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
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14
CEO MESSAGE YOUR EXPERTS Your questions
Interact 3
INTERCARE News & events
4
SNIPPETS Latest health news
30
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18
follow on sociauls media!
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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
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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
page 29
recipe
S A E T G N I L A E H the doctor away
A cuppa a day keeps
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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