BodyLanguage Issue 14 Winter 2018

Issue 14 | winter 2018

Health Benefits of INTERMITTENT

FASTING Hearing Loss IN CHILDREN

ALL ABOUT

Your Hormones

Winter Blues MAKING YOU SAD?

Dental Emergencies

IN CONTACT SPORTS

FIRST AID Dealing with EPILEPSY

HEALTH ADVICE

Ask our experts

8

contents

Issue 14 | winter 2018

Be personal 2 32

10

14

CEO MESSAGE YOUR EXPERTS Your questions

Interact 3

INTERCARE News & events

4

SNIPPETS Latest health news

30

6

18

follow on sociauls media!

24

Your health 8

HEALTH STRATEGY Winter Blues making you SAD?

10

HEALTH IQ The Health Benefits of Intermittent Fasting

21

KNOW IT ALL The Battle for Breath

From the experts

RECIPE Healing Teas

14

NEED TO KNOW Dental Emergencies in Contact Sports

Your body

18

DIAGNOSIS Understanding Hearing Loss in Children

INFOGRAPHIC Your Hormones FIRST AID Dealing with Epilepsy

27

TRAVELGROUND Fun 4x4 Trails

yo u. ..

W e wa nt to hentsarandfrcusom to air their ers tom

21

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ite all patie We would like to inv ing this magazine. us with input regard e vid views and pro will then be able remain relevant and In doing so, we can at healthcare gre a e eat “cr and to make a difference Please email us at er” on a daily basis. experience altogeth intercare.co.za ce@ en eri OR myexp info@intercare.co.za ideas and topics you with any suggestions, out. would like to read ab ORIAL ENQUIRIES ADVERTISING & EDIT ng: Health-B ytes Publishi health-b ytes.co.za 021 913 0504 | christa@ Grobler ista Chr or Publishing edit : Bernette Becker Design – Health-B ytes t | Printing BusinessPrin Proofing Albert Buhr

ADVERTISING: Language FREE copies of Bod y rcare are distributed at Inte tres.

Medical and Dental Cen act cont se To advertise, plea ent. our advertising departm

CEO message

CEO

message

Before we started Intercare in 2002, we made it our business to understand our patients’ needs – the reason why we opened in retail centres with extended hours. We have reached the stage in the evolution of healthcare delivery where a patientcentred approach to healthcare which, inter alia, includes an exceptional patient experience, is no longer an option, but a necessity. A patientcentred approach does not only refer to worldclass clinical care, it addresses all aspects of the patient’s encounter with the provider.

Intercare is essentially about people. We combine the very best healthcare professionals with an exceptional staff complement to maximise the experience of our patients. With this in mind we also accept our responsibility to lead and manage this business in a sustainable manner.

On 1 March 2018 we partnered with Medfem in Sandton to have our first specialised hospital in the group. Today we have 20 medical and dental centres, 4 day hospitals, 4 sub-acute hospitals and 1 specialised hospital as part of the Group.

Medical and dental centres, dedicated

We are proud to have 29 facilities operating

units for sub-acute care and

under the Intercare brand.

rehabilitation, as well as ambulatory day surgery centres, are key components

We believe that the future is here, but not here

of the Intercare Group’s healthcare

entirely. We are operating in an interesting and

model in South Africa. A patient-centred

challenging, intermediary state, an ice cube that

organisation structures its services

is standing in a puddle of its own water, neither

around the health status and needs

completely ice nor completely water. It is a

of patients and not merely traditional

challenging time, as the demands of the new

levels of care. It represents a transition

system pull at the structures and capabilities of

from the out-dated traditional hospi-

the old. As a group, we are standing up and taking

and provider-centric model, offering

on the challenge of being a leader in this change,

consumers accessibility and convenience

despite the difficulties that it presents and the

through the location of their facilities and

investments that are often required.

extended operating hours, high quality clinical care, and reduced costs amid an

I would like to close with a quote from

escalating disease burden. The Intercare

Wayne Gretzky, a professional ice hockey player:

Group is an example of what is possible

“I skate to where the puck is going to be,

when one is profoundly committed to

not where it has been.”

change and willing to invest, collaborate and partner to make that change a reality.

That is the Intercare Way!

NEWS AND EVENTS 2 0 18 I nt er ca re C on fe re nc es

m la) and Hendri Haneko Wouter Lombard (Cip Dr Hendrik Hanekom,

onyane Drs Magosh ane & Map

Panel Discussion

Intercare hosted two successful regional conferences during June this year that were attended by Intercare healthcare professionals and a number of specialists.

We were privileged to have speakers of note at the conferences such as Dr Azar Jammine (Chief Economist, Econometrix), Dr Eugene Allers (Specialist Psychiatrist, Glynnview Private Hospital), Peter Fuller (Vice-President & General Manager Southern Africa, Medtronic), Koert Pretorius (Chief Executive Officer, Mediclinic), Andrew Boden (Related Business Executive, Mediclinic), and Raymond Raves (Business Development Manager Southern Africa, Servier Laboratories).

Dr Hendrik Hanekom (Chief Executive, Intercare) and Dr George Veliotes (Chairman, Intercare) as well as a number of Intercare executive team members also addressed the delegates. Some of our own experts, such as Dr Johan Hartshorne (dentist at Intercare Tyger Valley) and Dr Anil Ramjee (family physician at Intercare Century City) also participated in panel discussions.

Spouses and partners joined the delegates after the conferences for evenings filled with good food and entertainment. Cipla sponsored both the evening functions and went all out to spoil the guests.

Dr George Veliotes Dr Azar Jammine &

page 03

snippets

tHhEAeLTlaHtNeEsWtS DO GOOD – feel good!

Source: DoGoodLiveWell.org.

“It is one of the most beautiful compensations of this life that no man can sincerely try to help another without helping himself.” Ralph Waldo Emerson Volunteering is a great way to get out and help your community. Plus, according to the Mayo Clinic, volunteering can decrease the risk of depression, provide a sense of purpose and even help you live longer. Taking a few hours out of your schedule to do good in the lives of others could thus help your own physical and mental health too.

Many large-scale studies and surveys back up the claim that volunteering improves health. Here are some of the physical and mental health benefits that have been found: • People who volunteer have lower mortality rates. And they often have more functional ability, too. This means they’re more able to do things such as walking a half-mile a day or

getting chores done at home. And they’re more likely to leave the house to go to church or see a movie with friends without needing assistance.

• 68% of people who volunteer say that it makes them feel physically healthier. And almost one-third say it helps them manage a chronic health condition.

• Volunteering decreases a person’s risk of depression. That’s because it increases their social interaction and support, reduces stress and causes “The Happiness Effect.”

• Older adults who tutor children or volunteer in other ways can delay or even reverse declining brain function.

THE TRUTH ABOUT SMOKING AND PROSTATE CANCER THE RELATIONSHIP BETWEEN PROSTATE CANCER AND SMOKING IS CONTROVERSIAL. Cigarette smoking has been linked to more aggressive disease at diagnosis, increased risk of biochemical recurrence with elevated levels of prostate specific antigen and higher risk of death from prostate cancer.

The Health Professionals Follow-Up Study found that current smokers had a 61% greater risk of death from prostate cancer and biochemical recurrence of prostate cancer as compared to those who had never smoked. Studies reveal that smokers tend to have worse

pathological features of prostate cancer, with more aggressive cancer. Smokers with prostate cancer also have a worse outcome when treated with radiotherapy, medical or surgical treatments. Smoking at the time of prostate cancer diagnosis has a negative impact on long-term survival, regardless of the stage of your prostate cancer.

If you are a smoker, there are benefits to stopping.

Men who stopped smoking ten or more years prior to their diagnosis of prostate cancer had mortality and biochemical recurrence rates similar to those who had never smoked.

If you have a family history of prostate cancer or have been diagnosed with it yourself, you will know that this is not something you can change.

IF YOU ARE A SMOKER, YOU CAN CHANGE. YOU HAVE THE OPPORTUNITY TO TAKE ON THE CHALLENGE OF QUITTING. Your healthcare professional can provide you with great advice to help you successfully quit. Not only is this likely to improve your physical and psychological wellbeing, but also improve your longevity.

Source: Here4You.co.za

MAKE TIME FOR FRIENDS

KNIT AWAY YOUR WORRIES

Spending time with friends is good for your health. Call a friend or better yet, schedule a get-together! STUDIES FIND THAT BEING FACE TO FACE WITH FRIENDS BOOSTS THE POSITIVE EFFECTS ON YOUR WELLBEING EVEN MORE. Not having close friends can be as detrimental as smoking 15 cigarettes a day.

The subtle, rhythmic click-clack of knitting needles can be a stress reliever for life's worries. It helps elicit the relaxation response in your body and is the counterbalance to the brain's flight-or-fight response to stressful situations. Knitting a scarf for the winter is a great way to relax your mind and unwind.

Teenage brain IS REAL

Teens may think they are officially adults, but their brain development says otherwise.

Until they reach their mid- to late 20s, the brain continues to develop, increasing in both processing speed and efficiency. Their ability to control emotions, thoughts and actions improves slowly but surely. This growth, along with synaptic pruning during which the body rids itself of excess connections in the brain, allows the brain to function more efficiently during adulthood. Brain development begins from the back to the front of the brain. The frontal lobes, which control planning and reasoning, are the last to strengthen and structure connections. These parts control the cognitive skills, such as abstract reasoning, problem solving, judgment and emotional expression.

AS YOUR TEEN’S BRAIN UNDERGOES THESE CHANGES, HERE ARE FOUR KEY THINGS YOU SHOULD KNOW.

Your teen may take risks.

At the same time that your teen’s frontal lobes are developing, the limbic system in his brain is still very active. This area is responsible for immediate reactions to threat, and controls anxiety, fear and aggression. These areas also are involved in assessing risks and rewards, which might make your teen more likely to engage in questionable, even dangerous, behaviour. The thoughtful frontal lobes are not yet fully developed, so your teen may experience sudden mood swings and impulsive behaviour, which can lead to accidents, fights and other dangerous activities.

Your teen may be prone to anxiety and depression.

Adolescents experience heightened stress-induced hormonal responses.

Many areas of the brain are affected by these hormones. As a result, your teen is more likely to experience feelings of anxiety and

depression when stressed. Risk factors for anxiety and depression can include academic pressure, overscheduling, bullying and family conflict. Additionally, expectations for teens have skyrocketed. These pressures — including often-unrealistic academic, social and parental expectations — could further contribute to teen depression.

FOMO is also a real thing.

FOMO (fear of missing out) is a real thing. However, it’s not about tropical vacations or fine dining — it’s about social connection. In a study published by the American Association for the Advancement of Science, individuals who felt social exclusion showed increased activity in regions of the brain associated with pain. Teenagers place a high premium on social acceptance and are especially vulnerable to this type of pain.

Teens are vulnerable to addiction.

With poorly developed coping skills, poor decision-making, poor inhibition and a desire for social acceptance, teens might turn to alcohol, prescription pills or drugs to cope. These substances can ignite “reward” chemicals in the brain, creating artificial signals of pleasure. This creates the instant gratification that they are seeking. Therefore, it’s important to talk to your teen about the consequences of alcohol and drug use, and promote healthier outlets like exercise or journaling.

Your teen’s behaviour may sometimes be a mystery to you, but it’s comforting to know that their brains are doing what’s normal for this stage of development. However, if something doesn’t seem quite right or behaviours seem too extreme, talk to your child’s paediatrician or psychologist.

page 05

Sources: eblogfa.com | www.jagranjosh.com | quizlet.com | www.shape.com | hormone.org | www.hormonereset.com | Images: www.freepik.com | www.flaticon.com

health strategy DO YOU HATE THE LONG WINTER EVENINGS? DO YOU WANT TO HIBERNATE AND OVEREAT? DO YOU FEEL EXHAUSTED, ANXIOUS AND DEPRESSED? DO YOU CRAVE SUNLIGHT? THE “WINTER BLUES” IS REAL AND YOU ARE NOT ALONE… TAKE STEPS TO KEEP YOUR MOOD AND MOTIVATION STEADY THROUGHOUT THE YEAR.

Winter blues making you SAD?

WHAT IS SAD?

more consecutive “miserable”

WHEN TO SEE A DOCTOR

Seasonal affective disorder,

winters. Long periods of

It's normal to have some days

also known by its appropriate

sunless skies may also trigger

when you feel down, sluggish

acronym SAD, is a type of

episodes for some people.

or unmotivated. But if you

depression that's related to seasonal changes — especially the shortened daylight hours

feel down for days at a

SAD SYMPTOMS CHECKLIST

time and you can't get motivated to do activities

and lack of sunlight. For

Lack of interest in normal

you normally enjoy, see your

about 2% of the population,

activities

doctor. Seek immediate help

SAD is a seriously disabling

Social withdrawal

if you think about suicide or

illness which prevents normal

High Carb Cravings

turn to alcohol or any other

function without appropriate

Fatique

substance abuse for comfort

treatment. How do you know

Sleep problems

or relaxation.

if your low mood is to do with

Anxiety

winter? How do I know if I’m

Loss of libido

not just miserable anyway?

If you feel very depressed or are having thoughts about harming yourself seek help

WHAT ARE THE MOST COMMON SYMPTOMS OF SAD?

WHAT CAUSES SAD? Researchers have yet to

immediately.

In most cases, seasonal

sunlight in winter can throw

WHAT TREATMENTS MIGHT WORK FOR ME?

affective disorder symptoms

your biological clock out of

With any mental health

appear during late autumn or

whack and reduce levels of

problem, there is no one-size-

early winter and go away during

serotonin (a brain chemical

fits-all treatment. Here are a

the sunnier days of spring

that regulates your mood) and

few options to explore with

and summer. Diagnosis can

melatonin (a chemical which

your doctor.

usually be made after three or

regulates sleep and mood).

uncover the specific cause for SAD. The reduction in

Light Therapy

effective. They alleviate the

and activation of the mood

Bright light or phototherapy

depressive symptoms of SAD

elevating neurotransmitters

has been shown to be

and combine well with light

serotonin, dopamine and

effective in up to 85% of

therapy.

noradrenaline/norepinephrine.

Vitamin D (The Sunshine Vitamin)

When exposed to certain

The sun not only affects the

the sun the skin produces

mimics the effects the sun

physiology of our bodies (and

vitamin D3 (cholecalciferol).

has on the body; namely

our mood) by the action of

Vitamin D3 is also widely

suppressing production of

bright light hitting the retina of

available in supplement form.

the sleep hormone melatonin

the eye but also by triggering

The combination of getting

and stimulating production

the production of vitamin D

as much sunlight as possible

of the mood-enhancing

in the skin as its rays strike

and taking high dose vitamin

neurotransmitter serotonin

uncovered areas. "Vitamin D"

D3 can be highly effective at

(along with a number of

is actually not a vitamin at all;

relieving SAD symptoms.

others). Most modern light

its active form is actually a

boxes allow you to receive

form of steroid hormone. As a

10,000 lux and treatment

result, it has powerful effects

will usually take at least 30

on the body beyond aiding in

Behavioural Therapy (CBT)

minutes to 1 hour a day at the

the absorption of calcium and

and counselling may help

appropriate distance.

prevention of osteoporosis for

the sufferer to manage SAD.

which it has traditionally been

Complementary therapies and

known. For SAD sufferers, it is

meditation, which help with

The established non-sedative

important to know that vitamin

relaxation and acceptance of

antidepressant drugs are all

D is required for the production

the illness, are also useful.

diagnosed cases. It involves exposing oneself to artificial (full-spectrum) light via a special box or lamp. This

Antidepressants

wavelengths of UVB rays from

Complementary Therapies Psychotherapy, Cognitive

WHAT CAN I DO TODAY TO LIFT MY MOOD?

park, or simply sit on a bench

Try to keep a regular sleep

and soak up the sun. Even on

pattern. Make sure you are

If you feel like pulling the covers

cold or cloudy days, outdoor

getting enough sleep.

over your head until the sun

light can help — especially

shines again, consider our tips

if you spend some time

to boost your emotional health:

outside within two hours of

• Eat right. Eat a good, balanced diet, not junk food.

getting up in the morning.

• Laugh (a lot). Watch your

• Make your environment sunnier and brighter. Open

• Exercise regularly. Exercise

favourite comedy or hang out

blinds, trim tree branches

and other types of physical

with your friends who get you

that block sunlight or add

activity help relieve stress

giggling. Laughter triggers

skylights to your home. Sit

and anxiety, both of which

the release of endorphins

closer to bright windows

can increase SAD symptoms.

which make us “feel good”.

while at home or in the office.

Include some relaxation exercises in your routine.

• Go outside. Take a long walk, eat lunch at a nearby

• Get your ZZZZ’s.

Here’s to brighter and happier winters!

Source: www.mayoclinic.org, www.sada.org.uk.

page 09

health IQ Fasting and especially intermittent fasting (IF) is currently one of the world's most popular health and fitness trends because it can help you lose weight without feeling hunger, and help reduce your risk of chronic diseases like diabetes and heart disease. If done correctly, intermittent fasting can also lead to better sleep and lots of energy.

Many studies show that it can have powerful effects on your body and brain, and may even help you live longer.

Intermittent fasting (IF) is a term for an eating pattern that cycles between periods of fasting and eating. It is not a "diet" in the conventional sense but can be more accurately described as an "eating pattern" or meal timing plan where you simply restrict your normal daily eating to an hours-long window of time, without cutting calories. Sometimes you eat, sometimes you don’t.

Common intermittent fasting methods involve daily 16 hour fasts, or fasting for 24 hours twice per week.

DID YOU KNOW? IT TAKES BETWEEN 10-12 HOURS TO FULLY DIGEST YOUR LAST MEAL.

The health benefits of

Intermittent Fasting

THE MANY BENEFITS OF INTERMITTENT FASTING

• Increases the rate of human

reducing the calorie intake to

growth hormone (HGH)

25% for the remaining 2 days.

Humans have actually

production, which has an

The 5:2 Fasting Diet has been

been fasting throughout

important role in health,

shown to significantly improve

evolution. Sometimes it was

fitness, and slowing the

blood sugar levels and even

done because food was not

aging process as it helps

reverse diabetes in some

available, and it has also been

build muscle, slash fat and

cases.

a part of major religions,

increase energy levels.

including Islam, Christianity, and Buddhism.

When you think about it, our hunter-gatherer ancestors

• Lowers triglyceride and LDL

Intermittent fasting helps with

cholesterol levels, reducing

the detoxification process

the likelihood of heart

and fat metabolism speeds

disease.

up. When your body glucose

• Helps suppress inflammation

stores have been used up,

didn't have supermarkets,

and fight free radical

the body begins to burn fat

refrigerators or food available

damage – look and feel

as a source of energy. This

year-round. Sometimes we

younger for longer.

can result in weight loss. Also,

couldn't find anything to eat,

• Increases the ability to

and our bodies evolved to be

become “fat adapted”,

in the body’s fat are now

able to function without food

which increases your energy

dissolved and removed from

for extended periods of time.

by burning stored fat

the body.

some toxins that are stored

• Weight loss and decreasing

If anything, fasting from time to time is more "natural" than constantly eating 3-4 (or more) meals per day.

TODAY, MODERN SCIENCE HAS PROVEN THAT FASTING YIELDS THE FOLLOWING BENEFITS: • Increases insulin and leptin sensitivity. Insulin resistance

metabolic disease risk.

• Better brain health which

Fasting is thus a wonderful antidote for our usual

protects memory and

indulgences. By fasting,

learning functionality giving

we rest our system from

you a sharper mind.

the constant onslaught of foodstuffs.

In addition, exercising in a fasted state can help counteract muscle aging and wasting, and boost fat-burning.

We have been trained to believe that we need to consume food which gives us energy. However digesting, assimilating and metabolising

or poor insulin sensitivity

The Western concept of

food requires a great deal of

contributes to nearly all

“intermittent fasting” diets

energy. By fasting, you free up

chronic diseases, from

has actually been around

this energy that can be used

diabetes to heart disease

for centuries.

for healing and recuperation

and even cancer.

• Improve appetite control.

resulting in weight loss and One of the most well-

improved blood pressure and

Normalises ghrelin levels,

known intermittent fasting

cholesterol levels.

also known as your “hunger

diets is the 5:2 Fast Diet.

hormone” to reduce hunger

This plan involves eating

Some research suggests that

pangs, sugar cravings and

the recommended calorie

fasting improves longevity

overeating.

intake for 5 days a week but

and healthier ageing.

page 11

health IQ

By fasting, you free up this energy that can be used for healing and recuperation resulting in weight loss and improved blood pressure and cholesterol levels.

Additionally, there appears

intermittent fasting produced

A further study showed

to be an increase in

a significant decrease in BP

fasting and chemotherapy

insulin sensitivity, a lower

values. This drop was even

combined, slowed the

risk of diabetes and an

more so in subjects who

progression of breast and skin

improvement in your immune

woke up before sunrise. In

cancer. The dual treatment

system as the digestive

another study, in patients

caused the body to produce

process is given a rest.

with borderline hypertension,

a type of white blood cell

fasting seemed to delay the

which migrates into tumours

onset of true hypertension.

and helps to kill the tumour.

Almost a third of adults have hypertension. High blood pressure (BP) is not necessarily something you can feel. It is essential to have your BP checked regularly as it increases the risk of serious conditions such as strokes and heart attacks.

Besides medication prescribed by a doctor, it is

Fasting has been shown to be effective for regenerating immune cells.

During this process, the body gets rid of parts of the immune system that may be damaged or “old” and generates a new, healthier immune system.

FASTING THE WAY THAT'S RIGHT FOR YOU There are many considerations to apply when fasting intermittently: • Intermittent fasting is not a form of extreme calorie restriction. It's a practice

essential to cut down salt

A 2016 study from the

that should make you feel

intake, and a low carbohydrate

University of Southern

good. If your fasting strategy

diet has been shown to lower

California (USC) in Los

is making your feel weak,

BP (with the added benefit

Angeles has shown that

you need to re-evaluate it.

of weight loss and improved

cancer patients who

blood sugar levels).

fasted three days prior to

• Typical fast time ranges

chemotherapy seemed to be

from 14 to 18 hours, and the

A study done by the Turkish

protected against immune

longest you'll ever abstain

Society of Hypertension and

system damage caused by

from food is 36 hours. You

Renal Disease has shown that

the treatment.

may also opt to delay eating

by skipping breakfast and

protein, and healthy fats

damage, then with the

eating your lunch and

such as butter, eggs,

correct advice and dietary

dinner within a six to eight-

avocado, coconut oil, olive

adjustments this category

hour time frame, and stop

oil, and raw nuts.

may, in consultation with

eating three hours before you go to bed.

a doctor, be able to fast. • Intermittent fasting is not something you should

The other end of the

Fasting will help your

carelessly undertake.

spectrum would be patients

body adjust from burning

ALWAYS pay close

who have multiple medical

carbs to burning fat.

attention to your body

problems, who are on insulin

Eating on a six- to eight-

and your energy levels.

and chronic medication –

hour window can take

Individuals who are

they may do more harm

a few weeks and should

hypoglycemic, diabetic,

in trying to fast. These are

be done gradually. Once

or pregnant (and/or

putting themselves at risk

your body has successfully

breastfeeding) should

of developing serious health

shifted into fat burning

avoid any type of calorie

complications which in

mode, it will be easier for

restriction until your blood

some cases may be fatal.

you to fast for as much

sugar or insulin levels are

as 18 hours and still feel

regulated.

satiated. Your craving for

WHAT HAPPENS TO MY BODY WHEN I AM FASTING?

When one considers this information, there are certain categories of patients where one could potentially fast and others where it may be too risky to fast.

The body has the ability to

foods. Addressing the

In diabetes the sugar can

maintains the sugar levels. If

quality of your diet is

run low especially if patients

you don't eat for 10-16 hours,

crucial before you venture

are taking medication

your body will go to its fat

into fasting. It's critical

that cause hypoglycemia.

stores to maintain energy,

to avoid the wrong

Sugars can also run high in

and fatty acids called

calories, including refined

patients who do not take

ketones will be released into

carbohydrates, sugar/

their medicine. Dehydration

the bloodstream.

fructose, and grains.

is also a risk, especially

sugar will slowly dissipate and managing your weight will be easier. • It is not advisable to practice intermittent fasting if your daily diet is filled with processed

maintain the blood glucose levels for a long time.

Initially it converts stored glycogen into glucose and

during summer. High sugars

If you want to start an

Within the six to eight

and dehydration can be

intermittent fasting diet,

hours that you do eat, you

a serious problem. If a

it is highly recommended

need to eliminate refined

patient has type 2 diabetes,

that you consult your

carbohydrates like pizza,

which is well controlled and

health practitioner on best

bread, and potatoes. Fill

the patient is using only

practice and suitable action

your diet with vegetable

metformin and has no other

based on your medical

carbohydrates, healthy

disease or target organ

history.

page 13

need to know

Dental emergencies IN CONTACT SPORTS

and the high levels of organised school sports of ity cial lar pu po s ou nd The treme mber of dental and orofa ulted in a significant nu res es. ve tch ha ma d ess an en ns tiv sio eti comp ice ses l children during pract injuries amongst schoo

Written by: Dr Johan Hartshorne B.Sc., B.Ch.D., M.Ch.D., M.P.A., Ph.D. (Stell), FFPH.RCP (UK) Intercare Tyger Valley Medical and Dental Centre | johan.laptop@intercare.co.za

Be prepared and save your tooth!

permanent tooth (crown

The upper lip, upper jaw

fracture)

and front teeth are involved

• Knocked out permanent

in up to 90% of all orofacial

Most of your permanent

tooth (avulsion) – the

and dental trauma cases

teeth may be saved if you

complete displacement of

arising from contact sports.

know what to do after a

the tooth from its socket

blow to the mouth. Hockey,

• Displacement of

Prevention is better than cure

being a contact sport,

a permanent tooth

has long been known to

(subluxation) – a tooth is

be associated with an

displaced from its normal

would be complete without a

increased risk of dental

position resulting in

plea to make sure your child

emergencies.

malalignment of the tooth

has a well-fitting mouth

or teeth

guard and that they wear

THE MAJORITY OF DENTAL

• Bleeding soft tissue i.e.

No article on dental trauma

it for all contact sports.

EMERGENCIES ARE:

tongue, cheeks, gums and

Mouth guards can’t work in

• Chipped or broken

lip lacerations

pockets.

WEARING A MOUTH GUARD

health care. The lifetime

fractures of teeth and jaws.

DURING CONTACT SPORTS

economic, emotional,

It also provides soft-tissue

IS A SIMPLE, INEXPENSIVE

physical and social impact

protection to decrease oral

WAY TO PREVENT DENTAL

of dental injuries can be

and lip lacerations.

AND SOFT-TISSUE INJURIES

significant in costs of care.

All contact sport players

OF THE MOUTH.

are required to wear mouth A mouth guard provides

guards during pre-match

Recent research shows that

support to your teeth and

warm-ups and matches

the overall risk of a dental

acts as a protective layer

to prevent any dental

and/or orofacial injury

between your teeth and the

emergency. Wearing a

almost doubles when a

point of impact, thereby

helmet with a face mask or

mouth guard is not worn.

absorbing the shock or

face guard can also help to

It also significantly reduces

impact of a hockey stick or

protect the face, mouth

or eliminates the cost of

ball to reduce or prevent

and sometimes jaw.

What type of mouth guard offers the best protection?

• Boil-and-bite mouth

Although more expensive,

guards are made from a

they offer a superior level

thermoplastic material,

of protection unmatched

The type of mouth guard you

which you heat in boiling

by anything you could buy

get will determine how much

water and then bite

at a local sporting goods

your teeth will be protected.

into shape. This moulds

store. Also, keep in mind

an imprint. Biting too

that the cost to restore a

THERE ARE THREE DIFFERENT

hard may decrease the

damaged tooth far exceeds

TYPES OF MOUTH GUARDS:

thickness thus reducing

the cost of a custom mouth

• Stock mouth guards are

its protective capability.

guard. The materials used

generic or readymade. It's

Boil and bite mouth guards

for a custom-made mouth

available in different sizes

are only slightly better

guard are durable, yet

but is not custom-fitted

than stock mouth guards.

comfortable enough so

and will not contour to an

The material is shaped

you can breathe and talk

individual’s mouth. Biting

to your teeth, but isn’t as

with ease. A mouth guard

down keeps it in place. It's

durable or comfortable

can also be made to wear

the least expensive and

as a custom-made mouth

over braces.

can be worn immediately.

guard, which can only be

These mouth guards are

provided by a dentist.

uncomfortable and make it difficult for players to

Dental injuries can happen in playground collisions, in

• Custom mouth guards,

car accidents, at swimming

breathe or talk. They are

made by your dentist or

pools, and by falling off

not recommended when

oral hygienist to fit the

bikes and stairs. We can’t

playing contact sports

unique shape of your

always prevent dental

because they don’t offer

upper teeth, offers the best

trauma so here’s what to

an adequate level of

protection against dental

do if your child’s tooth is

protection.

and orofacial injuries.

knocked out.

Written by: Dr Johan Hartshorne

page 15

need to know What to do if your child has a dental injury

• Ask your child to bite

WHEN SHOULD A TOOTH

down on a gauze or a clean

NOT BE REPLANTED?

TIME IS OF THE ESSENCE.

handkerchief to keep the

• Baby (primary) teeth

The sooner the tooth is back

tooth in place.

should never be replanted as this can cause damage

in the mouth the better.

This is because the root of

WHAT TO DO IF YOU CANNOT

the tooth is covered in cells

REPLANT THE TOOTH

which we need to keep alive

If you cannot replant the

in order for the tooth to be

tooth, ideally ask your child to

injuries, which are more

able to reintegrate back into

keep the intact tooth or

severe and need treating

the mouth. Ideally an avulsed

tooth remnants between their

first.

tooth should be replanted

cheek and gum until you get

within 5-10 minutes.

to the dentist. If your child is

Successful replantation is

too upset to do this, place the

much less likely after 20

tooth in a clean container

minutes of 'extra oral dry

and cover with cold milk (skim

fractures or displacement

time' and highly unlikely after

milk, preferably), saline, or

with successful treatment,

60 minutes out of the mouth.

bottled still water. The storage

the player may return to

of any remnant of tooth is

play with a mouth guard

HOW TO REPLANT

also extremely beneficial to

(REINSERT) AN AVULSED

the success of functional and

PERMANENT TOOTH

aesthetic replacement.

to the permanent tooth underneath the gum.

• When the child has other

When can my child return to play hockey?

• In case of minor tooth

within 24 to 48 hours.

• For completely avulsed teeth with no chance of replantation, the player

Check for any airway obstruction and rinse the

If the tooth is displaced,

could return within 48

mouth preferably with

move the tooth to its normal

hours with mouth guard

bottled still water. Explain to

position, especially if it is

protection, if no bone

your child gently but firmly

interfering with the bite.

fractures are evident.

• Players who have

that the tooth needs to be put back into their mouth. Try to

GET TO YOUR DENTIST

replantation and splinting

give them as much privacy

Ideally you should be aiming

of avulsed teeth should

as the situation allows.

to access dental care within

wait at least 6 to 8 weeks

the hour. Call your dentist

before returning to play

to tell them that you are

and only with mouth guard

crown, not by the root and

on your way and that your

and face mask protection.

rinse it quickly with still

child’s tooth is knocked out.

bottled water.

Your dentist will provide the

Fortunately, many injuries

necessary treatment of soft

are preventable by wearing

into the socket. Use the

tissues (suturing), splinting

a proper mouth guard. When

adjacent teeth as a guide

teeth and/or restoring

available, a dentist can be a

to work out which way

fractured teeth. Prompt

valuable part of the sports

round it goes. Try to get it

referral for complicated

medicine team, helping with

as close to the level of the

crown fractures or proper

acute treatment and return-

other teeth as possible and

treatment is "paramount” and

to-play management of

replant in the socket.

can improve outcomes.

these injuries.

• Pick up the tooth by the

• Firmly reposition the tooth

diagnosis

Understanding

HEARING LOSS

in children

Written by: Sybrand Strauss - Audiologist (BSc. Audiology) (UCT) Panorama Intercare Centre | Tel: 021 492 3230 | sybrand@strausshearing.co.za

Hearing loss is one of the most common conditions that affect newborns worldwide. Current research indicates that on average every 4 out of 1000 newborns present with hearing loss and in South Africa it is estimated that over 6000 babies are born with permanent hearing loss every year. As a result of this, universal newborn hearing screening has been strongly advocated in recent years and it has now become the international standard.

Early detection of hearing loss is vitally

CAUSES OF HEARING LOSS

important, even if it is a temporary hearing

There are a range of causes associated with

loss. Neural connections in the brain that

hearing loss in children and can be congenital

are involved in the understanding and

(present at birth) or acquired.

interpretation of sound are at its most vulnerable and are best formed in the first

CONGENITAL HEARING LOSS may often be

two years of life. A lack of early childhood

due to genetic factors, but may be hereditary or

sound stimulation will influence a child’s

due to other factors present at the time of birth.

cognitive-, language-, speech-, emotional-

These may include intrauterine infections such

and social development. Fortunately

as German measles (Rubella), Cytomegalovirus

there are currently sophisticated methods

and the Herpes simplex virus. Other factors may

available for estimating a child’s hearing

include prematurity, maternal diabetes and

ability, even in infancy.

preeclampsia.

ACQUIRED HEARING LOSS can present itself

diagnosis of hearing loss

it is best to consult your

and will indicate whether a

family doctor, who will then

at any period of time after

diagnostic hearing evaluation

refer you to a paediatric

birth and may include ear

is needed.

audiologist to conduct a hearing evaluation.

infections (Otitis Media), meningitis, mumps or noise

SIGNS AND SYMPTOMS

exposure amongst others.

Recognising some of the

An audiologist's evaluation

signs and symptoms of

will assess the severity of any

Otitis media (ear infection)

hearing loss in children

hearing impairment, even in a

is the most frequently

may also lead to an early

very young or uncooperative

diagnosed cause of hearing

diagnosis and consequently

child, and will also indicate

loss in children and involves

to successful management.

if a middle ear, inner ear

inflammation of the middle

Parents are often the first to

or neural hearing loss is

ear that usually results in a

notice that their child may

present. If a child has wax

build-up of fluid behind the

have difficulty in hearing.

build-up, an ear infection or

eardrum.

another problem causing temporary hearing loss, the

Infection may or may not

SOME OF THE EARLY SIGNS MAY INCLUDE:

be present in the fluid and

• No reaction to loud sounds

a general physician or ear,

therefore the symptoms

• Not responding in any way

nose and throat physician

and severity of otitis media varies significantly. The reason otitis media is so

audiologist will refer you to

to your voice

(ENT) to have the temporary

• Minimal vocalising that may

hearing obstruction treated.

eventually taper off.

If a permanent hearing loss

common in children is due

is diagnosed, care will be

susceptible to infection and

AS A CHILD BECOMES OLDER, SOME OF THE SIGNS AND SYMPTOMS OF HEARING LOSS MAY INCLUDE:

may easily become blocked

• Delayed speech

involvement of a speech

due to enlarged adenoids or

development

to the Eustachian tube being more horizontal in children compared to adults.

It may therefore be more

an infection of the tonsils.

The hearing loss associated with otitis media is often only a temporary hearing loss. In most cases it can be treated medically, after which hearing ability should return to its original state.

taken by your audiologist to ensure an appropriate management plan is discussed in detail with the therapist.

• Using only gestures to communicate

It is important to note that

• Not responding to your

even though your child may

voice

have had a hearing screening

• Constantly asking for

at birth, parents should not

repetition

be afraid to let their instincts

• Asking for the television to be louder

guide them in requesting or independently arranging for further evaluation whenever

DIAGNOSIS OF HEARING LOSS

If you are ever concerned

they are concerned about

that your child may have a

their child’s health or

Newborn hearing screening

hearing loss at any stage

development. Prevention is

serves as a method of early

during their childhood,

always better than cure.

Written by: Audiologist, Sybrand Strauss

page 19

diagnosis PARENTS, HERE ARE THE MAJOR SPEECH AND HEARING MILESTONES: NORMAL DEVELOPMENTAL MILESTONES FOR HEARING AND SPEECH* AGE

MILESTONES

Newborn

• Variable response to sound • Startles to sudden loud noises • Wakes up or stirs at loud noises

1 month

• Soft guttural noises when content

6 weeks

• Quiets in response to soft sound 15cm from ear • Calms down at a familiar voice

3 months

• Turns head to sound at ear level • Responds to your voice by smiling or cooing

6 months

• • • •

Visually locates soft sounds at 40-60cm at ear level Smiles when spoken to Notices toys that make sounds Turns head toward familiar sounds

9 months

• • • •

Tries to communicate vocally Makes babbling noises Localises soft sounds above and below ear at 1m Understands hand motions like the bye-bye wave

12 months

• • • • • •

Makes various babbling sounds Repeats some simple sounds Understands basic requests Uses voice to get your attention Responds to name Says 2-3 words with meaning

18 months

• • • •

Uses and says 5-20 recognizable words, understands many more Points to body parts when you ask Listens with interest to songs, rhymes and stories Points to familiar objects that you name

2 years

• Follows basic commands • Names common objects • Says two- and three-word phrases

3 years

• Gives full name, uses plurals • Says 3-5 word sentences

4 years

• Asks many questions • Gives name and address • Names four primary colours

5 years

• Speech fluent, with good articulation

*Adapted from the American Speech-Language-Hearing Association’s (ASHA) milestones and the Paediatrics Manual: The Children’s Hospital at Westmead Handbook References 1. Dhooge, I.J. (2003). Risk factors for the development of otitis media. Current Allergy and Asthma Reports, 3: 321– 325. 2. National Institute on Deafness and Other Communication Disorders. (2002). Otitis media (ear infection) (NIH Publication No. 974216). Bethesda, MD: Author. 3. Alsarraf, R., Jung, C.J., Perkins, J., Crowley, C. & Gates, G.A. (1998).

Otitis media health status evaluation: A pilot study for the investigation of cost-effective outcomes of recurrent acute otitis media treatment. Annals of Otology, Rhinology and Laryngology, 107: 120–128. 4. Canalis, R.F., & Lambert, P.R. (2000). The ear: Comprehensive otology. Philadelphia: Lippincott Williams & Wilkins.

The COPD is a progressive and (currently) incurable disease, where the airways become inflamed, clogged and the air sacs (alveoli) in the lungs are damaged.

h t a e r B r o f le t t a The B ple worldwide affects 384 million peo monary disease (COPD) ny people with ma But 0.

203 by th Chronic obstructive pul dea get the third biggest cause of t of ageing and do not and is likely to be the ptoms as a normal par itting sym Qu . ir ple the e peo tak st mis mo in on the conditi t COPD is preventable tha is g it. s idin new d avo of goo s The nce rease your cha help the y need. g, is the best wa y to inc smoking, or never startin

page 21

know it all

RECOGNIZING CHANGES IN YOUR CONDITION EARLY MAY HELP YOU AVOID A TRIP TO THE EMERGENCY ROOM. WHAT IS COPD? Chronic obstructive pulmonary disease (COPD) is an umbrella

This causes the airways to become narrower, which makes it harder to breathe in and out.

term used to describe

contribute to COPD. Chronic bronchitis is inflammation of the lining of the bronchial tubes, which carry air to and from the air sacs of the lungs.

progressive lung diseases

Symptoms include breathing

It's characterised by daily

including emphysema, chronic

difficulty, cough, mucus

cough and mucus (sputum)

bronchitis, and refractory

(sputum) production and

production.

(non-reversible) asthma. This

wheezing. It's caused by long-

disease is characterised by

term exposure to irritating

Emphysema is a condition in

increasing breathlessness,

gases (fumes) or particulate

which the alveoli at the end

a chronic cough (smoker’s

matter, most often from

of the smallest air passages

cough) and fatigue. COPD

cigarette smoke. People with

(bronchioles) of the lungs

is ranked as one of the most

COPD are at increased risk of

are destroyed as a result

disabling conditions in the

developing heart disease,

of damaging exposure to

world.

lung cancer and a variety of

cigarette smoke and other

other conditions. Breathing

irritating gases and particulate

difficulties can also affect many

matter.

COPD is a progressive and (currently) incurable disease, where the airways become inflamed, clogged and the air sacs (alveoli) in the lungs are damaged.

aspects of their day-to-day life.

Rates of diagnosis for COPD Emphysema and chronic

are still reckoned to be far

bronchitis are the two most

less than its real prevalence

common conditions that

– according to research,

approximately 95% of those with mild COPD and 80% of those with moderate COPD

COPD exacerbation signs and symptoms: COPD can be particularly

COMMON TRIGGERS TO AVOID THIS WINTER

around the world are

troublesome in winter months,

undiagnosed. This is, in part,

when colds and flu are more

• Air pollution/smog

because patients often present

common and it affects people

• Second hand smoke: Avoid

quite late in the progression of

in different ways. Some

second-hand smoke

the disease. Furthermore, some

people are most troubled

whenever possible, and

mistake COPD as a normal

by the symptoms, such as

make sure no one ever

part of ageing, while others

breathlessness; others can

smokes inside your home

feel a stigma – that they have

experience frequent flare-ups,

“brought it on themselves” by

or “exacerbations”, where

smoking and this may deter

symptoms become suddenly

them from seeking help.

much worse. Recognising

ANYONE WITH THE FOLLOWING SHOULD GET TESTED FOR COPD:

changes in your condition

smoking • Long-term exposure to air pollutants (including pollution and second-hand smoke) • Chronic coughing, with or without sputum • Wheezing • Shortness of breath that has become worse over time • Trouble keeping up with people of your own age

to the emergency room. Call

• Cold air or hot/humid air

your doctor right away if you

• Campfires and fireplace

think you are having a flare-up. possible if you report the symptoms to your doctor and begin treatment quickly.

Watch for:

• More shortness of breath than usual • Wheezing or wheezing more than usual

smoke

Taking the right precautions can mean a more favourable winter forecast for those with COPD: • Minimise stress and pace

yourself during the winter months.

• Follow a doctor-prescribed

• Coughing more than usual

exercise programme.

• Phlegm or sputum changes

• Eat a variety of healthy

– an increase in the normal amount of sputum or clear to yellow-green)

number of treatments that can

• More tiredness or less energy

improve your health, reduce

• More difficulty sleeping than

exacerbations (flare-ups) and

perfumes • Pollutants in your home

change in colour (goes from If you have COPD, there are a

chemicals • Scented products and

early may help you avoid a trip

At-home management is often • Smoker or a history of

or car.

• Strong fumes and harmful

usual

improve your energy levels.

• Fever

Getting the right treatment can make it easier for you to carry out daily activities like dressing, washing and walking.

AT LEAST 50% OF ADULTS WITH LOW PULMONARY FUNCTION WERE NOT AWARE THAT THEY HAD COPD.

foods and drink plenty of water.

• Get an appropriate amount of sleep and rest.

• Avoid sick people and large crowds.

• Wash your hands frequently and avoid touching your face.

• Get your flu shot.

• Call your doctor if you think you’re having an exacerbation.

Source: Centers for Disease Control & Prevention; cdc.gov, copdfoundation.org, umr.com

page 23

first aid

Your guide to:

DEALING WITH

EPILEPSY SEIZURES CAN BE FRIGHTENING TO SEE, BUT WITH THE RIGHT MEDICAL CARE, IT CAN BE MANAGED.

occur when there is abnormal

Some with epilepsy may

electrical discharge in the

identify their triggers (specific

brain. This may be triggered

circumstances under which

by chemical imbalance or

some people with epilepsy will

a structural abnormality.

be more prone to seizures).

Epilepsy affects 1 in every 100

The term epilepsy is used

people in South Africa, i.e.

to cover a variety of seizure

These could include stress,

approximately half a million

types. These differ in cause,

hormonal changes, heat,

South Africans based on a

nature,severity, management

forgotten or incorrect

total estimated population

and long-term outcome.

medication or illness.

with epilepsy has 4 immediate

CAUSES

A particular type of epilepsy,

family members, at least

Some people develop epilepsy

photosensitive epilepsy, is

another 2 million South Africans

because of brain damage

triggered by visual stimulation

are affected by the condition.

from injury, infection (e.g.

such as flashing lights or a

There are approximately 50

encephalitis), hormonal

flickering TV.

million people with epilepsy

problems, circulatory

worldwide.

problems or tumours (known

TYPES OF SEIZURES

as symptomatic epilepsy)

There are many types of

People with epilepsy have a

However, for most the

seizures and a person may

tendency for recurring seizures.

underlying cause can’t be

have more than one type.

Seizures, or convulsions,

identified.

of 52 million. If every person

No two people have the same

PEOPLE WHO CAN HELP

+ EMPLOYERS:

symptoms, and the type of

+ GP AND NEUROLOGIST:

Most people with epilepsy have

seizure depends on which

To help your doctors, keep

steady jobs. Many are afraid

part of the brain is affected.

a record of your seizures,

to disclose their epilepsy, but

noting how you felt before,

you really should tell your boss

If the whole brain is affected

and the circumstances

and co-workers if you have

then the seizure is known

surrounding it. You may find

frequent seizures. That way

as generalised and there

it useful to prepare a list of

people will know what to do if

is a loss of consciousness,

questions before you visit

you have a seizure.

however brief. If only part of

your doctor. + TEACHERS:

the brain is affected, then it is known as partial or focal

QUESTIONS TO ASK:

It’s very important to tell your

and consciousness is not

+ Which type of epilepsy do

child’s teacher if he or she has

necessarily lost. Recovery time varies from seconds to minutes.

I have? + Is there an identifiable

you get from your doctor.

cause? + Will I have to take

SOME PEOPLE WITH EPILEPSY MAY IDENTIFY THEIR TRIGGERS. THESE COULD INCLUDE STRESS, HORMONAL CHANGES OR ILLNESS.

epilepsy. Share any advice

medication? + How long will I have to take it?

HELPING YOURSELF YOU CAN PREVENT GETTING INJURED DURING A SEIZURE.

+ What does the medication do?

HERE ARE SOME TIPS:

+ Are there any side effects?

Fires and stoves:

+ Is control possible?

•

+ How will it affect my life?

Never come too close to an

DIAGNOSIS

open fire. Keep guards around

An accurate description

hearth fires and primus and

of the seizures and the

+ RELATIVES AND FRIENDS:

circumstances in which they

Be as open as possible. The

occur is important. CAT scans

support and understanding

•

may be taken to determine

of family and friends are

Doors should be left unlocked

whether or not there are any

invaluable. Give accurate

and if possible should open

structural changes in the

information to your family

outwards. A shower is often

brain. EEG tests will measure

and friends, as their correct

better than a bath, but if not

changes in the brain’s

understanding of your

available, bath water should

functioning.

condition will assist them in

be kept shallow and the taps

supporting you.

should be turned off before

MEDICATION

gas stoves.

Bathrooms:

getting in. Avoid bathing while

The ma jority of people with

+ SOCIAL WORKER:

epilepsy have their seizures

You can get practical advice

controlled by anti-epileptic

from your clinic social worker.

•

medication. About 80% of

Advice and support are

Some people have seizures

people with epilepsy will

available from Epilepsy SA

during their sleep. Sleeping

have their seizures totally

(contact details at the end of

without a pillow may be

controlled or greatly reduced

the article). Never hesitate

advisable.

thanks to these drugs.

to reach out.

alone at home.

Sleep:

page 25

first aid •

Sports:

counsellor with any epilepsy

OTHER REASONS TO CALL AN

With adequate precautions,

related questions to socdev.

AMBULANCE INCLUDE:

you can take part in any sport.

no@epilepsy.org.za.

+A seizure that lasts more

When horse riding, always

than 5 minutes or shows no

wear a helmet. Don’t swim, go

HOW CAN YOU HELP?

mountain climbing or sailing

+ Protect the person from

alone.

•

injury. Cushion the head. + Do not restrict movement or

Identity discs:

put anything in the mouth.

Wear a Medic Alert identity disc at all times. These are available from Medic Alert or through Epilepsy South Africa.

+ Help breathing by laying the person on his/her side. + Stay with him/her until fully recovered.

Keep an identity card with

FIRST AID FOR SEIZURES

your doctor’s details in your

Most seizures in people with

purse or wallet.

epilepsy are not medical emergencies. They end after

Self-help groups:

minutes. +N o “epilepsy” or “seizure disorder” Medic Alert identity disc. +S low recovery, a second seizure, or difficulty breathing afterwards. +R epetitive seizures occur without the person regaining

your name and address and

•

sign of stopping after a few

a minute or two without harm

consciousness in between. +P regnancy or other medical diagnosis. +A ny signs of physical injury or sickness. + Stay with him/her until fully

Epilepsy South Africa

and usually do not require a

has an online community

trip to the emergency room.

support group, dedicated

But sometimes there are good

to supporting those with

reasons to call for emergency

epilepsy and others impacted

help. A seizure in someone

by it at www.healthunlocked.

who does not have epilepsy

SOUTH AFRICA ON

com/epilepsysouthafrica.

could be a sign of a serious

0860 374 537 OR EMAIL

You can also email an online

illness.

INFO@EPILEPSY.ORG.ZA.

recovered.

FOR MORE INFORMATION CONTACT EPILEPSY

SEIZURE

WHAT IT LOOKS LIKE

HOW YOU CAN HELP

Generalised absence (previously named petit mal)

The person looks blank and stares.

There may be blinking or slight twitching. It lasts a few seconds then normal activity continues.

Be reassuring. The person may be unaware of the seizure. Note that it has occurred and, in a classroom situation or similar, repeat missed information.

Generalised tonic-clonic (previously named grand mal)

The common sequence is: stiffening of the body; falling; possible blue colour around the mouth; jerking movements.

As breathing returns to normal the normal colour returns. There may be blood-flecked saliva and incontinence (rare). Lasts a few minutes.

Protect the person from injury.

Cushion the head. Don’t restrict movement or put anything in the mouth. Help breathing by putting the person on to their side.

Stay with him or her until fully recovered.

Complex partial (affecting a specific area of the brain)

May start with a warning or “aura”.

The person may appear confused or distracted or may display abnormal behaviour. There may be repetitive movements, e.g. plucking at clothes.

Remove harmful objects and guide the person away from danger. Reassure him or her quietly.

FUN 4X4 TRAILS

AYS ACROSS AND SPECTACULAR ST

SOUTH ARICA

Is the winter season sending chills down your spine? Check out our list of fun 4x4 trails and cosy stays to chase the winter chills away. Get your gear ready, start your engines and let the adrenaline flow through your veins.

Biedouw Valley 4x4 Route, Clanwilliam WESTERN CAPE

You’ll find this valley hidden amongst the Cederberg Mountains between Clanwilliam and Uitspankraal.

This route offers amazing views of the green valley, Biedouw River and a whole host of natural pools and waterfalls. If you time your trip just right, you'll be able to watch the wildflowers open closer to the end of the winter season. The last section of this route is very steep and reaches a plateau from where you can gaze at the Sneeukop, Krakadouw and Citadel Kop Mountains as well as the Tankwa Karoo in the distance.

Difficulty: 2 - 3 | Distance: 30 km More information: 049 851 9804 WHERE TO STAY:

De Pakhuys, Clanwilliam

From R200 per night for 2 people There’s something to suit every budget at De Pakhuys – from luxurious cottages to camping facilities.

We recommend that you make your way to this beautiful part of the world towards the end of winter, so that you can look forward to loads of wild flowers. Take a walk to the famous rock formations and cave drawings after a day on the 4x4 tracks.

Trail Grades: 1. Easy – for 4x4 novices or 4x2s with differential lock. | 2. Easy to moderate – 4x4 vehicle and some driving experience is essential. | 3. Moderate – low range and 4x4 driving experience recommended. | 4. Difficult – experienced drivers, low range and differential lock.

Recovery equipment recommended. | 5. Extreme – experts only with serious vehicles, not for solo trips. Recovery backup essential.

page 27

TravelGround

Baviaans-Kouga 4x4 Route, Baviaanskloof EASTERN CAPE Set in a World Heritage Site, this route has no shortage of spectacular sights on offer. You’ll make your way past several mountain ranges, rivers, birds and wildlife on this route. Cycads, fynbos and honeybush tea will fill your senses and nature lovers will be right at home on the overgrown paths. Please keep the erosion in mind and don't underestimate it.

Difficulty: 2 - 3 | Distance: 33 km

More information: 049 839 1160 WHERE TO STAY

Baviaans Lodge, Tsitsikamma

From R1500 per night for 2 people This lodge borders the Baviaanskloof Heritage Site and is situated really close to the route’s starting point. The cottages have fireplaces and no electricity, so you can truly immerse yourself in your natural surroundings.

Bergwoning 4x4 Route, Golden Gate National Park FREE STATE This route starts approximately 15 km from Clarens and you have the option of taking it on your own or with the help of an expert. The route is seldom closed due to the fact that each season boasts a new challenge as the terrain changes.

You can return to this route every season to appreciate what it has to offer.

Difficulty: 3 Distance: 6 km or 26 km (circle routes) More information: 058 256 1124 WHERE TO STAY:

Dynasty Red Mount Ranch, Clarens From R1430 per night for 2 people

If you want to be close to the charming town of Clarens as well as the Golden Gate National Park, this self-catering mountain ranch is just the place for you.

Sani Pass 4x4 Route, Drakensberg KWAZULU-NATAL

Possibly one of the most famous routes in South Africa, this route stretches all the way from Underberg to the border of Lesotho and back.

Its prime location makes it possible to see some snow in the winter months and offers a unique challenge for those daring enough to take on the slippery slopes. The view from the top of the pass makes all the hard work worthwhile.

Difficulty: 2 - 4 | Distance: 45 km

More information: 033 702 0330 WHERE TO STAY:

Over the Edge Cottages, Underberg From R800 per night for 2 people

This one is for true 4x4 enthusiasts as the route starts on the gravel road leading to the cottages.

If you’re lucky, you might catch the snow falling while staying in Underberg during the winter – keep an eye on the weather report!

Hennops 4x4 Route, Pretoria GAUTENG

You can find this jam-packed route between Pretoria and Hartbeespoort. Even though some experts find it really challenging, beginners can simply skip the tricky sections and still be able to spot a blue wildebeest, kudus and even zonkeys (zebra-donkeys)! Keep in mind it can get quite muddy during winter when the Hennops River breaks its banks.

Difficulty: 2 - 4 | Distance: 9 km

More information: 082 825 9205 WHERE TO STAY:

Hills and Dales Accommodation cc, West Rand From R850 per night for 2 people

This countryside haven is situated between Pretoria and Johannesburg and is set on a 23 hectare plot surrounded by hills and rivers.

Source: All images found on Travelground.com

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recipe

S A E T G N I L A E H the doctor away

A cuppa a day keeps

g times more virus-fightin ck tea for 2 weeks had 10 nk, in a Harvard study. bla of day a s cup 5 nk People who dra placebo hot dri than others who drank a ant in both black interferon in their blood le for this immune boost, L-theanine, is abund To get up to sib ly. dai pon s res cup t's l tha era imal dose: sev The amino acid sions have it too. Your opt b them up and down while you brew. and green tea – decaf ver from your tea bags, bo 5 times more antioxidants

THE ONE TONIC TEA This combo of ginger, lemon, turmeric, rooibos tea, and apple cider vinegar makes a bracing tonic. If you like these flavours separately, you’ll love them together.

This tonic is also great after holidays and other occasions when you feel like you’ve overindulged, or as a preventive measure against illness during cold and flu season.

TOTAL TIME: 25 mins Cook time: 15 mins Prep time: 10 mins Serves: 4 to 5

Tools • Tea kettle or strainer

Ingredients • 2 bags rooibos tea • 1 cup boiling water • 2,5 cm piece fresh turmeric, sliced (or use ½ to 1 teaspoon dried)

• 2,5 cm piece ginger, sliced • Juice of ½ to 1 lemon, to taste • 3 to 4 tablespoons organic unfiltered apple cider vinegar • Pinch of cinnamon, optional • 4 cups fresh water • Liquid or powdered stevia or other sweetener to taste, optional

Instructions 1. Let the two teabags steep in the boiling water for at least 15 minutes.

2. If using fresh turmeric and ginger, you might like to do this in a blender. Combine them in the blender with a small amount of water and process until smooth.

3. Otherwise, combine dried turmeric, squeezable ginger, lemon juice, apple cider vinegar, optional cinnamon, and the steeped tea in a glass pitcher. Stir up vigorously with a large spoon or butter knife.

4. Add the remaining water, then sweeten (or not) as desired.

5. Stir the mixture up each time before pouring. Refrigerate unused portions.

SORE THROAT TEA

COLD-AWAY TEA

Instead of reaching for the ice cream when you’re suffering from a sore throat, try this bacteria- and virus-fighting tea instead. The enzymes in the raw honey will help soothe your sore throat while fighting bacteria, while the chamomile will help reduce inflammation.

The lemon juice and cinnamon also have antibacterial and antiviral effects, making them a great addition to help knock out the root cause of your sore throat. With this healing tea you can soothe your sore throat, fight bacteria and reduce inflammation – an all-in-one health-promoting tea!

Both echinacea and elderberries have been shown to not only act as potent immune boosters to help prevent colds, but are also excellent at reducing cold symptoms and shortening cold duration. One study even showed this combination of echinacea and elderberries “can be as effective as the conventional antiviral medicine oseltamivir” for early treatment of the flu. Combining these with the antibacterial and antiviral powers of raw honey, gives this tea extra cold-fighting benefits. Boost your immune system with this antibacterial and antiviral flu-fighting concoction!

TOTAL TIME: 6 mins Cook time: 1 min Prep time: 5 mins Serves: 1

Tools • Tea kettle or strainer

Ingredients • 1 t chamomile flowers or a chamomile tea bag • 1 T raw honey • 2 t freshly squeezed lemon juice • Dash cinnamon • 1 cup (250 ml) water

Instructions 1. Bring the water to a boil, then pour into a cup.

2. Add the lemon juice, cinnamon, and raw honey.

3. Stir and sip as needed.

TOTAL TIME: 20 mins Cook time: 15 mins Prep time: 5 mins Serves: 1

Tools • Tea kettle or strainer

Ingredients • • • •

2 t echinacea roots or flowers, dried 1 t dried elderflowers or elderberries 1 T raw honey 1 cup (250 ml) water

Instructions 1. Bring the water to a boil, then add all ingredients minus your honey.

2. Let the tea simmer for 15 minutes, then remove from heat.

3. Strain away the leaves and add raw honey.

4. Serve.

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your questions

YOUR s to Email your question .za experts@intercare.co

Migraine Triggers

I think I’m having migraine headaches. It is a severe pounding and throbbing pain that seems to affect my whole head. I am also sensitive to light and noise. I changed to another birth control pill last month. Might this be the cause? What can I do to prevent it?

Headaches can be triggered by various substances that you might be sensitive to.

The most important point in ruling out a suspicious cause is to avoid the suspected trigger for two weeks and then to reintroduce it after two weeks and to note if it is making a difference. If it does not I suggest you make an appointment with your general practitioner who will do a full history, clinical examination and maybe a few special investigations to determine the cause of the headaches. This can also rule out whether your headaches are true classical migraines or another subtype. In true classical migraines hormonal therapy is often contra-indicated.

Dr Ina de Beer – GP

Pain Medication Addiction

I have severe chronic back ache. Can I take ibuprofen and paracetamol at the same time for pain and can I become addicted to any pain medication?

Yes, you can take paracetamol and ibuprofen at the same time as long as you have no diagnoses of peptic ulcers. If this is the case, rather just stick to paracetamol and heat packs. It is best to consult your GP or physiotherapist if you have chronic back pain as some of the pain medication, especially those containing codeine, can be addictive.

Dr Charline Kemp – GP

Pregnancy and Medicines

Can I take cough and cold remedies while I'm breastfeeding? I am worried that it might affect my baby.

With regard to medicines taken during pregnancy and breastfeeding it is safest to avoid those that have not been proven to be safe during pregnancy and breastfeeding.

Due to ethical issues there are no formal studies being done on pregnant and breastfeeding patients. The only information we have is retrospective information. In other words if a certain medicine has been used in the past with no ill effect it is safe to assume that it will cause no harm in future. Consult with your General Practitioner if you are unsure. Prevention is better than cure. Go for the necessary vaccination against Influenza.

Dr Ina de Beer – GP

Asthma Medication

My 5-year-old daughter has asthma. What is the effect of using an asthma preventer long-term? I heard that using it for years might cause bone shrinkage. Is it true?

The safest way of treating asthma is inhaled (asthma pump) medication. As long as it is used as prescribed by your doctor. The longterm effect on growth of the preventative inhaled corticosteroids, used corectly, is far less than giving your child oral cortizone (prelone/aspelone/celestamine) on a regular basis. Oral cortisone should not be used more than 3 times per year and then only for 5-7 day periods at a time. Asthma should be prevented a with low-dosage inhaled corticosteroid pump. Your child should not need his/her rescue pump more than 3 times per week, or have a wet cough every night or when excercising. If this happens consult your doctor.

Dr Charline Kemp – GP Contact our Intercare experts at INTERCARE WOODHILL: Tel: 012 995 4300 Email: woodhill@intercare.co.za Address: Parkview Lifestyle Centre, Corner of Garsfontein & Netcare Road, Moreleta Park, Gauteng