Healthy times ; October 2017 edtion by Healthy Times

SPRING 2017

MEDICAL AID

ADDICTION

HEALTHY HOME

GLOBESITY

SELECTING THE RIGHT ONE FOR YOU

THE CODEINE CONNECTION

A CHECKLIST FOR CLEANING

THE ESCALATING OBESITY EPIDEMIC

Also inside :

Lucas

ADHD Dental implants Sciatica Angina …

and more

RADEBE

The football icon’s credo: discipline, focus, appreciation, gratitude

contents

SPRING 2017

45 HEALTHY HOME

27 4

FROM THE EDITOR

HEALTHY FINANCES

COVER STORY Football legend Lucas Radebe talks about his physical and emotional resilience

NHI – In the pipeline or a pipe dream?

How do you choose a medical aid?

HEALTHY HEART Understanding angina

HEALTHY MIND All about ADHD

HEALTHY EYES What is retinitis pigmentosa?

BREAST CANCER UK researchers have identiﬁed a molecule that may help to ﬁght ‘triplenegative’ breast cancer

ADDICTION OTC meds: the codeine connection

How to ensure your home is safe for the elderly

Time to springclean

HEALTHY WORK Repetitive stress or strain injury

HEALTHY BACK About sciatica

HOSPITALS How day hospitals are making life easier for doctors and patients

HEALTHY BODY The escalating obesity epidemic

ALTERNATIVE HEALTH How complementary and alternative medicines are regulated

HEALTHY TEETH Dental implants have changed the way teeth are repaired and replaced

HEALTHY HOLIDAYS Health-focused getaways

HEALTH TECHNOLOGY The usefulness of ﬁtness trackers

HEALTHY TIMES l 3

FS R T ROAMP LT IHNEE EHDEI R TO ER

spring love spring. I love the promise it brings – the warmer days, blossoms on the trees and an intangible optimism in the air. In this spring issue, we have a wonderful variety of reads for you, and hope they will leave you empowered and optimistic when it comes to your health. Our cover star, Lucas Radebe, is one of South Africa’s best-loved sportsmen. He talks to us, on page 6, about what it takes to stay in tip-top condition as a professional athlete, and opens up about his health challenges (we’re pleased to report that he is in excellent health now).

EDITORIAL Editor: Mandy Collins

Art Director: Janine Wait Copy Editor: Joy Capon

Contributors: Louise Ferreira, Caryn Gootkin, Subashni Govender, Georgina Guedes, Penny Haw, Nia Magoulianiti-McGregor, Zaza Motha, Tamara Oberholster, Adam Oxford, Lisa Witepski Cover image: Christoph Hoffmann ADVERTISING Project Manager: Roman Ross

romanr@picasso.co.za Tel: 021 469 2498

Sales Team: Jay Deary, Sandile Koni, Marc Plastow, Lyzette September, Noel van Breda Advertising Co-ordinator: Vanessa Payne

Advertisement Design: Nichole Liedeman

Copy Editor Advertisements: Brenda Bryden PRODUCTION Production Editor: Shamiela Brenner

Distribution: Shihaam Adams subscriptions@picasso.co.za Tel: 021 469 2523 Printing: Paarl Media Gauteng MANAGEMENT

At this time of year, breast cancer is a big focus. We look at a recent breakthrough scientists hope will help in the fight against this disease. You can read about it on page 13.

Senior Bookkeeper: Deidre Musha

It’s also the time of year when people are planning two very different things: their medical aid needs for the next year, and their holidays. Our holiday feature, on page 51, looks at active holidays you can take to ensure you come back healthier, not heavier, and we tackle medical aids from two angles: on page 19 we give you advice on how to choose a medical aid, and on page 16 we look at the proposed National Health Insurance, and where it is right now.

Published by

“Our holiday feature looks at active holidays you can take to ensure you come back healthier, not heavier.”

Our feature on page 52 is for the fitness wearable geeks – find out how to get the most out of yours as you gear up for your beach body (although I am more of the persuasion that says, if you want a beach body, just take your body to the beach). Finally, we tackle some very serious concerns, such as ADHD (page 9), codeine addiction (page 27) and angina (page 22). So, there’s plenty to get your teeth into. I wish you a happy, healthy spring!

Mandy Collins Editor 4 l HEALTHY TIMES

Business Manager: Lodewyk van der Walt

General Manager, Magazines: Jocelyne Bayer

Central Park, Black River Park Fir Street, Observatory, 7925 Tel: +27 21 469 2400 Fax: +27 86 682 2926

Disclaimer While every effort has been made to ensure that the information in this publication is sound, it is expressly not designed to diagnose or treat a medical condition or health problem. The information does not constitute medical advice. It is also subject to personal interpretation and may become dated or obsolete. The publisher, editor, authors and their employees or agents, therefore, cannot accept responsibility for the information in this publication or for any errors, omissions or inaccuracies contained therein, whether arising from negligence or otherwise. They are therefore not liable for any direct or indirect effects of the information. Please consult a qualiﬁed healthcare practitioner regarding any medical or health issues. Copyright: Picasso Headline. No portion of this magazine may be reproduced in any form without written consent of the publishers. The publishers are not responsible for unsolicited material. Healthy Times is published by Picasso Headline Reg: 59/01754/07. The opinions expressed are not necessarily those of Picasso Headline. All advertisements/advertorials and promotions have been paid for and therefore do not carry any endorsement by the publishers.

Image: Cobus Bodenstein

TO A HAPPY, HEALTHY

cover story

True

grit At 48, football legend and South African icon Lucas Radebe has stared down many brutal trials, including a heart attack and the death of his beloved first wife. He’s still standing. Nia Magoulianiti-McGregor finds out the secret to his unflinching emotional and physical resilience

These are not just words to former Leeds captain and Bafana Bafana football icon Lucas Radebe. They are the secrets to his success. Radebe has formed his life around them. Carved his way with them. Defeated the odds because of them. Radebe’s abundant love of life and generosity of spirit belie not a few punishing experiences. He’s had to confront his own mortality twice, overcome the pressures of international sport in a cold climate, and find his emotional lightness again after the death of the first great love of his life, wife Feziwe Radebe. Far from defeating him, Radebe’s brushes with death and hard times have, he says, made him all the more grateful for everything in his life. “Everything happens for a reason,” Radebe says philosophically. Thank Emily Radebe, his late mother. As a 16-year-old in Diepkloof, Soweto, the young Lucas ran with a tough crowd – some hell-bent on, as Radebe puts it, “choosing the road to criminality”, with every intention of taking him along for the ride. 6 l healthy times

Not on Emily’s watch. She and his father, Johannes, “shipped” him off to a small town in (then) Bophuthatswana, now North West, to attend the same school as his older brother, Abraham – and remove him from harm’s way. “I was enjoying life in Soweto. I was at the heart of everything. It all came to a stop. Suddenly I was at Ngotwane High School in this rural – I mean very rural – town called Lehurutshe. There were no parties or drinking spots, and the only club was a football club called the ICL Birds. I joined it to pass the time,” says Radebe, who adds that he was lonely and completely out of his comfort zone. “This was the first test of my mental and emotional strength. I had to learn to focus. To find my direction and discipline. To

eat healthily to build myself up physically. Sticking to a routine helped me emotionally. Football had started occupying my mental space and, I learnt, I could do better there than living with all the distractions in Joburg. “This time of my life moulded my career. It carved my character.” When, in 1989, Kaizer Chiefs asked him to join the team, he went against the advice of Emily, who wanted him to become a teacher. “I had no choice but to make it work.” That required more discipline, added focus. He was, at the age of 20, a professional footballer. He was also back in Johannesburg. Though the City of Gold glittered, Radebe kept to his newly learnt lifestyle of discipline and routine. “My confidence in my ability to stay focused built me up mentally.”

Images: Christoph Hoffmann

Discipline. Focus. Appreciation. Gratitude.

While Emily still kept a close eye on her son, Radebe had learnt to access his internal parent. “My lifestyle defined me.” He built up his character, adding layer upon layer to form a strong template for the future. “To this day, I do things wholeheartedly. I finish what I start. I don’t back down.” This has helped him to survive more than a few trials and close calls, including a shooting in 1991. On his way to the shops in Diepkloof, Radebe, 22, heard a bang. “In Soweto, you heard shots all the time. But there was blood everywhere. It took a while for me to realise I’d been shot. “I needed emergency surgery, but, luckily, the bullet had entered my back and come out through my thigh, missing organs and arteries. Still, it hit me hard.” “Will I be able to play football again?” was his first question. “I knew then that I would have been depressed for the rest of my life if I couldn’t play.” It strengthened his resolve. “During recovery, it made me appreciate what I was doing. I worked even harder. I found I was grateful for so much, but especially for my big caring family.” (Radebe is one of 11 children.) He has described the shooting as a “blessing in disguise”. “After that, I was even more determined to make the most of my life.” A year later, he made his first appearance for Bafana Bafana, and two years after that, Leeds United head-hunted him and he moved to England. “It was freezing-cold in Leeds,” he says. “It got dark early. Training was hard. It tested my coping skills. I never played in the big games, and I was depressed and homesick. Phil Masinga (his South African team-mate) and I would try to save up 50 pence pieces to phone home from a payphone.” Then there were knee injuries and a clash with the team’s manager. “I wanted to leave. I thought, ‘My bags are packed; I’m going to go’. But I realised the opportunity I had, and the responsibility I had. I thought I would rather fail than not try at all. “I needed all my mental faculties and strength in that moment.” He stayed. He used his new emotional bulwarks: Discipline. Focus. Appreciation. Gratitude. Four years after arriving, Radebe was made captain. But the most devastating blow of all occurred when his beloved Fezi was diagnosed with cancer. “I had retired in 2005. She had been living in Leeds since 1997 and now we were going to do everything we had planned to do as a family. Seeing her going through chemo, especially with the kids, Owami and Little Lucas, so small, was terrible. “Focusing on playing football, training and then coming home to pain was very hard.” Fezi died in 2008, breaking his heart. Perhaps literally. A year later, on the treadmill at the gym, Radebe collapsed. “I didn’t know what happened to me. I didn’t feel anything. I was unconscious. I woke up in hospital.” He was diagnosed with a rare heart condition. “But I’m convinced it was related to my wife’s death. You think, as a man, you have to be strong for the kids. But inside? Inside, I was breaking. I didn’t know how I was going to cope. Fezi had helped me throughout my career. She helped make me strong. And then she just wasn’t there anymore.

“Physically, after the heart attack, it was difficult. I took about 30 tablets a day. I put on weight. I was scared of going to sleep in case it happened again. I couldn’t train for two years. I had to give up caffeine. I didn’t touch energy drinks. “I’m an active person and I pushed myself so I could train again.” Though he had a pacemaker inserted – “it’s my guardian angel” – Radebe had to learn to manage his stress. “I know when I need to be still and calm.” Radebe, who says single fatherhood wasn’t easy – “I soon appreciated what mothers go through” – delighted fans when he married Thobela Silver two years ago. “We have seven children between us and I sometimes think maybe just one more,” he smiles. (Lucas also has two older children: Jessica, 20, and Ofentse, 24.) He is passionate about maintaining his healthy lifestyle. “I manage pressure and stress. I don’t drink alcohol, except for a little red wine occasionally. I drink rooibos and eat healthily, with lots of vegetables.” He plays golf and a little soccer for exercise. He has reinvented himself as a businessman in sports management, and is involved with youth development at Gauteng schools, including the organisation of the ET Radebe Tournament. E for Emily. Emotionally, he has reframed past difficulties. “Knowing I have overcome tragedy makes me feel all the stronger. If it wasn’t for that heart attack, I wouldn’t appreciate my family as much as I do today. If my wife hadn’t passed on, I sometimes wonder if I would have taken my kids for granted. These are the things that have strengthened me. “I’m grateful to life. I appreciate I can see my kids grow. I know everything happens for a reason.” Some discipline. Focus. Appreciation. Gratitude. And a dollop of true grit.

“Knowing I have overcome tragedy makes me feel all the stronger.”

healthy times l 7

HEALTHY MIND

FOR YOUR

attention Attention deﬁcit hyperactivity disorder is widely researched, yet remains a challenge for many, writes Penny Haw

hat do Will Smith, Bill Gates, Liv Tyler, Emma Watson, Michael Phelps, Solange Knowles and Richard Branson have in common? Sure, they are all successful, but what you might not know is that they all have attention deficit hyperactivity disorder (ADHD). Also referred to as Attention Deficit Disorder (ADD) when hyperactivity is absent, ADHD is a commonly diagnosed (and sometimes misdiagnosed) neurological condition in children. In principle, says the head of the Department of Paediatrics and Child Health at the University of the Free State, Prof André Venter, ADHD is a lifetime disorder. However, most children with ADHD outgrow the hyperactivity trait by the age of 17 and, as adults, adapt their lifestyles and choose career paths that work best for them. Only 4% of children who are medicated for ADHD continue medication into adulthood.

Images: ©iStock.comHconQ/hidesy/Solphoto

A CLUSTER OF SYMPTOMS “ADHD is nothing less or more than a cluster of symptoms that hang around together and, if they are severe enough, impede a child’s development, educational and/or social,” says Venter, adding that ongoing research means knowledge is constantly evolving. One cluster of symptoms, he says, has to do with attention, and includes behaviours such as being easily distracted, inattentive and not capable of focusing on one thing for long. Another includes hyperactivity and talkativeness. There’s also impulsiveness, which Venter says can be the most impeding of the symptoms. Particularly in adolescents, the disorder is also associated with withdrawal and depression.

CAUSE AND EFFECT ADHD is a neurobiological condition. “It’s not a disease,” stresses the professor. “ADHD is a disorder and it has been shown biochemically exactly what the problem is: there is not enough dopamine (a neurotransmitter) in the areas of the brain that have to do with concentration. The most common reason why there is not enough dopamine is because it is cleared too fast. That’s why it is not a disease; it is a normal process, except it is super-effective to the point of being a detriment.” According to Venter, 80% of ADHD cases are genetic. The other 20% occur because of damage to the relevant parts of the brain as a result of issues such as premature birth, birth asphyxia, asphyxia caused by near drowning or near strangulation, severe concussion, meningitis and encephalitis.

“While anxiety is a comorbidity of ADHD, it is also a big imitator of ADHD symptoms.”

– Prof André Venter

BOYS VERSUS GIRLS

According to a 2013 study by the US Centers for Disease Control and Prevention, up to 11% of children between the ages of four and 17 have been diagnosed with ADHD at some point in their lives. While boys are nearly three times more likely to have been diagnosed than girls, it’s not because girls are less susceptible to the disorder, but because ADHD symptoms present differently in females. Girls’ symptoms, says the study, are often subtler and thus harder to identify. They generally display fewer behavioural problems and less obvious symptoms, which means their difficulties are often overlooked – often to their detriment.

HEALTHY TIMES l 9

healthy mind

misdiagnosing adhd According to Venter, children in grade six (age 12) also often present with what teachers and/or parents think is ADHD. “However, in many cases at this stage, it is anxiety, which, after all, also makes it difficult to concentrate and focus,” he says. “While anxiety is a comorbidity of ADHD, it is also a big imitator of ADHD symptoms. South Africa has one of the highest rates of anxiety among children in the world. It’s important to watch closely not to misdiagnose anxiety as ADHD.” ADHD is also linked to a variety of sleep problems, including daytime sleepiness, sleep-disordered breathing and restless legs syndrome. However, sleep deprivation can also be confused with ADHD in children. Adults and children behave differently when they are sleep-deprived. Whereas adults become sluggish, children tend to speed up and overcompensate when they are tired. “Sleepiness can cause hyperarousal in children,” explains clinical psychologist and neurophysiologist, and executive member of the South African Society of Sleep Medicine, Michelle Baker. “If there is any possibility of confusing ADHD with sleep deprivation – or vice versa – I recommend, as an initial step, careful assessment of both the child’s and the family’s sleeping habits and patterns.”

diagnosing adhd

10 l h e a l t h y t i m e s

treating adhd There are several ways of treating ADHD children, including with Omega-3 supplements and by adjusting diet. But, where necessary, Venter says there is nothing more effective than medication. “Medication is the single most important thing you can do – if the ADHD is significant. I’m not saying that everyone with ADHD must be medicated, but, for those who need it, medication is the most effective,” he says, adding that, regardless of whether they’re medicated or treated otherwise, ADHD children need special support from their parents, school and possibly other specialists.

Free adhd screening

Founded by psychiatrist Dr Renata schoeman and sportsman and entrepreneur Nic de Beer, the Goldilocks and the Bear Foundation raises funds to provide free access to aDhD screening, and early intervention and treatment, for rural communities across south africa. “Our initial aim is to use mobile screening units at schools to screen 500 children a month for aDhD,” says schoeman. “We want to provide mental-health support to aDhD children so that they can develop to their full potential.”

Images: ©iStock.com/energyy/woolzian

For those with the time and resources, there is plenty of information available about ADHD. The Attention Deficit and hyperactivity support Group of southern africa (aDhasa) provides support and information to families, therapists, teachers and caregivers of aDhD children and adults. living aDDventure (www.livingaddventure.com) is written and curated by Dave (who has aDhD) and Pat Pughe-Parry for those living with or alongside the disorder. Early identification and intervention are important in the treatment of aDhD. the reality, though, is that there is no simple or single test for the disorder. While parents might recognise symptoms of aDhD in their children and, in many cases, be nudged to seek professional help by teachers, a multidisciplinary approach to diagnosis is ideal. “aDhD is a clinical diagnosis, which should be made by a specialist psychiatrist, paediatrician or other healthcare professional with training and expertise in the diagnosis of aDhD,” says psychiatrist Dr Renata schoeman. “although screening children for the presence of aDhD is very important, the final diagnosis should always be confirmed by a thorough clinical assessment – which will also exclude conditions that mimic aDhD, such as depression, anxiety, visual problems, and certain medical conditions.” Most cases of ADHD present around the age of five-anda-half, says Venter. some aDhD children work around their challenges until around grade three (age nine or so), which makes up “the next large group we see”, he says.

BREAST CANCER

POSITIVE

prognosis UK researchers have identiﬁed a molecule that may help to ﬁght ‘triple-negative’ breast cancer, writes Louise Ferreira

Images: Shutterstock and ©iStock.com/kali9

ctober brings increased awareness of breast cancer, which means more conversations are happening around diagnosis and treatment. And it seems one potential new treatment holds promise for patients who are resistant to chemotherapy: London researchers have identified a molecule that influences the behaviour of the dreaded “triple-negative” breast cancer. But first, we need to understand the differences between cancers and how medical teams decide which treatment option is best for any one patient. “I am often asked by my patients why Jane had chemo and radiation, why Sue had radiation only, and why Nomsa had a bilateral mastectomy and her sister had a breast-saving operation,” says Dr Carol Ann Benn, breast-cancer specialist. Until a decade or two ago, breast cancers were classified and treated mainly according to size, which meant that tumours over a certain size would almost always require a mastectomy. Size also determined whether a patient would receive chemotherapy and radiation. Then age became a determining factor. “Young people got chemo; menopausal women did not,” says Benn. “Finally, we recognised that it is actually about understanding the behaviour of tumours.” This refers to the rate of growth, as well as to what Benn calls the “personality” of the cancer – that is, the type. “‘Triple-negative’ cancer means the tumour is not hormonesensitive,” she explains. During a biopsy, breast tumour tissue is tested for different hormone receptors, which indicate sensitivity. “Three important receptors that you should know about are the oestrogen receptor (ER), the progesterone receptor (PR) and the Her 2 receptor,” says Benn. “If your cancer is ER and PR-positive, your oncologist will advise you on some form of endocrine treatment. There are many available, and usually after discussion in an MDM (multi-disciplinary meeting), one will be recommended by your oncologist. “Endocrine therapy is chronic treatment, and usually starts after all other treatment is finished, and will need to be taken for at least five years, usually up to 10,” she adds. It is critical that the test for the Her 2 receptor is carried out during a core biopsy, and if results are negative, that the final tumour specimen is tested again, says Benn.

BREAST EXAM

All breasts are shaped differently, and one breast is usually larger than the other. Know the feel of your breasts; some feel fatty, some smooth, some lumpy. It’s important that you can recognise any changes. Examine your breasts both standing and lying down. Stand in front of the mirror, lift your arms to the side, and check that the skin of the breast does not pull in. Relax your arms on your tummy and use your left hand to check your right breast with the ﬂat of the hand. Do not squeeze the breast or lift your arm above your head to feel the glands (lymph nodes). If your arm is bent, you can feel the glands beautifully. Any pain, any nipple discharge, any mass, any “I am not sure” – see a doctor or clinic that has an interest in breast care. Do not be afraid to question your doctors. Go for second opinions, and do not be pressured into unnecessary surgery to ﬁnd out what something is. An ultrasound at a reputable unit for a young woman, and a mammogram and ultrasound if you’re over 40, is the way to start. — Dr Carol Ann Benn

H E A L T H Y T I M E S l 13

Almost all cancers that are Her 2-positive will be treated with the drug Herceptin, and Herceptin is given with chemotherapy, as a general rule. “All the above factors play a role in not only what the cancer looks like, but how it behaves,” says Benn. “The most important determinants of behaviour are the division rate and the receptors.” Depending on its hormone sensitivity, breast cancer can be classified into one of four categories. Luminal A cancer is ER and PR-positive, and is slow-growing. Luminal B cancer is also ER and PR-positive, but grows faster. “Most cancers can fit into this general category,” explains Benn. Both Luminal A and B are Her 2-negative, while Her 2-positive cancers can be either ER and PR-positive or negative. The fourth type of cancer tests negative to all three hormone receptors, and this is the dreaded “triple-negative” cancer. Triple-negative tends to be viewed more fearfully, since it can be more aggressive than the other types, often has a poorer prognosis and is more common among younger patients. But if that’s the diagnosis you receive, don’t panic. “They can have a low or high division rate, and care should be taken not to take this entire group of baddies and lump them together,” adds Benn. “Most [cancers], except the very small and the very sleepy, will probably need chemotherapy.” It’s in the treatment of triple-negative that researchers have discovered a potential breakthrough. According to a press release from the Institute of Cancer Research in the UK, scientists have identified a molecule called PIM1, involved in “driving and controlling triplenegative breast cancers”. PIM1 influences the “death threshold” of cancer cells targeted by chemotherapy, and the research teams have discovered that the molecule “has been hijacked and is being overproduced in the majority of triple-negative breast cancers”. This helps them to survive

“‘Triple-negative’ cancer means the tumour is not hormone-sensitive.” – Dr Carol Ann Benn

14 l h e a l t h y t i m e s

“by making them more resistant to the ‘death signals’ prompted by chemotherapy”, and explains why a large number of these cancers are aggressive and resistant to chemotherapy. While PIM1 has little effect on normal cells, triple-negative cancers become “addicted” to it, suggesting that PIM1 inhibitors could be used to target cancer cells and make them more sensitive to other forms of treatment. Benn points out that cancer treatment is not just about the tumour, but the individual person – their general health, as well as their body’s ability to fight disease and manage treatment. Two other new fields of cancer treatment are immunotherapy and what is known as “basket oncology”. The latter is related to genetic profiling, suggesting that the appearance of the tumour and where it is found in the body are less important than its genetic makeup. This would allow oncologists to choose the best treatment option for the cancer, depending on its genetics. “The frontier of cancer genetic profiling has expanded. We can study the sensitivity of cancers to certain drugs and whether certain chemo combinations may be more effective than others by understanding the genetic profiling of the cancer cell. This has resulted in more personalised cancer care.” Immunotherapy uses your own immune system to fight diseases such as cancer, by stimulating it to work harder. “Other drugs help train the immune system to attack cancer cells specifically,” explains Benn.

Images: Shutterstock

breast cancer

healthy finances

Nhi – iN the pipeliNe or a pipe dream? Universal healthcare coverage is a laudable goal for a nation, but the latest White Paper still hasn’t given a clear indication of how it might be afforded in South Africa, writes Georgina Guedes

16 l l hHeEaAlLtThHyY tTiIm MeEsS 16

preferred choice in primary healthcare facilities, and diagnosis-related groupers being the model of choice for hospital payments. However, Serfontein says: “There is somewhat less information on the massively advanced actuarial processes involved in costing these type of payments, or where in the state this untapped actuarial capacity currently lies, along with the enormous data required to do the analysis.” In fact, while the “how it will work” has been extensively addressed, most experts agree that “how it will be funded” is still sorely lacking.

“The critics aren’t criticising the concept, just the model that’s been chosen to implement it.” – Dr Johann Serfontein

Images: ©iStock.com/ Creativeye99/mckare/Niyazz

outh Africa is grappling with massive inequality in the provision of healthcare, with the rich being able to afford some of the best-quality services in the world, and the poor often entirely neglected. The proposed National Health Insurance (NHI) seeks to address this problem, but a recently released White Paper has done very little to explain exactly how this will be achieved. On 29 June 2017, the Minister of Health, Dr Aaron Motsoaledi, and his deputy, Dr Joe Phaahla, released the latest White Paper on National Health Insurance (NHI), as approved by cabinet. While industry experts have said this document is an improvement on its predecessor, released in 2015, it still leaves many questions unanswered. “Criticism of lack of detail in the previous draft was addressed thoroughly, with a much more comprehensive overview of service delivery in the NHI. The paper contains a detailed account of how the minister intends to provide access to quality healthcare for everyone, free of charge,” says Dr Johann Serfontein, a senior healthcare consultant and Free Market Foundation health policy unit member. He notes that the White Paper contains a detailed description of the primary focus of the system. Districts and clinics will be granted more authority to deliver services, and contracting units for primary healthcare will be established. Patients will be channelled from the primary care to the hospital system as required, and the only co-payments in the system will be for those who do not follow this referral path. “It is interesting to note that patients can make co-payments to skip the referral channel, which means that the rich will still have better access to healthcare in a system that has been established to try to equalise access,” he adds. Further information has been provided on how providers will be paid in the system, with risk-based capitation models being the

OLD FIGURES STILL BEING USED “The problem is that the most recent White Paper still used the numbers that they used in the old model – one that was based on expectations or forecasts on 2010 projections,” comments Mamoketi Lijane, an investment strategist at Aluwani Capital Partners. “A lot of time has passed and a lot has happened in terms of fiscal performance in the interim, so it is very difficult for us to make a judgment on what the actual costs of the NHI will be, and I expect that Treasury will have the same problem.” Since these numbers will need to be used in the budgeting process, she says that, as they are not up-to-date, the true costing cannot be calculated. “Two questions immediately arise. The first is how much consultation has taken place between the Department of Health and Treasury, and the other is whether the implementation timelines are reasonable, since timelines are dependent on financing,” she adds. Lijane’s biggest issue is that the old estimates were difficult to achieve, and South Africa has experienced poor fiscal performance since then, so funding has only become more difficult. “Growth has underperformed materially, and the funding gap is now wider, so we need newer numbers to get a sense of how wide it is and what the potential fiscal implications are, and what alternatives there are to fund that gap.” Serfontein is also concerned about affordability. He says a figure of R256-billion is listed as the requirement to deliver services to all South Africans, which is based on the 2010 state spend, with annual increases. “Even if all the cost-saving measures in the White Paper are meticulously implemented, South Africa still cannot afford that figure.” He explains that the funding shortfall at 2% GDP growth will be R108-billion in 2025, using 2010 monetary values. “These values have also not been adjusted to keep pace with the recent and upcoming credit ratings downgrades, and their effect on the local currency and inflation. We are thus looking at an actual funding shortfall of well above R150-billion to implement the system. Achieving this would mean at least an additional 42% in personal income tax being collected by SARS annually to fund only healthcare.”

POOR OUTCOMES AT PILOT SITES

In addition, Serfontein says pilot sites for the NHI have delivered worse healthcare outcomes than the national average. The District Health Barometer, carried out by the Health Systems Trust between 2012 and 2016, shows that, for example, some NHI sites have a maternal death rate of 130.5 per 100 000 people, while 119.1 is the South African average. Immunisation rates of 90% at an NHI pilot site went down to 85.6%, while the national average of 89.2% in the same period was an increase on 84.4% in the previous period. “The Office of Health Standards Compliance has said that the NHI sites do not comply with the NHI’s own standards,” he says. He describes the outlook for the NHI as “pretty grim”, but says that while the reality is that South Africa can’t afford it, the Department of Health is not looking at any other alternatives at this stage. “We need to look at other ways of achieving universal health coverage. The critics aren’t criticising the concept, just the model that’s been chosen to implement it.” Lijane agrees. “It is a necessary project, but it is not the only necessary project. I think the NHI would go a long way towards addressing the inequalities in basic services – and inequality in healthcare is something that is very difficult ethically to accept. But the implementation has to be doable.” She says the question is not whether South Africa should have an NHI, but that further thought needs to be given to the funding. “It’s about reprioritising expenditure in some way. Policymakers have to make a call about where they are going to find the money.” She adds that higher GDP growth would result in the collection of more taxes. “Things that are unaffordable in a 1% growth environment become affordable in a 5% growth environment. Things could change quite a bit if our economy were growing faster. It’s not just about the Department of Health; it’s about what everybody else does. Like so many of our issues, it comes down to what the leadership at the top looks like.” While the experts agree that universal healthcare is a worthy goal, they also agree that it cannot be achieved under the current funding model – and that the corners that would have to be cut would result in an outcome that continues to fail South Africans with a low income. Simply put: the aim is laudable, but the projected costs and implementation plan need a significant rethink. H E A L T H Y T I M E S l 17

HEALTHY FINANCES

HOW DO YOU CHOOSE A

medical aid? With 83 open medical aids in South Africa, each offering a variety of plans, it can be difﬁcult to know which one is right for you, says Lisa Witepski

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edical aids are something of a grudge purchase. When we’re well, it feels like a waste of money – but when we’re ill, we’re very grateful we have one. Among the many considerations that will inform your decision of which medical aid to sign up for, your life stage is one of the most critical. Gerhard van Emmenis, principal officer of Bonitas Medical Fund, points out that your medical needs increase with age and as your family expands. Thus, people who have just started out on their careers may find that a product combining a savings account and a hospital plan offers all the cover they need. Such new-generation products are ideal for single individuals and young couples who are generally able to afford the odd doctor’s consultation and pharmacy bills. By the time you’ve had children, you’ll be at the stage when you’ll know whether you have any health weaknesses – perhaps your eyesight isn’t particularly keen, for instance. There’s a strong likelihood that conditions of this sort will be passed onto your children, so it makes sense to invest in a product that offers benefits to address this. As middle age arrives, it’s time to consider the capitated environment. Van Emmenis explains that although members opting to go this route have less choice in terms of which practitioners they can consult and which medications may be prescribed, the quality of their care is in no way compromised. This is simply a smart way to ensure that income reduced through retirement is wisely spent.

Medical aid is an area where going the cheapest route may prove more expensive in the long term.

WHAT ABOUT LEGISLATION? Having selected a scheme, perhaps you are thinking about purchasing gap cover. This is designed to address the shortfalls that must be paid when medical-aid rates do not cover an in-hospital treatment, and it has come under the spotlight with the enactment of the Demarcation Act, which was passed in April and will become active next year. The Act sets out to make the distinction between medical aid and medical insurance clearer, Van Emmenis explains – and it’s an action he welcomes, as he believes it will help to stabilise the medicalaid industry and protect consumers. “In terms of the Act, gap cover will be aligned to the same underwriting requirements imposed by medical schemes, and the gap beneﬁt will be limited to a maximum of R150 000 per annum, per insured life, which is applicable to any co-payment and medical expense shortfall.”

H E A L T H Y T I M E S l 19

healthy finances

children who regularly fall victim to nursery-school germs. If you’ve chosen to implement an MSA, you need to find out whether there is a threshold benefit that would limit the amount your scheme pays for a certain condition. Yatt gives the example of orthodontic treatment. “If your option includes a threshold benefit, your scheme will limit how much of the cost they will cover up to your threshold level and, once you’ve reached this point, it will also limit how much they pay for orthodontic treatment from this limit.” Then, make sure you are aware of the rate at which your medical aid provides cover. The medical-aid rate is also something to bear in mind when you visit a specialist. Remember that if they charge more than stipulated rates, you will be required to make a co-payment to cover the shortfall that is not paid by your scheme. For Van Emmenis, two further crucial factors to consider are your budget and the scheme’s benefits. “Budget comes into play because your medical-aid contributions should not exceed 10% of your monthly income – so be sure to select your scheme accordingly. Benefits are equally important; choose a scheme offering the right ones, and you’ll be able to save on your day-to-day expenses.”

need to know

Your medical aid contributions should not exceed 10% of your monthly income – so be sure to select your scheme accordingly.

20 l h e a l t h y t i m e s

Budgeting for medical aid the cost of unexpected (or even planned) medical intervention can be significant – but, then again, monthly medical-aid contributions can reduce a household’s spending power. how to ease the pain? Says Mellony Ramalho, group executive for sales, branch network, at African Bank, the key lies in budgeting. “As a basic rule of thumb, 50% of your budget should be spent on fixed expenses like rent, school fees and medical aid; 20% on savings and investments; and 30% for variable expenses like entertainment, groceries and petrol.” With this in mind, Ramalho recommends shopping around for the most affordable cover that still meets all of your needs, just as you would when buying insurance for your car, and make sure you read all terms and conditions before finalising your purchase.

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Within these three broad bands of cover, many different policies are offered. But, before you choose a plan – and even a scheme – there are some key questions to ask, advises Jeremy Yatt, principal officer at Fedhealth Medical Scheme. Chief among these is whether the scheme is viable, dependable and able to withstand the turbulence of the economy. Medical aid is an area where going the cheapest route may prove more expensive in the long term, as smaller schemes are often more exposed. Remember, too, that smaller schemes often place more restrictions on their members in terms of the doctors and hospitals they may access. Thus, the length of time the scheme has been operating, its adherence to the Medical Schemes Act and its financial stability are all issues you need to investigate. Next, Yatt suggests taking a look at your actual medical expenses. This will determine the type of policy you purchase. For instance, if you seldom need any care beyond the odd dental checkup or a consultation for a seasonal bout of flu, you could manage with fairly basic cover. “In this case, you can make your savings go further if your scheme covers things such as doctors’ appointments from your risk benefits, rather than your savings account,” says Yatt. However, this certainly won’t suffice if you have greater needs – if you’re planning a family, for example, and there are several appointments with specialists in your future. A plan with the appropriate benefits is in order. Something else to think about: can you afford to forgo a medical savings account (MSA)? Again, if you can afford your occasional visits to the doctor, the answer may be yes, but think twice if you have a condition that requires fairly constant attention, or if you have young

HEALTHY HEART

UNDERSTANDING

angina

If you ever experienced a sudden, sharp pain on your left side, you may have worried that you were about to have a heart attack. But it may just be angina, says Lisa Witepski

WHAT’S THE DIFFERENCE? Although both conditions involve chest pain, angina and a heart attack are very different. A heart attack – which may cause lasting damage to the heart – occurs when the flow of blood to the heart suddenly becomes blocked. The pain may start gradually or it may be an intense sensation, and it will probably last for a few minutes or come in waves. In contrast, because angina is brought on by insufficient oxygen reaching the heart, it’s relatively shortlived and doesn’t cause lasting damage to the heart. It can be treated with nitroglycerin and responds well to rest. 22 l H E A L T H Y T I M E S

DON’T BECOME A STATISTIC Even if your genes count against you, it’s possible to keep angina attacks at bay. Most important, advises Nematswerani, keep a close eye on your health. Be sure to measure wellness indicators such as cholesterol and high blood pressure regularly, and address any warning signs as early as possible. Similarly, treatment for conditions such as diabetes and obesity should be sought sooner rather than later. Dhansay notes that the assistance of a medical professional is key in this regard, as the correct advice and precautions may make a significant impact. This is all the more important given that angina may be a warning sign of heart disease, and early treatment may help to ward off a heart attack.

Although both conditions involve chest pain, angina and a heart attack are very different. WHO’S AT RISK? Dhansay says the elderly and those who are genetically predisposed to heart disease are at risk for developing angina, but those living an unhealthy lifestyle are also vulnerable. Excessive consumption of alcohol and smoking count against you, as do medical conditions such as high blood pressure, diabetes mellitus and cholesterol. Fortunately, because angina is often related to lifestyle, it can be treated by making a few modifications. Stop smoking, cut down on the number of drinks you enjoy every week, stick to an exercise regime and maintain a healthy weight, and your risk will be greatly reduced. It is also possible to treat the condition with medication that helps to dilate the coronary arteries, thus preventing spasms. In some cases, surgery may be required, says Nematswerani.

Images: Supplied and ©iStock.com/dem10/pixelheadphoto

ngina doesn’t feel exactly the same for everyone. Dr Noluthando Nematswerani, head of the Centre of Clinical Excellence at Discovery Health, notes that the most common symptom is chest pain, although the pain may also spread to the shoulders, head, neck and back. In some cases, angina may present as aching, burning, a Dr Noluthando Nematswerani sensation of fullness, discomfort, or a feeling of heaviness or pressure in the chest. It may also be accompanied by nausea, shortness of breath, faintness and sweatiness, and it may be brought on by stimuli as varied as cold weather, a heavy meal, emotion or physical exertion. Why does it happen? According to Dr Afzal Dhansay, cardiovascular portfolio at Pharma Dynamics, plaque building on the walls of the arteries is to blame. Since the coronary system is responsible for transporting blood and nutrients to the heart muscle, the heart may be deprived of vital oxygen and nutrients if the arteries become too narrow. This is what causes chest pain.

HEALTHY EYES

What is RETINITIS

PIGMENTOSA?

With World Retina Day commemorated on 28 September, Tamara Oberholster explores a group of diseases speciﬁcally affecting the retina

etinitis pigmentosa (RP) is the name given to a group of inherited eye conditions affecting the retina. According to the Royal National Institute of Blind People (RNIB) in the UK, while RP causes permanent changes to vision, the extent of vision loss and rate of progression vary from person to person. “RP causes destruction of the retinal cells,” explains ophthalmologist Dr Dory Neu-Ner. “The retina is a layer of nerve cells in the back of the eye that senses light, and sends signals to the brain so we can see. RP affects the photoreceptor (light-sensing) cells. Initially rod cells are affected, followed by cone cells.” Rods work in low light, whereas cones, which help us to see colour and detail, require more light. According to Neu-Ner, there are two main groups of RP: primary RP (where the disease is confined to the eyes) and RP syndromes (where dystrophy is associated with other organ disease). The RNIB lists Usher syndrome, where people develop both hearing loss and sight loss, as an example of the latter. The National Organisation for Rare Disorders (NORD) in the US states that RP affects about one in 3 000 to one in 4 000 people.

SYMPTOMS Night blindness and difficulty seeing in dim light (including transitioning from light to dark and vice versa) are usually the earliest symptoms of RP, given that rod cells are affected initially, explains Neu-Ner. “Other symptoms include loss of peripheral vision, and loss of central vision in late stages and from complications of the disorder. There can be a variable range in the onset of RP, but both eyes are affected. Some people are diagnosed in childhood, while others are not affected until they are adults.” According to the RNIB, while some people with RP may become blind, most will keep partial vision well into old age.

CAUSES RP is a complicated genetic condition, says Neu-Ner, with multiple genes having been identified as causing various forms of RP. “The disease can be sporadic (with no prior family history), or inherited in an autosomal dominant, autosomal recessive and X-linked pattern (the types of gene mutations that can result in inheriting RP).”

DIAGNOSING RP “The disease is diagnosed following a comprehensive examination looking at the patient’s symptoms, a complete eye examination looking for typical features of the disease when testing vision, and examining the anatomical structures of the eye,” outlines Neu-Ner. If RP is suspected, special tests are performed, including an electroretinogram (ERG), which assesses electrical activity of retinal cells, to confirm the diagnosis.

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MANAGING RP “There are currently no proven or effective cures for RP,” says Neu-Ner. “The most important step in treatment is maximising the effective vision a patient has and preventing loss of vision from complications of the disease.” Assisted technologies can help patients with visual impairment, and research is underway into future treatments of RP using gene therapy (replacing defective genes), drug treatments to slow progression, stem cells, and artificial retinal implants. “Currently, most treatments are in clinical trials, although retinal implants are already available in some markets,” says Neu-Ner. It’s important to see an eye doctor if you’re experiencing symptoms suggestive of RP or have a family history of it. “If you have the disease and plan to have children, genetic counselling and testing are extremely important, to learn about your chances of passing it on,” Neu-Ner concludes. H E A L T H Y T I M E S l 25

ADDICTION

OTC MEDS:

the codeine connection

Addiction doesn’t apply only to ‘hardcore’ drugs such as cocaine, heroin and crystal meth. That cough mixture or painkiller you picked up at the pharmacy can be just as addictive if it contains codeine, writes Mandy Collins

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ichard* is a South African working and living in Dubai. When he returns to Dubai from South Africa, one of his preflight routines is to check any over-the-counter medications he might have bought here, for codeine. In South Africa, you can pick up a medication containing codeine over the counter, including some pain medications for children and babies. In Dubai, possessing codeine carries a jail sentence. South Africa is an exception when it comes to codeine – in most countries in the world, it’s available by prescription only. Here, some codeine medications have to be prescribed by your doctor, but there are also over-the-counter (OTC) versions. These have simply had their pack size and dosages reduced in recent years. Why? Because of the scourge of codeine addiction. Florence Phiriga, deputy nursing services manager at the Elim Clinic, a recovery centre for those battling addiction, points out that codeine is an opioid – like its cousin, morphine. And codeine addiction is a lot more common than most people realise. “Right now we are seeing many patients who are abusing codeine,” she says, “particularly in the form of cough syrups. And we don’t know why, but it seems to be more common in women than men.” In some cases, things start off innocently enough, says Phiriga. “A doctor prescribes a flu medication containing codeine, for example, and they’ll prescribe it three times a day. But some people start to take it every two hours if they feel it isn’t working, and before they know it, the box is finished. And then they get more. We’ve even had patients who use friends and relatives to help them to get more medication if the pharmacy refuses to give them more.” Among teenagers, however, most often the abuse is intentional – they’ll pour a whole bottle of codeine-containing cough syrup into a grape-flavoured fizzy drink, or an energy drink, to create something known as “purple drank” or “lean”. Then off they go to school, their high for the day disguised as an innocuous soft drink. “It began with some of the rappers in about 2007, and it’s become quite the trend,” says Dy Williams of drug addiction

South Africa is an exception when it comes to codeine – in most countries in the world, it’s available by prescription only. SIGNS AND SYMPTOMS OF CODEINE ABUSE Like other opiates, codeine abuse can cause nausea, vomiting, difficulty breathing and drowsiness. Someone who is abusing codeine might appear to be sedated. Or they might have stomach pain and constipation, and have itchy skin. They might also not be able to think clearly, operate large equipment safely or drive properly. When users first start taking codeine, they might even feel dizzy, or faint. Some people also experience changes in vision, and heavy users might have seizures. If someone overdoses on codeine, signs will include loss of consciousness, shallow and slow breathing, limpness, slow heartbeat, and cold and clammy skin. The most important sign, however, is that someone can’t stop using a drug and their life is being damaged or even destroyed by the addiction. Many people abusing opiates don’t even get high; they simply feel as if they need the drug to function each day. Source: Narconon.org

H E A L T H Y T I M E S l 27

ADDICTION

DON’T TRY TO DETOX AT HOME

“Remember that abuse leads to addiction, so use your medicines only as prescribed by your doctor, and then stop.” – Florence Phiriga, Elim Clinic

FAST FACTS: OPIOIDS • Some opioids, such as morphine and codeine, occur naturally in opium, and are made from the liquid harvested from the unripe seed pods of the opium poppy. • Semi-synthetic opioids, such as oxycodone, hydromorphone or hydrocodone, are made by changing the chemical structure of naturally occurring opioids. • Synthetic opioids, such as methadone, meperidine and fentanyl, are made from chemicals, without using a naturally occurring opioid as a starting material. • Prescription opioids come in various forms: tablets, capsules, syrups, solutions and suppositories. Source: Centre for Addiction and Mental Health, www.camh.ca

* Not his real name 28 l H E A L T H Y T I M E S

Images: Shutterstock and ©iStock.com/KatarzynaBialasiewicz/mrtom-uk

recovery centre Houghton House. “It’s less expensive than nyaope, which is essentially heroin, and you can buy it over the counter. And the more you take, the more you need it, until you get to the point where you are physically addicted to it, and you need it to get up in the morning.” When your doctor prescribes anything containing codeine, you’ll probably be warned that it can cause constipation. But if you start to abuse it, constipation is the least of your worries. “It can have terrible effects,” says Phiriga, “like bleeding ulcers, or kidney and liver damage. It can also lower your heart rate and blood pressure, cause sexual problems like low libido, and even cause depression.” And don’t think you can just stop at any time. It requires that you go through the same kind of detox most of us would associate with heroin and cocaine addiction – because it comes from the same family of drugs, and has the same effects on your body. “Codeine is a short-acting drug – it only lasts three to four hours,” explains Phiriga. “So, by the time you haven’t had it for six hours, you start to get withdrawal symptoms – pain, nausea, vomiting and chills. “When patients come in, they will be assessed by a doctor and put onto a detox regime, which usually includes a drug called Suboxone. This helps to minimise withdrawal symptoms. Generally, patients will stay in the clinic for three weeks, where we can monitor them until they are clean.” But it’s not enough to simply detox your body. “Addiction is in the brain, so psychotherapy is essential,” says Phiriga. “We have psychologists and social workers who work with patients in individual and group sessions while they are here.” She emphasises that codeine is meant to be used short-term. “You can’t go on drinking that cough mixture for four weeks or more. Remember that abuse leads to addiction, so use your medicines only as prescribed by your doctor, and then stop.” Williams adds that the biggest misconception is that codeine is safe because it’s available for sale over the counter. “Nothing is safe unless you use it in moderation and as prescribed,” she concludes.

Houghton House’s Dy Williams warns against DIY detox from codeine. “It’s dangerous to try and detox without assistance,” she says. “It should always be medically supervised.” Detox comes with a range of symptoms, including anxiety, convulsions, delirium, nausea, diarrhoea and seizures. If you can’t afford a private clinic, she advises, you can be admitted to a psychiatric ward in a government hospital for your detox. Williams says detoxing from the drug physically usually takes about five days. “But then we have to teach addicts how to cope without drugs, how to function in the world without them. That’s why the process takes several weeks.”

ADVERTORIAL

Unlocking the potential of

GREEN TEA Is every day a struggle? Do you suffer from low mood? No energy? Blood sugar imbalance? Extra ﬂab that you can’t shake off ? A feeling of constant tiredness?

urely we are meant to feel better than we do. Many of us are plagued with ill health and chronic inflammation, thanks to our modern lifestyles, increasingly high stress levels, polluted environment, poor gut health, and an over-reliance on processed, chemically enhanced foods. We often don’t even know we are suffering from inflammation, as it goes undetected for years before it manifests into a chronic disease. This low-grade systematic inflammation is known as the silent killer. We need to rethink our approach to disease. To take a biological system from dysfunction back to function, before disease sets in, we often need to support good diet, pure water, clean air, regular exercise, enough sleep and stress management with some good nutritional supplementation. Most chronic disease starts with inflammation, so a supplement to reduce inflammation and to help the body’s detoxification processes is instrumental in damage-proofing the body from the modern world we live in. Clinical studies of green tea have demonstrated its potential ability to reduce inflammation, balance blood sugar (assisting those with insulin resistance), improve liver function and detox, and reduce negative cholesterol levels, as well as the risk of heart disease. Over and above these benefits, green tea is known to boost the metabolism, allowing you to burn more fat for energy, resulting in weight loss. People using green tea report increased vitality, energy and a feeling of wellbeing. 30 l H E A L T H Y T I M E S

The challenge, however, is that to reap the benefits of green tea, you need to drink upwards of 10 cups of high-quality tea per day, every day. Green tea is active for only three to four hours, meaning it constantly needs to be taken. The same challenge lies in regular green tea supplements; to really obtain the benefit, you need to take them throughout the day, often three to five times per day. A group of South African scientists has developed an extract named Origine 8, which has been proven, through a single capsule taken once per day, to deliver over 24 hours of activity and 12 times more of the beneficial catechin found in green tea than regular supplementation. The clinical evidence proves we can conveniently and effectively unlock the potential of green tea.

While green tea is generally regarded as safe, it is important that you consult with a medical professional trained in botanicals should you have a health-related condition. Users may or may not experience an initial detox process, which is a positive, as the body rids itself of unnecessary toxic overload. It’s suggested that you drink additional water during this time. While green tea will start to have an immediate effect from the very first time you take it, the benefits will increase gradually over time.

HEALTHY HOME

SAFER FOR

seniors Whether you are caring for ageing relatives or expecting the occasional visit from senior citizens, Tamara Oberholster offers pointers on how you can ensure your home is safe for the elderly

lderly people may have deteriorating health and sensory systems, including vision, hearing, balance and touch, explains Jesse Kaplan, occupational therapist at Broughton and Jonck. “They may be weaker and struggle to complete certain tasks, and may be more at risk of falling and hurting themselves,” she says. “Modifications to the home may help them to navigate the spaces more easily, and allow them to accomplish daily living activities safely, or engage in activities they had previously struggled with.”

STAIR SAFETY Stairwells are another common accident zone. Single-storey homes are ideal for the elderly, but if you’re stuck with stairs, install handrails in the stairwell and ensure the lighting is adequate. Consider motion-sensor lighting to assist with vision during the night. A chairlift is also an option for those who can afford it. “Bear in mind that the person should be able to get in and out alone, and do up the safety harness/belt, as well as transfer from a wheelchair (where relevant) to the chairlift if they live alone,” Kaplan says. “Otherwise, they would need to ensure that someone is there to help them. If they only had one bathroom, they would need to ensure that they are on that level most of the time, as chairlifts can be slow and they will need time to transfer in and out of it.” Make sure passages and doorways are big enough to fit a wheelchair if necessary, and allow for turning space in each room.

QUICK FIXES BEGIN IN THE BATHROOM According to Kaplan, the most common safety challenges for senior citizens in the home are slipping and falling, and sustaining burns in the kitchen. Bathrooms tend to have tiled floors, which are slippery when wet. This means they are one of the most common sites for falls. Furthermore, if an elderly person struggles to lift his or her own body weight or battles with balance, getting in and out of a bath or standing up from a toilet can become difficult. Kaplan suggests installing handrails in the bathroom, on the wall of the bath and near the toilet. She says showers are preferable to baths (and a walk-in shower is best). “A chair can be placed in the shower and the person can shower seated if balance or endurance is a problem. Consider a bidet for ease of ablutions and cleaning, and ensure easy access to the showerhead, or a mobile (handheld) showerhead,” she adds. Refit taps with lever tap handles, which are easier for weakened or arthritic hands to manage. 32 l H E A L T H Y T I M E S

• Ensure mats have non-slip backing, to prevent slipping. • Remove unnecessary rugs and tripping hazards, including loose wires. • Decrease clutter wherever possible. • Install drawers instead of cupboards, for easier access. • Install wooden floors or non-slip tiles, for wheelchair access. • Ensure there’s enough space in the room for elderly people to move around easily, and for others (eg nurses or therapists) to have access when required. • Consider a panic button that the person can keep with them. • Consider seating height – very low or soft couches make getting up more difficult.

HANDY RESOURCE

Run by TAFTA, Ageing in Place aims to help in making it possible for older people to continue living independent lives in their homes or with loved ones. Visit www.ageinginplace.co.za or call 031 332 3721.

Images: ©iStock.com/BenDC/Onur Döngel/Onzeg/sdigital

These changes will make your home safer immediately:

UNDERSTANDING ALLERGIC SYMPTOMS AND IgE Celebrating the 50 year anniversary of the discovery of Immunoglobulin E

ost people are aware that allergic symptoms are caused by the release of powerful signal substances such as histamine that can cause everything from mild reactions such as a runny nose or skin rash to severe symptoms such as asthma, eczema and even systemic shock. But it wasn’t until the 1980s that scientists understood how these symptoms came about – or the central part that IgE antibodies played in the process. In principle, allergic reactions are misguided inflammatory reactions triggered by normally harmless substances from our day-to-day environment – allergens. An allergen is typically a protein found in for example plant pollens, animal dander and foods such as peanut, egg and milk. In allergic individuals, one or more of these allergens may be recognised as potentially dangerous. On first exposure, their immune system starts to produce antibodies that can bind to that antigen to protect the individual in the future. In atopic allergy (the most common type of allergy), the antibody formed is IgE. It was discovered that an allergic individual’s ‘memory’ of having first been exposed to an allergen is stored as IgE antibodies attached side-by-side on a special type of white blood cell. These blood cells, known as mast cells, contain the powerful signal substances that on their release create the inflammatory response we call allergy. On second exposure, sensitized individuals may suffer a reaction if the allergen cross-links adjacent IgE antibodies, triggering the release of the inflammatory chemicals from inside the mast cell. This is why measuring levels of IgE antibodies in blood is a good way of determining the risk of allergic reaction, and why IgE-testing is still a leader in allergy diagnostics.

The rest is history. IgE history. Visit www.isitallergy.co.za to download your free Allergy Guide e-book

Research in the 80’s demonstrated exactly how IgE binds to other compounds, based on a deeper insight into IgEreceptors, which opened the door to a better understanding of the origin of allergic symptoms.

HEALTHY HOME

Time to SPRINGCLEAN! Zaza Motha offers some ideas for freshening up your home after winter

s Images: ©iStock.com/arcady_31/didesign021/fcafotodigital/Ilya731/ucentius/xefstock/xjbxjhxm

pringcleaning might seem a little old-fashioned – the preserve of Victorian housekeepers – but there is some merit to opening up your house and freshening things up. Christopher Kapanga, owner of We Clean It All, a cleaning solutions company, says that while the origins of springcleaning vary according to temperature, culture and religion, spring is generally considered the season that brings with it new life and warmer temperatures. “We spend most of winter in closed spaces. Therefore, not much fresh air circulates through the house. The house and the linen inside tend to cling to the sweaty smell,” he says. The wind also brings dust particles inside, so we clean in preparation of spring to bring fresh life into the house, he adds. “The feeling of having a fresh start encourages individuals to pack away winter attire, linen, blankets, and so on, and remake their homes, both to have an inviting feel and to rid them of the dust that has accumulated.”

CLEANING CHECKLIST

PESTS TO LOOK OUT FOR

TIPS FOR SPRINGCLEANING

1. Windows – do the outside ﬁrst, for best results. Wash with a soft cloth and buff to a shine with a ball of newspaper.

Cockroaches: Cockroaches thrive on heat, and chances are that in winter they would be more active in places such as behind the geyser. With temperatures getting warmer, cockroaches become more active around the house.

1. Set a date for springcleaning.

2. Linen – wash and dry winter curtains, blankets and linen before you pack them away. Buy cedar blocks, or cut laundry soap into small blocks and scatter them into the storage to keep pests at bay. 3. Mattresses – drag them out into the sun for a day if you can, and give them a good vacuum. 4. Carpets/upholstery – hire someone to clean them for you, or rent carpet and upholstery-cleaners and do it yourself. It doubles as a workout!

Rodents: They love to ﬁnd small spaces to hide in, behind wardrobes and kitchen cabinets. Make sure pet food is kept in rodent-proof containers, and be sure to vacuum spaces where crumbs might accumulate. “If you suspect an infestation of pests in the house, it’s best to call on the services of a pest-control company,” says Kapanga. If the problem doesn’t seem too bad, you can buy pest solutions at most grocery stores – just be sure to keep items such as rat poison out of reach of children and pets.

2. Focus on one room at a time – the Internet is full of checklists that can help you to keep track of your chores. 3. Break down chores into bite-sized chunks, to avoid giving up halfway.

4. Make sure that you have all of the necessary supplies before you begin. 5. Before cleaning, declutter and organise. Recycle or donate items that you no longer need.

6. Get help from other household members! If the workload is too much or you are too busy, a cleaning service would be your best bet.

7. Use the top-down approach when cleaning a room. Start from the ceiling, then move on to walls, storage and, ﬁnally, ﬂoors. When the inside is done, move outside and hose down the exterior walls.

8. Concentrate on high-trafﬁc zones. Places where the family gathers most often will probably be grubbier.

9. Start as soon as possible. The more you delay, the less likely you are to start – or ﬁnish. 10. Don’t forget to throw away expired products such as medicines, some cosmetic items, and deﬁnitely food.

(Additional source: How Stuff Works, http://home.howstuffworks.com/home-improvement/household-hints-tips/ cleaning-organizing/10-spring-cleaning-tips.htm)

H E A L T H Y T I M E S l 35

HEALTHY WORK

THE PAIN OF

repetitive strain

If we were to sustain an injury, most of us would expect it to happen while doing something active, but that most sedentary of activities – sitting at your computer day in and day out – can be just as debilitating, writes Zaza Motha

Images: Shutterstock

any of us spend long stretches of time in front of our computer, without realising that what may seem to be inaction may actually lead to injury, particularly to the wrist, elbow and upper arm. “Repetitive stress or strain injury (RSI) is a term that is used to describe the pain felt in muscles, joints or tendons caused by repetitive movements or the overuse of a muscle when an injury has occurred,” explains Dr Ntlopi Mogoru, a sports physician and medical practitioner, and CEO of the Road Accident and Medicolegal Assessment Clinic. According to BodyLogic physiotherapist Fatima Pahad, repetitive stress injuries are generally related to occupation or sport-specific activity. Some of the more common injuries are: • Tennis elbow (pain focused on the area where your forearm meets your elbow); • Golfer’s elbow (pain on the inside of the elbow, with a general weakness in the wrist); • Carpal tunnel syndrome (a numbness and tingling in the hand and arm which is caused by a pinched nerve in the wrist); and • Iliotibial band syndrome (ITB) (common in runners, where the ligament that runs from the pelvic bone to the shin bone becomes tight or inflamed). There are three main culprits: repetitive movements, prolonged high-intensity activity without rest periods, and activity related to poor or awkward postures – all of which are hallmarks of most desk jobs. This makes computer users particularly susceptible to RSI. RSI is a soft tissue injury that can occur in the muscles, tendons, fascia, ligaments or neural tissue, and can even cause muscle tears in extreme cases. “Muscle strain is categorised as Grade One, which includes minor tears; Grade Two, which includes moderate damage; and Grade Three, which includes complete rupture that may require surgical correction. “Strains and sprains are treated with the aim of first ensuring good tissue healing, and then strengthening,” Pahad says. Even nerve tissue disorders may be classified as a soft tissue problem, she adds, pointing out that altered neurodynamics are commonly found in association with spinal problems or repetitive strain injuries.

Doctors aren’t sure exactly why RSI develops. Many sufferers don’t exhibit swelling, inflammation or other obvious problems, yet they have the symptoms. Also, it’s not clear why some people develop RSI and others who do the same repetitive tasks don’t. But you can help to prevent it by setting up your workstation correctly, and ensuring that you vary your activities. And, if you have any symptoms, see a physiotherapist sooner rather than later to prevent the problem from progressing.

HOW TO KEEP RSI AT BAY Type in a neutral position. Make sure your elbow is positioned slightly higher than your wrist – at 90 degrees or more. Sit up straight and maintain a healthy posture. Take regular breaks – 15 to 20-second breaks for every 15 minutes you spend at your desk. Stretch from time to time. Vary your routines. Make sure that you don’t follow the same routines at home. Try to do other things that don’t involve a lot of wrist usage.

SIGNS AND SYMPTOMS Dr Ntlopi Mogoru lists these common symptoms of RSI: 1. Pain in the affected area (joint or muscle).

2. Loss or reduced strength and sensation around the affected area. 3. Tenderness in the affected area (joint or muscle).

4. Sensory loss, such as a pulsating or tingling feeling around the affected area.

H E A L T H Y T I M E S l 37

HEALTHY BACK

TOUCHING A

nerve

edentary lifestyles, or extended desk time, have made it more likely for South Africans to develop sciatica, experts say. The condition, common in adults between the ages of 30 and 50, presents with agonising lower back pain, coupled with a tingling or numbing sensation radiating down the back of the leg to the toe. Prolonged periods of inactivity, causing weakness of the muscles supporting the spine, could increase the likelihood of the sciatic nerve becoming irritated or compressed. “Other influencing factors include one’s posture, spinal alignment and day-to-day working postures,” says Durban physiotherapist Ashleigh White. “In some instances, the increase and the speed at which certain sport is now being played can also be a reason for hurting or irritating these nerves,” she says. “Often people who experience this type of pain keep thinking it will get better or it will go away. In some of these cases, the sciatic nerve continues to be irritated and then there may be a sudden isolated movement, like a cough or a sneeze, or a sharp twisting movement, resulting in the pain and condition being exacerbated.” White adds: “Even carrying heavy bags on one side of the body and shoulder could lead to spinal compression and nerve irritation.” Other common causes, according to Durban biokineticist Dennis Jackson, include a bulging or herniated disc of the spine, lumbar spinal stenosis (narrowing of the spinal canal), spondylolisthesis (one of the vertebrae slips out of place onto the vertebra below it) and piriformis syndrome (spasm of the piriformis muscle causing compression of the sciatic nerve).

Sciatica seems to be on the increase, thanks to desk jobs and generally more sedentary lifestyles, writes Subashni Govender

AT A STRETCH There’s a lot you can do to offset the damage from a desk job. For starters, try these three simple stretches every hour. 1. Shrug your shoulders a few times. 2. Shake and nod your head slowly, as if gesturing “yes” and “no”. 3. Sit up tall in your chair, or stand up. Stretch your arms overhead, interlock your fingers, palms up, lift your chin, tilt your head back, and gaze up at the ceiling. Source: WebMD.com

TREATMENT

White describes the most common symptom of sciatica as a burning, tingling or numbing sensation with a “pins and needles” type of pain that radiates downwards. “The nerve has both a motor (muscle) and sensory (feeling of touch and pressure on the skin) function. Both of these functions may or may not be compromised when the sciatic nerve is irritated. Pain usually increases with sitting, straightening the affected leg, turning over in bed at night or even when driving,” says White. “Modalities used to treat sciatica may include soft tissue treatment, dry needling electrotherapy, and the application of heat or ice; the correct exercises and stretching should be provided. In some cases, strapping or a brace may be needed.” She adds: “There are times when a doctor may need to be consulted for the correct medication prescription.” An integral part of treatment will always be some kind of core stability exercises and posture correction. A qualified biokineticist can be consulted for a programme that will be designed specifically to treat that individual and his or her problems. “Physical rehabilitation programmes will include core strength exercises, flexibility, mobility, functional strength, balance and proprioception,” explains Jackson. In serious cases, the patient may be required to have further diagnostic imaging, such as X-rays or MRI scans, or surgical intervention. H E A L T H Y T I M E S l 39

ALL IN A

HOSPITALS

day’s work

More and more procedures are being done in day hospitals, which means a saving in both time and money, writes Georgina Guedes

“If you are admitted into an acute hospital with sick people and lthough the concept of day hospitals is not new, progress patients with possible multiple-site infections, the risk of infection in medical technology means that more procedures is significantly higher. Day case admissions have a lower rate of can now be carried out safely and effectively at these infection. From a patient’s perspective, this is a significant advantage.” facilities. He also says that being able to walk in and walk out of a day According to Marti Gelderblom, the executive officer of the Day hospital is a lot less intimidating for Hospital Association (DHA), day hospitals offer patients, which provides a psychological surgical and diagnostic procedures that are boost to the healing process. Simply put, performed on a same-day basis. “Almost 70% of all patients feel less sick. surgical procedures can be performed safely in a day And day hospitals are also equipped hospital, with substantial savings for patients and with state-of-the art medical equipment. medical schemes.” “Day hospitals are required by law to The DHA is an umbrella, non-profit organisation provide all the emergency and resuscitation that represents a national footprint of 42 registered, equipment that any other theatre would independent private day hospitals. have,” adds Von der Heyden. Dr Cornelius von der Heyden is an anaesthetist Gelderblom notes that patients also who works at both the Bellville and Somerset West benefit from guaranteed discharge times, Day Hospitals in the Western Cape. Although PROCEDURES THAT as theatre lists remain unchanged and he doesn’t work exclusively in day hospitals, he CAN BE CARRIED OUT theatre cases are not moved to later in the believes there is growing reason for surgeons to use AT A DAY HOSPITAL day because of medical emergencies. these facilities, and for patients to request that their She says that, in the same way, doctors procedures be done there. Almost 70% of all surgical procedures benefit from improved productivity with “Medical technology and advances in can be performed safely in a day hospital, with substantial savings for faster patient turnaround times, and anaesthetics have changed the way we can do patients and medical schemes. happier patients who receive treatment things,” he says. “Patients don’t require an overnight • Ear, nose and throat procedures in a more relaxed environment. stay, and after limited surgery with a keyhole • Gynaecological procedures They are also able to work with the approach, they wake up nausea-free and pain-free, • General surgery latest equipment, as day hospitals are and they recover much more quickly.” • Minor breast procedures continuously investing in and upgrading Medical advances mean that procedures such as • Ophthalmology procedures their facilities. orthopaedics, gynaecology, urology, ear, nose and • Dental surgery Despite all of these benefits, throat surgery, maxillofacial surgery, gastroenterology, • Scopes: gastroscopy, colonoscopy, Gelderblom says South Africa’s utilisation ophthalmology and dentistry (among others) can all sigmoidoscopy, etc • Vascular: varicose vein stripping of day hospitals is lagging behind that of be carried out in day hospitals. • Urological procedures the rest of the world. In the years to come, Medical aids are starting to put pressure on • Orthopaedic procedures pressure from medical aids and patients doctors to elect to do surgery in these facilities for • Cosmetic surgery should see more and more procedures short-stay procedures, because the theatre charge • Maxillofacial surgery being performed in these facilities, with per minute is more affordable. However, Von der • Dermatology better physical, psychological and financial Heyden says there are other very compelling reasons • Pain blocks and pain management outcomes for patients. for patients to choose day hospitals. H E A L T H Y T I M E S l 41

HS ET R AA L TPHL YI NBEOHDEYR E

WORRIES

tatistics from the World Health Organization (WHO) indicate that, of the global population, 15% of women and 11% of men aged 18 and over were obese in 2014. The same study classified 26.8% of adult South Africans as obese. The Heart and Stroke Foundation South Africa (HSFSA) says as many as 40% of South African women are obese, which means they have a body mass index (BMI) equal to or greater than 30kg/m2. (The WHO’s recommended/normal BMI range is 18.50-24.99kg/m2.) Indeed, the world is round. Worse still, it’s getting rounder. Worldwide, obesity has more than doubled since 1980. Research published last year by British medical journal The Lancet found that global obesity has increased by 167% since 1975 – and, says dietician Gina Fourie of Consultant Dieticians, Cape Town, it continues to rise. “What’s also worrying is that it’s no longer just an adult problem: a quarter of all young girls (between the ages of two and 14) are overweight or obese,” she says. Boys in the same age group aren’t faring much better: one in five are overweight or obese. The troubling truth? Overweight children often become overweight adults. “WHAT’S ALSO WORRYING IS THAT IT’S NO LONGER JUST AN ADULT PROBLEM; A QUARTER OF ALL YOUNG GIRLS ARE OVERWEIGHT OR OBESE.” – GINA FOURIE

42 l H E A L T H Y T I M E S

WHY THE SWELL? There are, says Fourie, many reasons for the world’s expanding obesity problem; most obese people reach unhealthy proportions because of a combination of things. Lifestyle is a major factor. Food, particularly “hyper-palatable” and highly engineered junk food that is high in unhealthy fats, sugar and salt, is easily accessible at all hours from a glut of outlets, from supermarkets, restaurants, corner cafés and mobile units to petrol stations. This type of food is often cheaper and faster to consume than more nutritious options. We eat and drink too much and exercise too little, which is further facilitated by our fascination with digital devices. There is also evidence that lower-income groups have a higher prevalence of obesity. “Poor people have been reported to buy the least expensive foods that are gastronomically the most filling and energy-dense,” says the Department of Health’s 2015-2020 strategy document for the prevention of obesity in South Africa. In addition, the department highlights excess sugar and alcohol consumption as reasons for weight gain among South Africans. “It is important to understand the interplay of factors between genetics and risk factors associated with lifestyle in the onset of obesity,” says the CEO of the HSFSA, Prof Pamela Naidoo. “Consuming food in excess or consuming large quantities of food with little nutritional value, combined with a lack of physical activity, are often drivers of overweight and obesity.” Obesity also has a strong genetic component, says Fourie. Other reasons include leptin resistance, insulin imbalance, the use of certain medications and psychological issues. Some studies indicate microbes inhabiting our digestive tract – the gut microbiome – are also linked to corpulence.

Images: Images: ©iStock.com/ClaudioVentrella/fcafotodigital/mediaphotos/sergeyskleznev/TheCrimsonMonkey/wragg ©iStock.com/ClaudioVentrella/fcafotodigital/mediaphotos/sergeyskleznev/TheCrimsonMonkey/wragg

Weighty

Labelled ‘globesity’ by the World Health Organization, the escalating obesity epidemic is compromising the health of millions across the world, including many South Africans, writes Penny Haw

WHY WORRY?

Obesity is associated with several diseases, including Type-2 diabetes, heart disease, stroke, hypertension (high blood pressure), musculoskeletal disorders (especially osteoarthritis) and some cancers (including endometrial, breast, ovarian, prostate, liver, gallbladder, kidney and colon). In addition to childhood obesity being associated with an increased likelihood of obesity, premature death and disability in adulthood, obese children experience breathing difficulties, increased risk of fractures, hypertension, early markers of cardiovascular disease and insulin resistance. No less worrying are the social and emotional effects of obesity. These include discrimination, lower wages, reduced quality of life and susceptibility to depression. Add to these the individual and collective healthcare costs of obesity – including outlay for medical aid and drugs, and the cost of things such as absence from work and higher insurance – and it’s clear: obesity costs on all fronts.

“Consuming food in excess or consuming large quantities of food with little nutritional value, combined with a lack of physical activity, are often drivers of overweight and obesity.” – Prof Pamela Naidoo

WHAT’S THE SOLUTION? More South Africans need to be educated about the risks of unhealthy lifestyles and being overweight, says registered dietician and physiologist for the HSFSA, Gabriel Eksteen. “If the public does not believe that they need to eat healthier and exercise more, any strategies that address these issues will be unsuccessful,” he says. The Department of Health’s goals in this regard include increased physical activity by 10%, reduced consumption of alcohol by 20%, and reduced percentage of people who are obese and/or overweight by 10% by 2020. The reality is there is no simple solution to globesity. It’s a complex crisis that needs a multifaceted approach. This is true of battling obesity as an individual too. While it is preventable, obesity is neither easily avoided nor easily overcome by many obese patients. The mainstay for treating obesity is reduced intake and increased physical activity. But, says Fourie, for some obese patients this is not sustainable. “By the time obese patients consult us, they’ve often tried several solutions. They might even have succeeded for a while,” she says. “But, particularly because the causes of obesity are multiple, the mismatch between intake and output is a pathology, which makes treating obesity without help from healthcare practitioners difficult for individuals.” There are prescription and non-prescription medicines available for weight loss, but they have side-effects and are not suitable for all people. It’s advisable to get professional advice before taking them. Obesity or bariatric surgery can also help obese people to lose weight by changing the way the body digests and absorbs food. Patients without weight-related complications whose BMI is greater than 40, and those with a BMI of between 35 and 40 and weight-related complications including diabetes, hypertension, raised cholesterol, sleep apnoea and polycystic ovarian syndrome, are candidates for surgery, says endocrinologist Dr Wayne May. “Ideally, patients (contemplating surgery) should have tried to lose weight before by following an appropriate diet and exercising,” he says. “Surgery shouldn’t be their first option. It is a big investment that is not covered by all medical aids, and often only by higher plans, and patients need to be well prepared. This preparation needs to involve a team comprising an endocrinologist, dietician, psychiatrist/psychologist, biokineticist, and eventually a surgeon.”

PREPPING FOR SURGERY

The ideal candidates for obesity surgery and the ones who do the best following surgery are the ones who are the best informed, says dietician Gina Fourie of Consultant Dieticians, Cape Town. “When patients do their own research, it indicates a good level of motivation, autonomy and selfefﬁcacy, which are good characteristics for long-term success,” she says. “Of course, they are not immune to misinformation, but it is encouraging to see patients being proactive. They generally ask more questions, become well-informed and highly motivated, and end up with realistic expectations.”

H E A L T H Y T I M E S l 43

Natural

ALTERNATIVE HEALTH

COMPLICATION Consumers opting for complementary and alternative medicines and supplements are spoilt for choice, writes Caryn Gootkin, but how can they be sure that what they’re buying is safe?

omplementary and alternative medicines (CAMs) are regulated in terms of the General Regulations to the Medicines Act. “Certain classes of complementary medicines have been called up for registration purposes,” explains Neil Kirby, a director of Werksmans Attorneys. “However, proposed amendments to the General Regulations will change the definition of complementary medicines, introducing formal regulation over so-called health supplements. It’s not certain when this will come into force. “To complicate matters further, we are currently between two regulatory regimes. The Medicines Control Council (MCC) will become the South African Health Products Regulatory Authority in due course.” To date, however, not one CAMs product has been registered under these regulations. “Registering their products with the MCC often isn’t an option for the makers of CAMs, not only due to capacity constraints at the MCC, but also because these products are considered food supplements in many first-world countries,” says Wayne Robinson, director of scientific and regulatory affairs at the Health Products Association of South Africa (HPA). “So, currently, all CAMs products must contain the MCC disclaimer: ‘This medicine has not been evaluated by the Medicines Control Council. This medicine is not intended to diagnose, treat, cure or prevent any disease.’” The HPA, a non-profit organisation representing the interests of South Africa’s natural health products, nutritional dietary supplements and CAMs industry, has worked for 30 years to establish an ethical, credible, relevant and vibrant local health products industry, says Robinson. It develops and maintains standards that ensure the quality, safety and efficacy of CAMs and health products, and engages extensively with the MCC on legislative and regulatory issues. “Over recent years, member companies have worked towards responsible manufacturing that adheres to a specific set of processes, safety procedures, packaging and labelling standards,” he states.

“The HPA also has guidelines about claims, to ensure that labels are truthful, and actual supplement contents match the contents on the Supplement Facts label and are not misleading in any way. A further safety control is that CAMs products are subjected to safety and quality evaluation criteria depending on the ingredients and product composition.” In the absence of MCC registration, the HPA recommends that consumers go through a checklist (see box) when buying products. And, while consumers of CAMs do not yet enjoy the specific rights contained in the Medicines Act, Kirby advises: “CAMs are ‘goods’ for the purposes of the Consumer Protection Act (CPA). If goods do not meet the standards of quality and, potentially, efficacy, a consumer has rights in terms of the CPA.”

THE HPA’S CONSUMER CHECKLIST: • Check on www.hpasa.co.za whether the company is a member of the HPA. All members have to comply with a set of ethical criteria. • Research the company’s product on its website. • Check the label for the product ingredient list. “The quality of the raw materials will determine the quality of the final product,” says Robinson. • Look for the expiration date, as supplements can lose potency over time. • Store the product in accordance with its storage requirements. • Avoid marketing hype. The HPA’s marketing code guidelines don’t permit claims that products cure or prevent disease (because no premarket testing is done).

NATURAL MEANS SAFE. RIGHT?

Wrong! Like manufactured products, natural products can be toxic. Yes, honey may be completely natural, but so is oleander and hemlock. Natural products are not necessarily healthy or safe.

H E A L T H Y T I M E S l 45

PERSONAL CARE Good for the environment and good for you body wash, liquid soap, shampoo/conditioner, hand and body lotion, air freshner, deodorant, toothpaste, bath soak, muscle rub, bath salts

CLEANERS Cleaning with nature dishwash, auto dishwash gel all purpose, toilet bowl cleaner, and degreaser, window cleaner fruit and veg wash, fabric softner laundry powder/liquid, dustbin and odour, pet stain, carpet, kitchen cleaner, ďŹ&#x201A;oor and tile cleaner drain cleaner, septic tank

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supermarkets

ADVERTORIAL

THE POWER OF

probiotics

e’ve come a long way in our understanding of gut health since the days when the only thing probiotics were used for were to offset the side-effects of taking antibiotics. Today scientists are calling the digestive tract the “second brain”, because of links they have found between digestion, mood, health and even the way you think. This “second brain” is actually the enteric nervous system (ENS) – two thin layers of more than 100 million nerve cells that line your gastro-intestinal tract from oesophagus to rectum. It’s not exactly capable of thought, but it does communicate backwards and forwards with your actual brain. This new understanding of the gut-brain connection helps to explain the effectiveness of antidepressants in the treatment of irritable bowel syndrome (IBS), and mindbody therapies such as cognitive behavioural therapy (CBT) and medical hypnotherapy. Because of the connection between the brain and the gut, therapies that help the one might help the other. So, probiotics are now being used in a variety of ways to improve gut health. When you lose “good” bacteria in your body (after you take antibiotics, for example), probiotics can help to replace them – which helps to keep your body in balance and working the way it should, benefiting both your digestive health and general immunity.

Other health benefits of probiotics include: • Protection against viruses, parasites, toxins and infections; • Optimum absorption of vitamin B12, and minerals such as iron and magnesium; • Assisting production of vitamin K2 and healthy enzymes; • Boosting immune function, gastric secretion and bile creation; and • Modulating inflammatory response.

When you lose “good” bacteria in your body (after you take antibiotics, for example), probiotics can help to replace them. There are natural ways of ingesting probiotics: adding sour foods such as apple cider vinegar and fermented vegetables to your diet can aid in balancing gut bacteria, as can organic probiotic yoghurt. Many people prefer to take a supplement, however. Probiotic supplements containing strain diversity (10 to 30 different strains) and a high CFU (colony forming units) count (15-100 billion) are sought after, as they cover a larger area of issues consumers might want to address.

With so many probiotic products on the shelf, it can be difficult to know which are good and which aren’t. It’s here that the Health Products Association of South Africa (HPA) is working as an industry body – a kind of watchdog behind the scenes. Companies that belong to the HPA are considered to be ethical, and are governed by rules and guidelines that support and foster natural health product quality, safety and efficacy, so consumers who purchase products from HPA members can be sure that companies are reputable and legitimate. “Our members’ products are usually preventive, not curative,” emphasises the HPA’s Deirdre Allen. “They are there to enhance and support wellbeing, not to cure diseases. That will require an intervention with allopathic medicine, most of the time. “We also can’t certify individual products; rather, the companies join the association and agree to abide by the guidelines. Consumers can find a list of our members on our website if they want to check out the manufacturer of a particular product.” Contact: Website: www.hpasa.co.za, Email: hpasa@hpasa.co.za

H E A L T H Y T I M E S l 47

healthy teeth

BriDge the gap

Dental implants have changed the way teeth are repaired and replaced, writes Mandy Collins

owever well you look after your teeth, you could find yourself in a situation where you’re missing one or two – or even more. Even if tooth decay or gum disease isn’t the cause, an injury sustained during sport or a car accident, for example, could see you sporting a toothless, rather than a toothy grin. Fortunately, these days, there is the option of having dental implants, which are titanium screws inserted into your jawbone to act as a replacement for a tooth root. These screws, says Sandton prosthodontist Dr Emile Cahi, can support crowns, bridges or dentures, which replace the missing teeth. For those who remember their grandparents having a small bowl of water at their bedside for their full rack of false teeth, this is very good news, because even if you do need dentures, crowns or bridges, implants make it possible to have a very natural look – and your teeth stay put in your mouth. But they also have other benefits, says Cahi. “Implants help to maintain bone levels, which in turn maintain gum support and facial tissues (cheeks and lips). By either supporting fixed teeth or a removable denture, they help to prevent the “sunken” or aged appearance. Implants prevent one from damaging healthy teeth that would have to be cut down to replace a missing tooth, as would be the case for a bridge. In other words, although implant dentistry involves surgery, it is often the more conservative treatment.” Cahi says there are many factors that affect the success of an implant. These may include bone quality and quantity, patient compliance and general health. Your starting point is finding a good prosthodontist, who will do a thorough assessment of your teeth and the underlying structures, and inform you whether implants are a realistic treatment option. As with any medical or dental treatment, not everyone may be a good candidate for implants, which is why a proper assessment is vital. “This is a complicated issue, but several factors appear to be

linked with poor success,” says Cahi. “These may include poor patient compliance (poor oral hygiene), alcohol and smoking, and some medical conditions.” If your prosthodontist has recommended implants as a good option for you, you are looking at a three to six-month process, says Cahi. “Implants need to be placed in the correct position to get the best result. Prosthodontists will assist the surgeon by constructing a surgical guide for the placement of an implant. “Once the implant has been placed, it may be immediately restored or it may be closed under the gum to heal in the bone, and then exposed three to six months later. This depends on the quality of bone and other surgical factors.” Once that is complete, the dental work can begin. Patients considering implants should discuss the costs with their prosthodontist beforehand – medical aids might contribute towards the cost of implant dentistry, but usually the majority of the cost is carried by the patient.”

Fast Facts about implants

• Dental implants have been traced back to around 600aD, when tooth-like pieces of shell were hammered into the jaw of a mayan woman. • teeth restored with dental implants can’t get cavities! But you do still need to care for them in the same way as you treat your natural teeth – daily brushing and flossing are essential. Source: American Academy of Implant Dentistry

h e a l t h y t i m e s l 49

HEALTHY HOLIDAYS

A growing number of South African travellers are swapping the traditional ‘sunbathing and sipping cocktails’ style of escape for detox retreats and green smoothies, writes Subashni Govender

Relax…

AND TAKE A HIKE

ellness tourism is booming, and experts say they have noticed an increase in travellers opting for more heath-focused getaways. Sedentary lifestyles and rising stress levels are forcing holidaymakers to shape up by enrolling in yoga retreats, foreign bootcamps and mountain-climbing expeditions, among others. Now it’s as much about the activities on holiday as it is about the destination. So, for example, fitness fans can choose from options such as hike, bike and kayak experiences in Vietnam or an adventure through Peru’s Machu Picchu and the Amazon, or even a cycling tour through picturesque Tuscany. “We have a lot of travellers executing the Kilimanjaro hike, followed by a post-hike relaxation holiday in Zanzibar,” says Sianna Book, marketing project manager at Pentravel. “The boost of feel-good endorphins, plus fresh air and excitement, ensure we quickly destress and forget about work-life pressures,” adds Flight Centre spokesperson Kate Kenny, recommending skiing, remote trekking, waterfall-jumping, abseiling and canyoning as a few alternatives to the regular beach and poolside vacations.

“The boost of feel-good endorphins, plus fresh air and excitement, ensure we quickly destress and forget about worklife pressures.” – Kate Kenny, Flight Centre

The growth of “wellness culture” has been fuelled by a growing number of health-conscious consumers who opt to incorporate their healthy lifestyles into their holiday. “The rise in health conditions such as diabetes, hypertension and cardiac disease has prompted more people to turn to healthy lifestyles,” notes Mark Lowenstein, owner of Fit Gym at Protea Wanderers, Johannesburg. “In addition, fitness trackers and smartwatches have been hot holiday gifts among clients, and they are now becoming even more conscious of their activity when on holiday.” As a bonus, healthy eating habits are carried through while on holiday, with clients adhering to their diets, and some ditching the booze for healthier alternatives, Lowenstein suggests. “Gone are the days when people return from a holiday feeling sluggish, having packed on a few extra kilograms.” Experts say yoga, dance classes and meditation feature high on the list of “must try” healthy holiday activities. Founder of Smiling Soul Creations, Brett Shuttleworth, who hosts holistic retreats in exotic locations throughout the world, says there is a growing trend, particularly among corporate women, to look to prioritise health and wellbeing in their spare time. “More and more people are realising that a holistic approach to wellbeing is the cornerstone to being effective in all areas of life. They have identified that relaxed, focused and clear-minded individuals can be better colleagues, partners and parents,” says Shuttleworth. Taking time out to detach from the day-to-day chaos of tasks, errands and responsibilities is essential to enjoying life, connecting to one’s heart, and tapping into what really makes one’s soul smile. “People are seeking purpose, fun and fulfilment, and the best kind of holidays offer an opportunity to discover just that,” he says. H E A L T H Y T I M E S l 51

HEALTH TECHNOLOGY

FIT OR

There’s conﬂicting evidence about the usefulness of ﬁtness trackers, says Adam Oxford, but don’t abandon yours just yet

hile the 20th Century vanishes in the rear-view mirror of our semiautonomous electric cars, and we hurtle into the high-tech, augmented world of the future, it’s important to remember the golden rule of progress: technology can only ever amplify human will, expertise and behaviour. It can’t replace it. Nowhere is this maxim truer than in the world of smart fitness bands. These tiny watchlike straps that combine heart-rate and motion sensors have been incredibly popular. In the most comprehensive study to date, involving 20 000 people in 16 countries, market research institute GfK found that 51% of people had tried wearing one, and 33% continued to do so. Not bad, considering fitness bands are only about 10 years old. Those numbers hide a lot of contradictory research, though, which suggests the jury is still out on whether or not fitness trackers are useful or desirable. On any given day, fitness bands are either in the front line of the fight against global obesity (CNN, June 2014) or they’re an irrelevance which nine out of 10 people stop using within a year (The Lancet Diabetes & Endocrinology, October 2016). There are even some studies that show people using fitness trackers lost less weight over time than those who didn’t use them (Journal of the American Medical Association, September 2016). There’s also a lot of evidence that many fitness trackers are gathering dust, rather than counting steps. According to the study in The Lancet, two-fifths of people stopped wearing a tracker within six months, even while being paid to keep it on. Does that mean fitness bands are useless? Not quite. 52 l H E A L T H Y T I M E S

LEAN CORPORATES

The companies that make fitness trackers haven’t fared well, though. One of the biggest names in the business, Jawbone, recently went into liquidation. Fitbit has seen 90% of its 2015 share value disappear. But none of this means the fitness-tracker story is over. Analysts at IDC reckon that although growth in the market for bands has slowed, the market will carry on growing and will be fuelled by better bands at cheaper prices. Xiaomi, for example, overtook Fitbit as the largest supplier of wearables, because its products, such as the Mi Band, are very keenly priced. One reason why many bands get abandoned, thinks Elan Lohmann, founder of exercise community Sleekgeek, is that early designs were cumbersome to use. They didn’t feature built-in displays, or overloaded owners with information. “Some devices track different things, but it gets complicated,” Lohmann says. “For the most part, people don’t want the bells and whistles; they just want to count steps.” Cynthia Herdman-Grant is the business development manager for Fitbit’s South African distributor, Core Technology. She says sales of Fitbits are growing sustainably here, in part thanks to many customers upgrading to newer models. Manufacturers are constantly refining designs to reduce the issues that see owners abandoning them, she adds. “If people stop using one of our fitness bands, it is most likely a function of them abandoning their exercise regime,” Herdman-Grant says, “not unlike the drop in gym attendance after the usual surge in memberships after the holiday season in January.” And that seems to be a fair analogy. Like a gym membership, fitness trackers can help to motivate and amplify our desire to live more healthily, but they’re just a tool, not a miracle cure.

GETTING RESULTS HOW DO YOU GET THE MOST FROM A FITNESS TRACKER? Sweat the small stuff

Sleekgeek’s Lohmann says the simplest functions are likely the most accurate. Calorie counters and sleep monitors are fun, but setting a daily step target can improve health.

Be social

Gamiﬁcation, like ﬁtness trackers, can work. Many people like to show off their achievements and are motivated by others, Lohmann says. One group within his community posts regularly with skipping scores.

Be active

Steps alone don’t seem to beneﬁt health hugely. Dr Eric Finkelstein, lead author of the report published in The Lancet, suggests differentiating between steps and “active steps”, such as brisk walking or more rigorous exercise.

Images: Fitbit and Shutterstock

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