JAN MAR 2014 ISSUE 24

uhealthdigest.com

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PROSTATEEXAMINATIONS.THE TRUTH ABOUT WHY MENSHY AWAY FROM THIS EXAM.

SUGAR APPLESTHE NAME SAYS IT ALL. HAVE YOUTASTED THIS SUGARY DELIGHT?

PLAYWHAT DOCTORS SAY ABOUT THE BENEFITS OF LETTING YOUR CHILDREN PLAY!

COMMON DISEASES THATAFFECT MAINLY MENSOME YOU MAY NOT HAVE KNOWN

Founders

Publisher

Editorial Director

Managing Editors

Writers

Creative Director

Design

Project Coordinator

Traffic

Photography

Medical Advisory

Sherine MungalStuart Fraser

Eidetic Publishing

Sherine Mungal

Roslyn CarringtonNirad Tewarie

Nasser KhanCarol QuashDr. Claudette MitchellDavid FentonMaia HibbenDr. Ricardo JurawanDr. David BrattMichelle Ash

Stuart Fraser

Damian Gill

Varesha Ramnath

Lorraine Biran

Hamish TaraunéiStockPhoto

Dr. Neil Singh MBBS PG MSc

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 spec ific adv ice f rom a hea l th 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 Publ ishing, 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.

U The Caribbean Health Digest subscriptions make the ideal gift for just about anybody - your friends, your family or anyone else with health interests as diverse as your own. Whether it’s a birthday or Christmas present or just to say thanks, a subscription to U is always appreciated. At long last, something to look forward to in the mailbox other than a bill!

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Quinoa – The ‘Mother of all Grains’Fans of the food network have seen this unusual food being prepared as a side dish to go with meats or veggies, but you may not have had the chance to taste it. You should! This delicious, ancient grain is easy to prepare and very good for you.

Why are men so afraid of prostate exams?If you’re male and over 40, have you had your prostate checked? If not, why not?In this article we explore the fears that men seldom admit to, but which may be holding them back from taking this easy, painless, but vital health check.

Do carbohydrates make you fat?For weight-watchers, carbs are often seen as the bad guy, and there are manypopular books and diets that underscore that idea. But do they really make you fat? Registered Dietician, Michelle Ash, weighs in on the controversy.

Childhood obesity - A matter for concernOne of the most frightening epidemics facing us is childhood obesity, not just because of how fast it is rising, but also because of the long-term implications for the health of our children. Claudette Mitchell explains how it happens, and how we can help stop it.

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PlayWe grown-ups complain about children playing too much, as if we forget the escapades of our own childhood. Worry not if your child would rather run about than buckle down to schoolwork. Dr. David Bratt, our “paediatrician in residence”, tells us why play is essential for child development.

Children get arthritis, too!Arthritis is a condition of the elderly, right? Wrong! It can be a symptom of a number of diseases that can affect children.

Sugar appleMmm! Sweet, creamy sugar apple. So good...and so good for you!

In�ammatory Bowel DiseaseIt’s painful, scary, and even life-changing, but there’s help for those who live with IBD. Check out this article to learn about the condition and what to do about it.

Be man enough - Take care of your healthCaribbean men believe in being strong and silent, but this doesn’t mean you shouldn’t be careful with your health. Carol Quash talks about a few common health risks that many men face, and explains why you need to watch out for them.

Hospital Acquired InfectionsSometimes, just being in a hospital can be a threat to your health. Find out what risks you might be exposed to, and how to avoid them.

FOUNDINGEDITORS

SHERINE & STUART

There are great things ahead for us at U as we continue to bring to you insightful and informative articles each quarter. We hear from

so many of you on how much you enjoy and appreciate the material and how much you look forward to each issue, but we would like to

encourage you to continue to email us, share your health stories and even make requests on topics you would like to learn more about.

Our Health and Wellness Expo is also in the planning stages and will take place a little later in the year but promises to be even more exciting, with many more exhibitors and so much more to learn.

In this issue we focus a lot on men’s health, with our feature article focusing on one particular medical exam that most men fear

the most: the prostate exam. Some of the other stories by our dedicated team of writers include In­ammatory Bowel Disease by

Dr. Ricardo Jurawan and a very compelling true story by David Fenton of a child su�ering from arthritis.

Our featured fruit in this issue is the mouth watering sugar apple and the bene�ts associated with it. On another not-so-sweet note,

Dr. Claudette Mitchell shares her observations on childhood obesity, a matter for concern in many societies in the Caribbean.

We hope that we have left you enough to ponder ‘till the next issue: in the mean time take care of yourselves.

We greet you in this New Year with great joy and immense gratitude for the gift of health and life. Our lives have been blessed with a

new member of our own family and we wish you, our readers, nothing but the same kind

of love and blessings for all of 2014.

WRITTEN BY MAIA HIBBEN

13 | u

Quinoa, pronounced keen-wah or kee-noh-u has transformed from a virtually unknown supergrain of the Inca people to a supercrop and a common staple food in today’s kitchens. Quinoa was first domesticated by the Andean peoples between 3,000 and 5,000 years ago, and has been a staple crop in South America ever since. The Incas believed the crop to be sacred and called it by the name chisaya mama – “mother of all grains”. It is also commonly referred to as “the golden grain of the Andes”.

QuinoaThe “Mother of all Grains”

FOOD | QUINOA QUINOA |FOOD

WRITTEN BY MAIA HIBBEN

13 | u

Quinoa, pronounced keen-wah or kee-noh-u has transformed from a virtually unknown supergrain of the Inca people to a supercrop and a common staple food in today’s kitchens. Quinoa was first domesticated by the Andean peoples between 3,000 and 5,000 years ago, and has been a staple crop in South America ever since. The Incas believed the crop to be sacred and called it by the name chisaya mama – “mother of all grains”. It is also commonly referred to as “the golden grain of the Andes”.

QuinoaThe “Mother of all Grains”

FOOD | QUINOA QUINOA |FOOD

15 | u

14 | u

he United Nations General Assembly declared 2013 as the International Year of Quinoa in recognition of the ancestral practices of the

Andean people, who “preserved quinoa as food for present and future generations, through knowledge and practices of living in harmony with nature”. Their belief is that quinoa can o�er an alternative for those countries su�ering from food insecurity and help eradicate poverty, in support of the Millennium Development Goals.

Dietary benefitsJust like amaranth, buckwheat or wild rice, quinoa is considered a pseudograin, which actually makes it a seed, despite commonly being referred to as “the mother of all grains”. Perhaps its most striking health bene�t is its overall nutrient richness: it is full of quality protein, dietary �ber, polyunsaturated fats and vitamins and minerals.

It is what they call a “clean” protein – meaning it is plant based, and therefore easy to digest; considerably easier on your gut than meat-based proteins. Quinoa has eight essential amino acids found in protein, thus making it a complete protein. In fact, it exceeds the required and recommended levels, in contrast to most

grains such as wheat, rice and maize, which have very low levels of several essential amino acids. What sets quinoa aside is not just the levels of amino acids, but the quality of its protein.

Dietary �ber is necessary for good digestion and preventing constipation. Quinoa is a great source of dietary �ber and again tops the list when compared to other grains.

Although we now live in a world that spends a lot of time focusing on fat-free foods, fats are essential to our diets. Over 50% of the fats in quinoa are poly-unsaturated (the good kind!) and it is high in two very important fatty acids that our body cannot produce itself. Quinoa is also a great source of lots of vitamins and minerals such as iron, zinc, magnesium, phosphorus and B vitamins. It has a particularly high vitamin E value, which is a great antioxidant.

In addition to all these wonderful bene�ts, it is also gluten-free, so is suitable for people with celiac disease, and a fantastic source of calcium, so perfect for vegans, vegetarians and those who are lactose intolerant. The facts suggest it is as close to a perfect ingredient as you can get!

Cooking with quinoaTiny bead-shaped seeds, similar in appearance to couscous and as versatile as rice, but which have a richer, nuttier �avor, which means it can be eaten alone, unlike other grains, which are often bland or starchy. There are endless ways you can combine quinoa into both hot and cold, and sweet and savory dishes.

The �rst, and perhaps most important step in preparing quinoa correctly, is to rinse the seeds thoroughly. The reason for this is saponin, which is a soapy substance that acts as a protectant from insect and fungal attacks. Because of its possible minor toxic e�ects, it is very important that you wash out the majority of the saponin before cooking your quinoa. The easiest way to do this is to put the quinoa into a

sieve and run it under the tap, moving the sieve gently from side to side, until the water runs clear.

Once this �rst step has been completed, you can now go ahead and �re up that stove. It takes 12 – 15 minutes to cook (2 cups of water per 1 cup of quinoa). So simple and quick to prepare and, once cooked, the seeds, which were �rm, will pu� up and quadruple in size. You can either create a deliciously sweet breakfast porridge or toss it with some onion, garlic and herbs for a savory and well-balanced meal. Quinoa really is a natural �t to any meal, lending itself to savory or sweet goods alike; if you happen to run into quinoa �our, the possibilities are endless. It is an extremely versatile ingredient and my larder would not be complete without it!

Delicious Quinoa Facts• One serving �lls 48% of our daily magnesium needs• It is cholesterol free (0 mg) and low in sodium (13 mg)• Its caloric ratio is 71% carbs – 14% fat – 15% protein• It takes 12-15 minutes to cook to perfection• There are red, white and black varieties• Although it is a seed, it is actually a relative of leafy green veggies like spinach and Swiss chard.• A typical serving is ¼ cup• Quinoa vs rice protein count: quinoa 31.1 g – brown rice 7.5 g – white rice 6.6 g

FOOD | QUINOA QUINOA |FOOD

T Other benefitsVirtually all �our industry products can be made from quinoa whole grains and �our. Trials in the Andean region and elsewhere have indicated the feasibility of adding 10, 15, 20 and as much as 40% of quinoa �our to bread, up to 40% in noodles, up to 60% in sponge cake and up to 70% in biscuits. The main advantage of using quinoa as a food supplement in the �our industry is that it helps meet growing international demand for gluten-free products. It is also being researched and used in food by-products, cosmetics and pharmaceuticals.

Quinoa leaves, stems and grains are also used for medicinal purposes: healing wounds, reducing swelling, soothing pain (toothache) and disinfecting the urinary tract. They are also used in bone setting, for internal bleeding and as insect repellents. It is also thought to have anti-in�ammatory properties, and research is predicted for the future in relation to diabetes, cardiovascular disease, cholesterol problems and allergy relief. Is there no end to the qualities and uses of this “mother of all grains”?

Energy (Kcal/100g)

Protien (g/100g)

Fat (g/100g)

Total Carbohydrate (g/100g)

Iron (mg/100g)

Zinc (mg/100g)

Quinoa

399

16.5

6.3

69.0

13.2

4.4

Maize

408

10.2

4.7

81.1

2.1

2.9

Rice

372

7.6

2.2

80.4

0.7

0.6

Wheat

392

14.3

2.3

78.4

3.8

4.7

Nutrient contents of quinoa and selected foods(per 100 grams dry weight)Source: Koziol (1992)

Quinoa has eight essential amino acids found in protein

In fact, it exceeds the required and recommended levels...thus making it a complete protein.

1 cup of quinoa1 can of black beans, rinsed and drained½ cup of cilantro (shadon beni)1 avocado, diced¼ cup cherry tomatoes

¼ cup chopped spinach4 Tbsp lime juice1 garlic clove, minced¼ cup extra virgin olive oilSalt and pepper to taste

Zesty Quinoa Salad with Black Beans and Cilantro

• Bring to boil 1 cup quinoa with 2 ½ cups water. Once boiling, cover and reduce heat to a simmer until water is evaporated and quinoa is light and �u�y.

• While quinoa is cooking, chop veggies and prepare dressing.• To make dressing, blend olive oil, lime juice, garlic, salt, pepper, and ¼ cup cilantro in a blender.• Once quinoa is complete, add dressing and coat. Fold in black beans and veggies. Add

remaining cilantro and toss.• Serve immediately with chips.• This can be placed in the fridge for up to two days and enjoyed cold.

Even the leavesof the quinoa plant are edible; they taste similar to spinach,

chard and beets.

15 | u

14 | u

he United Nations General Assembly declared 2013 as the International Year of Quinoa in recognition of the ancestral practices of the

Andean people, who “preserved quinoa as food for present and future generations, through knowledge and practices of living in harmony with nature”. Their belief is that quinoa can o�er an alternative for those countries su�ering from food insecurity and help eradicate poverty, in support of the Millennium Development Goals.

Dietary benefitsJust like amaranth, buckwheat or wild rice, quinoa is considered a pseudograin, which actually makes it a seed, despite commonly being referred to as “the mother of all grains”. Perhaps its most striking health bene�t is its overall nutrient richness: it is full of quality protein, dietary �ber, polyunsaturated fats and vitamins and minerals.

It is what they call a “clean” protein – meaning it is plant based, and therefore easy to digest; considerably easier on your gut than meat-based proteins. Quinoa has eight essential amino acids found in protein, thus making it a complete protein. In fact, it exceeds the required and recommended levels, in contrast to most

grains such as wheat, rice and maize, which have very low levels of several essential amino acids. What sets quinoa aside is not just the levels of amino acids, but the quality of its protein.

Dietary �ber is necessary for good digestion and preventing constipation. Quinoa is a great source of dietary �ber and again tops the list when compared to other grains.

Although we now live in a world that spends a lot of time focusing on fat-free foods, fats are essential to our diets. Over 50% of the fats in quinoa are poly-unsaturated (the good kind!) and it is high in two very important fatty acids that our body cannot produce itself. Quinoa is also a great source of lots of vitamins and minerals such as iron, zinc, magnesium, phosphorus and B vitamins. It has a particularly high vitamin E value, which is a great antioxidant.

In addition to all these wonderful bene�ts, it is also gluten-free, so is suitable for people with celiac disease, and a fantastic source of calcium, so perfect for vegans, vegetarians and those who are lactose intolerant. The facts suggest it is as close to a perfect ingredient as you can get!

Cooking with quinoaTiny bead-shaped seeds, similar in appearance to couscous and as versatile as rice, but which have a richer, nuttier �avor, which means it can be eaten alone, unlike other grains, which are often bland or starchy. There are endless ways you can combine quinoa into both hot and cold, and sweet and savory dishes.

The �rst, and perhaps most important step in preparing quinoa correctly, is to rinse the seeds thoroughly. The reason for this is saponin, which is a soapy substance that acts as a protectant from insect and fungal attacks. Because of its possible minor toxic e�ects, it is very important that you wash out the majority of the saponin before cooking your quinoa. The easiest way to do this is to put the quinoa into a

sieve and run it under the tap, moving the sieve gently from side to side, until the water runs clear.

Once this �rst step has been completed, you can now go ahead and �re up that stove. It takes 12 – 15 minutes to cook (2 cups of water per 1 cup of quinoa). So simple and quick to prepare and, once cooked, the seeds, which were �rm, will pu� up and quadruple in size. You can either create a deliciously sweet breakfast porridge or toss it with some onion, garlic and herbs for a savory and well-balanced meal. Quinoa really is a natural �t to any meal, lending itself to savory or sweet goods alike; if you happen to run into quinoa �our, the possibilities are endless. It is an extremely versatile ingredient and my larder would not be complete without it!

Delicious Quinoa Facts• One serving �lls 48% of our daily magnesium needs• It is cholesterol free (0 mg) and low in sodium (13 mg)• Its caloric ratio is 71% carbs – 14% fat – 15% protein• It takes 12-15 minutes to cook to perfection• There are red, white and black varieties• Although it is a seed, it is actually a relative of leafy green veggies like spinach and Swiss chard.• A typical serving is ¼ cup• Quinoa vs rice protein count: quinoa 31.1 g – brown rice 7.5 g – white rice 6.6 g

FOOD | QUINOA QUINOA |FOOD

T Other benefitsVirtually all �our industry products can be made from quinoa whole grains and �our. Trials in the Andean region and elsewhere have indicated the feasibility of adding 10, 15, 20 and as much as 40% of quinoa �our to bread, up to 40% in noodles, up to 60% in sponge cake and up to 70% in biscuits. The main advantage of using quinoa as a food supplement in the �our industry is that it helps meet growing international demand for gluten-free products. It is also being researched and used in food by-products, cosmetics and pharmaceuticals.

Quinoa leaves, stems and grains are also used for medicinal purposes: healing wounds, reducing swelling, soothing pain (toothache) and disinfecting the urinary tract. They are also used in bone setting, for internal bleeding and as insect repellents. It is also thought to have anti-in�ammatory properties, and research is predicted for the future in relation to diabetes, cardiovascular disease, cholesterol problems and allergy relief. Is there no end to the qualities and uses of this “mother of all grains”?

Energy (Kcal/100g)

Protien (g/100g)

Fat (g/100g)

Total Carbohydrate (g/100g)

Iron (mg/100g)

Zinc (mg/100g)

Quinoa

399

16.5

6.3

69.0

13.2

4.4

Maize

408

10.2

4.7

81.1

2.1

2.9

Rice

372

7.6

2.2

80.4

0.7

0.6

Wheat

392

14.3

2.3

78.4

3.8

4.7

Nutrient contents of quinoa and selected foods(per 100 grams dry weight)Source: Koziol (1992)

Quinoa has eight essential amino acids found in protein

In fact, it exceeds the required and recommended levels...thus making it a complete protein.

1 cup of quinoa1 can of black beans, rinsed and drained½ cup of cilantro (shadon beni)1 avocado, diced¼ cup cherry tomatoes

¼ cup chopped spinach4 Tbsp lime juice1 garlic clove, minced¼ cup extra virgin olive oilSalt and pepper to taste

Zesty Quinoa Salad with Black Beans and Cilantro

• Bring to boil 1 cup quinoa with 2 ½ cups water. Once boiling, cover and reduce heat to a simmer until water is evaporated and quinoa is light and �u�y.

• While quinoa is cooking, chop veggies and prepare dressing.• To make dressing, blend olive oil, lime juice, garlic, salt, pepper, and ¼ cup cilantro in a blender.• Once quinoa is complete, add dressing and coat. Fold in black beans and veggies. Add

remaining cilantro and toss.• Serve immediately with chips.• This can be placed in the fridge for up to two days and enjoyed cold.

Even the leavesof the quinoa plant are edible; they taste similar to spinach,

chard and beets.

17 | u

As brief, painless and routine as it is, the prostate exam ranks high on every man’s anxiety list. It has been the subject of an infinite number of comedy sketches, stand-up routines and dirty jokes. In public, we laugh, but in private, it’s an entirely different story.

Men are so nervous about undergoing a prostate examination that many find ways to rationalise putting off their annual health check-up altogether.

WHY ARE MEN

OF PROSTATEEXAMS?

AFRAIDWRITTEN BY STAFF WRITER

FEATURE | WHY ARE MEN SO AFRAID OF PROSTATE EXAMS? WHY ARE MEN SO AFRAID OF PROSTATE EXAMS? |FEATURE

17 | u

As brief, painless and routine as it is, the prostate exam ranks high on every man’s anxiety list. It has been the subject of an infinite number of comedy sketches, stand-up routines and dirty jokes. In public, we laugh, but in private, it’s an entirely different story.

Men are so nervous about undergoing a prostate examination that many find ways to rationalise putting off their annual health check-up altogether.

WHY ARE MEN

OF PROSTATEEXAMS?

AFRAIDWRITTEN BY STAFF WRITER

FEATURE | WHY ARE MEN SO AFRAID OF PROSTATE EXAMS? WHY ARE MEN SO AFRAID OF PROSTATE EXAMS? |FEATURE

19 | u

18 | u

n fact, men are so reluctant to discuss, or even think about the topic, that an informal poll taken among a number of men for this article was met with stony

silence. Unfortunately, like many health issues, prostate problems are not likely to simply resolve themselves without intervention, and may even become worse, with serious consequences.

Why have a prostate exam?Adult male patients are usually o�ered a prostate exam as part of a general health check-up, especially if they are over the age of 40, members of high-risk groups such as Afro-Caribbean men or men who have a brother or father who has been diagnosed with prostate cancer, or are experiencing di�culty urinating. The prostate exam is a basic screening tool, particularly for prostate cancer.

How is the prostate exam performed?The patient is either asked to undress completely and stand feet apart with his back to the doctor, and bend forward, supported by his forearms on the examination bed. Alternatively, he may lie on his side with his knees drawn up to his chest.

The procedure takes about two minutes. The doctor will gently insert his gloved, lubricated �nger into the rectum, which he will rotate to identify the lobes, grooves, size and texture of the prostate gland. A normal prostate is 2–4 cm in size and shaped roughly like a triangle or heart. Any changes in shape, texture or size may be cause for further diagnostic tests.

Are there other ways to test for prostate cancer?The American Cancer Society states that about 17% of men will be diagnosed with prostate cancer in their lifetime. The digital prostate exam, also known as a Digital Rectal Exam (DRE) is only one of few tests used for preliminary screening for this disease.

There is the Prostate Speci�c Antigen (PSA) blood test, which examines levels of a speci�c protein produced by the prostate. Higher levels may suggest an enlargement of the prostate.

If there is an abnormality in either the DRE or PSA, a doctor will send for a Trans-Rectal Ultrasound (TRUS), following which he might decide to do a prostate biopsy, in which several small samples of prostate tissue are removed with a needle to be analysed for the presence of cancerous cells. This is usually done under local anaesthesia.

HOw useful is the prostate exam?The DRE is the gold standard for diagnosing prostate cancer, and can be used in conjunction with the PSA and /or the TRUS (ultrasound). It is also done to check for prostatitis or benign Prostatic Hyperplasia (BPH), or enlarged prostate.

And even though the Caribbean region ranks among the highest in the world in terms of per capita deaths from prostate cancer, there is still a general reluctance to undergo the exam. The question is...why?

Men dislike going to the doctor, periodMen in general are more reluctant than women to go to doctors for any reason. This is, in part, because of our busy lives and hectic schedules, and the fact that the long stints in the waiting room are enough to deter anyone, especially men, who are more prone to be restless and less likely to sit still for long periods than their female counterparts.

Men equate illness with weaknessEven more daunting to them is nagging sensation that an admission of being ill is tantamount to an admission of weakness, and a threat to their masculinity.

It’s bad enough to give in and go to a doctor, but what about the possibility that

they might discover something wrong?

I

JUSTDO IT!

FEATURE | WHY ARE MEN SO AFRAID OF PROSTATE EXAMS? WHY ARE MEN SO AFRAID OF PROSTATE EXAMS? |FEATURE

Regardless of what society we are from, where we live in the world, there is one truth that holds constant: that masculinity is equated with good health, vibrancy, strength, and energy. For men, therefore, illness not only saps the body and mind, but it undermines their perception of themselves as powerful, masculine, and dominant. In other words, for many, it’s better to live in denial than to know that something is wrong.

They dislike the submissive position during the examThe bent-over or knees-up position, particularly with someone examining such an intimate and personal part of their body, can leave men feeling vulnerable and, therefore, weak.

They’re afraid of appearing - or even becoming - gayAt �rst glance, this idea may seem ludicrous, but the Caribbean is home to a culture of machismo that fears and derides even the appearance of homosexual activity.

Some people may equate the brief penetration of the rectum with being gay, or somehow mimicking intercourse. And, once again, our culture asserts that submission to this penetration is weak, feminine, and wrong.

They are afraid of embarrassing themselvesThe prostate is a very sensitive part of the male reproductive system, and may respond to stimulation, even in a non-sexual situation. To put it another way, it is possible to experience an erection, even ejaculation, during a prostate exam. This in no way re�ects how the patient feels about the person performing the exam; whether they are male or female, attractive or unattractive, older or younger. It is simply cause and e�ect. Furthermore, there is the concern that the penetration of the anus may result in the patient passing gas as the

�nger is being withdrawn. Once again, this can and may happen.

But it’s helpful to remember that there are precious few things that a doctor has never seen or experienced over the course of their career, and an unwanted erection isn’t likely to rank very high on their list of shockers.

It’s probable that they will choose not to react or comment, and continue with their duties like the trained professionals that they are.

The largest number of diagnosed prostate

cancer cases occur in those aged 70 to 74

When it comes to prostate health, burying your head in the sand and pretending everything is fine is unwise, and even dangerous. Now is the time to face the reality that, whatever the outcome, it’s better to have the information you need to act, if necessary. So just do it.

19 | u

18 | u

n fact, men are so reluctant to discuss, or even think about the topic, that an informal poll taken among a number of men for this article was met with stony

silence. Unfortunately, like many health issues, prostate problems are not likely to simply resolve themselves without intervention, and may even become worse, with serious consequences.

Why have a prostate exam?Adult male patients are usually o�ered a prostate exam as part of a general health check-up, especially if they are over the age of 40, members of high-risk groups such as Afro-Caribbean men or men who have a brother or father who has been diagnosed with prostate cancer, or are experiencing di�culty urinating. The prostate exam is a basic screening tool, particularly for prostate cancer.

How is the prostate exam performed?The patient is either asked to undress completely and stand feet apart with his back to the doctor, and bend forward, supported by his forearms on the examination bed. Alternatively, he may lie on his side with his knees drawn up to his chest.

The procedure takes about two minutes. The doctor will gently insert his gloved, lubricated �nger into the rectum, which he will rotate to identify the lobes, grooves, size and texture of the prostate gland. A normal prostate is 2–4 cm in size and shaped roughly like a triangle or heart. Any changes in shape, texture or size may be cause for further diagnostic tests.

Are there other ways to test for prostate cancer?The American Cancer Society states that about 17% of men will be diagnosed with prostate cancer in their lifetime. The digital prostate exam, also known as a Digital Rectal Exam (DRE) is only one of few tests used for preliminary screening for this disease.

There is the Prostate Speci�c Antigen (PSA) blood test, which examines levels of a speci�c protein produced by the prostate. Higher levels may suggest an enlargement of the prostate.

If there is an abnormality in either the DRE or PSA, a doctor will send for a Trans-Rectal Ultrasound (TRUS), following which he might decide to do a prostate biopsy, in which several small samples of prostate tissue are removed with a needle to be analysed for the presence of cancerous cells. This is usually done under local anaesthesia.

HOw useful is the prostate exam?The DRE is the gold standard for diagnosing prostate cancer, and can be used in conjunction with the PSA and /or the TRUS (ultrasound). It is also done to check for prostatitis or benign Prostatic Hyperplasia (BPH), or enlarged prostate.

And even though the Caribbean region ranks among the highest in the world in terms of per capita deaths from prostate cancer, there is still a general reluctance to undergo the exam. The question is...why?

Men dislike going to the doctor, periodMen in general are more reluctant than women to go to doctors for any reason. This is, in part, because of our busy lives and hectic schedules, and the fact that the long stints in the waiting room are enough to deter anyone, especially men, who are more prone to be restless and less likely to sit still for long periods than their female counterparts.

Men equate illness with weaknessEven more daunting to them is nagging sensation that an admission of being ill is tantamount to an admission of weakness, and a threat to their masculinity.

It’s bad enough to give in and go to a doctor, but what about the possibility that

they might discover something wrong?

I

JUSTDO IT!

FEATURE | WHY ARE MEN SO AFRAID OF PROSTATE EXAMS? WHY ARE MEN SO AFRAID OF PROSTATE EXAMS? |FEATURE

Regardless of what society we are from, where we live in the world, there is one truth that holds constant: that masculinity is equated with good health, vibrancy, strength, and energy. For men, therefore, illness not only saps the body and mind, but it undermines their perception of themselves as powerful, masculine, and dominant. In other words, for many, it’s better to live in denial than to know that something is wrong.

They dislike the submissive position during the examThe bent-over or knees-up position, particularly with someone examining such an intimate and personal part of their body, can leave men feeling vulnerable and, therefore, weak.

They’re afraid of appearing - or even becoming - gayAt �rst glance, this idea may seem ludicrous, but the Caribbean is home to a culture of machismo that fears and derides even the appearance of homosexual activity.

Some people may equate the brief penetration of the rectum with being gay, or somehow mimicking intercourse. And, once again, our culture asserts that submission to this penetration is weak, feminine, and wrong.

They are afraid of embarrassing themselvesThe prostate is a very sensitive part of the male reproductive system, and may respond to stimulation, even in a non-sexual situation. To put it another way, it is possible to experience an erection, even ejaculation, during a prostate exam. This in no way re�ects how the patient feels about the person performing the exam; whether they are male or female, attractive or unattractive, older or younger. It is simply cause and e�ect. Furthermore, there is the concern that the penetration of the anus may result in the patient passing gas as the

�nger is being withdrawn. Once again, this can and may happen.

But it’s helpful to remember that there are precious few things that a doctor has never seen or experienced over the course of their career, and an unwanted erection isn’t likely to rank very high on their list of shockers.

It’s probable that they will choose not to react or comment, and continue with their duties like the trained professionals that they are.

The largest number of diagnosed prostate

cancer cases occur in those aged 70 to 74

When it comes to prostate health, burying your head in the sand and pretending everything is fine is unwise, and even dangerous. Now is the time to face the reality that, whatever the outcome, it’s better to have the information you need to act, if necessary. So just do it.

DO CARBOHYDRATES

MAKE YOU

FAT?WRITTEN BY MICHELLE ASH, MPH, RD, DIP.

21 | u

The Facts About Weight Loss and Low-Carb Dieting

NUTRITION | DO CARBOHYDRATES MAKE YOU FAT? DO CARBOHYDRATES MAKE YOU FAT? |NUTRITION

Carbohydrates are one of the three major

nutrients that are needed to sustain life.

The other two are fats and proteins. During

digestion, carbs are broken down into

simple sugars, which are then used by the

body for energy. While protein and fat can

be used for energy, carbohydrates remain

the body’s prime energy source. Without

them, the brain would not be able to

function normally, because they are its

chief nutrient. Carbs are found in a variety

of forms, such as sugars, fibre and starches.

Many foods also contain a wide range of

nutrients, and not just one. A simple

example is a slice of bread. It contains

carbohydrates, protein and some fat. Some

foods are higher in a particular nutrient

versus another, for example, one standard

serving of bread contains a greater amount of

carbohydrate than a standard serving of milk.

What are carbohydrates?

DO CARBOHYDRATES

MAKE YOU

FAT?WRITTEN BY MICHELLE ASH, MPH, RD, DIP.

21 | u

The Facts About Weight Loss and Low-Carb Dieting

NUTRITION | DO CARBOHYDRATES MAKE YOU FAT? DO CARBOHYDRATES MAKE YOU FAT? |NUTRITION

Carbohydrates are one of the three major

nutrients that are needed to sustain life.

The other two are fats and proteins. During

digestion, carbs are broken down into

simple sugars, which are then used by the

body for energy. While protein and fat can

be used for energy, carbohydrates remain

the body’s prime energy source. Without

them, the brain would not be able to

function normally, because they are its

chief nutrient. Carbs are found in a variety

of forms, such as sugars, fibre and starches.

Many foods also contain a wide range of

nutrients, and not just one. A simple

example is a slice of bread. It contains

carbohydrates, protein and some fat. Some

foods are higher in a particular nutrient

versus another, for example, one standard

serving of bread contains a greater amount of

carbohydrate than a standard serving of milk.

What are carbohydrates?

23 | u

22 | u

NUTRITION | DO CARBOHYDRATES MAKE YOU FAT? DO CARBOHYDRATES MAKE YOU FAT? |NUTRITION

What does “low-carb” or “zero carb” mean? These terms usually refer to diets that contain very little amounts of carbohydrates and higher amounts of protein and fat. A purely low-carb diet, therefore, will be low in vegetables, fruits, starchy and high �bre foods including whole grains, and peas and beans as well. Many popular and commercial “low-carb diets” such as the widely media publicized Atkins Diet™ and similar others are not truly low-carb, because such diets will limit consumption of vegetables, peas and beans. Such diets are often actually selective-carb diets. Complex carbohydrates, �bre and low glycemic index foods are highlighted for consumption in these types of popular diets.

Simple carbohydrates Simple carbohydrates are made of just one or two sugar molecules. They are the quickest source of energy, as they are rapidly digested. Simple carbs can be found in brown sugar, corn syrup, honey, maple syrup, molasses, jams, jellies, soft drinks and candy.

Complex carbohydrates and fibre Complex carbs are made up of a few sugar molecules strung together like a necklace, or branched like a coil. These are found in unre�ned grains, starchy roots (such as ground provisions, e.g. dasheen and sweet potato), starchy fruits (e.g. breadfruit and green banana) and peas and beans. Complex carbohydrates are satisfying and can help with appetite control because they take longer to digest – which means they have less of an immediate impact on blood sugar, causing it to rise more slowly.

Fibre comes from plant foods that contain non-digestible carbohydrates. Eating �bre daily can help promote bowel regularity, lower cholesterol, and maintain normal blood sugar levels. The Institute of Medicine (IOM) recommends that adults should consume between 25 and 35 grams of �bre each day. Examples of high-�bre foods include brown rice, carrots, wheat bran, oatmeal and beans.

The Glyceamic Index (GI) Most carbohydrates, apart from �bre, are ultimately broken down to sugars, but their e�ect on the body’s blood sugar levels varies from food to food. This is largely due to how fast the food can be digested and its sugars absorbed. This is measured on a scale called the Glyceamic Index (GI). This in turn is in�uenced by:

- The type of starch in the carbohydrate- Ripeness of the food- How processed or cooked the food is- Whether there is any fat or �bre accompanying the carbohydrate

According to the Glyceamic Index (GI) theory, the lower the GI number, the slower food is digested, allowing for sugar (glucose) to be delivered more slowly to the bloodstream than with foods having a higher GI number.

Foods that raise blood sugar quickly have a high GI (70 or more) whilst those that raise it slowly have a low GI (55 or less). This is fundamental to planning a healthy diet, especially for people with diabetes or for those looking for healthy weight loss or peak sports performance.

Most scientists agree that more research is needed prior to recommending GI as a measure on which to base dietary recommendations for the general population.

"Low-carb" or "zero-carb" diets are not recommended for persons with diabetes, as they can be very harmful for them. However, for generally healthy persons with no other pre-existing medical conditions, these diets might be great for weight loss in the short-term. However, there are some serious concerns about low-carb diets, which are highlighted below.

Carbohydrates and Weight Loss — What Should I Eat? Your diet should comprise foods high in complex carbohydrates and �ber which can help control hunger and prolong the feeling of being full.

Everyone, including persons with diabetes, can consume moderate amounts of fruits. Try eating whole fruits rather than drinking sweetened juices.

After a workout, it may actually be helpful to have a meal low in carbohydrates. Some studies found that eating a meal high in carbohydrates resulted in losing many of the bene�ts of the workout. Therefore, it may not be helpful to consume high-carbohydrate foods such as sugary sports drink and sweet energy bars after a workout. Consuming a high carbohydrate meal or snack after exercising is usually only recommended if you are a high-performance athlete.

Here are a few post-workout snack ideas:- 1/2 cup mixed nut trail mix- A smoothie made with milk and a bit of peanut butter- A hardboiled egg- 3/4 cup Greek-style yogurt (low sugar) with 1/2 cup berries- Leafy green salad with 1/2 cup cottage cheese

Who Cannot be Recommended to Follow a Low-Carbohydrate Diet? Aside from persons diagnosed with diabetes, it is harmful to follow a low-carb (and high-protein) diet if you have any of the following conditions:

- Pregnancy- Kidney disorders or kidney damage- High blood pressure - Osteoporosis

1: Loss of Lean Muscle Mass

For those looking to build muscle, a very low carb diet may not be solution, since carbohydrates and protein tend to work together to prevent muscles from becoming depleted during exercise. For those focusing on weight loss, note that the body requires carbohydrates in order to burn body fat. If a low-carb diet is consumed over a period of time, the body eventually uses its own lean muscle mass for energy, leading to weight loss. If there is weight loss resulting from depletion of lean muscle mass from eating a low-carb diet, this can mean that there is a greater chance for cellulite formation. Furthermore, as more muscle mass is lost, the body’s ability to burn fat is also decreased.

Side Effects of Low-Carb Dieting

2: Dangerous side effects for persons just beginning an exercise program

Headaches, nausea, fatigue, and even blackouts are just some of the undesirable e�ects that can be experienced by persons on a low-carb diet who just started out at the gym. Such e�ects are mainly due to very low blood sugar.

3: Concentration and decision-making skillsare impaired

The brain needs carbs to function, and low concentration is another side e�ect of low blood sugar.

4: Excess strain onthe kidneys

A low-carb diet can surpass the normal recommendations for protein intake, which may lead to impaired kidney function.

5: Too much fat and cholesterol

Some of the original versions of popular high protein diets tended to promote consumption of foods higher in fat and cholesterol. Countless scienti�c studies throughout the last decade have documented the negative health e�ects of diets high in total fat and saturated fat and their relation to heart disease.

6: Bone Loss

This can occur when following a low-carb and high protein diet in the long term.

7: Severe Constipation

This problem can arise because of reduced bulk and �bre in the diet.

To �gure out the real nutrition facts versus �ction, please ask your doctor to refer you to a Medical Board Certi�ed nutrition professional.

23 | u

22 | u

NUTRITION | DO CARBOHYDRATES MAKE YOU FAT? DO CARBOHYDRATES MAKE YOU FAT? |NUTRITION

What does “low-carb” or “zero carb” mean? These terms usually refer to diets that contain very little amounts of carbohydrates and higher amounts of protein and fat. A purely low-carb diet, therefore, will be low in vegetables, fruits, starchy and high �bre foods including whole grains, and peas and beans as well. Many popular and commercial “low-carb diets” such as the widely media publicized Atkins Diet™ and similar others are not truly low-carb, because such diets will limit consumption of vegetables, peas and beans. Such diets are often actually selective-carb diets. Complex carbohydrates, �bre and low glycemic index foods are highlighted for consumption in these types of popular diets.

Simple carbohydrates Simple carbohydrates are made of just one or two sugar molecules. They are the quickest source of energy, as they are rapidly digested. Simple carbs can be found in brown sugar, corn syrup, honey, maple syrup, molasses, jams, jellies, soft drinks and candy.

Complex carbohydrates and fibre Complex carbs are made up of a few sugar molecules strung together like a necklace, or branched like a coil. These are found in unre�ned grains, starchy roots (such as ground provisions, e.g. dasheen and sweet potato), starchy fruits (e.g. breadfruit and green banana) and peas and beans. Complex carbohydrates are satisfying and can help with appetite control because they take longer to digest – which means they have less of an immediate impact on blood sugar, causing it to rise more slowly.

Fibre comes from plant foods that contain non-digestible carbohydrates. Eating �bre daily can help promote bowel regularity, lower cholesterol, and maintain normal blood sugar levels. The Institute of Medicine (IOM) recommends that adults should consume between 25 and 35 grams of �bre each day. Examples of high-�bre foods include brown rice, carrots, wheat bran, oatmeal and beans.

The Glyceamic Index (GI) Most carbohydrates, apart from �bre, are ultimately broken down to sugars, but their e�ect on the body’s blood sugar levels varies from food to food. This is largely due to how fast the food can be digested and its sugars absorbed. This is measured on a scale called the Glyceamic Index (GI). This in turn is in�uenced by:

- The type of starch in the carbohydrate- Ripeness of the food- How processed or cooked the food is- Whether there is any fat or �bre accompanying the carbohydrate

According to the Glyceamic Index (GI) theory, the lower the GI number, the slower food is digested, allowing for sugar (glucose) to be delivered more slowly to the bloodstream than with foods having a higher GI number.

Foods that raise blood sugar quickly have a high GI (70 or more) whilst those that raise it slowly have a low GI (55 or less). This is fundamental to planning a healthy diet, especially for people with diabetes or for those looking for healthy weight loss or peak sports performance.

Most scientists agree that more research is needed prior to recommending GI as a measure on which to base dietary recommendations for the general population.

"Low-carb" or "zero-carb" diets are not recommended for persons with diabetes, as they can be very harmful for them. However, for generally healthy persons with no other pre-existing medical conditions, these diets might be great for weight loss in the short-term. However, there are some serious concerns about low-carb diets, which are highlighted below.

Carbohydrates and Weight Loss — What Should I Eat? Your diet should comprise foods high in complex carbohydrates and �ber which can help control hunger and prolong the feeling of being full.

Everyone, including persons with diabetes, can consume moderate amounts of fruits. Try eating whole fruits rather than drinking sweetened juices.

After a workout, it may actually be helpful to have a meal low in carbohydrates. Some studies found that eating a meal high in carbohydrates resulted in losing many of the bene�ts of the workout. Therefore, it may not be helpful to consume high-carbohydrate foods such as sugary sports drink and sweet energy bars after a workout. Consuming a high carbohydrate meal or snack after exercising is usually only recommended if you are a high-performance athlete.

Here are a few post-workout snack ideas:- 1/2 cup mixed nut trail mix- A smoothie made with milk and a bit of peanut butter- A hardboiled egg- 3/4 cup Greek-style yogurt (low sugar) with 1/2 cup berries- Leafy green salad with 1/2 cup cottage cheese

Who Cannot be Recommended to Follow a Low-Carbohydrate Diet? Aside from persons diagnosed with diabetes, it is harmful to follow a low-carb (and high-protein) diet if you have any of the following conditions:

- Pregnancy- Kidney disorders or kidney damage- High blood pressure - Osteoporosis

1: Loss of Lean Muscle Mass

For those looking to build muscle, a very low carb diet may not be solution, since carbohydrates and protein tend to work together to prevent muscles from becoming depleted during exercise. For those focusing on weight loss, note that the body requires carbohydrates in order to burn body fat. If a low-carb diet is consumed over a period of time, the body eventually uses its own lean muscle mass for energy, leading to weight loss. If there is weight loss resulting from depletion of lean muscle mass from eating a low-carb diet, this can mean that there is a greater chance for cellulite formation. Furthermore, as more muscle mass is lost, the body’s ability to burn fat is also decreased.

Side Effects of Low-Carb Dieting

2: Dangerous side effects for persons just beginning an exercise program

Headaches, nausea, fatigue, and even blackouts are just some of the undesirable e�ects that can be experienced by persons on a low-carb diet who just started out at the gym. Such e�ects are mainly due to very low blood sugar.

3: Concentration and decision-making skillsare impaired

The brain needs carbs to function, and low concentration is another side e�ect of low blood sugar.

4: Excess strain onthe kidneys

A low-carb diet can surpass the normal recommendations for protein intake, which may lead to impaired kidney function.

5: Too much fat and cholesterol

Some of the original versions of popular high protein diets tended to promote consumption of foods higher in fat and cholesterol. Countless scienti�c studies throughout the last decade have documented the negative health e�ects of diets high in total fat and saturated fat and their relation to heart disease.

6: Bone Loss

This can occur when following a low-carb and high protein diet in the long term.

7: Severe Constipation

This problem can arise because of reduced bulk and �bre in the diet.

To �gure out the real nutrition facts versus �ction, please ask your doctor to refer you to a Medical Board Certi�ed nutrition professional.

CONDITION | CHILDHOOD OBESITY – A MATTER FOR CONCERN CHILDHOOD OBESITY – A MATTER FOR CONCERN |CONDITION

A Matterfor Concern

25 | u

WRITTEN BY

CLAUDETTE MITCHELL, PH.D., RD Childhood Obesity

CONDITION | CHILDHOOD OBESITY – A MATTER FOR CONCERN CHILDHOOD OBESITY – A MATTER FOR CONCERN |CONDITION

A Matterfor Concern

25 | u

WRITTEN BY

CLAUDETTE MITCHELL, PH.D., RD Childhood Obesity

besity among children is documented in the Health Report Card 2011 of the Ministry of Health, in which they reported that a Caribbean

Food and Nutrition Institute (CFNI) study from 2009–2010 found that 23% of primary school children and 25% from secondary schools were overweight/obese; while 14% of their counterparts were underweight. Overall, in the Caribbean, 3-6% of pre-schoolers are obese. Furthermore, as children get older, the trend of obesity also increases. At the global level, the Center for Disease Control and Prevention in the United States noted 17% of children and adolescents are obese, tripling the rate from just one generation ago. Also, the Surgeon General reported that Type 2 diabetes had increased dramatically in children and adolescents who are overweight/obese, and the risk factors for heart disease, such as high cholesterol and high blood pressure, occur more frequently in this target population with excess weight, compared to those of their peers who had healthy weights.

How do we define obesity?Obesity is generally de�ned using the body mass index (BMI), which is calculated by dividing weight in kilograms by height in meters square. In the case of an adult, a BMI less than 18.5 is classi�ed as underweight, whereas a BMI between 25 to 29 is overweight, and a BMI of 30 and above is obese.

O

27 | u

26 | u

CONDITION | CHILDHOOD OBESITY – A MATTER FOR CONCERN CHILDHOOD OBESITY – A MATTER FOR CONCERN |CONDITION

societal trendsFor the purposes of this article, the BMI Classi�cation for children is:• Underweight ≤ 5th percentile• Healthy weight 5th to 85th percentile• Overweight 85th to 95th percentile• Obese ≥ 95th percentile• BMI for Age Percentile (2 – 19 years)(The Surgeon General’s Vision for a Fit and Healthy Nation, 2010)

What is the cause of the problem?The cause of childhood obesity can be described as multifactorial. There are several contributing factors, for example, unhealthy eating patterns (e.g., eating large portions, consuming foods high in calories, and rich in fat and sugar), physical inactivity, lack of nutrition knowledge among parents/guardians and caregivers, societal trends, socioeconomic status, media marketing, genetics, the environment, and much more. A combination of these aforementioned factors can negatively impact the nutrition status of children and adolescents and, as such, increase their risk for chronic diseases.

A different approachGiven the aforementioned factors, you may be thinking: how can we do a few things di¢erently? Here are some recommendations:

For families• Involve children in meal planning and grocery shopping.• Promote regular physical activity programs in

schools, communities, and the workplace.• Encourage parents to participate with children in physical activity to build a buddy system support network.• Provide behavioural counselling and nutrition

education for parents and children.• Explain the health bene�ts gained by consuming

fruits, veggies, whole grains, legumes, nuts, and ground provisions.

• Develop focus groups with parents, and provide instructions in meal planning and food preparation to encourage more home-cooked meals.

• Prepare foods using cooking methods of such as baking, roasting, steaming, grilling, and boiling.

• Eat fried foods and concentrated sweets (cakes, cookies, and candies) sparingly.

• Drink water in plain or ¥avoured forms; limit sweetened beverages.

For others• Manufacturers should state nutrition facts – serving

size, amount of calories, and total fat for the food items served.

• Parents/caregivers, restaurant managers and communities can work together to provide more healthy o¢erings.

• Encourage collaboration among government o§cials in the region to review and update nutrition policies.

UNHEALTHY EATING PATTERNSPHYSICAL INACTIVITY,

lack of nutrition knowledgegeneticsmedia marketing

drink more water

positive Reinforcement

physical activityinvolveMENT in food prepArationproper eating

socioeconomic status

Taking a closer look at some of these significant factors

Dietary intake Food usually add joy and pleasure, and is most appreciated in social gatherings. Mealtimes are happy times and most children look forward to sharing a meal with family and friends at the table. However, the food choices the family makes can re¥ect positively or negatively in dietary habits that the child will later adopt. For example, the selection of fried and greasy foods and concentrated sweets have a higher caloric content and contain more fat and sugar, providing excess calories.

Moreover, Henry (2004) stated that the excess availability of calories helped in the rapid decline of under-nutrition, but, on the other hand, has contributed to the indiscriminate consumption of high energy foods among the Caribbean population.

Another issue is that children and adolescents are consuming a number of meals, snacks and sweetened beverages outside of the home, and show a preference for foods sold at the fast food restaurants. Hence, to bring about a resolution, parents/caregivers, schools, businesses and communities can work together to promote the selection of more nutritious foods.

Physical inactivityThe involvement of children and adolescents in video and computer games, spending long hours viewing television and using hand-held devices takes away from play or exercise programs. “Get moving” is an essential component of behaviour modi�cation. Physical activity helps in the control or management of weight, strengthens bones and muscles, decreases risk for chronic diseases, and improves mood and overall well-being. Household surveys of adults conducted by CFNI in three countries evaluating physical activity within a 24 hour period found that in Trinidad, Jamaica and Guyana, 39%, 38%,

and 56% of adults, respectively, participated in sedentary activities, while only a small percentage of the population from these countries were involved in strenuous activities. Overall, they noted that a large proportion of the Caribbean population performed sedentary activities, and suggested the need for urgent plans to encourage greater participation in planned exercise programmes.

Moreover, the Center for Disease Control and Prevention listed guidelines for physical activity: children or adolescents should do 60 minutes of physical activity each day. Encourage them to participate in activities that are age appropriate, enjoyable, and o¢er variety; some examples are aerobic activity – brisk walking, running; muscle strengthening – gymnastics, push-ups; bone strengthening – jumping rope or running for at least three days weekly.

The lack of nutrition knowledgeNutrition information on good sources of nutrients, understanding food labels and incorporating foods from the six food groups can help individuals have a more balanced diet. If this vital information is lacking, poor food choices over a period of time will impact one’s nutritional status.

The amount of money availableMoney, or lack thereof, can in¥uence the nutritional quality of the product selected, type, amount, and the price families can pay. This of course, may control diet quality and, by extension, the number of meals available in the household.

Media marketingAdvertisements can make a huge impact on food preferences in the young population. The many techniques used such as television advertising, internet marketing and sales promotion appeal to consumers; taking this into consideration, food choices may be sometimes made based on media messaging.

besity among children is documented in the Health Report Card 2011 of the Ministry of Health, in which they reported that a Caribbean

Food and Nutrition Institute (CFNI) study from 2009–2010 found that 23% of primary school children and 25% from secondary schools were overweight/obese; while 14% of their counterparts were underweight. Overall, in the Caribbean, 3-6% of pre-schoolers are obese. Furthermore, as children get older, the trend of obesity also increases. At the global level, the Center for Disease Control and Prevention in the United States noted 17% of children and adolescents are obese, tripling the rate from just one generation ago. Also, the Surgeon General reported that Type 2 diabetes had increased dramatically in children and adolescents who are overweight/obese, and the risk factors for heart disease, such as high cholesterol and high blood pressure, occur more frequently in this target population with excess weight, compared to those of their peers who had healthy weights.

How do we define obesity?Obesity is generally de�ned using the body mass index (BMI), which is calculated by dividing weight in kilograms by height in meters square. In the case of an adult, a BMI less than 18.5 is classi�ed as underweight, whereas a BMI between 25 to 29 is overweight, and a BMI of 30 and above is obese.

O

27 | u

26 | u

CONDITION | CHILDHOOD OBESITY – A MATTER FOR CONCERN CHILDHOOD OBESITY – A MATTER FOR CONCERN |CONDITION

societal trendsFor the purposes of this article, the BMI Classi�cation for children is:• Underweight ≤ 5th percentile• Healthy weight 5th to 85th percentile• Overweight 85th to 95th percentile• Obese ≥ 95th percentile• BMI for Age Percentile (2 – 19 years)(The Surgeon General’s Vision for a Fit and Healthy Nation, 2010)

What is the cause of the problem?The cause of childhood obesity can be described as multifactorial. There are several contributing factors, for example, unhealthy eating patterns (e.g., eating large portions, consuming foods high in calories, and rich in fat and sugar), physical inactivity, lack of nutrition knowledge among parents/guardians and caregivers, societal trends, socioeconomic status, media marketing, genetics, the environment, and much more. A combination of these aforementioned factors can negatively impact the nutrition status of children and adolescents and, as such, increase their risk for chronic diseases.

A different approachGiven the aforementioned factors, you may be thinking: how can we do a few things di¢erently? Here are some recommendations:

For families• Involve children in meal planning and grocery shopping.• Promote regular physical activity programs in

schools, communities, and the workplace.• Encourage parents to participate with children in physical activity to build a buddy system support network.• Provide behavioural counselling and nutrition

education for parents and children.• Explain the health bene�ts gained by consuming

fruits, veggies, whole grains, legumes, nuts, and ground provisions.

• Develop focus groups with parents, and provide instructions in meal planning and food preparation to encourage more home-cooked meals.

• Prepare foods using cooking methods of such as baking, roasting, steaming, grilling, and boiling.

• Eat fried foods and concentrated sweets (cakes, cookies, and candies) sparingly.

• Drink water in plain or ¥avoured forms; limit sweetened beverages.

For others• Manufacturers should state nutrition facts – serving

size, amount of calories, and total fat for the food items served.

• Parents/caregivers, restaurant managers and communities can work together to provide more healthy o¢erings.

• Encourage collaboration among government o§cials in the region to review and update nutrition policies.

UNHEALTHY EATING PATTERNSPHYSICAL INACTIVITY,

lack of nutrition knowledgegeneticsmedia marketing

drink more water

positive Reinforcement

physical activityinvolveMENT in food prepArationproper eating

socioeconomic status

Taking a closer look at some of these significant factors

Dietary intake Food usually add joy and pleasure, and is most appreciated in social gatherings. Mealtimes are happy times and most children look forward to sharing a meal with family and friends at the table. However, the food choices the family makes can re¥ect positively or negatively in dietary habits that the child will later adopt. For example, the selection of fried and greasy foods and concentrated sweets have a higher caloric content and contain more fat and sugar, providing excess calories.

Moreover, Henry (2004) stated that the excess availability of calories helped in the rapid decline of under-nutrition, but, on the other hand, has contributed to the indiscriminate consumption of high energy foods among the Caribbean population.

Another issue is that children and adolescents are consuming a number of meals, snacks and sweetened beverages outside of the home, and show a preference for foods sold at the fast food restaurants. Hence, to bring about a resolution, parents/caregivers, schools, businesses and communities can work together to promote the selection of more nutritious foods.

Physical inactivityThe involvement of children and adolescents in video and computer games, spending long hours viewing television and using hand-held devices takes away from play or exercise programs. “Get moving” is an essential component of behaviour modi�cation. Physical activity helps in the control or management of weight, strengthens bones and muscles, decreases risk for chronic diseases, and improves mood and overall well-being. Household surveys of adults conducted by CFNI in three countries evaluating physical activity within a 24 hour period found that in Trinidad, Jamaica and Guyana, 39%, 38%,

and 56% of adults, respectively, participated in sedentary activities, while only a small percentage of the population from these countries were involved in strenuous activities. Overall, they noted that a large proportion of the Caribbean population performed sedentary activities, and suggested the need for urgent plans to encourage greater participation in planned exercise programmes.

Moreover, the Center for Disease Control and Prevention listed guidelines for physical activity: children or adolescents should do 60 minutes of physical activity each day. Encourage them to participate in activities that are age appropriate, enjoyable, and o¢er variety; some examples are aerobic activity – brisk walking, running; muscle strengthening – gymnastics, push-ups; bone strengthening – jumping rope or running for at least three days weekly.

The lack of nutrition knowledgeNutrition information on good sources of nutrients, understanding food labels and incorporating foods from the six food groups can help individuals have a more balanced diet. If this vital information is lacking, poor food choices over a period of time will impact one’s nutritional status.

The amount of money availableMoney, or lack thereof, can in¥uence the nutritional quality of the product selected, type, amount, and the price families can pay. This of course, may control diet quality and, by extension, the number of meals available in the household.

Media marketingAdvertisements can make a huge impact on food preferences in the young population. The many techniques used such as television advertising, internet marketing and sales promotion appeal to consumers; taking this into consideration, food choices may be sometimes made based on media messaging.

PAEDIATRICS |PLAY PLAY |PAEDIATRICS

THE LOVE OF PLAY, WHETHER IN CHILDREN OR ADULTS, SEEMS TO BE HARD WIRED INTO OUR BRAINS. IN THE WEST INDIES, HOWEVER, AS IN MOST UNDERDEVELOPED COUNTRIES, MANY ADULTS BELIEVE THAT PLAY IS WASTEFUL.

WRITTEN BY DR. DAVID BRATT (MD,MPH,CMT)

CHILDREN EVERYWHERE LOVE TO PLAY.

29 | u

PAEDIATRICS |PLAY PLAY |PAEDIATRICS

THE LOVE OF PLAY, WHETHER IN CHILDREN OR ADULTS, SEEMS TO BE HARD WIRED INTO OUR BRAINS. IN THE WEST INDIES, HOWEVER, AS IN MOST UNDERDEVELOPED COUNTRIES, MANY ADULTS BELIEVE THAT PLAY IS WASTEFUL.

WRITTEN BY DR. DAVID BRATT (MD,MPH,CMT)

CHILDREN EVERYWHERE LOVE TO PLAY.

29 | u

dults should work! We have quite a guilt complex about play

which says that adults should not enjoy their work. If you enjoy your work, you are playing, and play is bad. If you enjoy work, you are being a child. Play is reserved for the moments when we go out to enjoy ourselves, as for example when we “play Mas”. Or, for people who are not serious about themselves, as in “playing the fool”.

We try to teach our children this adult attitude. “Grow up; you too playful”. But children are not easily fooled. Children are wonderful readers of body language and easily see through our words. They realise that we do not mean what we say. In addition, children understand instinctively what we, in our rush to be considered adults, have forgotten: that to be able to learn anything, you must enjoy what you are doing. To be happy in your job, you must enjoy your work. You must make your work, play. In fact, for children, play is both work and play! Play is the way children make sense of the world, the way they learn to be mature, con�dent adults. Watch them at play. Most of the time, they are imitating you. That is what all children want to become, big people like Mummy and Daddy! Play does more than make children happy and grow up healthy. Play helps children to develop motor and language skills and self-confidence that they need to become adults. Play helps them to develop creative and enquiring minds. Through play they learn to interact socially with other children and develop support systems. Play is how children learn to live with others, where they �t in to the grand scheme of things. Play is how they learn to survive in this mad world.

The best schools allow children to play, inside and outside the classroom. Because that is the best way — in fact, the only way — for children to learn. Practical experience on the job as well as

innumerable studies attest to this fact. That’s why no matter what “serious adults” try, children turn everything into a game. Of course, some degree of control needs to be maintained by the teacher. That is not an easy task. It is much easier to shout and insist the children sit down at a desk and learn their multiplication tables by rote. But anyone who thinks that kids should be "studying" at age 5 and not playing knows nothing about the way children learn.

Play also helps sick children recover more quickly from illness,

because it increases the secretion of anti-anxiety hormones like oxytocin, and decreases stress hormones like cortisol. Chronic stress causes increased cortisol secretion and dampens the immune cells’ ability to �ght infection. It prolongs wound healing, decreases response to vaccines, and increases the frequency and severity of upper respiratory infections. Sick children need to be encouraged to play.

I’ve been bothered for some time by parents who believe that I spend too much time “playing” with their children. Apparently they believe that coming to the doctor is such serious business that no one should enjoy themselves. Everyone must look glum. The child must shut up and stay quiet. The parents must look concerned and the doctor must look caring.

I remember thinking, when I was a little boy going to doctors, that if I ever became a doctor, my o�ce would be bright and alive with sunshine, toys and laughter. Doctors frightened me. They looked so gloomy, dressed the same and had sad faces. Their o�ces were tiny, cramped and smelled of alcohol. I am still perturbed when someone tells me that my o�ce smells of alcohol. It shouldn’t. It should be a place where children, even sick ones, feel comfortable and able to play, if they so want, not only in the waiting room but in the examining o�ce or consulting room itself.

Playing with a child, especially a sick child, is the only way for the doctor to examine a child. By playing with the child, the smart doctor makes the child relax and behave more like a healthy child. Children can change from looking sick as they come into the o�ce, to looking well within a few minutes, simply because the doctor begins to “play” with the child. Play also gives the child the opportunity to retain control of the situation in the o�ce and this is immensely satisfying to the child.

Play makes it easier for the doctor to examine the child. On one hand, the relaxed child will allow a more formal examination. On the other, it is impossible to examine some parts of the child without play. The only way to examine a child’s neurological system is by playing with the child. When I throw a ball for a child to catch, I am not pleasing myself. I am examining that child’s eyesight, muscle tone and coordination. I am also looking at the child’s face to see the child’s reaction: thrilled; scared; paralyzed? Play is the way the doctor learns what the child is really feeling at the moment of the examination. It is also the way he learns about the child’s behaviour, his likes and dislikes, his attention to detail, his concentration, and a whole host of other factors.

Society should be encouraging parents and other family members to develop play activities for children. Play does not need to be sophisticated. Simple play activities help develop a child’s language and motor skills. Things like singing along with songs heard on the radio; continually talking to the child by describing all the activities you are going to do; teaching action words with activities such as “bang bang” as he beats a drum or, “bye bye” as he waves; bouncing the child up and down while supporting the child well; encouraging the child to crawl after toys on the �oor and holding the child’s hand and helping him to walk. Fortunately, we still do many of these things instinctively in the Caribbean.

Children do not need toys to play. The best “toy” is actually you! Children love to play with people. You should not buy expensive toys for children. Most expensive toys are made for parents, not for children. The simpler the toy, the more the child has to use his imagination. This is where the fun is: cheap simple toys like a brightly coloured ball to bounce with daddy; a large, empty cardboard box that can become, with imagination, a car or a truck or a plane, and lots of old pots and pans to endlessly pack and repack.

You can also make your own toys. A rattle, by cutting strips from coloured plastic bottles and placing them in a small clear plastic bottle and gluing the top �rmly on. A drum can be any tin with a tightly �tting lid. A doll can be made by cutting out two doll shapes from a piece of cloth and stitching them together. Leave a small opening and stu� the doll with scraps of material through the opening. Sew up the opening and either draw or sew on a face. You can even make your own books by cutting out four small pages from a piece of cardboard and gluing a picture on each page.

You might be surprised at how much fun you will have making these toys and playing with them and the children. Unlike modern games, which are invariably discarded once their secrets have been discovered, these toys have endless appeal. They

will be used over and over again. Their secret lies in their simplicity, which encourages children and adults to use their imagination to make up exciting games and discover new joys.

Real play is imagination and imagination is total play. In watching your child play and learn so easily, perhaps you will rediscover the magic of those long-ago Christmas mornings when you instinctively knew that to do something well, you had to enjoy doing it.

PAEDIATRICS |PLAY PLAY |PAEDIATRICS

APlay is the waychildren make sense of the world, the way they learn to be mature,confident adults.

31 | u

30 | u

dults should work! We have quite a guilt complex about play

which says that adults should not enjoy their work. If you enjoy your work, you are playing, and play is bad. If you enjoy work, you are being a child. Play is reserved for the moments when we go out to enjoy ourselves, as for example when we “play Mas”. Or, for people who are not serious about themselves, as in “playing the fool”.

We try to teach our children this adult attitude. “Grow up; you too playful”. But children are not easily fooled. Children are wonderful readers of body language and easily see through our words. They realise that we do not mean what we say. In addition, children understand instinctively what we, in our rush to be considered adults, have forgotten: that to be able to learn anything, you must enjoy what you are doing. To be happy in your job, you must enjoy your work. You must make your work, play. In fact, for children, play is both work and play! Play is the way children make sense of the world, the way they learn to be mature, con�dent adults. Watch them at play. Most of the time, they are imitating you. That is what all children want to become, big people like Mummy and Daddy! Play does more than make children happy and grow up healthy. Play helps children to develop motor and language skills and self-confidence that they need to become adults. Play helps them to develop creative and enquiring minds. Through play they learn to interact socially with other children and develop support systems. Play is how children learn to live with others, where they �t in to the grand scheme of things. Play is how they learn to survive in this mad world.

The best schools allow children to play, inside and outside the classroom. Because that is the best way — in fact, the only way — for children to learn. Practical experience on the job as well as

innumerable studies attest to this fact. That’s why no matter what “serious adults” try, children turn everything into a game. Of course, some degree of control needs to be maintained by the teacher. That is not an easy task. It is much easier to shout and insist the children sit down at a desk and learn their multiplication tables by rote. But anyone who thinks that kids should be "studying" at age 5 and not playing knows nothing about the way children learn.

Play also helps sick children recover more quickly from illness,

because it increases the secretion of anti-anxiety hormones like oxytocin, and decreases stress hormones like cortisol. Chronic stress causes increased cortisol secretion and dampens the immune cells’ ability to �ght infection. It prolongs wound healing, decreases response to vaccines, and increases the frequency and severity of upper respiratory infections. Sick children need to be encouraged to play.

I’ve been bothered for some time by parents who believe that I spend too much time “playing” with their children. Apparently they believe that coming to the doctor is such serious business that no one should enjoy themselves. Everyone must look glum. The child must shut up and stay quiet. The parents must look concerned and the doctor must look caring.

I remember thinking, when I was a little boy going to doctors, that if I ever became a doctor, my o�ce would be bright and alive with sunshine, toys and laughter. Doctors frightened me. They looked so gloomy, dressed the same and had sad faces. Their o�ces were tiny, cramped and smelled of alcohol. I am still perturbed when someone tells me that my o�ce smells of alcohol. It shouldn’t. It should be a place where children, even sick ones, feel comfortable and able to play, if they so want, not only in the waiting room but in the examining o�ce or consulting room itself.

Playing with a child, especially a sick child, is the only way for the doctor to examine a child. By playing with the child, the smart doctor makes the child relax and behave more like a healthy child. Children can change from looking sick as they come into the o�ce, to looking well within a few minutes, simply because the doctor begins to “play” with the child. Play also gives the child the opportunity to retain control of the situation in the o�ce and this is immensely satisfying to the child.

Play makes it easier for the doctor to examine the child. On one hand, the relaxed child will allow a more formal examination. On the other, it is impossible to examine some parts of the child without play. The only way to examine a child’s neurological system is by playing with the child. When I throw a ball for a child to catch, I am not pleasing myself. I am examining that child’s eyesight, muscle tone and coordination. I am also looking at the child’s face to see the child’s reaction: thrilled; scared; paralyzed? Play is the way the doctor learns what the child is really feeling at the moment of the examination. It is also the way he learns about the child’s behaviour, his likes and dislikes, his attention to detail, his concentration, and a whole host of other factors.

Society should be encouraging parents and other family members to develop play activities for children. Play does not need to be sophisticated. Simple play activities help develop a child’s language and motor skills. Things like singing along with songs heard on the radio; continually talking to the child by describing all the activities you are going to do; teaching action words with activities such as “bang bang” as he beats a drum or, “bye bye” as he waves; bouncing the child up and down while supporting the child well; encouraging the child to crawl after toys on the �oor and holding the child’s hand and helping him to walk. Fortunately, we still do many of these things instinctively in the Caribbean.

Children do not need toys to play. The best “toy” is actually you! Children love to play with people. You should not buy expensive toys for children. Most expensive toys are made for parents, not for children. The simpler the toy, the more the child has to use his imagination. This is where the fun is: cheap simple toys like a brightly coloured ball to bounce with daddy; a large, empty cardboard box that can become, with imagination, a car or a truck or a plane, and lots of old pots and pans to endlessly pack and repack.

You can also make your own toys. A rattle, by cutting strips from coloured plastic bottles and placing them in a small clear plastic bottle and gluing the top �rmly on. A drum can be any tin with a tightly �tting lid. A doll can be made by cutting out two doll shapes from a piece of cloth and stitching them together. Leave a small opening and stu� the doll with scraps of material through the opening. Sew up the opening and either draw or sew on a face. You can even make your own books by cutting out four small pages from a piece of cardboard and gluing a picture on each page.

You might be surprised at how much fun you will have making these toys and playing with them and the children. Unlike modern games, which are invariably discarded once their secrets have been discovered, these toys have endless appeal. They

will be used over and over again. Their secret lies in their simplicity, which encourages children and adults to use their imagination to make up exciting games and discover new joys.

Real play is imagination and imagination is total play. In watching your child play and learn so easily, perhaps you will rediscover the magic of those long-ago Christmas mornings when you instinctively knew that to do something well, you had to enjoy doing it.

PAEDIATRICS |PLAY PLAY |PAEDIATRICS

APlay is the waychildren make sense of the world, the way they learn to be mature,confident adults.

31 | u

30 | u

First, she lifts one knee, and then the other. Then she moves her ankles, and then her wrists. It's difficult for her because her joints are painful with arthritis and she needs someone to manipulate them. Bella has had arthritis for 18 months

now. She can't walk very far and she needs painkillers

every day, plus an injection once a week at the local hospital.

children get

I AM WATCHING BELLA DOING HER EXERCISES.

33 | u

arthritis, too!WRITTEN BY DAVID FENTON

DISORDER | CHILDREN GET ARTHRITIS, TOO! CHILDREN GET ARTHRITIS, TOO! |DISORDER

First, she lifts one knee, and then the other. Then she moves her ankles, and then her wrists. It's difficult for her because her joints are painful with arthritis and she needs someone to manipulate them. Bella has had arthritis for 18 months

now. She can't walk very far and she needs painkillers

every day, plus an injection once a week at the local hospital.

children get

I AM WATCHING BELLA DOING HER EXERCISES.

33 | u

arthritis, too!WRITTEN BY DAVID FENTON

DISORDER | CHILDREN GET ARTHRITIS, TOO! CHILDREN GET ARTHRITIS, TOO! |DISORDER

t's a common enough ailment, especially among the elderly. But what makes this scene so extraordinary is that Bella is just three years old.

Many people have no idea that children — even infants — can get develop arthritis, which is not a disease in itself, but a symptom of a cluster of diseases, such as juvenile rheumatoid arthritis in children, or osteoarthritis in the elderly. But they can, and it's not unusual. It a�ects one in a thousand children in the UK — that's more than su�er from childhood diabetes. And no one knows what causes it. The sad fact is that many of these youngsters can go for years without ever being properly diagnosed or without receiving the basic treatment that could help them. The reason is often that people — including many healthcare professionals — simply don't expect children to get what many consider an “old person's” condition.

Sitting in the front room of Bella's house, watching her mother Gabby manipulating the swollen joints, I heard the story of how arthritis has dramatically changed the life of this little child. Gabby knew something was wrong with her daughter when she saw her struggling to walk at about 18 months old. She was clearly in pain, but also very determined.

"She would literally keep trying to walk until the pain was too much,” she said. “One time, she got down on her hands and knees and tried to cross

a car park because she did not want to give up and admit that she was in pain — but the pain was obvious.”

Bella is one of more than 150 children currently being cared for by a specialist team at Southampton General Hospital in southern England. The team takes referrals from all across the south coast, an area roughly three times the size of Trinidad, with about eight million people living in it.

Over the past four years, referrals to the unit have gone up by more than 300%. There are now 1,000 appointments a year for children aged from just 12 months to teenagers. One of the big problems these children face is not being diagnosed quickly enough by their local doctors. Sarah Hartfree, the Paediatric Rheumatology nurse who looks after them, is trying to change that.

“If you know what you are looking for, then the symptoms of childhood arthritis are easy to see,” she told me. “But often they can be confused with other

things — especially in young children.

“Doctors see all sorts of problems with youngsters: sprains,

bruises, bumps … and most of them heal themselves

or just go away. But arthritis isn't like that. It won't go away, and it can be very nasty if it's left untreated.

35 | u

34 | u

I

The reason is often that people, including many healthcare professionals, simply don't

expect children to get this old

person's condition.

...and for many it's the big unanswered question... WILL MY CHILD EVER GET BETTER

“One of the biggest problems is a condition called Uveitis, which is part of a larger in�ammatory disorder. This is potentially very serious and can even cause blindness, so it's vital these children are picked up early.” To raise awareness of the condition, Sarah got her children to paint pictures describing what the condition meant to them. Those paintings have now gone on display at a public art gallery and I went along to see them. They don't make easy viewing.

The opening day of the exhibition was attended by about twenty families, all with young children who have the condition. The paintings they had made showed how they really felt about their arthritis. Some had painted limbs with big crosses over them, or needles stuck into knees, or words like Fear, Pain and Hopelessness.

“They are very sad pictures,” said Sarah. “And I think they tell a true story. You can read all the facts in a textbook, but that doesn't show you the reality of the disease; these pictures really do that.” But the fact is there are many e�ective treatments available for childhood arthritis, especially if it is caught early.

At the specialist unit where many of these children are cared for, they often give steroid injections into the joints. Because of the young age of the children, these have to be done in an operating theatre under general anaesthetic. Some children need ten or twelve injections, depending on how many joints are a�ected. One child needed twenty-four injections: in several digits in every �nger and thumb, plus injections in the knees and in the wrists.

But once they have been done, relief is quick and relatively long lasting. The children are able to move freely after just a few days and the e�ects can last for up to nine months. For the more serious cases, biologic drugs are needed. Some of these are basically cancer drugs, and no one really knows the mechanism by which they work on childhood arthritis, except that they a�ect the cells known to be part of the condition. The children take a course over 12 weeks, although this can cause temporary problems for their immune systems. At the moment, 65 out of 100 children at the centre are on these drugs. Most will take them for at least two years. Some will be on them for the rest of their lives.

The sad fact is that the arthritis will not always leave these children when they progress to adulthood. Some simply seem to grow out of it in their teenage years. For others, it never goes. That can be a very di¡cult thing to accept for any parent, and for many it's the big unanswered question: Will my child ever get better?

Looking at Bella, a bright and pretty little three-year-old, it's di¡cult to think that she may be burdened with this condition for life. But in the 18 months that she's been getting treatment, she has come a long way. She's walking farther than she's ever done, and she seems in much less pain.

It'll be a long road ahead for both Bella and her mother, but who knows what advances science and medicine may bring to the treatment of this di¡cult and often overlooked illness.

?

DISORDER | CHILDREN GET ARTHRITIS, TOO! CHILDREN GET ARTHRITIS, TOO! |DISORDER

t's a common enough ailment, especially among the elderly. But what makes this scene so extraordinary is that Bella is just three years old.

Many people have no idea that children — even infants — can get develop arthritis, which is not a disease in itself, but a symptom of a cluster of diseases, such as juvenile rheumatoid arthritis in children, or osteoarthritis in the elderly. But they can, and it's not unusual. It a�ects one in a thousand children in the UK — that's more than su�er from childhood diabetes. And no one knows what causes it. The sad fact is that many of these youngsters can go for years without ever being properly diagnosed or without receiving the basic treatment that could help them. The reason is often that people — including many healthcare professionals — simply don't expect children to get what many consider an “old person's” condition.

Sitting in the front room of Bella's house, watching her mother Gabby manipulating the swollen joints, I heard the story of how arthritis has dramatically changed the life of this little child. Gabby knew something was wrong with her daughter when she saw her struggling to walk at about 18 months old. She was clearly in pain, but also very determined.

"She would literally keep trying to walk until the pain was too much,” she said. “One time, she got down on her hands and knees and tried to cross

a car park because she did not want to give up and admit that she was in pain — but the pain was obvious.”

Bella is one of more than 150 children currently being cared for by a specialist team at Southampton General Hospital in southern England. The team takes referrals from all across the south coast, an area roughly three times the size of Trinidad, with about eight million people living in it.

Over the past four years, referrals to the unit have gone up by more than 300%. There are now 1,000 appointments a year for children aged from just 12 months to teenagers. One of the big problems these children face is not being diagnosed quickly enough by their local doctors. Sarah Hartfree, the Paediatric Rheumatology nurse who looks after them, is trying to change that.

“If you know what you are looking for, then the symptoms of childhood arthritis are easy to see,” she told me. “But often they can be confused with other

things — especially in young children.

“Doctors see all sorts of problems with youngsters: sprains,

bruises, bumps … and most of them heal themselves

or just go away. But arthritis isn't like that. It won't go away, and it can be very nasty if it's left untreated.

35 | u

34 | u

I

The reason is often that people, including many healthcare professionals, simply don't

expect children to get this old

person's condition.

...and for many it's the big unanswered question... WILL MY CHILD EVER GET BETTER

“One of the biggest problems is a condition called Uveitis, which is part of a larger in�ammatory disorder. This is potentially very serious and can even cause blindness, so it's vital these children are picked up early.” To raise awareness of the condition, Sarah got her children to paint pictures describing what the condition meant to them. Those paintings have now gone on display at a public art gallery and I went along to see them. They don't make easy viewing.

The opening day of the exhibition was attended by about twenty families, all with young children who have the condition. The paintings they had made showed how they really felt about their arthritis. Some had painted limbs with big crosses over them, or needles stuck into knees, or words like Fear, Pain and Hopelessness.

“They are very sad pictures,” said Sarah. “And I think they tell a true story. You can read all the facts in a textbook, but that doesn't show you the reality of the disease; these pictures really do that.” But the fact is there are many e�ective treatments available for childhood arthritis, especially if it is caught early.

At the specialist unit where many of these children are cared for, they often give steroid injections into the joints. Because of the young age of the children, these have to be done in an operating theatre under general anaesthetic. Some children need ten or twelve injections, depending on how many joints are a�ected. One child needed twenty-four injections: in several digits in every �nger and thumb, plus injections in the knees and in the wrists.

But once they have been done, relief is quick and relatively long lasting. The children are able to move freely after just a few days and the e�ects can last for up to nine months. For the more serious cases, biologic drugs are needed. Some of these are basically cancer drugs, and no one really knows the mechanism by which they work on childhood arthritis, except that they a�ect the cells known to be part of the condition. The children take a course over 12 weeks, although this can cause temporary problems for their immune systems. At the moment, 65 out of 100 children at the centre are on these drugs. Most will take them for at least two years. Some will be on them for the rest of their lives.

The sad fact is that the arthritis will not always leave these children when they progress to adulthood. Some simply seem to grow out of it in their teenage years. For others, it never goes. That can be a very di¡cult thing to accept for any parent, and for many it's the big unanswered question: Will my child ever get better?

Looking at Bella, a bright and pretty little three-year-old, it's di¡cult to think that she may be burdened with this condition for life. But in the 18 months that she's been getting treatment, she has come a long way. She's walking farther than she's ever done, and she seems in much less pain.

It'll be a long road ahead for both Bella and her mother, but who knows what advances science and medicine may bring to the treatment of this di¡cult and often overlooked illness.

?

DISORDER | CHILDREN GET ARTHRITIS, TOO! CHILDREN GET ARTHRITIS, TOO! |DISORDER

AFRUIT | SUGAR APPLE SUGAR APPLE |FRUIT

37 | u

36 | u

According to the information supplied by the Research Division of the Ministry of Food Production at Centeno, Trinidad, the following is the nutritional content of the delicious sugar apple (values are expressed per 100g):

This round to conical fruit, 5–10 cm (2.0–3.9 in) in diameter, 6–10 cm (2.4–3.9 in) long, and weighing 100–240 g (3.5–8.5 oz), with a thick rind composed of knobby segments, is a favourite among the many edible fruits found throughout the Caribbean. The sugar apple tree is relatively short, and its �esh is fragrant and sweet, juicy, creamy white to light yellow, and resembles and tastes like custard. It is soft, slightly grainy, and slippery. The hard, shiny seeds may number 20 or more per fruit, and have a brown to black coat.

The ripe sugar apple is usually broken open and the �esh segments enjoyed while the hard seeds are separated in the mouth and spat out. It is so luscious that it is well worth the trouble. After removal of the visible seeds, the �esh can be pressed through a sieve to eliminate any remaining seeds and is then added to ice cream or blended with milk to make a cool beverage, but most times the eager subject tends to guzzle it as is. Documented usage and bene�ts of the various species around the world: The seed kernels contain 14–49% of whitish or yellowish, non-drying oil.

It has been proposed as a substitute for peanut oil in the manufacture of soap, and can be detoxi�ed by an alkali treatment and used for edible purposes. The leaves yield an excellent oil, which �nds limited use in perfumes, giving a woody, spicy accent. Fiber extracted from the bark has been employed for cordage. The crushed leaves are sni�ed to overcome hysteria and fainting spells; they are also applied on ulcers and wounds and a leaf decoction is taken in cases of dysentery. Throughout tropical America, a decoction of the leaves alone or with those of other plants is imbibed as a tonic, cold remedy, or digestive. The leaf decoction is also employed in baths to alleviate rheumatic pain. The green fruit, very astringent, is employed against diarrhea; the crushed ripe fruit, mixed with salt, is applied on tumors. The bark and roots are both highly astringent. The bark decoction is given as a tonic and to halt diarrhea. A paste made from the �esh and used as a balm is said to treat abscesses, boils and ulcers. The �esh can be sun-dried and ground into a powder which can be used to treat dysentery and diarrhea. Though there is no solid scienti�c data, many believe that the fruit act as a stimulant, “coolant” and expectorant, and is good for treating anemia.

Sugar apples are a good source of vitamin C, which provides the body with healthy anti-oxidants to prevent unnecessary oxidation reactions. It is recommended for lowering cholesterol levels as it contains niacin, which helps in increasing your good cholesterol.

Even though its availability and supply in Trinidad and Tobago have been hampered in recent years by serious insect pests

such as fruit �ies, mealy bugs, and, most importantly, the seed-boring weevil, the sugar apple makes for one of the most delicious fruits. These pests, especially the seed-boring weevil,

have signi�cantly reduced the popularity of the fruit as a backyard tree. However, both St. Vincent and Grenada are free of this pest, and can supply other Caribbean countries with the fruit when in season. On Gasparee Island, o� the north-western coast of Trinidad, on the uninhabited parts,

you’ll �nd many sugar apple trees growing wild.

SUGAR APPLE

Nutrition Facts

Amount per serving

Calcium 28 mg Iron 1.8 mg

Thiamin 0.11 mg Riboflavin 0.15 mg

Niacin 0.9 mg Vitamin C 35

Serving Size : 100 g

WRITTEN BY NASSER KHAN

Grow your own sugar apple tree

at home

Choose a heavy container (bore drainage holes) that is wider than deep to accommodate the sugar apple tree’s shallow roots. Plant the tree in a mixture of potting soil and shredded bark, which provides excellent drainage, as it does not survive wet soil.

Place the container in an area with full sun exposure and protection from wind.

Prune about a third of last year’s growth away with hand pruners around April of each year. Sugar apple trees can be kept at 8 to 12 feet tall with pruning. Cut back extra long branches and trim the ends of other branches to obtain the desired shape.

Pour water into the top of the container until it runs out the bottom. Water the tree every week or whenever the soil starts to dry out while the tree is actively growing.

Feed every eight weeks with water-soluble fertilizer designed for fruit trees.

Pick the fruit when the white, yellow or red tint appears between the rind segments. The �avor is best when the fruit is picked while it is full but has not started to ripen. Place it in a paper bag to ripen the rest of the way. If the fruit is picked too early, it turns black and dries out. If the fruit ripens on the tree, it falls apart.

The Sugar Apple is the most widely grown of all the species of

Annona (Annona squamosa). Its relative, the custard apple, is

Annona reticulata. In most places in the Caribbean it is called

sugar apple, but in Jamaica for example, it is called sweet sop.

WRITTEN BY NASSER KHAN

Now you can enjoy your home-grown, succulent, sweet alternative to a sugary custard dessert. Bon appétit!

AFRUIT | SUGAR APPLE SUGAR APPLE |FRUIT

37 | u

36 | u

According to the information supplied by the Research Division of the Ministry of Food Production at Centeno, Trinidad, the following is the nutritional content of the delicious sugar apple (values are expressed per 100g):

This round to conical fruit, 5–10 cm (2.0–3.9 in) in diameter, 6–10 cm (2.4–3.9 in) long, and weighing 100–240 g (3.5–8.5 oz), with a thick rind composed of knobby segments, is a favourite among the many edible fruits found throughout the Caribbean. The sugar apple tree is relatively short, and its �esh is fragrant and sweet, juicy, creamy white to light yellow, and resembles and tastes like custard. It is soft, slightly grainy, and slippery. The hard, shiny seeds may number 20 or more per fruit, and have a brown to black coat.

The ripe sugar apple is usually broken open and the �esh segments enjoyed while the hard seeds are separated in the mouth and spat out. It is so luscious that it is well worth the trouble. After removal of the visible seeds, the �esh can be pressed through a sieve to eliminate any remaining seeds and is then added to ice cream or blended with milk to make a cool beverage, but most times the eager subject tends to guzzle it as is. Documented usage and bene�ts of the various species around the world: The seed kernels contain 14–49% of whitish or yellowish, non-drying oil.

It has been proposed as a substitute for peanut oil in the manufacture of soap, and can be detoxi�ed by an alkali treatment and used for edible purposes. The leaves yield an excellent oil, which �nds limited use in perfumes, giving a woody, spicy accent. Fiber extracted from the bark has been employed for cordage. The crushed leaves are sni�ed to overcome hysteria and fainting spells; they are also applied on ulcers and wounds and a leaf decoction is taken in cases of dysentery. Throughout tropical America, a decoction of the leaves alone or with those of other plants is imbibed as a tonic, cold remedy, or digestive. The leaf decoction is also employed in baths to alleviate rheumatic pain. The green fruit, very astringent, is employed against diarrhea; the crushed ripe fruit, mixed with salt, is applied on tumors. The bark and roots are both highly astringent. The bark decoction is given as a tonic and to halt diarrhea. A paste made from the �esh and used as a balm is said to treat abscesses, boils and ulcers. The �esh can be sun-dried and ground into a powder which can be used to treat dysentery and diarrhea. Though there is no solid scienti�c data, many believe that the fruit act as a stimulant, “coolant” and expectorant, and is good for treating anemia.

Sugar apples are a good source of vitamin C, which provides the body with healthy anti-oxidants to prevent unnecessary oxidation reactions. It is recommended for lowering cholesterol levels as it contains niacin, which helps in increasing your good cholesterol.

Even though its availability and supply in Trinidad and Tobago have been hampered in recent years by serious insect pests

such as fruit �ies, mealy bugs, and, most importantly, the seed-boring weevil, the sugar apple makes for one of the most delicious fruits. These pests, especially the seed-boring weevil,

have signi�cantly reduced the popularity of the fruit as a backyard tree. However, both St. Vincent and Grenada are free of this pest, and can supply other Caribbean countries with the fruit when in season. On Gasparee Island, o� the north-western coast of Trinidad, on the uninhabited parts,

you’ll �nd many sugar apple trees growing wild.

SUGAR APPLE

Nutrition Facts

Amount per serving

Calcium 28 mg Iron 1.8 mg

Thiamin 0.11 mg Riboflavin 0.15 mg

Niacin 0.9 mg Vitamin C 35

Serving Size : 100 g

WRITTEN BY NASSER KHAN

Grow your own sugar apple tree

at home

Choose a heavy container (bore drainage holes) that is wider than deep to accommodate the sugar apple tree’s shallow roots. Plant the tree in a mixture of potting soil and shredded bark, which provides excellent drainage, as it does not survive wet soil.

Place the container in an area with full sun exposure and protection from wind.

Prune about a third of last year’s growth away with hand pruners around April of each year. Sugar apple trees can be kept at 8 to 12 feet tall with pruning. Cut back extra long branches and trim the ends of other branches to obtain the desired shape.

Pour water into the top of the container until it runs out the bottom. Water the tree every week or whenever the soil starts to dry out while the tree is actively growing.

Feed every eight weeks with water-soluble fertilizer designed for fruit trees.

Pick the fruit when the white, yellow or red tint appears between the rind segments. The �avor is best when the fruit is picked while it is full but has not started to ripen. Place it in a paper bag to ripen the rest of the way. If the fruit is picked too early, it turns black and dries out. If the fruit ripens on the tree, it falls apart.

The Sugar Apple is the most widely grown of all the species of

Annona (Annona squamosa). Its relative, the custard apple, is

Annona reticulata. In most places in the Caribbean it is called

sugar apple, but in Jamaica for example, it is called sweet sop.

WRITTEN BY NASSER KHAN

Now you can enjoy your home-grown, succulent, sweet alternative to a sugary custard dessert. Bon appétit!

SUGAR APPLE |FOOD

As a gastroenterologist, I see many patients who present with rectal bleeding. The causes of the rectal bleeding can vary from relatively simple haemorrhoids to the worrisome colon cancer. However, there is a significant emerging proportion of individuals who, through a careful history with exploration of their symptoms, examination, blood investigations and endoscopy, turn out to have a condition called inflammatory bowel disease (IBD). The purpose of this short article is to enlighten readers about inflammatory bowel disease and, hopefully, engender some understanding about the condition and treatments available.

Patients with a new diagnosis of inflammatory bowel disease are naturally apprehensive about the diagnosis. Firstly, Crohn’s disease and ulcerative colitis are chronic inflammatory disorders that can affect the digestive system.

Crohn’s disease can affect any part of the digestive system, from the mouth to anal region, while ucerative colitis mainly involves the large intestine. There is a smaller proportion of individuals (approx. 15%) with indeterminate colitis, which means that is difficult to distinguish the two separate conditions. Inflammatory bowel disease can coexist with other conditions like irritable bowel syndrome (IBS), but the two are separate well defined conditions.

Inflammatory bowel disease comes about as a result of a dysregulated gut immune response to bacteria in the intestine, coupled with a person’s DNA make up and various environmental triggers. Symptoms can include having frequent bowel motions which may be bloody and associated with a sense of urgency to pass the stool. The bloody diarrhoea can also be associated with abdominal pain and cramping, weight loss and poor appetite.

Your doctor will be able to determine how severe your disease is based on your age, how much of the digestive tract is involved, and various other complications which can occur with inflammatory

bowel diseases. Many people with inflammatory bowel disease live normal lives, and your specialist will be able to identify various treatment regimens and lifestyle changes that can help to keep the inflammation at bay.

Some persons may have more aggressive disease that may not be responsive to conventional treatments, and so more aggressive medications will need to be given under close supervision. Having frequent bowel motions also means that a work day or having a day out with the family needs to be closely planned to have restrooms nearby.

In short, treatment options can include tablet medications which may include antibiotics and steroid tablets, as well as other therapies that may require a short hospital visit for an infusion or having an injection at home. Depending on the clinical situation, surgery may also be a considered option. It is important in persons with IBD that nutrition is paid special attention to, as well as having regular visits with their specialist to have the necessary monitoring blood tests done.

At all times we encourage an open line of communication with our patients. The newly formed National Association of Crohn’s Colitis Trinidad and Tobago presents an invaluable partner where patients can share their own experiences to learn from each other as well as develop a closer rapport with their specialist. I would encourage all patients with inflammatory bowel disease to join at any of the following contacts:

Website: www.crohnsandcolitistt.comFacebook: www.facebook.com/crohnsandcolitisttPostal address: 5 High Street, Princes TownEmail: crohnsandcolitis.tt@gmail.com

I hope this short article has stimulated your interest in inflammatory bowel diseases. I welcome any comments or questions at my email address below.Here’s to your digestive health!

Inflammatory Bowel Diseases

Dr Ricardo Jurawan (FRACP, MBBS) Specialist Gastroenterologist and HepatologistEmail: digestivehealthtt@gmail.com

• One in 10 000 men under the age of 40 develop prostate

cancer, whereas one in eight men between the ages of

60 and 80 suffer from the disease.

• For some reason not yet fully understood, the rate of

prostate cancer among black men is higher than that of

other race groups. A possibility exists that higher levels

of testosterone may be responsible.

• Many men die with prostate cancer, but not from it.

• Although it has not been proven conclusively, it is

thought that a diet high in fats could lead to increased

testosterone production.

• Lack of exercise can lead to general ill-health and makes

someone more susceptible to all sorts of diseases,

prostate problems included.

• A man with three first degree relatives with prostate

cancer has a ten times increased risk of developing

prostate cancer himself.

• The prostate needs time and male hormones to develop

cancer. Testosterone does not cause prostate cancer,

but is essential for prostate cancer to develop.

• Men whose mothers or sisters have developed breast

cancer are also at increased risk for prostate cancer.

• Because prostate cancer generally takes so long to

develop, many doctors opt for the so-called 'watchful

waiting' as a treatment option.

• Besides castration at a young age, which is obviously not

a viable option, there is no certain way of preventing

prostate cancer.

10 FACTS About Prostate Cancer

SUGAR APPLE |FOOD

As a gastroenterologist, I see many patients who present with rectal bleeding. The causes of the rectal bleeding can vary from relatively simple haemorrhoids to the worrisome colon cancer. However, there is a significant emerging proportion of individuals who, through a careful history with exploration of their symptoms, examination, blood investigations and endoscopy, turn out to have a condition called inflammatory bowel disease (IBD). The purpose of this short article is to enlighten readers about inflammatory bowel disease and, hopefully, engender some understanding about the condition and treatments available.

Patients with a new diagnosis of inflammatory bowel disease are naturally apprehensive about the diagnosis. Firstly, Crohn’s disease and ulcerative colitis are chronic inflammatory disorders that can affect the digestive system.

Crohn’s disease can affect any part of the digestive system, from the mouth to anal region, while ucerative colitis mainly involves the large intestine. There is a smaller proportion of individuals (approx. 15%) with indeterminate colitis, which means that is difficult to distinguish the two separate conditions. Inflammatory bowel disease can coexist with other conditions like irritable bowel syndrome (IBS), but the two are separate well defined conditions.

Inflammatory bowel disease comes about as a result of a dysregulated gut immune response to bacteria in the intestine, coupled with a person’s DNA make up and various environmental triggers. Symptoms can include having frequent bowel motions which may be bloody and associated with a sense of urgency to pass the stool. The bloody diarrhoea can also be associated with abdominal pain and cramping, weight loss and poor appetite.

Your doctor will be able to determine how severe your disease is based on your age, how much of the digestive tract is involved, and various other complications which can occur with inflammatory

bowel diseases. Many people with inflammatory bowel disease live normal lives, and your specialist will be able to identify various treatment regimens and lifestyle changes that can help to keep the inflammation at bay.

Some persons may have more aggressive disease that may not be responsive to conventional treatments, and so more aggressive medications will need to be given under close supervision. Having frequent bowel motions also means that a work day or having a day out with the family needs to be closely planned to have restrooms nearby.

In short, treatment options can include tablet medications which may include antibiotics and steroid tablets, as well as other therapies that may require a short hospital visit for an infusion or having an injection at home. Depending on the clinical situation, surgery may also be a considered option. It is important in persons with IBD that nutrition is paid special attention to, as well as having regular visits with their specialist to have the necessary monitoring blood tests done.

At all times we encourage an open line of communication with our patients. The newly formed National Association of Crohn’s Colitis Trinidad and Tobago presents an invaluable partner where patients can share their own experiences to learn from each other as well as develop a closer rapport with their specialist. I would encourage all patients with inflammatory bowel disease to join at any of the following contacts:

Website: www.crohnsandcolitistt.comFacebook: www.facebook.com/crohnsandcolitisttPostal address: 5 High Street, Princes TownEmail: crohnsandcolitis.tt@gmail.com

I hope this short article has stimulated your interest in inflammatory bowel diseases. I welcome any comments or questions at my email address below.Here’s to your digestive health!

Inflammatory Bowel Diseases

Dr Ricardo Jurawan (FRACP, MBBS) Specialist Gastroenterologist and HepatologistEmail: digestivehealthtt@gmail.com

10 things• One in 10 000 men under the age of 40 develop prostate

cancer, whereas one in eight men between the ages of

60 and 80 suffer from the disease.

• For some reason not yet fully understood, the rate of

prostate cancer among black men is higher than that of

other race groups. A possibility exists that higher levels

of testosterone may be responsible.

• Many men die with prostate cancer, but not from it.

• Although it has not been proven conclusively, it is

thought that a diet high in fats could lead to increased

testosterone production.

• Lack of exercise can lead to general ill-health and makes

someone more susceptible to all sorts of diseases,

prostate problems included.

• A man with three first degree relatives with prostate

cancer has a ten times increased risk of developing

prostate cancer himself.

• The prostate needs time and male hormones to develop

cancer. Testosterone does not cause prostate cancer,

but is essential for prostate cancer to develop.

• Men whose mothers or sisters have developed breast

cancer are also at increased risk for prostate cancer.

• Because prostate cancer generally takes so long to

develop, many doctors opt for the so-called 'watchful

waiting' as a treatment option.

• Besides castration at a young age, which is obviously not

a viable option, there is no certain way of preventing

prostate cancer.

10 FACTS About Prostate Cancer

41 | u

WRITTEN BY CAROL QUASH

BE MAN ENOUGH: TAKE CARE OF YOUR HEALTH |HEALTHHEALTH | BE MAN ENOUGH: TAKE CARE OF YOUR HEALTH

Most men are convinced they are more resilient to illnesses than women. Never mind that diseases such as the common cold usually knock them off their feet for days on end, while their female counterparts carry on with business as usual in spite of how they feel. Or that the results of a 2010 study by researchers at the University of Cambridge suggests that women have stronger immune systems than men.

TAKE CARE OFYOUR HEALTH

41 | u

WRITTEN BY CAROL QUASH

BE MAN ENOUGH: TAKE CARE OF YOUR HEALTH |HEALTHHEALTH | BE MAN ENOUGH: TAKE CARE OF YOUR HEALTH

Most men are convinced they are more resilient to illnesses than women. Never mind that diseases such as the common cold usually knock them off their feet for days on end, while their female counterparts carry on with business as usual in spite of how they feel. Or that the results of a 2010 study by researchers at the University of Cambridge suggests that women have stronger immune systems than men.

TAKE CARE OFYOUR HEALTH

WebMD says that men are more likely to to su�er from hypertension from the age of 45, although the disease can develop at a younger age.

Hypertension is one of the leading risk factors in heart disease, as having high blood pressure puts a strain on your heart and promotes plaque formation in the arteries as blood �ows through it. Also referred to as the silent killer, hypertension is symptomless, sometimes until it is too late.

Men who smoke, don't exercise regularly, are overweight, or have a family history of hypertension, or who have hyperlipidaemia, are at risk of developing hypertension.

Men who smoke, don't exercise regularly, are overweight, or have a family history of heart disease or stroke are at risk of developing hypertension.So, men, inasmuch as you hate taking that annual checkup and may not care what you put into your body, its better to be safe than sorry. Saving your life may just take a visit to the doctor and a few lifestyle changes such as:• Checking your blood pressure regularly• Setting aside at least 30 minutes in your busy day

to engage in some form of exercise• If you must consume alcohol or smoke, do so in moderation• Cutting back on fried foods and those that are high

in sodium (salt)

Diabetes is a lifestyle disease, and men are at risk of developing it at any age. Type 1 diabetes is developed when the pancreas does not produce enough insulin, the hormone that is needed for converting sugar and other foods into energy.

Type 2 diabetes occurs when the body does not use the insulin properly. There is no cure for diabetes, but it can be controlled with medication and developing and practicing proper lifestyle habits.

Symptoms of diabetes include:• Frequent thirst and urination• Sudden weight loss• Blurred vision• Impotence• Major fatigue• Wounds that take long to heal

Your doctor will determine the best way to treat your condition and advise you on whatever lifestyle changes you will need to adopt.

Male pattern baldness, caused by follicles that are oversensitive to male hormones, is the most common type of hair loss and can begin as early as the teenage years.

It is a hereditary condition that almost always follows a sequence – thinning hair that gradually leads to major hair loss, and sometimes even complete baldness.

If you inherit the gene there is very little you can do to prevent it. It must be noted that although this condition will have no e�ect on your physical health, it can a�ect a man's self esteem. Mid Yorkshire Hospitals NHS Trust consultant dermatologist, Dr. Susan McDonald-Hull, advises that if male pattern baldness causes emotional distress you should visit your dermatologist.

43 | u

42 | u

Hypertension or High Blood Pressure

Athlete's Foot

Ingrown Hairs

Athlete's foot is a disease of the skin and is caused by a fungus. Closed-toed shoes worn by men can create the ideal environment for fungi to thrive, as their insides are warm, dark and humid. Although the fungus attacks between the toes, it is not uncommon for the soles of the feet and the toenails to fall prey to the disease. There have also been cases where the groin and underarm became infected because the patient touched those areas after scratching his feet.

The American Podiatric Medical Association says the fungi that causes athlete's foot frequently lurk in swimming pools, shower stalls and locker rooms, and can even contaminate bed sheets or clothing.

Symptoms of the skin condition include:• Dry skin• Scaly skin• Itching and burning• Blisters• In�ammation

Men with athlete's foot should frequently wash their feet with soap, dry them thoroughly, paying special attention to the area between the toes, and use talcum powder to minimize perspiration. They should also change their socks and shoes regularly, and seek treatment from a podiatrist. Although proper hygiene can control the e�ects of athlete's foot, people with severe cases are advised to visit a medical doctor.

Ingrown hairs, which are also sometimes called razor bumps, are caused by shaved hair that gets inside the follicle or grows back into the skin. People with coarse hair are more at risk of developing ingrown hair. The armpit, face, legs, neck and pubic areas are more susceptible to ingrown hair than any other parts of the body. Ingrown hairs can be very painful, and can cause scarring, redness and swelling.

There is no cure for ingrown hairs, but it can be controlled with proper and regular hair and skin regimens. The following recommendations, which were published on the onhealth.com website, may help: • Hydrate and soften both the skin and the hair

before shaving. This can result in a duller, rounded tip to the hair, which decreases the likelihood for hairs to reenter the skin.

• Use a moistened washcloth, a wet sponge, or a soft-bristled toothbrush with a mild soap to wash the beard or hair for several minutes via a circular motion to help dislodge stubborn tips.

• Some natural mild exfoliators, such as salt and sugar, can be applied to treat the redness or

irritation that comes with the ingrown hair.• Do not shave against the direction or grain of the

hair growth.• Avoid shaving too closely to the skin.• When using electric razors, some shaving

techniques may help prevent ingrown hair. Keep the head of the electric razor slightly o� the

surface of the skin and shave in a slow, circular motion. Pressing the razor too close to the skin

or pulling the skin taut can result in too close of a shave.• Leave very short (1 mm – 2 mm) stubble when

shaving to help reduce the tendency of shaving too closely. These shaving techniques can avoid creating a sharp tip when shaving and prevent hair from reentering the skin by leaving slightly longer stubble.

• Another way to prevent ingrown hairs is by avoiding shaving and allowing hair to grow naturally.

• Carefully use a sterile needle and alcohol wipe to dislodge stubborn ingrown hairs or use tweezers to gently tease the hair out of the skin. However, this is usually not recommended in that these procedures may be too aggressive and cause further damage to the skin.

BE MAN ENOUGH: TAKE CARE OF YOUR HEALTH |HEALTHHEALTH | BE MAN ENOUGH: TAKE CARE OF YOUR HEALTH

ut for those men out there who still believe that they are invincible and refuse to visit their doctor or take medicine no matter how sick they feel, here is a little food for thought: there are a number of

diseases and conditions lurking around to which you are more prone than your female counterparts, whether or not you want to admit it.

B

Diabetes

Hair Loss

Men, the bottom line is that you are human, and every little effort and contribution you make to your health and well being will be to your benefit. Remember, if you treat your body well, it will reciprocate.

WebMD says that men are more likely to to su�er from hypertension from the age of 45, although the disease can develop at a younger age.

Hypertension is one of the leading risk factors in heart disease, as having high blood pressure puts a strain on your heart and promotes plaque formation in the arteries as blood �ows through it. Also referred to as the silent killer, hypertension is symptomless, sometimes until it is too late.

Men who smoke, don't exercise regularly, are overweight, or have a family history of hypertension, or who have hyperlipidaemia, are at risk of developing hypertension.

Men who smoke, don't exercise regularly, are overweight, or have a family history of heart disease or stroke are at risk of developing hypertension.So, men, inasmuch as you hate taking that annual checkup and may not care what you put into your body, its better to be safe than sorry. Saving your life may just take a visit to the doctor and a few lifestyle changes such as:• Checking your blood pressure regularly• Setting aside at least 30 minutes in your busy day

to engage in some form of exercise• If you must consume alcohol or smoke, do so in moderation• Cutting back on fried foods and those that are high

in sodium (salt)

Diabetes is a lifestyle disease, and men are at risk of developing it at any age. Type 1 diabetes is developed when the pancreas does not produce enough insulin, the hormone that is needed for converting sugar and other foods into energy.

Type 2 diabetes occurs when the body does not use the insulin properly. There is no cure for diabetes, but it can be controlled with medication and developing and practicing proper lifestyle habits.

Symptoms of diabetes include:• Frequent thirst and urination• Sudden weight loss• Blurred vision• Impotence• Major fatigue• Wounds that take long to heal

Your doctor will determine the best way to treat your condition and advise you on whatever lifestyle changes you will need to adopt.

Male pattern baldness, caused by follicles that are oversensitive to male hormones, is the most common type of hair loss and can begin as early as the teenage years.

It is a hereditary condition that almost always follows a sequence – thinning hair that gradually leads to major hair loss, and sometimes even complete baldness.

If you inherit the gene there is very little you can do to prevent it. It must be noted that although this condition will have no e�ect on your physical health, it can a�ect a man's self esteem. Mid Yorkshire Hospitals NHS Trust consultant dermatologist, Dr. Susan McDonald-Hull, advises that if male pattern baldness causes emotional distress you should visit your dermatologist.

43 | u

42 | u

Hypertension or High Blood Pressure

Athlete's Foot

Ingrown Hairs

Athlete's foot is a disease of the skin and is caused by a fungus. Closed-toed shoes worn by men can create the ideal environment for fungi to thrive, as their insides are warm, dark and humid. Although the fungus attacks between the toes, it is not uncommon for the soles of the feet and the toenails to fall prey to the disease. There have also been cases where the groin and underarm became infected because the patient touched those areas after scratching his feet.

The American Podiatric Medical Association says the fungi that causes athlete's foot frequently lurk in swimming pools, shower stalls and locker rooms, and can even contaminate bed sheets or clothing.

Symptoms of the skin condition include:• Dry skin• Scaly skin• Itching and burning• Blisters• In�ammation

Men with athlete's foot should frequently wash their feet with soap, dry them thoroughly, paying special attention to the area between the toes, and use talcum powder to minimize perspiration. They should also change their socks and shoes regularly, and seek treatment from a podiatrist. Although proper hygiene can control the e�ects of athlete's foot, people with severe cases are advised to visit a medical doctor.

Ingrown hairs, which are also sometimes called razor bumps, are caused by shaved hair that gets inside the follicle or grows back into the skin. People with coarse hair are more at risk of developing ingrown hair. The armpit, face, legs, neck and pubic areas are more susceptible to ingrown hair than any other parts of the body. Ingrown hairs can be very painful, and can cause scarring, redness and swelling.

There is no cure for ingrown hairs, but it can be controlled with proper and regular hair and skin regimens. The following recommendations, which were published on the onhealth.com website, may help: • Hydrate and soften both the skin and the hair

before shaving. This can result in a duller, rounded tip to the hair, which decreases the likelihood for hairs to reenter the skin.

• Use a moistened washcloth, a wet sponge, or a soft-bristled toothbrush with a mild soap to wash the beard or hair for several minutes via a circular motion to help dislodge stubborn tips.

• Some natural mild exfoliators, such as salt and sugar, can be applied to treat the redness or

irritation that comes with the ingrown hair.• Do not shave against the direction or grain of the

hair growth.• Avoid shaving too closely to the skin.• When using electric razors, some shaving

techniques may help prevent ingrown hair. Keep the head of the electric razor slightly o� the

surface of the skin and shave in a slow, circular motion. Pressing the razor too close to the skin

or pulling the skin taut can result in too close of a shave.• Leave very short (1 mm – 2 mm) stubble when

shaving to help reduce the tendency of shaving too closely. These shaving techniques can avoid creating a sharp tip when shaving and prevent hair from reentering the skin by leaving slightly longer stubble.

• Another way to prevent ingrown hairs is by avoiding shaving and allowing hair to grow naturally.

• Carefully use a sterile needle and alcohol wipe to dislodge stubborn ingrown hairs or use tweezers to gently tease the hair out of the skin. However, this is usually not recommended in that these procedures may be too aggressive and cause further damage to the skin.

BE MAN ENOUGH: TAKE CARE OF YOUR HEALTH |HEALTHHEALTH | BE MAN ENOUGH: TAKE CARE OF YOUR HEALTH

ut for those men out there who still believe that they are invincible and refuse to visit their doctor or take medicine no matter how sick they feel, here is a little food for thought: there are a number of

diseases and conditions lurking around to which you are more prone than your female counterparts, whether or not you want to admit it.

B

Diabetes

Hair Loss

Men, the bottom line is that you are human, and every little effort and contribution you make to your health and well being will be to your benefit. Remember, if you treat your body well, it will reciprocate.

DISEASE | HOSPITAL ACQUIRED INFECTIONS HOSPITAL ACQUIRED INFECTIONS |DISEASE

45 | u

44 | u

WHAT THE PUBLIC NEEDS TO KNOW:The USA Center for Disease Control (CDC) has

warned of an alarming increase in several dangerous “Super Bugs” that are antibiotic resistant and which have manifested themselves around the world, and

have now been found in US hospitals.

ccording to the CDC’s website, “Antimicrobial drug resistance occurs everywhere in the world and is not limited to industrialised

nations. Hospitals and other healthcare settings are battling drug-resistant organisms that spread inside these institutions. Drug-resistant infections also spread in the community at large. Examples include drug-resistant pneumonias, sexually transmitted diseases (STDs), and skin and soft tissue infections.”

The report goes on to say “The e�ects of Antimicrobial Drug Resistance are far-reaching; people infected with drug-resistant organisms are more likely to have longer and more expensive hospital stays, and may be more likely to die as a result of the infection. When the drug of choice doesn’t work, they require treatment with second- or third-choice drugs that may be less e�ective, more toxic, and more expensive. This means that patients with an antimicrobial-resistant infection may su�er more and pay more for treatment.”

A recent Fox News feature (available on YouTube) reports that forty-six US hospitals have now con�rmed one or more infections. Dr. Brad Speelberg of The Infectious Diseases Society of America, interviewed on RT Studio, Washington DC, comments on the CDC’s �gures of 2 million Americans becoming ill from these bacteria each year, and as many as 23,000 related deaths, saying, “the �gure is extremely

low; this �gure could be closer to 99,000 deaths.”When asked if we should fear going to the doctor since a lot of this bacteria is contracted by people in hospitals, Dr. Speelberg’s answer was, “I don’t think that people should fear going to the doctor; I do think people need to understand that the hospital is an inherently dangerous place, and it is not because hospitals are dirty or the doctors are lazy or anything like that.

“Think about it this way: you are taking the sickest people in society, crowding them into one building, tearing new holes in their bodies where they didn’t used to have any by placing plastic catheters in their blood stream, in their bladder, putting tubes down into their lungs so they can breathe, and we are using very large quantities of antibiotics to treat infections. So that’s a perfect breeding ground to generate antibiotic-resistant bacteria. So the point is, you go into the hospital if you have to, you work carefully with your team to get out of the hospital as quickly as you can, and I think patients should be empowered, for example, if healthcare providers enter their room and the patient does not see them wash their hands, the patient should say ‘Hey, do you mind washing your hands?’”

Well, since going to a health care facility, as we have heard, is loaded with the threat of contracting HAIs, especially one of these “Super Bugs”, yet we really

don’t have much of a choice as there are legitimate reasons for us to do so, everyone should agree that this is a very scary scenario, to say the least. You may then ask what is being done to prevent the spread of these harmful bacteria in these institutions, apart from health care professionals having to be clean and e�cient. Every report talks about washing hands more frequently, especially before attending to patients. There may be good news after all; Midbrook Medical of Michigan, USA, has put on the market several products/pieces of equipment which, when used appropriately, are designed to stop the spread of harmful bacteria and are available from their agent, Frank Mouttet Limited in Trinidad.

Here are some of the sources of the spread of bacteria that can cause (HAIs) Hospital Acquired Infections and Midbrooks’ solution:

• Surgical Cannulated instruments, when not washed properly, cannot be sterilized. When used on more than one patient, harmful bacteria can be transferred from patient to patient. Midbrook has designed the Tempest washer, which is e�ective and exceeds the standard for washing cannulated instruments.

• Health care professionals need to wash their hands before attending to patients; however, items such as B/P cu�s, stethoscopes, penlights, thermometers and

other frequently handled items remain contaminated. Midbrook’s answer to this is the UV Flash Sanitizer, which utilizes UVC Light Technology, which kills 99.9% of germs in 60 seconds. This should be used frequently, especially together with the washing of hands.

• How do we measure standards for cleaning sta�? How clean is clean? Midbrook’s ATP Medicount is an instrument that will measure the amount of ATPs — Adenosine Triphosphate — which is present in all cellular life (even the simplest single-celled organisms). It is therefore possible to note the presence of cellular life on any surface, especially in ICU areas. With its software, one can track results and create a history of performance to set management standards for cleaning.

• Antimicrobial copper kills 99.9% of bacteria within two hours, and continues to kill 99% of bacteria even after repeated contamination. Especially for ICU areas, Midbrook can equip your health facility with antimicrobial copper medical carts, copper tables, copper IV poles, and copper cabinetry.

These products, when used, can greatly reduce the spread of harmful bacteria which can cause Hospital Acquired Infections. The next time you visit your healthcare provider, ask what is being done to prevent the spread of harmful bacteria. We all should be so empowered.

HOSPITALACQUIRED

INFECTIONS

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DISEASE | HOSPITAL ACQUIRED INFECTIONS HOSPITAL ACQUIRED INFECTIONS |DISEASE45 | u

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WHAT THE PUBLIC NEEDS TO KNOW:The USA Center for Disease Control (CDC) has

warned of an alarming increase in several dangerous “Super Bugs” that are antibiotic resistant and which have manifested themselves around the world, and

have now been found in US hospitals.

ccording to the CDC’s website, “Antimicrobial drug resistance occurs everywhere in the world and is not limited to industrialised

nations. Hospitals and other healthcare settings are battling drug-resistant organisms that spread inside these institutions. Drug-resistant infections also spread in the community at large. Examples include drug-resistant pneumonias, sexually transmitted diseases (STDs), and skin and soft tissue infections.”

The report goes on to say “The e�ects of Antimicrobial Drug Resistance are far-reaching; people infected with drug-resistant organisms are more likely to have longer and more expensive hospital stays, and may be more likely to die as a result of the infection. When the drug of choice doesn’t work, they require treatment with second- or third-choice drugs that may be less e�ective, more toxic, and more expensive. This means that patients with an antimicrobial-resistant infection may su�er more and pay more for treatment.”

A recent Fox News feature (available on YouTube) reports that forty-six US hospitals have now con�rmed one or more infections. Dr. Brad Speelberg of The Infectious Diseases Society of America, interviewed on RT Studio, Washington DC, comments on the CDC’s �gures of 2 million Americans becoming ill from these bacteria each year, and as many as 23,000 related deaths, saying, “the �gure is extremely

low; this �gure could be closer to 99,000 deaths.”When asked if we should fear going to the doctor since a lot of this bacteria is contracted by people in hospitals, Dr. Speelberg’s answer was, “I don’t think that people should fear going to the doctor; I do think people need to understand that the hospital is an inherently dangerous place, and it is not because hospitals are dirty or the doctors are lazy or anything like that.

“Think about it this way: you are taking the sickest people in society, crowding them into one building, tearing new holes in their bodies where they didn’t used to have any by placing plastic catheters in their blood stream, in their bladder, putting tubes down into their lungs so they can breathe, and we are using very large quantities of antibiotics to treat infections. So that’s a perfect breeding ground to generate antibiotic-resistant bacteria. So the point is, you go into the hospital if you have to, you work carefully with your team to get out of the hospital as quickly as you can, and I think patients should be empowered, for example, if healthcare providers enter their room and the patient does not see them wash their hands, the patient should say ‘Hey, do you mind washing your hands?’”

Well, since going to a health care facility, as we have heard, is loaded with the threat of contracting HAIs, especially one of these “Super Bugs”, yet we really

don’t have much of a choice as there are legitimate reasons for us to do so, everyone should agree that this is a very scary scenario, to say the least. You may then ask what is being done to prevent the spread of these harmful bacteria in these institutions, apart from health care professionals having to be clean and e�cient. Every report talks about washing hands more frequently, especially before attending to patients. There may be good news after all; Midbrook Medical of Michigan, USA, has put on the market several products/pieces of equipment which, when used appropriately, are designed to stop the spread of harmful bacteria and are available from their agent, Frank Mouttet Limited in Trinidad.

Here are some of the sources of the spread of bacteria that can cause (HAIs) Hospital Acquired Infections and Midbrooks’ solution:

• Surgical Cannulated instruments, when not washed properly, cannot be sterilized. When used on more than one patient, harmful bacteria can be transferred from patient to patient. Midbrook has designed the Tempest washer, which is e�ective and exceeds the standard for washing cannulated instruments.

• Health care professionals need to wash their hands before attending to patients; however, items such as B/P cu�s, stethoscopes, penlights, thermometers and

other frequently handled items remain contaminated. Midbrook’s answer to this is the UV Flash Sanitizer, which utilizes UVC Light Technology, which kills 99.9% of germs in 60 seconds. This should be used frequently, especially together with the washing of hands.

• How do we measure standards for cleaning sta�? How clean is clean? Midbrook’s ATP Medicount is an instrument that will measure the amount of ATPs — Adenosine Triphosphate — which is present in all cellular life (even the simplest single-celled organisms). It is therefore possible to note the presence of cellular life on any surface, especially in ICU areas. With its software, one can track results and create a history of performance to set management standards for cleaning.

• Antimicrobial copper kills 99.9% of bacteria within two hours, and continues to kill 99% of bacteria even after repeated contamination. Especially for ICU areas, Midbrook can equip your health facility with antimicrobial copper medical carts, copper tables, copper IV poles, and copper cabinetry.

These products, when used, can greatly reduce the spread of harmful bacteria which can cause Hospital Acquired Infections. The next time you visit your healthcare provider, ask what is being done to prevent the spread of harmful bacteria. We all should be so empowered.

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