three servings of fish per week,’ advises Ivison.

■ BANANAS Contain tryptophan, an important amino acid associated with serotonin production. In raising serotonin levels, tryptophan is good not only for fighting anxiety and depression, but for treating insomnia and restlessness too: try a banana at bedtime before you reach for sleeping pills. Other good sources of tryptophan include poultry, tuna, and soya products.

■ CHILLIES Capsaicin, the natural ingredient that gives chillies their zing, stimulates nerve endings in the mouth, causing not only that characteristic burning sensation, but the release of endorphins in the brain. These are your body’s natural painkillers, which produce a temporary ‘high’. So, believe it or not, the more hot chillies you eat, the stronger the mood-boosting effect.

■ OATMEAL Oats are rich in soluble fibre, which plays a role in stabilising

healthyliving

2. Add the tomatoes and spinach; then return to a boil. Reduce heat, cover and simmer for 15 to 20 minutes longer or until the lentils are tender.

Stir in the vinegar and season to taste.

Discard the bay leaf and serve with crusty bread.

2. Blend on low speed until ingredients start to mix together. Then increase to high speed and blend until smooth. Serve with a light dusting of cinnamon or, if you’re feeling indulgent, grated dark chocolate.

Nutritional analysis per serving

■ Kilojoules: 1 121 kJ ■ Fat: 11 g ■ Carbohydrate: 41 g ■ Fibre: 2.5 g ■ Protein: 6 g

■ Kilojoules: 705 kJ ■ Fat: 3 g ■ Carbohydrate: 27 g ■ Fibre: 10 g ■ Protein: 10 g

Nutritional analysis per serving

BANANA AND WALNUT SMOOTHIE (Serves 2)

Ingredients

Spinach and lentil soup SPINACH AND LENTIL SOUP

1 ripe banana, frozen and sliced ½ cup soy milk or cow’s milk ¼ cup chopped walnuts 1 or 2 tbsp honey cinnamon, to dust, or grated dark chocolate

Method 1. Place the banana, milk, walnuts, and honey in a blender.

Banana and walnut smoothie

(Serves 6) 1 onion, chopped 2 garlic cloves, minced 1 cup chopped carrots 1 tbsp olive oil 1.5 litres vegetable or chicken stock 1 cup lentils, rinsed ½ tsp dried thyme 1 bay leaf 1 x 400g can chopped tomatoes 2 large bunches fresh spinach, washed, stems removed and chopped 1 tbsp red wine vinegar

Method 1. In a large pot, sauté the onion, garlic and carrots in the oil, until tender.

Add the stock, lentils, thyme and bay leaf, then bring to a boil. Reduce heat, cover and simmer for 20 minutes.

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DO’S AND DON’TS Genevieve Jardine suggests the following do’s and don’ts: DO keep your blood sugar levels stable by eating regular meals with optional small snacks. Your moods, emotions and energy levels are greatly influenced by your blood sugar levels.

DON’T skip meals, as doing this will result in energy dips and unhealthy food cravings.

DO make sure you eat balanced meals that contain good quality protein (lean meat, chicken and fish), whole grain (low-GI) carbohydrates and small amounts of healthy fats. Balanced meals will stabilise blood sugar levels.

DON’T give in to cravings for refined starch and sugars, as this will wreak havoc on your blood sugar levels.

DO eat plenty of fruit and vegetables (a minimum of five servings a day). Fruit and vegetables (along with whole grains) are high in antioxidants, folate and B vitamins and magnesium, which can reduce the severity of depression and boost serotonin levels.

DON’T be a couch potato – exercise encourages the release of the feel good hormone serotonin and is also essential for weight management.

DO drink more water, and watch your intake of alcohol and caffeine.

IMAGES: SHUTTERSTOCK

Ingredients

Your

health is in good hands We’re rolling out Pick n Pay Pharmacies at more of our stores.

So while you get great value every day on your groceries, you’ll also find our full pharmacy service. We’re here for you with everything from over-the-counter medicine and supplements to all your prescription needs. *We’ll also deliver your medication at no extra charge. *We charge up to 20% below the maximum legislated dispensing fee. No admin charges. Visit our qualified nurses for any clinic services you require

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1166372

books Cabin Fever

Diane Awerbuck (Random House Struik) Diane Awerbuck is one of the up and coming voices in the South African literature scene – and for good reason. In Cabin Fever, a collection of short stories, she seamlessly weaves together myth and memory and marries the surreal with the all-too-real. From the lost history of the Observatory Library Lady to a swimming lesson for some Kimberley wedding guests, the predominant theme throughout is the idea of personal responsibility and when a person should intervene, making this book some serious food for thought as well as for the imagination.

We are giving away three copies of Cabin Fever. To stand in line to win, SMS the words Bankmed/Cabin Fever, with your full name, postal address and daytime phone number to 34509 by 31 October 2011.

John Grisham (Random House Struik) Nine years ago, Donte Drumm, a local football star, was convicted of a crime he didn’t commit and sent to death row to await execution. More than 400 miles away, Travis Boyette, the man who really abducted, raped and strangled the high school cheerleader is dying of an inoperable brain tumour and reflecting on his miserable life. Travis decides to use his last chance to do the right thing and to confess, but how is he going to convince the lawyers, judges and politicians that they have sentenced the wrong man to death with only four days to go?

We are giving away five copies of The Confession. To stand in line to win, SMS the words Bankmed/Confession, with your full name, postal address and daytime phone number to 34509 by 31 October 2011.

IMAGES: SUPPLIED

Beatrice and Virgil

Yann Martel (Penguin Books) This is the story of a donkey and a monkey, Beatrice and Virgil. More importantly though, it is also the story of Henry, an author trying to publish a follow-up to his hugely successful first novel (you can already see the parallels here between Henry and Martel himself). What is especially significant is not the interesting characters that Martel creates or his artful storytelling, but rather the seriousness of the topic that lies at the heart of this novel: the Holocaust. Beatrice and Virgil will certainly stir the emotions and remain in your memory long after the last page has been read.

We are giving away five copies of Beatrice and Virgil. To stand in line to win, SMS the words Bankmed/Martel, with your full name, postal address and daytime phone number to 34509 by 31 October 2011.

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BANKMED BOUNCE Your World of Wellbeing Winter/Spring 2011

The Confession

A world of information, support and security

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For sector news, Sasbo news online and your membership benefits, visit www.sasbo.org.za

For over 90 years, SASBO and Bankmed have worked together to provide you with a greater sense of wellbeing. So when it comes to enhancing your life, you can bank on us, through good times and bad.