OCT DEC 2014
ISSUE 27
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THE CARIBBEAN HEALTH DIGEST
Self Diagnosis and the potential dangers and risks.
Antibiotics - The Body's Immunity Ally Learn more about this prescription drug used to treat infection. Fit As A Fiddle In Old Age Can some activities protect us from illness and disability than other activities? Pomerac The juicy low calorie Fruit of the islands.
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12 Chikungunya It’s been a part of almost everyone’s vocabulary here in the Caribbean in recent months, not only because it’s a fun word to say, but because Chikungunya is raising serious concerns everywhere. This viral infection is spread by one of the deadliest and smallest insects, the mosquito. Basil Lai separates the facts from the myths in his article.
16 Self Diagnosing When something doesn’t feel right, there’s no denying that we just “google it” with the intention of giving ourselves our very own diagnoses. Some of us just stick with traditional treatments for the things we feel we have. However we treat with it, self diagnosing comes with many dangers. Our writer Charrise Broome looks at them here.
20 Cranberries Despite all the other superfruits that are being bandied about as the next best thing, the properties and taste of cranberries have stood the test of time. Here’s a little reminder of why the fruit is so good for you.
24 Breast Pumping Breast feeding for a new mother and baby may not always come as naturally for some as it does for others, Faine Richards recalls from her own recent experience the challenges associated with breast feeding and discusses how breast pumping can be a healthy alternative for both mom and baby.
30 Antibiotics It’s usually one of the main medications prescribed for people with infections when our bodies can’t fight them quickly enough. In fact, some people even ask for them to fight off a simple flu infection as a quick fix. There are, however, many side effects associated with antibiotics. We take a closer look in this article.
32 Pomerac Whether we use pomeracs for a nice peppery chow, making jams and jellies, or some nice homemade wine, it’s one of the traditional fruits of the Caribbean. Here’s some health facts about the fruit you’ll be happy to know.
36 Dementia Every year in the UK more than 40,000 people with dementia go missing for the first time. They wander off, sometimes putting themselves in danger and causing great anxiety and worry to their loved ones. But now some families are using GPS tracking devices to help locate them.
40 Community Nutrition Programs Dr. Claudette Mitchell discusses the importance of Community Nutrition Programs and how they can work to achieve healthier communities and people, incidentally one of our main objectives at U The Caribbean Health Digest.
42 Fitness in Old Age As you grow older, occupying yourself with both physical activities and those that stimulate your brain all contribute to an overall healthier you. Occupational Therapist Lesley Garcia discusses the many options.
Welcome to our 27th edition of U! We’d like to start off this, the last issue for 2014, by extending our sincere gratitude to all the people that collaborate each quarter to pull this magazine together. Whether it be our writers, who sometimes get a late request for a story from us; our editors, who have to quickly turn it around, sometimes in mere hours; our artists, who have the task of conveying the content into compelling design; our printers, who we challenge each time to deliver the finest quality print in the shortest timeframe; and, of course, our advertisers, who pay to make this all happen. You are the ones that make it possible for us to continuously and consistently bring to our readers this material, intended to educate and create a greater awareness on health matters that relate to us here in the Caribbean. We are proud to bring yet another insightful issue. While all of the articles bring a certain clarity on the relevant subject, some of them are sure to stand out from the rest. The Caribbean, especially here in Trinidad and Tobago, has been inundated with cases of Chikungunya, and we have featured our research and findings on this as a matter urgent concern. Our cover feature focuses on something we are all guilty of: Self Diagnosing, and the dangers of doing it. Other articles like Antibiotics and what we should know about them, Breast Pumping, for when babies don’t feed directly, and Pomerac, the pulpy, sweet and tart Caribbean fruit, have all made this quarter’s cut for your reading enjoyment. We hope you will enjoy this issue that our team has put forward. Have a great end to 2014!
SHERINE & STUART
FOUNDING EDITORS
DISEASE
| CHIKUNGUNYA — SEPARATE THE FACTS FROM THE MYTHS Using painkillers can be a particularly concerning course of action for diseases like chikungunya, as the blood of the infected person is thinned during the course of the illness and some painkillers like aspirin can exacerbate this situation rather than relieve it.
Chikungun separate the facts from the myths WRITTEN BY BASIL LAI
Changes in the ongoing fight against infectious diseases can be confusing. Your best defense? Awareness. As a citizen of the tropics, I've been aware of the ongoing battle with a host of viral infectious diseases in our society for decades. The culprits can be repeat offenders, like dengue, or can be seemingly new ones to our shores, as is the case with our latest infectious offender, chikungunya. I first heard of the arrival of chikungunya on my travels to Dominica in March of this year. While I was conducting a weeklong seminar at the State College, the local radio, press and television were a constant reminder of the presence of the disease, its symptoms and precautionary measures. The other source was the public.
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The topic invaded every discussion and casual conversation, and had transformed the tone of these exchanges from one of concern and general fear, to that of information and actual awareness. I felt this was very effective, and brought home a real issue about this and other similar viral diseases and their seemingly timed cycles of appearance, but I will get to that in a moment. First, let us discuss what chikungunya is all about.
CHIKUNGUNYA — SEPARATE THE FACTS FROM THE MYTHS
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nya
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DISEASE
| CHIKUNGUNYA — SEPARATE THE FACTS FROM THE MYTHS
WHAT IS CHIKUNGUNYA? First the history: encountered in the nineteen fifties, chikungunya first appeared along the borders of Mozambique and Tanzania. Named by the African tribe where it was first found, Chikungunya literally translates to “that which bends up”, a reference to the walking posture of those infected due to intense joint pain. Although the name can be a bit misleading, with the similarity to the word “chicken”, I have not encountered any instances in my daily interactions where it was thought to be spread by chickens or through their consumption. This is very important, as misinformation can contribute to the spread of diseases. Chikungunya is actually spread in much the same way as dengue, via the bite of the Aedes aegypti mosquito. Although this is not the only known species that carries the disease, it is the more prevalent of the two species, the other being the Aedes albopictus.
HOW CHIKUNGUNYA IS SPREAD
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This insect is able to spread the disease with surprising efficiency, due in part to the assistance of humans and our penchant for harboring uncovered containers, clogged drains, and other sources of still water near to our homes, giving the mosquito ample breeding pools, a necessity for an insect that only has an adult life span of just two weeks to a month. Another enabling factor is its ability to infect during the daytime, when persons are actively up and about, also adding to what can seem to be spiraling cases in localized areas. The mosquito can transmit the disease by using humans as both the target of infection for one
insect, and the source of infected blood for another, and with one mosquito able to infect many people, the opportunity for high spikes in localized infections is sadly a common sign of diseases spread through these means.
INFECTION The infection is followed by an incubation period of about 3 to 7 days, within which time up to 28% of persons infected can exhibit no symptoms at all. What about the other 72%, you ask? Well, these will be counted as the unlucky, exhibiting symptoms including sudden onset of high fever and body pains or stiffness, rash, headaches, fatigue, nausea or vomiting and vision problems. The fever can also be considered “biphasic”, meaning it can subside for a short while, only to return when the patient is already weakened. Joint pains tend to be focused on the extremities and can be intense, with a long-lasting fatigue for weeks after being commonly reported. As debilitating as the disease can be, chikungunya, unlike dengue, is rarely known to be fatal, although older persons or persons with underlying illnesses can be at higher risk of the disease, leading to fatality. For the most part, with the correct treatment and care, patients can be nursed back to health within the reasonably short time frame of just a few weeks.
SIMILARITIES AND DIFFERENCES There are many similarities between chikungunya and dengue, but one symptom is more prevalent and potentially longer lasting
CHIKUNGUNYA — SEPARATE THE FACTS FROM THE MYTHS
that the others: joint pain. Although extremely painful in its appearance in dengue patients, the joint pain of chikungunya can be longer lasting, and affects victims for months, or sometimes years, after infection, leading to arthritis of the joints of the ankles, fingers and wrists, among others. Another fact about these diseases is that one does not protect against the other, so a single person can be infected with both the chikungunya and dengue virus at the same time. Rare cases have been reported in some African countries, where both diseases thrive on the temperature, humidity and other environmental conditions.
SUGGESTED TREATMENTS Unfortunately, the standard response to treating this and other viral diseases in the Caribbean can sometimes include uninformed trips to the pharmacy for painkillers to relieve the symptoms of the infection. This can be a particularly concerning course of action for diseases like chikungunya, as the blood of the infected person is thinned during the course of the illness and some painkillers like aspirin can exacerbate this situation rather than relieve it. So remember, paracetamol and other similar drugs are acceptable for the treatment of the fever and associated pains, but asprin is not an option for chikungunya patients. Instead, the first action should be to seek medical advice. A correct diagnosis can help with treatment, and education on the progression of the disease being understood by the patient and their caretaker. The preferred course of treatment is a combination of rest and hydration for the most part, as the body’s
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immune system takes on the virus. During that time, the body builds up the antibodies necessary to take on the disease and ultimately builds a resistance against possible re-infection. It has been noted that home remedies like honey and lime, popular in the Caribbean, have been known to soothe symptoms.
PREVENTION In this case, however, the age-old adage of prevention being better than a cure is the very best option. Along with keeping clean surroundings and keeping a watchful eye out for stagnated water within the environs of your home or other places you regularly visit, wearing long clothing to the wrists and ankles may be off-fashion for the tropics, but worth considering. As we were also advised on our trip “up the islands”, dusk (around sunset) seems to be a time of the day when infection is especially likely if you are outdoors and improperly dressed or unprotected. Should fashion be the deciding factor, then be sure to get yourself a can of bug repellant, or those handy wrist-worn ones that can both ward off the offending mosquito and look cool, all at the same time. Whether you are inclined to the use of nets over your beds at night, spraying rooms and surroundings with bug spray, wearing protective clothing for your ventures outdoors, or maintaining a clean environment; the best approach, certainly, is to be aware of the ways both chikungunya and dengue are spread, and safeguarding yourself and your loved ones against these two painful and dangerous viral infectious diseases.
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FEATU RE
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SELF DI AG NOS IS - HOW S A FE IS IT?
SE LF D I AGN O SI S - H OW SA F E I S I T ?
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FEATURE
It’s no surprise that we Caribbean people are on the top ten list of a people who self-diagnose — and self-prescribe — on a regular basis. A little salt on the tongue to combat nausea; a glass of Guinness if we’ve had some giddy spells (because we believe this is due to low blood pressure); Christmas bush to combat the flu, or papaya (paw paw) leaf juice for Chikungunya. Self-diagnosis is a common practice in the Caribbean. But what is self-diagnosis, and why is it problematic?
WRITTEN BY CHARISSE BROOME
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FEATU RE
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SELF DI AG NOS IS - HOW S A FE IS IT?
ACCORDING TO ONE MEDICAL DICTIONARY, SELF-DIAGNOSIS IS THE “DIAGNOSIS OF ONE'S OWN ILLNESS OR DISEASE WITHOUT PROFESSIONAL MEDICAL CONSULTATION.” WIKIPEDIA EXPLAINS IT AS “THE PROCESS OF DIAGNOSING OR IDENTIFYING MEDICAL CONDITIONS IN ONESELF. IT MAY BE ASSISTED BY MEDICAL DICTIONARIES, BOOKS, RESOURCES ON THE INTERNET, PAST PERSONAL EXPERIENCES, OR RECOGNIZING SYMPTOMS OR MEDICAL SIGNS OF A CONDITION THAT A FAMILY MEMBER PREVIOUSLY HAD.” The problem often occurs when there is mis-diagnosis, and more harm is done to the patient than good, resulting in a professional healthcare provider addressing more problems that he/she would have had to before. Dr. Srini Palley, in his contribution to Psychology Today on “The Dangers of Self Diagnosis”, determines that when patients self-diagnose, they are essentially assuming that they know the subtleties that diagnosis constitutes. And while doctors cannot stop patients from self-diagnosing, they strongly suggest that you consult with them first regarding your findings or regarding any persistent and recurring symptoms.
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This should be done particularly if the symptoms concern a child, an infant, an elderly person, or an ill, infirm, pregnant, or otherwise at-risk patient. This practise, according to Annemarie Jutel in a systematic review of self-diagnosis published in the Journal of Participatory Medicine, can lessen the tension self-diagnosis poses, as it is often viewed as “an encroachment on medical
diagnosis”, and serves as “an impediment to successful communication between client and doctor.” Dr. Pillay posits that self-diagnosing undermines the role of the certified health practitioner, and places the patient at higher risk of misdiagnosis and over-diagnosis, which are not without their own consequences. Professor Gerard Hutchinson, Head of the Department of Clinical Medical Sciences at the University of the West Indies, St. Augustine campus, stated that the top five illnesses against which the medical fraternity are battling are “depression, anxiety disorders, bipolar disorder, schizophrenia and substance abuse, predominantly alcohol.” Serious ailments which entail serious treatment. Yet many such ailments can be missed, and prognosis and proper treatment delayed, when patients self-diagnose, resulting in less-than-desirable repercussions. Professor Hutchinson explained that while there are no hard statistics on the number of persons who self-diagnose in this region, nor on the effects thereof, he mentioned that doctors are noticing an acute increase in the
number of persons who, through the use of online medical and self-diagnosing sites, read up about their symptoms and suggest to doctors/psychologists what they might have. The Professor also explained that alternative medicines have become more popular in recent years, and that the worrying factor for professional healthcare providers is regarding the levels of dosage taken. The Professor shared that religious/spiritual healers are also another favoured destination patients go to first for help. He indicated that up to half of our population still believe that mental illness is caused by supernatural/spiritual factors. Professor Hutchinson warns that even if you have self-diagnosed, it is always best to get confirmation from someone who is trained for the job, since, for example, many people don't know that many physical illnesses can present with mental symptoms. So, before you run out to take one of our famed “bush baths”, the experts strongly recommend that you visit the nearest health professional, who can test for the true cause(s) of your symptoms, and administer the appropriate treatment and after-care services
SE LF D I AGN O SI S - H OW SA F E I S I T ?
Both doctors agree that self-diagnosing, especially in psychological syndromes, can prove problematic, as persons can miss a medical disease that masquerades as a psychiatric syndrome; and while they also agree that self-diagnosing is undeniably a seductive option, they cannot stress enough that it is best to discuss your impressions with a qualified doctor before deciding to treat yourself for an ailment that you may or may not have. Over the past decade or more, there has been an upsurge in online self-diagnosis websites and naturopathic shops, promising to rid you of every possible disease, known and unknown. However, crushing a few garlic cloves with salt may not always extend to the root of your problem — no offence meant to anyone’s granny — but the symptoms we experience can be indicators of deeper medical, physiological or even psychological issues that perhaps even grandma’s potent remedies cannot cure. And then again, they may not. So, how is a balance struck? Is it ever ok to self-diagnose?
Dr. Pillay explains it this way:
We may know and see ourselves, but sometimes, we need a mirror to see ourselves more clearly. The doctor is that mirror. For example, a patient may be overwhelmed by anxiety and think that he or she has an anxiety disorder; however, the anxiety disorder may be covering up a major depressive disorder. Or, just because a patient may have experienced unexplained weight loss, does not mean that cancer is the cause. Now that the Ebola virus has been recognised as a clear and present danger, it would be undesirable for any person with a far lesser ailment to diagnose him or herself with the deadly disease, or worse, to unnecessarily ingest any advertised alternative or “bush” medicines promising to eradicate it. The panic alone
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FEATURE
caused from this self-diagnosis can have an adverse effect on one’s mental and physical health, and on the health of those around them. To put it in a coconut shell, self-diagnosis is not a recommended practice, and is therefore not a substitute for a personal visit to the experts. Wherever possible, it is recommended that persons seek prompt in-person medical advice from a qualified medical professional if they are concerned that their ailment may be more than it seems. Professor Hutchinson reminds us that there are lots of free physical and mental health services all over the country. The Ministry of Health also places an ad in one of the local papers on Fridays explaining this. Persons are also free to walk in to any of the major hospitals and be referred to a clinic, as there are mental health clinics on days at many of the health centres across the country. The bottom line? Even doctors need to be doctored by doctors. Save yourself some time and potential trouble by talking to your doctor FIRST.
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NUTRITION
| THE BE NE FITS OF C R ANB E R R IE S
aberry healthy perspective WRITTEN BY CAROL QUASH
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CRANBERRIES MAY BE SMALL AND TART, BUT THEY ARE A POWER-HOUSE OF NUTRITIONAL VALUE. IMAGINE AS LITTLE AS ONE CUP OF UNSWEETENED JUICE CONTAINS ONLY 118 CALORIES, BUT IS PACKED WITH GENEROUS HELPINGS OF VITAMINS A, C AND K, POTASSIUM AND MAGNESIUM. IN ADDITION, THEY ARE A GREAT SOURCE OF ANTI-OXIDANTS, FLAVONOIDS, LUTEIN AND BETA-CAROTENE. Meanwhile, one cup of whole cranberries contains only 45 calories, yet has fibre, vitamins and a Total Antioxidant Capacity (a means of measuring the ability of antioxidants in food to remove harmful free radicals from your cells) of over 8,900. In light of this, imagine what eating and drinking cranberries on a regular basis can do for your overall health.
T H E B E N E F I T S O F C R A N B E R RI E S
T
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NUTRITION
he Latin name for the cranberry is Vaccinium macrocarpon. It is native to North America, and was first used by Native Americans as a food, fabric dye and as a healing agent. Today, new health benefits of the cranberry are still being discovered.
complications. In a health-conscious era, when the issue of keeping hydrated is always on the front burner, the cranberry has made its mark in the form of juices and flavoured water, especially among consumers who find plain water boring.
Fresh cranberries are thought to contain the highest number of nutritious and health benefits. The red berry is in the peak of its season from October through December, when its tangy sauce is used to garnish the Thanksgiving turkey and many a Christmas meal. But even when dried or frozen, the cranberry still packs a wallop of health benefits.
There are a number of these available on the local market, among them the Cran+ drink, which is a refreshing combination of water and cranberries. This drink is reputed to be low in calories and very low on the glycemic index – which makes it safe for diabetics, and the ideal hydrating drink for fitness enthusiasts.
Research has shown that the cranberry has been used to help prevent and treat urinary tract infections (UTIs) as a result of the proanthocyanidin (PAC) it contains. The PACs makes it difficult for certain types of bacteria to get into the urinary tract linings. Additionally, the phytonutrients found in the cranberry provide anti-inflammatory benefits for the cardiovascular system and sections of the digestive tract. Studies have also shown that the cranberry works as a natural detoxing agent and an immune system booster that helps lower the frequency of symptoms of the cold and flu – great news during this season of runny noses and chronic coughs. And while the studies in the area of cranberries having anti-cancer benefits are still limited, scientists have been discovering small pockets of evidence that support this theory.
So, in this season of excessive calories, which precedes the season of more calories and dehydration due to alcohol consumption and fêting in the hot sun, forego the sugary juices and sodas and include cranberries or its by-products on your grocery list. Your body will thank you for it.
There are many ways to consume the cranberry. Some people prefer to eat it raw or to sip it in a smoothie, while others opt for the cooked version. Using cranberries in hydrating drinks and juices has also become a popular trend. We all know that keeping our bodies properly hydrated is an important component of healthy living. Our bodies are made up of two-thirds water, which we lose through normal bodily functions such as perspiring. This water must be replenished on a daily basis in order to prevent dehydration, which can lead to a number of health
CRANBERRY SMOOTHIE Ingredients: • 1 cup sweet apple cider (or apple juice) • 2 cups whole cranberries • 1 banana • 1/2 cup yoghurt • 2 Tbsp. maple syrup (add an extra Tbsp if you prefer sweeter) or honey • 1/4 tsp cinnamon (optional) Directions: Place all ingredients in the blender and blend until smooth and uniform. Taste and add more cinnamon or maple syrup if you wish. Serve right away. Yield: 2 large servings Sources: webmd.com, nutritiondata.self.com, nutritionandyou.com, pbs.org
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PEDIATRICS
| BREAST PUMPING - AN ALTERNATIVE TO FORMULA WHEN YOU CAN’T BREASTFEED
BREAST PUMPING - AN ALTERNATIVE TO FORMULA WHEN YOU CAN’T BREASTFEED
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PEDIATRICS
Breast Pumping an alternative to formula when you can’t breastfeed WRITTEN BY FAINE
RICHARDS
STARING INTO YOUR NEWBORN’S EYES, YOU VOW TO DO EVERYTHING TO GIVE YOUR BABY THE BEST START. MANY MOTHERS FIRST FULFIL THAT PROMISE BY BREASTFEEDING — PROVIDING THE PROVERBIAL ‘LIQUID GOLD,’ RICH IN NUTRIENTS AND DISEASE-FIGHTING ANTIBODIES. AFTER MY SON WAS BORN, I STRUGGLED TO DO WHAT SEEMS TO COME NATURALLY TO SOME WOMEN. BUT PERSISTENCE AND INNOVATION HAVE PAID OFF. THIS IS THE STORY OF HOW I TURNED MY BREASTFEEDING CHALLENGE INTO A TRIUMPH.
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PEDIATRICS
| BREAST PUMPING - AN ALTERNATIVE TO FORMULA WHEN YOU CAN’T BREASTFEED
reastfeeding was an alien concept to me; mom always tells the story of how I 'rejected' her when she tried to nurse me in the hospital. Separated from me while she recovered from a C-section, mom missed a crucial opportunity to breastfeed in the first hours of my life. By the time she tried, nurses had already introduced me to a bottle.
I reluctantly told Jabari I needed a reprieve, and he agreed; there was no sense subjecting myself to pain when I needed to be strong to take care of Donny. We agonised over the decision, and purchased a tin of formula. Donny wasn't even a week old yet, and already we were pulling out the bottle. I felt like a failure.
I yelped at her breast and pined for the bottle. So, like many new moms, she gave up. Nonetheless, Jabari and I vowed to breastfeed our son exclusively for the first six months. I was scared that I wouldn't get it right, but we were eager, and committed, so I tried to stay optimistic. At first, Donny struggled to latch on to my breast. After we left the hospital two days later, his feeds improved. He latched on well, and nursed longer. But by Sunday evening, I was wincing in pain. On Monday, I was in tears. Deep gashes and pink cracks left my nipples raw. They stung so intensely when Donny was nursing that I had to grit my teeth to withstand the burn, tears streaming down my face.
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I felt so deflated. What was I doing wrong? Why did it hurt so much?
We called Aimee Bartholomew, a counselor from The Informative Breastfeeding Service (TIBS). She reassured me that breastfeeding challenges are common.
We learn from what we see, and we just do not see enough breastfeeding in our lives for it to come naturally, she said.
Most women hide to breastfeed, and we do not see it in books or on television…. and although there is a lot of breastfeeding information available out there, not all of it is correct. The most common challenges include latch issues and sore nipples. During a home visit, Aimee observed that Donny wasn’t
opening his mouth wide enough while he was feeding. She also said I was holding him incorrectly. She showed us to how to improve our technique so that I wouldn’t be in so much pain. Armed with information, Jabari and I felt confident enough to try again. But Donny now seemed unwilling to consistently latch on. He'd latch on for one feed, then get frustrated trying to latch on for the next. I didn’t understand how a mere two days away from breastfeeding had interrupted his routine. Aimee explained:
Nipple confusion usually occurs when a baby is given a bottle or pacifier too early, before breastfeeding is well established... Sucking at a bottle is different from breastfeeding, and when a baby tries to use the bottle-feeding technique at the breast, he has difficulty latching on and becomes frustrated. Jabari and I were frustrated, too, and feeling helpless. Desperate not to deprive Donny of breast milk, I began using a manual breast pump. I expressed milk every
BREAST PUMPING - AN ALTERNATIVE TO FORMULA WHEN YOU CAN’T BREASTFEED
two-and-a-half hours to ensure my output kept pace with Donny’s appetite. I’d wake up to pump at night — even if Donny was asleep — just to ensure my supply didn’t diminish. This was territory I had no pioneer to guide me through; everyone had bombarded us with 'breastfeeding', not 'breast milk in a bottle'. No one had offered an alternative, but I decided to make my own. Some of the people around us didn’t understand why I chose to pump instead of continue trying to breastfeed directly. I was told Donny wouldn’t bond with me the same way because he was feeding from a bottle instead of suckling at my breast. Still, I remained firm in my resolve, prioritising the immediate need of giving my son the best nutrition by any means necessary. At first, I could only express 3 ounces of milk. God forbid a growth spurt hit and Donny clamoured for milk I hadn't been able to pump yet! Jabari and I were tense; our newborn was always hungry, and we didn’t want to reach for formula again. But as the days turned into weeks, I graduated to 4 ounces. Eventually, I could get 5 or 6 ounces. My supply began outpacing Donny’s appetite, and in a few weeks, I had four 6- ounce bottles stored in the
fridge at any given time. And the bonus: I had an extra inventory of frozen milk numbering more than a hundred 6-ounce bags. I’m not sure how to explain what happened; Donny breastfed for less than a week, and yet I’ve been able to sustain a milk supply for six months. Aimee said it was a bit of biology, with a healthy dose of determination.
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the most natural maternal function, but it is not automatic. I hope that by sharing our story, another mom or mom-to-be won't feel like a failure when breastfeeding doesn't click right away. If expert guidance doesn’t help, there is another way. I am a proud pumping mommy. One day, when he’s old enough to hear this story, I know Donny will be proud of me, too.
You are indeed very blessed to have been able to sustain your milk supply using a pump, she told me three months after our initial meeting.
Many women are not able to pump successfully... Pumping and hand expressing often, as though your baby was feeding, is what maintained your supply. Donny turned six months in October, and he hasn't touched an ounce of formula since those two days in April. I couldn't have done it without Jabari's support. Whenever I felt deflated, he encouraged me to keep going. It turns out that not all mammals can manage breastfeeding 'instinctively'. It's
The Informative Breastfeeding Service (TIBS) is a non-profit, non-governmental organisation that was founded in 1970. TIBS provides research-based breastfeeding education and evidence-based breastfeeding practices. TIBS offers breastfeeding counselling, free of charge, seven days a week. Support is provided by telephone, face-to-face at TIBS Centres, personal visits, and with counsellors at Support Group Meetings. Contact Info: Office: 8 Rust Street, St. Clair, Port of Spain, Trinidad and Tobago
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RECIPE
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CRANB ER R Y AND C IL A NTR O Q U INOA S A LA D
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Cranberry and Cilantro Quinoa Salad Ingredients
Directions
1 1/2 cups water 1 cup uncooked quinoa, rinsed 1/4 cup red bell pepper, chopped 1/4 cup yellow bell pepper, chopped 1 small red onion, finely chopped 1 1/2 teaspoons curry powder 1/4 cup chopped fresh cilantro 1 lime, juiced 1/4 cup toasted sliced almonds 1/2 cup minced carrots 1/2 cup dried cranberries salt and ground black pepper to taste
1. Pour the water into a saucepan, and cover with a lid. Bring to a boil over high heat, then pour in the quinoa, recover, and continue to simmer over low heat until the water has been absorbed, 15 to 20 minutes. Scrape into a mixing bowl, and chill in the refrigerator until cold. 2. Once cold, stir in the red bell pepper, yellow bell pepper, red onion, curry powder, cilantro, lime juice, sliced almonds, carrots, and cranberries. Season to taste with salt and pepper. Chill before serving.
MEDICINE
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ANTIB I OTIC S – THE B ODY ' S IMMU NIT Y A LLY
The Body
A
ntibiotics are prescribed drugs used to treat infections of many types. Also known as antibacterials, antibiotics work by stunting the growth of or annihilating bacteria. Bacteriostatic antibiotics slow down the growth of bacteria in and around an infected area, while bactericidal antibiotics kill the bacteria completely.
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Antibiotics have been around since 1928, when it was accidentally discovered by researcher Alexander Fleming, who returned to work after a weekend away from his lab and found that a certain type of mould in his Petri dishes, Penicillium notatum, had terminated
WRITTEN BY CAROL QUASH
the growth of Staphylococcus or staph – a bacteria that can cause infections such as skin infections, pneumonia, and some food-borne illness. He tried it against other bacteria, including Streptococcus, Meningococcus and Diphtheria bacillus, and it worked. There are over 100 types of antibiotics, with Penicillins, Cephalosporins, Macrolides, Fluoroquinolones, Sulfonamides, Tetracyclines and Aminoglycosides being among the main classes. Antibiotics are used to treat a range of bacterial infections that our body's natural immune system are unable to fight off — from simple bacterial
illnesses such as strep throat, ear infections, bladder infections, and skin infections, to more serious ones such as syphilis, tuberculosis, some forms of meningitis, and bronchitis. Broad spectrum antibiotics are specially designed to treat a wide variety of bacteria, and are often prescribed when doctors are unable to diagnose the exact type of bacteria causing the infection. Narrow-spectrum antibiotics are used to treat a select group of bacterial types. It must be noted that, contrary to popular belief, antibiotics will have no effect on viral infections such as colds or stomach flus.
Like any other type of medication, antibiotics can have side effects that may manifest immediately or be delayed. Among the effects that are common to most classes are diarrhoea, mild stomach upset, yeast infections, oral thrush, and mild allergic reactions. More serious side effects, some of which can be fatal, include severe allergic reactions such as swelling of the tongue and face, and difficulty breathing. There have been cases in which elderly patients have experienced inflamed bowels, while a study, conducted by New York School of Medicine and published in the
International Journal of Obesity, revealed that babies who were exposed to antibiotics prenatally or through breast milk have a greater risk of becoming overweight. Antibiotics of whatever class are powerful meds and must be used with extreme care, especially by patients who are pregnant, breast feeding or have reduced liver or kidney function. A doctor will prescribe antibiotics based on the cause of the infection, and they can be administered in the following ways: • ORAL ANTIBIOTICS – tablets, pills, capsules or a liquid
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THINGS ABOUT ANTIBIOTICS Antibiotics are commonly prescribed for respiratory infections, but most of these are caused by viruses, not bacteria. At the beginning of treatment, antibiotics wipe out the most vulnerable and weakest bacteria. Premature termination of an antibiotic course will allow relatively resistant bacteria to survive and multiply. If you take antibiotics when you don’t need them, they may lose their ability to kill bacteria. You should never take antibiotics given to you by someone else or prescribed for a previous illness.
• TOPICAL ANTIBIOTICS – creams, lotions, sprays or drops, which are mainly used to treat skin infections • INJECTIONS OF ANTIBIOTICS – these can be given as an injection or infusion through a drip directly into the blood or muscle, and are usually reserved for more serious infections When antibiotics are prescribed, it is essential to finish the course, even if you feel better, unless otherwise advised by a healthcare professional. Stopping part way through a course may result in the bacteria becoming resistant to the antibiotic — the antibiotic having little or no effect against the type of bacteria that caused the infection for which you were being treated. This can also occur if the drug is overused, as a number of people are prone to do. According to a statement released by the European Centre for Disease Prevention and Control in 2012, “... an estimated 25,000 people die each year in the European Union from antibiotic -resistant bacterial infections.” Because there is a risk that antibiotics may interfere with the effectiveness of other drugs, it is
advisable that before you begin a course of antibiotics you inform your doctor of any other medicines — prescribed, over the counter, or herbal — you may be taking. Additionally, ask your doctor if there are any types of food or drink you should avoid while taking antibiotics. Treating your infection with antibiotics may take a little time and effort, but if you do it the right way you are sure to reduce your pain and discomfort, and to save a little something on future medical bills.
QUESTIONS YOU SHOULD ASK YOUR DOCTOR IF HE/SHE PRESCRIBES ANTIBIOTICS. • Why do I need antibiotics? • What is this particular type supposed to do? • Will there be any side effects? • If yes, what are they? • Can I do anything to prevent them? • What time should I take the medication? • Should I take them with or without food? • Should I avoid consuming alcohol or any specific types of food?
Only your doctor can determine if you have an infection and the type of antibiotic that will be most effective and that is safe for you to take. Antibiotics are generally active against multiplying bacteria, but are much less effective against non-replicating (latent) bacteria. Green tea can help antibiotics be more effective in fighting bacteria. Researchers have found that green tea and antibiotics may work synergistically against certain pathogenic bacteria. Children who are given broad-spectrum antibiotics before two years of age are three times more likely to develop asthma than are children who are not given such antibiotics. You should always take the full course of antibiotic treatment, so none of the drug should be "left over." However, if this has occurred the antibiotics should not be taken to treat any other illness. Different types of infections require different types of antibiotics, so taking leftover medications is often not effective. While experts are working to develop new antibiotics and other treatments to keep pace with antibiotic-resistant strains of bacteria, infectious organisms adapt quickly.
FRUIT
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PO MERAC - THE R E D MAR V E L
pomerac THE RED MARVEL
WRITTEN BY SHELDON WAITHE
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CLUSTERED IN A RED GROUP, NESTLED AMONGST THE THICK FOLIAGE OF THE TALL, FLOWERING TREES THAT IT CALLS HOME, THE POMERAC (OR POMME AU RAC), IS A UNIQUE DELICACY. THIS FRUIT IS A BIT OF A CONUNDRUM: you can neither describe its taste as sweet nor tangy; the dominance of one taste over the other is dependent upon ripeness; it looks like a pear but behaves like an apple. However, like most fruits, it is packed with health benefits, both from the fruit itself and the tree upon which it grows.
P O M E R AC - T H E RE D M A R V E L
B
ut first, a few historical tidbits. ‘Pomerac’ is derived from ‘pomme malac’, which means ‘Malaysian Apple’ in French; the Malay were blessed with the fruit, but thankfully shared it with the rest of the tropical world. With its travels came a number of monikers, for example in Guyana it is called ‘cashew’, though it is not related in any way to the nut. Regardless of the name, it is sought after as though it were a rarity — witness the clamour for it as cars pass any vendor on the side of the road. The skin is consumed along with the white flesh, so pomeracs provide the double dose of fibre and vitamins, and as is the case with most fruit, large amounts of the vital daily requirement of Vitamin C. The fibre helps to reduce cholesterol; one study of 125 people who consumed one to two raw pomeracs per day for one week showed remarkable results. Their cholesterol levels reduced by an average of 19%; that’s outstanding work by the fruit and a huge health benefit packed into a little red package. In sub-Saharan Africa and Asia, the pomerac is seen as a naturally strong brain and liver tonic. The powerful diuretic qualities aid the clearing of toxins in quick time, leaving less work for the liver and kidneys to process on their own. The fibre also makes the pomerac very good for the regulation of food passing through the digestive tract. Thus, it alleviates medical issues that can arise from constipation, and is a serious consideration to the aftermath of the foods that we consume in the modern society. While no food group can boast of being cancer preventative, there are factors that combine to make up deterrents to the disease. A mixture of vitamins A and C, together with active organic compounds, have been proven by research and medical texts of the past decade to reduce the risk of developing breast and prostate cancer. Your humble pomerac is, of course, bursting with all three. Where the fruit has found an even greater following is amongst the diabetic community. Some believe that the
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FRUIT
consumption of the fruit’s flesh and seed allows the jambosine within to block the transformation of starch into sugar. Targeting the pancreas, jambosine is an alkaloid that is very important for diabetics, and preventing the development of diabetes in those at risk. The large single seed is dried out and ground into a powder, which is added to water and drunk up to four times a day to lessen sugar in the urine. The bark of the pomerac tree has been used for medicinal purposes for centuries; it is removed, crushed and boiled, then drunk to help fight dysentery (diarrhoea containing blood). The concoction is also used to treat swelling, via the same application as a medicinal drink. Other decoction processes of the root bark are used to alleviate vaginal inffections such as thrush, or applied to the skin to stop itching from rashes, while Asian territories use the bark to reduce fever, and claim that it can attack nasty coughs in the chest and throat. The leaves can be crushed and added to baths for soothing qualities of both the resulting aroma and the water texture. Yellow oil is also extracted from the leaves, to be used in perfumes. The pomerac tree — the whole tree, down to its roots — just keeps on giving to us. And we have found many ways in which to enjoy its primary function, that is, as food. Of course, it is eaten as raw fruit; its different hues, from deep red to almost light pink, beckon us to sink our teeth into is pear shaped exterior. Caribbean people, with our penchant for all things tangy and spicy, of course revel in ‘pomerac chow.’ The region also produces, albeit rarely, a jam derived from the fruit. In Puerto Rico both red and white wine are manufactured from the fruit, while in Guyana, the peeled fruit is stewed, while the skin is cooked separately, to make a syrup that is then added to the fruit. Regardless of the manner of consumption, it is truly all-encompassing, in terms of both its benefits and the parts used. We probably just want to receive all that goodness the traditional way, from a beautiful bunch of raw pomeracs making our tongues salivate. Now if we can just buy some before others get to it first....
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CONDITION
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DEME NTIA
WRITTEN BY DAVID FENTON
EVERY YEAR IN THE UK MORE THAN 40,000 PEOPLE WITH DEMENTIA GO MISSING FOR THE FIRST TIME. THEY WANDER OFF, SOMETIMES PUTTING THEMSELVES IN DANGER AND CAUSING GREAT ANXIETY AND WORRY TO THEIR LOVED ONES. BUT NOW SOME FAMILIES ARE USING GPS TRACKING DEVICES TO HELP LOCATE THEM.
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Rose Dunn lives with her husband John in a remote cottage in Southern England. John has dementia but he’s physically fit and likes to walk – sometimes for several miles a day.
DEMENTIA
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CONDITION
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CONDITION
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DEME NTIA
People with dementia don’t experience the environment the way that you or I do, ‘He just feels that he has to get up and go somewhere,’ she said, ‘and so he starts going for a walk, and then of course he goes where he is led.’
Now, whenever he leaves the house John wears a locator around his neck. This uses satellites to plot his exact position, which can then be read by a computer or even a mobile phone. The locators are accurate to within a distance of ten metres.
Most people with dementia who go missing are found within a mile of their homes – so it’s easy to see why equipment like this is proving popular with families.
I went for a walk with John in the woods near his home. While we were out his movements were being tracked at a control centre twelve miles away.
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Sitting in front of one of the computer screens and watching his progress was Louise Morgan.
She could see a map, and tiny red figures indicating where John was. ‘You can tell if he’s in open ground or if he’s in the middle of a large copse – you can even see if he’s in the middle, near the outer edge or close to a path. So you can describe exactly where someone is. We can show on a map all the points that he has covered since he has been out today.’
To some this all sounds a bit Big Brother – someone watching over you all the time. But actually it’s only ever used in an emergency, when the family want to know where a loved one is.
Adrian Wolf, whose company Mindme supplies the locators, said it actually gives people their freedom back.
‘People with dementia want to have freedom; they want to go out and about but there is a duty of care that the carer has to observe and they have to be sure that they are safe. No one has
come up with a better solution yet – either have a GPS tracker, or lock them in their own home.’
But why do people with dementia go missing in the first place?
Dr Karen Shalev Greene is an academic with the University of Portsmouth who has spent years studying the problem.
‘People with dementia don’t experience the environment the way that you or I do,’ she said. ‘They have a very different way of understanding and navigating the environment because of the brain injury, as such, that dementia causes.
‘So for instance, you will see that people will walk until they reach a natural dead end, like a fence or bush or water - and then they will stop. As a dementia patient they won’t be able to turn back and return the way they came from and they will be standing there until someone finds them.’
DEMENTIA
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CONDITION
A lot of people if not found quickly will become exhausted, Karen said that people with dementia tend to walk with their heads down and will often follow straight lines – pavements, walls, marks in the road. What’s more, they follow the path of least resistance, so they almost always go downhill. This means that they are frequently found near water, by rivers, lakes or streams, which of course can be dangerous.
When someone with dementia wanders off, time is of the essence. Half of all dementia patients who go missing will be injured or die unless they are found within 24 hours.
some may die from hypothermia.’
It’s a serious reminder of the dangers that dementia patients face, if they go missing.
covered in mud and his trousers were torn but he looked so forlorn. But he was safe, he was safe - that’s what all I was worried about.’
On Christmas day last year, John disappeared on a family walk at a place called Durdle Dor in Dorset. These are famous cliffs, overlooking the sea.
Rose and John are back in their cottage. The tracking device helps keep him safe, but it also means the couple can stay together, at the least for the time being, because Rose can be certain of where he is.
Rose searched and searched but couldn’t find him. It was only because he was wearing his locator that the emergency services were able to tell exactly where he was.
‘I see us being able to live here independently for now, and with the help that we get we can live here a lot longer,’ she said. ‘You can never see into the future – but now is good enough.’
They found him on a lonely farm track, confused and covered in mud and not more than a hundred yards from the cliff edge. He had been missing for two hours.
And who could deny her that?
Sergeant Alan Heath is a police search specialist.
‘A lot of people, if not found quickly, will become exhausted,' he said. 'We tend to find them near fences, and sometimes they try to climb over them to carry on walking. If they do that and get their clothes caught they can get stuck there, and if not found,
‘Somebody shouted, “We’ve got him”,’ said Rose, almost breaking down in tears. ‘He was just
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COMMUNITY
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CO MMU NITY NU TR ITION P R OG R AM S
COMMUNITY NUTRITION PROGRAMS CAN HELP WRITTEN BY CLAUDETTE MITCHELL, Ph.D., RD – Assistant Professor, University of the Southern Caribbean, School of Education and Human Sciences
YOU WILL AGREE THAT WHENEVER PEOPLE COME TOGETHER AND WORK AS A GROUP/TEAM, MUCH CAN BE ACCOMPLISHED. THEY CAN RAISE AWARENESS ABOUT ISSUES, DESIGN AND IMPLEMENT PROJECTS, AND TAKE ACTION TO BRING ABOUT CHANGE IN POLICIES AND PROCEDURES, DEVELOP PROGRAMS, AND HELP BUILD STRONGER COMMUNITIES.
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Therefore, nutrition intervention to improve the health of communities is vital in order to make a positive impact on the nutrition status of individuals. Currently, given the statistical data of the nation’s health, 24.6%, 13.7%, and 13.6% of deaths in Trinidad and Tobago are due to heart disease, cancer, and diabetes mellitus, respectively. Also, lifestyle practices such as physical inactivity, poor diet (high in fat, sugar, and salt), obesity,
elevated blood pressure, cholesterol and blood sugar levels, smoking and alcohol abuse are contributing factors to these non-communicable diseases (Health Report Card Trinidad and Tobago, 2011). Moreover, given the aforementioned results, there is a greater need for community nutrition programs that will help persons using a step by step approach; they can begin by making small changes.
C O M M UN I T Y N UT R I T I O N P RO GR A M S
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COMMUNITY
Let us take a look at the basic role of community nutrition programs… The program can be designed to address specific target populations, e.g. pregnant women, children, adolescents, senior citizens, and chronic disease risk groups. Seek to build awareness by using intervention strategies such as nutrition posters and brochures, make nutrition messages available on your website or social media page, and implement a campaign to encourage greater consumption of fruits and vegetables, and promote physical activity for a healthy lifestyle. Design of the program should incorporate appropriate activities, focusing on adopting a
healthy lifestyle, e.g. a healthy cooking short course, aerobics, etc. The program coordinator can encourage participation of community residents in one-on-one behavioural counselling sessions that will aid persons in making necessary changes. Also, create a support group in which individuals can help each other, not only to make changes (choosing nutritious foods, including exercise in their daily schedule, etc.); but also to sustain the changes.
So, then what can communities do? As communities come together, they can work with faith-based organizations, businesses, and educational institutions to plan and implement health fairs, screenings, weight management activities, cooking classes, and nutrition and wellness programs in the workplace. For example, some businesses or faith-based organizations may offer incentives to employees, such as fitness club membership, prizes for weight management competitions, T-shirts, etc. Also, community residents may choose to form a community-based wellness committee which will serve not only in promoting health-related activities, but in implementing new health initiatives for the community. As a group, they may elect to ensure that school cafeterias, workplaces, and restaurants within their community and environs provide healthy foods and beverages for the target population they serve.
about healthy lifestyle changes that they have made and the challenges associated with behaviour modification.
Therefore, as the committees collaborate and work together, they can develop policies that may prove to be helpful, e.g. “restricted access to candy and soft drink machines at the school.” They can also promote greater use of local produce in menus, and that surplus of goods be made available at a reasonable price to employees in various workplaces. Group leaders should be willing to share, telling others
At the end of the community nutrition program, the coordinator should evaluate its effectiveness. This, of course, will enable them to make decisions about the short-term and long-term operations of the program; as well as inform community residents about its success or failure and what new methods may be utilized for upcoming events (Boyle and Holben, 2013).
Next, if you consider yourself to be an advocate for community health programs, promoting involvement of community residents in activities can help make a difference. You should aim to make the activities enjoyable and relevant to the needs of the target group, helping persons to see the immediate benefits that can be derived from the activity. Also, the program coordinator should make it rather easy for community residents to sign up and attend activities. The activities should be scheduled at convenient times. Note: The program coordinator should keep in mind the cultural heritage, socio-economic status and age of the target population, when designing nutrition programs.
REFERENCES
Ministry of Health, The Directorate of Health Policy, Research and Planning: Health Report Card for Trinidad and Tobago, 2011 Henry Fitzroy. Promoting Workplace Wellness in the Caribbean: Cajanus the Caribbean Food and Nutrition Institute, Nutrition and Workplace Wellness. 2010; Vol. 43, No. 4 Boyle, Marie A & Holben, David H. Community Nutrition in Action An Entrepreneurial Approach, 6th ed. Wadsworth, Cengage Learning. 2013 41 | u
FITNESS
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FI T AS A FIDDL E IN OL D AG E
Fit as a fiddle in old age WRITTEN BY LESLEY
GARCIA, MS, OT, REGISTERED OCCUPATIONAL THERAPIST
The older the fiddle the sweeter the tune.
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According to the Central Statistical Office (2001), Trinidad and Tobago is considered an ageing society, with persons 60 years old and over representing 13.4% of the population. This group is anticipated to increase to 17.7% in 2025 and 30.1% by 2050 (Rouse, 2013). This will place a huge social, healthcare, and economic strain on the country, unless a full continuum of healthcare services IS developed now.
F I T A S A F I D D LE I N O LD AGE
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FITNESS
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FITNESS
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FI T AS A FIDDL E IN OL D AG E
As society ages, there is growing interest among the health-conscious in finding the perfect gym workout, the latest brain software, and best vitamin supplement that might hold the key to good health and long life. Health, as defined by the World Health Organization, is a state of complete physical, mental and social well-being and not merely the absence of disease. Similarly, scientists are coming to regard fitness beyond the narrow boundaries of physical fitness. Social, emotional and mental fitness are now seen as important to overall well-being and are shown to even have a rebound long-term impact on physical fitness. You know the old saying: To a carpenter, every problem can be fixed with a hammer. And, likely, to a nutritionist, most health problems can be fixed by a proper diet. And maybe to an exercise instructor most health problems can be fixed by a good exercise regimen. What would an occupational therapist say is the answer to most health problems? First of all, let me explain that the “occupation” in occupational therapy has to do with how you occupy yourself on a day-to-day basis. What you do with your time and where you spend it and with whom you spend it makes up your occupational profile.
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Your occupational profile is what an occupational therapist would say has the answer to most of your health problems. In essence, you are what you do! And where you do it and with whom you do it.
On a routine daily, weekly, and monthly basis, everyone engages in certain occupations or activities. It is this arrangement of your time, social interactions and exposure to environments, that make up your particular occupational profile. For example, a widowed 77-year-old housewife who babysits her three under-12 grandchildren twice a week, volunteers in her church fortnightly and walks 20 minutes daily with a neighbour has a very different occupational profile from another 77-year-old housewife in similar health who mostly enjoys reading and watching TV in the company of her husband at home, and the occasional visit to the mall. Is one occupational profile better than the other for good health? Can some activities protect us more from illness and disability than other activities? The short answer is Yes. Recent research has shown that it is a range of activities rather than any single magic bullet activity, or puzzle or exercise that produces the greatest health benefits for holistic well-being. In particular, any activities that involve a social aspect such as being part of a bridge club, community gardening, or volunteering with a group, have been found to have the greatest for longevity in older adults. We recommend taking part in physical activities or exercise for 30 minutes a day a minimum of three times a week. Activities and exercises that promote flexibility, balance and strengthen the muscles and bones are preventive against falls and are beneficial to independence in older adults.
F I T A S A F I D D LE I N O LD AGE
The added point of interest is that we also strongly recommend incorporating social activities done with friends and loved ones on a regular basis, as recent research is showing the long-term effects of these social activities to even physical and mental fitness. Positive emotional states that come from socializing, and laughter in particular, are associated with decreased levels of cortisol, the stress hormone, decreased pain and inflammation, lowered blood pressure, and also increased immunity, heart rate and blood flow to the brain. The protective effect of stress reduction is well documented in preventing and managing stress-related disorders such as heart disease, obesity, depression and cognitive decline. Humour has been linked in studies of older adults to increasing memory and longevity. So laughter really is a great medicine! Brain fitness, that is, the brain’s ability to learn, reason, remember, plan and adapt to changes, continues to develop even into adulthood by a process called neurogenesis. The activities we do and the interactions we have with our environment can promote the growth of neurons in the brain and enrich the complexity of the neural pathways leading to optimal cognitive functioning. Occupations that demand active attention, recall, problem-solving and analysis challenge the brain and stimulate the ongoing regeneration of pathways. Cognitive activities such as taking up a new hobby or a class, watching educational TV, and sightseeing curiously are examples of activities that help to maintain cognitive fitness.
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FITNESS
So, we understand that a variety of social, mental, and physical activities has positive health benefits that come from the variation itself. The final important point about occupations is that different personal meanings are attached to each of these familiar activities and their corresponding routines. Occupational scientists have shown that the type of activities that one engages in is important for another reason. The act of engaging in activities that you enjoy or which, elicit satisfaction upon completion, is the key. This stimulates the release of dopamine, the pleasure hormone, in the brain, which reduces the effect of cortisol, and therefore has a protective effect on brain fitness. Thus this brings us back to the question of which activities are better. The longer answer is a variety of any type of activities that challenge both your brain and body, allow for socializing with a positive mood, and will give you a reason to be proud and satisfied. Obviously this is not likely to be one single activity or sport. Your personal occupational profile will enhance your holistic fitness level if it is a balanced range of many activates that you enjoy. You get to choose from anything you love to do!
Lesley Garcia is an Occupational Therapist who manages Hibiscus Place Adult Day Centre. She can be reached at 632-3669 or hibiscusplace@gmail.com
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