JULY SEPT 2013
ISSUE 22
TT$35.00 US$5.99
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THE CARIBBEAN HEALTH DIGEST
JAUNDICE a common condition
in some newborns.
Lupu Lu pu p us A di d se eas a ea afffe ec cttin ng th t e im i mu mune ne sys yste tem te m a d a tr an t ue e story to orryy abo out a you ung n sufffe ere rer. r. Kiidn dney eyys a an nd Di D et P ottec Pr ct your yo our kid dne neys y by ys eatitit ng ea ng the h rig gh htt foo ods ds.. Pllan anta ta ain ins ns A mu ust hav ave in n the e car a ib bbe ean a , de eliici cio ciou ou us an and nd nutr nutritittio nu ous u ! uhealthdigest.com
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12 Congestion and itching
34 Transcendental meditation Hocus pocus, you say? Not at all. Meditation is an ancient, time-tested way to relieve stress, release pent-up negative emotions, and settle into your day. In this story, you get plenty of reasons why a little spiritual time-out could do you a world of good.
You can’t sleep because your nose is stuffed up, and the itch is driving you mad. Is it an allergy, or is it sinusitis? Knowing the difference will help you choose the right treatment...and let you find peace at last.
16 Newborn Jaundice Just the term “jaundice” is enough to strike fear into the heart of even the most experienced parent, and understandably so. Yellow skin in a newborn looks scary, and, if left untreated, jaundice can have serious consequences. In our feature article, Dr. David Bratt explains the causes, effects and treatment of this rare, yet unsettling condition.
18 Giving Lupus a voice
36
42
Lupus is a thief that robs its victims of energy and vitality, exposing them to a range of symptoms that can impact their careers and their day-to-day life. But The Voice of Lupus Foundation is here to give hope and share information that can make this condition less mysterious.
26 Anxiety
44
When every step you take goes “Ouch!”, especially in the heel and sole, you might have plantar fasciitis. This story tells you what symptoms to look for, and what to expect if you decide to visit your doctor.
Urticaria Got an itch that won’t quit? It could be urticaria, commonly known as hives. Desiree Seebaran tells us how we get it and what we can do to feel better.
As science fiction becomes science fact, robots are being relied upon more and more to perform delicate, critical manoeuvres, including surgery on humans. BBC Health correspondent David Fenton gives a peek into the operating theatre of tomorrow, where robots wield the scalpel.
Balance your hormones with exercise
30 Plantain: our local superfood
32 Plantar Fasciitis
You can’t live without them, so it’s best you treat your kidneys right. Michelle Ash explains the importance of the kidneys, and tells us how to nurture them by eating and drinking right.
The robot will operate on you now…
A built-in mechanism that has helped our species survive, anxiety also develops into a range of psychological disorders that can intrude upon your inner peace.
This cousin of the banana, inedible when raw, gives up its yummy goodness when fried, baked, steamed or boiled. And as Sheldon Waithe shows in this article, it’s ever so good for you.
Protect your kidneys
48
Hormones are the body’s chemical messengers that tell it what to do and when. They also play a part in the way your body responds to exercise. See how to get the most out of your workout by being hormone-savvy.
Dearest Readers, thank you for reaching for another issue of U and for your continued commitment to a publication dedicated to improving your health and well-being. Issue twenty-two brings a colourful mix of engaging and telling stories, each carefully researched and written by our dedicated U writers. In this issue, pediatrician Dr. David Bratt brings us his feature story on infant jaundice, answering the many questions parents and parents-to-be may have on this condition. The term “plantar fasciitis” may sound new to many of us, but the condition itself may not be. If you have experienced pains either in your heels or the bottom of your feet, then this article, written by Mezaan Beljic, may reveal the source of your discomfort. Anxiety, transcendental meditation, and ways to protect your kidneys by eating right are some of the topics to be tackled in this eclectic issue. Other articles featured are on conditions of the blood like lupus and conditions of the skin, like urticaria. Our featured fruit is one of our favorites in the Caribbean; plantains. As always, we are pleased to have brought you another compelling issue of U, and to bring a greater awareness of these topics, and we are even more eager to get working on the next U. Till then, happy reading!
SHERINE & STUART
FOUNDING EDITORS
NASAL BLOCKAGE
| CONGESTION AND ITCHING: SINUS OR ALLERGY?
Congestion SINUS OR ALLERGY? WRITTEN BY CAROL
QUASH
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The nasal discharge and itchy throat you've been nursing for the past two weeks are driving you crazy, and you silently curse the pharmacist who recommended the sinus medication you've been religiously taking to no avail. But the label says it “treats the symptoms of sinusitis,” including the ones you are experiencing. Why isn't it easing your distress? Could the annoying symptoms be caused by something else – say an allergy? Telling the difference between sinusitis and an allergy isn't always easy, as the symptoms can sometimes overlap.
CONGESTION AND ITCHING: SINUS OR ALLERGY?
|
NASAL BLOCKAGE
& Itching
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NASAL BLOCKAGE
| CONGESTION AND ITCHING: SINUS OR ALLERGY?
stuffy nose and runny, itchy eyes are common symptoms to both ailments,” says pharmacist Gail Ramnath. Sinusitis, often referred to as rhino-sinusitis, can be caused by a virus or bacteria, or by fungus in patients with impaired immune systems, and causes congestion in one or more of the four pairs of cavities (air-filled spaces) known as paranasal sinuses. They are located over the eyes in the brow area (frontal sinuses), inside each cheekbone (maxillary sinuses), behind the bridge of the nose and between the eyes (ethmoid sinuses). Sinus symptoms can occur at any time of the year and usually include: • Thick, foul-smelling nasal discharge that has turned yellow, green, or gray • Tenderness or pain around the face and eyes • Headaches, usually around the forehead • Nasal obstruction • Congestion • Post-nasal drip • Fever or a persistent cough • Halitosis (bad breath) • Fatigue • Loss of taste or smell “Sinus infections often feel like tooth pain, even severe tooth pain, because the roots of the upper teeth are so close to the inflammation of the maxillary sinuses,” Ramnath says. Sinusitis falls into four categories: • Acute sinusitis, where symptoms last for more than four weeks • Subacute sinusitis, where symptoms last between four and twelve weeks • Chronic sinusitis, where symptoms last longer than twelve weeks • Recurrent sinusitis, where symptoms are present three or four times a year Allergies, Ramnath explains, are triggered by exposure to allergens such as dust, pollen, pet dander, mold spores, certain types of food, and even the time of the year. “Seasonal allergies can come on and end with the particular season of the allergen.”
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Allergic reactions can range from minor to severe and life threatening (anaphylaxis). The severity of an allergy varies from person to person and different types of allergies manifest in different ways. Hay fever or allergic rhinitis, for example, may cause congestion, runny, itchy nose and eyes and red and itchy skin. Eczema may cause red, itchy
CONGESTION AND ITCHING: SINUS OR ALLERGY?
skin, while allergy to foods such as peanuts may cause a tingling in the mouth, swelling of the face, including the lips, tongue and throat, hives, stomach cramps, vomiting or diarrhea, or even anaphylaxis. An allergic reaction to a drug may result in hives, itching, rash, shortness of breath and wheezing, swelling of the face, and anaphylaxis. Insect sting allergies may cause swelling, hives, shortness of breath or anaphylaxis. Effectively treating the symptoms of sinus or allergies begins with a proper diagnosis. Since sinusitis is almost always caused by a viral infection such as the flu or the common cold, general practitioners (GPs) make their diagnosis based on the symptoms. However, in severe cases, the patient will be referred to an ear, nose and throat (ENT) specialist and may be required to do an X-ray or CT scan to determine the cause of the sinusitis.
|
NASAL BLOCKAGE
Ramnath says mild symptoms of allergies can be temporarily treated with over-the-counter antihistamines and decongestants. “Antihistamines such as diphenydramine (Benadryl), loratadine (Claritine and Erolin) or Cetirizine (Zyrtec and Triz) block the production of histamines (an allergy-causing chemical found in some of the body's cells). Decongestants reduce blood flow to the affected area, creating more room to clear the congestion.” Ramnath identifies the nasal spray as one of the more common types of decongestants. However, she warns, nasal sprays should not be used for more than three days because they can cause the nostrils to become more stopped up. Another common treatment for chronic allergic Rhinitis is inhaled corticosteroid, an anti-inflammatory medicine that is available only by prescription.
Diagnosing an allergy takes a little more time. In addition to answering questions about their symptoms, medical history and habits, the patient will be required to undergo some allergy tests, such as skin and blood tests, to determine the source of their allergy. This, however, is not available in the Caribbean. Once a diagnosis is made there are a number of treatment options available to sinus and allergy sufferers.
Ramnath says based on her experience, seasonal allergy patients prefer the use of non-drowsy medication containing both an antihistamine and decongestant. “However, I advise that they use these meds with caution and under a doctor's advice, especially in patients with glaucoma, high blood pressure that's not under control, heart conditions, thyroid problems, enlarged prostate, and diabetes.”
In treating Bacterial sinusitis, Ramnath says while over-the-counter (OTC) drugs work for some people, others opt to visit their doctors as a result of the severity of the symptoms and the long-lasting nature of the infection. They are usually put on a course of antibiotics and a decongestant.
In the event of anaphylaxis, which can cause airway blockage, cardiac arrest, respiratory arrest and shock, the patient should be immediately taken to the nearest medical facility for treatment. While there are no known cures for sinusitis or allergies, there are measures sinus and allergy sufferers can take to decrease the chances of symptoms.
“Decongestants make some people feel jittery or have trouble sleeping. If that happens, cut back on your caffeine intake while taking them. If that doesn't help, you may need to stop taking them. Nasal sprays are less likely to cause these problems and may be a short-term solution,” she advises, and adds, “Avoid taking two medicines that contain decongestants at the same time because of possible overdose. Many non-prescription preparations for other health problems, such as some diet pills, contain decongestants.”
Ramnath advises people prone to sinus symptoms to keep their nose moist by frequently using saline sprays and washes and to avoid: • Exposure to irritants such as cigarettes and smoke. • Fumes from cleaning products and hairspray. • Long periods of swimming in pools treated with chlorine, as this can irritate the lining of the nose and sinuses. • Water diving, which forces water into the sinuses from the nasal passages
On the other hand, there are those who prefer to go the alternative route with the use of at-home saline solutions, applying eucalyptus oil and warm water to the cheekbone, gargling lemon balm, using humidifiers and the ever-popular vapor therapy.
People who are prone to allergies should be aware of what triggers their reactions and avoid them as much as possible, as allergies tend to disappear when they are away from the source.
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PEDIATRICS
| NEWBORN JAUNDICE
NEWBORN
JAUNDICE
NEWBORN JAUNDICE
WRITTEN BY DR.
|
PEDIATRICS
DAVID BRATT, MD. MPH. CMT
In 1977 when I returned to Trinidad, no one bothered about jaundice in newborn babies. The post natal wards, managed solely by obstetricians, were full of jaundiced babies. No one did anything for them. I often wonder what became of those babies. At the best, they would have emerged from their bout of newborn jaundice, anemic and at risk of not developing their full potential. Babies with anaemia do worse in school than their normal classmates. In the worst case scenario, they would have become brain damaged to some degree or another.
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PEDIATRICS
| NEWBORN JAUNDICE
ow times have changed. Severely jaundiced newborns are now a rarity and when parents refuse to allow doctors to treat them, the case makes newspapers. Nowadays, one is called urgently at the slightest sign of jaundice. Mothers are warned to check the skin colour on a daily basis and to “walk the baby in the sun”, resulting in not a few cases of neonatal sunburn, a medical entity unknown up to a few years ago. They are also wrongly advised to stop breastfeeding, to give the baby extra water, to drink bush tea and, if of the proper tendency, to “jarre” the baby. All needless and often harmful procedures. In fact, newborn jaundice has become much less common in T&T. So much so, that it is rare to see a case, even rarer to have to measure the level of jaundice and almost unheard of, to have to treat. Once common instruments like the bilirubinometer, used to measure the level of jaundice, and phototherapy (light treatment) units are difficult to find in most nurseries.
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What caused this change, which began somewhere in the 1990s, is not known, but it must have been something in the environment, some medication or procedure that was routine at the time, that was responsible for so many babies developing jaundice, because women have not changed. You see, most of the causes of jaundice in those babies were not known. Once that cause or those causes were eliminated, the incidence of neonatal jaundice dropped sharply. One of the known causes of environmental jaundice in the West Indies used to be mothballs. Mothballs contain naphthalene and affected babies with something called
Jaundice is the name given to the yellowish coloration of the skin and sclera, the white part of the eye. G6PD deficiency. It is fairly common in babies of Asian, African or Middle Eastern origin, who can suffer blood-cell breakdown if placed too close to fabrics stored with naphthalene mothballs. Jaundice is the name given to the yellowish coloration of the skin and sclera, the white part of the eye. In adults it is an ominous sign, usually of liver disease, generally associated with inflammation of the liver (hepatitis) or with alcoholic destruction of the liver, or gallbladder obstruction. One of the rarer causes of jaundice today is yellow fever, named centuries ago because of the jaundice that accompanies the fever. There are a whole slew of similar appearing diseases. In babies, however, jaundice is usually normal. It is called “physiologic jaundice of the newborn”. This type of jaundice occurs because of the normal or physiological breakdown of the baby’s red blood cells. It usually appears about two days after birth and lasts about ten to fourteen days. Red blood cells, like all cells, live for a certain time (about three months in the case of red blood cells) and then die or are broken down in the spleen. This breakup of the red blood cells liberates a yellow colored chemical, called bilirubin, which in large amounts (hyperbilirubenemia) is toxic to the brain and which therefore must be excreted from the body, by the liver, through the bile ducts into the intestine as part of bile. (Bili-rubin and bile have the same root). This is a process that
continues throughout life and it is one of the so-called “cleansing” functions of the liver. The yellow chemical combines with many other substances in the intestine, food remnants, intestinal cells and so on, and is responsible for the yellowish-brown colour of our stools. That’s why, when you are sick and feverish the doctor will ask you about the colour of your stools. Pale stools may mean an absence of bile which could mean liver dysfunction or gall bladder disease. What happens in babies is that, because of their huge brain and the need for the head containing this enormous brain to pass through the mother’s pelvis, they are born before their time and many of their body functions are not ready for life outside the womb. This happens especially with their livers, which may be unable to completely rid the blood stream of bilirubin. The level of the pigment then rises, overwhelms the capacity of the blood to carry this amount of bilirubin and the excess is deposited in the skin, causing it to turn yellowish and upset mothers and inexperienced doctors and nurses. In extreme cases, if the level of bilirubin rises beyond the buffering power of the skin, it then begins to be deposited in certain brain cells, causing brain damage, especially to the motor part of the brain, leading to a condition known as kernicterus, a form of cerebral palsy, and to the auditory cells, causing hearing loss. High bilirubin levels can also cause gaze abnormalities and dental enamel weakness.
NEWBORN JAUNDICE
This is permanent damage, hence the urgency to treat the very jaundiced child. Untreated hyperbilirubenemia can cause the baby to die. The traditional “bad” cause of newborn jaundice, at least in European countries, was blood group incompatibility. This is fairly rare in the Caribbean. Everyone is born with either Rh-positive or Rh-negative blood. Most people are Rh-positive, which means they have the Rh Factor, a protein found on their red blood cells. Rh-negative people do not have this protein. Rh-positive blood is not compatible with Rh negative blood. When an Rh-negative mom is pregnant with an Rh-positive baby, the baby's Rh-positive blood can pass into the mother's body during pregnancy or birth. When this happens, the mother becomes sensitized to the baby's Rh-positive blood and her body starts to produce antibodies against the Rh antigen. These antibodies can pass through the placenta into the baby during pregnancy or birth, depending on when the sensitization occurs. Once Rh antibodies from the mom have passed through to the baby, they can destroy the baby's red blood cells. This rapid breakdown of red blood cells can cause the baby to have severe anemia during pregnancy or after birth. At the same time, the rapid breakdown of the baby's red blood cells causes a quick build up of bilirubin, causing severe jaundice, usually within the day after birth. A similar situation can happen if the mother is blood group O and her baby is blood group A or B. Blood group O
means the mother does not have the proteins or antigens known as A & B on the surface of her red blood cells. In this case the mother can produce antibodies against the baby’s blood group, A or B, which can result in destruction of the baby’s red blood cells and again, cause anaemia and jaundice. This type of blood group jaundice usually appear within forty-eight hours of birth. Treatment is either by phototherapy or exchange transfusion. Phototherapy or light therapy makes use of the observation that sunlight helps rid the body of the bilirubin by altering it and enabling the baby to eliminate it in the urine. There is a actually a piece of equipment called a bili light which uses a specific wave length of light (420-470nm) which is best for altering the bilirubin. The light treatment is administered for a prescribed amount of time while the bilirubin levels intermittently measured and come down to normal. Soft eye shields are placed on the baby to protect the retina which can be damaged by the bright light. Apart from this, there are no other risks involved. Exchange transfusion is a complicated procedure, not without risk, which involves getting rid of the baby’s blood and transfusing new blood into the child. This is a life-saving procedure. In eliminating the baby’s blood, bilirubin is also removed. Of course this procedure does not alter the underlying problem and multiple exchange transfusions may be needed before the baby’s liver begins to function effectively.
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PEDIATRICS
All of this sounds really dreadful but it is good to remember that it seldom happens these days. The type of jaundice we see now is much milder. Most babies, especially breastfed babies, become a bit jaundiced in the first week of life and there is nothing wrong with that. A touch of jaundice is actually considered healthy. Bilirubin is beneficial to the baby in small amounts since it is an antioxidant and protects brain cells from the damage typically caused by free radicals. Free radicals come from smoking, pollution, poisons, fried foods, and as a by-product of normal metabolism. Free radical damage is associated with an increased risk of many chronic diseases. Bilirubin also protects premature babies against retinopathy, the damage that too much oxygen can do to the retina, causing blindness. There is also some belief amongst medical professionals that bilirubin is a bacteriostatic compound which acts to slow or eliminate bacterial growth and therefore give an advantage to babies with higher levels of jaundice. This theory would contribute to the fewer infections in breastfed babies, whose bilirubin counts often descend at a slower rate. So there is no reason to panic if your baby becomes jaundiced, especially if the jaundice appears after forty-eight hours of life. Like vitamins and governments, jaundice can either be a hero or a villain. In small amounts, good. In large amounts, bad.
In adults it is an ominous sign, usually of liver disease. In babies, however, jaundice is usually normal. This type of jaundice occurs because of the normal or physiological breakdown of the baby’s red blood cells.
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AUTOIMMUNE DISEASES
| GIVING LUPUS A VOICE
AUTOIMMUNE DISEASES
| GIVING LUPUS A VOICE
oung, beautiful and talented, Reeanna Harrilal does not strike you as someone who is ill. But some days, she can barely get out of bed. That is one of the biggest problems with her disease: the fact that it often cannot be seen by the naked eye. Harrilal is the President and Founder of The Voice of Lupus Foundation (VLF), a non-profit organisation established to foster greater awareness about Lupus in Trinidad and Tobago.
Y
This role demands significant courage. In a 2012 Trinidad Newsday Women’s Weekly article “Revealed”, she discussed dealing with a morphine addiction, overcoming a nervous breakdown, and even multiple suicide attempts. “I was very scared as to how people would react, as there are things in my past I’m not proud of,” she admitted. “But to be able to turn around my life and be a positive force giving lupus a face and a voice is essential.” 20% of people with lupus will have a parent or sibling who already has lupus or may develop lupus.
WHAT IS LUPUS?
Systemic Lupus Erythematous (SLE) is a chronic auto-immune disease. It can be described as a type of self-allergy, whereby the patient’s immune system creates antibodies which, instead of protecting the body from bacteria and viruses, attack the person’s own body tissues. There is no single blood test that can reveal lupus. If someone has four out of the eleven identified criteria, they should get tested for lupus. These criteria, established by the American College of Rheumatology, are:
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1. Malar rash or “butterfly rash” on the face 2. Discoid rash on the body (red, scaly patches) 3. Serositis or pericarditis (inflammation of the membrane around the lung and heart, respectively) 4. Mouth ulcers 5. Arthritis, with tenderness, swelling or effusion 6. Photosensitivity (sensitivity to light) 7. Blood disorder – including low red blood cell count or low white blood cell count 8. Renal disorder 9. Positive antinuclear antibody test 10. Immunologic disorder 11. Neurologic disorder, including seizures or psychosis
These are not the only symptoms, and individual symptoms may vary, which makes the disease difficult to diagnose. Lupus ‘flares’ are often exacerbated by stress, excessive sunlight, a viral infection, a drug allergy, and even one’s diet. A major flare can attack a vital organ and cause death. It is a terminal disease, though many patients may appear to be in ‘remission’ for years.
LIVING WITH LUPUS
There is no known cure for lupus, and treatment may sometimes be worse than the disease itself. Common treatments for lupus include Cellcept, an immune suppressant drug that can be harsh to the body; prednisolone, a corticosteroid; and even chemotherapy For Reeanna, it has been a long battle with various treatments. “Due to years of steroids, I gained a lot of weight and my stomach became severely damaged,” she said. “I developed leaky gut syndrome – when I eat foods I am not supposed to eat, they leak into my bloodstream and make me sick.” Dissatisfied with medical treatments, she is now trying more alternative methods at the Eden Heights Clinic in Trincity, east Trinidad. Her current treatment includes prolozone therapy, a non-surgical ligament reconstruction involving injecting collagen to treat chronic pain; ozone therapy, which increases the amount of oxygen to the body; and, most recently, an experimental treatment called frequency-specific microcurrent, which treats nerve and muscle pain through micro amperage current. These treatments go hand in hand with her daily cocktail of supplements, which includes a wide range of supplements – Super Bio-Curcumin, Super Booster B-12 Soft Gels, probiotics, sun chrollela, and Omega 3-6-9, just to name just a few. She also takes a daily dose of a vitamin we are all familiar with – Vitamin C. 90% of individuals diagnosed with the disease are women
10%
90%
GIVING LUPUS A VOICE
|
AUTOIMMUNE DISEASES
GIVING LUPUS A VOICE WRITTEN BY SACHA
T. Y. FORTUNÉ
“It is the uninvited guest at a dinner party, the shadowy figure lurking over your shoulder for many years until one day it steps into the light for all to see…”
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GIVING LUPUS A VOICE
FINDING HER OWN VOICE
Lupus can be a full-time job. The disease cost Reeanna her flourishing media career, which she tries not to dwell on. “I’ve stopped looking at it like ‘what lupus has robbed me of ’, but rather what it has taught me,” said Reeanna, who spent eleven years in the media industry working at television stations including CNMG and Gayelle, and radio stations Masala 101.1FM, Music Radio 97 FM, Sweet 100.1 FM, and Talkcity 91.1FM. Though she had symptoms since she was 13, and was tentatively diagnosed since the age of 17; it wasn’t until several years into her media career at the age of 24 that her disease truly reared its head, demanding to be noticed. Even then, she struggled to cope and balance her career, until finally her last media stint was swiftly cut short.“I had just started working at a media house, and within the first month, I picked up the flu from my boss. Because I have lupus, the flu is not the flu for me,” she explained. “I ended up in the hospital with pneumonia for over three weeks. When I was finally discharged, I no longer had a job.” Looking back on it, Reeanna acknowledged that the media was just a stepping-stone to fulfill her purpose in life. “For about three days, I was really depressed. I didn’t know how I would survive. But The Holy Spirit guided me to the Facebook page I had created about a year before, and told me to make this ‘hobby’ of mine a physical entity.” Now, she uses her skills and experience in the media for the betterment of her Foundation.
THE VLF: A PILLAR OF STRENGTH
Founded in November 2011 by Reeanna along with Directors Dera Harrilal (Reeanna’s mother), Reshma Cooke and Dianne Seepersad; The Voice of Lupus Foundation aims to provide hope, compassion, support, empowerment, independence and dignity to those living with lupus and to their families. Through programmes of education and advocacy, the VLF hopes to bring national attention and resources to elevate lupus to a place of prominence on the nation’s health care agenda. The VLF has embarked upon national awareness campaigns, a proactive media outreach, and has developed innovative online content through its website www.thevoiceoflupus.com and social networking sites Facebook, Twitter, and YouTube. The Foundation has been featured on CTV, and on
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AUTOIMMUNE DISEASES
radio stations Talk City 91.1FM and Wack 90.1FM. They have partnered with the Chaguanas Lions Club and the Indian Women’s Group of Trinidad and Tobago, and have visited schools to speak about the disease. The VLF also participates in health fairs almost every month. In January 2012, the VLF filmed their infomercial “The Faces of Lupus Project” at San Fernando Hill in south Trinidad. Reeanna thanks film directors Oyetayo Raymond Ojoade and Steven Taylor for making this project possible. “I wanted to focus on local faces, persons who have the illness and have been living with it, so that we can show that anyone and everyone is at risk, regardless of the colour of their skin, texture of their hair or ethnic background,” Reeanna said. Currently, the VLF is working on setting up the “Gift of Hope” fund, which will help lupus patients that cannot afford medication by allowing a benefactor to ‘sponsor’ a patient for a period of time to assist with these expenses. Needless to say, it is no easy task getting funding for a disease that few understand. Nevertheless, she does not let it discourage her. “One of our major accomplishments is that for the first time in T&T there is a website solely for lupus awareness,” Reeanna said. “Our tagline, ‘A Pillar of Strength’, was chosen because this Foundation aims to be just that; a pillar of strength for someone who has lupus – and in today’s world, being able to reach people through online means is crucial.” For Reeanna, it is heartening to see her efforts being realised. Looking back on the troubled past she revealed to the nation, she acknowledges the journey was necessary to get to where she is today. “Coming from a place where you really gave up on life and gave up on yourself… to be able to propel yourself and reposition yourself to become an overcomer and to help others to cope – that is a blessing in itself,” she said. “I’ve come too far to turn back now. I may have lupus but lupus does not have me.” For more information and resources on lupus, visit www.thevoiceoflupus.com. You can also check out their Facebook page at www.facebook.com/thevoiceoflupus or contact the VLF directly at (868) 221-9677.
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Ten things
about
Jaundice... and newborns
and treatment
Jaundice is a yellow discoloration of the newborn's skin and eyes.
Water or other liquids do not help. Only breast milk or formula helps pass bilirubin.
Jaundice is caused by the buildup of old blood cells make a yellow substance called bilirubin.
Feeding every one-to-three hours is important so bowel movements can pass the bilirubin.
Half of all newborns will have normal jaundice beginning one day or more after birth.
Baby needs to stay in light therapy at all times except during feeding.
Jaundice that appears within the first 24 hours of life or after the first week is not considered normal.
Make sure baby has at least three bowel movements and four-to-five wet diapers a day.
Jaundice is very common, temporary and is treatable.
Severe, abnormal jaundice may require baby to have a blood transfusion.
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MOOD
| A. IS FOR ANXIETY
A. IS FOR ANXIETY
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MOOD
IS SOMETHING WE ALL EXPERIENCE FROM TIME TO TIME, BUT IT IS ALSO SOMETHING THAT CAN ESCALATE AND DEVELOP INTO SERIOUS AND DEBILITATING MENTAL AND PHYSICAL HEALTH PROBLEMS IF NOT RECOGNISED AND TREATED EARLY ON. IN TRINIDAD, PSYCHIATRISTS, PSYCHOLOGISTS AND MENTAL HEALTH TEAMS HAVE ALL SUGGESTED THAT THERE HAS BEEN A DECREASE IN SOME OF THE MORE SEVERE MENTAL HEALTH PROBLEMS, SUCH AS SCHIZOPHRENIA, BUT A SIGNIFICANT RISE IN DEPRESSION AND ANXIETY-RELATED MENTAL HEALTH PROBLEMS OVER THE LAST 5-10 YEARS.
WRITTEN BY MAIA
HIBBEN
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MOOD
| A. IS FOR ANXIETY
ost people can relate to feeling tense, uncertain or fearful at the thought of sitting an exam, going into hospital or attending an interview. You may worry about feeling uncomfortable or appearing foolish, or how successful you will be. In turn, these worries can affect your sleep, appetite and ability to concentrate. If everything goes well, the anxiety will go away. This type of short-term anxiety can be useful. Feeling nervous before an exam can make you feel more alert, and enhance your performance. However, if the feelings of anxiety overwhelm you, your ability to concentrate and do well may suffer. The 'fight or flight' reflex
Anxiety and fear can protect you from danger. When you feel under threat, anxiety and fear trigger the release of hormones, such as adrenalin. Adrenalin causes your heart to beat faster to carry blood where it's most needed. You breathe faster to provide the extra oxygen required for energy. You sweat to prevent overheating. Your mouth may feel dry; as your digestive system slows down to allow more blood to be sent to your muscles. Your senses become heightened and your brain becomes more alert. These changes make your body able to take action and protect you in a dangerous situation, either by running away or fighting. It is known as the 'fight or flight' reflex. This response is useful for protecting you against physical dangers; for example, it can help you run away from wild animals, attackers or fires, very quickly. The response is not so useful if you want to run away from exams, public speaking, a driving test, or having an injection. This is because, if there is no physical threat, and you have no need to physically run away or fight, the effects of adrenaline subside more slowly, and you may go on feeling agitated for a long time.
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If the anxiety stays at a high level for a long time, you may feel that it is difficult to deal with everyday life. Sometimes the anxiety may become severe; you may feel powerless, out of control, as if you are about to die or go mad. Sometimes, if the feelings of fear overwhelm you, you may experience a panic attack.
Anxiety Disorders
• Panic Disorder • Generalized Anxiety Disorder (GAD) • Obsessive-Compulsive Disorder (OCD) • Post-Traumatic Stress Disorder (PTSD) • Social Phobia (Social Anxiety Disorder) • Specific Phobias Panic Disorder
Panic disorder is characterized by sudden attacks of terror, usually accompanied by a pounding heart, sweatiness, weakness, faintness, or dizziness. During these attacks, people with panic disorder may flush or feel chilled; their hands may tingle or feel numb; and they may experience nausea, chest pain, or smothering sensations. Panic attacks usually produce a sense of unreality and a fear of losing control. An attack usually peaks within 10 minutes, but some symptoms may last much longer. Panic disorder affects about 6 million American adults and is twice as common in women as men. Panic attacks often begin in late adolescence or early adulthood, but not everyone who experiences panic attacks will develop panic disorder; many people have just one attack and never have another. Generalised Anxiety Disorder (GAD)
GAD is diagnosed when a person worries excessively about a variety of everyday problems for a prolonged period of time. They anticipate disaster and are overly concerned about health issues, money, family problems, or difficulties at work. People with GAD have trouble relaxing; they startle easily, and have difficulty concentrating, they have trouble falling asleep or staying asleep. Physical symptoms can also occur, including fatigue, headaches, muscle tension, muscle aches, twitching, irritability, sweating, nausea, having to go to the bathroom frequently, feeling out of breath, and hot flashes. GAD affects about 6.8 million adult Americans and about twice as many women as men. Obsessive Compulsive Disorder (OCD)
People with obsessive-compulsive disorder (OCD) have persistent, upsetting thoughts (obsessions) and use rituals (compulsions) to control the anxiety these thoughts produce. Most of the time the rituals end up controlling them. Some people, for example have obsessive thoughts about being contaminated with germs and have a compulsion to wash their hands over
A. IS FOR ANXIETY
and over again. Others have a fear that they have forgotten to lock a door and will repeatedly check that it is locked. Repeatedly checking, counting and touching things; being preoccupied with order and symmetry and having difficulty throwing things out are common rituals/issues for those with OCD. Healthy people also have rituals, such as checking to see if the stove is off before leaving the house. The difference is that people with OCD perform their rituals even though doing so interferes with daily life and they find the repetition distressing. OCD affects about 2.2 million American adults, and it strikes men and women in roughly equal numbers and usually appears in childhood, adolescence, or early adulthood. One-third of adults with OCD develop symptoms as children, and research indicates that OCD might run in families. Post-Traumatic Stress Disorder (PTSD)
PTSD develops when someone experiences or witnesses a very stressful or threatening event, for example a war, a natural disaster, child abuse, a serious accident, a violent death or rape. People with PTSD may startle easily, become emotionally numb, lose interest in things they used to enjoy, have trouble feeling affectionate, be irritable, become more aggressive, or even become violent. Most people with PTSD repeatedly relive the trauma in their thoughts during the day and in nightmares when they sleep. These are called flashbacks. Flashbacks may consist of images, sounds, smells, or feelings, and are often triggered by ordinary occurrences, such as a door slamming or a car backfiring on the street. A person having a flashback may lose touch with reality and believe that the traumatic incident is happening all over again. PTSD affects about 7.7 million American adults, but it can occur at any age, including childhood. Women are more likely to develop PTSD than men, and there is some evidence that susceptibility to the disorder may run in families. Social Phobia (Social Anxiety Disorder)
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activities, and can make it hard to make and keep friends. Many people suffering with SAD may realise it is an unjustified fear but cannot control the anxiety they experience. The phobia may be limited to just one situation such as talking to new people or eating in public, or it may be so broad that the person experiences extreme anxiety around anyone other than their family. Physical symptoms that often accompany social phobia include blushing, profuse sweating, trembling, nausea, and difficulty talking. Social phobia affects about 15 million American adults. Women and men are equally likely to develop the disorder, which usually begins in childhood or early adolescence. Phobias
A phobia is an irrational or intense fear about something that actually poses little or no danger. Common phobias are things such as spiders, heights, flying or crowded places. For example, a person may know a spider isn’t venomous to humans or won’t bite, but this still does not reduce their anxiety. Likewise, a person may know that it is safe to be out on a balcony in a high-rise building, yet feel terrified to go out on it or even enjoy the view from behind the windows inside the building. While people with phobias can realise that these fears are irrational, they often find that facing, or even thinking about facing, the feared object or situation brings on a panic attack or severe anxiety. Specific phobias affect an estimated 19.2 million adult Americans and are twice as common in women as men. They usually appear in childhood or adolescence and tend to persist into adulthood. All these disorders can be treated and managed with psychotherapy, cognitive behavioural therapy (CBT) and medication. Do not suffer in silence. Seek help! If you are experiencing any of the symptoms in this article or have a friend or loved one that you think may be suffering from an anxiety disorder, please contact your GP, a local health centre or a psychologist for advice or assistance.
Social phobia is diagnosed when people become overwhelmingly anxious and excessively self-conscious in everyday social situations. People with social phobia have an intense, persistent, and chronic fear of being watched and judged by others and of doing things that will embarrass them. This fear may become so severe that it interferes with work, school, and other ordinary
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FOOD
| PLANTAIN. OUR LOCAL SUPERFOOD
Plantain our local superfood. WRITTEN BY
SHELDON WAITHE
It may be slightly less popular than its smaller cousin the banana, but the humble plantain is gaining ground in the health food sector, as knowledge of its benefits becomes more widespread beyond its traditional homes of Asia, Africa, Central America and the Caribbean. Inedible in its raw form, the plantain really comes into its own when it is washed, its skin is trimmed and any number of varieties of preparation and cooking lie before it. From roasts, soups, and sautés, through to fried, diced snacks, its versatility at any point in the meal spectrum is where it outshines other fruits and vegetables.
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Tasting great and offering an appetizing option is one thing, but in today’s health conscious world, what does plantain bring to your body? The scientific bit starts with fibre. A one-cup measurement of cooked plantain delivers ten per cent of the 30 gram daily requirement for men (20 grams for women), helping to ensure a healthy digestive system. More importantly, fibre reduces those dreaded cholesterol levels that can lead to heart disease. Similarly, the level of potassium in plantains helps to regulate the heart beat and also aids with the digestive system. It also contains very high levels of vitamin A (more than bananas); in fact, one
serving has a whopping thirty-seven per cent of the recommended daily requirement. This essential vitamin not only acts as a powerful antioxidant, it also supports healthy eyesight and enhances the skin’s complexion; vitally important repair work for the damage done by the Caribbean sun. Though citrus fruits are the first port of call for vitamin C, plantains contain a surprisingly high amount of the popular supplement, with one serving containing twenty per cent of the daily requirement, which needs to be replenished, as the body cannot store it. Plantains are also a rich source of the B6 vitamin. Throw in its appropriate levels of iron, magnesium and niacin (for the nervous system) and it becomes quite clear why the benefits of eating plantains have
been around for centuries. In fact, they date back to 327 BC, when their taste was discovered in India by conquering Greeks and soon spread to Africa by Arab sailors. The Africans in turn made it a staple part of their diet, which continued when they came to the Caribbean. With good reason, the plantain was seen as vital to child growth, while it remains a major part of both the agricultural and culinary landscape of the Caribbean. Greener plantains indicate a higher level of starch and a consistency closer to potatoes, while the riper versions will be sweeter, with their natural sugars easier for the body to digest than processed and refined versions. Both types contain relatively low calories, and as per the benefits outlined above, they will enhance any healthy diet.
PLANTAIN. OUR LOCAL SUPERFOOD
Indeed, plantains are often highlighted as the ‘Superfood of the week’ by nutritionists and dieticians. However, as with most foods, it is the way that it is cooked that will determine if it enhances the body and mind. The societal inclination to deep fry everything applies here as well: a piece of fried plantain is as much part of the traditional Caribbean Sunday lunch as callaloo and macaroni pie. But it is not the best way to prepare and eat plantains, when one considers the oil and butters used that will contribute to the unhealthy fat content and especially when there are delicious and healthier alternatives. At one end of the meal course, they can be used to replace potatoes in a vegetable soup (this applies to stews as well); sautéed plantain slices are
the perfect complement to barbequed meats, while cooked plantain slices can be used to garnish a salad for a departure from the norm. Boiled plantains that are then mashed are a nutrient-rich side for both kids and adults. A truly healthy option is to place the plantain slices on a baking tray, and brush them lightly with oil, add garlic powder and black pepper, roasting them to a crisp texture. The resulting plantain chips are a lot healthier than the ever-popular potato chip, with no trans fat. Finally, as a dessert, slices sautéed until they reach a soft consistency can be drizzled with honey and sprinkled with cinnamon to satisfy the sweet tooth but not trouble the waistline (too much). The chances are that plantains are already part of your diet, especially with its place amongst traditional
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fare such as the Saturday soup, or mixed up in a ‘blue food’ concoction. Each mouthful of this superfood delivers benefits which few others can, so get cooking and enjoy!
Nutrition Facts Serving Size : 200g
Amount per serving Calories 232 Total Fat 0g Saturated Fat 0g Trans Fat Cholesterol 0mg Sodium 10mg Total Carbohydrates 62g Dietary fibre 5g Sugars 28g Protein 2g Vitamin A Calcium
36% 0%
Calories from Fat 3 % Daily Value* 1% 1% 0% 0% 21% 18%
Vitamin C Iron
36% 6%
* 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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HEEL PAIN
| PLANTAR FASCIITIS
Plantar Fasciitis A Common Cause of Heel and Foot Pain WRITTEN BY
MEZAAN BELJIC
Ever stand in your kitchen barefoot for hours preparing a feast for special guests, then throw on a pair of high heels for your night of fun and wonder why your heel hurts so badly? Well, if you’re approaching middle age and also happen to be female, you just might be experiencing the pain of plantar fasciitis, the most common cause of heel pain and one of the most common causes of foot pain. What is plantar fasciitis?
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The plantar fascia is a thick band of tissue that basically connects the heel bone to your toes (WebMD). It forms and supports the arch of your foot. Plantar fasciitis occurs when the plantar fascia is strained or overstretched. This leads to inflammation and heel pain, which makes standing and walking rather uncomfortable, and for some, quite unbearable. Chronic heel pain can alter how you walk, and over time, if ignored, it can lead to problems with your knee, hip, and back.
source of pain
plantar fascia s us aneu calcan (heel bone)
For the most part, plantar fasciitis affects just one foot but it can affect both feet simultaneously. You may feel achiness, sharp pain, stiffness, or a burning sensation at the bottom of the foot or heel. Most experience pain first thing in the morning upon taking their first few steps. The pain may decrease as the foot loosens up or the pain may be triggered during the day after long periods of standing, after sitting awhile then rising up to a standing position, or after intense physical activity such as running.
PLANTAR FASCIITIS
Who is at risk? Plantar fasciitis is strongly associated with the following: • Flat feet or high arches • Excessive pronation (the foot rolls inward too much when you walk) • Long distance running, especially on hard surfaces • Prolonged standing or walking • Being overweight/obese • Wearing shoes with poor arch support • Wearing ill-fitting or worn out shoes with poor shock absorption • Middle-age and female gender • Wearing high heels
How is it diagnosed? Your doctor or health care provider will ask questions related to your complaints and the aforementioned risk factors. He/she will examine your feet, noting tender points, tightness, and any swelling. The doctor will closely observe your gait and assess the degree to which your foot pronates. Plantar fasciitis is usually diagnosed by a thorough review of your history and examination of the feet alone. However, you may have X-rays taken to rule out a fracture or even an MRI to rule out nerve impingement. Referral to a podiatrist or sports medicine specialist may be necessary.
Treatment & prevention Most people diagnosed with plantar fasciitis recover from it with conservative measures. With the implementation of such, some notice pain relief within a few weeks while for others, it may take a few months to a year. Resting your feet is essential to healing. You may need to keep off of them for several days or longer for severe pain. Exercises that stretch the plantar fascia (such as toe, calf, and towel stretches) will help prevent and treat flare ups. Such exercises also stretch the Achilles tendon that joins the calf muscles of the leg to the heel bone, thus reducing strain on the tissues around the heel. Performing these upon rising in the
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morning or even before getting out of bed can markedly reduce morning pain. Massage therapy, cold therapy (applying ice to reduce pain and inflammation) and oral medications (anti-inflammatories such as ibuprofen) may also help relieve the pain. Your doctor may recommend a night splint to stretch your calf and foot while you sleep. If the pain persists, a steroid shot into the heel may be advised. For persistent plantar fasciitis that is non-responsive to conservative measures, surgery may be necessary to relieve daily pain. Additionally, extracorporeal shock wave therapy, which directs sound waves to the heel to stimulate healing, has been used to treat plantar fasciitis, although its effectiveness is debatable. The best treatment is prevention. To prevent plantar fasciitis, wear supportive shoes with good arch support and cushioned soles. Your doctor may recommend custom orthotics (foot inserts) or commercial orthotics to provide arch support, correct pronation, and ultimately redistribute the pressure on your foot. Replace worn-out sneakers so you do not lose the intended support. You may need to avoid or reduce high impact activities such as walking, jogging or running. Consider bicycling or swimming instead. It is important to select shoes with a low to moderate heel and avoid high heels. Also, avoid completely flat shoes or sandals. High heels tend to contract or shorten your Achilles tendon and calves, which strains the tissue around the heel, causing pain. Flat sandals do not provide adequate arch support or shock absorption and direct weight bearing primarily to the heel of the foot only. Walking barefoot, especially on a hard surface, may aggravate your symptoms, so avoid this, including while indoors at home. Finally, maintain a healthy weight for your height to reduce stress on your plantar fascia and foot. Plantar fasciitis can be quite disabling, significantly limiting one’s activities and job performance. If ignored too long, it can be difficult to treat. Know the risk factors for it and take measures to support your foot and stretch your Achilles tendon and calves. Your feet will thank you.
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WELLNESS
| TRANSCENDENTAL MEDITATION
Transcendental Meditation Could it be your oasis of peace in a stress-filled world? WRITTEN BY
NIK LASHLEY
Transcendental Meditation has extended beyond its cultish, slightly 60s flower power image, and is perceived by some as a cure-all and the vital antidote to the sensory overload of modern living. All you need is a chair and 20 minutes.
M, as it’s universally referred to, has found itself front and centre of a worldwide spiritual regeneration that promotes the benefits of inner peace and a higher state of consciousness. There’s now a sizable body of extensive research that exists, underpinning the health benefits of meditation.
International Journal that states Transcendental Meditation reduces anxiety and tension, and results in a vastly relaxed state of mind. That was published back in 1993. And here is a mind-bogglingly simple process that, if practiced just twice a day, can super-charge your thinking skills and de-junk your mind. Really, what’s not to love?
But meditation doesn’t work in isolation; there’s also the fascinating world of quantum physics, which is the study of the fundamental unity of life. You see, beyond the molecular, atomic, sub-atomic, sub-nuclear, unified electroweak (known in physics as the carrier 'messenger' particles) there is the unified energy field that likely created the cosmos and the universe. Translated, this means that all things are not distinct and separate from one another on a material level, rather that we are a whole.
Oprah and Dr. Oz do it, and talk about it on TV, along with a clutch of other celebrities. But this is more than just a passing fad; TM has woven its mystic magic over an estimated six million people worldwide. And like any product intended for mass consumption, it has attracted its fair share high-profile ambassadors and ardent critics. Whilst the ancient Vedic tradition of meditation comes from the wisdom of yoga and has been around for thousands of years, the founder-cum-guru of Transcendental Meditation, Maharishi Mahesh Yogi to India, long before his death, promoted TM through the establishment of a global network of foundations, through which thousands of people are initiated into the programme to this day.
Stay with me. Through meditation we can, neurologically through our own minds, gain access to the creative energy field from which all energy and matter has come. And, the practice of Transcendental Meditation can unlock this deep and powerful state of consciousness. Not sleeping, not dreaming and not waking. In this meditative state, the entire brain is engaged and is in optimal operation mode. I admit, it does sound a little esoteric, but scientific studies support the effects.
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Here is a lifestyle practice that may reduce the risk of heart disease and strokes. Here is a study by the
Anthony Grell the National Coordinator from the Maharishi Institute of Science and Technology, Trinidad and Tobago, says bridging the gap between knowing about TM and signing up for a course is less of a hard sell than it use to be. “Transcendental Meditation is not a religion, and it’s not a cult, or a philosophy,” explains Grell, “It is the master key to great health, happiness, and peace. We know that stress is often the cause of ill health, so if we can eliminate stress we can eliminate the root of the
TRANSCENDENTAL MEDITATION
problem. Everyone should meditate, if for no other reason than it is proven to develop your prefrontal cortex.” Put simply, the prefrontal cortex is the chairman of the board and plays a crucial role in keeping us balanced and rational. During TM, there’s an increase in alpha activity, which translates as a relaxed state of wakefulness with your eyes closed. With practice over time, within a few months, the brain’s function will be greatly improved. If you practice TM, you’re less likely to act impulsively, you’re slower to anger, and communication with others is greatly improved. Dressed in a business shirt and sitting barefooted behind his desk at the Maharishi Institute of Science and Technology based in Deigo Martin, Trinidad and Tobago, Grell reminds us that wear and tear on the brain caused by stress can have a negative impact in our day-to-day lives. “Stress responses happen in society and in our homes. We see the effects of accumulated stress—criminal behaviour and domestic violence, those who act before they think, and that decision to act is made in a split second.” Maharishi said “If you can think, you can meditate.” So, on that note I enrolled with Shelley Hosein, Anthony Grell’s colleague at the centre. It begins with four consecutive sessions that last about 90 minutes. I had an idea of what to expect as my own recent spiritual transformation had just a few months earlier led me to the wonders of meditation.
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Shelley was warm and friendly and for the next four days she imparted the fundamental information I would need, to fully understand how TM works. On day one, following a short, enchanting initiation ceremony, I was given my personal mantra, a special word chosen for me by Shelley, with instructions never to reveal it to another living soul. Then she taught me how to use it. Since then I’ve used it twice a day, in the morning and in the evening, for 20 minutes. What I found most daunting, alarming even, was the absolute simplicity of Transcendental Meditation. But it’s a very private undertaking and it’s important that a qualified teacher like Shelley trains you. By day three I was feeling pretty invincible. Shelley asked me to describe the feeling in more detail. I explained that I felt there was more of me on the inside—a sense of order and alignment on a physiological level, and a feeling of stillness that was cellular. “Deep within all of us there is eternal happiness, wellbeing, balance, orderliness, stability and bliss,” beams Grell, “so we don’t need to suffer; the power is within us and all we need to do is tap into it. It is the most basic level of life; we have an inner transcendental level that goes beyond. Way beyond.” Contact The Maharishi Institute at 633-0716 or email invinciblett@gmail.com
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DISEASE
| PROTECT YOUR KIDNEYS
PROTECT YOUR KIDNEYS
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DISEASE
PROTECT YOUR KIDNEYS BY EATING RIGHT TO AVOID KIDNEY DISEASE WRITTEN BY
MICHELLE ASH MPH, RD, DIP.
Kidneys are complicated and amazing organs that carry out many important bodily functions. They are located at both sides of your backbone, relatively high on the back, just under the lower ribs. They are shielded from injury by a large padding of fat, the lower rib cage and several muscles. Each kidney is about 5 inches (about 13 centimetres) long and about 3 inches (about 8 centimetres) wide — about the size of a person’s fist.
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DISEASE
| PROTECT YOUR KIDNEYS
Kidney functions include Removing waste products from the body
Helping maintain the body’s water balance
Each kidney is made up of tiny filtering units which clean the blood and remove wastes such as excess salts and extra water. These wastes leave the body as urine.
Keeping body chemicals in balance Kidneys regulate the body's salt, potassium and acid. Controlling the body's acid balance helps maintain an environment that prevents diseases.
Releasing hormones that regulate blood pressure Renin is an enzyme that is stored in the kidneys. They release this enzyme into the blood, and it converts a type of blood protein into a hormone called angiotensin. Together, renin and angiotensin regulate how much salt and fluid the body keeps; and also how well the blood vessels can expand and contract. This, in turn, controls the body’s blood pressure.
Healthy kidneys maintain the correct amount of water in the body.
Controling the production of red blood cells A very important hormone, responsible for making red blood cells, is produced by the kidneys. This hormone is called erythropoeitin (EPO).
Producing the active form of vitamin D Calcium and phosphate are used to make strong bones. However, they can’t be absorbed from the blood and into the bones without the help of the active form of Vitamin D. Kidneys are responsible for the conversion of Vitamin D from its inactive state to its active state.
To reduce your risk of kidney disease: Don’t pass the salt!
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A diet that is high in salt (sodium) can contribute to the development of hypertension. High blood pressure, over a period of time, can cause damage to tiny blood vessels within the kidneys and can lead to chronic kidney disease and kidney failure. Also, kidney function naturally declines with age. Therefore, older persons and persons with high blood pressure should try to avoid or limit foods that are high in sodium. The newest recommendation for sodium is no
more than 2500 milligrams (which is about 1 teaspoon) per day! Monitor your blood sugar levels
Poor control of blood sugar contributes to the development of kidney disease since it damages blood vessels and nerves. Chronically high blood sugar can lead to kidney failure. If you’re diabetic, getting and keeping your blood sugar under control can help prevent or minimize these complications.
“Having high blood pressure over a period of time can cause damage to tiny blood vessels within the kidneys and can eventually lead to chronic kidney disease and kidney failure.”
Unfortunately, damage to the nerves, kidneys, or other tissues may not be reversible once it has occurred.
PROTECT YOUR KIDNEYS
Ask your doctor about the “haemoglobin A1C” test. This test shows how well your blood sugar was controlled within the past 3 to 4 months. Are regular sugar and artificial sweeteners harmful to the kidneys?
To date, there are no scientific studies about the effect of artificial sweeteners and kidney function. However, two recent studies tested the relationship between ‘diet’ soft drinks made with various types of alternative sweeteners and regular sugar-based soft drinks. The studies showed that moderate consumption of 1 or fewer servings of soft drinks (whether sugar or artificially sweetened) did not appear to be harmful to kidney health. However, consumption of 2 or more servings of soft drinks was associated with a faster development of kidney disease. These results mean that soft drinks in general should only be used in moderation. However, more studies are still needed to confirm if this is also true for multi-ethnic countries. Don’t overdo it with animal fat, meat and protein supplements
Also, consumption of high amounts of animal proteins is linked with the development of kidney stones. In general, protein should not provide more than a third of your calories. A high intake of red meat (2 or more servings a week) is not recommended. It is possible to meet your protein needs using regular foods like eggs, meat, nuts, soy, all other types of peas and beans as well as dairy foods. You can also use protein powders or shakes if you find them convenient.
Maintain a healthy fluid intake
Drinking plenty of fluid helps the kidneys get rid of salt, urea and toxins. Most adults should drink between 2 and 3 litres of water per day. If you are very active, or work in the heat, or just sweat a lot, or had a history of kidney stones, try to consume closer to 2½ to 3 litres of water every day.
“A diet where protein sources are more plant-based can help to preserve kidney health.”
Alcohol
Moderation is key. Take caution if you have high blood pressure. For someone with healthy kidneys, recent studies suggest moderate alcohol consumption has some benefits as well as risks. However, drinking too much alcohol—even for a completely healthy person—can cause many medical problems, including kidney, heart, and liver disease and high blood pressure. Look for the antioxidant power in your foods!
For most healthy adults, diets rich in whole grains, fruit, and low-fat dairy foods have been known to protect kidney health. The antioxidants beta-carotene (the plant-based form of Vitamin A) and Vitamin E, have been shown to help prevent damage to the kidneys since they help to remove and destroy free radicals. Free radicals are harmful and damaging molecules that are naturally created by your body. They cause damage to the body’s cells and organs such as the heart and kidneys.
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DISEASE
These harmful molecules also speed up the process of aging and disease. Although the body manufactures its own antioxidants, researchers say that isn’t enough to remove sufficient free radicals. Since the body tends to use and absorb nutrients from foods better than supplements, it is recommended to eat foods such as fresh vegetables and fruits that are full of antioxidants.
Symptoms of kidney disease Kidney disease is called a ‘silent disease’ as there are often few or no symptoms. Therefore, you should take an active role in your kidney health by asking your doctor about checking your kidney function. A few signs and symptoms of kidney disease include: • Consistently frothy or foamy urine (almost soap-like) • Puffiness/swelling of the hands, abdomen, ankles or feet (oedema) • A change in the frequency and quantity of urine passed, especially at night (usually an increase at first) • Blood in the urine • Pain in the back (under the lower ribs, where the kidneys are located) • Pain or burning when passing urine
Since some of these signs may be mistaken for other issues, please seek the advice of your doctor if you are experiencing any of the above symptoms.
Feel free to email the author of this article with any of your nutrition questions or concerns and they will be answered in the next issue. Email michelle.ash.tt@gmail.com
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are ulnerable
Always protect your eyes from harmful UV rays You’ve thought about your skin. Now think about your eyes. Most of us understand the importance of protecting our skin from UV rays. We wear moisturisers with SPF as well as sun creams in the hotter months, we know to keep out of the sun in the midday heat and we use UV protection at the beach. But did you know that what goes for skin also goes for eyes? That’s because UV rays can be harmful for our eyes and can lead to both short-term conditions as well as permanent eye damage. Year-round danger needs year-round protection. UV exposure is not just a problem in the hotter months either as it can cause damage all year round. Once outside, almost any location, from hills to sea level, and any pastime from football to hiking expose us to UV radiation whether from a direct or reflected source. Even under water, at half a metre depth, UV radiation is still 40% as intense as at the surface. Most people do not realise that UV eye exposure is greatest during early morning and late afternoon. This makes exposure of eyes to harmful UV rays more likely.
Not only can UV rays pierce cloud cover, they reflect off all surfaces at different - and often surprisingly high - degrees. For example in bright sunlight, walking on a concrete pavement produces nearly 10 times more UV exposure to the eye than walking on green grass. Young eyes need extra care. Young people are especially vulnerable to the effects of UV exposure. That is because they have larger pupils, clearer lenses and tend to spend more time out of doors. They are less likely to wear sunglasses and hats, so it is important that they protect their eyes from UV exposure at an early age. ACUVUE Brand Contact Lenses is the only major brand that blocks more than 98% of UVB and 85% of UVA rays as standard across the range. This additional protection is important even if you wear sunglasses, in order to provide added protection. And unlike sun protection for the skin, the UV-blocking ingredient is incorporated into the ACUVUE lens material permanently - it will not peel or wear off. Wearing UV-blocking contact lenses every day means that you have additional protection for your eyes, even on cloudy days when you do not want to use sunglasses. Available at
SKIN
| URTICARIA
Urticaria WRITTEN BY
DESIREE SEEBARAN
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Maybe you’ve just enjoyed a bowl of crab and callaloo for the first time or had a jam sandwich with the tiniest smear of peanut butter. Maybe you have a headache and since you’re out of your usual migraine medicine, a friend offers you some aspirin. You could even be at a new gym, trying jogging for the first time. Within ten minutes to an hour, your legs begin to tingle; then you feel your skin itching, and though you scratch and scratch, the itching gets worse. Finally, your irritated skin swells into disturbing red welts (wheals), patches of skin where the itching is even more intense, and the only thing that helps is applying a cool compress. It’s not some fatal new illness; you’ve had an allergic reaction and developed hives.
URTICARIA
ives, less commonly called urticaria, is an allergic skin reaction that can be caused by several kinds of stimuli. The New Illustrated Medical Encyclopedia and Guide to Family Health says that people usually get them if they are allergic to foods like nuts, chocolate or seafood, or have sensitivity to insect bites, pet dander and certain antibiotics. Hives is characterised by raised, red welts on the skin, and intense itching. They can be as small as the circumference of a pea or occupy patches of skin a big as a basketball and form anywhere on the body – limbs, torso, face, genitals, and even inside the mouth cavity. Gina* first developed hives when she was 24; she’d never taken aspirin, but when she pulled a muscle in her ankle, her GP prescribed the drug for the pain. “Within two hours, I started itching really badly, so much so that the only thing that provided relief was standing under really hot water in the shower. My mother rushed down to a pharmacy to get antihistamines, and while she was gone, I noticed patches of skin on my calves, made up of tiny bumps, beginning to swell. The more I scratched, the more they itched.” Acute urticaria lasts less than six weeks, according to Web MD, but chronic urticaria lasts for more than six weeks and the cause may be near impossible to determine. Angioedema is like a ‘super’ form of hives; swelling happens beneath the skin surface instead of on top, creating a puffy look that is especially noticeable around more delicate skin areas like the eyes, lips and genitals. Like chronic urticaria, angioedema can last much longer than hives and the cause may be difficult to pinpoint. Physical urticaria is quite unique in that it signals a reaction to the physical environment or physical stimuli. For example, exercise-induced anaphalaxis – a severe allergic reaction to vigorous physical activity – may present with hives as well as pruritus (itching) and nausea among other symptoms. Other people may develop physical urticaria when their skin comes into direct contact with heat (rays of the sun); cold; vibrations against the skin (for example, through various chiroprator’s devices); or pressure. Physical urticaria can also develop as a secondary reaction when the person experiencing pruritus scratches at their skin, causing the red, swollen welts to develop on their skin, called dermographism.
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SKIN
Angie*, her sister and her father, all show symptoms of exercise-induced allergy when they run or jog. But taking an antihistamine before bed usually prevents symptoms. But once, Angie forgot to take her medication the night before an early morning race. Fifteen minute into her run, the itching started all over her thighs. When she rubbed at her legs to get relief, “Everywhere that I touched or scratched turned into huge, red welts. It almost looked like I’d been attacked by a violent animal,” she explained. “It took nearly two days for the swelling to subside, even thought the itching faded once I stopped running. And the hives actually left a scar that took several months to fade.” Hives, like most other allergic reactions, is relatively easy to treat. The best way to prevent the reaction is to avoid contact with the allergen. But when this is not possible, antihistamines like Piriton, Benadryl or Claritin can usually prevent or stop symptoms within a few hours. “I was advised to crush the antihistamine and put it under my tongue, because that was the quickest way to get it into my bloodstream,” said Gina. “It took maybe 30 minutes for all my symptoms to subside, including the hives.” Angie takes an antihistamine every day when she adds running to her exercise regime, but because of the medication’s side effects of sleepiness, she tries not to use it for more than two weeks at a time. Doctors also advise that while waiting to hives to subside, patients should try to wear loose clothing and relax in a cool room. Cool baths and cortisone creams may also help to assuage itchiness. More severe forms of hives require more immediate treatment. Persons with fatal allergies to nuts, chocolate or bee stings may develop angioedema in their ear, nose and throat passages upon exposure to an allergen, which may obstruct their breathing and cause death by asphyxiation. They may be advised by their doctor to carry around an Epi-Pen (a shot of epinephrine, an adrenalin substitute) or cortisone medication. If you develop hives along with tightness in the chest, wheezing or swelling on the tongue and lips, it’s time to call your doctor or go to the hospital. “It’s best to know what you’re allergic to,” said Gina of her experience. “I try to keep Piriton in the house now at all times. You never know.” (*Not their real names.)
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SURGERY
| THE ROBOT WILL OPERATE ON YOU NOW
The robot will operate
on you now WRITTEN BY
DAVID FENTON
In a recent story we looked at the science behind robotic surgery. Now David Fenton, a Health Correspondent for BBC Television and U-Health writer, examines what future it might have in hospitals around the world. He reports from inside an
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operating theatre in England, where a robotic procedure is taking place…
THE ROBOT WILL OPERATE ON YOU NOW
E
veryone knows what an operating theatre looks like. Even if you have never been in one the surroundings will be familiar to you. It's a scene we have all seen in TV shows and films. There will be a table with a patient on it and a huge circular light illuminating the nurses and technicians, and, of course, centre stage, gowned and masked, will be the surgeons — staring down at the patient with an air of detached concentration. But recently I was in an operating theatre with a difference. The patient was there — but the surgeons were not! Or at least, they were not where they were supposed to be. Instead of standing over the unconscious patient, scalpels in hand, they were sitting twelve feet away at the back of the room. What's more —they weren't even
looking at the patient they were operating on. Instead they were staring down the eyepiece of what appeared to be a giant video game console. The patient himself was surrounded by three robotic arms attached to a large machine positioned directly above him. To the untrained eye it looked like a giant steel spider. Each of the arms, about three feet long, was covered in thick transparent plastic to maintain a
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SURGERY
sterile environment and at the pincer-like ends were the tools that would do the work — cutting and probing and searching out a bowel cancer. This was robotic surgery with a da Vinci machine.
Technically speaking, this device is not actually a 'robot'. That is something of a misnomer because robots are designed to operate semi-independently of human beings, and the da Vinci does not. It relies completely for its actions and movements on the surgeons at the controls. Think of the old fairground or carnival game where you use levers to operate a mechanical claw to grab a toy and you get the principle — then multiply the complexity and skill (and technology) a thousand times! The operation I saw took place in Portsmouth, in the South of England, at the Queen Alexandra hospital, which has just become a European training centre for this type of surgery. Robotic surgery is now widespread in the United States and more and more hospitals over here are looking at it too. But at the moment the availability is limited.
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SURGERY
| THE ROBOT WILL OPERATE ON YOU NOW
In the UK there are just 14 high definition da Vinci machines — used for prostate cancer operations, head and neck surgery, gynaecology and other procedures.
although that does not do justice to its clarity. Forget what you may or may not think 3D is — from cinemas or TV — this is the real thing!
Many hospitals which do not offer robotic surgery would like to — if they could afford it. Because this technology does not come cheap.
Every part of the internal anatomy appeared crystal clear and with a definite sense of space and perspective — in fact so clear and sharp it seemed almost artificial or synthetic. I could see the tools that were being used moving past blood vessels and internal organs with the utmost clarity, searching out the tumour which had to be cut out.
So, is the future of surgery now robotic? And where will it end? Could there come a time when a surgeon at a hospital in Florida operates on a patient in Port of Spain — via a robot? It may sound far fetched but perhaps the technology is not too far distant. Prof. Amjad Parvaiz is helping to develop robotic surgery at the Queen Alexandra hospital, and was part of the team at the operation I witnessed. I asked him about the benefits. ‘When I operated on this patient,' he said, 'I was able to use the robot to hold small surgical instruments to take this surgery beyond the limits of the human hand.’
'Because the instruments are so small the robot also offers less invasive surgery, far reducing the patient recovery time — as large cuts are not needed.' Other surgeons I have spoken to have said similar things. One explained how the machine 'reduces tremors' in the surgeon's hands during long operations — making cuts and stitches much more precise. Conventional keyhole surgery can often be a long and arduous process for surgeons. They are on their feet for hours, concentrating on delicate movements inside a body which they must watch on screens above the patient. With robots the surgeons are seated, and the sheer physical effort involved in operating is largely taken away from them.
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One of the things that I noticed about the robot is the striking views that it gives of the inside of the body. On a second console which was being used for training purposes, I was able to look down the eyepiece of the da Vinci machine and see exactly what the surgeons saw. It was, quite frankly, incredible. It is described as a high definition 3D image —
It seemed to me, a layman, much clearer and more detailed than the traditional view which keyhole surgeons get from cameras pushed into the body on the end of a probe with pictures transmitted on TV screens above the patient. There is no doubt that the technology is impressive, but it comes at a price. The machine that I saw, with its training console, would cost the hospital about £2.5 million to buy and maintain — that's about $3.7M US — a significant investment. Interestingly, many of the hospitals which are buying these robotic machines are doing so through charitable, public appeals. Dr. Mohammad Abu Hilal is a pancreatic and liver surgeon (and a laparoscopic specialist) at Southampton General Hospital — one of the big teaching hospitals in England. He has just launched a £1 million public appeal to help buy a da Vinci machine for the hospital. I asked him what difference it would make to patients, and surgeons. 'Even with good skills, keyhole surgery is not easy,' he said. 'The movement of the hands in narrow spaces can be difficult and you can't get 360 degree rotation. The instrument you use is basically a stick with 2D movement and you can't bend it. Sometimes that can be a problem. 'You can do more robotically — for instance, it allows you to perform sub-millimetric stitches, with less than a one millimetre gap between them.‘
‘And it's comfortable to use — it's much better for the surgeon than spending six hours standing, and, of course, it's much less invasive for the patient.'
THE ROBOT WILL OPERATE ON YOU NOW
Dr. Hilal's charity — Liver and Pancreatic Research and Development — has already raised £30,000 in six months. His concern is that patients are beginning to realise the benefits of robotic surgery and expect it. 'For certain procedures, especially on the prostate, patients are becoming very aware of robotic surgery now and they will migrate to the hospitals which have these machines,’ he said.
lives in the hands of a surgeon they had never met, and who was operating on them from a different time zone? Dr. Hilal said, 'At the moment it is important to be in the same room as the patient you are operating on, for many different reasons. Sometimes things do not go to plan and then you might have to revert to open surgery.’
What happens then, if the surgeon is hundreds of miles away?
And, presumably, away from hospitals which do not... One intriguing possibility which robotic surgery may offer in the future is the chance for a surgeon to operate on a patient 'at a distance'. And by that I mean from a different city, or even from another country! We are not there yet, but even if the technology existed, is that something we would want? Would patients really feel comfortable putting their
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'But certainly I can see a use for remote training of surgeons, using these robots. That would be possible and useful.' For every answer that technology provides, another question is asked. The technology behind robotic surgery is impressive, but expensive — and perhaps the biggest question for many hospitals in the future will be, is it worth it?
SURGERY
EXERCISE
| BALANCE YOUR HORMONES WITH EXERCISE
BALANCE YOUR HORMONES WITH
EXERCISE
UNDERSTAND HOW PHYSICAL ACTIVITY IMPACTS YOUR HORMONES TO YOUR ADVANTAGE. WRITTEN BY
SARA OUELLETTE. CNP
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ormones are the body’s chemical messengers. They direct biochemical reactions that happen inside your body. Your environment is constantly changing: at times, food is plentiful, and other times it’s scarce. You may be having a good day, or a stressful one. Your hormones help you to adapt to these changes. An imbalance can lead to health complications, from infertility and acne to depression and loss of strength, which can result in serious long-term health issues.
BALANCE YOUR HORMONES WITH EXERCISE
|
EXERCISE
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EXERCISE
| BALANCE YOUR HORMONES WITH EXERCISE
If you can lift heavier weights, do it! Simply ensure you are performing your exercises with proper form to avoid injury. THE BODY AS A WHOLE Everything in the body is interconnected. Many hormones interact with one another to send messages to your cells. The amount of one hormone can regulate another. Major hormones such as insulin, adrenaline and cortisol are necessary for life. Along with a healthy lifestyle, exercise is an environmental input that can significantly affect your hormonal balance – and subsequently your health. If you understand how exercise impacts your hormones, you can use physical activity to your advantage. THE LOW-DOWN ON EXERCISE Exercise is defined as activity that requires physical or mental exertion. There are three general categories of exercise: cardiovascular, strength and flexibility. Cardiovascular exercise improves hormone function and sleep. Strength exercise builds lean body mass, accelerates metabolic rate, and aids fat loss. Flexibility exercise lowers stress and adrenaline, and helps maintain range of motion.
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KEEP IT SHORT AND SWEET When it comes to hormonal health, more exercise is not
always better. This is true especially for people showing signs of adrenal fatigue, insomnia, underactive thyroid, suppressed immunity, or slow recovery after exercising. Although beneficial in moderation, exercise is actually a form of stress imposed on the body. It’s therefore a good idea not to over-do it. According to popular athletic websites and publications, including Livestrong.com, long workouts can crank up cortisol levels. Cortisol is a hormone that is usually associated with stress. It is destructive to muscle tissue. There is a strong relationship between elevated cortisol and decreased testosterone. As a result, many athletes prefer keeping their workouts shorter. OUT WITH THE SUGAR Exercise impacts the three major hormones mentioned above in positive and negative ways. Insulin is an anabolic hormone that regulates your blood sugar levels. Excess sugar causes an insulin spike, which stresses your body. While cortisol is often blamed for causing increased body fat, especially around the tummy, it is more fair to say that high stress can cause many
people to overeat. This is what causes the weight gain. Insulin resistance syndrome encompasses a collection of symptoms that are associated with diabetes and heart disease. They include obesity, high blood pressure, high cholesterol, and polycystic ovary syndrome. Fortunately, exercise can help regulate insulin. It doesn’t necessarily impact blood sugar in the short term, but it increases your sensitivity to insulin, which will help you manage your blood sugar in the long term. GO HARD OR GO HOME Don’t hold back, ladies especially! If you can lift heavier weights, do it! Simply ensure you are performing your exercises with proper form to avoid injury. Pumping iron will help you increase lean muscle mass, accelerate your metabolism and boost growth hormone. To do this, do fewer repetitions with heavier weights. By the last repetition, your muscles should reach exhaustion. DON’T BE A NIGHT OWL Exercise increases the production of adrenaline in your body and this persists for hours after. With excess adrenaline, you cannot
BALANCE YOUR HORMONES WITH EXERCISE
|
EXERCISE
True health and hormone balance are achieved with a holistic approach, by considering all aspects of a healthy lifestyle. sufficiently produce melatonin, the sleep hormone. If your body is not stimulated by melatonin, you cannot wind down and fall asleep at night. Without proper rest, other hormones become unbalanced and your metabolism slows down. Hormones can also affect your circadian rhythm, or body (internal) clock. At sunrise, your body produces serotonin, which is the hormone that keeps you awake and happy. With the sunset, it produces melatonin. Many people therefore find it most beneficial to exercise early in the morning, or in daylight. This helps your body balance and synchronize itself with nature. TRAINING VERSUS EXERCISE It’s important to understand the difference between training and exercising. When you train, you’re choosing to stress your body in order to reach a goal, like completing a race. This is acceptable, but you must be sensitive to your body’s need to rebuild. Exercising, on the other hand, is for fitness, health and wellbeing – something that should be important for all of us. Choose the length and type of exercise wisely. To reap the
benefits without allowing exercise to become a stressor, remain cognizant of how it impacts your hormones. There is no role for long and stressful exercise sessions in a wellness-oriented routine, unless training for a sport. Exercise smart! GROUND YOURSELF AND BREATHE Along with challenging your heart and muscles with cardio and weights, you can increase flexibility and tone by practicing yoga. This grounding and stress relieving activity lowers cortisol, reduces adrenalin, improves sleep and concentration, and balances hormones. Yoga also has a positive effect on mood and anxiety. If you aren’t so much of a yogi, there are other forms of relaxation you can choose. Practice tai chi, meditation, deep breathing, or take long walks in the forest or beach, preferably barefoot, to ground yourself with the subtle but ever-present healing electrical energy that is on the earth’s surface. Grounding is simple, free and it gives you a deep sense of well-being. You simply connect your bare feet directly to the earth and enjoy the
organic healing benefits. THE HOLISTIC PICTURE Your hormones are critical to your health and wellbeing. Hormonal balance allows you to remain responsive to your environment. Exercise is one way you can have an input to maximize this balance. Constant attention to diet, sleep, and stress management are also important components, along with quality exercise. True health and hormone balance are achieved with a holistic approach, by considering all aspects of a healthy lifestyle. Eat well, sleep peacefully and play joyfully. Sara is a Certified Holistic Nutritionist and Fitness Consultant. You can find out more about Sara by visiting www.beyondvitality.com or by “liking” the Beyond Vitality Facebook page.
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