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THE CARIBBEAN HEALTH DIGEST OCT DEC 2012
| ISSUE 19
MAKING A STRONG FOOTPRINT WITHOUT FEET...
PACOMPELLING ROSTHETICS TICS TRUE STORY! ALCOHOLIC LIVER DISEASE. UNDERSTANDING THE CONNECTION BETWEEN THE TWO CASHEW FRUIT. JUST AS GOOD AS THE NUT!
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32
STDS AND TEENS. GET A REALITY CHECK… PROTECT YOURSELF 34 uhealthdigest.com
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10 Alcohol and Liver Disease Most of us who take an occasional drink of whatever type of alcoholic beverage must have heard at one point or another that too much can affect one’s liver. This article takes a look at just how this can happen. Who knows: it may just get some of us to cut back on our alcohol intake.
14 Bells Palsy In this engaging article our staff writer tells of an actual experience with her teenage daughter and her encounter with Bells Palsy, a disorder of the nerve that controls facial muscles.
18 Prosthetics A compelling true story about a young boy born without hands or feet, yet who manages to laugh a little each day. Learn what it’s like to live without the basic things we tend to take for granted, yet still have an extreme passion for life and living.
24 Yellow Fever Recognized from historic texts stretching back 400 years, Yellow Fever causes a wide spectrum of ailments, ranging from mild symptoms to severe illness and even death. Dr. Hamish Mohammed discusses this more in this article.
28 Breaking The Fast Sure you must know that breakfast is our most important meal of the day, but do you know why? Nutritionist Michelle Ash explains. Hopefully, after this, there’ll be no more skipping of breakfast!
32 Cashew We all love those crunchy, creamy roasted cashew nuts and we must know a little about some of the health benefits, but did you know that the fruit this nut is attached to also has its fair share of natural goodness?
34 Teens and STD’s No matter how much information there is out there, many teens today still seem oblivious to the severity and effects of STDs. Carol Quash explores some of them with the intention of getting through to teens today.
38 Ask U Dr. Neil Singh answers questions on Sexually Transmitted Diseases, especially for the benefit of our teens.
40 Emotional Freedom Technique. The Art Of Tapping The art of Tapping is being practiced throughout the world as a method of managing and removing physical and emotional stress. This article explores the concept and explains exactly how it works. The way we see it is, if a little tapping can remove your stress, then go ahead and tap it away!
44 The First Hour Nutrition and NCD's Lets face it, at some point in our lives and that of our children there will always be conditions that will threaten our health and wellbeing. This article discusses the benefits of breastfeeding and how giving our babies the best nutrition can help protect them as adults from Non-communicable Diseases (NCD's).
48 Paediatrics Small Ting... Usually! When it comes to our children, most of us are usually quick to get alarmed! Dr. David Bratt guides panicky parents on when we should be concerned and when we should just relax, because, like he says, most of the time it’s just “small ting”!
So here we are again; feels like just yesterday when we were welcoming you to our first issue for 2012, and now we are already saying farewell to a year that for more reasons than one will always be remembered. And as we express gratitude for all things past and all that is yet to come, we’d like to take a few lines to extend special thanks to all our U readers for your continued interest in what we have to say each quarter, and to each of our contributors, writers and editors for the enormous efforts you put into ensuring that each issue is published consistently and without compromise. We are grateful to our advertisers for making it possible to publish U every three months and for seeing value not only in the effectiveness of advertising but in educating people about their health and well-being. Most importantly our sincere appreciation to our amazing staff at U and Eidetic Creative; you guys are simply the best! With little space left to brag about this issue, let us just say that the cover story will soften your hearts. It’s based on the true story of a young boy born without hands or feet, yet he manages to overcome the challenges with a little help from his prosthetic legs, but mainly from a lot of love from his humble and loving family. Stories that will undoubtedly be of great interest to everyone, like Alcohol and Liver Disease, Yellow Fever, and STDs and Teens, have all found a place in this issue, plus so much more. We hope that 2012 was a great year for U as it was for us and we look forward to bringing more exciting stories in 2013. God Bless!
SHERINE & STUART
FOUNDING EDITORS
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ALCO HO L A ND L IV E R DIS E A S E
O L H A O N C D
AL
DISEASE
WRITTEN BY MEZAAN
BELJIC
WH ? N AT’S THE CONNECTIO
A LC O H O L A N D LI V E R D I SE A SE
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DISEASE
Last year, I came across a Facebook post by a partying college student stating something to the effect of “Sorry liver, but you’re going down tonight!” My reaction was one of perplexity and concern. Clearly, the student knew enough to acknowledge that alcohol affects the liver; but, I wonder if he or she truly realizes the extent of this strained relationship. Born in a country that produces exemplary rum, I can appreciate the pastime of drinking a rum and Coke, with Caribbean music in the background and a friendly cricket match in progress. Here in the United States, it’s beer during football or baseball season or wine in the evenings after work, or maybe a combination of cocktails that helps one unwind on the weekends. But how much is too much? When should you fear for the viability of your liver? Why should you even worry about alcohol and your liver? Understanding the function and purpose of the liver will help answer these questions. 11 | u
DISEASE
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ALCO HO L A ND L IV E R DIS E A S E
The liver:
a vital organ. The human liver is a large triangular organ in the right upper quadrant of the abdomen, protected by the lower rib cage. It is the largest internal organ in the human body and normally weighs between three and four pounds. The primary function of the liver is to filter and detoxify blood flowing from the digestive tract en route to the rest of the body. It plays major functions in carbohydrate metabolism, lipid metabolism, protein synthesis and breakdown. Bile, a yellowish-green liquid necessary for emulsifying fat, is produced and excreted by the liver. Specific proteins and coagulation factors necessary for blood clotting are also produced by the liver, as well as hormones necessary for physical growth and development.
The primary function of the liver is to filter blood flowing from the digestive tract en route to the rest of the body.
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The liver metabolizes drugs, alcohol and other dangerous toxic substances. In the case of alcohol consumption, the liver releases the enzyme, alcohol dehydrogenase, to detoxify the blood of alcohol. When you consume more alcohol than your liver can metabolize in an hour, alcohol continues to circulate in your bloodstream, affecting other bodily functions, until it is completely metabolized by the liver. This taxing process, which may take a long while when a person drinks heavily or even in moderate amounts, can cause inflammation of the liver (hepatitis) and, over time, scarring of the liver (cirrhosis). Precluding these two stages is fatty liver disease. The liver’s ability to metabolize fats is impaired as the act of metabolizing alcohol takes precedence. When alcohol is consumed excessively on a regular basis, more and more fat is stored in the liver. Fatty liver disease is an early sign of alcohol abuse and can be reversed, whereas liver cirrhosis is permanent and can lead to liver failure.
Alcoholic
Hepatitis. Acute alcohol overdose in the presence of a cirrhotic liver can lead to acute liver failure, which is a life threatening condition. It commonly occurs in chronic drinkers who binge drink. Generally, binge drinking is considered as five or more drinks on one occasion for men and four or more drinks for women. Symptoms include abdominal pain and tenderness, nausea, vomiting, jaundice (yellow discoloration of the skin and eyes), fever, fatigue, dry mouth, thirst, weight gain (due to swelling of the legs (edema) or abdomen (ascites), and loss of appetite. Confusion and brain damage (encephalopathy) can result when ammonia, a by-product of digestion, cannot be filtered by the affected liver. In severe cases, coma and death can occur. Diagnosis is made by a thorough history and clinical presentation, blood tests, abdominal ultrasound and CT scan. Acute emergency admission is required to prevent severe complications. Treatment should include complete alcohol cessation. If you stop drinking alcohol entirely and liver cirrhosis has not occurred, the liver can recover.
Cirrhosis. When liver cells are repeatedly destroyed, irreversible scarring of the liver occurs. This is known as cirrhosis of the liver. A liver biopsy confirms cirrhosis. Eventually, the lesser remaining healthy liver tissue cannot maintain the great many functions of the liver, and over time, liver failure occurs. Alcohol abuse is the strongest associated factor for developing liver cirrhosis, next to hepatitis B and C infections. Alcohol, which contains ethanol, is considered a psychoactive drug. Initially, a small amount of alcohol is a stimulant, but after consumption in large amounts, it becomes a depressant. Ethanol is broken down to acetaldehyde, which is considered carcinogenic. Consequently, liver cirrhosis is associated with increased risk of liver cancer.
A LC O H O L A N D LI V E R D I SE A SE
Generally, binge drinking is considered as five or more drinks on one occasion for men and four or more drinks for women. The symptoms of liver cirrhosis include those of alcoholic hepatitis; however, symptoms of cirrhosis may not be evident until the disease is advanced. Symptoms such as fatigue, anorexia, nausea, swelling in the legs and abdomen may develop gradually. Portal hypertension, a result of increased pressure in the portal vein that delivers blood to the liver, is not uncommon. One might notice a tendency to bruise and bleed easily (from the nose or gums, for example) as well as red, spider-like blood vessels on the skin over time. This results from other veins getting engorged as the pressure builds in the portal vein and blood backs up into the vascular system. Bleeding esophageal varices are a fatal complication, as well as bleeding from smaller vessels in the liver that burst from higher pressures. Confusion, hallucinations, agitation, sluggishness, pain, numbness or tingling represent complications involving the brain and nervous system (hepatic encephalopathy). A liver transplant may ultimately be necessary.
So, what’s
the lesson? Hazardous alcohol use is deleterious to one’s physical, emotional, mental, economic and social well-being. It spans generations, as you are more likely to abuse alcohol if you have a parent who abuses alcohol. We live in a culture where alcohol use is increasingly accepted, and, consequently, the number of people engaging in harmful alcohol use is rising. Peer pressure, anxiety/depressive disorders, and stressful lifestyles are also cited as contributing factors to the rise in alcohol use and abuse.
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DISEASE
The goal of treatment when alcohol abuse exists is complete alcohol cessation, or abstinence. It is important to note that drunkenness is not necessary to develop alcoholic liver disease as one can build up a tolerance to alcohol and consume enough to affect the liver over time without ever getting drunk. According to PubMed, men who consume 15 or more drinks a week, women who consume 12 or more drinks a week, and anyone who consumes five or more drinks on one occasion at least once a week, are at increased risk of developing alcohol dependency, a physical addiction to alcohol. A 12-ounce bottle of beer, a 5-ounce glass of wine, or a 1½ ounce shot of liquor is considered one drink. The National Institute on Alcohol Abuse and Alcoholism (in the USA) recommends that women limit their drinks to no more than one per day and men should not drink more than two drinks per day.
We live in a culture where alcohol use is increasingly accepted, and, consequently, the number of people abusing alcohol is rising. Helping one recognize that their drinking is getting out of control and ruining their health and personal and professional relationships is the first step to curtailing alcohol dependence. This epiphany can be accomplished best with the help of family members and employers. Once a decision is made to quit, local support programs and recovery centers, working in conjunction with your doctor, can lead you down the path of rehabilitation. Relapses can and do occur after quitting, but a good support system can help manage this before you, and your liver, go “down.”
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DISORDER
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B EL L’S PAL SY
AS A PARENT, THERE ARE A FEW PHONE CALLS YOU REALLY DON'T WANT TO RECEIVE WHEN IT COMES TO YOUR CHILDREN. I COULD THINK OF MANY OF THEM OFF THE TOP OF MY HEAD,
BELL’S WRITTEN BY
STAFF WRITER
BUT THIS WAS NEVER ONE. MY TWELVE-YEAR-OLD DAUGHTER WAS SPENDING THE WEEKEND AT MY PARENTS’ IN AROUCA, SO THE PHONE CALLS WERE COMING IN QUITE FREQUENTLY; YOU KNOW, THE CHECK UPS ON HOW THINGS WERE GOING AT HOME, THE "I'M READY TO COME HOME NOW"; THE "NO, I'VE CHANGED MY MIND," ETC., BUT THEN THE ONE CALL I DIDN'T EXPECT, THE ONE THAT CAME FROM MY MOTHER, RAN ALONG THE LINES OF "SOMETHING FUNNY SEEMS TO BE HAPPENING WITH EMMA’S FACE."
B E LL’ S PA LSY
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DISORDER
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DISORDER
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B EL L’S PAL SY
What do you mean,
funny? I asked
Well,
it seems to be
twisted she replied
Now scared out of my senses, instructions and questions flew across the phone lines. The most important thing I noted was that she was not in any kind of pain or discomfort. Is her blood pressure normal? Yes—ruling out a stroke. Did she eat anything unusual? No—(thinking it may have been an allergy but knowing fully well that I had never heard of anyone with symptoms of any allergic condition like this.) Ah, finally a reason I could live with, at least to get through the night; you see they had all been to the river the day before on a "lime" as we say and "she must have picked up a draft," my mother said. As children growing up, we were all made to believe that certain actions and indulgences would affect our health and well-being. Like, we're likely to catch a cold if we played in the rain, and though there is some scientific reasoning behind this claim, a little playing in the rain will hardly get us the cold as much as being exposed to the cold virus itself.
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When she whispered to me, “Mummy, I’ve gotten ugly,” my heart sank.
Now I don't quite know what “catching a draft” really meant; in fact I still don’t, but if I had to explain it to myself it would be based on what the older people have said and it would sound something like this: it’s a weird reaction of the body, either a stiffening or painful sensation to that part of the body that was exposed to a cold atmosphere for some length of time, a.k.a. “a draft”. So I was willing to temporarily accept the “draft” explanation, hoping that by morning it would pass. It didn’t; in fact it became more pronounced. Still in good spirits, Emma joked and laughed a bit, but upon seeing the absolute fear on my own face, her spirits began to sadden; perhaps not for the same reasons as mine. If anyone knows her, the mirror is her best friend; she loves herself and how she looks and really appreciates her god-given beauty... constantly! When she whispered to me on our way to the doctor’s office, “Mummy, I’ve gotten ugly,” my heart sank.
Bell’s Palsy was his diagnosis! Although our doctor’s explanation was able to give great reassurance on this condition and its ability to subside eventually, I found the most amount of comfort in learning everything I could from the experts at WebMD as follows: Bell's palsy is a paralysis or weakness of the muscles on one side of your face. Damage to the facial nerve that controls muscles on one side of the face causes that side of your face to droop. The nerve damage may also affect your sense of taste and how you make tears and saliva. This condition comes on suddenly, often overnight, and usually gets better on its own within a few weeks.
B E LL’ S PA LSY
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DISORDER
With a short course of steroids, her symptoms disappeared within two weeks. Bell's palsy is not the result of a stroke or a transient ischemic attack (TIA). While stroke and TIA can cause facial paralysis, there is no link between Bell's palsy and either of these conditions. But sudden weakness that occurs on one side of your face should be checked by a doctor right away to rule out these more serious causes.
Causes. The cause of Bell's palsy is not clear. Most cases are thought to be caused by the herpes virus that causes cold sores. In most cases of Bell's palsy, the nerve that controls muscles on one side of the face is damaged by inflammation. Many health problems can cause weakness or paralysis of the face. If a specific reason cannot be found for the weakness, the condition is called Bell's palsy.
Symptoms. > Sudden weakness or paralysis on one side of your face that causes it to droop. This is the main symptom. It may make it hard for you to close your eye on that side of your face. > Drooling. > Eye moisture problems, such as excessive tearing or a dry eye. > Loss of ability to taste. > Pain in or behind your ear. > Numbness in the affected side of your face. > Increased sensitivity to sound.
How is Bell's palsy diagnosed? Your doctor may diagnose Bell's palsy by asking you questions, such as about how your symptoms developed. He or she will also give you a physical and neurological exam to check facial nerve function. If the cause of your symptoms is not clear, you may need other tests, such as blood tests, an MRI, or a CT scan.
Treatment. Most people who have Bell's palsy recover completely, without treatment, in 1 to 2 months. This is especially true for people who can still partly move their facial muscles. But a small number of people may have permanent muscle weakness or other problems on the affected side of the face. If your doctor suspects that your Bell's palsy is caused by inflammation, you may be given corticosteroids, such as prednisone, to reduce the inflammation. If your doctor thinks that a virus is causing your Bell's palsy, he or she may prescribe antiviral drugs, such as acyclovir. But there is no clear evidence that antiviral drugs are effective for Bell's palsy. With our doctor’s prescription of a short course of steroids, Emma’s symptoms disappeared within two full weeks, but the one thing that continued to baffle both us and her doctor is that the condition rarely affects people under 15 and over 60 years old. Today, at almost 15, she and her mirror continue to be best friends, but somewhere deep inside she will always remember the close call she had and the temporary loss of her much-cherished physical appearance. Source: WebMD
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PROSTHETICS
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AM NIOTIC B A ND SY NDR OME
1.3 MILLION ONE LITTLE BOY TRIUMPHS OVER
Amniotic Band Syndrome WRITTEN BY STAFF
WRITER
JOSIAH
Arthur’s small, pointed face is the picture of concentration as he struggles to stand. It’s his first time on roller skates. As his mother guides him around the paved space at the front of his small but beautifully tended garden, he breaks into a smile. But the skates swivel and spin, and finding his balance is next to impossible. The skates have nothing to hold on to. Josiah was born without insteps or toes. He was also born without hands.
A M N I OT I C B A N D SY N D RO M E
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PROSTHETICS
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DISORDER
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AMNIOTIC B AND SY NDR OME
OVERCOMING THE INITIAL SHOCK WITH LOVE His mother, Karen “Julie” Arthur, tells the story of his birth at Sangre Grande General hospital eight years ago. After a textbook pregnancy, and an ultrasound that showed no problems, she had a quick labour and a normal birth. The nurses whisked her son away without a word. Back on the ward again, she was approached by a doctor who NO ONE TO TURN TO and her baby were discharged the next demanded to know what Karen day, without any advice. “We didn’t know drugs she’d taken during her what to do,” Perry says. “Or where to go.” pregnancy. Just folic acid In frustration, they called the media. That’s the firestorm of attention started. and maternal vitamins, she when Politicians turned up, wanting to get into the responded. The doctor left. picture. Her anxiety aroused by this strange question, she asked a nurse if everything was okay with her newborn. The nurse brought her child, set him down, and said, “Take a good look at your baby.” “I started from the head come down,” she says, “and then I realised.” The shock would have crushed a weaker woman, but Karen relied on her unshaken faith in God and prayer to get her over the blow. “I heard a voice saying, ‘Nothing is wrong with him,’ three times.” She was warned not to show her baby to any of the other women on the ward, for fear of upsetting them.
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Josiah’s father, Perry, remembers there was a parade in Sangre Grande on the day his son was born, so he was late getting to the hospital. “They say a man mustn’t cry in front of his wife,” he recalls. “But my eyes filled with tears. But he’s our son. To me, he is beautiful.”
But the attention also brought help. Dr. Petronella Manning-Alleyne called them in. She explained that Josiah’s condition was due to Amniotic Band Syndrome, in which fibrous bands of tissue within the womb become wrapped around a developing limb or body part, preventing it from growing normally. The syndrome usually affects one body part, causing missing fingers or “club” feet, even a cleft lip, but it is extremely rare for all four limbs to be affected. The Arthurs believe that Josiah is the only child in Trinidad and Tobago who has been so severely affected. Nevertheless, Josiah is a happy, healthy child, well loved by his parents and his 10-year-old sister, Tehilla. He attends a government school near his home, and is an avid student, recently coming second in test. He wants to be a doctor when he grows up. His mother says his handwriting is beautiful; he achieves this feat by grasping the pencil between his wrists.
A M N I OT I C B A N D SY N D RO M E
THE UNKINDNESS OF STRANGERS
As you might imagine, starting school was tough on a child who is different, but the other children soon got used to him. Adults, however, can be far more rude and insensitive than the little ones, and don’t seem to care if their staring—or even chasing him around to get a good look—hurts his little heart. But Perry has been steadfast in encouraging Josiah to hold his head up under scrutiny, and to keep his hands out of his pockets. Some people have even wondered aloud why the Arthurs don’t simply put him in a home. One woman went as far as to say that if he were her baby, she would have left him at the hospital. But the Arthurs are blind to the ugliness in these hearts. “I said, ‘No way!’ That’s our child!”
Expenses pile up but help arrives They let their son develop normally, rather than be coddled. He learned to walk on his heels, and pick things up on his own. They were even cautioned not to allow him to take advantage of his situation, as some children with disabilities quickly learn to manipulate their parents into doing everything for them. Support from the State has been sporadic, but every little bit helps. Councillors keep tabs on Josiah’s development, and he has received medical attention at the Princess Elisabeth Home for Handicapped Children in Mucurapo. With the help of Dr. David Toby, and a few visiting foreign doctors, Josiah received prosthetic limbs after turning two. He has had three sets of legs since then, changing as he grows.
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DISORDER
The legs keep Josiah from tipping over on the football field as he chases the ball, an activity he loves, but he hated the stiff, inflexible pair of hands he was given. “They were like doll’s hands,” Perry says. He sent them back and relies on his wrists to skilfully carry on his daily tasks, feeding himself, doing school work, and even holding a bat. He can cut his own bread and open his drinks. He can dress himself. He receives occupational therapy and counselling at Caribbean Kids and Families Therapy Organisation in St. James. But for Perry, a labourer, just the taxi fare to get his son to the West is prohibitive, especially piled on top of the wages lost when he has to take time off from work. While Josiah is entitled to a meagre disability payment, the family’s TTCard, representing a mere $500 or so per month, was taken away when Perry found employment as a handyman with the Health Authority. The bite it took out of the family budget was deep and painful. Josiah’s prosthetic legs are worth TT$50,000, and though almost all of it was paid by donors, the family is responsible for its upkeep. “One screw costs US$100,” Karen says. Out of love for their son, they feel no embarrassment in accepting help with his therapy from people who care. He has just switched to larger “feet”, and will need another full pair of legs of in a couple of years.
“He’s our son. To us, he is beautiful” Love and faith in God have proven the perfect recipe for the growth and development of this bright, beautiful child. “Josiah means ‘Sent from God’” says Perry. “There’s nothing wrong with him. We take him wherever we go. We show him love, and let him be free.”
U readers wishing to help Josiah with his therapy and care can make a contribution to Republic Bank account #490446715101. The account is in the name of his mother, Karen Caesar Arthur. They can also contact Karen or Perry on 492-6258, 668-6574 or 319-2734.
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PROSTHETICS
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O F FE R ING AMP U TE E S A B E TTE R LI F E
A new wave in prosthetics offers amputees a better life. n many countries, a large number of persons who have lost limbs have done so through military conflict and civil unrest. In peaceful Trinidad and Tobago and throughout the Caribbean, however, most people lose limbs, especially legs, to an equally ruthless killer: diabetes.
The first defence against this phenomenon, de Windt thinks, is education. Increased awareness can reduce not just cases of diabetes, but long-term health care costs as well.
This is according to Mr. Thomas de Windt, a Dutch Certified Prosthesist and Orthosist operating in Curacao. Mr. de Windt visits Trinidad twice a month to service patients through the Specialist Centre.
Mr. de Windt thinks that patients with prosthetics here in Trinidad would benefit from better training in their use. Training is so critical that he encourages the more complicated cases to travel to his Centro Orto Fisiko Korsou, where patients are guided in the use of their device as early as four to ten days after amputation.
Diabetes and limb loss Diabetic patients may lose sensitivity in their feet due to circulatory and nerve problems, which lead to improper pressure distribution across the sole of the foot. Pressure points may develop into ulcers. At this point, the condition can be halted by simply using shoe inserts to correct the pressure distribution.
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However, Caribbean diabetics are notorious for not taking proper care of themselves, neglecting their diet, exercise and treatment. Often, treatable foot ulcers deteriorate into serious infection and tissue damage, leading to amputation. And when one leg is lost, the other is also at risk.
NEED FOR TRAINING
Prosthetics have come a long way from the “mannequin’s body parts” of the past. There are prosthetics equipped with electrodes that can read impulses coming from the brain, and move naturally, almost like a limb of flesh and blood. Computer-controlled legs have sensors that check the position of their host’s knee, 500-1,000 times a second, and are able to anticipate and respond to their next move. “You need to be trained in the technique in how to master these complicated devices,” he says. “A hand can exert 15 kilos of force, so you can punch something if you don’t control it.”
O F F E RI N G A M P UT E E S A B E T T E R LI F E
This innovative technology helps patients resume their normal lives quickly. “A lot of people drive to work with their leg. I’ve had older patients, over 80, lead fruitful lives. The limb helps determine their quality of life.” Mr. de Windt has even made a leg for a professional cyclist in Barbados, who rides 5 hours a day.
EMOTIONAL IMPACT His centre also gives patients the counselling they need to overcome the shock that such a change inevitably brings to their lives. “People come in and think their life is over. They have provided for their family their whole life, and now they think they can’t. They have to know there is life after amputation.”
HOW YOU LOOK MATTERS Another drawback to many of the prosthetics available here is their lack of aesthetic appeal. “Many don’t look life-like,” Mr. de Windt observes. And how we look is important to our self-esteem and well-being. In places like the US, which have a long history of engagement in armed conflict, there is a large population of amputees. The sight of someone with a titanium limb is commonplace, and a tradition of respect for their military veterans and for the disabled leads to matter-of-fact acceptance. Not so here, where rude stares accompany anyone who is different. In this case, de Windt thinks, more life-like and realistic prosthetics would be much more appreciated.
UNBEARABLE COSTS
Part of the problem here in Trinidad is the high cost of prosthetics, which run into tens of thousands of dollars. Those who are unable to afford it are forced to jump through bureaucratic hoops that can take more than a year for a government or charitable grant, by which time, it’s too late to receive adequate training.
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PROSTHETICS
ATTITUDE IS EVERYTHING
A living, breathing example of the power of a positive attitude over adversity is Mr. Hugh Roberts, a patient of Mr. de Windt’s who lives in Tobago. Mr. Roberts, then a fire officer, noticed something wrong when an ill-fitting pair of new shoes produced a bruise. Within days, he was diagnosed with diabetes, and that same week lost his little toe. Another soon followed, and then the entire foot was in jeopardy. He made the decision to remove the limb from the knee, knowing that this provided a better option for a more versatile prosthetic. His delight over his prosthetic has been so great that when two toes on his remaining foot were threatened, he opted to remove them all, knowing that their loss would not be the end of the world. Today, he boasts of the full life he leads. “I drive, I dance, I ride a bike. I have a small vegetable and rabbit farm.” In fact, prosthetics did nothing to slow him down recently when, coming upon a 3-car accident, he ran from car to car and relied upon his training as a paramedic to save three victims, including a child. Far from hiding his prosthetics, Mr. Roberts volunteers his time to talk to others in his same situation. Living proof, we think, that attitude is everything.
Where to find help locally
The Trinidad and Tobago Orthotics and Prosthetics Amputee Centre is located at #26 Henry Pierre Street, Woodbrook and #715-716 Mc Connie Street, Gulf View, San Fernando. They can be contacted on 622-1366 or 652-7102. They work in conjunction with doctors who specialise in orthopaedics, neurosurgical and general surgeries. Apart from upper and lower limb prosthetics, the centre provides appliances for the physically challenged, such as back braces, arm and foot splints, special shoes and inner soles.
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INFECTION
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YEL LOW FE V E R
The Panama Canal, one of the greatest feats of engineering in the world, was officially opened in 1914. Several thousand West Indians, the majority of whom were from Barbados, were hired to dig the canal and build the locks. These pioneering West Indians were essential to the success of this venture, but they had to overcome an obstacle so huge that it derailed the initial attempt, by the French, at constructing a canal some 25 years earlier:
Y E LLOW F E V E R
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INFECTION
YELLOW FEVER. WRITTEN BY DR.
HAMISH MOHAMMED
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INFECTION
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YEL LOW FE V E R
Tens of thousands of workers fell ill with yellow fever or malaria during the construction of the canal. At the time, it was thought that yellow fever was spread by ‘miasma’, a poisonous vapour containing particles of decaying matter. It was not until the late 19th Century, when researchers in Havana hypothesized its spread by mosquitoes, that researchers slowly reviewed their stance. William Gorgas, Chief Medical Officer of the canal zone, was a proponent of the mosquito-vector theory and, in 1905, embarked on a widespread campaign to control the mosquito population. The efforts bore fruit and succeeded in halting yellow fever outbreaks by late 1906; this ultimately led to successful completion of the canal.
Y
Yellow fever is caused by infection with the yellow fever virus, and its name stems from the jaundice, or yellowing of the skin and eyes, that occurs with the more serious form of illness. Although most infected persons do not have any symptoms, those that do become ill usually experience a flu-like illness with fever, chills, body pain, nausea and vomiting. Most yellow fever cases occur in tropical South America and sub-Saharan Africa, where just under one billion persons are at risk of infection. Globally, an estimated 200,000 cases occur annually, resulting in 30,000 deaths.
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There are three cycles of yellow fever transmission, each found in different ecosystems and involving different mosquito vectors. In nature, the virus is found in forest-dwelling primates, such as African green and red howler monkeys, that occupy the rainforest canopy.
This is known as the sylvatic, or jungle, cycle. In this case, humans are only infected when they come into contact with infected mosquitoes, such as Haemogogus species mosquitoes, that feed on these monkeys; this usually occurs in woodcutters who visit the forests to harvest lumber. If such a person, within three to six days after infection, visits an urban area with a high population density, the risk for the second, more concerning, type of transmission cycle, the urban cycle, is quite high. This is because urban yellow fever is spread by the Aedes aegypti mosquito, the infamous, black and white stripe-legged vector of dengue virus. So close is the association between the two that Aedes aegypti was previously referred to as the ‘Yellow Fever mosquito’. Urban yellow fever outbreaks are often very explosive and can result in many deaths; one of the largest outbreaks of the last century occurred in Ethiopia from 1960-1962, during which period some 100,000 cases were reported.
Y E LLOW F E V E R
O
On an historical note, the last major urban yellow fever outbreak in the Americas occurred in Brazil in 1928. Prior to that, outbreaks of urban yellow fever were so devastating that the fever was referred to as the ‘American plague’, having caused massive outbreaks in Philadelphia and New Orleans in the late 19th Century. The last outbreak in the U.S. occurred in 1905 in New Orleans, and resulted in 1,000 deaths. In 1912 the Tulane School of Hygiene and Tropical Medicine, the first such school in that country, was established in New Orleans to study yellow fever and the other tropical diseases that afflicted the southern U.S. The third type of transmission cycle, known as the intermediate cycle, occurs in the humid or semi-humid parts of Africa. This involves semi-domestic mosquitoes, such as Aedes africanus, and is the most common type of transmission in Africa. There is no cure for yellow fever, and treatment is based on supportive care to alleviate symptoms of illness. Most people infected with yellow fever virus recover without any lasting effects but, among the 15% of infected persons who experience the more severe form of illness, as many as 50% of them may die from complications such as bleeding, shock and multisystem organ failure. There is a widely used, relatively safe vaccine (the Yellow Fever 17-D vaccine) that prevents yellow fever. It is administered by a single injection, with booster shots required at 10-year intervals. The vaccine is recommended for persons at least 9 months of age, and without any altered immune status due to HIV infection or a thymus disorder. As is the case with all vaccines, there is a small risk of adverse events. In this case, the most severe is Yellow Fever Vaccine Associated Viscerotropic Disease, which can result in multisystem organ failure and death. The good news is that the risk of this reaction is very low; among persons vaccinated in the U.S., there
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INFECTION
are 0.4 cases out of every 100,000 vaccines. However, the risk increases in persons over the age of 60 or with an altered immune status; if there is any doubt, a doctor should be consulted before receiving the vaccine. It is not a well-known fact that the World Health Organization classifies Trinidad and Tobago as being endemic for yellow fever, that is to say, that cases occur from time to time. More specifically, the risk of yellow fever is restricted to Trinidad, and only in towns and villages close to forested areas. No other Caribbean island is regarded as endemic, but they are all at risk of outbreaks if an infectious traveler visits, as the Aedes aegypti mosquito is very widespread throughout the region. Red howler monkeys, found in the forested areas of Trinidad, are susceptible to yellow fever infection and, as previously mentioned, people only become infected if bitten by infected mosquitoes found in the forest canopy. For reasons not clearly understood, every 5-10 years, there is an outbreak of sylvatic yellow fever among Trinidadian monkeys. The most recent, in 2009, resulted in over 10 deaths in red howler monkeys. Fortunately, there were no human cases and this has been so since 1979, when 18 un-vaccinated persons from forested areas were infected. None of these died but, since then, the Ministry of Health has focused on vaccinating persons for yellow fever. This vaccination campaign has achieved considerable success; as of the late 1990s, there was a 91% level of coverage for yellow fever vaccine among children. Yellow fever is a severe, mosquito-borne disease, but infection can be avoided by vaccination or by preventing bites from the Aedes aegypti mosquito. If you are planning to visit South America or sub-Saharan Africa, online resources, such as the WHO or the CDC, should be consulted for details on the risk for travelers to countries in these areas. If needed, a visit to the health centre for vaccination may also be advised; prevention is always better than cure.
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BREAKFAST
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B REAK ING THE FAS T
BREAKFAST:
BREAKING THE FAST. HOW TO DO IT RIGHT. WHAT IS BREAKFAST? Breakfast typically represents your first meal of the day. But, the word ‘breakfast’ actually means, ‘to break the fast’. While you are sleeping, your body is not being fed. This means that you have been fasting for around 8 to 12 hours since your last meal from the evening before. Breakfast is generally the perfect time to give your body some healthy fuel to set it up for the day ahead.
WHY IS BREAKFAST IMPORTANT? Breakfast is an important meal for people of all ages. • Breakfast can improve your attention, mental performance and memory. If you start the day hungry, your body stays in a fasting state, which makes it much more difficult to concentrate. Eating breakfast has been shown to improve learning, memory and academic performance, especially in school children. • Breakfast helps boost your intake of important nutrients. Foods eaten at breakfast are usually breads, cereals and milk, which contain energy-giving carbohydrates, bone and teeth-building calcium, and add wholesome fibre to your diet. People who miss breakfast usually do not make up these nutrients later on during the day.
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• Eating breakfast helps adults maintain a healthy weight. Skipping breakfast is usually not a good way to lose weight – in fact, numerous studies have shown that people who skip breakfast are more likely to be heavier than those who actually find the time to eat something in the morning.
WRITTEN BY MICHELLE
High fibre and protein choices such as wholegrain cereals and lean meats or milk will help you feel full for longer and can help prevent you from snacking on high fat, high sugar choices during the rest of the morning.
MAKE TIME FOR BREAKFAST. Many people think they do not have time for breakfast, but eating breakfast is a good habit to develop. If you skip breakfast, most likely you will not meet your daily needs for some essential vitamins and minerals and you will have less energy. Five minutes is all it takes to drink some milk or eat some yogurt and a piece of fruit. If you don’t have time at home, carry it with you and try to have a proper breakfast when you get to work or school. There are also now available, a number of healthy “on-the-go” choices in the grocery stores, such as breakfast drinks and cereal bars.
A full, well-balanced breakfast usually contains: 1. A starchy item: for example, whole grain bread or high-fibre cereals like oatmeal. 2. A milk serving: for example, a small glass of milk or a cup of yoghurt. 3. Another protein source: poultry/meat, fish, egg or peas/beans, peanut butter. 4. Any type of fruit, such as an orange, pineapple, paw-paw (papaya), West Indian cherries, watermelon.
ASH
BREAKFAST IDEAS. #1: THE QUICK AND HEALTHY BREAKFAST OPTION: CEREAL
• Choose a ready-prepared wholegrain or high fibre cereal, unsweetened granola or quick-cooking oats or wheat porridge. • Then, add some low-fat milk. • Top off your cereal or porridge with fresh fruit or use dried fruit such as raisins or canned fruit packed in its own juice.
#2: LIGHT BREAKFAST OPTIONS:
• Tub of low-fat yogurt topped with fruit or nuts. • Low-fat custard with sliced banana • Make a creamy fruit and milk drink: blend low-fat milk, low-fat yogurt and fruit (e.g. banana, watermelon or paw paw). • Fresh Fruit salad - plain or jazz it up with some plain unsweetened low-fat yogurt
#3: BREAD TYPE OPTIONS:
• Use whole-wheat bread, whole-wheat sada roti or whole-wheat roast bake. • Toasted raisin bread with thinly spread margarine. • Add a topping: lentil peas, baked beans, pumpkin, tomato or bhaigan choka; cheese, peanut butter, avocado, fresh tomato, sardines, tuna or chicken or turkey slices • Scrambled, boiled or poached eggs with sautéed tomatoes and onions. Feel free submit your nutrition questions and concerns to info@uhealthdigest.com and they’ll be answered in our next issue.
HELP MORE CHILDREN REACH 5 THROUGH HANDWASHING WITH SOAP! Remember when you turned five? What a big day that was, for such a little person! But every year, over two million children do not make it to their fifth birthday. This is often due to diseases, such as diarrhea and pneumonia, that can be prevented by the simple act of handwashing with soap. In fact, washing hands with soap on key occasions can reduce diarrheal risk by 45% and pneumonia risk by 23%. Lifebuoy knows that handwashing with soap saves lives. We have helped 48 million people adopt this habit in the past two years through our handwashing programmes – but we know that millions more children could be saved by adopting the handwashing habit. Through Unilever’s Sustainable Living Plan; we have set out to help more than a billion people take action to improve their health and well-being by 2020.
EVERYONE HAS A ROLE– YOU CAN HELP TOO. Each year we celebrate Global Handwashing Day on the 15th of October. 2012 marks our 5th Anniversary celebration of this event. As part of this year’s celebrations, we planned a series of initiatives throughout the month of October to highlight this important day and the importance of handwashing with soap. These initiatives included an educational school visit programme, teaching children the importance of washing their hands with soap, to protect themselves against germs and diseases, as well as a drawing competition for children ages 5—12 that reinforced the handwashing message and rewarded our nation’s children. Handwashing with soap is not just a practice to be done on or around Global Handwashing Day. It is a practice that we encourage everyone to transform from an abstract, good idea into an automatic behavior. So, we urge parents to continue to make the pledge with their children to ensure that they always wash their hands with soap at the 5 key times a day: after using bathroom, at bathtime and before breakfast, lunch and dinner. By making this commitment, the risk of respiratory infections and diarrhea can be reduced dramatically, especially in children under the age of 5.
10 THINGS TO TALK ABOUT
HYGIENE “Hygiene” comes from Hygieia, the Greek goddess of health, cleanliness, and...the moon. Ancient Greek gods apparently worked double shifts. The first soaps were formed by boiling animal fat with ashes from a wood fire, which contain potassium hydroxide, by the Celts or the Phoenicians as early as 600 B.C. Monks of the Jain Dharma (a minority religion in India) are forbidden to bathe any part of their bodies besides the hands and feet, believing the act of bathing might jeopardize the lives of millions of microorganisms. The number of germs on your fingertips doubles after you use the toilet. Up to half of all men and a quarter of women fail to wash their hands after they’ve been to the toilet. Millions of germs hide under watches and bracelets and there could be as many germs under your ring as there are people in Europe. Handwashing is the best way to avoid colds, flu and other viruses.
Pledge to “help a child reach their fifth birthday” and Lifebuoy will teach handwashing habits to one more child through handwashing programmes globally.
Soaps can have different pH – they may be neutral, slightly alkaline or slightly acidic. That’s why some soaps irritate some people and not others.
Parents, log on to our FB page for more information and to make the Lifebuoy pledge with your kids today! www.facebook.com/lifebuoy
It is recommended to wash your hands for at least 15 seconds, though studies show thay the reduction of skin bacteria is nearly 10 times greater by washing with soap for 30 seconds.
Pledge 5 with Lifebuoy Today! Clean Hands, Good Health.
Lifebuoy soap has been proven in laboratories to provide 100% more effective germ protection than ordinary soaps.
FRUIT
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CASHEW! NOTHING TO S NE E ZE AT
C
ashew!
Nothing to sneeze at. WRITTEN BY CAROL
QUASH
Someone once told me cashews have the ability to make even God cough. I smiled, vividly recalling how tightly the tangy juice of a ripe cashew grasps the back of my throat, eliciting several bouts of coughs, with a little sneezing in between.
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But still, who—unless you're allergic to it—can resist the taste and numerous health benefits of the soft, waxy-skinned, upside down heart-shaped cashew fruit and nut, whether in a lashing chow, salad, or as a salty snack? Not me, and I'm sure not even God, for apart from its nutritious goodness, it is a fun fruit to eat, with a lot of sucking, slurping and chewing involved. But be warned, the juice can 'tie up your tongue', cause a bit of itching around the mouth and will most certainly stain your clothes.
CA SH E W ! N OT H I N G TO SN E E Z E AT
T
he cashew is native to the coastal areas of northeastern Brazil. When ripe, the fruit turns either bright yellow, varying shades of orange, or deep red, and is slightly sour. It contains a lot of water and fibre, which is good for the digestive system. The seed can either be round or long, and is usually brown in colour. The ripe fruit can be eaten raw or can be used to add a zing to various dishes. The juice of a cashew contains five times the Vitamin C found in orange juice, and is also rich in Vitamins B1, B2, B3, calcium, beta carotene and iron. Ironically, it can also be used to soothe a sore throat. The cashew nut is a popular and expensive snack worldwide. Before it is eaten, the nut must be roasted to get rid of the toxic oil in it that causes skin irritation, removed from the seed coat and allowed to cool. No wonder it costs so much! It is cholesterol free and promotes a healthy heart with its abundant storehouse of Omega-3 fatty acids. According to healthdiaries.com, cashew nuts are an excellent source of the minerals—copper, magnesium, zinc and manganese—required daily. They are also a good source of Vitamin E.
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FRUIT
The copper found in cashew nuts converts tyrosine, one of the 22 amino acids that are used by cells to synthesize proteins, to melanin, the pigment responsible for giving hair and skin its color. It also enhances the enzymes that work to give flexibility and substance to bones and joints. Cashew nuts are particularly rich in magnesium, which is just as important as calcium for building strong bones. It is stored in our bones. Magnesium also helps in keeping nerves relaxed, controlling hypertension and in preventing heart attacks. In some cultures, various parts of the cashew and the tree are used for medicinal purposes. The bark is used to treat diabetes, thrush and constipation; the nuts are used for inflammation of the cervix, toothaches and venomous snake bites; the seed coat is used to treat some types of skin cancers and to clean tartar buildup; the juice is used to treat worms in children; and the young leaves are used to treat hypertension, diabetes, malaria, thrush, rheumatism and rash. Whoever said healthy doesn't have to taste good obviously never ate a cashew or the nuts. And while I admit cashew nuts are a bit costly, when it comes to my health and well-being I am hardly ever hesitant to “cough” up a little extra cash.
The antioxidant, proanthocyanidins, found in cashews, reduces the risk of numerous health conditions, especially cancer, by preventing the malignant cells from dividing. The fat contained in cashew nuts is considerably lower than that of other nuts, and is the ideal snack for preventing weight gain. The majority of fat found in cashew nuts is oleic acid or monounsaturated fat, which helps control high triglyceride levels that may increase the risk of heart disease.
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STDs
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EMB RACE A HE ALTHY L IFE : P R OTE CT YOU RSE LF
EMBRACE A HEALTHY LI FE:
E M B RAC E A H E A LT H Y LI F E : P ROT E CT YO UR SE LF
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STDs
Aggress ive campaig global awaren es ns abou t HIV/A s-building teenage ids have rs and y oung ad forced against ults to t the spre a k ep ad disease (STD). B of that sexually recautions ut what transmit STDs? ab ted Are teen agers aw out other types prevalen of are of t ce and heir danger?
LF... WRITTE N BY C
AROL Q UASH
Ninetee n-y HIV, can ear-old be treat Justin o ed risk in h pin aving un , and are not a s prevale es that since S protecte girlfrien TDs, inc nt as the d d, Alex, sex is un ludin y used t agrees. wanted commo o " I be, the o g pregnan don't kn n anym o c nly o y r w e . to cure His sixt and peo what th it now," een-yea e big de p le n o J r lo ustin de -old al is; HI can be c nger die clares w V is not ured. N from AI ith conv so ot as m D S . T hey hav ic any peo e drugs ple have tion. "Herpes a nd gono them, rig r r ht!" Ale hea x assert s.
Wrong!
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STDs
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EMB RACE A HE ALTHY L IFE : P R OTE CT YOU RSE LF
A
ccording to the World Health Organisation (WHO), "Each year an estimated 333 million new cases of curable sexually transmitted infections (STIs) occur worldwide, with the highest rates among 20-24 year olds, followed by 15-19 year olds. One in 20 young people is believed to contract an STI each year, excluding HIV and other viral infections." WHO says there are more than thirty different bacteria, viruses and parasites that cause STDs, which can result in a number of health complications and can even cause death. The more common diseases are HIV/Aids, chlamydia, gonorrhea, syphilis and pelvic inflammatory disease (PID), herpes and genital warts. HIV (human immunodeficiency virus) is a virus that kills the body's CD4 cells, which help the body fight off infection and disease. The virus can be passed from person to person through sexual intercourse—vaginal, anal, oral—or via shared drug injection needles with an infected person. It also can be passed through vertical transmission—from an infected mother to her baby during pregnancy, delivery or breastfeeding. HIV is not transmitted from handshakes, water fountains, bathrooms or eating utensils. The acquired immunodeficiency syndrome—AIDS— results from the failure of the immune system. If not treated, the disease can cause death from something as simple as the common cold.
Symptoms that may be warning signs of HIV infection include: • rapid weight loss • dry cough • recurring fever or profuse night sweats • profound and unexplained fatigue • swollen lymph glands in the armpits, groin, or neck • diarrhea that lasts for more than a week • white spots or unusual blemishes on the tongue, in the mouth, or in the throat • pneumonia • red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids • memory loss, depression, and other neurological disorders
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However, you cannot rely on symptoms to know whether or not you are infected. The only way to know for sure is to get tested. While there is still no cure for HIV, there are treatment options available, including antiretrovirals (ARVs), which work against the HIV infection by slowing down the spread of the virus in the body. "But even so, the financial burden, the stigma attached and the psychological trauma that accompanies this disease is not worth the few minutes of unprotected pleasure," says 20-year-old HIV-positive John.
Chlamydia is caused by the bacterium, Chlamydia trachomatis and is the number one sexually transmitted disease in the United States. People who are infected by this STD are usually unaware that they have contracted the disease because of its asymptomatic (no symptoms) nature. If there are symptoms, they are usually mild and may include: • Vaginal or penile discharge • Burning during urination • Women may experience lower abdominal pain, pain during intercourse and irregular bleeding between periods. • Men may experience swelling or pain in the testicles. Chlamydia can be transmitted during sexual intercourse—vaginal, anal, or oral—as well as via vertical transmission. Sexually active teenage girls and young women are at greater risk of contracting the disease because their cervix are not fully mature. The danger lies in the fact that it can cause irreversible damage to a woman's reproductive organs before she even becomes aware that there is a problem. If left untreated, the infection can spread into the uterus or fallopian tubes and cause PID, which can permanently damage a woman's fallopian tubes, uterus, and surrounding tissues, resulting in infertility, ectopic pregnancy, abscess formation, and chronic pelvic pain. Studies show that women infected with chlamydia are up to five times more likely to become infected with HIV, if exposed. In men, the infection may spread to the epididymis (the tube that carries sperm from the testes), which causes pain, fever, and in rare cases, sterility. It is recommended that sexually active women 25 and under be screened annually for chlamydia, and if they test positive they should notify all recent sex partners so they too can be treated. Gonorrhea is caused by the bacterium Neisseria gonorrhoeae, which easily grows and multiplies in the warm, moist areas of a woman's reproductive tract and in the urinary canal in women and men. It also grows in the mouth, throat, eyes, and anus. Like chlamydia, it is frequently asymptomatic. If symptoms do manifest, they are usually mild and include vaginal, penile or rectal discharge, burning or itching during urination and sore throat. If left untreated it can cause arthritis and lead to PID in women and epididymitis, a painful condition of the testicles that can lead to infertility in men. A person with gonorrhea is at a higher risk of contracting HIV. Consequently, an HIV-infected person with gonorrhea is more likely to transmit HIV to a sexual partner.
E M B RAC E A H E A LT H Y LI F E : P ROT E CT YO UR SE LF
G
Gonorrhea can be contracted through contact with the penis, vagina, mouth, or anus of an infected person. It can also be spread from mother to baby during delivery.
The virus is released from the sores, as well as skin that does not appear to be broken or to have a sore and can only be transmitted through sexual contact from kissing.
In the United States, the highest reported rates of gonorrhea infection are among sexually active teenagers and young adults.
Herpes infection can be severe in people with suppressed immune systems, making them more susceptible to HIV infection. It can also result in potentially fatal infections in babies. Fortunately, vertical transmission of herpes is rare.
The disease can successfully be treated with antibiotics; however, the damage done by the disease is irreversible. In addition, sexual contact with an infected person after treated may result in re-infection. Syphilis, often referred to as "the great imitator" because its symptoms are similar to those of other diseases, is caused by the bacterium Treponema pallidum. It develops in three stages: • Painless reddish-brown sores (chancres) on or near the genitals. • A skin rash that develops anywhere on the body, along with flu-like symptoms such as mild fever, fatigue and sore-throat. • Late stage symptoms include brain damage, mental illness, blindness, heart disease and death. The disease is only transmitted from person to person through direct contact with a syphilis sore, which occur mainly on the external genitals, anus, or in the rectum, the lips and in the mouth. The organism is transmitted during sex—vaginal, anal, or oral—or via vertical transmission. It must be noted that syphilis cannot be contracted through contact with toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, shared clothing, or eating utensils.
Infected persons should abstain from sexual activity with uninfected partners when lesions or other symptoms of herpes are present. However, even if a person does not have any symptoms, he or she can still infect sex partners. Genital HPV infection is caused by human papillomavirus (HPV), a group of viruses that includes more than 100 different strains. Over 30 of these are sexually transmitted, and they can infect the skin of the penis, vulva, or anus, and the linings of the vagina, cervix, or rectum. Most HPVs have no symptoms, but those that do include genital warts that are painless, soft and usually flesh colored. They appear one to eight months after infection. The virus is transmitted during sexual intercourse. There is no cure for HPV infection, but the infection goes away on its own in most women. Research has shown that only a small percentage of women have persistent infection with high-risk types of HPV—the main risk factor for cervical cancer. An abnormal Pap result can be a woman's first warning sign of an HPV infection. Regular Pap testing and careful medical follow-up, with treatment if necessary, is recommended for the prevention of life-threatening cervical cancer.
Genital herpes is caused by the herpes simplex viruses type 1 (HSV-1) and type 2 (HSV-2). Infected persons have no or only minimal signs or symptoms, which may show up one to thirty days after contraction and may include:
While the proper and consistent use of latex male condoms can reduce the risk of STDs, the most effective ways to avoid contracting these diseases are abstinence or a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.
Blisters go away and return weeks or months after the first, and are almost always is less severe and shorter than the first outbreak.
STDs
While there is no cure for herpes, antiviral medications can shorten and prevent outbreaks during the period of time the person takes the medication. Proper use of latex condoms may reduce the risk of genital herpes only when the infected area is protected.
The sores caused by syphilis makes the transmission of the HIV infection easier. A person who has had syphilis for less than a year can be cured with a single antibiotic shot, usually penicillin. For people who were infected longer than a year, additional doses are needed. As with gonorrhea, treatment will not repair the damage already done by the disease.
• Small, painful blisters that last one to three weeks • Itching or burning before blisters appear
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It is also extremely important that sex partners talk to each other about their HIV status and history of other STDs.
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ASK U
| DR. NEIL SINGH
MBBS PG MSc
ASK U ANYTHING ANSWERED BY DR.
Can you get a particular STI more than once?
There are over thirty different STIs that infect the human body. Many of them can be completely cured with appropriate treatment but it is quite possible for someone to contract an STI more than once if repeatedly exposed to these pathogens. Sexually transmitted infections (STIs) are caused by overgrowths of bacteria, viruses, fungus (yeast), or protozoal pathogens in infected persons. They are spread by inhalation of infected air, contact with infected body fluids, and by contact with infected skin (rashes, lesions). It is important to note that you don’t have to have sexual intercourse to contract an STI.
Do all STIs have symptoms?
NEIL SINGH MBBS PG MSc
Cynthia Edson
Many STIs are spread by direct skin contact. Everyone who has “risky contact” is at risk. Teens and young adults are more “at risk” than other populations. Avoiding contact with infected air, fluids, and skin is the only way you can prevent contracting an STI. Condoms do NOT completely protect from infections spread by skin contact, because they do not cover all infected areas of the skin. Infection with these organisms does not require penetration during intercourse if there is other “risky contact”. Avoid “risky contact,” which is any contact with skin or fluids that may contain the viruses and bacteria that cause STIs. Don’t share intimate apparel such as swimwear or underwear.
Sherlyn Hoang
Sexually transmitted infections (STIs) are caused by overgrowths of bacteria, viruses, fungus (yeast), or protozoal pathogens in infected persons. There are over thirty types of infections one can contract and their signs and symptoms are quite different. A person can contract an STI either by inhalation through the air, direct contact with an infected skin lesion or through contact with infected body fluids. Generally, STIs present with obvious clinical symptoms and can therefore be detected easily. However there are a few infections which can
remain asymptomatic (no symptoms) for a long period of time and these persons can transmit these infections to others through risky sexual behavior. Asymptomatic infections can occur in persons who are infected with pathogens transmitted via the exchange of body fluids. HIV, Syphilis and Hepatitis B are common examples of STIs that initially show no symptoms when a person is first infected. It is therefore important that one should at all times avoid risky sexual behavior and if one has engaged in such behavior then STI screening is recommended.
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
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
THERAPY
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EMOTI ONAL FR E E DOM TE C HNIQ U E
EMOTIONAL FREEDOMTECHNIQUE
WRITTEN BY MAYA
HIBBIN
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Holistic therapy is a term given to treatments and approaches that aim to work with an individual as a whole, on all levels – their mind, body and spirit. It is a broad term that covers a diversity of techniques, but all of which aim to create healing, health and happiness through the balancing of these three aspects. It is about recognising that these elements of every human being are always connected, so when one area is out of alignment we learn to look at the mind, body and spirit for the reasons, and also for the solutions.
E M OT I O N A L F RE E D O M T E C H N I QUE
Eyebrow
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THERAPY
Top of Head
Side of Eye
Under Eye
Under Nose Under Lip
Collarbone
Tender Spot
4 inches below armpit
Under Arm
Liver
One ancient technique that has gained recognition and worldwide momentum in recent years is a therapy called the Emotional Freedom Technique or EFT. It is rooted in the same ancient principles as acupuncture: that our bodies have an energy circuit or Meridian System; energy travels through our body, entering at one point and leaving at another, which is why it is also sometimes referred to as “emotional acupuncture”. But unlike the use of needles in acupuncture, the practitioner uses a gentle tapping technique with their fingers on the energy point.
This motion gave it its more commonly used name, “tapping”. It is carried out through a combined process where you “tune” into your body’s energy system while speaking what you are feeling at that moment when you are tapping on your body’s meridian points. Simply by remembering a difficult experience, the emotion felt at that time will show up. According to EFT, it does not matter how many years have passed since the experience, it will show as a blockage in the meridian system, and the therapist will speak a simple phrase and tap at the same time.
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THERAPY
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EMOTI ONAL FR E E DOM TE C HNIQ U E
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The theory behind the technique is simple: all human experiences, good and bad, create a memory. Memory always has an emotion attached to it. These memories and the corresponding emotion can be triggered at any time by one of our 5 senses. When a negative memory is triggered and the bad feeling or emotion arises, it is known as a disruption in our energy field. More simply put, emotional problems, or negative emotions, create negative energy, which causes blockages in our energy flow, which can then lead to continued emotional and physical problems. The tapping technique balances the energy system and appears to relieve psychological stress and related, physical pain. Restoring the balance of the energy system allows the body and mind to resume their natural healing abilities. It is said to be one of the most efficient, effective and gentle treatment techniques available and can be used for many emotional or physical problems. In Trinidad and Tobago we are very fortunate to have an extensively trained and experienced EFT therapist, Louise Hawkins. She explained to me that “tapping is a very simple, non-intrusive technique which anyone can learn in a couple of sessions, and then apply to themselves whenever it is needed”. She went on to say that “by tapping on the 13 different meridian endings (points where energy enters the body), which are located on our hands, face and body, we send a deactivating signal to the part of the brain where the responses to memories lie, and clear the negative emotion”.
It is now widely understood that between the ages of 0 and 10 years old, children experience many emotions and form many of their beliefs, understandings, patterns and reactions. Past 10 years old, there are relatively few “new” experiences, so reactions after this point are simply patterns that we follow based on established early experiences, the memories and emotions, which are simply triggered throughout our lifetimes, over and over. Did you perhaps have an adult in your life when you were a child that would speak roughly to you? When you meet someone in your life now, who speaks similarly, does it remind you of that person from your childhood? Do you find yourself feeling or reacting in the way you might have done as a child? Does a song on the radio, or the smell of a certain perfume, or the sounds of a door slamming take you back to a certain point in your life? Tapping allows us to go back to those early memories and remove the negative emotion attached to it and replace it with a new reaction. In order to understand this technique better I decided to visit Louise for a session. Sitting comfortably in a chair, with Louise to one side of me, I closed my eyes and she asked me what my most prominent emotion or feeling was at that time. I was somewhat anxious on that particular day, and as she began to tap on the various points, following a particular pattern, she asked me to recall my earliest memories of feeling anxious. As she tapped she asked me to repeat certain statements and affirmations, while also taking deep breathes at the end of the cycle of tapping. The session lasted an hour, but the
time passed very quickly and afterwards I was quite amazed at how light I felt, and that I no longer felt the anxiety I had previously been experiencing. I was also surprised at how many memories I recalled in the process. Louise explained that this is very common “as you clear areas of negativity and your energy shifts, you will find memories that perhaps you have never recalled before, come back to you”. It almost seems to simple to have any real impact, but surprisingly I found it to be an incredibly uplifting and freeing experience. Our emotional and physical elements are tightly woven together and Louise indicated to me that when clients come to her with serious physical or medical problem, she knows that they are usually rooted in long-term emotional issues that have been ignored. She often sees clients who have visited numerous doctors and no physical reason for their illness can be found. She went on to explain that “our bodies are the greatest indicator of what is happening within us emotionally, as extreme or continued emotional issues manifest in physical ailments and illnesses”. But all too often we do not look at ourselves from this holistic perspective, and may not necessarily see the connection between our emotional, spiritual and physical elements and how they interact and affect each other. We drag around our emotional distress for years, decades and lifetimes, and even as our bodies manifest physical problems as a result of this, we still don’t listen. These issues build up over the years, and it is Louise’s job to peel away the layers, recognise the core issue and apply this technique to
E M OT I O N A L F RE E D O M T E C H N I QUE
shift this negative energy and restore the natural flow of energy in the body’s system. Trinidad and Tobago is a high-pressure culture and has high levels of stress-related illnesses. This is also reflected in the types of issues Louise deals with. “Stress is not recognised, nor coped with well in Trinidad, and it invariably leads to depression, anxiety, behavioral issues and other unwanted behaviours”. She also highlights that she sees a great amount of anxiety and depression among young people, “there is great pressure on children and young adults in school and society as a whole, and this is a simple technique
that could be taught to children to help them better cope with these pressures”. This is a tool that can not only deal with existing problems, but can also be used as a preventative measure. In this fast-paced, high stress society that we live in, where stress-related problems are becoming the norm; perhaps it is time that we quiet our minds and our bodies and pay attention to how our minds, bodies and spirits are interlinked and learn simple techniques such as EFT to help find better alignment in ourselves so we can have emotional and physical health, happiness and harmony.
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THERAPY
Louise Hawkins is an experienced Holistic Therapist specializing in trauma therapy, who provides a wide range of therapeutic services, including Hypnotherapy, Neuro-Linguistic Programming (NLP), Cranial-Sacral Therapy and Reiki. She is a fully trained EFT practitioner accredited by the Association for the Advancement of Meridian Energy Techniques (AAMET), and she works both in Trinidad and Tobago.
If you would like to experience a session with Louise or learn more about EFT and the other services she offers please contact: Waveney Richards, Psychologist’s Office, 2A Roberts Street, Woodbrook, Trinidad: 628-6314 or Tobago: 620-9788.
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BREASTFEEDING
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THE FIR S T HOU R : NU TR ITIO N A N D N C D S
T H E F I RST H O UR : N UT R I T I O N A N D N C D S
WRITTEN BY ADEPEJU
OYESANYA
THE
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BREASTFEEDING
HOUR
NUTRITION & NCDS I give my children the best. I deserve the best, I overheard a man state matter-of-factly as he discussed his one-month-old daughter and her mother’s decision to continue the breastfeeding tradition. I continued to listen, realizing that this father was making the best nutritional decision by advocating breastfeeding. This decision, I reflected, would go a long way towards protecting his daughter from Non-communicable Diseases (NCDs).
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BREASTFEEDING
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THE FIR S T HOU R : NU TR ITIO N A N D N C D S
> NCDs are by far the leading cause of death in the world, more than 36 million out of 57 million global deaths per year.
> 80% of all NCD deaths occur in low- and middle-in-
According to the World Health Organization, the four main NCDs, cardiovascular disease, cancer, chronic lung diseases and diabetes, kill three in five people worldwide, and cause great socioeconomic harm in all countries, particularly developing nations such as ours. The genesis of many of these
A
diseases lies in our nutrition and lifestyle. Giving our newborn babies the best can ensure needed nutrition to fight NCDs and it begins with breastfeeding (AAP Policy Statement on Breastfeeding & the Use of Human Milk, published Feb 27, 2012). Children, who are primarily unable to make their own health decisions, must depend on adults to modify or avoid behavior which places them into risk categories.
HUMAN MILK
Proper infant nutrition—which begins with breastfeeding—may aid in abating poverty, stress and hereditary health factors. Human milk’s claim to the title of ‘superfood’ is based on evidence that it dramatically acts as a preventative agent by setting the body toward a path of optimal health. It lowers the risk of childhood onset diabetes, asthma and eczema. It decreases the risk of obesity later in life, and it may reduce the risk of developing psychological disorders.
WHAT WE KNOW
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NCDs are commonly referred to as lifestyle diseases. They are non-transferable from person to person, are preventable, and are chronic because of their long duration and lasting medical effects. A person’s genetics, background, lifestyle, economic and social conditions are factors which contribute a higher prevalence of NCDs.
come countries.
> NCDs affect women and men almost equally. > Close to 43 million children under the age of five were overweight in 2010.
> Eliminating major risks could prevent most NCDs. If the major risk factors for chronic disease were eliminated, approximately three-quarters of heart disease, stroke and Type 2 diabetes would be prevented; and 40% of cancer would be prevented.
BEHAVIORAL RISK FACTORS FOR NCDS IN CHILDREN
The most important behavioral risk factors are unhealthy diet, being overweight or obese, tobacco exposure (second-hand tobacco smoke), low fruit and vegetable consumption during the introduction of solids and beyond, intake of foods that are high in fat, sugar and salt, and lack of physical activity.
PREVENTION OF NCDS Interventions such as diet modification and increased physical activity are proven to control NCDs.
STARTING RIGHT... EDUCATION
Prior to birth, breastfeeding classes during the pre-natal stage are recommended for all parents, first time or otherwise, so that they better understand that human milk is the natural food of choice for the human infant during the first year of life and beyond. Breastfeeding is the biological norm after delivery, in contrast to artificial infant feeding, which is becoming our cultural norm. If you choose to breastfeed your baby, it is important to discuss it with your medical professional prior to delivery, take a breastfeeding class, read a breastfeeding book or attend a support group for breastfeeding.
T H E F I RST H O UR : N UT R I T I O N A N D N C D S
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BREASTFEEDING
STARTING RIGHT...
BABY-LED FEEDING: THE GOLDEN HOUR The first hour of life is when nutrition begins for all human infants. Immediately after birth, a newborn, once placed between his mother’s breasts, will bop his head, suck his hands and find his mother’s breast. The newborn is familiar with their mother’s heartbeat, smell and voice. This time is commonly referred to as the Golden Hour. It’s a time when mother, baby and father can begin their lifetime dance of knowing each other intimately without disturbance. The medications and vaccinations needed after birth can be given while the baby remains directly with the mother. Among these are treatments for the eyes (erythromycin ointment ), Vitamin K (injection after birth to make the blood clot and prevent bleeding) and, possibly, Hepatitis B vaccination. They can even can be postponed so that mother and child are not separated until the baby receives his first feeding. Have you thought about what you ate the first hour of your life? Take time to ask a parent what decision was made. It might help you understand your current health situation a little better.
D
During this stage the volume of milk increases. This form of human milk replaces colostrum. The more milk is properly removed from the breasts, the more the breast will produce milk. Milk supply is influenced by how often the baby feeds and how well it transfers milk from the breast. Another alternative is proper use of either hand expression or a pump to guard milk supply. During early stages, milk production is hormonally driven (endocrine control system), but by the third stage it is dependent upon effective and frequent milk removal from the breast. Milk production slows when the newborn does not feed frequently or poorly transfers milk. Most pediatricians advise that babies should be exclusively breastfed for the first 6 months, with the addition of complementary foods after this. Breastfeeding can continue as long as mutually desired by mother and child. There is no set guideline to the length of breastfeeding, but it is accepted that breastfeeding up to five years is desirable and acceptable; there is, however, no consensus on what is good or bad after that time period.
STARTING RIGHT...
KNOW THE FIRST DEFENSE The first milk a breastfed newborn receives during this first hour is colostrum. Colostrum is often called “liquid gold”; it is small in quantity but rich in nutrients and immunities. Colostrum coats the gastrointestinal tract, has a laxative effect, stimulating the baby’s bowel movement, and is important in helping the infant pass the first stool. The first few days after birth, the baby's dark tarry stools are called meconium.
Nutrition decisions made at birth defend babies (who eventually become the adults and decision makers) from NCDs. According to the WHO, one and a half billion adults, 20 and older, were overweight in 2008. Understanding and using nutrition to maximize the quality of our lives, our families and communities can be both lifesaving and cost effective.
When breastfeeding is going well the baby should feed a minimum of eight times in a 24-hour period. The more time a baby gets at the breast during the first few days allows him to learn to breastfeed effectively before his mother’s milk becomes more plentiful, usually on the third or fourth day after birth.
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PAEDIATRICS
| SMALL TING, USUALLY!
SMALL TING.. . USUALLY!
Bumped heads, cuts and skinned knees are inevitable in childhood. Many can be prevented by supervising children and creating a child-safe environment. But it’s impossible to prevent every scrape and bruise. No matter what you do, adventurous little boys and girls will get into trouble and harm themselves. WRITTEN BY DR.
DAVID BRATT, MD. MPH. CMT
Most injuries can be treated at home, because most of them are minor. Although attending to an injury with a crying, panicky child is not easy, a good thing to remember is that a noisy response usually is a good sign. A child who is screaming and flailing her arms is probably fine. Silence, after an accident or an argument, is bad news. What should you do if your child gets injured? First of all, keep calm! I find that modern mothers panic far too quickly. Your fear will make your child scream even louder. It seems to me that long ago mothers were much more sensible and as long as the child was crying and moving all extremities, they would hug up the child, reassure him, keep an eye on him for a couple of hours and go on with their work.
SMALL TING, USUALLY!
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PAEDIATRICS
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PAEDIATRICS
| SLEEPING THROUGH THE NIGHT
Is it the horrible accidents that we daily see in the media that have us uptight about children’s pain? Is it guilt that we do not spend enough time with our child that makes us overreact? This has always been the case with fathers, but now it seems the mothers are behaving much the same. Whatever it is, and it's probably a combination of various things, it seems to be becoming an epidemic with people running to the doctor or A&E at the first drop of blood. If your child is old enough to explain himself, calmly but firmly and loudly, ask him where it hurts. Everyone should know this by now because all the TV shows about emergencies always have the starboy taking charge and asking precisely this: “Where does it hurt?” If he’s too young to direct you and you do not see an obvious wound, then run your hands down his body, pressing gently on different areas to find out where it hurts. If you can’t find what is wrong and you cannot calm him down, then call the nearest emergency room for advice. This is what emergency rooms are for: emergencies. Despite the failure of our Ministries of Health to provide adequate emergency room care, there are a number of private nursing homes where such care is available. If you cannot afford private care, then maybe it’s time you thought about talking to your area representative about health care in this country, or changing your voting pattern.
IF YOUR CHILD IS OLD ENOUGH TO EXPLAIN HIMSELF, CALMLY BUT FIRMLY AND LOUDLY, ASK HIM WHERE IT HURTS.
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If you believe that the injury is minor, proceed with basic first care. Here’s what you need to know about treating the two most common injuries, scrapes and cuts.
SCRAPES
Scrapes are known medically as abrasions. All children go through the childhood initiation of falling down and getting a scrape or abrasion. Elbows and knees and the palms of the hands are seemingly made for scrapes. Sometimes the forehead, too. They are the places we hit the most when falling down. Scrapes hurt a lot because the top layer of the skin has been scraped off, exposing millions of nerve endings. Bleeding, however, is minor. Numb the wound with ice wrapped in a clean cloth for a few minutes. Then gently clean the area with a soft cloth, soap and warm water. Make sure you get out all the dirt. If not, infection can set in easily.
CHILDREN'S PAIN MAGICALLY DISAPPEARS AS SOON AS THE PLASTER IS PRODUCED. AND WHY NOT? MAGIC IS REAL FOR CHILDREN. If you want, you can apply an antibiotic ointment like “triple antibiotic” which you can now sometimes get over the counter. The antibiotic ointment is not really necessary, however, once you clean the abrasion thoroughly with soapy water and continue to do so once or twice a day for four to five days. Ordinary soap is an excellent anti-infectious agent. If the scrape is small, there is no need for a bandage, and warm, tropical air seems to stimulate the healing process. However, never underrate the psychological value of a plaster or Band-Aid to a child. Some children's pain magically disappears as soon as the plaster is produced. And why not? Magic is real for children. Red Flags (warning signs): If signs of infection — severe redness, swelling, pus or fever—develop, contact your physician. These symptoms usually appear a couple of hours after the injury.
SLEEPING THROUGH THE NIGHT
CUTS OR LACERATIONS Many children cut themselves whilst playing. They should not be blamed for this. Getting stitches is almost a part of growing up. The two areas most commonly cut are the forehead, just above the eyebrows, and just under the chin. These are prominent bony places, designed to jut out and protect softer, more fragile areas, like the eyes and lips, and they certainly do their job well. Most cuts in these areas are small and superficial.
PRESSURE WITH A CLEAN CLOTH FOR FIFTEEN MINUTES WILL ALWAYS STOP THE BLEEDING. NOTICE HOW LONG PRESSURE MAY NEED TO BE APPLIED. MOST PEOPLE THINK A COUPLE MINUTES IS ENOUGH. NOT AT ALL. A quite frightening but usually innocuous laceration frequently occurs in adventuresome toddlers who fall and hit their mouths. A tooth may cut through the lip and cause lots of bleeding, scaring mothers out of their wits. The same amount of bleeding happens with cuts on the scalp. Both the lip and the scalp have lots and lots of blood vessels. For this reason, these sites bleed heavily, even though the cut may be quite small and superficial. Pressure with a clean cloth for fifteen minutes will always stop the bleeding. Notice how long pressure may need to be applied. Most people think a couple minutes is enough. Not at all. Cuts of the lips or tongue rarely need suturing. Because of the abundance of blood vessels, they heal rapidly and cleanly, rarely leaving scars. Moreover, with a cut of the lip or the tongue, you can tell the child is well when he asks for food after a couple of hours.
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PAEDIATRICS
The important thing for any cut is to stop the bleeding: Press the cut hard with a clean cloth for at least five minutes initially. If bleeding continues, apply more pressure for another five minutes, etc. When the bleeding stops, clean the cut with soap and warm water and cover it with a tight bandage. If bleeding recurs, don't panic. Reapply pressure. The laceration should heal in about 7 to 10 days. Red Flags: A cut that is more than one-half inch long or is deep or jagged usually requires stitches. Also see a doctor if the bleeding doesn’t stop; if the area around the injury becomes numb or weak; if the cut is on the face or any other part of the body; if you think foreign matter may be embedded in the cut; if signs of infection (see above) appear; or if the cut doesn’t heal within two weeks.
THE IMPORTANT THING IS TO STOP THE BLEEDING: PRESS THE CUT HARD WITH A CLEAN CLOTH FOR AT LEAST FIVE MINUTES INITIALLY. Most scrapes and cuts are minor, and, as you see, respond to a calm disposition, reassurance and a little sensible First Aid. Seldom is there need for that overused Caribbean expression, "We had was to rush the chile to Accident & Emergency!" And of course, if you are not sure, then that's why you have your family doctor or paediatrician or local emergency room.
Dr. David Bratt is the author of The Book of Brats: Bringing up Children in the Caribbean.
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THE NEXT U January to March 2013
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