U The Caribbean Health Digest - Issue 18

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THE CARIBBEAN HEALTH DIGEST JUL SEP 2012

| ISSUE 18

ROBOTIC SURGERY TECHNOLOGICAL DEVELOPMENTS USING ROBOTIC SYSTEMS TO AID IN SURGICAL PROCEDURES PRACTICED AT BAPTIST HEALTH AND SOUTH MIAMI HOSPITAL CENTER. GET SCOPED. COLORECTAL SCREENING FOR ONE OF T&T’S LEADING CANCERS.

10

UTERINE FIBROID EMBOLIZATION. A LESS INVASIVE TREATMENT OPTION FOR UTERINE FIBROIDS 14 PUMPKIN POWER. MANY SHAPES. MANY SIZES. SO MANY BENEFITS! 26

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Sherine Mungal

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Roslyn Carrington Nirad Tewarie

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This information is of a general nature only and is not intended as a substitute for professional health advice and no person should act in reliance on any statement contained in the information provided and at all times should obtain s p e c i f i c a d v i c e f ro m a h e a l t h professional. Eidetic Publishing has made reasonable efforts to ensure that the health information contained herein is accurate and up to date. To the extent permitted by law, Eidetic Publishing, their employees, agents and advertisers accept no liability

(even if negligent) for any injury, loss or damage caused by reliance on any part of this information. U also contains information supplied by third parties.

This information is identified with the name of the source and has been chosen for publication because we believe it to be reliable. To the extent permitted by law, Eidetic Publishing, their employees, agents and advertisers accept no liability (even if negligent) for any injury, loss or damage caused by reliance on any part of this information.

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.

10 Get Scoped Dr. Feisal Daniel shares his knowledge and experience on one of the region’s major health conditions relating to the colon. In this article, he discusses the importance of screening for early detection of cancers and other diseases of the colon.

14 Uterine Fibroid Embolization For many women in the Caribbean the treatment options for uterine fibroids seemed to be limited to either hysterectomy or myomectomy, both very invasive surgical procedures with many associated risks. Today, the third and least invasive option is available in Trinidad, as Carol Quash reveals in her interview with UK based interventional radiologist, Dr. Nigel Hacking.

18 Robotic Surgery We take a glimpse into the future of surgical procedures as we explore this minimally invasive method practiced at Baptist Health and South Miami Hospital Center.

22 Indoor Air Quality We are all too familiar with air pollution, contaminants in the atmosphere and the air we breathe outdoors, but how many of us ever considered the quality of the air indoors? This article reveals some shocking facts that may have you thinking twice.

26 Pumpkin Power The pumpkin may take many shapes, sizes and colours, but one thing’s for sure: you can’t argue with the health benefits associated with this nutritious and versatile vegetable.

30 Atrial Fibrillation Many people experience irregular heartbeats or arrhythmia. Although this may be linked to cardiac conditions, it can occur in normal hearts as well. Learn about atrial fibrilation, a procedure done right here in Trinidad.

34 Genetically Modified Foods In our last issue we explored genetically modified foods and how safe it was to eat them. In this issue we take a closer look at the process that goes into genetically modifying many of the foods we eat.

38 The X-Factor The term “X-Factor” is usually used to explain the “unexplained”. In this article we explore the concept as it relates to physical fitness and how it is possible to achieve the impossible.

44 Mauby – Health Benefits All of us in the Caribbean have tried mauby at least once and though some say you have to acquire a taste for this bittersweet beverage, the rest of us couldn’t enjoy a Sunday lunch without it.

Here are some interesting facts about mauby and some of the health benefits associated with this Caribbean tradition.

46 The Process of Aging Aging is a continuous process that begins from birth and though many of us try to avoid the inevitable, perhaps understanding the process may help us to embrace it.

50 Sleeping Through The Night Most of us believe that once a baby comes sleep automatically leaves.

Though there is some truth in this theory, Dr. David Bratt explains the concept a bit more and helps us to understand the psychology behind getting the sleep we need - for us and baby.

Welcome to our 18th issue of U, the first issue into our 5th year of publishing…and what a journey it’s been for us!

What started out as project founded on a passion we had to share information and educate people has really turned our own lives around, too.

We have learnt so much from the many published articles, the conversations we’ve had with the many people we have met and the friendships we have developed, but more importantly we can say that we, too, have started to lean to living and enjoying healthier lives.

We are happy as ever to bring you this issue of U as we are always excited to share information with you, our readers, on any new technology in health, wellness and medicine. Our feature story takes us on a short flight to the Baptist Health and South Miami Hospital in Florida, where we explore robotic surgery and the amazing technology behind it.

As we continue to explore new technology and treatment options, Carol Quash interviews UK based Dr. Nigel Hacking, Interventional Radiologist who specializes in Uterine Fibroid Embolization, a less invasive procedure for treating uterine fibroids, a condition that affects up to 40 percent of women.

We are convinced that, combined with articles on the importance of colorectal screening, the health benefits of mauby and the power of pumpkin, this is yet another great issue.

We hope you enjoy it, ‘cause we certainly enjoy bring it to you!

SHERINE & STUART

FOUNDING EDITORS

CANCER

| PREVENT COLORECTAL CANCER...GET SCOPED

PREVENT COLORECTAL CANCER...

GET

SC

PE

PREVENT COLORECTAL CANCER...GET SCOPED

|

CANCER

B

eing a developed nation in the Western world has its advantages.

We enjoy freedom, wealth and a unique Trini lifestyle.

However, this comes at a price. The western world is in economic turmoil, with increasing debt and, among other things, a rising incidence of colorectal cancer (CRC).

PED. WRITTEN BY DR.

FEISAL DANIEL

Locally, colorectal cancer is a major health concern. Speak to any surgeon, doctor or health care professional at our hospitals, and they will all tell you that colorectal cancer is a leading cause of emergency admissions, surgery and the dreaded colostomy bag.

The good news is that with increased awareness, and taking action, we can change things.

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CANCER

| PREVENT COLORECTAL CANCER...GET SCOPED

M

ost people in Trinidad & Tobago know about getting a mammogram or checking one’s prostate specific antigens (PSAs). Colorectal cancer screening, however, has not been a priority - until now. In recent times, efforts are being made to raise awareness of colorectal cancers on par with that of breast and prostate cancers.

Colorectal cancer screening actually presents us with an opportunity to reduce the incidence, increase the diagnosis of early-stage disease, and reduce deaths from this potentially preventable disease.

The premise for screening lies in the simple fact that cancers bleed, and specific to the colon and rectum, invasive malignancy may be preceded by the development of polyps.

This phenomenon, the adenoma-carcinoma sequence, was published in a landmark paper in the Lancet journal in 1978, based upon work done by pathologists at the St. Marks’ Hospital in London.

P

olyps (adenomas) are growths that develop from the inner lining (mucosa) of the large bowel. They may be flat (sessile) or stalked (pedunculated). These polyps, once detected, should be removed (polypectomy).

Colorectal Cancer.

Do not wait for symptoms to develop.

There is certainly a menu of options to choose from when considering how to get screened. They include the following: 1. Testing the stool for blood (faecal occult blood testing / FOB).

2. Examining the inner lining of the large bowel (colon, rectum and anus).

This may be done radiologically via the classic barium enema or non-invasively with the CAT scan (virtual colonoscopy).

However, the single best test to screen for colorectal cancer is colonoscopy.

Etiology of Adenoma-Carcinoma Sequence in large bowel.

Lancet journal in 1978, based upon work done by Pathologists at the St. Marks’ Hospital in London.

“A hypothesis, based on epidemiological and histopathological data, is proposed to account for the ætiology of colorectal adenomas and carcinomas. Adenomas are initially caused by an environmental agent which acts on the colorectal cells of adenoma-prone persons, a further environmental agent causes small adenomas to grow, and a carcinogen causes malignancy in a high proportion of large adenomas.”

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Polypectomy is prevention

Colonoscopy is the endoscopic examination of the large bowel and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus. http://en.wikipedia.org/wiki/Colonoscopy

This procedure is the gold standard. A flexible, lighted instrument is used to wiggle through the colon to examine the colonic surface like no other test can, take biopsies to establish diagnoses, and, most importantly, to remove polyps, through the scope, without surgical incision.

This evidence of this procedure’s superiority was first published in the New England Journal of Medicine (NEJM Dec 1993), and lit the path for colorectal cancer screening across the globe.

PREVENT COLORECTAL CANCER...GET SCOPED

W

ith almost twenty years of data from around the world, these are the lessons learnt:

World report on CRC.

1. Colorectal cancer screening significantly reduces death from colorectal cancer.

The global position, according to the World Health Organization, International Agency for Research on Cancer (GloboCan 2008) is this:

2. Screening should begin at age 50.

3. A single flexible sigmoidoscopy in persons aged 55-64 reduced the incidence (33-50%) and risk of dying from colorectal cancer (43%) after eleven years of follow-up and persists beyond that (UK flexible sigmoidoscopy screening trial).

What is flexible sigmoidoscopy?

This is a similar test to colonoscopy, but involves using a shorter scope to examine the rectum, sigmoid and left colon, the site of 50-60 percent of colorectal cancers.

|

CANCER

The western and developed world (Australia, New Zealand, Europe & North America) have the highest incidences of colorectal cancer (due to environmental factors and diet). The world’s poorest countries (Africa) have the lowest CRC rates due to dietary factors and lower life expectancy.

Where does Trinidad and Tobago stand?

The Caribbean is in the middle of the league tables with regard to incidence and mortality. Our gene pool is largely African and Indian / Asian, and we have acquired bad western habits. Lifestyle factors, poor diet, obesity, smoking, diabetes all increase our cancer risk. This has been compounded by the relative lack of CRC awareness, screening opportunities, and the tendency to ‘mind symptoms’ or seek alternative treatments (herbs, colon cleansers).

I dare to propose that, as a nation, we do the following: 1. Improve lifestyle factors (be active, avoid obesity).

2. Eat real food (like the old time days), or eat as we would have our children eat (fruits & vegetables).

3. Get screened for colorectal cancer 4. Pay prompt attention to symptoms.

This is a practical approach that can have significant impact over time.

Sigmoidoscopy is the minimally invasive medical examination of the large intestine from the rectum through the last part of the colon. Flexible sigmoidoscopy uses a flexible endoscope, and is generally the preferred procedure. A sigmoidoscopy is similar to, but not the same as, a colonoscopy. A sigmoidoscopy only examines up to the sigmoid, the most distal part of the colon, while colonoscopy examines the whole large bowel. http://en.wikipedia.org/wiki/Sigmoidoscopy

This method has been popularised and well studied by the British, because they wisely admitted that colonoscopy at a national level would be neither affordable nor practical. The UK model provides robust evidence that flexible sigmoidoscopy, saves lives, is sustainable and can be implemented on a national scale there.

In the USA, colorectal cancer incidence rates and cancer-specific mortality has dropped amongst white Americans solely due to compliance with and access to screening. This benefit has not been observed amongst African-Americans and Hispanics, due to lack of compliance / opportunity for screening.

So come on, Trinidad & Tobago, we are 50 years old now; time to

BE SCREENED & GET SCOPED! Dr. Feisal Daniel is a General Surgeon, who subspecialized in Interventional GI Endoscopy at the European Endoscopy Training Centre in Rome, Italy. At present, he is Consultant GI Endoscopist at the San Fernando General Hospital, and is Medical Director of the Colorectal Cancer Screening Centre at the Medical Associates Hospital in St. Joseph. T:223-3636 (ENDO) Email: endoscopytt@gmail.com

WARNING !

You should be concerned if you have any of the following symptoms: • • • • •

rectal bleeding a change in bowel habits persistent abdominal discomfort unexplained anaemia (low blood count) a family history of colon cancer or polyps

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SURGERY

| UTERINE FIBROID EMBOLIZATION

TO EMBOLIZE OR NOT TO EMBOLIZE...

THE CHOICE IS MINE WRITTEN BY

RESEARCH

CAROL QUASH

shows that fibroids, non-cancerous tumors that grow from the muscle layers of the uterus, affect at least 20 percent of all women at some time during their life. Women between the ages of 30 and 70 are the most likely to develop fibroids. It is also very common among Afro-Caribbean women. While some women with fibroids may not experience any symptoms, for others, like business woman Sherine Mungal, the symptoms may be debilitating.

UTERINE FIBROID EMBOLIZATION

|

SURGERY

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SURGERY

| UTERINE FIBROID EMBOLIZATION

“I didn't even know I had fibroids. I went to my GP for a regular check up and my blood work revealed that my red blood count was alarmingly low (8), placing me in an anemic (iron deficient) category and that really concerned her. I had been experiencing heavy menses over the past year, and other symptoms like headaches, extreme fatigue, racing heart, etc., all suggested that fibroids might be the reason for my anemia. An ultrasound

Mungal, an informed, modern woman, opted for UFE. "Sadly, my gyne almost cornered me into committing to doing a myomectomy. Whether his intentions were to scare me into making a decision almost right away, the thought of having a huge cut on my abdomen and multiple ones on my uterus, the possibility of having blood transfusions pre- and post-operation and having to be laid up for weeks thereafter really scared me even more. Having some small knowledge of UFE, I did ask about that as an option, but was told that since I still wanted to consider fertility in the future, it was definitely not an option for me. I didn't feel comfortable with that as I felt I needed to be more informed and so left his office and tried to educate myself on not only my condition but the all options that I should consider.

revealed that I had two 4 cm fibroids anda few smaller ones."

Interventional Radiologist Dr Nigel Hacking says fibroids can range from the size of a pea to the size of a melon, and in cases where the symptoms become overbearing, surgery may become necessary.

However, women no longer have to undergo the trauma of having invasive treatments such as myomectomy (surgical removal of the fibroids) and hysterectomy (removal of the uterus). Since 1999, Dr. Hacking has done 2,000 Uterine Fibroid Embolization (UFE) surgeries, a non-invasive procedure that blocks blood flow to fibroids in the uterus.

"UFE gives modern women another option. They have the choice of not being laid up for weeks after an invasive procedure. Once they have decided that their family is complete, UFE can become an option," he says, admitting that fertility decreases with the procedure.

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"The average age of women who do this procedure 40. These are women who are not very fertile in the first place, so they have even less chance of conceiving. For women in their 20s and 30s who opt to do UFE, their chances of conceiving decreases, but they still have a greater chance of getting pregnant than older women."

"I went on iron pills that helped to keep my hemoglobin levels up and used the next few weeks to make a decision. One of the things that stood out to me most in my research was that the risks associated with both UFE and myomectomy as far as fertility is concerned are almost on par, and that was the other and perhaps main reason for choosing the least invasive option," Mungal says.

Dr. Hacking is based at the Southampton University Hospital in the UK, and performs UFE surgeries on two days twice every year in Trinidad at St Clair Medical, through Caribbean Heart Care.

"I was absolutely surprised at how many people are looking at UFE as their option,” said Mungal. “Dr. Hacking had nine patients, including me, on day one and the same number of patients the following day. I was nervous and scared, but more importantly, anxious to get it over with so that I could have normal periods."

THE PROCEDURE

According to Dr. Hacking, the procedure is quite simple and takes 15 to 30 minutes. "The patient fasts for six hours before and is required to shave the groin area. She is given a local anaesthetic, a 1 mm micro incision is made and a flexible cathether is placed in the artery in the

UTERINE FIBROID EMBOLIZATION

groin. The progress is followed by the radiologist via a fluroscope.

"Particles of plastic or gelatin are injected into the artery that supplies blood to the fibroids, causing them to starve. Fibroids are exquisitely sensitive to losing oxygen. They die soon after," Dr. Hacking says.

THE UTERUS

The uterus, which is resistant to loss of oxygen and blood, will then rely on its blood supply from the ovaries, vagina and cervix.

"Although the procedure is virtually painless and done under sedation, when fibroids die it is very painful. The uterus has a rich nerve supply and when the fibroids die it stimulates the pain fibres in the uterus."

As a result, some patients can expect to be in quite a bit of pain for a few days following the procedure, and are prescribed painkillers, as well as antibiotics.

Mungal, however, is one of the tough ones. "After the surgery I was relieved. There was some discomfort, but hardly any pain. I was able to move around the following day, although a bit drowsy from the meds," she says. She was discharged two days after.

"Patients are usually required to stay one to two days in the hospital, and after that they can leave and resume their normal lives. They can go back to work, eat as normal, have sex. But I always ask the women to wait until they leave the hospital to have sex," Dr. Hacking says with a chuckle.

"Husbands and employers procedure," he adds.

will

love

|

SURGERY

into the body. After six months a scan will show that fifty percent of the mass is gone. After one year, sixty percent, until it’s all gone," he says.

But for some women it may not be that simple.

"Sometimes fibroids lying very close to the womb can pass through the vagina. And although it is not risky, it can be unpleasant."

Dr. Hacking assures that death stemming from UFE is minimal-one in 30,000. He says following the procedure, in addition to the pain, the patient may have a vaginal discharge for about a week or two, and women over 45 may risk going into menopause, if they are not already there.

"UFE is successful in 90 percent of patients, and there is a 20 percent chance that the fibroids may return. But it all depends on the age of the patient and the number of fibroids she had," he explains.

Mungal is grateful that she was able to explore all her options before making an informed decision, and encourages other women to do the same.

"My disappointment in my own gyne and others whom I have heard about is justified. It seems that once they do not offer or are not trained or educated enough on the UFE procedure they tend to dissuade their patients from it and try to compel them to choose of the two very invasive options, hysterectomy or myomectomy. I urge women to consider all the options available to them, and, unless their condition is life-threatening, take the time to learn more about UFE," Mungal emphasizes.

this

Although the fibroids don't go away immediately, within a month or two the symptoms begin to improve. "They (the fibroids) shrivel over the course of the next few weeks and are reabsorbed

For more information on UFE visit Dr Hacking's Websites at www.fibroidcaribbean.com www.ukfibroidexperts.com

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FEATURE

| ROBOTIC SURGERY

STUDY THE SCIENCE OF ART AND THE ART OF SCIENCE. FURTHERMORE, MAY YOUR WORK BE IN KEEPING WITH YOUR PURPOSE AND DESIGN. LEONARDO DA VINCI, 1452-1519

ROBOTIC SURGERY ALMOST FIVE CENTURIES LATER, I WONDER IF LEONARDO DA VINCI, CREDITED WITH INVENTING THE FIRST ROBOT, EVER IMAGINED HIS WORKS OF ART WOULD END UP REVOLUTIONIZING THE SCIENCE OF MINIMALLY INVASIVE SURGERY.

WRITTEN BY MEZAAN

BELJIC

ROBOTIC SURGERY

|

FEATURE

Aptly named after the genius, the Da Vinci Surgical System is a robotic-assisted surgical system that was approved in the USA in 2000, initially for adult and pediatric urologic and abdominal surgeries. This modern system is now used for more complex operations, including complete removal of the diseased prostate, uterus, or gallbladder. Successful lung cancer surgery, weight loss surgery, and cardiac mitral valve repair have been documented as well using robotic assistance.

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FEATURE

| ROBOTIC SURGERY

SO WHAT EXACTLY IS ROBOTIC-ASSISTED SURGERY? LET’S FIND OUT! To learn more about this fascinating technology, I had the pleasure of interviewing Ricardo Estape, M.D., Director of Robotics at Baptist Health and South Miami Hospital Center for Robotic Surgery.

Dr. Estape and his team of specially trained surgeons have performed more than 3,500 various robotic surgical procedures since 2006.

HOW DOES IT WORK?

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Well, think less of R2D2 and more of a side cart with arms. The robot side cart is equipped with four arms which are stationed by the surgical team over the operating table. One arm is equipped with a camera and the other three arms have surgical instruments attached. Several small open incisions are made by the surgeon, through which the robotic arms operate.

The robot, however, does not operate on its own. It is basically an extension of the surgeon’s hands and feet. The surgeon sits comfortably at a nearby console and uses his/her hands and feet to direct the robotic arms while watching a three dimensional, magnified view of the body on a monitor. Generally, the right foot controls manage the energy supply to the instruments needed to cauterize, coagulate, or cut tissue. The left foot controls help manipulate and zoom the camera.

WHAT ARE THE BENEFITS OF ROBOTIC SURGERY? When compared to open/ traditional surgery, robotic surgery results in less blood loss (by 10-fold) and, consequently, fewer blood transfusions.

Recovery is quicker, with shorter hospital stays and faster return to work and activities of daily living.

Due to smaller, more precise incisions, there is less pain and scarring. Also, according to Dr. Estape, “in many cases [the surgeon can perform] a more radical procedure for cancer as you can do more microscopic surgery to get wider margins on cancers. Therefore, the efficacy is the same or better. The outcomes are definitely better.”

Robotic-assisted surgery is not the only minimally invasive surgical option available, but when compared to laparoscopic surgery, which uses a long, stiff fiber optic scope, it becomes clear that the robotic system has multiple advantages.

Robotic-assisted surgery provides 3-D magnification (up to 10x) which means, for example, the surgeon can see blood vessels and lesions not visible to the human eye. Laparoscopy, according to Dr. Estape, provides a 2-D view and 3-4x magnification. Unlike the laparoscope, the robotic arm instruments are wristed; meaning they can rotate 360 degrees, more like the human hand. This results in increased dexterity and precision while suturing or cutting around obscure tissue. Additionally, Dr. Estape appreciates “the steady camera view as the robot holds the camera in one place and is not shaking around like in laparoscopy cases. The surgeon is sitting in a comfortable, ergonomic position and has control of 4 arms and not just 2 as in laparoscopy.”

“All of these benefits,” he states, “add up to being able to do more radical procedures for the patient and converting more open cases into minimally invasive cases.”

ROBOTIC SURGERY

|

FEATURE

WHAT DO THE CRITICS SAY? Some claim long-term studies which indicate better results compared to laparoscopic surgery are lacking. Comparatively, Dr. Estape states, the two minimally invasive options are similar with regards to recoveries, blood loss, and pain “but you cannot tackle the bigger cases laparoscopically and therefore you can offer more patients minimally invasive surgery robotically.”

If you are wondering how many cases start out minimally invasive and ultimately finish with a traditional/open approach, Dr. Estape maintains, “in my practice, it is less than 1%. If you look at published data, conversion from laparoscopy to open is 25%. Conversion from robotic to open is less than 5%. This shows that you can do more robotically than laparoscopically.”

In some instances, robotic surgery can add 20-30 minutes to a case, but as Dr. Estape points out, “if these 20-30 minutes allow patients to go home 2-3 days sooner with much less pain, then do those minutes matter?” Furthermore, he states, “robotic surgery is as fast if not faster than open surgery or laparoscopic surgery because of the ability to use 4 arms and have wristed instruments.”

Certainly, the length of the surgery is dependent on the experience of the surgeon as there is a steep learning curve for surgeons utilizing the robotic-assisted surgical system. More and more surgeons, however, are being trained on the Da Vinci Surgical System early in their careers as it is used increasingly for larger, more complex cases that cannot be handled laparoscopically.

It is quite costly to acquire and maintain the Da Vinci Surgical System. The cost effectiveness for hospitals and surgeons to adopt the system can be uncertain despite the numerous advantages of the robotic system and improved outcomes.

Regardless, more and more organizations are purchasing the system and offering this minimally invasive option for a variety of surgeries.

For more information on the da Vinci Surgical System and to view real life patient stories as well as video of the robot in action, visit www.southmiamirobotics.com.

You will be amazed to see how steadily and precisely the robot peels a small grape and draws an image on the head of a thumbtack. To find out if minimally invasive robotic assisted surgery is an option for you, contact the following: For physician referrals, coordination of medical appointments or other medical inquiries, contact 786-596-2373, email international@baptisthealth.net or visit BaptistHealth.net/international.

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AIR QUALITY

| INDOOR AIR QUALITY

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AIR QUALITY

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AIR QUALITY

| INDOOR AIR QUALITY

Good indoor air quality: exactly what is it?

What is the definition of good indoor air quality? The American Society of Heating, Refrigeration, and Air-conditioning Engineers (ASHRAE) et al 2007 defines acceptable indoor air quality (IAQ) as “air in which there are no known contaminants at harmful concentrations as determined by cognizant authorities and with which a substantial majority (80% or more) of the people exposed do not express dissatisfaction.”

The problem with this definition is that in non-industrial environments such as offices, contaminants are rarely present in levels that are known to be harmful, even in instances where 20% of occupants may be experiencing symptoms.

What we need to take from this definition is the importance of ensuring that the quality of our indoor air meets recognized standards and guidelines and provides for the health and comfort of occupants.

Why do I feel this way whenever I’m at work?

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Those symptoms such as skin rashes and itching, runny eyes, coughing, sneezing, lethargy and tiredness may not all be related to the boss or job stress. Certain indoor spaces may present the right environment for conditions which contribute to or create these symptoms.

There are diseases clearly related to building occupancy; these include: + Hypersensitivity diseases such as allergic rhinitis or hay fever and hypersensitivity pneumonitis. + Humidifier fever, which is characterized by flu-like symptoms, lethargy, myalgia, fever and arthralgia (neuralgic pain in joints). These symptoms usually appear on initial exposure such as on the first day of the work week and improve during the week. + Allergic asthma due to exposure to dust, animal fur/feathers, mould and pollen. + Infectious diseases such as tuberculosis, influenza, Legionnaires’ Disease and measles + Toxic syndromes resulting from exposure to specific chemical agents such as carbon monoxide, pesticides (eg. Malathion), or microbial toxins. + Long-term exposure to indoor air quality contaminants, such as radon and environmental tobacco smoke (ETS) can increase the risk of developing lung cancer.

Many persons are now more familiar with the term sick building syndrome or SBS in terms of health effects of air pollutants. According to Hansen et al, 2008 “A building is said to be ‘sick,’ when 20 percent or more occupants voluntarily complain of discomfort symptoms for periods exceeding two weeks, and affected occupants obtain rapid relief away from the building.”

It should be noted that SBS is not a medically diagnosable condition, but as the name implies, is a syndrome where several occupants experience these symptoms.

How can I tell if my building is sick?

SBS shows up as a set of ailments that seem to flare up when you are in a particular building and are generally relieved once you leave that building.

Common symptoms of SBS include nasal irritation, sinus congestion, eye irritation, chronic fatigue, dry skin, dizziness, nausea, headaches and non-productive cough.

You can also determine whether the building is “sick” by speaking to colleagues that work in the same area as you, and learning whether they suffer from similar symptoms.

An appointment with your family doctor or physician in order to verify if your symptoms are exclusively related to your presence in the building or whether you may be suffering from another ailment is always a useful option.

Remember, when communicating symptoms to your doctor, try to include all of the symptoms that have occurred within recent months (since symptoms of SBS often occur at different times, making it easy to be passed off as unrelated).

Some common sources of poor indoor air quality The above symptoms and diseases may be caused by numerous contaminants beyond the scope of this article. However, broad categories of sources of indoor air quality contaminants are listed on the following page:

INDOOR AIR QUALITY

+ Occupants: occupants can introduce contagious diseases, allergens and fungal spores on clothing and tobacco smoke into building + Building components such as new office furniture can themselves become indoor air quality pollutants by releasing volatile organic compounds (VOCs) and formaldehyde, for instance. Asbestos insulation can release fibres into the air. + Contaminated building components—building components in contact with microbial agents, allergens and pesticides—can also become sources of air pollutants. + Outdoor air introduced into a building can be the source of chemical air pollutants, microorganisms, allergens and radon. + HVAC (Heating, Ventilation and Air-conditioning) Systems in Buildings: In T&T we focus primarily on the VAC aspect of these systems. These can distribute dust or dirt in ductwork or other HVAC components, and may provide a moist environment for microbiological growth in drain pans, humidifiers, ductwork and coils. It has been our experience here at CARIRI that many symptoms of poor IAQ (and ensuing SBS) occur as a result of faulty, ill-maintained and poorly designed HVAC systems.

So, what can I do?

Many of us are not aware our actions can affect the quality of the indoor air and can pose a serious threat to our health. So what can we do to decrease the risk of developing a building-related disease?

Some simple steps are to use building materials that have minimal impact on occupants (such as low-VOC-emitting paints). Also, the scheduling of renovations, carpeting, carpet and duct-cleaning and painting, for example, should be conducted in the building during periods of zero occupancy to prevent exposure of persons to potential contaminants and irritants.

Proper maintenance of buildings, which includes servicing of the air-conditioning and ventilation system on a regular basis, implementing a proper housekeeping programme and addressing moisture leaks and water problems as soon as they occur cannot be overemphasized.

Training of facility managers and maintenance personnel on the importance of all the above should be provided to prevent and respond to IAQ problems.

Since occupants themselves can be sources of IAQ problems, they should be informed of good IAQ practices, sources of contaminants, good housekeeping practices, as well as what to do and whom to contact in the event of an IAQ issue.

Building occupants should also be more proactive in dealing with IAQ problems. Your health is ultimately your responsibility. If you observe a stained ceiling tile or a strange odour in your home or building, speak to the building maintenance manager about it. Also ask those responsible for building maintenance when was the last time the carpet was shampooed or the HVAC system is serviced. These simple observations and questions can go a long way in preventing the onset of building-related diseases.

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AIR QUALITY

The science behind it IAQ building investigations may involve a simple investigation to complex diagnostics and post-treatment monitoring.

Monitoring for carbon dioxide may be conducted to determine ventilation effectiveness, while monitoring for specific contaminants such as particulate matter (dust), airborne fibreglass, VOCs, fungal spores, temperature and relative humidity may be necessary, all depending on the complaints received.

The Caribbean Industrial Research Institute (CARIRI) has developed expertise in monitoring a range of indoor air quality indicator parameters as well as recommending measures to restore the quality of air you breathe indoors. CARIRI also conducts ventilation and air-conditioning inspections to identify any shortfalls and to ensure that the air-conditioning systems are properly maintained and operated.

Indoor air quality can indeed pose a silent threat to our health. However, by being aware of its importance and causes, we can control the quality of the indoor air that we breathe on a daily basis.

Courtesy the Air Quality Management Services Group of CARIRI – Caribbean Industrial Research Institute www.cariri.com References: 1. American Society of Heating, Refrigerating and Air-conditioning Engineers, Inc. (ASHRAE) ANSI / ASHRAE Standard 62.1-2007, Ventilation for Acceptable Indoor Air Quality, United States of America, 2007.

2. Burroughs, H.E.; Hansen, J. Shirley. 2008. Managing Indoor Air Quality, 4th ed. The Fairmont Press, Inc. 3. U.S. Environmental Protection Agency, Building Air Quality; A Guide for Building Owners and Facility Managers, United States of America, 1991.

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PUMPKIN

| PUMPKIN POWER

WRITTEN BY CAROL

QUASH

PUMPKIN POWER

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PUMPKIN

WHILE THE PUMPKIN TAKES THE SPOTLIGHT IN NORTH AMERICA AT HALLOWEEN TIME IN THE FORM OF SPOOKY JACK-O’-LANTERNS, HERE IN THE CARIBBEAN IT GRABS ATTENTION ALL YEAR ROUND WITH ITS DELICIOUS, NUTRITIOUS AND AESTHETIC TRAITS.

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PUMPKIN

| PUMPKIN POWER

PACKED WITH POTASSIUM, THE PUMPKIN AIDS IN BALANCING THE BODY'S FLUID LEVELS, BUILDS STRONG BONES, BOOSTS FOR ENERGY PRODUCTION, AND HELPS TO CONTROL BLOOD PRESSURE...

never eat roti without a pumpkin talkari on the side, neither do I make callaloo without adding the rich orange-coloured vegetable to the mix. It gives a rich texture, colour and taste to my soups, and assures that my pelau always appears festive and delicious. And don't talk about the creamy goodness of a pumpkin punch poured over crushed ice, a delicious pumpkin smoothie on a hot day, or a huge slice of pone with the orange tell-tale signs.

I

The pumpkin is a member of the Cucurbita family, as are squash and cucumbers. A native to North and Central America, it has since been cultivated around the world. The vegetable got its name from the Greek word “pepon”, which means large melon. And it’s no wonder, for the pumpkin is 90 percent water. But in addition to its good looks and great taste, it contains a number of valuable nutrients.

It is very low in calories and contains no fats or cholesterol. It is a rich source of dietary fibre, anti-oxidants, mineral and vitamins: + + + +

Alpha-carotene Beta-carotene Fiber Vitamins C and E

+ Potassium + Magnesium + Pantothenic acid

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The potent antioxidants, alpha-carotene and beta-carotene, found in pumpkin, are pro-vitamin A carotenoids, which means the body converts them to vitamin A, the vitamin that promotes healthy vision and proper functioning of the immune system

S

kin damage caused by the sun may be erased by the beta-carotene in pumpkin, as it acts as an anti-inflammatory.

Alpha-carotene slows the aging process and reduces the risk of cataract development and aids in the prevention of tumor growths.

An excellent source of fibre, the pumpkin helps reduce levels of bad cholesterol, protects the body against heart disease, controls blood sugar levels, promotes healthy digestion, and plays a major role in weight loss.

It is a storehouse of Vitamin C, which boosts immunity, reduces the risk of high blood pressure and heart disease, and regulates cholesterol levels. The Vitamin E in pumpkin promotes healthy skin by protecting the body from sun damage and may reduce the risk of Alzheimer's disease and certain cancers. Packed with potassium, the pumpkin aids in balancing the body's fluid levels, builds strong bones, boosts for energy production, and helps to control blood pressure. Meanwhile, its rich magnesium content promotes a healthy immune system, strengthens the bones, and aids in the normal functioning of the heart. The pantothenic acid, or vitamin B5 found in pumpkin, helps balance hormone levels and manage stress.

But the flesh of the pumpkin is not the only part that is nutritious. Pumpkin seeds also contain essential vitamins and minerals. They are a good source of vitamin E, iron, magnesium, potassium, and zinc, and are an excellent plant-based source of omega-6 and omega-3 fatty acids.

PUMPKIN POWER

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PUMPKIN

THE NUMEROUS VALUES OF THE PUMPKIN DATES BACK THOUSANDS OF YEARS. NATIVE AMERICAN TRIBES USED THE SEEDS TO TREAT BURNS AND WOUNDS, KIDNEY AND URINARY TRACT PROBLEMS...

T

he other parts—leaves and flowers, are also edible and contain as much nutrients as the flesh and seeds. The leaves are used in herbal medicine and the yellow blossoms are still used as medicine in some native traditions. In China they are consumed as cooked greens or in soups.

The numerous values of the pumpkin date back thousands of years. Native American tribes used the seeds to treat burns and wounds, kidney and urinary tract problems, to get rid of intestinal worms in children, and to ease menstrual cramps and discomfort.

Pumpkins are readily available year-round and a fully ripened pumpkin can be stored for many weeks at room temperature in cool, well ventilated places. When cut, though, it should be kept in the refrigerator, where it will keep for a few days.

Pumpkin can be used in various recipes— baked, stewed, fried. However, its maximum nutrients can be derived when eaten steamed. Pumpkin seeds can be eaten as a snack, used to top salads or added to sautéed vegetables. Pumpkin-seed oil can also be used in cooking or as a salad dressing.

But for all its aesthetics and nutritional value, for me the top pumpkin moment comes with the huge smile and the look of love my four-year-old son flashes at me when I greet him with an endearing, “Hello, Pumpkin”.

PUMPKIN TALKARI RECIPE 3-4 lbs pumpkin (peeled and cubed – 1 inch pieces) 1/2 medium onion (divided) 1/2 hot pepper (to control heat, don’t use the seeds or inside ribs of the pepper) 3 cloves garlic, chopped fine or crushed 1 tablespoon olive oil (extra virgin works best as it gives it a nutty flavour) 1 teaspoon salt (check at the end of cooking to add more if needed) 1/2 teaspoon golden brown sugar METHOD 1 Peel, cube and wash the pumpkin and drain off the excess water.

2 In a deep pan, heat the oil on medium heat and add 1/4 of the sliced onion. Cook this for a couple minutes (until soft), then start adding the cubed pumpkin.

3 Add the rest of the ingredients, stir. Cover and allow to simmer (low heat – covered) for about 30 minutes or until the pieces are tender and start to melt. You will notice that it will spring its own natural juices; the key at the end is to ensure all of this is burnt off. After the 30 minutes or so you’ll need to use the back of your cooking spoon to gently crush any of the pieces that may still have the cubed shape (cook last few minutes with the lid off). Don’t forget to check for salt.

Nutrition Facts

Serving Size : 245g, boiled, drained, without salt Amount per serving Calories 49 Total Fat 0g Saturated Fat 0g Cholesterol 0mg Sodium 2mg Total Carbohydrates 12g Dietary fibre 3g Sugars 2g Protein 1g Vitamin A Calcium

245% 4%

Calories from fat 1 % Daily Value* 0% 0% 0% 0% 4% 11%

Vitamin C Iron

19% 8%

* Percent Daily Values are based on a 2,000 calorie diet.

Your daily values may be higher or lower depending on your calorie needs.

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SURGERY

| A SURGICAL PROCEDURE TO CURE ATRIAL FIBRILLATION

a surgical procedure to cure

Atrial Fibrillation WRITTEN BY DR

RANDOLPH RAWLINS MBBS, FRCS, FRCS CTH CONSULTANT CARDIOTHORACIC SURGEON

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Atrial fibrillation (AF or A-fib) is the most common cause of an irregular heart beat or arrhythmia in adult medical practice.

It affects 1% to 4% of the population, with the incidence increasing to 6% to 10% above the age of 65.

A SURGICAL PROCEDURE TO CURE ATRIAL FIBRILLATION

AF is linked to several cardiac conditions, but may occur in otherwise normal hearts as lone A-fib.

Primary heart diseases include: • Coronary artery disease, • Mitral stenosis (e.g. due to rheumatic heart disease) • Mitral valve prolapse • Mitral regurgitation, hypertrophic cardiomyopathy (HCM), pericarditis, congenital heart disease, previous heart surgery • Aortic valve stenosis or regurgitation.

• Hypertension (high blood pressure) A family history of AF may increase the risk of AF. A study of more than 2,200 AF patients found that 30 per cent had parents with AF. Various genetic mutations may be responsible More than 2.5 million people are affected by this condition in the United States, with 360,000 new cases annually. Untreated, atrial fibrillation patients are at a 4% to 12% annual risk of developing a stroke.

This is reflected by the CHADS risk score which is influenced by the number of pre-existing conditions.

Twenty five percent of patients who develop a major stroke are at risk of death. Chronic AF also increases the chances of heart failure.

SURGERY

The normal heart beat has its origin in the sinuatrial node (SA). Electrical impulses spread from the SA node to left and right atria (the upper chambers of the heart) then via the AV node, into the ventricles or lower chambers of the heart.

Mechanism Atrial fibrillation results from a disorganized uncoordinated transmission of electrical impulses and abnormal reentry pathways between chambers of the heart.

Classification AF may be paroxysmal, persistent or permanent.

Paroxysmal AF may lasts minutes but less than 7 days and is self-terminating. Persistent AF requires medical intervention or extends beyond 7 days, and permanent AF is an acknowledgement of failed medical therapy, and longstanding cases usually extend beyond 1 year.

Non-Surgical Treatment

Symptoms

The mainstays of AF treatment for many years were antiarrythmic medication, warfarin and electrical cardioversion. Long term antiarrythmics are not without side effects and warfarin therapy is associated with a bleeding risk of approximately 1% to 2% per year.

Patients in AF are asymptomatic, meaning they have no symptoms and are diagnosed incidentally on ECG. AF, however, is often associated with symptoms such as palpitations, fainting, chest pain, dizzy spells, blackouts or syncope, shortness of breath, difficulty breathing or poor exercise tolerance.

Only 15% of patients in AF treated with medical therapy and cardioversion experience successful restoration of sinus rhythm. This has forced some clinicians to accept rate control over rhythm control but this has no survival advantage.

AF is a source of major healthcare cost. In the USA Medicare alone pays $15.7 billion annually treating newly diagnosed AF and $8 billion annually to treat strokes in patients with AF.

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Surgery

History

Advances in surgical technology has made it possible to cure AF using the Radiofrequency Ablation Maze procedure, with a success rate of 90% to 92%. The Maze procedure is recognized as the most effective surgical treatment of AF.

Eliminating AF has presented a challenge for medical practitioners for many years. Early descriptions of AF date back to the 1870s when it was termed “delirium cordis”, but it was not until 1906 that Eintoven published the first ECG demonstrating AF.

The Cox Maze procedure was developed by James Cox, Professor of Cardiothoracic Surgery, formerly at Duke University Medical Centre in the United States of America.

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SURGERY

| A SURGICAL PROCEDURE TO CURE ATRIAL FIBRILLATION

Surgical ablation involves the use of radiofrequency waves to create multiple trans-mural scar lines to redirect the erratic electrical impulses of AF to follow a normal electrical pathway through the heart.

The objectives of surgical ablation are: 1. Restoration of normal sinus rhythm 2. Heart rate control with improvement in blood pressure and cardiac output.

3. Prevention of thrombo-embolism or clot formation and stroke.

The majority of patients with structural heart disease and AF remain in AF after the structural defect has been corrected. This increases mortality.

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Surgical ablation is effective and can be performed as a standalone procedure in patients who present with lone AF or patients with AF undergoing open heart surgery for valvular heart disease, coronary artery disease or other structural abnormalities.

After successful surgical ablation there is a 47% reduction in antiarrythmic medicine use and as much as 70% of patients have been able to discontinue anticoagulation at follow-up. There is also significant stroke reduction in people with AF who undergo surgical ablation compared to those did not have the procedure. This procedure is regularly performed at Hospitals in Europe and North America.

Conclusion Surgical Maze Ablation to eliminate atrial fibrillation is available in Trinidad & Tobago. It is safe & effective, improves quality of life and carries minimal risk.

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 The record for the longest period without sleep is 18 days, 21 hours, 40 minutes. The record holder reported hallucinations, paranoia, blurred vision, slurred speech and memory and concentration lapses.

2 It's impossible to tell if someone is really awake without close medical supervision. People can take cat naps with their eyes open without even being aware of it.

6 The "natural alarm clock" (which enables some people to wake up more or less when they want to) is caused by a burst of the stress hormone adrenocorticotropin.

Researchers say this reflects an unconscious anticipation of the stress of waking up.

7 Alcohol consumption may help you get to sleep but it will be a light slumber and you won't dream much.

3 Anything less than five minutes to fall asleep at night means you're sleep deprived. The ideal is between 10 and 15 minutes, meaning you're still tired enough to sleep deeply, but not so exhausted you feel sleepy by day.

8 Ten per cent of snorers have sleep apnea, a disorder which causes sufferers to stop breathing up to 300 times a night and significantly increases the risk of suffering a heart attack or stroke.

4 A new baby typically results in 400 to 750 hours lost sleep for parents in the first year.

9 Most of what we know about sleep we've learned in the past 25 years.

5 REM sleep occurs in bursts totaling about two hours a night, usually beginning about 90 minutes after falling asleep.

10 Experts say one of the most alluring sleep distractions is the 24 hour accessibility of the Internet.

FOOD

| GENE GUNS, CODE SCRAMBLERS AND MUTANT FOOD

GENE GUNS, CODE SCRAMBLERS AND MUTANT FOOD

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FOOD

GENE GUNS,

CODE SCRAMBLERS AND

MUTANT FOOD. WRITTEN BY DR.

AMANDA JONES

If I said I’d just blasted avocado cells with a gene gun, spraying tiny gold particles coated with fish DNA (protected with an

antibiotic resistant marker gene and armed with a promoter from a cabbage virus), you might be quite alarmed. If I told you this new avocado was safe, would you want documented evidence of its safety?

Let’s look at the safety concerns that surround genetically modified foods.

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FOOD

| GENE GUNS, CODE SCRAMBLERS AND MUTANT FOOD

HOW ARE PLANT CELLS GROWN IN A LAB? Plant cells are isolated and grown in tissue cultures. After transgenes are inserted, the cells are replaced in tissue culture, and allowed to develop into new plants. Tissue culture may also be used when cloning the transformed plants.

Unfortunately, plant cells grown in tissue culture suffer several mutations. These mutations alter RNA and protein production.

Transposons are at least partly to blame.

HOW ARE TRANSGENES INSERTED? One approach is to use a bacterium that in nature causes plants to grow tumours. The tumour producing part of the bacterial DNA is replaced by the transgenes. The transgenes are then incorporated into the plant genome.

Another approach is to coat tiny particles of tungsten or gold with millions of transgenes and shoot them into plant cells at high speed. Only a minority of millions of target cells incorporate the foreign gene.

HOW ARE THE MODIFIED CELLS SEPARATED FROM THE UNMODIFIED ONES AFTER GENE INSERTION?

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The cells are flooded with high concentrations of antibiotics, which kill all the cells - except those with the transgene. How? Transgenes come with ARMS or

Antibiotic Resistant Markers genes. The ARM gene protects the transgene cells from otherwise deadly antibiotics. So the modified cells are the ones that survive.

So cells chosen because of successful gene insertion will have common active transgenes but the other changes to their genome and the insertion point of their transgene would vary.

HOW DO SCIENTISTS ENSURE PRECISION AND CONSISTENCY WHEN THEY USE A GENE GUN?

HOW EXTENSIVE ARE THE CHANGES ON THE ORIGINAL PLANT GENOME?

They can’t. It’s impossible to recreate the random process of gene gun particle insertion. Each event creates a different and unpredictable result. Many of the new organisms generated are useless, as the traits sought, even after successful gene insertion, are not always produced.

Research shows that the natural gene sequence is disrupted 27-67% of the time. New genomes can have additional fragments of transgenes, re-arranged chromosomes, multiple copies of transgenes and deleted genes. In one study of 112 GM plants, these insertion mutations were found in 100% of the plants!

Successful gene insertion is less than straightforward.

Only insertion in specific areas of the genome will allow the new gene to be activated. To further complicate the process, successful insertions come with their own “side effects”. Think of the side effects as additional changes which were not intended but occur anyway. Just as side effects to drugs vary between unique human beings, gene insertion and the “side effects” vary between cells.

WHAT DO WE MEAN BY “SIDE EFFECTS” TO GENE INSERTIONS? Since genes determine protein production, the side effects lead to changes in the proteins produced in the new organism.

The “What, When and How Much” questions of the plant’s protein production can now have radically different answers.

WHY WOULD PLANT CELLS RESPOND TO FOREIGN INSTRUCTIONS? The use of promoters, such as CaMV (Cauliflower Mosaic Virus) promoter, as part of the transgene, allows the cells’ built-in defence against the activation of foreign DNA to be overcome.

In nature, genes are switched “on” and “off” as needed. Promoters create a permanent “on” switch so that the plant continually produces the novel protein commanded by the new transgene.

The CaMV has been shown to switch “on” native genes up and down the length of the plant genome and not merely the transgene that it was meant to promote! GM foods can therefore have new properties besides the ones intentionally generated.

GENE GUNS, CODE SCRAMBLERS AND MUTANT FOOD

Common transgenes in cotton and corn are those which order the production of the Bt toxin, a bacterial toxin which acts as a self-generated pesticide. Under the influence of the CaMV promoter, these plants produce their pesticide continuously.

The RNA is a bit like a restaurant menu. Think of the code scrambler as the waiter taking your orders from the menu and ensuring that you get what you want, rather than something else on the menu.

GLOSSARY DNA: an extremely long molecule found in cells of most living things, made of repeated and varying sequences of only four units. (The units are known as bases).

The sequence pattern varies from person to person and from species to species. Of at least 3 billion base pairs in humans, only 3% represent genes.

The orders for pesticide production never get switched off.

WHAT HAPPENS WHEN CODE SCRAMBLERS MEET THE TRANSGENE INTRODUCED BY THE LABORATORY? IS THE RNA EVER RESCRAMBLED TO CREATE A NEW PROTEIN THAT WAS NEVER INTENDED?

Genes: the parts of the DNA molecule that instruct or code for the creation of proteins.

THE MORE WE KNOW, THE MORE WE RECOGNIZE THAT WE DON’T KNOW. When GM food technology was conceived there was a lot we did not yet know about genetics.

Decades later, despite progress, there remains much to understand about molecular genetics.

We still don’t know the function and potential disruptive possibilities of disturbing large stretches of dormant DNA. Remember, only about 3% of our genome are functional genes.

Much of the rest of the genome is as yet not fully understood.

However, this 97% is vulnerable to gene insertions, deletions and rearrangements when new genes are inserted. The consequences of this are both unknown and unpredictable.

Code scramblers, properly called “spliceosomes”, take RNA generated by our genes and rearrange it. Each arrangement allows different proteins to be produced from the same RNA.

Unfortunately, testing of new GM organisms does not mandate that any new proteins be discovered, measured or tested.

DNA chip monitoring shows that 1 in 20 genes in GM crops are creating increased or decreased proteins compared to the original crops. The argument that GM foods are fundamentally the same as non-GM food is questionable.

Joseph Cummins, Professor Emeritus of Genetics at the University of Western Ontario, has this to say, “The bio-technology industry is based on science that is forty years old and conveniently devoid of more recent results…What the public fears is not the experimental science but the fundamentally irrational decision to let it out of the laboratory and into the real world before we truly understand it.”

Do you find this disturbing? If so, be sure to pay attention to what is happening in the world of GM food. You need to decide if and how you will take a stand.

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FOOD

Genetically Modified (GM) food: food or additives from plants or organisms with modified DNA due to laboratory gene insertion.

Genome: the full DNA code common to a specific species.

Proteins: produced from combinations of amino acids. Enzymes, hormones and our bodies’ integrated organ systems all require constant and precise protein production.

RNA: represents the orders of the gene, almost like a manager. These shorter strands are made of base units, (like DNA) and are produced by active genes. RNA specifies the details of amino acid production: if, when and how much.

Transgene: (i)The gene sequences created artificially for insertion into a species and (ii) the new genes that result after insertion.

Transposons: virus-like structures found within plant DNA that rarely activate in nature. Tissue culture seems to act as a stressor, awakening the dormant transposons into activity, which leads to mutations.

Promoters: in nature promoters are the parts of the genome that help determine which genes should be active at what time.

Genes can be switched on or off. When transgenes are inserted they must include a promoter in order for their new function to be activated.

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THE X FACTOR

| THE UNEXPLAINED INDICATOR FOR PHYSICAL AND ATHLETIC GREATNESS

A BUDDHIST MONK PERFORMS ONE-FINGER HANDSTANDS… A POWER-LIFTER SQUATS TWICE HIS BODY WEIGHT… A SPRINTER, WHOSE PERFORMANCE HAS BEEN MEDIOCRE ALL SEASON, PULLS AHEAD OF EVERYONE ELSE TO WIN THE 200M SPRINT…

THE FACTOR WRITTEN BY ROBERT

TAYLOR

THE UNEXPLAINED INDICATOR FOR PHYSICAL AND ATHLETIC GREATNESS.

THE X FACTOR

| THE UNEXPLAINED INDICATOR FOR PHYSICAL AND ATHLETIC GREATNESS

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THE X FACTOR

| THE UNEXPLAINED INDICATOR FOR PHYSICAL AND ATHLETIC GREATNESS

We’ve all seen it happen. Defying reason, exceeding expectations, and at times even challenging the laws of physics - tremendous althletic feats are accomplished by the human body.

How is it possible? What generates that extraordinary burst of power, and how can it be quantified?

Some persons may refer to this as “THE X-FACTOR”

THE X-FACTOR

In the early twentieth century, the expression “the X-factor” was coined. In general terms, “the X-factor” can be used to describe an unknown and unexplainable quality of a person or thing that adds immeasurable value. As it is applied to athletic feats, “the X-factor” is the unexplainable element that may be responsible for one’s success.

Many great athletes spoke about the X-factor; Arnold Schwarzenegger spoke about the power of the mind as it relates to shaping and sculpting the body, and this is what set him apart from other bodybuilders.

Dwight Phillips, world-class long jumper, believed in the role of destiny and divine intervention in achieving sports greatness. Sports journalist David Epstein discussed the role of biological or genetic factors as key elements in the evolution of athletic performance.

Could the X-factor be genetic? To what extent are genetics ingrained in our degree of physical ability? Or should it be attributed to psychological factors? We may even consider the role of destiny – is greatness predestined?

THE X-FACTOR: GENETIC X

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The genetic X-factor is more tangible than the other factors. This can be seen in sports such as horseracing, where studs are chosen to breed due to their favourable genetics. With humans, this type of breeding to achieve superior performance is not practiced in such a strategic manner; if it were, there would be numerous little Usain Bolts running around Jamaica… literally!

Nevertheless, genetics influence strength, muscle size and muscle fibre composition (fast- or slow-twitching fibres), anaerobic threshold, lung capacity, flexibility, and, to some extent, endurance.

For instance, athletic performance in a particular sport is often dominated by those with a similar genetic background. As Epstein pointed out, long-distance running is by far dominated by those of East African descent, and it is mainly Kenyans from the Rift Valley, the Kalenjins, that hold the world records in this sport.

Epstein also noted that middle-distance running is better distributed in terms of records held, although these races are most prominently won by those of North African descent. Sprinting, on the other hand, is dominated almost exclusively by West Africans, whose ancestors can be traced to Senegal, Cameroon or countries within that region.

Furthermore, Caucasians – particularly Scandinavians – dominate sports such as weight-lifting, power-lifting, throwing sports and many other strength and power-oriented sports.

While these examples are not the hard-and-fast rule, it cannot be denied that the history of superior sport performance may coincide with the genetic X-factor. Of course, there are exceptions whereby elite athletes prevail despite the genetic odds being stacked against them.

So, in theory, if we wanted to engineer a genetically superior athlete that was both strong and fast, we would “cross-breed” a Scandinavian power-lifter with an East African sprinter. Though this is a very simplistic view; if this thinking were applied practically, it would be highly unlikely to get a “dud”!

THE X-FACTOR: PSYCHOLOGICAL X

Another factor often attributed to superior athletic performance is psychology. Psychological factors can influence analytic and tactical ability, motivation and self-confidence, coping with pressure, and psychoneural factors. Analytic and tactical abilities influence a person’s reaction to a situation. These abilities, while more pronounced in some than others, can be learnt.

THE X FACTOR

| THE UNEXPLAINED INDICATOR FOR PHYSICAL AND ATHLETIC GREATNESS

For instance, a child of an ancient warrior tribe will grow up in an environment where he is forced to think in order to survive; this mentality may be reflected in sporting endeavours through tactical application.

Being motivated (either internally or externally) and having self-confidence can also result in sporting glory and extreme levels of physical fitness, as a well-adjusted person is likely to be better able to focus in order to achieve a higher degree of self-efficacy than another person who may be lacking in this aspect.

The ability to cope well under pressure is another factor than can affect sports and physical fitness. One must be able to stay focused and perform to meet and exceed expectations while under increasing pressure. Adaptability is key to performance.

We can also consider psychoneural factors, which are related to the interrelationship of the nervous system and consciousness — how the individual connects with his or her body.

In bodybuilding, for example, it’s crucial to master the ability to mentally connect to specific body parts or groups of muscles at any given time, for the purpose of achieving the maximum contraction while exercising or posing in a competition. If a bodybuilder is not able to isolate a muscle and contract it, the end result of his training – his body definition will not be on par with other competitors who have mastered such abilities.

THE X-FACTOR: DESTINY X, DIVINE INTERVENTION

Finally, there’s the factor to which many athletes attribute their success: destiny.

they are meant to achieve”, with sports as the connecting bridge that brings the two aspects together.

This catch-all category of “destiny” or “divine intevention” may be a simplistic way of considering this mysterious factor that many believe is very real. But from boxers who visit the church before a big fight or golfers who believe that they are preordained to win tournaments, we should not discount this “X-factor” of fate or destiny.

Whether it be in sports, physical fitness or life in general, we must admit there is an unexplained element that ought to be accounted for. While seeking inspiration from the “greats” when it comes to achieving our own goals, it might be useful to consider what exactly is responsible for their greatness, so we can apply it to our own situations. Sports movies, where we see exceptional comebacks and extraordinary feats, are in fact depicting the X factor where the little guy or the underdog comes back and is victorious.

It’s notable that many sports movies are based on reality, and chart the biographies of sporting history’s greats. Thus, we see it is possible to achieve such glory – the human body has the capacity to embrace its own individual X-factor to push itself the extra mile to get to its ultimate goal. Perhaps the root of that X-factor could be the mere belief in its power – the belief in ourselves to not settle for what has been achieved, and to push beyond the realm of normal expectation.

A combination of some or all these factors may contribute to successful performance, therefore the X-factor could be a combination of a genetic or biological strain, with a psychological element to boost its potency, and the guiding hand of destiny. The ultimate success of the individual may therefore require the entire range of factors to come together and interact in the right way to lead the way to victory. That is why human beings are so very beautiful.

…Or even divine intervention, as long jumper Dwight Philips claimed after winning his fourth World Championship in 2011. Having already triumphed three times before, he saw it as a sure sign of victory when he was randomly allotted bib number ’1111’ before the event.

Fate or destiny is a strong belief among sports professionals. The concept of “who they are meant to be” potently and victoriously combines with “what

Robert Taylor, CPT New Wave Wellness Consultants

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ASK U

| DR. MEDFORD CONSULTANT AT NORTH ELEVEN

ASK U ANYTHING ANSWERED BY DR.

MEDFORD, CONSULTANT AT NORTH ELEVEN

Is sleep apnoea related to or caused by asthma?

Several studies have suggested that people with asthma may be at increased risk for sleep apnoea, and that sleep apnoea can worsen asthma.

Sleep apnoea worsens asthma in a number of ways, such as increasing gastro esophageal reflux (acid reflux), contributing to weight gain and obesity, and causing decreased airflow in the airways of the lungs. It may also cause increased inflammation throughout the body (including the lungs).

Sleep apnoea can cause and/or worsen acid reflux, suggested by decreasing the ability of the sphincter muscles in the esophagus to keep acid in the stomach. Acid reflux during sleep is known to cause and worsen night-time asthma symptoms.

Sleep apnoea may cause an increase in the amount of inflammatory chemicals within the bloodstream, which could worsen the inflammation in the lungs caused by asthma. These inflammatory chemicals also contribute to weight gain and obesity, which further worsens asthma.

Airflow is decreased during sleep apnea, leading to low oxygen levels in the blood stream and strain on the heart.

Narrowing of the small airways also leads to more irritation and contraction of the smooth muscle around the airways in people with asthma, therefore worsening asthma symptoms.

Are there surgery options in treating sleep apnoea?

While positive airway pressure therapy is the first line of treatment for moderate to severe sleep apnoea, surgery can be an option after other treatments have failed and for those few people with certain jaw structure problems. Surgery is often effective in treating snoring. It is less effective in treating obstructive sleep apnoea.

The goal of surgery for sleep apnoea is to enlarge the airway through your nose or throat that may be vibrating and causing you to snore or that may be blocking your upper air passages and causing sleep apnoea. Surgical options may include: The surgeon may remove tonsils, adenoids, nasal polyps or excess tissue at the back of the throat or inside the nose. They may straighten a crooked partition between your nostrils (deviated nasal septum). Or, the surgeon may reposition the jaw, place implants into the soft palate or create a new air passageway (tracheostomy).

Surgery carries risks of complications and infections, and in some rare cases, symptoms can become worse after surgery.

Kristina Chung

Marian Solomon

The challenge that confronts the surgeon is determining what part of the upper airway is causing the obstruction to airflow. There are many possible sites, and conventional sleep testing does not identify the area the surgeon should modify. If the surgeon does not treat that site in the airway, or if there are multiple sites of obstruction, it is unlikely that the sleep apnoea will diminish to a degree that eliminates the need for other treatment.

There are many surgical options for the treatment of sleep apnoea for patients who can not tolerate CPAP therapy. Because the airway pattern and the severity of obstruction vary greatly between individuals, the surgical regimen must be catered to that particular individual. Often it takes a combination of procedures to achieve success. A logical step-wise approach much be taken when a patient seeks surgery, and it is a requisite that the patient find a surgeon who understands both the pathophysiology of sleep apnea and the anatomy of the upper respiratory tract to ensure the best chance of success.

We always enjoy hearing from you!

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Email your questions to info@uhealthdigest.com

Ignorance is our biggest competitor.

One out of five adults suffers from sleep apnoea

Sleep Smart!

We offer the most comprehensive investigation and treatments for Snoring and Sleep Apnoea in the English Speaking Caribbean.

Our solutions allow you to be treated quickly and conveniently either at our sleep testing facilities or your home.

When it comes to Sleeping Smarter, we have the experience and the expertise to explain all your treatment options and will work with you to determine the course of action that’s right for you.

Our certified and accredited team ensures your treatment is effective and easily tolerated as all testing, reporting and follow-up is conducted by us locally.

Trinidad and Tobago Sleep Centre Gulf View Medical Centre, Gulf View, La Romaine, Trinidad.W.I. Ph: 1 868 657 7636 email: ttsleep@gmail.com website: www.ttsleep.com

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

MAUBY

| THE HEALTH BENIFITS OF MAUBY

mauby ma the health benefits of

WRITTEN BY LYLAH

PERSAD

Did you know that mauby is not JUST a refreshing, cold, bittersweet drink on a hot summer day...or any sunny day, for that matter? Did you know that mauby is referred to as ‘refreshing’ although we know it to have a very bitter after taste? Did you also know that mauby just has to be served cold? Well, since I have your attention so far, let’s see how much else you know…

Did you also know that there are many health benefits of mauby?

Well, mauby comes from Colubrina arborescens (or is it Colubrina elliptica, which is a Buckthorn commonly referred to as “soldier-wood” or “naked wood” outside of the Caribbean).

This Buckthorn’s bark has many health advantages. It contains antioxidants called anthraquinone which are anti-inflammatory and herbal. Anti-inflammatory, meanings that it helps in relieving pain and, by extention counteract arthritis.

THE HEALTH BENIFITS OF MAUBY

Anthraquinone compounds in Buckthorn may stimulate movement in the colon and in some cases, soothe the nerves in the intestinal tract, helping with constipation and making it easier to have a bowel movement.

But that’s not all, buckthorn also contains dihydroxy-anthracene compounds which, because of their diuretic properties, it may make food digestion easier. Dihydroxy-anthracene also helps the body rid itself of toxins and waste, reducing bloating and easing digestion.

Therefore, both the anthraquinone and dihydroxy-anthracene compounds found in the buckthorn/mauby bark allow for reducing high blood pressure, lowering blood sugar levels, lowering cholesterol and act as a ‘coolant’, because of their ability to rid the body of such unwanted “wastes”.

To make the mauby drink, one would have to get pieces of the buckthorn bark and boil it. Many ingredients go into it afterwards, mostly herbs and spices.

Here are some of the ingredients that are used in making the mauby drink, and their health benefits as well: CINNAMON STICKS: Cinnamon has an extremely high antioxidant capacity. It is one of the oldest spices known, with powerful oils that contain strong antimicrobial compounds... it relieves over-acidity in the stomach and aids digestion. It can also decrease blood sugar levels. I use it in everything!

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MAUBY

CLOVES: CLOVES are a powerful anti-parasitic and can relieve toothaches.

NUTMEG: Nutmeg is one of the oldest spices. It soothes stomach or joint pain. It is also high in antioxidants.

Of course, many people, because of tradition, may use other spices or more preferred ones... none of them being “wrong” because they all serve their purpose and we all have our preference.

Most people in the Caribbean tend to use Bitters to balance off the bitter taste of mauby, some people depend on the sweetness of brown sugar and some even on cane juice. But, it doesn’t matter how you drink it, how you view it or what you think about mauby... What is important is that you know it IS a healthy choice and like everything else, should be taking in moderation.

IMPORTANT TIP: Always remember, if you’re unsure about these benefits as you may have a special diet or situation please consult your doctor first.

Now that you know what goes into your body, go ahead and drink to your pleasure.

Savor and sip your drink, engaging all your senses!

Instead of gulping in a hurry, taste and enjoy!

Here’s to a Healthier U!

STAR ANISE: In traditional Chinese medicine it is prescribed as a digestive aid and to help cure colic in babies.

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AGING

|

THE PRO CESS OF AG ING

THE PROCESS

OF AGING WRITTEN BY AFIYA

RAY

WHEN OUR FIRST SON WAS BORN, MY HUSBAND AND I PLACED A HEIGHT CHART ON THE WALL OF HIS BEDROOM AND FROM TIME TO TIME, AS OUR FAMILY GREW, WE MEASURED THE HEIGHT OF OUR CHILDREN AGAINST THIS CHART TO DETERMINE HOW MUCH THEY HAD GROWN.

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Recently, my three year old son started to measure his own height.

Determined to grow quickly, he developed his own remedy: he agreed to eat healthy meals just so that he could measure the difference in his height every day. Though we laughed privately at his actions, my husband and I were both reminded of our own antics at a similar age.

T H E P R O C E SS O F AGI N G

|

AGING

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AGING

|

THE PRO CESS OF AG ING

DO YOU REMEMBER THOSE DAYS WHEN YOU WERE KIDS AND ACHED TO BE ADULTS?

Other signs include a decrease in the amount of lubrication and a reduction in the size of the cervix, uterus and ovaries. Changes in the body during menopause can lead to a lowering of sexual desire and orgasms may be less intense.

When we were kids, it was considered a feat of astronomical proportions to be the first among our friends to discover signs of fuzzy hair growth in private places. Girls competed ferociously, prayed anxiously to develop full breasts as this was seen as an induction into much coveted womanhood. Boys prayed for the first sign of facial hair.

SYMPTOMS OF AGING IN MEN

Many women keep marching to that beat through their early 20s, losing some enthusiasm for growing older in their late 30s and then, as they hit their 40s (some in their 50s), that enthusiasm for the aging process comes to an abrupt and screeching halt.

Many older women, facing societal pressures to look young, are fearful of the impact that age would have on their appearance. While the early signs of graying hair are embraced by some men as a distinguishing mark, they often have the opposite effect on the softer sex, as many women are pressured to join the frenzied rush to pluck, trim or dye away any evidence of age.

Despite their different reactions to the appearance of age, the process of aging can be tough on both sexes.

SYMPTOMS OF AGING IN WOMEN

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For women, menopause is arguably one of the most dramatic and traumatic signs of aging. It is the transition period in a woman’s life, usually occurring between 45 and 55. At that age, her estrogen and progesterone levels fall and menstruation becomes less frequent, until it stops altogether. With the reduction of estrogen, the thickness and size of a woman’s reproductive organs also changes and is manifested through the loss of elasticity and a thinning of the vaginal tissue.

A man usually experiences a drop in testosterone and changes in his sexual function as he ages.

The decrease in testosterone usually stabilizes around age 60, but at the end of this period, fewer sperm are produced, a man’s erections would take longer to occur and are not as rigid and his recovery time between erections increases while the force of ejaculation decreases.

Still, an elderly man can maintain a healthy testosterone level through exercise and proper nutrition.

CHALLENGES WITH AGING Both men and women face a number of other challenges as they age. Some health conditions include cardiovascular disease and high blood pressure, which alter the way blood flows in the body and can impact on a man’s sexual performance. Diabetes is another health condition that can sometimes cause erectile dysfunction in men.

Incontinence or the loss of bladder control also become more common as people age.

There are also changes to the brain. One of the most devastating ailments that come which age is Alzheimer’s disease, a much dreaded form of dementia with profound memory loss. However, while memory does deteriorate, profound memory loss is not a natural consequence of the aging process.

T H E P R O C E SS O F AGI N G

Parkinson's disease is one of the most common nervous system disorders that affect the elderly.

Symptoms of Parkinson’s disease include shaking and difficulty with walking, movement, and coordination.

LEARNING TO EMBRACE LIFE AT ANY AGE There are a number of changes to the body that are inevitable as we age, and many of these changes we fear. As our organs become weaker, we naturally fear losing the heady independence of youth, which is one of the main reasons why so many of us struggled desperately to become adults before time in the first place.

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AGING

Still, life is an adventure that should be appreciated for the different benefits that come at any age.

Rather than focus on fear of the future or of the unknown, we could focus our energies instead on the benefits of the present. And, if we want to remain strong and healthy so that we can enjoy the many benefits of age—then we need only maintain a healthy lifestyle during our youth, which is a guaranteed way to ensure that we age gracefully.

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PAEDIATRICS

| SLEEPING THROUGH THE NIGHT

SLEEPING THROUGH THE NIGHT

|

PAEDIATRICS

Sleeping through the WRITTEN BY DR.

DAVID BRATT, MD. MPH. CMT

Being a parent, first time or otherwise, is difficult. It is a time of adjustment, for you and for the baby. The baby, to life outside the womb; you, to the presence of this little stranger whom you feel you should know but really don't and now have to learn

about. It becomes exceptionally difficult when your expectations do not match the reality of your new baby’s behavior. This is especially so when your culture teaches you that children should have certain needs or wants or behaviors and then your children don’t seem to fit that mold.

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PAEDIATRICS

| SLEEPING THROUGH THE NIGHT

This problem of a mismatch between expectations and reality can be very difficult for all parents to accept and adjust to. Occasionally, some children can be encouraged or forced to fit the mold that is expected, and they do fine. Other times, though they eventually fit the mold, it is at the expense of their sense of who they are, their self-confidence, their view of the world as a safe and trusting place, sometimes, even at the expense of their health or life. Sleeping behavior of babies is one of those areas where cultural expectations and the reality of children’s needs come into conflict.

Let's get something straight right away. You are a new mother and if you want to be a mother, your days of sleeping how you want, where you want and with whom you want, are gone forever.

Finished. Finito. The end. Forget it. You don't sleep when your children are babies and you don't sleep when they are teenagers. First because they don't let you sleep and then because you don't let yourself sleep. You are a mother and you are not ever going to sleep the way you did when you did not have a child. Our children are in their thirties and if they are spending time home with us, leave the grandchildren with us and go out with their friends. My wife does not sleep, one, because the grands keep her up and two, because she is worried until her children come home safely.

In between the first five years and the adolescent ones you might catch a good nap one afternoon.

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Human children are designed to sleep with their parents as part of their learning experiences. Along with sight, the sense of touch is the most important sense to primates and it is mainly through these senses that small primates, babies, learn about their surroundings. Among many things, touch, especially a mother's touch, helps in controlling the baby's body temperature, heart rate, breathing pattern, blood pressure, glucose metabolism and even brain wave activity. All young primates are carried on their mother’s body and sleep with her for years after birth.

For the human species, the natural living arrangement is for kids to stay in almost constant contact with their mother during the day and to sleep alongside her for the first few years. That's the norm in hunter-gatherer societies, the closest thing we have to a model of the social environment in which our ancestors evolved over hundreds of thousands of years. As an important part of this living arrangement, mothers nurse their children to sleep and then nurse on demand through the night.

It sounds taxing, and it is, but it’s not overwhelming.

When the baby starts to get up, usually before any crying occurs, research in sleep labs has shown that the mother starts nursing reflexively, often without really waking up. If she does reach consciousness, she soon fades back to sleep with the child.

The problem is when this pattern of sleeping affects the mother’s life style. Some find it hard to believe that their social life must change now that another human being is involved. After two or three weeks, some mothers suddenly realize that their darling baby is here for good. He’s not going back to wherever he came from. You cannot give him up after a couple hours, the way you did with your cousin’s baby. The kid is here to stay. And he has his own needs. Not wants, needs. This, of course, is often the start of a pattern of future conflict between what the child’s genes are encouraging him to do and what the mother or grandmother or modern society believes the child should be doing.

It seems possible that this life style of what is now called co-sleeping developed as an evolutionary survival mechanism. The safest place for a child to sleep in a primitive society is with the mother and babies whose mothers did this must have survived more than other babies. All of us today are descendants of those babies who slept with their moms and who in turn carried on this behavioral pattern, which would have given rise to the development of genes that command the baby to expect to sleep with its mother. In other words, baby's brains are hard-wired for sleeping with their mothers.

SLEEPING THROUGH THE NIGHT

So are ours, but we adults have other programs that enable us to change. Babies do not change, for many years.

So the expected pattern is for mother and child to sleep together, and for the child to be able to nurse whenever they want during the night. Normal, healthy, breastfed children who sleep with their moms, do not sleep "through the night" (say 7-9 hours at a stretch) until they are 2-3 years old, and no longer need night nursing. This is expected, normal and healthy. Luckily for us, this pattern of sleeping has been the norm so far in our society.

Perhaps it is because of this, that Sudden Infant Death Syndrome (or SIDS) is so rare in the West Indies. Unfortunately, like the true mimic people that we are, we are beginning to copy the North American way of bringing up children; that babies should sleep by themselves and that you should let them cry so as not to "spoil" them.

Because although there are now fewer outside threats to where we sleep, there are other dangers, internal dangers.

Research on co-sleeping clearly shows the dangers of solitary sleeping in young infants, who slip into abnormal patterns of very deep sleep from which it is very difficult for them to rouse themselves when they experience an episode of apnoea.

Apnoea is when the baby stops breathing. It happens in all babies for the first six or so months of life and is part of the baby's adaptation to extero-uterine life.

When co-sleeping, the mother subconsciously monitors her baby’s sleep and breathing patterns, even though she herself is asleep.

When the baby has an episode of apnoea, she rouses the baby by her movements and touch. This is thought to be the primary mechanism by which co-sleeping protects children from Sudden Infant Death Syndrome.

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PAEDIATRICS

In other words, many cases of SIDS in solitary sleeping children are thought to be due to them having learned to sleep for long stretches at a time at a very early age. If they find themselves in these deep troughs of sleep, then they may experience an episode of apnoea, and since no one is there to notice or rouse them from it, they just never start breathing again. Co-sleeping also allows a mother to monitor the baby’s temperature during the night, to be there if they spit up and start to choke, and just to provide the normal, safe environment that the baby/child has been designed to expect.

Is this convenient for parents? No! Is this difficult for some new parents to adjust to? Yes! There is no doubt about it. The gap between what our culture teaches us to expect of the sleep patterns of a young child: they should sleep alone; they should never cry; they should sleep through the night so give them a bottle of milk thickened with cereal and leave them to cry themselves to sleep, and the reality of how healthy, normal babies actually sleep, is a yawning gulf.

So the first steps to dealing with the fact that your young child doesn’t sleep through the night, or doesn’t want to sleep without you, is to realize that: (1) Not sleeping through the night until they are 3 or 4 years of age is normal and healthy behavior for human infants. (2) Your crying, touchy-feely children are not being difficult or manipulative, they are being normal and healthy, and behaving in ways that are appropriate for our species.

Once you understand this, it can become easier to deal with parenting your child at night. Once you give up the idea that you must have 8 hours of uninterrupted sleep at night, and view these nighttime interactions with your child as precious and fleeting, you can get used to them very quickly.

Dr. David Bratt is the author of The Book of Brats: Bringing up Children in the Caribbean.

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THE NEXT U October to December

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A COMPELLING TRUE STORY.

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Cashew fruit. just as good as the nut!

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