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THE CARIBBEAN HEALTH DIGEST APR JUN 2012
| ISSUE 17
PHYSIOTHERAPY AN INTEGRAL PART OF THE HEALING PROCESS DYSLEXIA. RECOGNIZING THIS DISORDER AND FINDING TREATMENT OPTIONS
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GENETICALLY MODIFIED FOOD. IS IT MORE THAN A JUST MERGER OF HUMAN BRILLIANCE AND TECHNOLOGY?
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POMMECYTHERE. MAKES THE BEST CHOW BUT ALSO PACKED WITH GOODNESS 26 uhealthdigest.com
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U The Caribbean Health Digest is published 4 times a year by Eidetic Publishing, Gaston Court, Gaston Street, Lange Park, Chaguanas, Trinidad & Tobago. Distribution is handled by Eidetic Limited.
Entire contents are copyright. Reproduction in part or whole is prohibited. Eidetic Publishing is in no way affiliated with companies or products covered in U. Produced and printed in Trinidad & Tobago.
APR JUN 2012 • VOL. 1 NO. 4
10 Dyslexia
Far from being less intelligent, dyslexics are as bright as, or far brighter than, most of us; it’s just that when it comes to reading, their wires are a little crossed. Discover what a dyslexic person sees on the printed page, and learn more about what causes the condition and how it can be treated.
14 Genetically Modified Food
Frankenstein’s dinner, or safe to eat? Sure, genetically modified crops are more pest-resistant, have a longer shelf-life, and could well hold the key to the global food crisis. But are these designer crops really safe to eat? And if they are, shouldn’t we be told what we’re eating?
18 Physiotherapy
There’s more to physiotherapy than a simple “rub-down”. Find out why physiotherapy is the science of healing and the art of caring.
23 Sleep Apnoea
Do you sound like a freight train rumbling through a tunnel the moment you fall asleep? It’s not just annoying for your bed-mate. Sleep apnoea is a dangerous condition that can lead to high blood pressure, depression, heart disease and more.
26 Pommecythere
You can’t call yourself a West Indian if you’ve never settled down on the front steps with a bowl of red-hot pommecythere chow. This tangy and versatile fruit does more than assault your salivary glands; it’s packed with fibre and vitamins and can even help heal what ails you.
29 Open Heart Surgery
Relax: it only sounds scary. Knowing these 10 facts about open heart surgery can raise your understanding and calm your fears. This intervention is proven, safe, tried and true, and can add years to the lives of cardiac patients.
38 Zumba
Bored with the same old one-two-shuffle-shuffle-turn? This blazing hot Latin-infused exercise craze may just be the solution to your exercise blahs. What are you waiting for? Read this article, then get up and get moving!
42 Raising Healthy Eaters
Raising kids to make healthy eating choices over their lifetimes means more than threatening them with no TV if they don’t clean their plates. In order to teach them to eat right, you have to feed them right. Here’s how.
44 Milk...it Does Your Body Good
The celebrities we see splashed across magazine pages sporting milk moustaches have a point. Milk doesn’t only taste good, it’s good for you. But there are so many varieties of milk on the market (pasteurised, homogenized, reconstituted) that it can be tough to tell the difference. This article will tell you what you need to know.
46 Do Your Kids
Really Need Their Shots? Parents in the US are clamouring for their right NOT to have their kids immunised... but is that what’s best for the children? Paediatrician Dr. David Bratt says no. This eye-opening article will tell you why.
50 Healing With Horses
The soothing sway of a horse can calm the soul and bring out the best in children with disabilities such as autism, Down syndrome and cerebral palsy. Find out how these huge, gentle beasts can become a therapist’s—and a disabled child’s—best friend.
All issues of U The Caribbean Health Digest are special to us in one way or the other, some a little more than others. Since this issue marks our 4th anniversary (yes, four very long and enjoyable years) we feel compelled to brag a little. After four years, seventeen issues, one hundred and seventy five articles we are happy to say that we have touched some lives. We can’t help but reflect on what our initial goals were when we launched in 2008; we simply wanted to educate and inform people on health and wellness issues that were close to them and their families. And though we feel we have made a small difference, there is still so much we would like to do that would enable to our readers to enhance their quality of life. Our commitment to increase our readership by exploring new regional and international territories is only but one small step among the many that we have planned for the immediate future. Our U Health and Wellness Exposition 2012 was a resounding success, as you will see from the highlights inside. Plans are already underway for Expo 2013, an event that will be open to the regional and international markets. Look out for updates in future issues of U. Without a doubt there is something in this issue for each of you. Our feature article focuses on Physiotherapy and the importance of it as part of the rehabilitative process. Dr. Amanda Jones really opens our eyes to the truth behind genetically modified foods and one of our other favorites, Dyslexia - gift or impediment was written by Mezaan Beljic. There is much, much more for you to enjoy. It is always a pleasure to share our thoughts and ideas with you, our dear readers. Stay healthy, and God bless until next time!
SHERINE & STUART
FOUNDING EDITORS
DISORDER
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DYSL E X IA
WHAT DO GEORGE WASHINGTON, PABLO PICASSO, STEVE JOBS AND WINSTON CHURCHILL HAVE IN COMMON? HOW ABOUT
HOW ABOUT TOM CRUISE, ABHISHEK BACHCHAN, SALMA HAYEK AND MUHAMMAD ALI? INTERESTINGLY, THEY WERE ALL DIAGNOSED WITH THE LEARNING DISABILITY KNOWN AS DYSLEXIA.
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WRITTEN BY MEZAAN
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BELJIC
Even inventors Albert Einstein, Alexander Graham Bell and Thomas Edison were said to have struggled with this reading disorder. You’ll notice this famous group of dyslexics represents a variety of backgrounds and talents, a testimony to the fact that although dyslexia can range from a mild reading impairment to complete illiteracy, the disorder commonly occurs in those with normal or high intelligence.
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WHAT IS DYSLEXIA?
SYMPTOMS OF DYSLEXIA?
According to the U. S. National Institute of Neurological Disorders and Stroke (NINDS), dyslexia is a “brain-based type of learning disability that specifically impairs a person’s ability to read.” It is also called specific reading disability. Children with dyslexia struggle with spelling and the phonetic processing of letters and words. Difficulty sounding out particular letters leads to difficulty connecting those sounds and blending them into words. Letters within words may get mixed up, out of order, or blend incorrectly.
Delays in speech/talking, learning new words, and rhyming are some of the earliest signs of dyslexia as cited by the Mayo Clinic. The preschooler may have difficulty staying focused and may write letters or words reversed.
SEE HOW QUICKLY YOU CAN READ THE FOLLOWING SENTENCES: Hes aw his bal land batin thega rage. Hesawhisballandbatinthegarage. Wurdz ma be spelld xatle az tha snd. Not so easy, is it? I suspect you needed a few more seconds than usual to read the first line. To a child with dyslexia, the words within a sentence may appear incorrectly spaced, regardless of syllables. The letters may appear all together and they might spell words exactly as they sound. Furthermore, despite normal vision and normal intelligence, some dyslexic children may see letters or words in reverse (“b” for “d” or “was” for “saw”) or more commonly, they will substitute similar-appearing but unrelated words for the ones intended (ball/bell, land/hand). Now try to read the sentence, “He saw his ball and bat in the garage” replacing “saw” with “was” or “ball” w with “dall” Clearly, one’s ability to read sensibly would be im impaired by such reversals or mirroring.
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Dy Dyslexia can vary widely from one individual to another. A child may have one of the characteristics noted above or all of them. The degree of each individual symptom may vary as well. Someti Sometimes children also have difficulty comprehending rapid audit auditory instructions, following more than one command ommand at a time, and recalling the sequence of things.. Dyslexic childr children may have difficulty le lear earn ear ning a foreign language. angu learning Learning to read the English lang la guage is particularly ularly challenging given its complex language el ng sys spelling system.
Once the child enters school, it may become apparent he/she is reading significantly below the age-appropriate level of their peers. Difficulties with auditory short-term memory, comprehending rapid instructions, and remembering sequences may emerge. When reading and writing, the child might omit or add letters or words. Poor spelling of basic sight words is cause for concern early on. The teacher may notice that the child has difficulty staying focused. A diagnosis of attention deficit disorder/ attention deficit hyperactivity disorder may be entertained as children with dyslexia are at increased risk for ADD/ADHD. Although the dyslexic child has difficulty with reading, spelling, writing and paying attention, the astute teacher will also notice that the child meets or exceeds expectations in other areas (such as math, science, the arts, and sports) thereby supporting normal intelligence. Children with dyslexia are likely to exhibit low self-esteem, anger, frustration and/or sadness. They may resent lagging behind their peers, being assigned to a special reading group or requiring a special tutor. The child may behave aggressively or withdraw socially over time, especially if the disorder is not recognized and addressed early on.
WHAT CAUSES DYSLEXIA? According to the Dyslexia Association of Trinidad and Tobago (www.dyslexiatt.org) and several other international sources, dyslexia is estimated to affect ten percent of the world’s population. It is thought to be primarily inherited and more often occurs in males. Several recent research studies have identified specific genes associated with developing dyslexia. Biological differences in areas of the brains of children with learning
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disabilities such as dyslexia have been identified and continue to be studied. Generally, unless dyslexia goes unrecognized and untreated into adulthood, the disorder in adults “usually occurs after a brain injury or in the context of dementia” (NINDS).
DIAGNOSIS & TREATMENT STRATEGIES The diagnosis of dyslexia begins with keen observation by concerned parents and teachers. Once those concerns are relayed to the child’s pediatrician, a thorough family, medical, and personal developmental history will be obtained. The doctor or specialist may request that teachers or family members answer questionnaires. The child may undergo neurological tests such as a functional MRI or PET scan to look for organic causes of their learning disability. Vision and hearing tests are also necessary to ascertain whether there are any underlying or contributing sensory problems. A battery of academic and psychological tests will ensue prior to making a final diagnosis of dyslexia. There is no cure for dyslexia, but, fortunately, the majority of children with dyslexia can learn to read with specialized teaching as well as psychosocial and emotional support. Early diagnosis and intervention while language centers in the brain are still developing is crucial to minimizing long-term effects of dyslexia. Reading aloud to children from early infancy on is strongly recommended and beneficial for all. As they age, reading the same stories together may alert parents to the possibility of a learning disability at its earliest manifestation. In the United States, schools are legally obligated to provide a strategic, tailored education to children with dyslexia in order for them to learn. Educational seminars have emerged to train teachers to recognize the disorder early on, refer and intervene accordingly. A variety of teaching strategies can be implemented to help children remember sounds. Techniques involving several senses such as hearing, vision and touch may be used to help with phonetic processing, recall, spelling, writing and reading. A reading and disability specialist can spend extra time tutoring the child. Initially, students may not like having to
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get special attention, but with such, there is no stopping them from excelling in life. Providing plenty of activities that do not involve reading will help preserve the child’s self esteem. Again, the key to a good prognosis is early detection and early intervention. As children with dyslexia age and begin to take tests, it is important that teachers give them extra time to finish and show their work. Dyslexic children may wish to tape record classroom lessons (versus taking notes) to help cope with their reading disability and keep up with their lessons and peers. Technology, including computers or audio books, can be used to help children listen to books read out loud. Also, voice dictation systems with context sensitive spell checkers can be used for composition.
SO WHAT’S THE PROGNOSIS? This really depends on the severity and variety of dyslexic symptoms. Recognizing the characteristics of dyslexia and intervening with individualized, appropriate teaching methods in the preschool stage is imperative to preventing long-term struggles. During my research for this article, I came across several websites created by persons diagnosed with dyslexia. They suggest that the disorder is a gift rather than a disability. It is, they declare, not a disability of learning but rather, a disability of teaching. Some proclaim that the current educational system is geared toward teaching the majority “norm” and conventional teaching methods are the real impediment, not the disorder itself. Imagine the ridicule and anxiety a dyslexic child must experience as they are asked to read aloud or to write or spell a sentence on the blackboard in front of their peers. Being labeled “slow,” “lazy,” “stupid” or “hyper” by their peers or even teachers is an adversity frequently reported by dyslexics, including the famous, highly intelligent ones initially listed. But clearly, whether their giftedness is compensatory or intrinsic, if given extra time, effort, and support, being dyslexicc does not ha have to be an impediment!
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FOOD
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GENETICALLY MODIFIE D FOOD
GE N E T I CA LLY M O D I F I E D FO O D
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GENETICALLY
MODIFIED
FOOD Should genetically modified food be labelled? That’s a question the Just Label It activists of Vermont, California and 16 other US states hope legislators will answer with a “Yes!” very soon. WRITTEN BY DR.
AMANDA JONES
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Here in the Caribbean, if asked for an opinion on genetically modified (GM) food labelling, most of us would frown, take a deep breath - then confess we don’t know enough about GM foods to really say.
Now consider that we’ve all been eating unlabelled genetically modified foods since the late nineties. These foods are generally unlabelled in the United States. So do we really need to worry? After all, soy protein, soy sauce, high fructose corn syrup (often labelled as corn syrup) find their way into almost all our processed foods. Sausages, burgers and deli meats often include soy or corn by-products. Think, too, about the widespread use of soy and corn oil in margarines, pastries, cookies, snacks and sauces! Today, 93% of soy and 86% of corn produced in the US are from genetically modified crops.
COULD GM FOOD JUST BE A MERGER OF HUMAN BRILLIANCE AND TECHNOLOGY? Such a relaxed and optimistic perspective is not shared by consumers around the globe. The European Union updated its labelling law in 2003, requiring foods with more than 0.9% GM ingredients to be labelled. This year Hungary destroyed 1000 acres of GM corn. GM seeds are in fact illegal in Hungary! Similarly, France is seeking to have the European Union ban the only authorized GM crop in Europe, MON810, a modified variety of corn. The 2010 Eurobarometer poll shows that 65% of Europeans are not in favour of the continued development of GM foods. Some surveys tell us 87% of Americans want GM foods labelled. Sentiment against GM foods is also strong in nations as diverse as Peru, Japan and Germany.
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Is the distrust mere paranoia and fear of change - or is it founded on solid ground?
Often, lack of understanding of the GM issue is fuelled by a sense that it’s all too complex for the average person to understand. So let’s simplify things, because any issue that affects our health and the ecology of our planet needs to be very clear.
HERE ARE THREE KEY THINGS WE NEED TO KNOW ABOUT GM FOOD: 1) GM foods or organisms are created when genetic material from one species (such as a bacterium) is inserted into another species (often a seed) to create new properties in the receiving species. The industry has used this technology in an attempt to create superior crops. Drought resistance, pest resistance, longer shelf lives, etc., are sought in the laboratory. 2) The GM industry has been able to get their foods classified in the US as GRAS or Generally Recognized as Safe. They’ve also secured legislation which allows their scientists to decide whether their products are safe or not, relieving the FDA of the responsibility to investigate new GM food products independently. 3) When a gene is experimentally inserted into a new species, scientists eventually get the effect they are looking for. However, other random and unpredictable changes to the original species have been known to occur. The argument of the GM food industry is that the changes are minor, insignificant and have no impact on health, thus the new food can be classified as GRAS, Generally Recognized as Safe. They argue, too, that with climate change and the expected strain on the planet’s resources, GM bio-technology will better enable us to feed the world’s population. Yet experts from outside the world of GM bio-technology have raised several alarms. They protest that the research coming from the world of GM bio-technology has not been peer reviewed by independent scientists. Moreover, leaked internal documents show that the industry is fully aware of health risks which have emerged from initial animal studies, but deliberately masks or hides them.
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Such research, as well as some independent studies, is presented very convincingly in Genetic Roulette, The Documented Health Risks of Genetically Engineered Foods by Jeffrey M. Smith. This book is written in such a way that the non-scientist can understand it. Yet it’s full of facts and reliable references. The academic credentials of the scientists and authorities often quoted in Genetic Roulette are presented in the appendix. This is critical, as their position is sometimes at odds with that of various regulatory bodies. None other than Michael Meacher, former UK Government Environmental Minister, writes in the forword to Genetic Roulette, “The case presented is absolutely a smoking shotgun that should stop in its tracks any dabbling with GM foods, whether by individual families, food companies or indeed nations.” Many experts are also alarmed by the potentially irreversible damage already sustained to the environment, small scale agriculture and organic crop development. They point out that the benefits that the GM industry claimed would result from introduction of its products have never materialized. Indeed, dairy farmers in the US were made to feel that their businesses would cease to be competitive if they did not adopt BGH or bovine growth hormone to boost milk production. (BGH is sometimes also known as BST). Instead, the cost of dairy farming and the amount of antibiotics administered to cows has taken a leap, as cows experience side effects like infected udders and reduced fertility! So the Just Label It movement in the US States of Vermont, California and others was born of concerns about health, the environment, and ethics. Championing “the right to know what we are eating,” is a rallying cry of the movement. If California succeeds in passing this legislation, then the impact is likely to be felt throughout the United States and naturally, here in the neighbouring Caribbean.
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On March 12th 2012 the UK’s The Guardian put it like this: “If approved by voters, the California proposition would have a national ripple effect, just as the state's air rules have influenced the cars that get made in Detroit. The sheer size of the California market likely would prevent most food companies from segmenting products sold in the Golden State from those sold elsewhere; food producers would probably have to put the labels on all their products sold nationwide.” Nonetheless, while a 2003 poll showed that more than 90% of Americans want GM foods labelled, only 54% said the labels would affect their buying decisions. However, labelling paves the way for health researchers to be able to trace the effects of this great food experiment in much the same way they do with other additives when health concerns are raised. Opponents of the GM bio-tech industry hope that labelling will be the first stage in an outright ban of the progress and presence of all or most GM foods and organisms. In the US, supporters of the industry argue that labelling is unnecessary on the grounds that GM foods are safe. They warn that food manufacturers will be forced to find new sources for ingredients, turning agriculture and the food industry upside down. All costs, they argue, will be passed onto the consumers. As usual, health, economics, agriculture and public policy are all knotted together. Which perspective will win over the lawmakers? Follow The Just Label It campaign on Facebook to find out. Back home in the Caribbean, your local politicians, farmers and grocers will only care about this issue as much as you do.
Further recommended reading: Seeds of Deception by Jeffrey M. Smith Dr. Amanda Jones, Wellness Educator www.organicconsumers.org
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FEATU RE
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PHYSI OT HE R A P Y
PHYSIOT THE SCIENCE OF HEALING, THE ART OF CARING. WRITTEN BY DR.
STACY DE GALE
so you are a physiotherapist! “Oh, Can I get a rub down?” Sound familiar? It should as this is a common phrase used by many persons when they encounter a physiotherapist. But physiotherapy is much more than a rub down…it is the science of healing and the art of caring.
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THERAPY 19 | u
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hysiotherapy/physical therapy, (which can be used interchangeably), can be traced as far back as 460 BC. Hippocrates and Hector of Ancient Greece are arguably considered to be the first known physical therapists, who used water and massage to heal. So it should bring a smile to one’s face to know that the oath my medical colleagues take, is actually the oath of the first named PT, Hippocrates! Ancient Chinese, Egyptian and Persian writings also noted the therapeutic value of the sun, water and exercise! So from ancient days, physical therapy existed in some form or fashion. But it made a true resurgence in England, where nurses, in 1894, formed the first physiotherapy association. And it still exists, that is, the Chartered Society of Physiotherapy. This was also the year when the United States of America experienced its first polio epidemic, which led to an interest in training of rehabilitation aides to help those with disabilities resulting from polio. The development of the profession in Trinidad and Tobago was first noted in an article written by I.D. Waterman, entitled “A Century of Services 1858 – 1958”. It stated that in 1935 an English-trained nurse, Miss Wolfe, was appointed as superintendent Sister of The Massage and Physiotherapy Department in Port of Spain General Hospital. In 1952 Mrs. Marjorie Lassalle (nee Callender) was the recipient of the first Physiotherapy Scholarship; in 1953 the first British-trained local Physiotherapist, Mrs. Ambah Wooding–Thomas, returned. These two women were pioneers of the profession in T&T. The outbreak of polio in Trinidad and Tobago in 1954 brought recognition to the profession, as the need for rehabilitation of polio patients became paramount. The public then began to appreciate the value of physical therapists as part of the medical team.
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Physical therapists are university-trained experts in restoring, maintaining and improving patients’ function and quality of life. This is done through assessment, diagnosis, treatment and rehabilitation
of diseases and disorders that affect the musculoskeletal (bone, muscle, tendons, ligaments), cardiopulmonary (heart and lungs), neurological (brain, spinal cord, nerves) and integumentary (skin) systems. PT’s are also actively involved in health promotion and injury-prevention activities. Physical therapists enter the profession with at least a Bachelor’s degree or equivalent. Many also receive their Master’s and doctoral degrees in Physical Therapy. Currently there are no schools for physical therapy in T&T. PTs here are trained mainly in programmes in Jamaica, the USA, Canada, England and Australia. However, whatever the place of training, PTs can ONLY practice if licensed with the Physiotherapists’ Board of Trinidad and Tobago, which is part of the Council of Professions Related to Medicine. The beauty of being a physical therapist is being able, through our training, to treat all health populations and individuals across their lifespan—from the newborn to the old woman celebrating her 106th birthday. Because of physical therapy, many persons are able to avoid many types of surgery, and avoid the long-term use of medications. We enable that young woman who received multiple injuries in her car accident to walk again and return to work. We help the child, who many thought would never be able to stand, to be able to take steps to his parents. We enable the footballer who severely damaged his knee to score a winning goal for his team. As a close friend of mine, a general surgeon said, “We (doctors) save lives, but physical therapists give quality of life.” And what would life be without that quality? What would life be without the ability to move, function and be pain free? Many a time, someone may come to a physical therapist, even medical persons, and say “I have some back pain. Give me an exercise sheet please.” The truth of the matter is, that there may be 10 persons standing in front of a PT, all with lower back pain, but on proper assessment and diagnosis, each person’s plan of care will be different, because each may have a different root cause of their pain. So
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though many claim to have the “cure” to get rid of pain, physical therapists get rid of your pain and dysfunction for longer, if not for good, by managing not just the symptom, but the cause. Because of our in-depth knowledge of anatomy, biomechanics, movement analysis and exercise science, we manage and care for each patient/client on an individual basis, as one size does not fit all. Physical therapists can be generalists, or, like their medical colleagues, specialise in specific areas. Some of these include sports, orthopaedics, geriatrics, paediatrics, women’s health, pain management, industrial ergonomics, and cardiopulmonary and neurological physical therapy. Again, due to extensive and intensive training, PTs are able to work in many settings, including hospitals, private offices, schools, industries, gyms, in homes, and rehabilitative units. Because of our wide knowledge base, the tools we use to manage clients are varied. Some of these include heat, cold, therapeutic exercise, electrical modalities (e.g. therapeutic ultrasound, electrical stimulation, laser), spinal and joint manipulations, dry needling (similar to, but not exactly acupuncture) and therapeutic massage. So physical therapy has truly evolved from the days of Hippocrates. To date, there are approximately 70 physical therapists licensed to practice in Trinidad and Tobago. This means that for every 19,000 citizens of T&T, there is only 1 physical therapist that can serve. In other words, there are just not enough! Many nationals are PTs but they may not return to T&T after training, or they gain experience and leave our shores. This may be due to poor recognition of the profession, lack of competitive remuneration, particularly in the public service, and poorly built, spaced and stocked physical therapy departments, again particularly in the public service. So there remain a few dedicated PTs in the county, and they must be commended for their tireless work against all odds.
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Still, there is a continuous struggle for recognition of the profession, and this is even more so in a so-called ‘third world nation”, despite provision of first world physical therapy. We now live in a world where there is a massive burden of non-communicable diseases (NCDs), such as diabetes, heart disease, obesity, cancer, smoke related diseases, all of which are priorities of the World Health Organization and the United Nations. The irony is that PTs already manage millions of persons worldwide to prevent and combat these conditions, but yet in many countries, including T&T, PTs are not involved in policy and planning phases to combat these burdens. As Dr. Marilyn Moffat, PT, DPT, PhD, DSc, FAPTA, CSCS and president of the World Confederation for Physical Therapy stated, “But their (PTs’) impact could be much more if there were wider acknowledgement of our contribution to keeping populations healthy and reducing health costs. We must be recognised as exercise experts across the lifespan. We must be the ones that ministers of health and governmental health agencies seek out for advice on exercise guidelines in the face of NCDs. And we must be at the forefront of pushing our societies to increase physical activity and exercise.” And, I dare add, we are and must continue to be the profession of choice in managing and advocating for those with any degree of disability, disease or injury. Physical Therapy is truly the science of healing and the art of caring, as this profession intricately weaves the science of restoring mobility and function and reducing pain with empathy, care, and the art of ensuring good quality of life.
Dr. de Gale is the Chair of the North America Caribbean Region of the World Confederation for Physical Therapy, Chairperson of the Physiotherapists’ Board of Trinidad and Tobago, Public Relations Officer of the Physiotherapy Association of Trinidad and Tobago, and is employed with the Petroleum Company of Trinidad and Tobago as a physical therapist.
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SLEEP APNOEA
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HOW S L E E P P R OB L E MS AFFE CT YO UR H E A LT H
How sleep problems CAN AFFECT YOUR HEALTH AND WELL-BEING SUBMITTED BY NORTH
ELEVEN
Imagine falling into a deep, restful sleep, your muscles relaxing as the cares of the day drift away—only to find that you begin snoring; your upper airway temporarily closes, causing you to stop breathing. Now imagine this happening every couple of minutes ALL NIGHT LONG. This is what the untreated sufferer has to live with. Approximately one in every five adults has Sleep Disordered Breathing (SDB). Potentially millions of people worldwide are affected by chronic sleep disorders and intermittent sleep problems that can significantly diminish health, alertness and safety. In addition to their societal consequences, untreated sleep disorders have been linked to hypertension, heart disease, stroke, depression, diabetes, obesity and other chronic diseases.
HOW SLE E P P RO B LE M S A F F E CT YO UR H E A LT H
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SLEEP APNOEA
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HOW S L E E P P R OB L E MS AFFE CT YO UR H E A LT H
Sleep problems can take several forms and can involve too little sleep, too much sleep or inadequate quality of sleep. This is not limited to middle-aged, overweight men—the condition is found in younger men, young and older women and in a smaller percentage of children as well. If you snore, you might have a common sleeping disorder called Sleep Apnoea, also known as Obstructive Sleep Apnoea (OSA). OSA is a sleep disorder that is caused by repetitive, short-duration blockages of the upper airway. This means your upper throat muscles temporarily relax too much during sleep, cutting off or restricting the airway while you sleep, causing you to stop breathing. These periods when your breathing stops (called apneoa) or a reduction in airflow (called hypopnea), can last from 10 seconds to a minute or longer.
The brain registers the lack of oxygen and the individual wakes up (called an arousal) just enough to open the throat and begin breathing again, starting the cycle over.
People with moderate or severe sleep apnea may be waking up hundreds of times every night without knowing it. Most of the time, you are unlikely to remember these episodes in the morning but they severely disrupt the restorative effects of sleep. Otherwise, you may be aware that you have restless sleep or that you wake up in the middle of the night for no apparent reason.
The most common symptom of OSA—excessive sleepiness (ES)—can negatively affect quality of life. Poor alertness due to lack of quality sleep can cause reduced concentration, decreased productivity at work or school, increased risk of occupational accidents, decreased daily functioning, and even motor vehicle accidents.
OSA has been observed since ancient times, and there are records of its symptoms, such as heavy snoring, dating back over 2,000 years.
Some studies suggest that driving while sleep-deprived can post the same risks as driving while intoxicated.
The consequences of sleep problems and sleep apnoea are diverse and in many cases are serious, yet the condition remains largely under-diagnosed. Compounding the problem is the fact that most people know when to seek medical help for physical discomfort such as fever or pain—but sleep problems are often overlooked or ignored. In fact, the overwhelming majority of people with sleep disorders are undiagnosed and untreated.
Signs & Symptoms Sleep problems and lack of sleep can affect everything from personal and work productivity to behavioral and relationship problems.
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Signs and symptoms of obstructive sleep apneoa include loud and frequent snoring, including choking or gasping during sleep, sleepiness or fatigue during the day, and difficulty concentrating.
OSA doesn’t just cause annoying tiredness; the untreated sleep apnoea patient is at greater risk of developing cardiovascular disease, leading to heart attack and stroke. They are at greater risk of metabolic syndrome, which can contribute to developing diabetes and obesity. There are many cases of depression, especially in women, that are in fact untreated sleep apnoea. Untreated sleep disorders can also cause or contribute to high blood pressure, early onset diabetes, nocturnal heart palpitations or arrhythmias (irregular heart beat), nocturia (awakening from sleep to pass urine), depression, daytime tiredness and lethargy, gastro-esophageal reflux, morning headaches, impotence, stunted growth in children, accelerated ageing in adults and cognitive dysfunction. Despite the worldwide prevalence, the condition remains largely under-diagnosed and undertreated, so North Eleven / Resmed applauds
HOW SLE E P P RO B LE M S A F F E CT YO UR H E A LT H
efforts to help raise awareness about OSA, which are very important to our efforts to help those who are suffering needlessly. Look out for an upcoming issue of U the Caribbean Health Digest, in which we will discuss sleep evaluations, sleep specialists, sleep studies and treating sleep problems. ResMed is dedicated to working with the Medical Community, Corporate Trinidad & Tobago, NGOs and Government Ministries to identify and treat sleep disorders and sleep apnea patients. We recognize that all are vital to effective patient care and play a critical role in the identification, diagnosis and management of sleep disorders in patients.
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SLEEP APNOEA
Ignorance is our biggest competitor. One out of five adults suffers from sleep apnoea
As a leading developer of medical equipment to diagnose, treat and manage sleep apnoea and sleep disordered breathing, our most critical challenge comes not from a competing company, but from the lack of awareness about the serious consequences of untreated sleep apnoea. Untreated sleep apnoea is a known cause of high blood pressure, and is strongly associated with heart disease, diabetes and obesity. Treating sleep apnoea has been shown to lower blood pressure, improve heart function and glucose control, and improve the symptoms of sleepiness and fatigue that sleep apnoea sufferers feel. ResMed, along with North Eleven in the Caribbean, is dedicated to educating physicians and the public about the health risks of untreated sleep apnoea and how to effectively diagnose and treat sleep apnoea sufferers. Our mission is to deliver the best therapy equipment on the market to help sleep apnoea sufferers enjoy better sleep, better health and a better quality of life.
www.resmed.com
www.northelevenlife.com
FRUIT
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PO MMECYTH E R E
P O M M E CY T H E RE
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FRUIT
ommecythere
Great taste and nutrition WRITTEN BY CAROL
combined.
QUASH
THE POMMECYTHERE OR GOLDEN APPLE IS KNOWN BY MANY DIFFERENT NAMES THROUGHOUT THE WORLD.
IN BERMUDA AND JAMAICA IT IS CALLED THE JUNE PLUM, WHILE IN COSTA RICA IT IS KNOWN AS THE JUPLON. VENEZUELANS CALL IT THE JOBO INDIO, WHILE BRAZILIANS REFER TO IT AS THE CAJA-MANGA. QUẢ CÓC IS THE NAME BY WHICH IT IS KNOW IN VIETNAM, AND IN INDONESIA IT IS CALLED THE KEDONDONG. BUT BY WHATEVER NAME IT IS KNOWN, THE TASTE AND NUTRITIONAL VALUE OF THE POMMECYTHERE REMAIN COMMON GLOBAL ELEMENTS OF THE FRUIT.
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FRUIT
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PO MMECYTH E R E
T
The pommecythere is a small, oblong fruit with a core that contains a mass of tough, indigestible, wooden fibers, which increases in size and density as it ripens, making it almost as difficult to eat as it is to spell. The skin is a very shiny green when unripe, and turns yellow when it ripens. A green pommecythere has a sour, acidic taste, which is enhanced by sprinkling a little salt on it. When it ripens, the flesh becomes soft, juicy, and has a taste similar to a pineapple. Here in the Caribbean the pommecythere is eaten either raw or cooked. Even as I write, my mouth waters at the thought of a bowl of pommecythere chow, made with green or half-ripe pommecytheres, marinated in a combination of bandania (chadon beni) leaves, garlic, hot pepper, black pepper and salt. And don’t talk about a nice helping of curried or masala pommecythere, either as a side dish with roti, or by itself ! And what about some phulorie heaped with pommecythere chutney? The fruit is also used to make preserves such as sweet or peppery red pommecythere and jam, and condiments such as anchar and kuchela. The pommecythere can also be compressed to make a refreshing and delicious juice—a #1 and #2 seller in Jamaica and Barbados respectively. According to fruitsinfo.com, the pommecythere is rich in vitamin C, with 41 mg of vitamin C present in every 100g of fruit. It also contains potassium, which is necessary for proper nerve function, muscle control and regulating blood pressure; carbohydrates, which provide the body with energy; and fibre, which is best known for its ability to relieve or prevent constipation, as well as lower the risk of diabetes and heart disease. The fruit is sodium-and cholesterol-free and contains just a trace of fat. The rich pectin content in its skin is among its most notable qualities. Pectin is a fibre found in fruits that is used as a thickening agent when cooking and baking. It is also used in the manufacturing of some adhesive dentures and for medicinal purposes.
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WebMd identifies the use of pectin as a good way of treating high cholesterol, high triglycerides, diabetes and gastroesophageal reflux disease (GERD), and as a preventative measure against colon and prostate cancer, and lead, strontium and other heavy metal poisoning. It also serves as a shield against bacteria when applied to raw or ulcerated mouth and throat sores.
The pommecythere is a native fruit of the South Pacific islands, and was introduced to the tropics in the late 1870s. It grows abundantly in the Caribbean, and according to a report by the Express newspaper on August 4th, 2010, its production in Trinidad and Tobago increased by 150 per cent in that year – from 100 tons in 2009 to 250 tons in 2010. Prior to the cultivation of the “dwarf variety”—a grafted version of the original tree—the pommecythere tree could reach up to 75 feet in height. Now, the plants can be grown in flower gardens and are small enough to be kept as container plants. They can even be kept indoors. With that said, now there is no excuse for you to not sink your teeth into a mouth-watering green or a juicy ripe good-for-you pommecythere. And if you have the time, I’ve added a couple of recipes that you can try. Enjoy!
Pommecythere Jam Ingredients
June plums as required + Sugar as required + Water as required
Method
Wash fruits and bring to a boil Add 500 g of sugar and 250 ml water per kilogram of fruits added Reduce the heat and let simmer for a few minutes Place the fruit into the syrup, return to the boil and allow it to cook for no more than 25 minutes. Check the thickness of the jam; if it's okay, then remove it from heat, allow to cool and seal it in an airtight container.
Pommecythere CHOW Ingredients
d and diced 4 large pommecytheres, peele 2 tsp salt 1/2 tsp black pepper pieces) 1 hot pepper (chopped in big s (finely chopped) 8 bandania (chadon beni) leave 4 garlic cloves (finely chopped) 4 tbs water
Directions
e for 1 minute. large bowl, cover bowl and shak Combine all ingredients in a for 10-15 minutes. Leave in the sun to marinate
D R . N E I L SI N GH
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ASK U
ASK U ANYTHING ANSWERED BY DR.
NEIL SINGH MBBS PG MSc
How does belly fat affect our heart?
People store fat basically in two main ways. Fat stored under the skin is called subcutaneous fat and is largely the visible fat that we have in our abdomen legs and arms. This subcutaneous fat stored in our abdomen is call centripetal obesity (belly fat) and is associated with insulin resistance and an increase risk of type 2 diabetes.
Obesity, particularly abdominal obesity, is not only a major risk factor for type 2 diabetes but also for other non-communicable diseases such as cardiovascular disease (heart attack and stroke). Today, diabetes and other non-communicable diseases related to obesity account for more deaths each year worldwide than AIDS.
What are the main differences between H1N1 and the seasonal Flu?
The seasonal flu and the H1N1 swine flu are very similar conditions caused by different strains of the influenza virus. The spread of the swine flu (H1N1) is thought to happen in the same way that the seasonal flu spreads. Flu viruses spread mainly from person to person through coughing and sneezing of people with influenza.
The current flu vaccines available now cover the H1N1 flu strain as well as the current seasonal flu virus strain. It is important to note that most people infected with the flu do recover spontaneously. The flu vaccine offers additional protection and should be considered for all high risks patients.
Does smoking affect your risk of developing NCDs?
Smoking increases your risk of cardiovascualr disease (heart attack and stroke). When you have diabetes, your risk of cardiovascular disease (heart attack and stroke) increases four-fold when compared with people without diabetes .
If you have diabetes and smoke, your risk of cardiovascular disease increases eleven-fold when compared to someone who does not smoke or have diabetes.
We always enjoy hearing from you! Email your questions to info@uhealthdigest.com
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SURGERY SUR GERY
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O PEN HE AR T S U R G E R Y. 1 0 THING S YO U SH O ULD KN OW
10 things you should know WRITTEN BY DR
RANDOLPH RAWLINS MB.BS. FRCS ( ED), FRCS CTH
Cardiovascular disease is the number one cause of death worldwide. It accounted for 17.3 million deaths in 2008 and this number is expected to rise to 23 million by 2030, based on World Health Organisation projections. Most deaths are due to coronary artery disease. Untreated heart attack or myocardial infarction survivors are at risk of reduced life expectancy, worsening symptoms, or poor quality of life. Open heart surgery prolongs life and relieves symptoms in patients with surgically treated heart conditions. Here are 10 things you should know about open heart surgery:
Open heart surgery is safe. Published data indicate risks associated with open heart surgery are low. This is despite many patients being older, with multiple pre-existing conditions. Improvements in anaesthesia, improved cardiopulmonary bypass technology and better heart protection strategies have contributed to risk reduction.
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This, combined with dedicated and committed medical and nursing teams providing good “after care” or post operative care, has lead to excellent outcomes for patients. The cardiac surgeon now has at his disposal significantly advanced technology and equipment not previously available.
OP E N H E A R T SURGE R Y. 10 T H I N GS YO U SH O ULD KN OW
After open heart surgery the following symptoms of heart disease are usually eliminated: • Chest pains or angina: This refers to chest tightness or pains radiating down the arms, to the neck or jaw. Diabetics may have atypical symptoms. • Shortness of breath • Irregular heartbeat • Leg oedema or swollen legs.
Patients undergoing open heart surgery may present with one or more of the following risk factors: • • • • •
Diabetes Hypertension or high blood pressure Dyslipidemias or high cholesterol levels Smoking Family history of coronary artery disease.
There are different types of open heart surgery operations. Heart surgery may be performed for defects present from birth or conditions acquired in adult life. Operations include coronary Artery Bypass Grafting (CABG), heart valve repair or replacement for defective valves, aortic dissection or aneurysm surgery, or a combination of these. Arrythmia surgery or ablation to eliminate atrial fibrillation is one of the most significant advances in cardiac surgery, with a high success rate. Coronary Artery Bypass Grafting (CABG) is the most frequently performed open heart surgery in adults. It is performed to treat blocked arteries due to plaque build up. New arteries and veins are used to create new routes of blood flow thus reducing the chance of heart attacks. More than 20,000 CABG operations are performed annually in the United Kingdom. Successful surgery prolongs life, relieves symptoms and improves quality of life.
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SURGERY
Heart surgery does not involve breaking or cracking of ribs. Some patients are afraid of undergoing life saving heart surgery because of misinformation that surgery involves “cracking open the chest”. The median sternotomy, the standard surgical incision at the front of the chest, does not involve cracking or breaking ribs. It is a stable incision associated with less discomfort. Additionally, patients are routinely prescribed strong intravenous painkillers, for example morphine infusions. This is subsequently replaced by strong oral analgesics when patients are able to swallow.
Heart surgeons can predict the chances of successful outcomes. Risk assessment allows for open discussion between patients, relatives and the cardiac surgeon before surgery. There are risk assessment models, such as the Euroscore and logistic Euroscore, which allow cardiac surgeons to quantify risks. Scores are given for patient-related factors, cardiac-related factors and surgery-related factors. Factors include age and gender, underlying medical conditions such as renal/kidney disease, lung diseases and intraoperative findings. The cumulative score reflects the overall risk.
Being female may influence outcome after heart surgery. Women referred for heart surgery usually present at older ages than men. Older age means they are more likely to present with age-related conditions like diabetes and hypertension or significant past medical history which may add to risks. Asymptomatic Females with known risk factors or patients with new symptoms or a family history of heart disease should be encouraged to undergo early investigations.
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SURGERY
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O PEN HE AR T S U R G E R Y. 1 0 THING S YO U SH O ULD KN OW
A coronary angiogram is performed before heart surgery in most patients.
Use of cell savers during open heart surgery reduces the need for blood transfusions.
Coronary angiography provides information about the blood supply to the heart. It provides a road map of the coronary arteries and is used to identify blocked arteries or other abnormalities in people with angina or chest pains. It is a low-risk procedure mostly performed as an outpatient or day case.
Cell savers are devices that collect the patient’s own blood from the operative field during surgery. Blood collected is returned to the patient, minimizing the need for blood transfusions.
Age influences the length of hospital stay after open heart surgery
This is important in societies with limited blood reserves, and also has benefits for the patients. It is especially important for patients undergoing open heart surgery who do not accept blood transfusions on religious grounds.
Patients recovering after cardiac surgery are usually suitable for discharge from hospital after five or six days. Most are fully mobile, able to shower independently and climb a flight of stairs. The younger and fitter the person, the more likely they can meet this target. Older patients, higher risk candidates, those undergoing complex procedures or those with post-surgery complications may remain longer in hospital.
Open heart surgery is safe, relieves symptoms and prolongs lives of patients with coronary artery disease, heart valve diseases and other heart conditions requiring surgery. Early referrals to cardiac surgeons are encouraged to minimize risks.
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Dr Randolph Rawlins MBBS, FRCSEd, FRCS CTH is a Consultant Cardiac and Thoracic Surgeon. He Specialised in London England at Guy’s, St Thomas’ and Kings College University Hospitals. He is a member of the Society for Heart and Lung Specialists of Great Britain and Northern Ireland.
TEN THINGS TO TALK ABOUT 1 People with learning disabilities are generally of average or above average intelligence
6 Dyslexics typically have a large spoken vocabulary for their age.
2 Dyslexia is life-long and often occurs in families.
7 Ninety percent of GM crops, and almost all GM food
3 There were 125 million hectares of GM crops worldwide in 2008, about 6 to 7 percent of the total cultivated land area. That is an increase of nearly 10 percent on the 114 million hectares in 2007.
8 4 in 100 middle-aged men and 2 in 100 middle-aged
4 Dyslexics have excellent comprehension of the stories read or told them.
9 Obstructive Sleep Apnoea is as common as adult
5 The first commercial GM food was the FlavrSavr tomato
developed in the early 1990s in California. It was genetically altered so that it took longer to decompose after being picked.
crops, are grown in four countries - the United States, Argentina, Brazil, and Canada. The U.S. produces almost half of all GM crops.
women have Obstructive Sleep apnoea.
asthma.
10 Obstructive Sleep Apnoea is when a person stops breathing repeatedly during sleep.
HIGHLIGHTS
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U EXP O 2 0 1 2
U E XP O 2012
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HIGHLIGHTS
ATTRACTS OVER
Expo 2012 was a resounding success
and could only be measured by the tremendous response from the thousands of visitors and from our amazing exhibitors. We at U would like to extend our deepest gratitude to each and everyone for making it a memorable and successful event.
See you all at Expo 2013!
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HIGHLIGHTS
|
U EXP O 2 0 1 2
THE LAUNCH The Opening Ceremony of the U Health and Wellness Exposition featured presentations by the Founding Editors Stuart Fraser and Sherine Mungal along with Dr. Neil Singh and John Smith. Dr. The Honourable Fuad Khan, Minister of Health delivered the Feature Address.
THE SEMINAR
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Dedicated to Healthcare and Your Heart. This Seminar highlighted 10 Things You Should Know about Open Heart Surgery featuring Dr. Randolph Rawlins MB.BS,FRCS (ED), FRCS (C/TH) Consultant Cardiovascular and Thoracic Surgeon - Advanced cardiovascular Surgeon. Motivational Speaker, Tony Ragoonan made his presentation on Stress and The Weight of Worry. Dr. Amanda Jones - MBBS, UWI presented her Wellness Workshop, Measurable Results.
U E XP O 2012
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HIGHLIGHTS
U EXPO WALL U-The Caribbean Health Digest launched its first fund in support of the the initiatives of the Physiotherapy Association of Trinidad and Tobago. To the hundreds of people who contributed to this fund and earned a space on this wall, A Thousand Thank U's.
THE AWARDS A prize giving ceremony was held at the end of the Exposition. Five Categories were chosen and the following companies were presented with awards. • Best Booth Design - GNC / Anthony P. Scott • Most Interactive Booth - Abbott Nutrition • Most Efficient Team - Westshore Medical • Most Innovative - North Eleven • Most Productive Booth - Biomedical
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EXERCISE
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Z UMB A
If you think traditional fitness routines such as aerobics and weight lifting are destined to be your fate, then surprisingly, you have probably never heard of the revolutionizing new fitness craze that has taken the globe by storm.
ZUM
Z UM B A
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EXERCISE
MBA WRITTEN BY CAROL
QUASH
Combining raw energy, hot dance steps and pulsating rhythms, Zumba, pronounced Zoomba, is an invigorating dance-fitness "party", which, according to certified Zumba instructor, Chanel Phillips, incorporates a variety of dances such as salsa, the merengue march, cumbia, African, marimba, belly dancing, reggaeton and cha-cha into a fitness workout that will see participants shedding the unwanted weight and toning the body in no time, all the while enjoying the routine. Zumba is done to predominantly Latin music, but genres such as soca and calypso have been added to cater to the Caribbean market.
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EXERCISE
|
Z UMB A
"And if there are mature people in the class, I throw in some jazz, or James Brown (funk music)," Phillips says. However, she highlights, instructors are required to adhere to the Zumba Fitness Company rules, one of which states that 75 percent of Zumba music must be used in the classes. "The company sends CDs to certified instructors every month. The music is Latin based."
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And although instructors are also given choreography directions, it is up to the individual instructor to decide whether they want to follow them. "I use some of their choreography, and I combine it with my own. I try to incorporate a workout of every muscle in a session," she explains.
Her classes average between sixty-eight and seventy-nine people, with women making up the majority. "I think it’s geared toward women because they are always in search of simple and fun ways to lose weight and stay in shape." Sporting a "slamming" body, the 24-year-old is a dancing Public Relations campaign for Zumba all on her own. "I would recommend Zumba to anyone. I saw positive results from the first day. I know what it is to train hard. I have been doing ballet and other dances for years. Plus I'm a UWI cheerleader and I trained under Orlando Griffith (strength and conditioning specialist), so I know what it takes to stay in shape."
Phillips, a final-year student at the University of the West Indies (UWI) St Augustine campus, says the only thing she requires of her students is a desire to have fun. "You don't even have to know how to dance. Just know how to have fun. It may be a bit strenuous at first, but eventually you get it," she assures.
Phillips says she can bear witness to the changes—physical and otherwise—in some of her students. "I have seen some students come in with absolutely no coordination," she chuckles. "And after a few sessions, I couldn't believe they were the same students," In terms of their movement, fitness, energy and attitude. "I keep the sequence of the music so students could get the used to the moves before I go on to another level," Phillips says.
Phillips offers classes at UWI SPEC, and assists another instructor, Alan Balfour, with his classes at La Joya in St Joseph and at the Country Club in Maraval. "I start with a warm-up, and although I try to keep it a fun class, I also try to get people to remember that they are working out," she notes, because most people don't associate working out with enjoyment.
Zumba was the accidental brainchild of Colombian dancer and choreographer Alberto "Beto" Perez, who forgot to bring his aerobics music to one of his classes and was forced to improvise using Latin music he kept in his backpack. The revolutionary dance-fitness was born when his trainees had fun focusing on letting the music move them instead of having to adhere to rigid aerobics steps. In 2001,
Z UM B A
Beto took Zumba to Miami, Florida, and, the rest, as they say, is history. The programme has evolved into a phenomenon, and is taught at gyms and studios worldwide.
Phillips says there are various Zumba levels to meet the differing needs of participants. • Zumba Gold targets a more mature demographic—baby boomers—and beginners. The moves and pacing are modified to suit their needs. • Zumba Toning raises the bar by combining targeted body-sculpting exercises and high-energy cardio work. The Latin-infused Zumba burn calories and builds strength. Lightweight, maraca-like toning sticks are used to enhance rhythm and tone all the student's target zones, including arms, abs, glutes and thighs. • Aqua Zumba, as its names implies, is done in water and gives an invigorating workout. The splashing, stretching, twisting and laughing combines to create a cardio-conditioning, body-toning workout. • Zumbatomic is exclusively designed for children between the ages of four and twelve. It includes specially choreographed routines done to hip hop, reggaeton and cumbia—music that children love. Zumbatomic helps to increase focus and self-confidence, boost metabolism and enhance coordination, according to Phillips. • Zumba in the Circuit is an intensive
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EXERCISE
30-minute dance workout that includes Latin-inspired dance-fitness moves combined with circuit training and a series of strength exercises at timed intervals. It boosts metabolism, burns calories, builds strength, while simultaneously perfecting Zumba moves. • Zumba Gold-Toning includes lightweight resistance training and international rhythms, marrying the exhilarating experience of a Zumba fitness-party with all the benefits of strength training. It builds muscle strength, increases bone density, and improves mobility, posture and coordination. • The Zumba Sentao keeps participants at the edge of their seats with a workout that combines the fitness-party and with chair-based choreography. It strengthens, balances and stabilizes the core, and enhances the cardio workout in a fun way. It teaches how to use body weight to enhance muscle strength, tone the body and improve definition and endurance.°
So if you are up to some fun, fitness sessions, email Chanel Phillips at cha_nelly7@hotmail.com or visit the zumbafitness.com Website to locate a trainer near you. And if you are the do-it-yourself type, you can purchase the Zumba Fitness DVD Experience, a Total Body System to try in the comfort of your own home.
HAPPY DANCING!
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NUTRITION
|
RAISING HE ALTHY E ATE R S
R ISING HEALTHY EATERS __________ WRITTEN BY MICHELLE
ASH, REGISTERED DIETITIAN (MPH, RD, DIP.)
_________
WHY IS YOUR CHILD'S NUTRITION IMPORTANT? Childhood is a key period for growth and development. It is essential that foods supply the energy and nutrients that are needed for their growth and development. Children who eat the right amount of nutritious foods and are physically active will enjoy a healthy life and will have lower risks for long-term health problems such as diabetes and high blood pressure when they get older.
_________
WHICH FOODS SHOULD CHILDREN EAT?
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Like adults, children should eat foods from all of the six food groups. A variety of foods will provide the entire range of nutrients needed and encourage good, long-term eating habits.
1 Staples: these foods are rich in carbohydrates and supply the body with energy. 2 Legumes & Nuts: most foods from this group are a good source of protein and fibre. Nuts also contain high amounts of healthy fats. 3 Foods from animals: these supply your body with high-quality proteins, which are necessary for growth and the repair of muscles and body tissues in a developing child. 4 Vegetables: rich in many nutrients, particularly vitamins and minerals. 5 Fruits: the best sources for vitamins, and they contain some minerals as well. 6 Fats & Oils: only very small amounts are needed from this group. Focus on using healthy fats or oils such as canola oil, olive oil, avocados, flaxseed oil, coconut milk and coconut oil.
RA I SI N G H E A LT H Y E AT E RS
_________
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NUTRITION
ENJOY A WIDE VARIETY OF NUTRITIOUS FOODS
• Encourage children to taste new foods, even if they don’t eat it all. Remember they learn by example, and you might find them following your adult eating habits, good or bad.
• Breakfast cereals with milk: look for calcium-fortified and iron-rich varieties with less than 15g of sugar per serving. • Homemade low-fat muffins with little added sugar are fun and easy for kids to prepare with adult supervision.
#2: HIGH INTAKE OF FOODS HIGH IN FATS, SUGAR AND SALT BUT LOW IN NUTRIENTS Eating too many ‘junk-foods’ such as candies, sugary juices/soft-drinks, fried foods and highly processed salty packaged snacks can result in your child getting:
• A range of different foods are important to balance nutrient intake. • Other healthy snack foods include fresh fruit, granola bars (low sugar), • Cavities • Include foods rich in iron, like dark homemade/air-popped popcorn, • High cholesterol green leafy vegetables, and also vegetable sticks and dips. • High blood pressure calcium, for example milk. • Overweight and obesity • Be creative! How about helping your • Nutrient deficiencies • Between-meal snacks are importchild make a mermaid banana? * ant for active children. Fruit smoothies and yoghurt are a great #3: FREQUENT SNACKING OR way to add extra calcium to a EATING SNACKS TOO CLOSE TO child’s diet. Calcium builds strong THE MAIN MEAL (e.g. lunch or dinner) TOP 3 NUTRITION bones and teeth. In addition, CONCERNS OF SCHOOL-AGE CHILDREN parents of very active children • This results in the loss of appetite during the main meal. should ensure that they get enough #1: SKIPPING BREAKFAST calcium because it helps prevent their bones from being easily • Teach your child how to snack instead To prevent skipping breakfast: of never snacking. Healthy snacking is broken or fractured. • Set your child’s sleeping time so that he will wake up early enough to have a important for kids since their stomachs are naturally smaller than adults and • Always offer plenty of water; limit good breakfast. Prepare and plan the much of their nutrition will be consumed consumption of sugary juices and night before for a good breakfast the in small amounts throughout the day. other sweetened drinks. next morning.
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Snacks should be taken more than 2 Kids who eat breakfast perform far • hours before a regular meal. better in school than those who skip SMART SNACKING TIPS FOR PARENTS AND KIDS: their morning meals! The ideal A well-balanced diet will provide all of well-balanced breakfast contains: the nutrients needed for a child’s growth • A starchy item: Example: whole-grain • Involve children in preparing their and development. Supplements are not bread or high fibre cereals like oatmeal. usually recommended for children. If you snacks. are unsure as to whether your child is • A milk serving: Example: a small glass • Fruit forms the basis of many getting adequate nutrition, please seek of milk or a cup of yoghurt. snacks. Try some fun fruit snacks advice from a Registered Dietitian (RD). such as fruits on a toothpick with a Feel free to email the author of this • A protein source: poultry/meat, fish, cup of yoghurt as dip, banana article with any of your nutrition egg or peas/beans, peanut butter. sandwiches or fresh fruit smoothquestions or concerns**. ies and frozen fruit. * Instructions for making this fun snack can be • Vitamin-C rich fruits like an orange, found at ziggityzoom.com/activity/mermaid bananarama tangerines, paw-paw (papaya), West • Fruit yoghurt or a glass of milk Indian cherries. provides both calcium and protein. ** michelle.ash.tt@gmail.com
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MILK
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IT DO ES YO UR B ODY G OOD
MILK MILK. We all drink it. We’ve grown up on it. We all know that it contains calcium, which builds healthy bones and teeth, but did you know that milk is also a natural source of protein, potassium, vitamin D, A and B12? Milk not only tastes good but it helps maintain healthy blood cells, nerve tissue, eyes, skin and immune system.
Milk drinking has been linked to weight loss, as people who drink more milk tend to replace sodas with this nutrient-rich drink. Nutritionists recommend three glasses of non-fat or low-fat milk daily, to provide 100% of our calcium needs and 75% of our vitamin D needs.
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Milk is even reputed to be a beauty aid. Queen Cleopatra is said to have bathed in milk daily to achieve a flawless, healthy complexion. If you have dry skin, the lactic acid in milk is said to help nourish and smooth skin as well as aid in removing dead cells.
...it does your body good
These days, everyone is a fan of milk but with an increasing range of options such as skimmed milk, high-calcium milk, fibre-enriched milk, omega-3 enriched milk, probiotic-enriched milk and a variety of flavoured milks, how much do we really know about the milk that sits on our grocery shelves? What happens to milk when it leaves the farm? PASTEURIZATION Commercial milk goes through several processes before it gets to your local supermarket. One of the most common processes is pasteurization, which involves the heating of milk to treat and remove bacteria such as Salmonella, E. coli, and Listeria, which cause numerous food borne illnesses. During standard pasteurization, manufacturers heat milk to a minimum of 161degrees Fahrenheit for at least 15 seconds. While the pasteurization process involves a 10% loss of thiamin and vitamin B12 content as well as a 20% loss of vitamin C content, these losses
are believed to be small given the large amount of vitamins present in cow’s milk. More recent research has questioned the benefits of the pasteurization process and the number of advocates of drinking unpasteurized, raw milk is on the rise. Advocates of raw milk state that it may be easier to digest by people who have problems digesting lactose. They also argue that the pasteurization process kills vitamins and good bacteria as well as harmful ones. Despite this, pasteurization or other processing methods remain the standard for milk production. ULTRA-PASTEURIZATION (UHT) Ultra-pasteurization or ultra high temperature treatment (UHT) is a newer process that heats the milk to at least 280 degrees Fahrenheit for a minimum of two seconds. The extreme heat used in ultra-pasteurization allows the milk to remain safe for consumption for up to six months if it remains unopened and stored properly.
I T D O E S YO UR B O DY GO O D
This process acts as a sterilizer and kills off the bacteria that pasteurization alone may miss. Opponents of UHT processing state that it reduces the nutritional value of the milk, breaks down proteins and forms insoluble substances that wreak havoc on our digestive systems. However, with milk production no longer being a local industry, UHT processing is good news for the consumer who values convenience, quality and long shelf life. HOMOGENISATION Homogenisation of milk involves forcing the milk at high pressure through tiny holes in order to separate and evenly distribute its fat globules. This process results in the uniform consistency we have come to expect from store-bought milk as it prevents the eventual separation of the milk into layers with the cream rising to the top. WHAT’S IN OUR MILK? While these processes are designed to make milk safer for human consumption, other processes are designed to make milk cheaper to produce, last longer on the grocery shelves and make storage more convenient for the consumer.
recombining of powdered milk, other milk by-products and other ingredients with water in order to get the liquid form we purchase. Big milk companies essentially pull milk apart and put it back together again. They adjust the constituent parts and recombine them to recalibrate protein, fat and carbohydrate levels to compensate for differences that would be apparent in raw, unprocessed milk. The process of producing reconstituted milk also carmelizes the naturally occurring sugars whichproduces the altered, falsely sweetened taste and off-white, dark beige colour that are not natural attributes of milk. Reconstitution is also a cost-saving mechanism for big companies. They ship the powdered form in large quantities and then recombine it locally with milk byproduct, oil and flavoring to get the taste that we’ve been used to.
Most standard, reconstituted milk contains a by-product from the dairy production process when the milk proteins and fat are removed, called permeate. Because permeate is a cheap by-product, combining it with farm produced milk makes a cheaper RECONSTITUTED MILK product for milk companies. However Did you know that most of the milk permeate can also increase the levels sold locally is actually reconstituted of lactose in store bought milk which milk? Reconstituted or recombined is bad news for people with lactose milk is a product resulting from the sensitivities.
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MILK
FRESH MILK Fresh milk is brought straight from the farm and treated for safety. Nothing is added and nothing is removed, except the bacteria. The problem is that fresh milk is not as prevalent as it used to be. It has a reduced shelf life and is not as common in the local market. Our local dairy industry is also quite small and simply cannot sustain the demand. MADE FROM FRESH Milk that is labeled “Made from Fresh” utilizes a greater proportion of liquid cow’s milk. It is never reconstituted and is shipped in liquid form. This milk goes through the same processes to ensure it is free from harmful bacteria but it is about as close to the cow as you can get without the hassle and still has that great milk taste.
DRINK UP Now that you know what’s in your milk and the processes used by milk manufacturers in bringing it from the farm to your kitchen, drink up and make sure you get your daily-recommended amount of calcium as part of a healthy, nutrient rich diet.
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PAEDIATRICS
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I MMU NIZATION
The great immunization debate: WRITTEN BY DR.
DAVID BRATT, MD. MPH. CMT
Do your kids really need their shots?
Paediatricians everywhere agree that if there was only one single thing a mother or father could do for their child’s health, it would be to breastfeed that child. Forgotten in that analysis is the role of immunizations, the single most useful thing a medical doctor can do for a child, That’s because of the unbelievable success of these vaccines. We simply no longer see any of what used to be common and in many, many instances, deadly examples of what were enthusiastically called “childhood illnesses”: diphtheria; whooping cough; tetanus or lockjaw; paralytic polio; meningitis or brain fever; inflammation of the epiglottis; measles; mumps and German measles. Few things in the history of mankind can illustrate better the short term memory of humans than the almost deliberate forgetting of these ailments, to the point where some parents are now trying to say that their children do not need their “shots”.
I M M UN I Z AT I O N
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PAEDIATRICS
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PAEDIATRICS
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I MMU NIZATION
There seem to be three other reasons for this attitude. First the mistaken belief that the germs that caused the illnesses are no longer around. They are, and very much so. Just because they cannot be seen does not mean that they are not present in homes, classrooms, offices, streets, banks, hospitals, swimming pools...you name it, they are there. Visible proof of this are the occasional cases of death from tetanus in old, unvaccinated adults; the many cases of whooping cough in older children and the present-day outbreaks of measles with its accompanying complications, in the UK and USA in unvaccinated children. Stop vaccinating children and all will reappear immediately.
individuals with immunity who stand between him and the diseased person. The corollary of this is that all those who refuse to have their children immunized are protecting their children on the backs of those who have had their child immunized.
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Second is the belief that children are too small or young to get “so many” immunizations. That proposition does not hold up when one considers that babies are born with little resistance to infection apart from what passed into their bloodstream from their mother's blood, via the placenta and umbilical cord, and what they may continue to get through their mother's breastmilk, and that from minute one of their extra-uterine life they are bombarded with hundreds of thousands of antigens from the In view of the increase in hundreds of thousands of germs unvaccinated children in recent they encounter each and every years, why aren’t there more day of their life. Adding seven or outbreaks? That’s because of something called herd immunity. eight attenuated antigens more, Infectious illnesses mainly spread three times in the first year of life, hardly seems anything to get by face to face contact excited about. Even if one (contaminated hands to mouth) wanted to talk about the or through the air by cough droplets. Herd immunity occurs “artificiality” of getting when at least 80% of a population immunized, I would ask what is more artificial than giving birth is immunized and therefore has under anaesthesia or giving the immunity against a particular newborn formula or processed disease. The disease cannot rice cereal or sweet potato pap in spread easily throughout that population since there will be few a little glass bottle, yet millions of individuals with the disease and people do these things to their infants and never give them a even fewer opportunities for second thought. those affected individuals scattered throughout the Finally, there is the very real population to come in contact possibility of side effects from the with a non-immunized person. vaccines. Every time you inject a An unprotected person is vaccine or antigen into a child, protected by the many
there can be a reaction. Most reactions are mild, but a very few are very severe and can cause death or brain damage. Some of the older vaccines containing mercury may be responsible for illness. All of these things are true, but the risks of not giving the vaccine and allowing the child to get the disease are far worse. The most common reactions occur with the “old” Diphtheria-Tetanus-whooping cough or Pertussis (DTP) vaccine. About one in four children will get a minor reaction. That is the time-honoured low grade fever or fretfulness or swelling of the injected site that occurs about four hours after the immunization and that requires only an anti-pyretic/painkiller. The old DTP immunization contained the “old” whooping cough vaccine. This is one of the least effective and most reactive vaccines. It’s now been cleaned up and purified so that the risk of a minor reaction has dropped to one in twenty or so. That vaccine is known as the DTaP. That old DTP vaccine may have been responsible for some of the fear that parents feel towards vaccines in general. From time to time it used to cause convulsions in susceptible children. That is not pleasant to have happen to your child and instances of brain damage and even death have occurred with DTP. Again, it’s a question of risk. It is much less risky to get the vaccine and be protected against diphtheria, tetanus or whooping cough than to remain unvaccinated and hope
I M M UN I Z AT I O N
that your friends’ children’s herd immunity protects your child against disease.
concerns, and fudging the pathology findings, the lynchpin of his association. In addition, there was evidence that his study The newer vaccines, like MMR was commissioned and funded (Measles, Mumps & rubella or for planned litigation by the German measles) or the injectable group of lawyers and doctors polio vaccine or either of the two involved. major meningitis vaccines (H. flu or pneumococcal) or the Rota However, there is little doubt that virus or chickenpox ones are many parents mistrust very safe. vaccination programs. The reason for this probably also lies in the actions of some of the The question of measles being pharmaceutical companies associated with autistic disorders involved in producing vaccines is only mentioned to say that as well as some of the most there has never been a shred of prominent public health evidence that there was any organizations in the world like association. This association was WHO and PAHO. For years a media funded blood frenzy sort pharmaceutical companies hid of thing. After two and a half from doctors the fact that they years of investigation, the doctor were adding mercurial who claimed to have found an compounds to vaccines for association in a study initially children. I can vividly recall the reported in the Lancet but later anger I felt on learning this not partially retracted, was struck off too many years ago. Trust gone the UK medical register in May is trust lost. 2010. Among the findings of the Then there have been several investigation were such things as public health scenarios where the taking of blood samples, WHO and PAHO tried to use which were used in his research, scaremongering tactics to from children at his son’s persuade people that influenza birthday party in return for vaccines were needed. The first payments of US$8; applying for a occurred in 1976 in the USA patent on a single measles where it became known as the vaccine nine months before he swine flu fiasco, remembered for published his paper (one of the the mass immunization that it things that resulted from his prompted. The flu strain itself paper was the idea that single killed one person and vaccines did less harm); hospitalized 13. However, misdiagnosing three of the nine side-effects from the vaccine original cases that were supposed caused five hundred cases of to be autistic; claiming that all Guillain-Barre syndrome (a the children in his study had paralytic disorder) and 25 deaths. been previously “normal” when A similar situation occurred in in fact five had documented the 2009 swine flu outbreak, pre-existing developmental which was supposed to have the
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PAEDIATRICS
potential for significant mortality and all and sundry were urged to get vaccinated. Few did and little harm was done. At the end there were a number of suggestions made that major pharmaceutical firms had organised a "campaign of panic" to put pressure on WHO to declare a "false pandemic" to sell vaccines. In June 2010, the editor-in-chief of the British Medical Journal, one of the world’s top medical journals, published an editorial which criticised the WHO, saying that an investigation had disclosed that some of the experts advising WHO on the pandemic had financial ties with drug companies which were producing antivirals and vaccines. Recently, there has been controversy when it was discovered that the governor of Texas, the first US state to pass laws insisting that all girls of a certain age be vaccinated against human papillomavirus, the cause of cervical cancer, had received substantial financial contributions to his election campaign from the pharmaceutical firm which manufactures the vaccine. It is a shame that a proven useful arm of medicine has been allowed to be tainted by the actions of an unscrupulous few. The real question that remains is this: given the low cost, low risk, easy availability and proven efficiency of globally accepted immunisations, why would you leave your child’s wellness to chance?
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THERAPY
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HIPPOTHE R A P Y
H I P P OT H E R A P Y
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THERAPY
HIPPOTHERAPY HEALING WITH HORSES. WRITTEN BY DESIREE
SEEBARAN
It may be out of fashion now, but the soothing sway of a horse and rider was once a common sight, before the whoosh and roar of the horseless carriage drove them off the thoroughfares. And that rhythmic bond between horse and human is now an essential element of an important therapeutic tool called hippotherapy
.
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THERAPY
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HIPPOTHE R A P Y
T
he movement of a horse under a rider is used as a part of a package of therapies performed by speech, occupational or physical therapists, and has been seen to be especially efficacious in adults and children who have physical, emotional and developmental disabilities like cerebral palsy, autism and substance addictions. “Horses know when they’re dealing with someone with special needs; they become very gentle. They have a high level of intelligence and are very sentient beings,” said Karen Stollmeyer. She’s a neurological speech and language pathologist who has spent nearly her whole life riding horses. And she’s a strong advocate of hippotherapy, especially in the case of children who need therapy.
Horsemanship International) and started practising the therapy briefly in Miami, “But it never worked out,” she said. Fast forward several years to 2011. Stollmeyer was back in Trinidad, teaching yoga, doing yoga therapy and practicing energy medicine at her studio, Bliss Yoga. On a trip to Tobago, she met Veronika Danzer La Fortune, one of the founders of the Tobago-based NGO Healing With Horses.
What you get from the child in this setting, you can’t get in a therapy room.
“It’s like watching a miracle in action,” she said. “What you get from the child in this setting, you can’t get in a therapy room. The basis of therapy is motivation and very often you have to reach the person. The horse we use is a living tool, so it’s not just the riding; it’s the interaction with the animal that works.”
HOW SHE STARTED
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While practicing in Miami nearly 15 years ago, Stollmeyer found herself thinking of ways to do therapy outside of the intense, sometimes restrictive hospital setting. She did an intensive course in hippotherapy with the North American Riding For the Handicapped Association (now the Professional Association of Therapeutic
“And that brought everything to the surface; I realised how much I missed riding.” LaFortune asked if Stollmeyer would help her with the therapeutic riding, but Stollmeyer felt she was too busy. Then Uni fell into her lap… not literally, thankfully.
A relative had used her horse Uni for competitive jumping; but when the horse was injured and could no longer compete, the relative called Stollmeyer to ask about finding a home for the animal, since no one wanted to think about the alternative. “Horses who can’t be used for anything else go to the zoo for lion food,” Stollmeyer explained. “This horse haunted me. I called Veronika and told her about the horse and I asked her, ‘So who would you get to do the therapy?’ She said very quietly, ‘Well, Karen, I thought you would.’” Stollmeyer became the Trinidad branch of Healing with Horses this January.
H I P P OT H E R A P Y
THERAPY IN MOTION She sees four private clients under age 12 at the stable where she keeps Uni: two young boys with autism, one little girl with cerebral palsy and a developmentally delayed boy. She’s also trying to get funding to open the therapy to the children at the Life Centre, a private school for children with autism and Down’s syndrome. Funding is also needed to expand the programme to five days a week and offer it to those children whose parents can’t pay the fee of TT$400 per 30 to 45 minute session. “It’s a very expensive therapy simply because it’s a very expensive thing to maintain a horse,” Stollmeyer said, adding that boarding Uni at the stables costs her $4,500 per month, not including vet bills and special provisions like blankets. A second therapist would also need to be hired, which is an additional cost.
“Children with autism have a hard time processing all the information coming through their bodies, which is why they shut down,” Stollmeyer said. “The rhythmic movement of the horse helps
THERAPY
them process all the sensory information around them because it’s very soothing.” During his second session, the boy went from screaming and crying to being very quiet, engaging in eye contact with Stollmeyer and using six words during his sessions. The therapy has even helped him to potty train effectively. Stollmeyer said: “He runs and hugs me now. And he loves Uni; I’ve been teaching him how to groom her. “I know because I’ve worked with children in a room before that there’s no way I would have gotten that kind of response in a room. All the children that I’ve seen have done things that they’ve never done before, after their sessions on the horse.”
There’s no way I would have gotten that kind of response in a room.
But the amazing results of the therapy far outweigh the cost, “especially with autistic children who have issues with bonding and social interaction,” Stollmeyer said. One of her clients, an autistic boy, didn’t speak at all when he first came to his sessions. He refused to touch Karen, made grunting noises and screamed when he was put on the horse, all common behaviours for severely autistic children.
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Uni is enjoying her second career as a ‘therapist’, Stollmeyer said.
“I trust her. You have to have the right kind of horse, they ideally should be calm, well-schooled and without any bad habits or aggressive traits.” Stollmeyer’s ultimate vision for the NGO is to have a centre dedicated to hippotherapy that also doubles as a horse sanctuary. “We’re open to funding and for this to be taken seriously. The disabled population here is seriously underserviced. We’re really looking for people to support it so that we can make this as open to as many people as we can.” For more information on hippotherapy in Trinidad and Tobago, visit Healing-with-horses.com.
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