JUL SEP 2015
ISSUE 30
TT$35.00 US$5.99
®
THE CARIBBEAN HEALTH DIGEST
s erilisation Are medical institutions doing enough to ensure their equipment is properly sterilized?
Aromatherapy Altering One’s Mood, Cognitive, Psychological or Physical Wellbeing. Green Therapy The Psychological and Physical Effects of Being In and Interacting with Natural Environments. Chennette A Delicious Nutritious snack that Nourishes and Gives Us Energy.
uhealthdigest.com
Founders
Sherine Mungal Stuart Fraser
Publisher
Eidetic Publishing
Editorial Director
Sherine Mungal
Managing Editor
Roslyn Carrington
Writers
Our Intention candles are hand-poured purposefully crafted to inspire your senses. We use blends of only one hundred percent pure therapeutic essential oils in combinations that have been researched and proven to soothe, calm and relax. Assembled using all natural soy wax which are free for all toxins and wicks constructed from natural, cotton threads and contains no lead, zinc or other metals.
Healing Blend Lavender • Eucalyptus • Sage Purify your mind and body with the healing candle. The essential oils of lavender and refreshing eucalyptus soothe the body while reducing physical and mental fatigue. Combined with sage, the “sacred herb,” anxiety can be relieved and euphoria can ensue. Detoxify, energize and release what doesn’t serve you any longer. Prosperity Blend Cinnamon • Bergamot • Petitgrain The prosperity candle will release negativity to create and receive abundance with the aromatic blend of cinnamon, bergamot and petitgrain essential oils. This spicy blend is grounding and powerful to welcome success and a sense of stability. Inspiration Blend Lavender • Spearmint • White Spruce Restore yourself to a place of restoration and calmness with the cooling floral blend found in the inspiration candle. Combined with the essential oil of spearmint, this candle will revatilize your mind and body while increasing your energy and mental clarity. Let your creativity flow and be inspired.
p: 1 (868) 464 2134
Gratitude Blend White Spruce • Rosewood A comforting blend of white spruce and rosewood essentials oils. The gratitude candle is a great gesture of giving thanks to someone special or to light when one wants to honor their blessings in their own life. Take a few moments every day to feel what you are most grateful for and it will shift your energy immediately to a place of peace and joy.
Creative Director Design Project Coordinator Traffic Photography
Medical Advisory
Roslyn Carrington Vernon Khelawan Nasser Khan Maia Hibben Carol Quash Tian Watson Dixie Ann Dickson Dr. Nicole Ramlachan Fazal Mohammed
Stuart Fraser Eidetic Cindy Singh Lorraine Biran shutterstock iStockPhoto Dr. Neil Singh
MBBS PG MSc
Healthy Blend Eucalyptus • Basil • Lemongrass These inviting smells of basil and refreshing orange will delight your sense of health and well-being. Feel confident in your healthy decisions in life to stay energized and focused with this invigorating blend of neroli, basil and lemongrass essential oils. Clarity Blend Litsea Cubeba • Peppermint The cleansing fragrance of this clarity candle will clear your mind while stimulating and energizing your mood. The essential oil of litsea cubeba, combined with refreshing peppermint oil will increase your concentration and help uncover solutions in times of fatigue or stress.
e: info@tortugahills.com
w: tortugahills.com
This information is of a general nature only and is not intended as a substitute for professional health advice and no person should act in reliance on any statement contained in the information provided and at all times should obtain s p e c i f i c a d v i c e f ro m a h e a l t h professional. Eidetic Publishing has made reasonable efforts to ensure that the health information contained herein is accurate and up to date. To the extent permitted by law, Eidetic Publishing, their employees, agents and advertisers accept no liability
(even if negligent) for any injury, loss or damage caused by reliance on any part of this information. U also contains information supplied by third parties. This information is identified with the name of the source and has been chosen for publication because we believe it to be reliable. To the extent permitted by law, Eidetic Publishing, their employees, agents and advertisers accept no liability (even if negligent) for any injury, loss or damage caused by reliance on any part of this information.
U The Caribbean Health Digest is published 4 times a year by Eidetic Publishing, Gaston Court, Gaston Street, Lange Park, Chaguanas, Trinidad & Tobago. Distribution is handled by Eidetic Limited.
Entire contents are copyright. Reproduction in part or whole is prohibited. Eidetic Publishing is in no way affiliated with companies or products covered in U. Produced and printed in Trinidad & Tobago.
Miami Cardiac & Vascular Institute at Baptist Health South Florida has been advancing care for over 25 years by pioneering treatments of heart and vascular conditions. Now with a $100 million expansion and integration of services at over 25 locations, you and your loved ones can experience the most trusted cardiovascular care in the region from some of the most renowned physicians in the United States. Learn more at BaptistHealth.net/Heart
786-596-2373 | International@BaptistHealth.net
12 Aromatherapy At one point or another we could all do with some mood altering, albeit for different reasons. Aromatherapy is a process that uses aromatic plant oils, including essential oils and other aromatic compounds, for that purpose. Learn how this is a good alternative and can actually contribute to your psychological and physical wellbeing.
16 Sterilisation This feature article explores the serious nature of the subject of sterilisation in hospitals, and the risks associated with improper sterilisation procedures.
22 Chennette This tropical fruit is a childhood favourite for many of us in the Caribbean; its juicy, jelly-like consistency leaves you asking for more, especially since it’s only the size of an olive. Now that we reveal how much goodness is packed in a small chennette, you’ll be waiting patiently for the next season to come around.
24 Thai Message Thai Massage is more energizing and rigorous than traditional massage therapies. Learn how you can benefit from this ancient treatment.
28 Green Therapy Time outside may not only be a great way to get some fresh air, but studies show that green time can help to relieve symptoms of depression. Writer Tian Watson shares with us some insights on the benefits of green therapy.
30 Antioxidants Product companies, among others, use this word all the time to promote the goodness of a brand, but do you really know what they are, where we can find these antioxidants, and what makes them so good? Learn more about antioxidants in this article written by Carol Quash.
36 Hand Sanitising There is no question that keeping your hands clean is one of the steps in keeping a virus-free and healthier you, but as simple as it sounds, there are pros and cons in the most popular ways we choose to do that. In this article, Dixie Ann Dickson explores them and shares her findings with you.
40 Genetic Testing Learning that someone in your family has or is at risk for a disease can be scary; some people may feel guilty, anxious or even depressed. In this article, Dr. Nicole Ramlachan explores these emotions and ways that people can deal with the results.
42 WOW Model for Wellness There are many scientific ways that one can evaluate their physical wellness. The Wheel of Wellness (WOW), developed by our wellness correspondent, creates a unique model to examine eight levels of wellness, including financial, physical and spiritual.
Welcome to our 30th edition of U! When U The Caribbean Health Digest was launched in 2008, we questioned whether we would be able to have sufficient relevant content to publish an issue every three months without being repetitive or monotonous. This issue marks seven and a half years of publishing and we can safely say that we have only just touched the surface on health and wellness topics. We live in a time when technology is combined with the commitment of incredible men and women who dedicate their lives to researching every level of the human body, and how it’s affected by varying conditions. There will always be a reason for publications like ours, where people eager to learn more would depend on us to enlighten them, and to this we remain committed. Here’s another one of those issues, in which we take you inside the hospital room and bring to the fore the importance of Sterilisation, in this well researched cover story by veteran writer Vernon Khelawan. Dr. Nicole Ramlachan discusses Genetic Testing, something that many people are now opting to do as a preventative measure, and in another article we also look at the use of Aromatherapy, how it works, and how it can benefit overall wellbeing. There is more to spending time outside than just fresh air, and we explore this in our Green Therapy article by our newest contributor. Tian Watson. The mouth-watering Chennette made its way into this issue as the Caribbean fruit, but again, these are just touching the surface of another incredible issue. Look out for us again in another ninety days
.
SHERINE & STUART
FOUNDING EDITORS
THERAPY
| ESSENTIAL OILS: A SWEET WAY TO BOOST YOUR WELL-BEING
WRITTEN BY ROSLYN CARRINGTON
There’s no doubt that a soothing massage with sweet-smelling aromatic oils will do us a world of good, and it’s not just because of the comforting hands-on contact that takes us psychologically back to the safety and love of our mother’s arms. An important element is the way the scent overtakes us, pouring into our soul with every inhalation, seeping in through our pores, making us feel rejuvenated, happy, and at peace.
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Essential oils are among humankind’s first medicines, found in leaves, flowers, tree bark, even the skins of some fruits. There isn’t a civilisation on Earth that doesn’t harbour some ancestral knowledge of extracting treatments for body and soul from everything that grows in the ground.
ESSENTIAL OILS: A SWEET WAY TO BOOST YOUR WELL-BEING
|
THERAPY
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THERAPY
| ESSENTIAL OILS: A SWEET WAY TO BOOST YOUR WELL-BEING
HOW ESSENTIAL OILS ARE EXTRACTED Essential oils can be extracted in several ways, but two methods are most common. There is distillation, which involves the heating of plant material and the removal and cooling of the resulting vapour. People, from medicine men to shamans to perfumers, have been using this method for 5,000 years. The problem, though, is that heat destroys some of the beneficial properties of the oils. They may lose their scent quickly, and with a few exceptions, such as lime oil, are less potent. These days, essential oils produced by distillation are cheap and plentiful, but less desirable. The second method is cold-pressing, in which the plant material is rubbed, pierced, or compressed to extract the oil. If you’ve ever squeezed a portugal and received an eyeful of oil from the skin, you’ll know how effective this method can be, especially for citrus. Cold-pressed essential oils are highly valued, but can be more expensive. Other processes include the use of a solvent such as alcohol, and CO2 extraction, which involves the use of liquidised carbon dioxide as a solvent.
HOW ESSENTIAL OILS WORK Essential oils are not to be confused with perfumes; they are a class of natural aromatics known to have medicinal, physiological or psychological effects. Some oils penetrate the skin and interact with the body as any other drug would. For example, ginger or black pepper extracts have an anti-inflammatory effect on painful joints, and are therefore widely recommended by practitioners of herbal medicine for arthritis. Others work better when inhaled, entering the body through the respiratory system. Eucalyptus and peppermint, for instance, help clear nasal passages and are favoured as a quick solution for a stuffy nose.
SPECIAL BLENDS FOR SPECIAL PURPOSES
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If essential oils have the power to influence an individual’s well-being, then oils with complementary properties can produce an even more powerful effect. According to Amira Mungal,
who creates a range of aromatherapy candles by hand, essential oils can be carefully combined to suit the purpose of the consumer. Mungal’s products are marketed under the brand Tortuga Hills, inspired by the hillside view from her Tortuga home. Her candles are made from hand-poured soy wax and, at the moment, come in a range of 6 blends, each designated to feed a specific need: • HEALING – Lavender and Eucalyptus • PROSPERITY – Cinnamon, Bergamot, Pettigrain • GRATITUDE – Fir Needle, Rosewood • INSPIRATION – Lavender, Spearmint, Fir Needle • HEALTHY – Neroli, Basil, Lemongrass • CLARITY – Litsea Cubeba, Peppermint
ESSENTIAL OILS AND YOUR EMOTIONS Okay, so maybe you accept that some of these oils work on physiological ailments, but how can one claim that they can affect our emotions? How can inhaling oils be said to alleviate grief or anxiety, or bring on feelings of optimism, clarity, or gratitude? As for stimulating sexual desire? Isn’t that a little much to accept? No, not according to most aromatherapists. When inhaled, many oils interact with the limbic area of our brains, a primitive area responsible for our emotions. Not only do the essential oils stimulate our brains in certain ways, but they also trigger memories in us from our childhoods that may be strong enough to produce an emotional reaction. Think: if your grandmother used to make the best cinnamon cookies in the world, and you walk into a room infused with the scent of cinnamon candles, how do you feel? Or, according to Mungal, if you took a walk through a pine forest, with the scent of needles rising with every footstep, wouldn’t you be filled with a feeling of oneness with nature, and a sense of gratitude just to be alive?
ESSENTIAL OILS AND SAFETY As wonderful and indulgent as they are, oils must even be treated with great respect by people with certain conditions. They are never to be used undiluted; they are usually applied a few drops at a time in a base or carrier oil, such as coconut or sweet almond, or inhaled using diffusers or candles.
ESSENTIAL OILS: A SWEET WAY TO BOOST YOUR WELL-BEING
Some oils may produce allergic reactions or irritate mucous membranes. Other oils, such as citrus oils, are photosensitizers, and can accelerate sunburn. Many oils are contraindicated during pregnancy because there is little research into their effect on the developing foetus. Only a few oils, such as lavender, are considered safe for use on children. Accidental splashes in the eye are, of course, a matter for concern, and it is not recommended that you swallow any, even oils derived from sources we commonly eat, such as rosemary, as the extraction process may not adhere to food production standards. Emergency treatment for accidental exposure includes flushing the affected area thoroughly with water. If the person appears to be in distress, a visit to the emergency room may be warranted. But, caveats aside, essential oils are the blessings of Nature herself, given to us to heal our bodies and replenish our souls. When you’re tired, irritable, or weary — or even if you’re feeling in the mood to celebrate — you need look no further than a luxurious massage, a calming foot soak, or a sweet smelling aromatherapy candle. Happy sniffing!
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THERAPY
15 ESSENTIAL OILS AND THEIR HEALTH BENEFITS CLOVE:
Antibacterial, anti-parasitic and antioxidant.
CYPRESS:
Improves circulation, reduces varicose veins, lifts confidence and can help heal broken bones.
EUCALYPTUS:
Improves respiratory issues like bronchitis, sinusitis and allergies. Also invigorating and purifies the body.
FRANKINCENSE:
Builds immunity, reduces inflammation, heals age spots, supports brain function and fights cancer.
GINGER:
Reduces inflammation, supports joints, improves digestion and relieves nausea.
GRAPEFRUIT:
Supports metabolism and cellulite reduction.
LAVENDER:
Helps with relaxation, improves mood, and heals burns and cuts.
LEMON:
Great to use in homemade cleaning products, improves lymph drainage, and cleanses the body.
MYRRH:
Natural antiseptic and can prevent or reduce infections. Also, supports beautiful skin by reducing stretch marks, and promoting hormone balance.
OREGANO:
Powerful antimicrobial properties; can kill fungus and help you kick a cold fast.
PEPPERMINT:
Supports digestion, improves focus, boosts energy, reduces fever, provides headache and muscle pain relief.
ROSE:
Incredible for reducing skin inflammation and great for creating glowing skin. Add a few drops to your facial moisturizer. Also, one of the most valued essential oils in the world at $1,000-plus for 15 ml.
ROSEMARY:
Can naturally thicken hair, so it is great to add to homemade shampoos. Improves brain function and memory, so it’s great to used when working, reading or studying. Natural antibacterial, antifungal, reduces bad odours and can help stimulate the immune system.
TEA TREE OIL:
SANDALWOOD:
Natural aphrodisiac that improves libido; can also improve energy.
SOURCE:
www.draxe.com
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FEATU RE
|
STERILI S ATION
s erili
WRITTEN BY VERNON KHELAWAN
EVERY DAY, THOUSANDS OF OUR CITIZENS SEEK MEDICAL ASSISTANCE FROM ONE OR OTHER OF THE SCORES OF HEALTH CARE FACILITIES THAT DOT OUR HEALTH LANDSCAPE. APART FROM THE MAJOR GOVERNMENT-RUN HOSPITALS AND HEALTH CENTRES, THERE ARE NUMEROUS PRIVATE HOSPITALS AND LABORATORIES.
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All these institutions constantly use medical instruments, equipment and machines. Because of heavy usage, there is a need to keep them free of harmful micro-organisms at all times.
ST E RI LI SAT I O N
|
FEATURE
sation in Health Care Facilities
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FEATU RE
|
STERILI S ATION
S
terilisation is a major
institutions, some unethical
as the cause of Hospital Acquired
factor that determines
practices can easily slip through the
Infections (HAIs) among local
whether equipment is
cracks, with detrimental results,
hospital patients or visitors.
safe enough for the next
particularly for patients. On the flip side, the Infectious
patient’s use. The
question therefore arises: Do
A report from the CDC states,
Disease Society of America (IDSA)
medical institutions do enough to
“Hospitals and other health care
has revealed that some two million
ensure their equipment and
settings are battling
Americans become ill from these
machines are properly sterilised
drug-resistant organisms that
organisms every year, and as many
and ready of the next patient?
spread inside these institutions.” It
as 23,000 related deaths occur
added that drug-resistant infections
annually, although the IDSA
In the United States, the prestigious
can also spread to nearby
believes that figure to be
watchdog institution – Center for
communities, and these would
“extremely low”,and puts the figure
Disease Control (CDC) — has
include sexually transmitted
closer to 100,000 deaths per year.
observed an alarming worldwide
diseases (STDs), skin and soft
increase in several dangerous
tissue infections and pneumonias.
To a large extent in T&T, therefore, it is a straight case of self-preservation
‘super bugs’ that are antibiotic resistant, and which are now
The report goes on to say,
against HAIs, both for persons who
present in US hospitals.
“The effects of Antimicrobial
are ill and confined to a hospital bed
Drug Resistance are far
and persons (family and friends) who
Similar or maybe some of those
reaching; people infected with
come to visit with them.
same ‘super bugs’ have been
drug-resistant organisms are
discovered in Trinidad and Tobago
more likely to have longer and
While there is no intention to
and the wider Caribbean. But unlike
more expensive hospital stays,
tarnish the hard-won good
developed countries, T&T does not
and may be more likely to die
reputations of many of the nation’s
have a proper monitoring system or
as a result of the infections.”
health care institutions, the reality must be faced: there exists the
an organisation with the responsibility of carrying out the
Because there is no regulatory
possibility that persons can become
mandate of ensuring compliance in
body to deal with sterilisation in
infected by just being within the
the area of sterilisation.
T&T, ethics and honesty must be
confines of a health care building.
the pre-eminent policy in health This means that proper and
care institutions and laboratories
With all the negatives attached to
thorough sterilisation methods can
that operate here.
infectious organisms in health
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be compromised, for many
care centres, which can create a
different reasons. And while policy
Lack of statistics does not allow for
demands that adequate sterilisation
a proper analysis of the incidents
methods are practised in the
where improper sterilisation
hospital, IDSA’s Dr Brad
majority of our health care
methods can be readily identified
Speelberg put it in perspective.
certain fear of going into a
ST E RI LI SAT I O N
“I don’t think people should
should say, ‘Hey, do you mind
reduced significantly, but this
fear going to the doctor; I do
washing your hands!”
does not dilute the importance
think people need to Such a scenario would prove to be
ensure the elimination of all
an inherently dangerous place
mighty difficult in Trinidad and
micro-organisms.”
and it is not because hospitals
Tobago, because our culture and
lazy or anything like that.” “Think about it this way: You are taking the sickest people
social behaviours simply do not, in
A local dentist said,
the majority of cases, allow for
“Sterilisation is extremely
questioning a professional practitioner. Such things just aren’t done.
in society, crowding them into
important in dentistry. It prevents transmission of diseases via micro-organisms from doctor to patient and from
one building, tearing new
Everyone should agree that the
holes in their bodies where
scenario thus painted is a very
called ‘autoclaving’, which uses
they didn’t used to have any by
scary one, and take steps to protect
super-heated steam, usually 137
placing plastic catheters in
themselves, whether health care
degrees Celsius for eight to ten
their blood system, in their
provider, patient or visitor.
minutes, is the norm in dentistry
bladders, putting tubes down
patient to patient. A process
today. The one-time use of
into their lungs so they can
The case for proper methods of
gloves, masks, suction tips, etc.,
breathe, and we are using very
sterilisation in all facets of medical
is one of the many ways by
practice is made all the more important
which one can control and
because of the ‘super bugs’ and
prevent transmission of disease
their resistance to antibiotics.
in dentistry.”
A Tunapuna medical doctor, a
As far as this country is concerned,
general practitioner for decades,
given what can be considered the
“you go into the hospital if you
emphasises the importance of
meteoric increase in health care
have to; you work carefully
sterilisation, even at the level of a
providers and health care facilities,
with your team to get out of
doctor’s office. He said, “All
a call has to be made for greater
the hospital as quickly as you
equipment used on patients in
control of monitoring mechanisms
can, and I think patients
this office is sterilised. Long
with oversight from some sort of
should be empowered, for
ago, this applied to almost
regulatory body, to guarantee, even
example, if health care
everything. In today’s practice,
through legislation, proper and
providers enter their room and
however, with the increasing
efficient policies leading to best
the patient does not see them
use of plastic, the need for a
practice in all areas of health care
wash their hands, the patient
sterilisation machine has been
in Trinidad and Tobago.
large quantities of antibiotics to treat infections. So that’s a perfect breeding ground to generate antibiotic -resistant bacteria,” he added. “So the point is,” he continued,
FEATURE
of proper care being taken to
understand that the hospital is
are dirty or the doctors are
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37B Mission Road, San Juan, Trinidad and Tobago Tel 1868-728-CARE (2273) Email execucare1@gmail.com or visit us on facebook.com/ExecuCareForYou
FRUIT
|
CHENNETTE. . . ME L IC OC C U S B IJU GATU S
WRITTEN BY
NASSER KHAN
KNOWN AS CHENNETTE IN TRINIDAD AND TOBAGO, THIS FRUIT IS PROBABLY CALLED BY THE MOST NAMES, SINCE VIRTUALLY EVERY COUNTRY HAS A DIFFERENT NAME (IN SOME CASES MORE THAN ONE) FOR WHAT IS TECHNICALLY OR SCIENTIFICALLY KNOWN AS MELICOCCUS BIJUGATUS.
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Native to South America and naturalized over a wide area of the tropics, including Central America, Mexico, Puerto Rico, the Dominican Republic, Haiti and other parts of the Caribbean, and parts of Africa and the Pacific, the fruit is one of the Sapindaceae family, also known as the Soapberry family.
C H E N N E T T E ...M E LI C O C C US B I J UGAT US
J
ust some of the many other names around the growth region are: honeyberry; Barbados ackee; mamoncillo or mamón in Spanish-speaking territories; quenette in the French-speaking islands of the Caribbean; guinep in Jamaica. It is also known as limoncillo or anoncillo, among many more. The fruit is about one inch in diameter, tipped with a small protrusion, and grows in clusters. The glistening pulp is salmon or yellowish in colour, translucent, gelatinous, somewhat fibrous, juicy but very scant and covers a hard-shelled seed which takes up most of the volume. It does resemble a small, unripe lime, but that’s where the resemblance ends. Its flowers, small green and about a ¼” in diameter and rich in nectar, are fragrant and attractive to hummingbirds and bees. The season extends from around June to September-October. The tree grows to a height of 85 feet (25 m) with a trunk of about 5 ½ feet (1.7 m) thick, with a smooth bark and spreading branches. It produces a compact, hard, heavy, fine-grained wood valued for indoor use in framing, cabinet work and rafters. Despite the light colour of the fruit's flesh, the juice stains a dark brown, and was used in some countries by indigenous natives to dye cloth. The fruit is sold in the markets and by roadside vendors. The common way to enjoy this fruit is to put one in your mouth, pierce the skin of the fruit with your teeth, and then squeeze the skin to pop inside into your mouth...fruit candy! Then you hold it in your mouth and suck the fruit pulp until there's just the pit, which you discard. The fruit can be either sour or sweet, and a bit tangy, depending on where it's from. The skin is green, smooth, thin, leathery, and rigid but brittle. Its nutritional content averages per 100 mg as follows: calcium 12 mg, vit C 5 mg, iron 0.6 mg, vit A 10 mg, niacin 0.7 mg, thiamine 0.05 mg, riboflavin 0.02 mg, tryptophan 14 mg, and lysine 17 mg. Here are some of the reputed nutritional and health benefits, and tidbits about the chennette. Not all the health benefits have been medically proven. The pulp is juiced with lime and/or ginger to make a refreshing drink, and some countries even can the pulp commercially.
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FRUIT
The roasted seeds are pulverized and mixed with honey and consumed as a syrup or tea to halt diarrhoea. Some indigenous people used the cooked seeds as a substitute for cassava, or ground it into a flour to make bread. Usually, the seeds are roasted before consumption for either dietary or medicinal purposes, most likely to reduce the toxicity of the seeds or make them more digestible. Pie filling, jam, marmalade or jelly are made from the pulp. It is full of fibre for lowering cholesterol and preventing constipation; vitamin A, which boosts the immune system and prevents formation of urinary stones; vitamin C, which is very important as an antioxidant; calcium, which keeps your teeth and bones strong and helps prevent cancer; phosphorus, which is important for digestion and regulating hormones. It contains a large amount of tryptophan, which is important for good sleep, and lysine, which is important for proper growth and for preventing herpes outbreaks. Lowers blood pressure and helps with asthma, and because it is high in antioxidants, also works to prevent cardiovascular disease, boost the immune system and prevent strokes. Studies are being done on it as an anti-diabetic food, because some of its proteins lower blood sugar levels. It is low in fat, calories, and is cholesterol free. Some say if you want to lose weight just keep eating the fruit all day long ... it will keep you busy. The leaves can be boiled and made into a tea, which is good for intestinal problems. Because of the leathery skin, the fruit remains fresh for a long time and ships and markets well. Tropical horticulturist, David Sturrock, related that horsemen in Cuba often hung branches of mamoncillos on the saddle horn to enjoy and relieve thirst during long rides.
NOTE: Primary source of information: Ministry of Food Production, Trinidad & Tobago. In some instances direct extracts/quotes are used.
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HEALTH
| THAI YOGA MASSAGE
hai T assage M
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WRITTEN BY MAIA HIBBEN
THAI YOGA MASSAGE
|
HEALTH
What is it?
Thai Yoga Massage or Thai Massage is an ancient healing system combining acupressure, energy balancing techniques, Indian Ayurvedic principles and assisted yoga postures. Thai Yoga Massage may come as an interesting surprise if you have only ever experienced a ‘conventional’ lie-on-a-table type of massage.
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HEALTH
| THAI YOGA MASSAGE
Thai yoga massage does not involve the use of oils and lotions; the client remains clothed in loose, comfortable clothing and the massage is performed on a long, soft rectangular mat on the floor. The giver of the massage will place the person into ‘yoga-like’ positions and compress, pull, rock and stretch the recipient, who remains passive and relaxed. Thai massage respects the body's limits, while encouraging clients to reach their edge of flexibility, but never beyond.
Origins
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The healing art of Thai Massage, known as Nuad Boran (ancient massage), in Thai, began to evolve well over two thousand years ago in present-day Thailand. The founding father of Thai massage is an Ayurvedic doctor named Jivaka Kumar Bhacca, who is revered to this day throughout Thailand as the Father of Medicine. Born in India during the time of the Buddha, he is mentioned in a variety of ancient documents for his extraordinary medical skills, for his knowledge of herbal medicine, and for having treated important people of his day, including the Buddha himself.
The technique of the massage incorporates martial arts moves, palming and thumbing along energy lines, gentle stretching and breath work. It is incredibly rhythmic, with the practitioner flowing slowly and seamlessly through the moves, resulting in something that looks more like a dance than a massage. The rhythmic stretches and compressions are focused along the body’s energy lines, which in Thai are called sen lines. The body is said to have over 70,000 sen lines, but Thai massage focuses on applying pressure on the 10 most important sen. Don’t be surprised if the practitioner uses his own body to do this, including using the palms of the hands, thumbs, elbows and feet, and he may also use bolsters and cushions to support the client more efficiently in certain poses. By manipulating and applying pressure to the important pressure points along the sen, the pathways are stimulated to help break down blockages, stimulate energy flow, and restore balance, harmony and wellness.
Thai yoga massage, as with many other ancient healing arts, was originally passed from teacher to teacher through word of mouth, and studying with the Masters of that time, within the Buddhist temples. Unfortunately, much of the history of Thai massage was lost during the Burmese invasion of Thailand in 1767, although some of the traditions remain inscribed on the stone walls of the Wat Pho monastery in Bangkok (still the leading centre of research on Thai Yoga Massage). Today, Thai massage continues to be a mainstay in Thai medicine, while it has also gained a new audience in the Western world.
THAI YOGA MASSAGE
I spoke with Terrance Aleong, a certified Thai Yoga Massage practitioner and teacher, based in Carenage, Trinidad, who trained at the Lotus Palm Centre, Montreal, Canada — the first dedicated teaching centre for Thai yoga massage in the West (founded by Kam Thyne Chow). He explained that “Thai Massage is rooted in the belief that all forms of life are sustained by a vital force (lom or Prana) that is carried along invisible pathways (sen) that run through our bodies. This force is extracted from air, water and food, and it is believed that disease and dysfunction come about when blockages occur along these pathways. Thai Yoga Massage’s intent is to free this trapped energy, stimulate the natural flow of life-force, and maintain a general balance of wellness.” He also explained that Thai Yoga Massage is a spiritual practice closely connected with the teachings of the Buddha. The giving of a massage is understood to be a physical application of Metta, which is the Buddhist practice of ‘loving kindness’ — and that a good practitioner should work in such a spirit — performing his art in a meditative mood. Terrance starts his massages with a Puja (a meditative prayer), to fully centre himself on the work, on the healing he is about to perform; and he works with full awareness, mindfulness and concentration. There is a world of difference between a massage performed in a meditative mood and a massage just done as a job! Only a practitioner working in a meditative mood can develop an intuition for the energy flow within a client’s body. A Thai Yoga Massage is both a physical and energetic massage!
So what are the benefits?
There are numerous benefits to having a Thai Yoga Massage! It • Promotes a deep sense of relaxation • Quiets the mind
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HEALTH
• • • • • • • • • •
Increases flexibility and range of movements Eliminates muscle pain and muscle spasm Improves posture and alignment Calms the nervous system Increases energy levels Balances the body energetically Allows for significant release of deep emotional distress Stimulates blood circulation and lymph drainage Stimulates internal organs Relieves fatigue, swollen limbs, painful joints and headaches • Rejuvenates the body and mind • Enhances the body-mind connection Experts say there is an interesting dichotomy that exists within Thai massage, as it both relaxes and rejuvenates. After my first session with Terrance, I felt awakened and energized, while simultaneously feeling deeply grounded and at peace. Are you feeling out of sorts? Or perhaps your fast-paced lifestyle has you feeling fraught and overly stressed? Whether you are looking for a deep stretch, some deep relaxation or you simply wish to invest a little time in yourself — to reenergise and feel invigorated — a Thai Yoga Massage is the answer! Perhaps you are feeling inspired to be become a practitioner and perform Thai Yoga Massages on others. Terrance is trained to teach Thai Yoga Massage Level 1 & 2, and once your training is complete you would be awarded the prestigious Lotus Palm International Certificate.
To find out more or to book a Thai Yoga Massage, contact: Terrance Aleong Prasanna Thai Yoga Massage terrancealeong@yahoo.com 868-632-1613 868-358-7590
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Green Therapy MIND
GREEN THERA P Y
WRITTEN BY
TIAN WATSON
The best remedy for those who are afraid, lonely or unhappy is to go outside, somewhere where they can be quite alone with the heavens, nature and God. Anne Frank, The Diary of a Young Girl
As our region races toward first world status, so grow the stress levels of our people when it comes to balancing the rigours of a fast-paced career and/or family life. Those who find themselves in this predicament sometimes seek relief in the conventional bar crawl; those in more unbearable situations may even opt for prescribed medication. While this may be the solution for some, others may be exploring the wrong avenues. A lot of research conducted suggests that our immediate surroundings impact on our stress levels. This in turn, has a direct effect on our bodies. These studies emphasize that not only is our disposition impacted, but our nervous, immune and endocrine systems also function differently.
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As this race continues, so, too, will anxiety levels grow for some. This has been proven to lead to feelings of depression, high blood pressure and general tension in the body. If we counteract this by placing ourselves in a more pleasant environment, this could all be overturned!
Research conducted by the Norwegian Ministry of Environment suggests that choosing nature or the natural environment as this option could be the solution. They suggest that since mankind has walked this earth, little has changed in our sensory apparatus. In fact, our genetic makeup has not changed more than 0.003% over the past 50,000 years. As a species, we have never detached ourselves completely from nature, regardless of how developed the world has become. Many researchers in this field hold the opinion that nature appeals to our basic instincts and hence assists us in establishing mental balance when modern life becomes unbearable. Professor Wilson, a renowned biologist at Harvard and Duke University, believes that life without contact with nature is actually an unhealthy situation to be in. Similar research even shows a simple plant or aquarium in an office environment can help reduce stress and anxiety.
GR E E N T H E RA P Y
PAIN AND GENERAL WELLBEING Dr. Robert Ulrich, a pioneer in Evidence Based Design (applied to the design and layout of health facilities), conducted a study and concluded that patients with views of trees coped with pain much better and spent less time in hospitals as compared to patients without a view of some form of nature. Other studies undertaken by Dr. Ulrich also suggest that time spent in nature, or even views of nature, are associated with a more optimistic mood, liveliness, and a greater level of general psychological wellbeing. Again, because of our inherent connection with nature, spending time in this environment can also help with our attention spans. Human beings will more often than not find some aspect of nature very interesting. This interest can in itself provide a much needed break or refresher from our daily routines. It can also provide us with the stimulation to embark on the tasks at hand. Dr. Andrea Taylor of the University of Illinois has also explored the impact of the natural environment of diverse populations of children diagnosed with ADHD. Here it was shown that this form of therapy increased attention spans of these children. CONNECTING PEOPLE The University of Illinois has also undertaken studies where the behaviour and attitude of tenants at Chicago public housing developments, who had access to ‘green’ spaces, were compared to those without. It was found that those who interacted with the natural environment had a more positive outlook on life and greater sense of community spirit. This was also accompanied with lower levels of crime and domestic violence in these poverty-stricken communities. NATURE, fMRI AND BRAIN ACTIVITY Even in studies utilizing Functional Magnetic Response Imaging (fMRI) to observe human brain activity, it was shown that when subjects viewed scenes of nature, the brain segments linked to love and compassion were stimulated. This was in direct contrast to the brain segments which were stimulated by fear and anxiety, when metropolitan scenes were shown. SMART PHONES, TV’S AND COMPUTER SCREENS Some persons may want to consider spending a bit less time in front of smart phones, TVs and computers and consider allocating time to some
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MIND
form of outdoor activity. It has been shown that large amounts of time spent in front of these devices is linked to depression. Dr. Netta Weinstein, a leading researcher on the effects of technology on human behaviour, associates extensive use of these devices with negative impacts on human connectivity and relationships. BENEFITS OF THE ‘Green’ All of this evidence suggests that making time at some point to plunge yourself in nature can be the stress reliever some of us have been searching for all along. Some of us may even experience the ripple effect of boosting overall health. Just the act of being outside would strongly persuade us to get in some much-needed exercise or even improve our social interaction just by being in a stress-free environment. Findings in the Environmental Science and Technology journal show that people exhibit more positive moods and overall increase in self esteem just by spending a few minutes outside as part of their daily routines. SOME SIMPLE SUGGESTIONS TO INCORPORATE NATURE Find a way to do your activities outside. This could include: • Do your light reading in the garden instead of at a desk or in bed; • Warm up before your gym session with a small jog within the vicinity of your gym rather than on the treadmill; • Substitute some evening cups of coffee with a quick stroll around the office building to get your rejuvenation. Studies at Washington University in St. Louis have directly related activities such as these to fostering more innovative ideas in the workplace. JUST A SHORT DRIVE AWAY So as we progress into the 21st Century, the drawbacks of becoming more and more metropolitan in our lifestyles seem to outweigh the gains, when it comes to our mental health and wellbeing. We should always bear in mind that the limited green spaces which world city dwellers grasp on to, or wait all year to experience a few days of during their annual vacation — our region has this vast option just a short drive away. For some of us, the option is right in our backyards. For those of us experiencing depression and anxiety at home or in the workplace, and conventional medication or therapy seems to not be giving you the desired results … maybe try some ‘Green Therapy’. 29 | u
FOOD
| ANTIOXIDANTS: CONTAINING FREE RADICALS
Containing Free Radicals
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WRITTEN BY CAROL QUASH
ANTIOXIDANTS: CONTAINING FREE RADICALS
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FOOD
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FOOD
| ANTIOXIDANTS: CONTAINING FREE RADICALS Most of us eat fruits and vegetables every day, and some of us can't function without at least one cup of green tea in the morning. And for good reason. According to the Harvard School of Public Health, a number of the vitamins, minerals and compounds in food have antioxidant properties. Consuming the recommended daily intake gives the body a variety of phytochemicals (chemical compounds that occur naturally in plants) and nutrients. Antioxidants are phytochemicals, vitamins and other nutrients that protect our cells from damage caused by free radicals, molecules with unpaired electrons that can be found everywhere – in the air, our bodies, and the materials around us – and can cause a number of aging-related illnesses, and contribute to heart attacks, stroke and cancers. In order to ensure that we get plenty of antioxidants in our daily diet, it is recommended that we eat a varied diet, with at least five servings of fruits and vegetables per day, and six to eleven servings of grains, including at least three servings of whole grains. Among the most well-known antioxidant properties are Vitamins A, C and E, beta-carotene, lycopene and selenium. Antioxidants can also be man-made in the form of supplements.
FIGHTING THE GOOD FIGHT
HEALTH BENEFITS OF ANTIOXIDANTS
As we age, our body's natural defences against
Because antioxidants clean free radicals out of our bloodstreams, they result in a range of health benefits. Studies have shown that they significantly help to reduce the signs of aging by minimizing wrinkles and preserving the skin's texture; they protect our skin from sun damage, and help reduce the risk of sunburn.
oxidation — a process that occurs when molecules within our body lose electrons to electrically charged molecules of oxygen in our blood stream — become less effective. The more free radicals build up in your body, the more oxidative stress you'll suffer. Certain lifestyle behaviours such as smoking, drinking and sunbathing can increase the rate of free radical production within our bodies. Other factors such as air pollution, radiation, infections and exposure to toxic substances can result in an unsafe increase in free radicals in our bodies. Researchers believe a diet rich in antioxidants is necessary to keep the levels of free radicals in your
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body low and maintain good health.
But their good work extends way past the external. Research has shown that antioxidants have helped in the prevention of a number of degenerative, age-related diseases, among them: • Cancer • Cardiovascular disease • Cognitive impairment • Immune dysfunction • Cataracts • Macular degeneration • Alzheimer's
ANTIOXIDANTS: CONTAINING FREE RADICALS
Some of the foods that we consume every day contain large amounts of antioxidants. They include: • CARROTS: an excellent source of vitamin A, vitamin C and iron. It is the antioxidant beta-carotene that gives carrots their bright orange colour. Beta-carotene is absorbed in the intestine and converted into vitamin A during digestion. • GREEN LEAFY VEGETABLES like kale, dasheen bush and spinach: full of vitamins, minerals, and disease-fighting phytochemicals. • BERRIES, CHERRIES AND GRAPES: rich in the antioxidant phytochemicals.
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FOOD
• TOMATOES: widely known for their outstanding antioxidant content, including, of course, their oftentimes rich concentration of lycopene. Researchers have found an important connection between lycopene, its antioxidant properties, and bone health.
• WATERMELON: lycopene-rich and provides 33 percent more protection against sunburn than other fruits.
• BEANS: loaded with phytochemicals which may protect cells from damage that potentially cause cancer, according to the American Institute for Cancer Research.
• DARK CHOCOLATE: rich in flavonoids, and is • GREEN TEA: the best food source of a group called catechins. Studies have found an association between consuming green tea and a reduced risk for several cancers, including, skin, breast, lung, colon, oesophagus, and bladder.
• COCOA: rich in antioxidant flavonoids called flavanols, which include procyanidins, epicatechins, and catechins. Studies have shown that people with high blood levels of flavonoids have lower risk of heart disease, lung cancer, prostate cancer, asthma, and type 2 diabetes.
• PEARS: naturally high in vitamins C and K, as well as nutrients such as copper—all of which act as antioxidants to protect our cells from damage from free radicals.
• NUTS: offer a good dose of healthy fats, along with a smaller amount of protein and carbohydrates. Each type of nut offers a unique profile of minerals, phytochemicals such as reservatrol, and plant sterols, which help lower cholesterol.
• PINK GRAPEFRUIT: a rich source of the cancer-protecting antioxidant lycopene.
• RED BELL PEPPERS: have a unique combination of large amounts of vitamins A, C, and E, making their skin a superfood.
• CITRUS: Research published in the journal Stroke shows that flavonoids, a kind of antioxidant in citrus fruits, seem to be linked with a lower ischemic stroke risk in women.
believed to promote heart health by reducing platelet activation, affecting the relaxation capabilities of blood vessels.
• MANGOES: high in antioxidants, low in carbohydrates, and, like other yellow/orange fruit such as pumpkin and carrot, they are an excellent source of beta-carotene (vitamin A). They also contain vitamin E and selenium, which help protect against heart disease and cancer.
• PAPAYAS/PAW PAW: may be very helpful for the prevention of atherosclerosis and diabetic heart disease. They are an excellent source of the powerful antioxidants, vitamin C and vitamin A. These nutrients help prevent the oxidation of cholesterol.
• SAPODILLA: studies have shown that the sapodilla has a relatively high content of antioxidants. Many beauty manufacturers offer products that contain antioxidants that make users look younger. The antioxidants found in different foods and supplements are beneficial to different parts of the body. Beta carotene found in carrots are good for the maintenance of eye health; while the lycopene found in tomatoes play a major role in prostate health. The flavonoids found in green tea, cocoa and chocolate contribute to a healthy heart, while the proanthocyanidins found in cranberries and apples can contribute to the maintenance of the urinary tract. 33 | u
1OAnti xidants THINGS ABOUT
1. Antioxidants prevent cell deconstruction caused by the action of free radicals. Free radicals are unstable molecules that take away electrons from other molecules and damage them, causing many diseases.
2. Do you wonder how antioxidants work to prevent diseases? Antioxidants donate electrons to these free radicals to stabilize them and this prevents free radicals from invading other cells and causing diseases. 3. Food rich with antioxidants helps prevent diseases such as cancer and coronary heart disease. 4. Brightly coloured foods like tomatoes, broccoli, blueberries and apples are excellent sources of antioxidants. 5. Vitamin E is a powerful antioxidant commonly found in nuts, fortified cereals and sweet potatoes and it helps decrease the development of age-related macular degeneration and cataract. 6. Herbs and spices are excellent sources of antioxidants, which means that adding them to your food may protect you against diseases. 7.
Caffeine, a healthful antioxidant in coffee and tea, is helpful against Alzheimer’s disease and heart diseases.
8. Drinking two glasses of tomato juice a day fulfills your lycopene requirement. Lycopene, a powerful antioxidant is also present in watermelons, pink grapefruits, apricots and pink guavas. 9. Children exposed to cigarette smoke have lower levels of antioxidants and would therefore require a larger intake of food rich in antioxidants. 10. Almost all fruits and vegetables lose at least some levels of antioxidants while cooking. The smallest losses were recorded with artichoke, green beans and garlic.
HEALTH
| IS SOAP O R HAND S ANITIS E R B E TTE R FO R WA SH I N G YO UR H A N D S?
IS SOAP OR HAND SANITISER BETTER FOR WASHING YOUR HANDS? 36 | u
WRITTEN BY
DIXIE ANN DICKSON
IS S OA P OR HA N D SA N I T I SE R B E T T E R FO R WA SH I N G YO UR H A N D S?
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HEALTH
IT IS INTERESTING THAT ONE’S CULTURE AND WAY OF LIFE CAN PLAY A MAJOR ROLE IN THE PREVENTION OF DISEASES. HAND SANITISING IS NOT THE ONLY FACTOR THAT CAN HELP PREVENT THE SPREAD OF VIRUSES AND BACTERIA, BUT OTHER FACTORS AS WELL. LET’S EXPLORE!
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HEALTH
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IS SOAP O R HAND S ANITIS E R B E TTE R FO R WA SH I N G YO UR H A N D S?
Dr Helmer Hilwig, Head of the Accident and Emergency Department at the Arima Hospital, says that Trinbagonians, based on their culture, are essentially clean people. The Dutch doctor has practiced here for more than 30 years and, comparing Trinidad and Tobago to some of the more developed countries in the world, he has observed that hygiene practices come naturally for us. As simple as it sounds, Dr. Hilwig says these fundamental practices and traditions, such as bathing, brushing teeth and washing our hands regularly, help fight against bacteria and viruses. I am sure you can attest to Dr Hilwig’s observations, because from an early age we were taught fundamental hygiene practices and habits, which became so embedded in us that it came automatically throughout our growing years into adulthood. We were schooled in washing our hands before and after meals, to avoid getting sick because of dirty hands, especially avoiding a major enemy, gastroenteritis. This is the same practice that is expected of medical practitioners when administering health care to patients.
HAND SANITISERS VS SOAP AND WATER Dr Hilwig, who has been in the medical field for over 35 years, says that using water — he stresses running water — and soap is the best method for cleaning hands, as opposed to hand sanitisers. Health practitioners may use both, but water and soap are more frequently used. According to webmd.com, a recent study found that staff in long-term care facilities who relied too much on hand sanitisers over hand washing actually reported more outbreaks of norovirus-related illness.
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Norovirus is the most common cause of viral gastroenteritis in humans. The site further states that while both are important, soap and water are number one, and hand sanitisers are a very effective, additional tool, meant to supplement, not replace, good old-fashioned soap and water washing. For norovirus, washing hands is the best prevention, especially after using the bathroom, changing a diaper, and before eating and doing food preparation.
If you are using hand sanitisers, you are advised to use one or two squirts or pumps, rub hands together briskly, front and back, between fingers, around and under the nails, until hands are dry. You should also use an alcohol-based sanitiser that contains a minimum of 60 percent alcohol, which is listed as ethyl alcohol. So what about alcohol-free sanitisers? According to the Berkeley Wellness University of California, some hand sanitisers contain quaternary ammonium compounds (notably benzalkonium chloride or benzethonium chloride) instead of alcohol to reduce microbes. These agents are less effective than alcohol, plus they lack evidence of real-life benefits. Moreover, they may contribute to bacterial resistance. Other alcohol-free hand sanitisers contain “natural” ingredients like tea tree oil and thyme, which may kill some germs, but not enough for them to be good alternatives to an alcohol-based hand sanitiser.
IS S OA P OR HA N D SA N I T I SE R B E T T E R FO R WA SH I N G YO UR H A N D S?
The Centre for Disease Control recommends only alcohol-based sanitisers. But be mindful that hand sanitisers don’t kill bacteria or viruses; they just reduce the amount that clings to your hands.
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HEALTH
Dr. Hilwig notes that every year there is a World Toilet Summit and Expo in Malaysia, showing the latest sanitary development. The most recent development in toilet design is totally hands-free: it has an automatic door, a washer-sprayer (bidet-style) instead of toilet paper and a dryer after using the toilet.
HOW TO WASH YOUR HANDS On the local front, Dr Hilwig says that while one may place emphasis on washing hands, there are two factors one should be mindful of: how to wash your hands properly, and the design set up of public and hospital toilets. In public bathrooms, you should follow these steps: • Turn on tap • Use soap and running water • Rub hands front, back, and between fingers with soap • Rinse hands under running water • Pull a piece of tissue to dry the hands • Use the same tissue to close the tap • Discard tissue (Ideally, there should be “NO DOOR to open” after having washed your hands. So washbasin should not be IN the toilet, but outside the toilet door). If there is a door to open, use a piece of tissue to open the door on exit.
WHAT THE IDEAL HYGIENE PRACTICE SHOULD BE Dr Hilwig says best international standards dictate that we should be using elbow taps, “push” taps (which run water for about 15 seconds when pushed in) or other hands-free faucets with the latest electronic-eye sensors, which automatically detect hands and dispense pre-set amounts of water and soap. “Your hands usually gets dirty again when you close the same tap your dirty hands touched previously, as well as the door when you are leaving the bathroom.” He strongly recommends that these types of taps/faucets should be instituted in all local hospitals, because the ideal practice when using the toilet is a hands-free approach.
The tap and the soap dispensers are also automatic. The automatic door then reopens and there is absolutely no involvement of the hands, Dr. Hilwig describes. With a smile in his voice, he says, “Toilet paper is not the best thing to use, if proper hygiene practices must be observed.” He points out that for many peoples, including those in Sudan and Senegal, it’s against their culture to offer food with their left hand, as that hand is considered “unclean”. For toilet hygiene, water is used and the left hand is used to “clean” while the right hand holds and pours the water from a bottle. So they must offer people food with their right hand. Some older people in T&T still adhere to this taboo. However, in everything there is a balance. Dr. Hilwig advises against becoming too obsessed with washing hands frequently. He pointed to another school of thought, that if one is obsessed with cleanliness and excessive washing, it is possible to wash away “friendly” bacteria that live in symbiosis with the human body and play a vital role in keeping “unfriendly” bacteria away. Each human requires a certain amount of bacteria and viruses to keep on triggering antibodies to act as defence mechanisms (similar to a booster shot for tetanus). If the body’s mechanisms don’t get triggered, then an immune response is slow, and the body becomes susceptible to infections. But Trinidadians have some favourable factors that assist in preventing viruses: their culture (a healthy sense of hygiene), and a nice, tropical climate and sea breeze, as bacteria and viruses hate sunlight and breeze. So, as in all things, be moderate: keep your hands clean and protect your health — but don’t overdo it!
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STUDY
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GENETI C TE S TING : IS K NOW L E DG E P OW ER O R C UR SE ?
Genetic
TESTING Is Knowledge Power or Curse?
WRITTEN BY
DR. NICOLE RAMLACHAN B.Sc., M.Sc., PhD., Post-Doctoral Fellow (Clinical Immunogenetics)
There are thousands of patients at risk for hereditary genetic disease, including cancers, in Trinidad and Tobago. Suppose your aunt, father and grandmother died of a fatal disease and someone offered you a test to determine if you had the disease-causing gene. Would you agree to be tested? The positive test would tell you your lifespan would probably be limited. Would you want to know, or would you rather not know? Would you feel that knowing would be a curse? As presymptomatic genetic testing becomes available for hundreds of family syndromes and genetic disorders, this dilemma faces potential carriers. We focus here on the large number of these cases related to hereditary breast and ovarian cancer (HBOC). Although most cancers are not hereditary in nature, for 5–10% of those diagnosed there is a family link, most often if a cancer has occurred at a young age in the affected individual or there are first degree relatives with occurrence of breast or ovarian cancer at a young age.
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Family cancer syndromes are usually caused by abnormal gene function, usually due to a “mutation”, which is a change in the sequence of a gene. If an abnormal copy of a gene is inherited, cells already have one mutation from birth. If the other copy of the gene stops working due to an acquired mutation (throughout that person’s life) there is no functioning protein produced. When the gene that stops working is a cancer
susceptibility gene, cancer can develop. Some cancer susceptibility genes function as tumour suppressor genes. These are genes that slow down cell division, repair DNA mistakes, or cause apoptosis or cell death. Without tumour suppressor genes functioning, there is uncontrolled cell growth, forming tumours that can lead to cancer, causing most hereditary family cancer syndromes. There are hundreds of genes with mutations linked to risk of cancer or efficacy of treatment. Specific mutations in the genes BRCA1 and BRCA2 or PALB2 result in an increased risk of breast and ovarian cancer in individuals that have been typed. The HER2 genetic mutation in a tumour suggests that it would respond to certain drugs, and this would be very useful for treatment of an affected individual. Most mutations are autosomal dominant, meaning one copy of the faulty gene gives a higher cancer risk. If these genes are mutated, the resulting proteins cannot repair damaged DNA; therefore, the body’s cells are more likely to develop genetic alterations leading to cancer. Scientists believe there is another gene called BRCA3 as well, but a genetic test is unavailable for that cancer-causing mutation.
GE N E T I C T E ST I N G: I S KN OW LE D GE P OW E R O R C UR SE ?
Mutations in either BRCA1 or BRCA2 can lead to HBOC (hereditary breast-ovarian cancer syndromes). The risk of breast and ovarian cancer is very high with mutations in either gene, but higher with BRCA1 mutations. This syndrome can also lead to other cancers, including fallopian tube, primary peritoneal, male breast, pancreatic or prostate cancer. Male breast, pancreatic and prostate cancers can be seen with mutations in either gene, but more commonly with BRCA2 mutations. In most countries where a patient has a family history indicating possible harmful mutations, the attending physician suggests genetic testing and takes preventative measures or treatments when available. For genes with breast cancer risk, these may include regular breast screening, risk-reducing surgery, and use of cancer-preventing drugs. Actor Angelina Jolie, who has a BRCA1 mutation and family history of ovarian cancer, brought risk-reducing surgery to popular media when she revealed that she had a preventative double mastectomy in 2011, in addition to having her ovaries and fallopian tubes removed in 2014 after a benign tumour was discovered. Genetic tests are currently reserved for those whose family history suggests they are at risk for HBOC. With no family history, a mutation would not be discovered unless an individual was diagnosed with the disease. This means that for those with no family history, there is no risk assessment until a diagnosis of cancer, which for some might be too late. Genetic screening of these genes should start for every woman at age 30, and be included in the course of routine medical care. Breast and ovarian cancer risks are high in women who carry mutations in BRCA1/BRCA2 or PALB2, even if these women do not have a family history of cancer. These individuals would be lost in the usual melee of health care cases of “unknown cancer cause”
unless they were tested and found to have a high cancer risk-causing mutation. Magnetic resonance imaging (MRI) should also be used in screening women, even without suspected HBOC to catch these “unknowns”. When considering genetic screening, if you test negative, routine screening for breast cancer (self-exams, mammograms, doctor’s visits) (note: ovarian cancer screening is not routinely recommended) is still important as for all women. Men with a negative test result have an extremely low risk of getting male breast cancer and relatively low risk of pancreatic or prostate cancer. If you test positive, there are steps you can take to lower your risk, or try to detect these cancers early: 1. Discuss hormonal therapy to reduce your risk of developing breast cancer, or oral contraceptives to reduce your risk of ovarian cancer. 2. Participate in a clinical trial on breast and/or ovarian cancer prevention to see whether other medications may be effective, or contribute to research to help find a cure. 3. Have frequent clinical exams and breast screenings, with digital mammography and/or MRI (magnetic resonance imaging) instead of, or in addition to, mammography. 4. Have regular pelvic exams, ultrasounds and CA-125 blood tests. 5. Consider and discuss preventive surgical removal of your breasts, ovaries, or both. 6. Provide genetic information for medical treatment decisions if any cancer is detected. 7. Make lifestyle and family planning changes or other decisions that could help lower cancer risk. Men who test positive for an abnormal BRCA1, BRCA2, or PALB2 gene are considered to be at higher-than-average risk for prostate cancer and should begin screens, including an annual digital rectal examination and PSA (prostate-specific antigen) blood test at 40–50. Their risk of male breast cancer is low, but higher
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STUDY
than it is for men who do not have an abnormal gene and BRCA2 mutation carriers should be screened for other cancers regularly. Not everyone agrees that genetic testing is useful, due to cost, insurance issues and misinformation. Some insurance companies are willing to pay for genetic testing, as this can reduce their overall cost by preventing the occurrence of disease or of treating existing disease more cost-effectively. Genetic counselling is critical. Individuals need to know if they are candidates, the harms and limits of the test. Family relationships are less easily disrupted and individuals are more informed. It is important to not test people for mutations without full consultations about what the test does and doesn’t mean. Beyond cost, counselling and risk, it used to be difficult to access genetic testing for all who need it in T&T and the wider Caribbean. Waiting lists for tests are getting longer, with waiting times more than a year in many countries. Locally, individuals and medical practitioners are able to access genetic testing, technology and information, from geneticists at Genix Diagnostics Limited. Candidates for genetic testing can make informed decisions and usually cope very well with the information, whether bad or good, once they are counselled on their options and possible outcomes. Genetic testing can be a very useful tool, giving you the power to make informed decisions on your lifestyle, medical treatment and possible prophylactic treatment, clinical trials and/or family planning. While some might feel they’d rather not know, individuals who do the test and receive a result can assess their risk accurately and have the power to make educated decisions. Knowledge through genetic testing is power. 41 | u
FITNESS
| WOW! EXER C IS E FOR A L L !
WHEEL OF WELLNESS
-2 -1 -0
AL
-6 -5 -4 -3
HE
ST RE
FAM ILY
-9 -8 -7
TH
- 10
LITY A U IT SPIR
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WE ALT H T DIE
EXE RCI SE
ER E R CA
WOW ! E X E R C I SE FO R A LL!
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FITNESS
Exercise for All!
Y WRITTEN BY
FAZAL MOHAMMED Caribbean Cardiac Rehabilitation and Wellness Centre
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FITNESS
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WOW! EXER C IS E FOR AL L !
D
espite all the new gyms cropping up, and a growing consciousness of general health among Caribbean people, we still seem to be losing the fight. Incidences of diabetes, heart disease, hypertension/stroke and certain types of cancers continue to rise. Even more worrying is the fact that the age ranges are widening. Whereas such lifestyle diseases were considered among the hazards of old age, we are seeing a growing trend towards their appearance in younger people, even children.
The fallout has been evident not just in the devastation and loss suffered by families, but the staggering costs being borne by the health care system, and both the public and private sectors due to loss of man-hours and productivity.
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One thing is evident: if we continue along this trend it is hardly likely we can expect any semblance of improvement. But improvement requires CHANGE, and change is often a difficult element to initiate. It requires, among other things,
an awareness of the problem, the desire to fix it, a knowledge and understanding of how change is to take place, and the support and wherewithal needed to effect this change.
To assist in this area, and to get the ball rolling, I have developed the WOW model, or the “Wheel of Wellness”.
The Wheel of Wellness allows you to examine where you stand in each of eight areas of wellness: Health, Spirituality, Wealth, Diet, Exercise, Career/Job, Family, and Sleep/Rest. No, perhaps I can’t help you advance in ALL of these areas, but at least your honest self-assessment will give you an idea of where you are, and how you plan to proceed.
In each area, try to pinpoint where you are now, in terms of quantity and quality. Then, decide for yourself where you want to be in what time frame, and how you are going to achieve it. For example, how are your basic health markers, such as resting heart rate, blood pressure, blood sugar and cholesterol? Are they in keeping with expectations for your age, sex, and medical situation?
If not, what are your plans for bringing about change? As you can see from the wheel, another important metric is time. How much time do you allocate to your personal advancement in each area? You’re probably spending 8 – 10 hours in the area of Career/Job (don’t we all!) but how much of the 24 hours we receive every day are you devoting to spiritual and physical wellness? In other words, what are your priorities?
Think of your WOW wheel as if it were a real wheel. If you were rolling it along the ground, and some areas were heavier than others, it would topple over, wouldn’t it? How do you balance your wheel? How can you shift time, reallocate time, and focus your attention into areas that better serve your goal of wholeness?
Great news! You can start right now, without even getting up to change into workout clothes or shoes; all you need is a pen.
Complete the WOW exercise and you are well on your way to becoming a better you. According to the results of your personal WOW wheel,
WOW ! E X E R C I SE FO R A LL!
and assuming you need to work on diet and exercise, the next thing you do is see your doctor. Get clearance to start an exercise program.
Next, you see a dietitian or nutritionist, who can help you come up with a healthy eating plan that suits your dietary needs, your personal and family situation, and your budget.
Finally, you hit the gym … but be patient with yourself. Too much too fast will do more harm than good. Initially, it is recommended that you work with a Personal Trainer (PT).
In selecting a PT, do not hesitate to ask to see his or her certification and ask about their experience. Do not be fooled by a buff and great looking body in a trainer; it’s not about how well they can attain their own fitness goals, it’s about how well they can help you attain yours.
Using a trainer who is underqualified, who does not keep up to date with trends in fitness and wellness, or who is simply not qualified or
experienced enough to cater to your specific needs, may result in your wasting good time and money or, even worse, seriously injuring yourself.
Also, be cautious about the gyms you choose; stick with those that have a good reputation. Ask around if you have to. Many gyms — be they big, medium or small — are unable to produce certification for their “trainers”, or cannot offer the equipment or programmes that can suit your needs.
However, there are many good trainers, professional, certified, and science-based, with the right passion to assist you along your way. After selecting a PT, you are not only ready to transform yourself — better body and better mind — but you have also now set the stage for a greater overall wellbeing.
Keep in mind this is for the long haul; you are reducing your risk of developing any of the serious lifestyle diseases we discussed above. You are well on your way to enjoying a better quality of life.
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FITNESS
Allow me to clarify a big misconception, however, that exercise is only for obese people. Wrong! Exercise is for ALL: the young, old, under-weight, overweight, sick, bed-ridden, special needs, challenged, female, or male — ALL.
Have Fun! NOTE: Fazal Mohammed has been working in the Health and Wellness field over the last 10 years. He holds the position of Wellness and Exercise Specialist, with many certifications, including American College of Sport Medicine (ACSM); National Personal Training Institution (NPTI); and T.A. Sciences (TAS). He is affiliated with The CEC Education Center (Tampa FL.); Feelrite Longevity and Wellness Center (Trinidad) and Caribbean Cardiac Rehabilitation and Wellness Centre (Trinidad).
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