Health - Parenting Hub

Expert Advice from Bonitas Medical Fund

Are day hospitals the new trend?

Globally, day surgery hospitals have changed the experience of patients by offering an alternative to acute/conventional hospital surgery. Hospital costs the highest expense In South Africa, the concept of day hospitals is also gaining popularity – particularly as a result of high hospital costs. Lee Callakoppen, Principal Officer of Bonitas Medical Fund, says, ‘Using our hospital dashboard for the full 2019 year, direct hospital costs were 43% of the total scheme expenditure. These excluded doctor and allied services while a patient was in-hospital. The increase in the use of day hospitals Internationally there is a trend in increased day surgery for multiple reasons including: Improved anaesthesia (with quicker recovery period) Improved pain control (anaesthetic blocks and improved medication) Instrumentation and procedures (keyhole surgery). Cost saving initiatives Private medical aids are struggling to keep up with rising healthcare costs, which usually outpace inflation by 3+%. They are continually looking for ways of reducing costs and keeping premium increases as low as possible without prejudicing the quality of healthcare or financial stability of the fund. ‘We negotiate special rates through our hospital networks and Designated Service Providers (DSPs) and encouraging members to use our Managed Care initiatives. Encouraging members to use day hospitals is another way in which we can save on costs. That said, the strategy amongst acute hospitals is to reduce the tariffs for day surgery to the level of day clinics to prevent a market shift away from their facilities. For the Scheme and members this is a win-win as it still translates to cost savings. Examples of price differences ‘There remains a difference in costs between day and acute hospitals,’ says Callakoppen. The table below represents savings across some of the most prevalent surgeries. Procedure Difference in Case-Mix Adjusted Hospital Cost per Event (Acute Hospital Base) Corneal, Scleral And Conjunctival rocedures -6.3% Eyelid Procedures -28.1% Circumcision -13.9% Tonsillectomy And/Or Adenoidectomy (Child) -13.0% Tonsillectomy And/Or Adenoidectomy (Adult) -11.7% Myringotomy (grommets) -15.5% Colonoscopy -15.4% Other advantages of day hospitals Patient satisfaction No overnight stay – patients are admitted, operated on and discharged on the same day Child-friendly wards and facilities – day hospitals are the ideal alternative for children requiring same day surgery as the trauma of overnight stays are eliminated Lower risk of infection – due to the fact that patients return home on the same day, the risks of cross infection are reduced, which results in a shorter recovery Mortality and major morbidity is extremely low (<1%)* Improved surgery scheduling – decrease in waiting lists Why is take up not higher? Day hospitals clearly have marked advantages but the reason take-up is not that high, is there are some perceived disadvantages of using them. One which is the geographical access – specifically in areas like the Eastern Cape. There is concern around procedure complications and the need for a patient to have advanced care. But legislation is strict around day hospitals and they have to be located within five kilometres of an acute hospital for exactly this reason.’ The issue of doctor access is another factor inhibiting the rapid increase in use. Many doctors have their consulting rooms close to an acute hospital and are unwilling to travel further. Equipment may be limited in day hospitals but the increasing list of procedures which can be performed in day hospitals speaks to this challenge being overcome. This is probably why the percentage of day cases, split between acute hospitals and day hospitals, is still biased toward acute hospitals. Currently the split of day cases being done in acute hospitals is 74% and 26% in day hospitals. This implies that 74% of all procedures which could be performed in a day hospital are currently performed in acute facilities. Safety is foremost Not all patients can go to day hospitals. Callakoppen says, “It should be noted that this percentage will be lower as some patients would have anaesthetic and comorbidity risks and from a safety perspective may rather have the procedure performed in an acute hospital where overnight facilities are available. Additionally, not all day clinics are adequately equipped to do some procedures and, as such, the true percentage will be lower.’ Day hospital options for 2021 Bonitas currently has 68 day hospitals on the BonCap network and 30 day clinics on the Select options. According to Callakoppen, ‘This will be enhanced in 2021 when we implement a day surgery network across all options. A comprehensive list of procedures that should be done as day procedures has been collated for our members. If any of these procedures need to be done then members must use a facility on the day surgery network, or alternatively pay a co-payment. While the day surgery network will be comprised mainly of day clinics, it should be noted that certain acute (conventional) hospitals will need to be included on the network where there are areas of access constraint to them.” Will day hospital use be enforced? The Day Hospital Association of South Africa has proposed that medical aid enforce day hospital use in the future but also caution that there are some cases which cannot be carried out in day hospitals. He says, “The Scheme is in agreement with the concept. Although we do promote the use of day hospitals, we must bear in mind that there are some procedures for which this is not suitable. High risk patients who require more intensive post-surgery care would require acute/conventional hospitals. But the benefits of day hospitals should definitely be considered by all patients when undergoing a procedure.”

November 17, 2020

Sunburn in babies, how to prevent and treat it

Living in sunny South Africa, worrying about your baby being exposed to the sun’s rays is a valid concern. Too much unprotected time in the sun can be harmful to your baby, leading to painful sunburn and, even skin cancer later in life. Here’s how to prevent and treat sunburn if your little one has spent too long outside. How to treat sunburn Babies and toddlers are more sensitive to the sun as they have less developed skin than adults. Prevention is better than cure when it comes to sunburn, however, if your baby has spent too much time in the sun, the reddy, painful burn will only show up a view hours later. Those who have darker complexions tend to be less sun sensitive, however, everyone has some risk of sunburn. Redness, swelling of the skin (warmth) and pain are all symptoms of sunburn. If the sunburn has caused fever, chills, blisters and headaches its best to consult your local health practitioner. You can treat mild sunburn with a cooling bath, moisturiser or aloe gel – all of which will help cool irritated and inflamed skin. Giving your baby extra fluid in the days following the burn should prevent dehydration. It is recommended that you keep your baby out of the sun until the burn has healed.x Tips for preventing sunburn Sun is strongest between 10am and 4pm so limit your little one’s sun exposure during this time. When your baby is spending time outdoors in the sun, be sure that they are wearing a hat and sunblock with an SPF of higher than 30, if your baby is older than 6 months (if they are younger you will need to find alternative protection for them). Try to find sunblock that is formulated for kids (as this will work best for sensitive skin) and do a patch test on their skin before using it. If your child doesn’t like the feel of sunscreen (or is younger than 6 months), sun protective clothing is the better option.

October 21, 2020

Ten tips for choosing the right medical aid

The medical aid landscape can be tricky to navigate so it’s best to compare all the available options and schemes to find a medical aid that works for your budget and your family’s health. Bonitas Medical Fund helps guide you through choosing the best plan. Analyse your healthcare needs No two people or families are alike, medical needs differ so do a quick personal healthcare needs’ analysis to determine what cover you need. If you have dependants, factor in their healthcare needs too. Factors to consider include: How often you visit your family visit a doctor or specialist Over-the-counter medication or chronic medication required Chronic conditions like high blood pressure or diabetes Specific conditions like cancer, HIV or renal failure Dentristy Optometry This will help you decide on whether you need a comprehensive medical aid or a hospital plan. Read the small print Benefits vary from plan to plan, so establish what is and isn’t covered and look at whether the option offers additional risk benefits which can save on day-to-date expenses. Such as free wellness screenings (blood pressure, cholesterol, blood sugar and BMI measurements) through to mammograms, pap smears and prostate screening. In some cases this extends to maternity programmes, dental check-ups, flu vaccinations and more. Managed Care options Managed Care programmes help members manage severe chronic conditions such as cancer, diabetes and HIV/AIDS. What about savings? Medical savings are a fixed amount a medical scheme gives you at the beginning of the year. There are ways to maximise your savings but first you need to know what you annual allocation is. The day-to-day detail Look at what the scheme suggests as a way to make your benefits last, bearing in mind the following: Some plans require you to use a specific GP, hospital network and have a list of Designated Service Providers (DSPs). These keep costs down because the scheme will have negotiated special rates with these services providers. Check the network in your area before making a final decision. Must you be referred to a specialist by your GP? Does your medical aid offer additional GP consultations, which they will pay for, after you have exhausted your day-to-day benefits? Virtual Care and technology Technology and virtual care is being embraced by medical schemes and members. Check what is offered on the plan you’re considering and whether it you want access to your benefits 24/7. Age impacts your decision As parents of young children, ensure the option you select provides sufficient child illness benefits If slightly older, select a plan that covers chronic conditions and provides sufficient in-hospital cover in the event of hospitalisation Ensure the affordability Consider all the costs involved before you make your final decision, such as: Monthly contributions: The rule of thumb is that contributions should not exceed 10% of your monthly income. A medical aid co-payment is a fee that the member is liable for when making use of certain medical services. These co-payments usually apply to specialist or elective medical procedures and will differ from one medical aid scheme to another. Waiting period and exclusions The Medical Schemes Act and the specific scheme’s rules determine this. Bonitas recommends that you enquire with the relevant scheme about their exclusion list and waiting periods. Brokers Using a broker doesn’t cost you anything. An independent broker will help you work your way through the different options and help choose the medical aid plan best suited to your and your family’s needs. For more information on the product offerings from Bonitas go to www.bonitas.co.za

October 21, 2020

Bonitas takes the edge off contribution increases

Financially solid, younger new members, two new plans, virtual healthcare and a renewed focus on Managed Care for chronic diseases are just a few of the insights from the Bonitas 2021 product launch. But it is the annual contribution increases which are highly anticipated and the moment of truth for all medical schemes. Lee Callakoppen, Principal Officer of Bonitas Medical Fund announced an unprecedented 0% increase on its BonFit Select plan and a weighted increase of 4.6% across all plans. The highest increase is 7.1%. ‘Members on our growth options, which contribute to 91% of business, will only experience an increase on 3.9%. I think, looking at the pricing and the benefit richness we offer in comparison to the market, the changes for 2021 will be well received.’ He says, ‘The guidelines received from the Council for Medical Schemes (CMS), clearly highlighted that medical schemes should limit contribution increases as far as possible. We crunched numbers and worked tirelessly to find the sweet-spot between sustainability and ensuring affordability. Not an easy task, especially in a weakened economy. We took a responsible stance, with a long-term view, to ensure that our members wouldn’t have to pay the price of a low increase for 2021 in the coming years. One of our core considerations was finding ways to ensure members could get access to full healthcare cover and avoid out-of-pocket expenses and co-payments.’ Pricing and technology Seven of our current options are priced between R1 500 and R3 000 which is where the medical scheme market is experiencing growth currently. Member behaviour has changed significantly and demand is for innovation, accessibility and technology. This has the benefit of attracting, a younger, target audience and driving sustainability. We can’t talk about 2020 without mentioning Covid-19. Key trends that emerged from a medical schemes perspective were: Changes to benefit structures and PMBs Lower than anticipated investment income as markets slumped Changes in claiming patterns in terms of seasonality and volume, due to the lockdown measures that came into effect And a Consumer Price Index that was lower than previous years which is expected to be at around 3.9% in 2021 In an industry like ours, it’s challenging to be different – to innovate, disrupt…to be better. But not impossible. The Fund needed to make short-term decisions with the long-term view and sustainability in mind. One of the highlights over the past few years, has been the introduction of four Efficiency Discounted Options (EDOs). Plans whereby members use network healthcare providers and pay around 15% less for the same benefits. The EDOs cover over 74 000 lives and the principal members who join are around 10 years younger than the average Bonitas member. 2021 – changes, contribution increases and enhancements Over the past five years, we have proactively driven innovative product design, actuarial modelling and constant engagement with various stakeholders. We believe we offer the ultimate split risk solution, with a comprehensive product range and diversified membership base. To stay at the forefront of innovation we have introduced: Edge – a new category driven by technology, intelligence and innovation, with two plans called BonStart and BonStart Plus. These are designed for economically active singles or couples, living in the larger metros. The plans include access to: A private hospital network and full cover for emergencies; PMB chronic medicine; excellent day-to-day benefits including unlimited GP consultations; layers of virtual care, dental and optical benefits; preventative care; wellness screenings; contraceptives and more. The cost: R1 452 and R1 731 respectively for the principal member. Managed Care One of the leading trends worldwide is the rise in non-communicable diseases, such as diabetes, high blood pressure and oncology. In fact, during this global pandemic, the impact lifestyle diseases and comorbidities had on Covid-19 patients was put in the spotlight. 20% of our members have multiple comorbidities which means, even without the pandemic, we need a stronger focus on preventing and managing lifestyle behaviours. Poor diet, smoking and lack of exercise are the three lifestyle factors that contribute to over 80% of chronic conditions. Managed Care continues to be a focus to empower members to take charge of their health and support them along the way. Home-based care During Covid-19, home-based care received renewed interest and focus. This dovetails with our strategy to move more care to the home and out of hospital. As an example, post-surgery or mild pneumonia, treatment can be effectively provided at home through the assistance of nurses. Not only is home-based care a cost effective delivery of care but it also promotes healing. Studies show that patients recover faster in their comfort of their own home. Day hospitals We believe the use of day hospitals and clinics should be encouraged, where possible. Some procedures such as cataract surgery, circumcisions and scopes are better suited to be performed in day hospitals or clinics versus larger hospitals. There is minimum disruption to members, speedier recovery times, less risk of infection and day hospital are also a more cost effective alternative. Technology One of the key learnings has been adapting to a new way of working – with virtual technology at the forefront. The WhatsApp channel we introduced has the most room for potential. This platform is convenient for members and allows them to manage their medical aid through live chats. Virtual Care There was a positive response to the launch of the new Bonitas Member Mobile App and free virtual care for all South Africans. This provided access to GP consultations for a range of conditions, including Covid-19, as well as free delivery for chronic medicine. At the heart of the model is the GP. This aligns to our care coordination initiatives, ensuring members receive the right level of care and support in managing their conditions. It allows access to a virtual nurse, advice in an emergency, auxiliary and home- based care, ensuring members have comprehensive support for any condition, in any circumstance, through our virtual based model. We’re pleased to announce that this model is unique and

September 23, 2020

Elective surgeries – the disruption, the trends and back to business unusual

On 9 September, South Africa recorded 1990 new cases of the pandemic in 24 hours. The country has now slipped to the eighth worst affected nation in the world in terms of the number of Covid-19 infections. In spite of this elective surgery has been given the green light and its back to business – albeit with strict protocols in place to safeguard staff as well as patients. Almost five months ago elective surgeries came to a standstill. This was reflected in claiming patterns in the private healthcare sector during lockdown – a disruption of the norm globally. In South Africa, elective surgery in both the private and public healthcare space and specialists’ visits are just two of the areas which have been affected by Covid-19. The link between the two is clear: Fewer specialists’ visits mean fewer referrals for surgery. So what exactly is elective surgery? The term can be ambiguous. It does not mean, as the name implies, that the surgery is optional but rather that it doesn’t need to be performed immediately. It can be scheduled at the patient’s and surgeon’s convenience. Some of these surgeries are necessary to prolong life, for example an angioplasty or, as in most cases, improve the quality of life. In brief, elective surgery is ‘A planned, non-emergency surgical procedure.’ Elective surgeries dropped by over half According to Lee Callakoppen, Principal Officer of Bonitas Medical Fund, ‘there has been a 60% reduction in hospital authorisation requests compared to 2019. A study release in March predicted that an estimated 28.4 million elective surgeries worldwide, would be cancelled during the 12 weeks of peak disruption due to the global pandemic. This has been a similar experience to other industry role players and is predominantly due to a combination of member fears related to Covid-19, lockdown and provider caution.’ Surgeries delayed not cancelled The postponement of surgeries was done to prevent patients taking up hospital beds and to avoid unnecessarily exposure to the virus – a strategy that worked well to flatten the curve. Surgeries were delayed based on provider discretion and subsequent patient engagement. Callakoppen says, ‘Providers are best placed to make these clinical decisions in the interests of their patients. If the procedures were emergencies or urgently required to enable member quality of life, those would have proceeded.’ The public sector too experienced backlogs in terms of elective surgeries. Examples are procedures including but not limited to, cataracts, orthopaedic surgeries, scopes, caesarean sections, tonsillectomies and adenoidectomies. BHF cautioned funders In July, The Board of Healthcare Funders (BHF) and its members in the healthcare funding space requested members of medical schemes to proceed with caution in scheduling elective surgical procedures. Dr Rajesh Patel, Head of Benefit and Risk at the BHF, said, ‘While the relaxation of the lockdown restrictions is good news for people, the country and the economy at large, we are still in the eye of the storm.’ The way forward? ‘As we move toward Level one, elective surgeries are almost back to normal,’ says Callakoppen. ‘It’s time to address the backlog of surgeries not considered emergency during lockdown. These include slow-growing cancers, orthopaedic and spine surgeries, airway surgeries, surgeries for non-cancerous tumours as well heart surgeries. We caution against a rush of elective surgeries though. Any surgery has an impact on the immune system which means the patient has a greater risk of contracting Covid-19 and developing complications from it. ‘It must further be noted that in some instances surgery is often recommended by specialists as one of the key courses of action. But we have noted that managed care protocols, in many instances, improve clinical outcomes with lower risk to the patient. One such example of this is spinal surgery, which is often unsuccessful. From a Bonitas perspective, we have noted that in the back and neck programme which enforces functional rehabilitation has been far more effective for our members. In addition, the risk to the member is significantly lower.’ Bonitas recommends the following is taken into account: That elective surgeries should only be resumed in instances where not having the procedure will severely impact the members’ health and quality of life That the current state of a patient’s healthcare is assessed – individuals with chronic conditions such as diabetes, asthma HIV/AIDS and hypertension, are at high-risk of developing Covid-19 complications The patient’s age is taken into consideration (older individuals are identified as one of the most vulnerable groups) The impact of waiting on the patient’s healthcare outcomes (for example, is it essential that the surgery takes place now or can it safely be deferred for a few months) Alternative care protocols – in some cases surgery, which should be a last resort, is prescribed without considering other treatment protocols such as rehabilitation. The most common examples of this include back and spine procedures, elective c-sections as well hip and knee replacements The use of day hospitals and clinics, where possible, to limit the possible chance of infection We may have flattened the curve but we are by no means out of the woods. Current Covid-19 cases in South Africa prove that. What is happening in hospitals? ‘Surgeries are being resumed responsibly with due collaboration and consideration exercised between the surgeon, the patient and hospital staff,’ says Callakoppen. Where there are capacity constraints, surgeries will be classified in terms of priority at the various hospitals. Pre-operative screening will continue. Facilities will continue to utilise separate zones for Covid-19 positive patients, Persons Under Investigation (PUI) and those for whom the status is unknown at the point of admission. Surgeries will be carefully planned and scheduled. Specialist visits on the up ‘Consultations are starting to increase once again but providers in general are likely to remain prudent. However we urge people who have not had their necessary annual check-ups, particularly our high risk members, to consult with their doctors. There may be members who have put these consultations on hold and are now more comfortable to visit a specialist. But care coordination

September 11, 2020

Physical touch & newborns – why is this so important

The birth of your baby is a beautiful and special moment in both of your lives. You may be wondering about your newborn’s senses, while they are born with all necessary senses, some are less precise than others and develop as your baby grows. Physical touch is an important aspect of your child’s growth, coming from your womb, where they are tightly cocooned in your womb. Skin to skin contact offers benefits to both you and your baby, and touch is one of the senses that can help comfort your baby, making them feel more secure and helping strengthen the bond between the two of you. Why is touch important? Touch enables your baby to learn more about the world, bond with their mother and learn communication skills, as touch and body language will be the first way that you can ‘speak’ to one another. Breastfeeding is an important part of this, as your baby then spends time in her mother’s arms. The benefits of touch goes beyond the physical. Contact between mom and baby has been shown to lower cortisol levels, which in turn benefits the functioning of the immune system. Children that are deprived of touch can be more aggressive with other conduct disorder problems. What is swaddling? Coming from a tightly packed womb, you’ll find that your baby is comforted by touch and close cuddles. Swaddling your baby in a blanket is also another technique that you can use on young babies to help them feel more secure, as it stops them from upsetting themselves from their own startle reflex. It’s important that your newborn finds their new world a comfortable and soothing place. Swaddling is an old technique, and beyond helping your little one feel safe and secure, your baby is likely to sleep better and will be kept nice and cosy in their blanket. If you decide to swaddle your baby it’s best to do so from birth, as opposed to introducing it when they are older as this can increase the risk of Sudden Infant Death Syndrome. Using the proper techniques when swaddling is also important, as incorrect wrapping can lead to issues.

September 8, 2020

Advice from the experts

Medical Aid and VAT

Since the announcement of the 1% Value Added Tax (VAT) increase by the Minister of Finance last month, there has been much debate around its impact on consumers and just how this will affect the money left in their pockets at the end of the month. With the revised general fuel levy, it’s clear that consumers will have to tighten their belts and adhere to stricter budgets. The rising costs of healthcare One area of concern is the cost of private medical aid and VAT. For years increasing healthcare inflation and economic pressures have been a challenge for the healthcare industry. ‘The reality is that when consumers are struggling, medical aid, which is essentially a grudge purchase, is often viewed as unaffordable,’ says Gerhard Van Emmenis, Principal Officer of Bonitas Medical Fund. ‘In addition healthcare costs are not regulated which is why it is crucial for medical aid schemes to continue to explore ways to contain costs without compromising the level of health care offered to members.’ Members’ contributions However he says there is some good news regarding VAT and medical aid because the 1% increase will not impact monthly contributions or annual benefits. ‘Many members are confused as to whether VAT is payable on medical aid contributions but let me reassure you it is not,’ says Van Emmenis. ‘The VAT increase will have no effect on members directly and what they pay every month. Medical aid contributions for 2018 are already set and Bonitas will not increase contributions mid-year to accommodate the change in VAT. So, while the increase in VAT may influence the price of services, it will not impact benefits.’ Van Emmenis says: ‘If your plan covers you at 100% of a Scheme’s Rate, you are still covered at 100% of that rate, no matter what the cost to the Scheme because the Scheme will absorb the VAT when paying for member’s benefits. The only impact is when it comes to savings and day-to-day benefits with members having a 1% lower buying power.’ The Council for Medical Schemes In fact changing contributions in the middle of the year can only be done with the permission of the Council for Medical Schemes following a request from the Trustees of the medical scheme. This is a rare occurrence and most schemes generally put through contribution increases in January each year. The law He adds that VAT is never the property of any private entity but belongs to the Government. ‘We are therefore only vendors that collect the monies on their behalf. From April 1, Bonitas will increase the VAT to all providers of the Scheme by 1%. However, although this will have a direct impact on the budget of the Scheme for 2018 it will be absorbed by operational surpluses and not passed on to members.’ Tax credits One positive announcement out of the budget speech regarding medical aid was around tax credits. ‘Medical tax credits are effectively used as an ‘expense’ when calculating tax and reduces the amount of tax payable by a household belonging to a medical aid,’ says Van Emmenis. ‘There are eight million people who rely on these credits to make medical aid more affordable. Speculation was rife that the tax credit would be removed but it is a relief that private medical aid members have some reprieve.’ Conclusion The bottom line: The 1% VAT increase and the additional 52 cents general fuel levy will have a knock-on effect for South African consumers, things will cost more. However, it will not affect monthly medical aid premiums or member benefits although it will have an indirect impact in terms of healthcare services being more expensive, which will reduce buying power.

April 12, 2018

11 Things to expect postpartum

Pregnancy is an amazing journey and towards the end moms to be start preparing for their labor and birth, as well as the exciting prospect of meeting their new baby. The baby nursery will be prepared and hospital bags packed and ready. Then once baby has arrived the new mommy will be spending her days caring for her new baby, breastfeeding and bonding. Another important thing to remember and focus on is that the first six weeks after birth is considered a recovery period. Some moms will recover faster and other moms may take longer. How you give birth will also play a role in your recovery period, your symptoms and how you will need to look after yourself. Here are some tips for recovering after birth: Postpartum Bleeding Postpartum bleeding is known as lochia. You can expect to bleed anywhere from 4 weeks to 6 weeks after birth. Postpartum bleeding is heavier than a normal period. Your bleeding will be heaviest for the first 3 to 10 days after birth and then it should get lighter. Postpartum bleeding is made up of blood, mucus and uterus tissue. Your bleeding will turn from red to pink to brown and finally to yellow-ish white. You will need to stock up on maternity pads which are much more heavy duty than normal sanitary pads. Keep in mind that you should not use tampons for the first 6 weeks after birth – tampons could lead to bacteria in your uterus during this time. Consider buying some disposable maternity panties for use in the hospital and while you are bleeding heavily at home. You will undoubtedly leak through your maternity pads at some stage and ruin your panties. Having these stretchy disposable panties means firstly that you are comfortable but also that you needn’t worry about stains and extra washing during this time. If you get large blood clots in your bleeding or your bleeding is excessively heavy so that you are bleeding through a pad in an hour or less contact your doctor immediately as this could postpartum hemorrhage. After Your C-section When you have a c-section you won’t be mobile on the day of the birth. You will receive a epidural which means your lower body is numb and you will have a catheter which will be removed the morning after your c-section. While you won’t be able to move around fast or far in the beginning it is important that you start moving around as soon as possible after your catheter has been removed. This will help your body functions to start working (especially your bowels). It will also help to lower the chances of any post-operation complications like blood clots in your legs. Many women experience gas and bloating after their c-section which may be uncomfortable and even painful. You will need to keep your c-section wound clean and dry for the first 10 days – you will probably have a waterproof bandage on it so you can shower. When you go for a checkup after birth your doctor will remove the bandage and check your scar to see if it is healing properly. Once the bandage is off clean your scar daily and pat it dry afterwards. Check with your doctor whether he advises you leave your scar open or keep it covered. Your c-section scar will be incredibly sore the first few days and stay tender for a long time after the operation. Your doctor will prescribe you anti-inflammatory medication as well as pain medication to help you manage the pain. Using a postpartum girdle after a c-section (or even after natural birth too) comes with many benefits, including providing your stomach with support which will help with easing the pain. You can read more about postpartum girdles here. It is important not to do any lifting after your c-section other than when you need to pick up your baby of course. Refrain from lifting anything other than your baby for the first 6 weeks to give yourself a chance to heal. After Natural Birth Giving birth naturally usually means a quicker and easier recovery than giving birth via c-section, however parts of your body will have taken a bashing. Make sure to look after your perineum (the area between your anus and vagina) properly. For the first 24 hours after birth ice your perineum. Keep a spray bottle handy and fill it with warm water when you need to urinate. Give your vaginal area and perineum a squirt of warm water before and after urinating. This will keep the urine from irritating any torn skin. Your perineum may have torn during birth requiring stitches or your doctor may have performed an episiotomy (a surgical cut to the perineum) to widen you vagina during an assisted birth, if your baby is in distress or to prevent your perineum from tearing. Your body may also be achy and sore from pushing. Your doctor may prescribe pain medication and you can also take a hot shower or use heating pads to ease the aching. Your Uterus and Tummy Your stomach will take a while to get back to its normal size, so don’t expect a flat stomach after birth. You may even still look pregnant for a while. It will take some time for your uterus to contract back to its normal size. You can also expect some cramping as your uterus contracts. Breastfeeding your baby will help your uterus to contract so you can expect to feel cramps when you breastfeed. It may take a few weeks to a couple of months for your tummy to start looking normal again. You can expect to have some stretch marks and if you have had a c-section you will have a scar. You can look into ways to reduce your stretch marks, but also remember that your stretch marks are a sign that you have brought life into this world. Caring For Your Breasts Whether you are breastfeeding or

April 11, 2018

How The Way You Feel About Yourself is Interpreted to How Your Child Feels About Themselves 

(attend one of our free EQ talks – click here for details) Emotions are energy and movements within our bodies based on how we interpret life and events. When we fall in love, our bodies feel wonderful, warm, tingly, cosy and excited as endorphins are released by the brain into our bodies. However, when we feel scared or threatened, our bodies feel constricted and tight which comes from the adrenalin and cortisol released to activate the fight or flight response. We experience hundreds of different feelings but interestingly enough all of these feelings are produced from two core feelings; love and fear which all starts with whether we feel accepted or not. Acceptance is a Primal Need Acceptance is our most primal human need. Every one of us strives for acceptance; who we are, what we stand for, what we believe and what we look like. ALL of this combined is what creates the way we feel about ourselves and how we respond and express ourselves. When we accept and love ourselves, we feel emotionally safe and are able to express ourselves from a place of love. But when we believe that we are unacceptable, we become defensive and express ourselves from a place of fear, which can come across as anger, frustration, irritation, impatience, judgement or by being dismissive. Rose-Tinted Glasses I’m sure you have heard the saying ‘seeing life through rose tinted glasses’. Well here’s the thing, we all have our own pair of tinted glasses that we view life through. When someone close to you – a partner, child or friend expresses their feelings of discontent to you, we immediately tend to assume it’s about us. We ‘view’ their words through our ‘glasses of non-acceptance’ and fear kicks in. We interpret whatever they are saying as criticism or believe that we did something wrong and feel responsible for their feelings and in the process become defensive. Putting our Parents On Pedestals So where does all this non-acceptance or acceptance of ourselves start? It starts in childhood and with our parents. If our parents like themselves and they feel good about themselves, those feelings are transmitted to us verbally and non-verbally. But if our parents are not okay with who they are, then this too gets transmitted to us verbally and non-verbally. Children tend to make everything about themselves, they put their parents on pedestals, and whenever something doesn’t feel right, they think that it’s because of them. My mom loved to turn simple events into adventures. She always tried to look on the bright side. I recall one evening sitting at the kitchen table watching her make pancakes. I adored my mother, we were extremely close and as I watched her, I picked up her distress. I realised that her act of excitedly making pancakes was to mask the fact that all we had in the form of groceries was milk, water, eggs and sugar; the very same ingredients needed to make pancakes. I felt my mother’s distress of not knowing where the next meal was going to come from and in my ‘adoration for my mother,’ I came to the conclusion that if I wasn’t there, then her burden would be less. From that moment on, I grew up not wanting to be a burden to anyone and took on a stance of ‘I can do without’ and therefore I did go without so much for so many years until I uncovered this crazy belief and got rid of it. As you can see from that example, I made my mother’s feelings all about me, it changed me as a person, it changed the way I felt about myself and it changed the way I expressed myself. Not for one instance did my mother tell me I was a burden, I concluded that all on my own. You see, the only way you can change the tint on your glasses is by changing your internal view, which basically means to change the way you view yourself. How Acceptance helps your child Acceptance is a choice, to accept yourself, means being totally open and honest about who you are, and then giving yourself permission to be that person. The minute you do this, you change the tint of your glasses and not only are you able to see all the good stuff about you and your life, but you are able to do the same with others. Your defensiveness of yourself and your judgement of others disappears. Once you accept yourself, you are able to accept others for who they are too. And, more importantly you will role-model this to your children, they too will feel acceptable just as they are. I am not saying that this includes accepting bad behaviour. what I am saying is that your children need to know that who they are is acceptable, that they are enough and worthy of your love and respect, that it’s not dependant on their good behaviour. Click here to attend one of our free EQ talks in April and May

April 10, 2018

How to teach your child to overcome their fear of water

Before your child can begin learning how to swim, it’s critical to build their water confidence and remove any mental barriers they may have developed. If your child exhibits fear of the swimming pool, you’re not alone. Many children experience water anxiety that can impede progress during swimming lessons. Fortunately, this mental block can be overcome. In this article, I’ll discuss how best to deal with children who are nervous around water to help your child on the path toward proficient swimming. For new parents, I’ll also cover some common mistakes to avoid that can help prevent problems when it’s time to teach your child how to swim. Born to Swim You might be surprised to learn that babies are natural born swimmers. Just like adults, children’s bodies are naturally resistant to water. The same reflex that prevents infants from inhaling milk while breastfeeding protects them from choking on water while swimming or in the bath. If you’ve ever blown sharply in your baby’s face, you may have observed a natural mammalian diving response; a baby will automatically close their eyes and hold their breath. This is known as the bradycardic reflex and is present in infants up to one year old. Also remember that your child spent the first nine months of their lives in a veritable lap pool. They understand buoyancy and most infants don’t fuss at all about being taken into the water as long as it’s not too cold. Since fear of the water is a learned behavior, children who are apprehensive about swimming have typically had a childhood experience that caused that apprehension. Many of my swim students who started class with an existing fear of the pool had doubts simply because a parent instilled those doubts in their child, or the parents were overly cautious about getting water on their baby’s head and face when bathing. Most of these parents are well-meaning and did what they thought was best for the child at the time. Unfortunately, this teaches the child to be nervous around water and can lead to resistance when it’s time to start swimming. Take It Slow If your child has already started showing signs of water aversion, such as resistance, crying or refusing to go in or near the pool, it’s important to take it slow and proceed with caution. Don’t try to force the issue before she is ready to tackle the challenge on her own terms. Otherwise, you could end up facing an uphill battle with strong emotions like panic, crying, and sometimes, deepened fear. Start With Bath Time As the adult, you have the divine knowledge that water is completely harmless for your child. When it’s bath time, your job is to be a calm and confident parent. Use a cup to scoop water from the tub and pour it over baby’s body and head. Don’t be hesitant or express worry. Don’t make a big deal out of it by telling your child to hold her breath and count to three. And, most importantly, don’t shield your child’s eyes and face from the water. If you’re concerned about soap getting into her eyes, do an initial rinse with her head tilted back and a second and third rinse straight over the head. Let the water flow over her eyes, nose, mouth and ears. Remember that children learn to react like their parents and peers do. The same way that we inadvertently teach children to scream at the sight of a cockroach, we often teach them to be afraid of water too, sometimes just by showing outward nervousness when our children’s faces get wet. Capitalize on Interpersonal Relationships I’ve found that a role model can be tremendously encouraging for a child. If your kid has an older sibling, cousin or friend who can swim, take everyone to the pool together so your younger kid can see how exciting it is to swim independently. Often, this is enough to stimulate a non-swimmer to want to start lessons. In fact, I often teach dual-level lessons to allow for a more advanced child and a beginner to share pool-time. When the novice student sees their older brother or best friend excelling, they’re more likely to try skills they wouldn’t have attempted had they been on their own. Or, if you have two children at the same level, you can try them in a class together as well. Though some siblings have a harder time concentrating when their counterpart is around, others are encouraged by natural sibling rivalry. Make Pool Time Play Time If you have your own pool or you take regular trips to a community aquatics facility, you’re already on your way to helping your child overcome their water anxiety. If you plan to sign up for lessons, there’s no need to work on any specific skills in advance. Just allow your child to get used to the water’s feel and buoyancy. Bring some pool toys along to make the experience a positive one. When shopping for pool toys, let your kids help you decide. After all, they’ll be using them more than you and you want them to be excited about a new game before they get to play it. There’s really no wrong toys. Any toy that floats can be tossed out into the water and “rescued” with your help; anything that sinks can be placed on a step and reached down to while you encourage them to blow bubbles into the water. Even toys that aren’t meant for the pool will often work as long as they don’t have holes that water can get trapped inside and grow mold. Among the odder things in my toy bag, I have a water-tight baby doll, ping-pong balls and artificial flowers with fishing weights attached to them so kids can “pick the flowers” off the bottom. It’s important to keep pool toys separate from the regular stash so that kids don’t lose interest in them before you make it into

April 9, 2018

Vitamin B12 deficiency: A silent epidemic with serious consequences

Vitamin B12 deficiency isn’t a bizarre, mysterious disease. It’s written about in every medical textbook and its causes and effects are well-established in the scientific literature. However, B12 deficiency is far more common than most health care practitioners and the general public realise. Research suggests that 40 percent of people between the ages of 26 and 83 years have vitamin B12 levels in the low normal range – a range at which many individuals experience neurological symptoms. Symptoms of a vitamin B12 deficiency are easily mistaken for signs of other ailments. If you’re feeling more anxious, tired, or worn out than usual, a B12 deficiency may be to blame. Vitamin B12 deficiency can be sneaky and harmful, so keep reading for some insight. WHAT DOES VITAMIN B12 DO? Vitamin B12 is a water-soluble vitamin and is also the only B vitamin that is almost exclusively found in animal foods. The human body needs vitamin B12 (together with folate) to make red blood cells, DNA and help promote healthy function of nerves. In addition, B12 is one of the vitamins responsible for a well-functioning metabolism and robust energy levels. Like most vitamins, B12 can’t be made by the body. Instead, it must be gotten from food or supplements. And therein lies the problem: Some people don’t consume enough vitamin B12 to meet their needs, while others can’t absorb enough, no matter how much they take in. The absorption of B12 is also complex and involves several steps – each of which can go wrong. As a result, vitamin B12 deficiency is relatively common. WHO IS AT RISK FOR B12 DEFICIENCY? There are many causes for vitamin B12 deficiency. In general, the following groups are at greatest risk for a deficiency: Vegetarians and vegans Because B12 is not generally found in plant-based foods, vegetarians are at risk for B12 deficiencies. This explains why studies consistently demonstrate that up to 50% of long-term vegetarians and 80% of vegans are deficient in B12. People aged 60 or over The condition is more likely to occur in older people due to the cutback in stomach acid production that often occurs with ageing, making it harder to absorb this vitamin. It has been estimated to affect about 40% of people over 60 years of age. It’s entirely possible that at least some of the symptoms we attribute to “normal” ageing – such as memory loss, cognitive decline, decreased mobility, etc. – are at least in part caused by a vitamin B12 deficiency. People who regularly use PPIs or acid suppressing drugs If you take proton pump inhibitors (PPIs) e.g. omeprazole (antacid or heartburn drugs) you may be at risk for B12 deficiency. These drugs reduce acid production in the stomach and acid is needed to absorb vitamin B12. Medical conditions Conditions that interfere with food absorption, such Coeliac or Crohn’s disease, Ulcerative colitis, irritable bowel syndrome (IBS), bacterial overgrowth (intestinal dysbiosis), atrophic gastritis (thinning of stomach lining) or gut inflammation, pernicious anaemia (an autoimmune condition where the body destroys intrinsic factor, a protein necessary for the absorption of B12) can cause B12 trouble. Certain medications Use of some commonly prescribed drugs such as metformin (insulin resistance and diabetes), or anti-seizure medications such as phenytoin may cause a B12 deficiency. Heavy drinkers or alcoholism Drinking alcohol, even in moderation (more than one alcoholic drink a day), can have profound effects on the way your body absorbs vitamin B-12. Genetic variations Common genetic variations may interfere with the absorption of vitamin B12, and subsequently levels of the vitamin in the blood. Weight loss surgery People who have stomach stapling or other forms of weight-loss surgery are also more likely to be low in vitamin B12 because the operation interferes with the body’s ability to extract vitamin B12 from food. SYMPTOMS OF VITAMIN B12 DEFICIENCY Vitamin B12 deficiency can be slow to develop, causing symptoms to appear gradually and intensify over time. It can also come on relatively quickly. A vitamin B12 deficiency occurs in four stages. Stage 1 – beginning with declining blood levels of the vitamin Stage 2 – progressing to low B12 levels within the body’s cells Stage 3 – increased blood level of homocysteine and reduced ability to repair and produce DNA Stage 4 – finally, macrocytic anaemia Anemia A vitamin B12 deficiency can cause anaemia (low red blood cell production). Red blood cells carry oxygen all over the body. When the body does not produce enough red blood cells, the amount of available oxygen in the body, decreases as well. B12-related anaemia can cause many other issues, including: Extreme Fatigue: It’s normal to get tired during the day if you didn’t sleep well the night before, just ate a large meal, or completed strenuous exercise. But it isn’t normal to experience an overwhelming fatigue that doesn’t go away with rest. Muscle Weakness: You might experience soreness after a hard workout for a day or two, but if your muscles feel like you just ran a marathon after a simple activity like brushing your hair, you may be anaemic. Heart Palpitations: Feel a flutter in your chest? You could be experiencing heart palpitations due to decreased oxygen circulation. Breathlessness: Breathlessness is normal after activity, but if you find yourself short of breath during rest, it’s an indicator that something’s not right. Just like heart palpitations, anaemia can cause breathlessness due to a lack of oxygen in the blood. Pale Skin: Red blood cells are responsible for the rosy colour in our cheeks. When red blood cell production decreases—as it does in anaemic individuals—the skin becomes pale and colourless. Pins-and-Needles Sensation You know the pins-and-needles sensation you often get when your foot falls asleep? This sensation is called peripheral neuropathy and can be linked to nerve damage caused by a B12 deficiency. According to the Foundation for Peripheral Neuropathy, a B12 deficiency damages the sheath that surrounds and protects nerves, resulting in an unpleasant and sometimes painful tingling sensation. Other diseases such as diabetes can

April 5, 2018

Children with ADHD: Bullied or bully?

Symptoms of Attention Deficit Hyperactivity Disorder (ADHD) are unlikely to go unnoticed in a school environment. It can quickly earn your child the “different”, “difficult” or “disruptive” label and attract the attention of bullies. ADHD can inhibit your child’s understanding of social cues, which can have a negative impact on everyday conversations and social interactions. The exclusion from social circles only leads to heightened feelings of isolation and depression. Bullying in schools can have a serious impact on your child’s participation and academic performance. Over 3.2 million South African students are bullied yearly but more than 67% don’t speak up due to fear, shame, and doubt that parents or teachers can change their situation. Bullying is often directed at insecure and passive children who display physical weakness and poor social skills. Bullied or bully? Whether brought on by ADHD tendencies or low self-esteem caused by the condition, research suggests that ADHD children are nearly 10 times more likely to attract the attention of bullies. They tend to avoid confrontation but when taunted by bullies, ADHD children often overreact emotionally. Unfortunately, the display of tears and anger or an impulsive retort to provocation usually adds fuel to the flame for a bully. That said, recent research found that children with ADHD are almost four times more likely to bully other children without the condition. Likewise, this can be due to low self-esteem or could be in response to victimisation or feelings of depression. The destructive impact of bullying Bullying can be linked to lasting emotional, mental and physical health issues for both the bullied and the bully. If your child is bullied at school, he or she is likely to experience heightened levels of insecurity, anxiety, depression, loneliness, poor sleeping and eating patterns, and decreased academic achievement – over and above ADHD symptoms. On the other hand, if your ADHD child has become the playground bully, he or she is more likely to get into fights or partake in risky activities. Keep a close eye on school attendance as both the bullied and the bully are more likely to bunk school. Fortunately, there are many other ways to deal with bullying at opposite ends of this spectrum. In addition to a holistic treatment plan and an active support group, the impact of ADHD in the school environment can be successfully managed. That means less attention from bullies and a memorable and carefree childhood. For more information around the symptoms, impact and treatment of ADHD, visit MyADHD.co.za or My ADHD on Facebook.

March 29, 2018

Making your medical benefits last

As each new year begins medical aid members start with a clean slate, with new benefits and replenished savings available. ‘If you manage your medical expenses correctly you can avoid out-of-pocket expenses and limit the possibility of running out of benefits,’ says Gerhard Van Emmenis, Principal Officer of Bonitas Medical Fund. Van Emmenis, gives some tips on managing your medical expenses to make them last. Find a GP on your medical aid’s network Using network doctors is an invaluable tool to make your medical aid last longer as it means you won’t be charged more than a specific amount. At present, Bonitas Medical Fund has the largest network of GPs in South Africa – with over 6 000 doctors. Always use partner networks Medical schemes negotiate preferential rates with providers who have partnered with them. This means if you use a network hospital, doctor or pharmacy you will not be charged more than the rate agreed with the scheme. This will also help you to avoid co-payments, deductibles and additional out-of-pocket expenses. Ask your pharmacist Buy over-the-counter medicine to treat less serious ailments and consider using generic medicine which is cheaper but effective. Pharmacists are able to provide sound medical advice on problems such as rashes, colds or illnesses that are not severe, simply ask! Going to hospital – get the facts Talk to your doctor or specialist before being admitted to hospital. Check what they are going to be charging and what your scheme will cover. If there is a large difference, don’t be afraid to approach your doctor to see if they are prepared to adjust their fee. Alternatively, you can also check if there are other healthcare providers who are on your scheme’s network that will charge you a better rate. Remember to pre-authorise Pre-authorisation is required for all hospital admissions to ensure your stay will be covered. Always ask if there are any co-payments or sub-limits that will apply and what you can do to avoid these. For planned procedures, it’s also worth checking with your scheme if you will obtain better cover by using contracted providers or having the procedure performed in the doctor’s rooms or a day clinic. ICD-10 codes If you need to undergo an operation, ask your surgeon for the codes that will be charged. This will include the procedure codes and those for any other products that will be needed, this all helps with pre-authorisation and ensuring the costs will be covered. Look for schemes that offer benefits paid from risk These benefits give you more value for money and are in addition to your savings and day-to-day benefits. Bonitas pays for maternity consultations, wellness benefits, preventative care and dentistry from risk on most plans. Managed care benefits Some schemes offer programmes to help you manage severe chronic conditions such as cancer, diabetes and HIV/AIDS. These programmes are usually covered from the risk portion of your medical contribution and are not funded from your savings account. They help you use your benefits to maximum advantage while ensuring you receive quality care by using specific providers. Be aware of consulting after hours In an emergency one has no choice, but after hours consultations are very expensive. As a general rule, try to avoid using an ER facility where possible. A bona fide medical emergency usually results in admission into hospital. Manage your chronic medicine correctly The golden rule for chronic illness benefits is to try to use the medication on your scheme’s formulary and to obtain this from a specified pharmacy, either on the network or a designated service provider. Bonitas offers a home delivery service for chronic medicine, to make things even more convenient for members. PMBs If you suffer from a Prescribed Minimum Benefit (PMB) condition, understand what benefits are provided as part of a PMB condition and utilise the service of the designated service provider to ensure that your claims are paid from risk rather than from your medical savings account. ‘Don’t be uninformed,’ says Van Emmenis. ‘Your health is important, so take the time to research and understand the medical aid plan you’ve chosen. Read the information sent to you by the Scheme or your broker. Ensure you read the fine print and understand the Scheme Rules. This will go a long way in helping you know your rights and making the most of your benefits.’

March 29, 2018

Key signs that your child may have eye problems

Our eyes are windows to the wonderful world around us. It allows us to see the world as it is, and it shows us the world in its full splendor. We see a lot of great and amazing things throughout our lives, but it’s also important to remember that our eyes work with us for as long as we take care of them. Sadly, children, perhaps the most creative beings out there, don’t always have the awareness needed to take care of their eyes. As parents, guardians, and people who are concerned for their welfare, it’s up to us to make sure their eyes stay as vibrant as ever. Here are some signs that our child might have an eye problem, or might develop an eye problem. Is Your Child Prone To Lean Close To Electronics? It’s not wrong to lean closer to objects we can’t exactly see properly, but if we see our children lean close to electronics all the time, then we might be witnessing the first signs of an eye problem in its infancy. Remember, electronics emit light radiation and bright light, and constant exposure to bright light can permanently damage our child’s eyes, especially now that they are still in development. If your child has a gadget like a smartphone, a tablet, or a laptop, and you find them leaning in close too much to watch a video or play games that are already on full screen, then your child might have a developing eye problem. If your child is exhibiting the above but is also wearing glasses, then it might be a sign of a worse eye problem. Try to observe just how close your child is compared to the electronic device you’re seeing, and gauge if the normal eye could see the things they’re leaning towards. If, say, a text is something visible from your end at the same distance, and it seems blurred for your child, then you may be facing a problem. Is Your Child Experiencing Difficulties In Things Related To Vision? The signs aren’t just related to electronics, however, as your child might exhibit difficulties in tasks related to vision as well. Try to observe their behavior towards tasks involving following objects, or using their eyes to do things. If your child likes to read books closer to their faces, then this might be one of the little signs that they may have an eye problem. If your child tells you they can’t distinguish colors properly, then they may have a problem. If they experience trouble seeing the blackboard, looking at small objects from a distance, or potential hazards such as corners and stairs, then this might be a vision problem. You have to pay attention if your child is clumsy when doing things that shouldn’t let them be prone to injury, such as walking to somewhere while holding something. If your child avoids tasks that involve near vision activities like writing or coloring, and if they avoid distance vision activities like catch, seeing planes and birds, then these may be signs of a vision problem. Does Your Child Have Strange Eye Habits? We all have our quirks, and children have theirs too. However, if they have “quirks” involving their eyes that seem out of place, then your child might be experiencing the signs of a vision problem waiting to happen. If your child squints or blinks often than usual, especially when doing tasks that need their eyes, then they might have an eyesight problem. If your child tilts to see better, or closes one eye to see an object better, then they may have an eye problem. If your child is prone to rub their eyes even if they aren’t itchy, then they might have an eye problem as well. Do Your Child’s Eyes Look Strange? Perhaps the most obvious signs of a potential eye problem might be staring us right in the face and we aren’t seeing it. This is especially when we’re talking about our children. Try to look for these signs in their eyes that might tell if they have a vision problem waiting to happen. If there are any changes to their eyes that don’t seem normal, then it might be best to get them checked. For instance, if they looked cross eyed, or if the eyes don’t seem to look like they work at the same time, or if there are droopy eyelids and bulgy eyes. If your child’s eyes appear to be extra sensitive to light, then you might have a child with an eye problem. If there are recurring headaches, or if your child’s eyes show sensitive to light with pain, or a redness that doesn’t seem to go away, then your child might have a vision problem. What To Do Next? If you see these signs in your child, it’s important not to panic and assess the situation more closely. Which of these signs appear and how often do they manifest? Start taking notes, especially when it comes to describing the frequency of these signs, and what sort of signs appear. If possible, try to take pictures while they’re “on the act” for your personal reference. These kind of data are important especially when presenting your case to an eye doctor, which can also get a better assessment of your child’s case when they see the things they do when they’re at home. Remember, try not to panic, especially when these signs manifest. It’s always better to try to get a cool and calm head by planning what to do next and finding the best remedies with your doctor. These signs don’t automatically mean your child is going blind. They may have a condition that affects their eyes. If you want to get an initial assessment before going to the doctor, then try to check if you have relatives that may have an eye problem that is known to be genetic. Knowing this, and sharing this to the doctor, may help

March 27, 2018

What is a doula?

A doula is a labour coach that offers emotional and physical support to a woman and her partner before, during and after childbirth. The word “doula” is a Greek word meaning “woman servant”. Women have complex needs during childbirth. In addition to the clinical aspects of birth, women need consistent, continuous reassurance, comfort, encouragement and respect. Studies have shown that when doulas attend birth, labours are shorter with fewer complications, babies are healthier and they breastfeed more easily. What does a doula do: Recognises birth as a key experience you will remember all her life Understands the physiology of birth and the emotional needs of a woman in labour Assists you in preparing for and carrying out her plans for birth Provides emotional support, physical comfort measures and an objective point of viewpoint, as well as helping you get the information you need to make informed decisions Facilitates communication during labour between you, your partner and your clinical care providers Perceives her role as nurturing and protecting your memory of the birth experience Allows your partner to participate at his/ her comfort level Stays with you throughout labour Helps you track your birthing sensations and help you to decide when to call your midwife or head to the hospital Gets your birthing pool set up Helps you get settled in at the hospital Works with your partner to help you get comfortable Wipes your brow and remind you to breathe Squeezes your hips Helps your partner feel confident Take photos Tidies up post home birth Supports with words of encouragement Guides you through your first round of breastfeeding Shares your emotion Steps back while you enjoy some precious moments Offers education, companionship and non-judgemental support during the postpartum fourth trimester Assists with newborn care, family adjustment, meal preparation and light household tidying Offers evidence-based information on infant feeding, emotional and physical recovery from birth, infant soothing and coping skills for new parents and makes appropriate referrals when necessary Did you have a Doula at your birth? How was the experience?

March 26, 2018

Should you be giving your child fish oil?

Fish oil is one of the most studied nutritional and health products. The main components of interest in it are the omega 3 fatty acids. The human body cannot synthesize omega 3 and so it has to be sourced from the diet. Fish is one of the best sources of omega 3. The two main biologically active ingredients in omega 3 are docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Sources of fish oil include the processing of oily fish such as salmon, sardines, tuna and cod. Fish oil also contains some small amounts of vitamin A. In view of all this; it is now easier to tackle the question of whether fish oil should be given routinely to children. The first question every parent should consider is whether they are giving their children adequate fish oil through the diet. This can be answered easily by assessing the number of times in a week the children eat any of the oily fishes. This has to be several times week. In the U.S, the American Heart Association recommends more than 3.5 oz. of oily fish two times per week. Since many children’s diet is a reflection of what the adults are taking, it is likely that they also get inadequate fish oil from the diet and hence supplementation is necessary. Everything in proportion The typical western world diet consists of high omega 6 fatty acids intake. These are mainly vegetable oils. High consumption of these oils has been linked with a high incidence of degenerative disorders. In an ideal situation the ratio of omega 6 and omega 3 should be about 1:1. This helps to counteract the undesirable effects of omega 6. In some cases the consumption ratio is disproportionate with omega 6 being up to 10 times more than omega 3. To bring the ratio to near normal fish oil should be given to the majority of children. The benefits of fish oil for children There are many documented benefits to giving your children Omega 3, including: Healthy brain development Improved cognitive ability Health bones and joints Good eye health Reduced hyperactivity disorders symptoms Healthy skin How much fish oil should children be given? The amount of fish oil supplementation depends on the amount of omega 3 it contains. Therefore the dosage for children is given in terms of omega 3 amounts (total DHA and EPA) and it is age dependent. Different countries also have slightly different recommendations. Below is a suggested dosage regime. 0-12 months about 0.5 grams per day 1-3 years about 0.7 grams per day 4-8 years 0.9 grams every day 9-13 years 1.2 grams each day for boys. Girls can do with 0.2 less grams than boys 14-18 years 1.6 grams daily with girls in the same age bracket needing about 1.1 per day Some countries recommend dosages in terms of mg per kg of body weight. Ascertain your country’s guideline before giving fish oil to your children. Side effects of fish oil Fish oil is generally well tolerated. However, children with known allergies to the oil or certain sea-foods should better avoid it unless your doctor says it is okay. Cod liver oil is a type of fish oil sourced from the liver of cod. It contains a lot of vitamin A and D. These vitamins are fat soluble and if taken in excess have accumulating effects in the body and they can cause serious health effects. Never exceed manufacturers’ recommended fish oil dosage. Jane Hutton is a nutritionist and health enthusiast. She also enjoys rock climbing and sailing in her free time. She’s passionate about animal rights and works for an Omega 3 brand called NothingFishy. Facebook: NothingFishy Omega3 Twitter : @nothingfishyco

March 23, 2018

What are the early signs of autism in children

Almost every mom gets herself into a twist if her baby or child is not reaching milestones according to the so called norm, wanting to know if her child is just late to reach those milestones or if there may be a more serious cause for this. While the majority of babies and children reach their milestones at the average age, there will be some babies that reach their milestones much earlier and some that just lag behind the rest. There is usually no need for alarm, they are just late bloomers and will get there in their own time. What is important to look out for is that your baby or child is developing and gaining new skills, even if they are a little slow to reach milestones. Some babies will start crawling late, or not even at all, yet start walking earlier than the norm. If your baby is making progress overall then chances are there is nothing to be concerned about. That said if you are concerned about anything it is best to take your baby for a check up since if there is any sort of developmental delay or disability it is always best to know about it as early as possible. Early diagnosis means that interventions with autism doctors and specialists can be implemented and outcomes can be improved drastically. You will also need to learn about special needs parenting and how you can help your child. Complex disorders of brain development are now classified under the broad terms of Autism Spectrum Disorder (ASD) and Autism. This means that autistic disorder, childhood disintegrative disorder, pervasive developmental disorder-not otherwise specified (PDD-NOS) and Asperger syndrome all fall under the broad spectrum of Autism Spectrum Disorder. Autism is a neurodevelopmental disorder characterized by impaired social interaction, verbal and non-verbal communication, and restricted and repetitive behavior. If your child does have autism it will make the world of difference if you can start behavioral therapy before 18 months of age. What makes this tricky is that very often the most obvious signs and symptoms of autism tend to emerge between the ages of two and three years old. According to Connecticut & Golf Coast ADHD Associates: Autism spectrum disorders are lifelong conditions with no known cure. However, children with ASD can progress developmentally and learn new skills. Some children may improve so much that they no longer meet the criteria for ASD, although milder symptoms may often persist. What are Early Signs of Autism in Children? The earliest signs of autism in children involve the absence of normal behaviors as opposed to the presence of abnormal behaviors. Since autistic babies are very often quiet and undemanding parents may think that they have an easy baby and not realize that there is a problem. It is very common for autistic babies to not respond to cuddling, not reach out to be picked up and not to make eye contact with anyone. Early signs that your baby may have autism are when your baby or toddler does not: follow objects or your movements visually, or does not visually follow where you point use gestures to communicate such as waving goodbye or pointing respond to the sound of your voice or respond to being called by name make eye contact with you reach out to you when being picked up respond to or initiate cuddling make noises to grab your attention play with other people show enjoyment or interest imitate facial expressions and gestures care or even seem to notice if you get hurt or are upset in any way The following symptoms are cause for concern, so you should take your baby to be evaluated: No big smiles or signs of happiness and enjoyment by the age of 6 months Does not interact by sharing sounds and smiles, and imitating of other facial expressions by 9 months old Your baby does not respond to his or her name by one year old Your baby does not make any noises or “baby talk” by one year old Your baby does not make any gestures such as waving, pointing. reaching or showing by one year old Your baby does not speak any words by 16 months old Your baby does not speak any meaningful two word phrases that are not imitating or repeating by two years old While some babies and toddlers just develop later than others, if you are worried about anything take your child to be checked out. It is better to be safe than sorry later on, especially since the younger the child is when autism is diagnosed the better. It is also vital as a mother or father to trust your own instincts, so get a second opinion from a child development specialist if you are not sure about a diagnosis. As children get older the signs for autism become more diversified and noticeable. Impaired social skills, non-verbal communication difficulties, inflexible behavior and speech and language difficulties are typical signs of autism.

March 22, 2018

WHAT ARE THE BENEFITS OF CO-SLEEPING WITH YOUR NEW BORN?

Co-sleeping is often thought to be synonymous with bed sharing – also known as letting baby sleep in the same bed with you. But co-sleeping can also mean putting baby to sleep in the same room as you but in a separate bed. If your baby is six months or younger, experts recommend that healthy infants be placed on their backs for sleep, as this is the safest position for an infant to sleep. Putting your baby to sleep on his back decreases his chance of sudden infant death syndrome (SIDS). This applies to daytime naps as well as during the night. Huggies® expert and midwife, Lynne Bluff, sheds some light on some of the benefits of co-sleeping with a newborn baby. Remember for the first three to four months of life it is recommended to have skin to skin between baby and mom and dad, as much as possible. Skin to skin is when baby only has nappy on and no clothes. Baby is then placed against mom’s bare chest (skin to skin) and baby is wrapped with a shirt or blanket against mom’s or dad’s chest. Many parents choose to co-sleep with baby because it allows for more skin to skin contact. There are many benefits to co-sleeping! Here are some benefits of keeping baby close: Babies naturally fall into a daytime and night time pattern: it isn’t uncommon for new-borns to mix up their days and nights. Many babies sleep extra soundly throughout the day but can be restless or wakeful much of the night. Keeping baby close during the day with lights and noise around can eventually help baby stay a bit more alert in the daytime. Keeping baby close at night, meeting their needs with a quiet and dim environment, can help them learn to rest more at night. Babies also rest more soundly when they feel secure. Co-sleeping helps babies practice rousing themselves: while having your new-born falling into and staying in a deep sleep might sound appealing, it isn’t the type of sleep they were designed to have. Co-sleeping babies are frequently aroused when close with their moms. This practice rousing can help babies learn to use their self-preservation instinct to rouse when there’s any danger such as being overheated, being too cold or something blocking their airway. Being able to easily rouse may reduce the risk of SIDS. Meet baby’s needs without getting up: Most babies need to be fed, soothed and changed at night. If baby is close by, mom can do all of these things while in bed and remaining in a restful state. Getting out of bed, walking down the hall, changing nappies on the changing pad, feeding in a glider and soothing baby back to sleep requires being fully awake and alert. Experience less night time crying: babies sleep well when they feel secure. Knowing mom is close will likely help baby sleep better and fuss less. Moms that co sleep are able to notice earlier signs of hunger and needing to be changed. Often mom can wake during these early signs and meet baby’s needs before they begin to cry. When you co sleep there is less trying to get baby to settle down to sleep before laying them down. This often means less crying. You aren’t likely to have an overtired baby fussing and protesting being laid down in their cot to sleep. Co-sleeping helps with bonding and secure attachment: a secure attachment between baby and caregiver is an emotional bond that leaves baby feeling secure and cared for. This secure attachment, fostered infancy, translates to a child feeling secure and knowing their caregiver will always return to meet their needs. Children with a secure attachment often respond appropriately to situations, show minimal distress when their mother leaves, and are happy when their mother returns. Co-sleeping helps with maintaining an adequate milk supply: feeding on demand helps moms maintain an adequate milk supply. Breast milk production is a supply and demand process. Babies are designed to eat frequently at night and co sleeping helps to make it easier for mom and baby to meet this need. Co-sleeping can mean better rest for mom: moms, not just babies, are wired for closeness. Studies show that new moms do not experience a better quality of sleep if their babies go to the nursery at night. Co-sleeping may not guarantee more sound sleep for every mom, but many report sleeping better knowing baby is safe and close by. Moms also release oxytocin when close to their babies. Oxytocin improves sleep quality and it’s also great for breastfeeding. As your baby grows, he may not want to sleep all night, every night, with you. With a bit of trial and error, you’ll eventually find a method that works for you, your partner, and your baby.

March 21, 2018

Natural remedies for heartburn during pregnancy

Heartburn affects a lot of women during pregnancy, particularly during the third trimester of pregnancy.The reason for heartburn during pregnancy is increased levels of progesterone. Progesterone relaxes muscle, including the stomach valve that keeps the stomach acid out of the oesophagus. Another cause of heartburn during pregnancy is the growing baby putting pressure on the stomach, pushing the acid from the stomach upwards and of course with the stomach valve relaxed it just goes up into the oesophagus. If you have suffered from heartburn during pregnancy you know how horrible it can be so this article is going to share with you some things you can do to avoid heartburn during pregnancy, some natural remedies for heartburn during pregnancy and if all that does not work some medication you can take to try and get rid of your heartburn during pregnancy. Ways to avoid heartburn during pregnancy Prevention is always better than cure, so here are some measures you can take to try and prevent getting heartburn during pregnancy. While they may not work entirely to prevent heartburn you can be assured the symptoms would be much worse if you didn’t do these things. Eat Smaller Portions – Instead of eating 3 larger meals a day eat much smaller meals more often. This gives your system a chance to digest the food without overloading your stomach. It also means you are eating more often and have less of a chance to get hungry. If you are hungry you will also be prone to heartburn during pregnancy. Keep snacks on hand if you are out so you can eat regularly. Eat Slowly – Eating slowly not only aids digestion but it gives your stomach a chance to let you know when you are full. This will help you to eat smaller portions which will also help prevent heartburn during pregnancy. Sip Liquids – Instead of drinking large amounts of liquids, sip constantly throughout the day and in between meals. Avoid drinking any liquids with a meal. Sit or Stand after eating – Make sure you sit or stand for a few hours after eating. Avoid bending over and lying down as this will cause the stomach acid to come up your throat, Don’t eat just before sleeping – Wait a few hours after eating before you lie down or sleep. This will give you a chance to digest your food before lying down. Sleep elevated at night – Being in the lying down position encourages the stomach acid to come up your oesophagus. Prop yourself up on pillows so your head and chest are elevated while you sleep. Avoid heartburn trigger foods – Certain foods trigger heartburn, so try and avoid these. While there are certain foods that are often triggers for a lot of people, they may not be for others. Pay attention to what you are eating and if you get heartburn try and eliminate those foods that caused it. Foods that commonly trigger heartburn are caffeine, fizzy drinks, chocolate, citrus, spicy foods, fatty foods, fatty red meat, french fries, omega 3 (fish oils), raw onion, oil, fried foods, butter and tomatoes. Wear lose fitting clothing – Avoid any clothing that can put pressure on your stomach or chest areas, this will just make any heartburn symptoms worse. So think stretchy, it will be much more comfortable for you anyway! Natural Remedies for Heartburn During Pregnancy Although there are some steps you can take to lessen your chances of getting heartburn during pregnancy the fact is that many women will still suffer from it. When you do here are some natural remedies you can try before you resort to medication. Yogurt or Milk for heartburn – Eating yogurt or drinking some milk can relieve heartburn. While cow’s milk often gives immediate relief, it can over time worsen the heartburn. Alternatives you can try are nut milk, rice milk or goat milk.You can also warm milk and add some honey. This can soothe your burning chest. Bentonite Clay for Heartburn – You can take bentonite clay before eating meals can coat the stomach and bring down acid levels. Bentonite clay is found in tablets, capsules and powder form.It is alkalising and absorbs the stomach acid, easing heartburn symptoms. Marshmallows for Heartburn – Sounds crazy right? Well apparently marshmallows coat the lining of the stomach and oesophagus, protecting them from the stomach acid. Slippery Elm Bark – Slippery elm bark is available in capsule, powder and lozenge form. It builds up the mucous lining of the stomach and protects it from the stomach acid. Chewing Gum – Try chewing gum for heartburn during pregnancy, it works! Apple Cider Vinegar – Low stomach acid creates heartburn, so drinking acid cider vinegar can increase the acids can result in relief. Papaya, pineapple, avocados and bananas – These all contain naturally-occurring enzymes which help break down food. Green Olives – Apparently eating a dozen green olives a day can help prevent heartburn and ease it if it does occur. Coconut Water – Coconut water has lots of potassium and electrolytes that help to keep the body hydrated. Sipping coconut water throughout the day and drinking a glass before bed can help to acid reflux away. Almonds – Roasted or raw almonds will do, just eat some every day to keep the heartburn away. Ginger – Ginger in any form is great for heartburn, whether powdered, pickled or fresh. You can even try ginger biscuits or ginger ale. Bicarb of Soda – Bicarbonate of soda quickly neutralises stomach acid, relieving heart burn. Drinking Aloe Vera Juice – The healing property of aloe vera soothes the entire oesophagus track and provides relief from heartburn. Chiropractor – Some recent studies show that seeing a chiropractor can help with heartburn. Certain chiropractic adjustments shift the oesophageal valve into a better working position. This relaxes the muscle, helping prevent acids from making their way back up. Aromatherapy for heartburn – Add four drops of lemon, orange blossom or orange essentials oils to a teaspoon of

March 19, 2018

Natural remedies for relieving back and neck pain during pregnancy

While pregnancy is a time of great joy and happiness, very often it is accompanied by aches, pains and unpleasant pregnancy symptoms. Although the mother to be is often very uncomfortable it is tolerated as a bitter sweet experience. It is very common for a pregnant woman to experience back pain and neck pain, sometimes it can be mild but some women experience quite intense pain that can impact her lifestyle negatively. Back pain during pregnancy can cause numerous problems from missing time at work, a more difficult labour and birth, and very often can also create problems that can extend long after birth. So while back pain and neck pain during pregnancy are common symptoms it is essential to look at the problem and manage the back and neck pain during your pregnancy. There are two common types of back pain during pregnancy, lower or lumbar back pain (sciatica) which is felt above the waist and posterior pelvic pain which is felt below the waist. Lumbar back pain is most often felt when standing or sitting for too long, or from repetitive lifting. Posterior pelvic pain is often brought on or made worse when sitting up from a lying position, standing up, rolling over, running, walking, taking stairs, bending forward, lifting something or twisting your body. The three most common causes of back pain during pregnancy are weight gain, changes in the moms centre of gravity which puts strain on different muscles and hormonal changes which relaxes muscles and joints. Here are some helpful natural remedies you can try for relieving your neck and back pain during this time. Proper Exercise During Pregnancy for Relieving Back Pain While exercising during pregnancy is highly recommended it is very important to do exercise that is appropriate for pregnancy. You don’t want to cause more damage than good. Being fit and active during pregnancy will help you to strengthen your back muscles, abdominal muscles and pelvic floor which will help to reduce back pain. Being active will also help to keep your weight gain under control, which will in turn also help manage back pain. The fitter and stronger you are during pregnancy the easier your labour and birth will be on your body, so it can also help reduce your labour pain. Exercise that is considered good during pregnancy is swimming, brisk walking, indoor stationary cycling, yoga and low impact aerobics. Make sure to take take yoga and aerobics classes taught by a certified instructor. Maintain a Good Posture to Manage Pregnancy Back Pain As mentioned above, when you are pregnant your centre of gravity shifts causing new muscles to take strain. Add in the additional weight and very often pregnant women then fall into the habit of bad posture. Having bad posture will cause back and neck pain, so try and hold your spine erect with balanced posture. Massage Therapy for Managing Pregnancy Back Pain Getting a massage during pregnancy can help your body to relax. A massage will also increase reduce joint swelling by increasing circulation and moving fluids around the body. This can help relieve sciatica. The massage therapy can also include heat pack or a cold pack for providing the maximum relief. It is important to be safety conscious and to only book a massage with a therapist that is qualified in prenatal massage. Get Enough Rest It is vitally important to get enough sleep during your pregnancy so you can enjoy your pregnancy in good health. If you are not getting enough restful sleep you will feel it in your body which could increase back pain. You can check this web article which provides you good information and tips on getting relaxed and pain free sleep at night. There are many high quality specially designed pillows for pregnant women that can support your back and your belly at the same time. Buy one for your body and baby to give yourself the best care. Sleeping on your side with a pillow between your knees can help to greatly reduce back pain. Visit Your Doctor This can be your last resort after trying out some of the basic things above. You doctor may recommend you do some effective exercise along with medications that are meant to reduce the inflammation and relieve joint pain during pregnancy. Neck and back pain during pregnancy can definitely be relieved with the help of these measures. In fact, as soon as you experience some form of pain, the ideal option for you is to become proactive and find out the most suitable measures that can help you. Consequently, you will be able to breathe a sigh of relief soon.

March 16, 2018

The benefits of yoga for pregnant woman

Introduction Unknowingly, many of you are transforming from a woman into a mother and you have all the privilege to give birth and to nurture. At this stage, pleasure and pain merge into this cosmic experience of creation, and you can think of nothing, but your little precious baby. This world will soon be your baby’s playground, a place that he/she can grow into his/her own unique characteristic. But for now, the child is starting experience the world through us, therefore, we need to prepare all of the best things to welcome them. Therefore, I would like to share my experience with yoga during my pregnancy which can help any moms stay fit as well as deliver healthy and happy babies. What Yoga Can Help Women in Pregnancy For me, pregnancy and bringing a child into the world is regarded as the unique experience, but it is also a time of immense change of excitement, joy, anticipation, nervousness as well as other fluctuating emotions. As a consequence, practicing yoga is extremely beneficial for pregnant women for many reasons that I will show you now. Nevertheless, you still need to consult with your doctor before taking it up so as to make sure that you will not suffer from any pregnancy-related complications. When I was pregnant for the first time a few years ago, many people advised that I should enhance strength for my lower and upper body in order to endure the additional weight as well as adapt to such adjustment in balance. Thus, I started coming to yoga and surprisingly, this routine deals with the actual birthing muscles which are utilized during the birth process including my lower back, pelvis muscles along with the hip. Furthermore, during my pregnancy, I had to put up with back pain as my tummy size increased dramatically. As a result, pain-busting moves in yoga did a great job in supporting my waist and then my lower back. Moreover, owing to the increase in my weight and the change in my body shape, I felt wobbly, so that some balancing exercises in yoga can help me to get familiar with my changing center of gravity. Going to the next point, I used to go through a depressed period when having my first baby and prenatal yoga can help me release endorphins in my system. Thanks to this incredible exercise, I can get into happy positive state of mind, avoid the morning sickness as well as keep me active the whole day. Therefore, do not hesitate anymore since you have to try this and you can totally achieve all of these great things like me. In addition, you and your baby are so intrinsically connected that when there is any toxicity in your body or any stress, all of them will go straight to the baby. Therefore, practicing yoga can help moms to live more purposely and efficiently. I used to have doubts in these benefits when first inviting to yoga, but now, I have to admit that it is exceptionally suitable for any pregnant woman. Before, I believed that sleeping is the the best way of rest but I have changed my mind after coming to a yoga class. You will be surprised to know that the relaxation pose that comes at the end of any yoga classes is useful for your rest. I am sure that many women do not believe at this moment, but you need to take my advice and see the magic in the end. Last but not least, I recommend that taking part in yoga classes is the cheapest method to meet moms who are going through the same process as you. After some classes, I have made a lot of good friends and until now, we still meet each other with our children at the weekends. We can share the difficulties as well as some tips to take better care of our precious children. Conclusion As you know, pregnancy is one of the most powerful and tough times in a woman’s life. Therefore, prenatal yoga really trains the woman’s mind and body to be able to give birth consciously. After reading this article, why don’t you join a yoga class right now and if you have any confusion, please feel free to contact me anytime. Emma Baster is the editor of Eruditemommy.com. She understands deeply about the difficulties of pregnant women and mothers. Therefore, she built this blog to share her knowledge about nutrition, taking care of children, mommies’ health. Better care for families is everything she wishes to convey in this blog. Follow Emma on Twitter @EruditeMommy

March 15, 2018

The do’s & don’ts of returning to exercise after a caesarean section

Moms out there who have had or are planning to have a caesarean we’d like to give you a few tips and coping mechanisms regarding that sometimes very scary and difficult recovery period. First and foremost a caesarean delivery can be considered as major abdominal surgery therefore postpartum return to exercise must be delayed until you have made a complete medical recovery. We therefore strongly suggest that your doctor needs to give you the “green-light” to commence exercise. Generally, it takes about 6 weeks for your stitches to heal if you have experienced no other complications. So here are our top 5 tips on coping with the return to exercise post C section. 1. First and foremost, getting in and out of bed… There’s no two ways about it, you WILL need to get in and out of bed countless times during the night to tend to that new born so here’s our advice as to how to protect that wound as well as your lower back when getting in and out of bed: Bend your knees up one at a time Roll onto your side with your knees still bent and together Push yourself up with your arms (Not sitting up using your abs), allowing your legs to swing down towards the floor Stand from this position Do the same in reverse to get back into bed 2. It has been suggested that new moms are, in fact, encouraged to walk as soon as possible after a caesarean delivery. Walking increases blood flow circulation, which helps speed up the healing process. Therefore it is safe to suggest that you should be up and walking as soon as your spinal block has worn off. So up you get, have a nice warm shower and then start with little bouts of walking to and from your baby and around the maternity ward as much as possible. Increase these bouts of walking slightly each and every day leading up to your 6 week doctors check-up. Remembering that if you would like to go walking with your baby, use your pram rather than a front pack or sling as this can stress your core and lower back. 3. Now for our personal favourite piece of advice for that 6 week recovery period, begin practising your pelvic floor exercises as soon as possible. Pregnancy can put a strain on your pelvic floor, so these exercises are important, however you gave birth. Every time you lift your baby, tighten your pelvic floor muscles and lower tummy muscles at the same time. This will help to protect your lower back, and will prevent you from any accidental leaking. 4. Whether you choose to breast feed or bottle feed your new born we suggest that you make sure you’re always seated comfortably, someone once told me to make sure that I bring my baby to me rather than taking me to my baby during a feed which made perfect sense. Avoid hunching over/leaning down to feed your baby. Feed in a comfortable and well supported chair that also supplies arm support and where possible make use of a feeding pillow so that it does the work rather than you bearing the weight of your baby. 5. Last but certainly not least, make use of any and all medication given to you. You will probably be supplied with a week to 10 days’ worth of pain relief, anti-inflammatory and constipation medication, and while you might start to feel great a couple of days after leaving hospital and think that you no longer need these meds TAKE THEM! They have been given to you for a reason which is to support your body during the inflammatory response of healing and so they are a necessity.

March 15, 2018

Heads up on infant health ahead of taps running dry

When the dam levels reach 13.5%, the city will begin to shut down its reticulation system in residential areas, which essentially means the taps will run dry. Day Zero, currently earmarked for mid-May 2018, has serious ramifications for the city, which has already been declared a disaster area and it’s close to 4 million residents. ‘We have been inundated with advice about water saving tips,’ says Gerhard Van Emmenis, Principal Officer of Bonitas Medical Fund, ‘and, as a medical scheme entrusted with taking care of our members wellbeing, we felt compelled to do our bit to help our members and the citizens of Cape Town with advice around health issues during a drought, especially for the more vulnerable such as infants and the elderly. ‘We have researched the potential health risks in the time of a water crisis and compiled easy to follow guidelines. Even before taps are turned off, when clean drinking water is not readily available there is a high risk of some diseases which, as a health care community, we need to anticipate and mitigate.’ In the case of infants (aged under 3 years), advice from the Bonitas Babyline team is as follows: Care should be taken to adequately sterilise bottles and pacifiers. In the current heat, any formula or milk left in the bottle after a feed should be discarded if not consumed immediately. Parents should take care to make just enough for baby for each feed Make sure your child has enough water to drink and is well hydrated. Children often do not realise they are thirsty and play in the heat. Ensure your child drinks water often With water restrictions, children are prone to bacterial and fungal infections of the skin. Ensuring the skin is cleaned as thoroughly as possible every day will help prevent these infections The single biggest threat to child health with water restrictions is from gastro-enteritis. Make sure food is prepared as hygienically as possible and reduce the amount of bought cold foods and salads in the child’s diet. Cooked foods served fresh are best. Here are 10 tips to help you stay healthy ahead of the taps being turned off Boil water or use water purification tablets for the rain water we are able to capture. However, preferably use this for flushing the toilet, not for drinking. Use Milton to add to water to wash raw veggies – with the listeriosis outbreak as well as the possibility of a Hepatitis A outbreak we can’t afford not to wash our fresh produce! Use an alcohol-based hand sanitiser or wet wipes to keep hands clean (and hand cream because that stuff gets pretty harsh after a while!). Bicarb and vinegar are excellent for cleaning especially as it doesn’t destroy water for grey use. Dodgy tummy prep: Rehydrate, probiotics and medicine for stomach cramps, vomiting and diarrhea. Use vinegar in the toilet and drains to help with any odours and bacteria. Clean with micro-fibre cloths or rags as sponges become unsanitary. It’s far easier to clean cloths and hanging them up immediately can delay them smelling. You can also throw rags away. Alternatively wipe down surfaces using wet wipes. Stock up on bottled water exclusively for drinking while water stations are being sorted out. The recommendation is 5 litres a day and to have four days’ worth of fresh water per person. Do not drink non-potable water (gray water). This water should also not be used for cooking. Vaccinate against Hepatitis A if you have never been vaccinated (especially healthcare workers, communal food handlers, patients in long-term care facilities and immune-compromised people.) Mental illnesses such as increased anxiety, depression and even suicide can be managed with the right help. If you, your family and especially your infant have any of the above symptoms, visit your doctor for an assessment sooner rather than later. ‘We know it is a difficult time for Capetonians’ says Van Emmenis, ‘it is stressful trying to save as much water as possible while trying to remain healthy through this time. But help is at hand, the local authorities and medical professionals are on high alert and standby to assist and, for Bonitas members, we also have our Babyline – 24-hour children’s health advice line manned by paediatric trained registered nurses. They are on the other side of the phone to assist with any parental concerns, or health related issues, 24/7, 365 days of the year.’ The Babyline service is available to members across all Bonitas plans, for children under 3 years. Parents simply need to call the Babyline on 0860 999 121.

March 15, 2018

The common myths & FAQ’s when talking about Teen Suicide

The South African Depression and Anxiety Group (SADAG) is highlighting Teen Suicide Prevention Week (11-18 February) to help parents, teachers and loved ones with tips and information to talk about Teen Depression and Suicide Prevention to their teens. 1 in 4 South African teens have attempted suicide, talking to teens about depression and suicide can help prevent them from taking their life. Most people are too scared to talk about the topic, or if they do they don’t know what to say. “For many teenagers adolescence is a transition into a different stage of life of the beginning of living itself, however unfortunately for some it can also be the end of their life altogether. Teen suicides are real and rob many young people of a future and our society of a future. Let us speak about teen suicide today so that we may never have too again in the future.” Says Clinical Psychologist, Zamo Mbele. Remember that people who are thinking about suicide feel alone and isolated, and often feel like no one understands how they feel. Changes in life may be upsetting and they may want to escape a difficult problem or situation, or get relief from terrible stress. You may know if your friend or loved one is going through a tough time. Here are some common myths and facts about Teen Suicide: death in the family – can cause depression. If you are worried about someone you care about, encourage them to tell their parents, see a doctor, counsellor, or teacher – you can even go with them so you know they get there, and they know you are there to support them. The most important thing is that they speak to someone and get help. If you are worried about your teen or friend who may be depressed or suicidal, contact a counsellor at SADAG 0800 567 567 or 0800 12 13 14 or visit www.sadag.org . We can provide free telephonic counselling, info and referrals to resources throughout South Africa.

March 14, 2018

What is PROM and is it a Cause for Concern in Pregnancy?

Pregnancy is one of the most beautiful miracles of nature, to have a human being formed inside us. This is a time filled with excitement and joy, but can also be overwhelming as we are expected to know everything there is to know about pregnancy, what is normal and what is not, what is cause for concern versus what is not and overall what to expect. This article is meant to give more information about PROM (Prelabor rupture of membranes); how common it is, what some of the associated risks are, and what we need to do in case we suspect PROM. How common is PROM? PROM (prelabor rupture of membranes) is very common in pregnancy, in fact, it is estimated that between 20%-30% of pregnancies are affected by PROM, but frequencies of up to 40% have been reported 1. PROM occurs when the amniotic sac ruptures and amniotic fluid starts to leak. What is this Amniotic fluid (water)? Amniotic fluid plays a very important role in supporting the fetus during pregnancy. The mother’s body produces amniotic fluid as soon as 2 weeks after conception. The most important role of the amniotic fluid is to protect the baby against physical shocks from outside. It also helps the fetus to move around in the womb, consequently, allowing the fetus to develop his muscles. Maintaining a constant temperature – The amniotic fluid is typically 1 degree Celsius higher than the mother’s body temperature. This helps the fetus to maintain his body temperature. At full gestational age, SROM (spontaneous rupture of membranes) occurs, which usually occurs after labor pains commence and is a normal part of the labor process. However, sometimes PROM occurs, and this could lead to complications. Complications associated with PROM: PROM is defined as the rupture of membranes (amniotic sac) and leakage of amniotic fluid before labor begins. This can happen after 37 weeks of gestation. If the rupture of membranes happens prior to 37 weeks of gestation, the condition is termed PPROM (preterm premature rupture of membranes)2. It is important to be able to identify PROM as sometimes it is a gush of water that comes out which is obvious, and sometimes it is a gradual continuous leakage which is not very obvious, and can thus be mistaken for urine. Diagnosing PROM is very important for proper management of the pregnancy and delayed diagnosis could lead to complications for both mother and baby. The two direct and most important complications of PROM are: Chorioamnionitis, which is an acute inflammation of the membranes & chorion of placenta, from ascending polymicrobial bacterial infection due to ruptured membranes and Preterm delivery (PTD)1 These complications could lead to neonatal respiratory distress syndrome (RDS), foetal distress, neonatal sepsis, congenital infections like pneumonia and intraventricular haemorrhage (IVH) and increased neonatal deaths1. According to an article in the South African Medical Journal, deaths due to prematurity had patient associated avoidable factors in 30% of the cases. The top 5 factors were: Inappropriate response to rupture of membranes. Delay in seeking medical attention during labor. Non-initiation of antenatal care. Booking late in pregnancy. Infrequent visits to antenatal clinics3 Diagnosis of PROM is important and facilitates the commencement of appropriate therapy and could lead to reduction in complications. PROM often occurs when the pregnant woman is not in a healthcare environment. For this reason, it becomes very important to identify and know when it is PROM, in order to seek medical care and thus reduce the associated risks. When the rupture of membranes occurs or the water breaks, there is usually a gush of fluid that comes out; this is the obvious sign of PROM. The challenge becomes when this classic gush of fluid doesn’t occur, and only a gradual continual leak occurs; in this case how do you know if it is amniotic fluid or just a urine leak which is common in pregnancy? The AMNIOPADTM is a self test kit used to test for leakage of amniotic fluid (water breaking) during pregnancy. The test comes in the form of a panty liner; it’s highly effective, easy to use, results are easy to interpret, and is the only test available in South Africa that can be used at home. This easy-to-use home test kit allows you to detect probable leakage of amniotic fluid whenever you encounter unidentified wetness, or among women with a history of premature membrane rupture. AMNIOPADTM panty liner changes colour when it comes into contact with fluid of pH levels greater than or equal to 6.5. Amniotic fluid pH levels are greater than 6.5. How to use: Simply attach the special AMNIOPADTM panty liner to your underwear and get on with your day. When you feel a fluid leak, check for a colour change on the yellow background. The pad colour change can be partial or complete (any intensity, shape, size or location). Note: a colour change appears within 10 minutes following a fluid leak. If there is a colour change to blue or green, amniotic fluid may be leaking from your uterus, or you may have a vaginal infection. You should consult your physician or go to the hospital without delay. If the panty liner remains yellow or turns yellow after 10 minutes, the fluid leak is probably urine, which is common during pregnancy. If you continue to experience vaginal wetness, apply a new panty liner and repeat the test. Any minimal amount of amniotic fluid leakage which can be sensed as wetness by the user will create a visible blue or green stain. For further diagnosis and medical care, report the results to your physician. AMNIOPADTM panty liners are recommended for screening either high-risk or normal pregnancies. Leaking amniotic fluid increases the risk of infection to both mother and foetus and early detection can help to: Prevent complications or premature birth. Identify a possible membrane rupture, especially after amniocentesis. Confirm that your water has broken so that you arrive at the hospital in time for a safe delivery. READING YOUR

March 12, 2018

Experts Weigh In on Pregnancy and Nutrition in SA

Good nutrition before and during pregnancy may influence the pregnancy, the delivery and the health of mother and child later on. What you eat now will help your baby to grow healthily and give them the best start in life and help you to feel your best. We asked registered dietitians and ADSA (Association for Dietetics in South Africa) spokespeople to provide their top tips for healthy eating during pregnancy. Does eating for two mean doubling up your portions? “Additional energy is needed during pregnancy to support the growth demands of your baby, however the saying ‘eating for two’ has been taken out of context,” says Cath Day, Registered Dietitian. “During the first trimester, you don’t need any additional energy. This means that if you were maintaining a healthy weight before you became pregnant, you can continue eating the same amount. It is only in your second and third trimester that you need to eat a little more.” But, how much more? The professional advice from a dietitian is that an expectant mom who is at a healthy weight should take in an extra 350 kCal / 1470 kJ per day in her second trimester. This would be the equivalent to eating an extra half a cup of fruit or one tennis ball-sized fruit, a 175 ml of plain low fat yoghurt, two wholewheat crackers, two teaspoons peanut butter without added sugar and salt, and a 30 gram portion of a medium fat cheese. In the third trimester, the recommended additional intake rises to just 460 kCal / 1930 kJ per day, and that would be equivalent to eating an extra one cup of fruit or two tennis ball-sized fruits, 175 ml plain low fat yoghurt, four wholewheat crackers with the same two teaspoons peanut butter without added sugar and salt, and a 30 gram portion of a medium fat cheese. What should you do if you are overweight and pregnant? Overweight and obesity can present health challenges during pregnancy, so health professionals do advise that women should get to a healthy weight before they fall pregnant. However, in South Africa where women’s rates of overweight and obesity are high, less than ideal conditions for pregnancy need to be managed. “Pregnancy is not the time to think about dieting and weight loss,” says ADSA spokesperson and Registered Dietitian, Nazeeia Sayed, “An overweight pregnant woman should focus on the healthy eating of a variety of nutritious foods, and her weight gain needs to be monitored at her ante-natal check-ups. She should also focus on light exercise such as walking.” Day also points out that: “Overweight and obese pregnant women would benefit from seeing a registered dietitian who can assist them with an eating plan which will support baby’s growth and ensure that they gain weight within healthy parameters.” How can you eat healthily on a budget? Day has some sensible tips: Eat fruits and vegetables which are in season and more affordable Get your family members and neighbours to shop with you for bulk fruits and vegetables that are more cost-effective Start a vegetable garden using water-saving ideas at home or in your community. NGOs such as Soil for Life and many more help households and communities to sustainably increase their access to fruits and vegetables Spend less money on fizzy cold drinks, junk food and take-aways, and use what you save to buy seasonal fruits and vegetables instead You can save money by reducing your meat intake by half and instead use beans, split peas and lentils to bulk up your favourite meat dishes. These legumes are a more affordable, healthy vegetable protein source that also include the B-vitamins and folic acid Buy frozen vegetables when they are on promotion – they contain as much or even more nutrients than vegetables which have been on the shelf for an extended period of time What can pregnant women who can’t afford supplements eat to get the micro-nutrients important to pregnancy? Pregnant women and those planning on falling pregnant should take a supplement of iron and folic acid, as these are essential nutrients needed for a healthy pregnancy. Sayed points out that it is important for all pregnant women to know that they have access to the State ante-natal services because supplements such as folic acid, iron and calcium are included in their free healthcare. Day also adds that there are many affordable food sources that provide these nutrients that are vital to a baby’s healthy development. “For instance,” she says “Green leafy vegetables such as spinach, morogo and legumes such as beans, split peas and lentils are good sources of folic acid and iron. You can also find staples such as maize meal and brown bread that are fortified with folic acid and iron. Amasi and milk provide calcium. Tinned sardines and pilchards provide calcium and iron, and chicken livers are another good source of iron.” How can you use your pregnancy to develop healthier habits? Pregnancy is a time when your health and the health of your developing baby is an absolute priority. Day says that it is not only what you consume but also what you do not consume that counts. “Don’t drink alcohol when you are pregnant. All forms of alcohol could be harmful to your baby and the safest choice for your unborn baby is not to drink any alcohol at all when you are pregnant.” Sayed concludes: “Pregnancy is not a state of ill health but a time to be enjoyed, and it can help you to develop life-long healthy eating patterns that you sustain as you become a role model for the new addition to your family!”

March 12, 2018

Oral Allergy Syndrome – are allergies leaving a bad taste in your mouth?

Does your teenager suffer from hay fever? Does he complain that certain fruits or nuts make his whole mouth feel itchy, his tongue swollen or his throat scratchy? Does this mouth discomfort only last for a few minutes and then resolve on its own, often not requiring treatment? Is this reaction confined to his mouth without any associated chest problems such as wheezing, or a skin rash, or diarrhoea and vomiting? Then perhaps your teenager suffers from a condition called Oral Allergy Syndrome (OAS) OAS, commonly known as Pollen-Food Syndrome, is an allergic condition that occurs generally in older children, teenagers or adults. OAS sufferers have hay fever, experiencing a runny nose and itchy watery eyes when exposed to certain pollens. The body sees the allergen -the pollen – as harmful and mounts a heightened, inappropriate response resulting in this picture of nasal congestion. People with OAS complain that certain fruits and nuts cause them discomfort in their mouths such as itchiness of their tongues or a scratchy sensation in their throats. The allergy is due to local contact with the offending fruit or nut resulting in only the mouth being affected. These two seemingly unrelated symptoms, the hay fever from pollen, and the mouth itchiness from fruit, are linked due to the fact that fruits, nuts and pollens share similar proteins which cause allergic reactions. This means that a person with a rye grass allergy may experience a tingling palate when eating watermelon. Or someone allergic to birch pollen may complain that apples and pears give him a scratchy throat. It therefore makes sense that OAS is generally more prominent during pollen season. How can a diagnosis of OAS be made? A careful history should be taken showing the typical symptoms – the hay fever as well as the mouth itch following eating certain fruits. The offending fruit or nut can be given in the rooms under supervision – an oral food challenge – to observe the symptoms. Skin prick tests to pollens can be done. This means that drops of diluted allergens are placed on the arm and then pricked with a lancet to see if there is a reaction. A positive result causes a mosquito-bite type of lesion within a few minutes. In OAS these will most likely show a positive result to certain pollens. Skin prick tests using fresh fruit can also be done and may cause a reaction too. OAS symptoms may improve if certain fruits are cooked. Interestingly, cooked food doesn’t cause a reaction as the heating process distorts the protein and the body doesn’t recognize it as an allergen. Peeling fruits may reduce the allergen content of the fruit too. For local mouth reactions, an anti histamine will help as well as rinsing with water after eating. Treatment of the allergic rhinitis definitely reduces symptoms in OAS. This includes taking an anti histamine and a steroid nose spray prescribed by your doctor. Long term treatment for allergic rhinitis may include immunotherapy. This is treatment in the form of drops that are put under the tongue daily for up to 3 years. This results in the immune system actually changing so it no longer see the specific pollen as harmful, and essentially eradicates the allergy. If you would like to take away the itch from your litchi-eating experience, then consult your allergy doctor!

March 8, 2018

7 Ways to keep your children off drugs

Children are the most vulnerable during their growing years and will always have their curiosity spiked by anything new. The same applies to the usual attractions of alcohol, cigarettes and drugs. Keeping them away from drugs is really important as this is a decision which can change the course of their whole life. The warnings have to be given to children in such a way that they really understand the repercussions of drug usage. Here are some parenting tips when it comes to keeping your children away from the danger of drug abuse for their own betterment. Be the Perfect Role Model Hypocrisy rarely works in such a situation. Advising your children while doing drugs yourself is never going to achieve the required objective. Children usually observe a lot and the same applies to the habits of their parents, whom they may see as their role models. This makes it really important to maintain a clean image and stay clean at least for the sake of your children. Only then will they be fully convinced by your words and stay away from drugs. Do the Talk It is important to sit down and talk about the effects of drug usage to your children. Assuming that your child will not be affected by drugs and feeling that there would have been enough information regarding the issue from schools is not very realistic. Give them all that they need to know about drug usage to make sure that the dangers are understood clearly. Make it as simple as required for them to fully grasp the consequences of any actions that they take. Use the Friendly Gesture When exposing children to such a sensitive issue, it should be done in a realistic way. Giving them a clear picture in the friendliest way should be done, rather than using harsh and threatening tones. The way the message was delivered will also highly impact how children react to any unsupervised situation. Showing that you have placed utmost trust on them can alter how they resist any peer pressure or temptations. Point Out Real-Life Examples There are many people who have become slaves to drugs and will do anything to get their next fix. Pointing out the deep slip that their life has taken works more effectively than all the lectures that you have planned on the subject of drug education. Children today, believe what they see. The same applies to this situation too. By showing them actual people whose lives have been drastically affected by drug usage, you can make sure that you have instilled the right fear in their minds of being exposed to drugs. Keep an Eye on Their Gang Peer pressutre seems to be one of the most common reasons for children to try drugs. This makes it important for parents to keep an eye on the people that their children hang out with. Getting to know their best friends, the people they party with and the things that they usually do with their friends is not only a way to bond better but also a precaution to make sure that they stay safe. Spend More Time Together As time passes, the distance can increase between you and your children. This is quite natural as they seem to develop their own interests and friends. However, it is important for you to keep them close by making sure that they can come to you for any matter. Encourage them to get a hobby which will keep them engaged and maybe opt for something which can be done together. This will help them be distracted from other unwanted distractions and also help you keep your relationship strong. Provide A Stress-Free Environment During this age, children are exposed to a lot of changes and are quite confused about themselves and their surroundings. If a violent or disturbed situation prevails in their environment persistently, children may look for other ways to manage the mental breakdown that they are being exposed to. This is why parents should try keeping the home a place where their children can be happy, in spite of any issues that they may be facing. Children are incapable of fully understanding the consequences of the actions that they may try out. It is the parents’ duty to ensure proper education on the subject for their kids to be safe out of harm’s way.

March 7, 2018

Weight isn’t the only thing you’ll be shedding after having a baby

Everything FINALLY seems to be settling down a few months after welcoming your new baby – she is in (somewhat of) a routine, her sleeping patterns are getting better and you have even managed to get more done this week. Just when things are coming together your hair starts to fall out! The average person loses around 100 hairs a day to make way for the newer hairs to come through. Most of the hair on your head is still growing, while around 10% is in a resting phase and will soon fall out. When you are pregnant this natural hair shedding ceases to happen, which is why an expectant mother is able to proudly display her shiny locks “Many new mothers aren’t aware of the amount of hair shedding that can take place after having a baby, and it can come as quite a nasty shock when they see how much of their hair is left behind in the shower. This noticeable hair shedding is caused by dropping estrogen levels and a lot more follicles entering their resting stages” says Nomfundo Majozi, Vigro® brand manager. To start the process of getting your hair back to its original glory the active ingredients in Vigro® can help reduce non-genetic hair thinning. These active ingredients can assist the scalp with non-genetic hair thinning by cleaning and opening the hair shaft preparing the scalp for penetration of the actives, as well as assisting hair follicles to reduce hair thinning through the active ingredient Follicusan™ (topical products). ** The Vigro® 3-Step System also provides a combination of vitamins and minerals needed for healthy hair growth. Consult your doctor before using Vigro® capsules during pregnancy or breastfeeding. * *Efficacy of support may vary between users. Consult a medical practitioner for a diagnosis or if symptoms persist. Use as indicated. Vigro®3-Step System is not indicated for genetic hair loss.

March 6, 2018

What can be done about night terrors

Night terrors can be very stressful and frightening. When a child has a night terror he/ she is so deep into the dream, he cannot hear the person trying to wake him, even though the child may look at you and seem to be awake. Often a child may cry out, ask for help, thrash, kick, and scream — but cannot be comforted. Make your child’s room safe to try to prevent him from being injured during an episode. Eliminate all sources of sleep disturbance, such as caffeine, sugar, and high-energy activities before bed. Maintain a consistent bedtime routine and wake-up time. Unfortunately, there is not much you can do to help your child during the actual episode except to make sure he is safe. Just take comfort in the fact that the night terror is short-lived. If your child has night terrors, you can try to interrupt his/her sleep in order to prevent one. Here is how to do it: First, note how many minutes the night terror occurs from your child’s bedtime. Then, awaken your child 15 minutes before the expected night terror, and keep her awake and out of bed for five minutes. You may want to take your child to the bathroom to see if he/ she will urinate. Continue this routine for a week. Have you had any experience with night terrors? What helped?

March 3, 2018

Hey Ladies are you feeling Wet down there? No need to worry …….

Most women at some stage in their lifetime will experience some form of vaginal discharge. The discharge may be normal or have a vaginal infection, characterized by discharge, itching, or odor. Vaginal infections are one of the top 25 reasons for women to consult doctors in the USA. The 3 most common types of vaginal infections (vaginitis) include: Bacterial Vaginosis, Trichomoniasis and Candidiasis, and these may or may not be associated with cervical infection1. The key to proper treatment of vaginitis is proper diagnosis. Bacterial vaginosis (BV) Bacterial Vaginosis is a vaginal infection that occurs when the balance of bacteria in the vagina is altered. It is a common condition affecting millions of women. Bacterial Vaginosis is characterized by the following symptoms: Increased vaginal pH to level of above 4.5. Thin homogeneous vaginal discharge – watery discharge (up to 50% of pts). Positive amine test – fishy odor (In pts with no discharge, the fishy odour may be more noticeable after sex or menstruation). Nearly 50% of pts with BV do not have symptoms and don’t know they have BV. Although the syndrome is curable with standard drugs, recurrence rates are high. Because many patients are asymptomatic (do not experience any symptoms), recurrence is difficult to differentiate from treatment failure. BV is associated with serious complications such as: Premature delivery Infections after abortion or hysterectomy and After placement of an IUD, increase in development of PID (pelvic inflammatory disease) and endometriosis, Inflammation of uterus / womb and fallopian tubes Bacterial vaginosis is not a sexually transmitted infection; however, it is associated with the transmission of sexually transmitted infections (STIs) including HIV/AIDS. Various diagnostic methods are available to identify the abnormal vaginal discharge. Clinical laboratory testing can identify the cause of vaginitis in most women OR BV can be diagnosed by the use of clinical criteria (i.e., Amsel’s Diagnostic Criteria considered the gold standard laboratory method for diagnosing BV) Clinical criteria require three of the following symptoms or signs: Homogeneous, thin, white discharge that smoothly coats the vaginal walls; Clue cells on microscopic examination; pH of vaginal fluid > 4.5; or a fishy odor of vaginal discharge before or after addition of 10% KOH (i.e., the whiff test). BV can be treated with over the counter medication or by prescription medication. Proper clinical evaluation is recommended to ensure proper treatment. Trichomoniasis Trichomoniasis is the most prevalent non-viral sexually transmitted infection. Trichomonal infections are asymptomatic in as many as 50% of male and female patients. The signs and symptoms of Trichomoniasis are: More extensive inflammation Erosion of the epithelial lining that is associated with burning, itching, and pain during urination Smelly or typically foamy discharge Yellow or gray-green discharge. Increased vaginal pH to levels above 4.5 Trichomoniasis should be treated by a clinician and not by over the counter medication. The sexual partner must also be treated in order to avoid reinfection. Candidiasis It is said that approximately 75% of women will experience at least one episode of Candidiasis in their lifetime. Candidiasis, otherwise commonly known as Candida is not a sexually transmitted infection and is usually caused by an overgrowth of the yeast that is normally present in the vagina. Some of the signs and symptoms of candidiasis are: Vulvovaginal irritation and / or soreness Whitish, cheesy discharge The pH levels of the vagina remains normal <4.5 With the availability of alternative therapies and over-the-counter medications for candidiasis, many women with symptoms seek these products before an evaluation by a medical provider. Obtaining a medical history alone has been shown to be insufficient for accurate diagnosis of vaginitis and can lead to the inappropriate administration of medication2. This makes it important for women to have a tool they can use either at home or at their Drs room to determine the cause of their vaginitis and treat correctly. Coincido offers the only rapid test on the market that can be used either by women at home or by healthcare professionals to monitor vaginal pH and assist in determining the cause of vaginitis: Result interpretation (considered as part of the clinical evaluation): Positive result (blue, green) consider BV or Trichomonas infections. Negative result (yellow) consider yeast infection The SwabEze is comprised of a vaginal swab with a polyester tip. The swab tip changes color when it comes in contact with vaginal secretions presenting elevated pH (abnormal acidity) or low buffer capacity (watery discharge). A change of color from pale yellow to green or blue (even if only part of the tip change color) is easy to identify, considered as positive reading No color scale needed to interpret results. The Swabeze gives you piece of mind and guidance with appropriate treatment of vaginitis. By using the Swabeze at home you can avoid embarrassing questions when seeking treatment at the pharmacy. The Swabeze is also available in Australia, USA, New Zealand, UK and many other international markets. For more information on how to order the Swabeze for monitoring vaginal pH you can visit: www.coincido.co.za or call 011 589 989 MANAGEMENT OF VAGINAL DISCHARGE A AHOOSEN CME February 2004 Vol.22 No.2 Page last reviewed: June 4, 2015 Content source: Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention

February 27, 2018

Nutrition in pregnancy: Giving your baby the healthiest possible start

With so many myths out there about diet and pregnancy, no wonder new mothers-to-be feel confused about the do’s and don’ts of their own diets. To eat appropriately is the one thing a mother have a lot of control over, and wants to get 100% right, but is so afraid of getting it wrong. We are regularly told that our weight, nutritional status and health during pregnancy and breastfeeding have effect on a baby’s risk of developing disease in future, birth risks, the baby’s health and growth both in the uterus and after birth. Scary as it may sound, with the right dietary advice and support it can actually be quite easy to get your diet right with a few easy tips. Keep reading. Will my pregnancy cravings influence my child’s eating habits? Want your child to love veggies? Start early. Very early! New research shows that WHAT a woman eats during pregnancy not only nourishes her baby in the womb, but can influence a baby’s palate and food memories before he/she is born. The study found that a mother’s diet shapes her baby’s food preferences and acceptance later in life. Flavour perception develops as early as in the unborn infant and taste and smell continues to develop once they are born. In the womb, a fetus is surrounded and nourished on amniotic fluids, which is filled with the flavours of what the mom has eaten in the last few hours. The fetus starts to swallow large amounts of amniotic fluid from about 12 week’s gestation. By the time a women reaches her third trimester the fetus’s brain starts to communicate with the taste and smell receptors – for the baby to start to associate with certain flavours and odours in the amniotic fluid. A baby therefore already starts to build a memory bank of tastes and flavours during pregnancy. Amniotic fluid is therefore the first food for the baby to feast on and contains protein, sugars, fat and different flavours of the food that the mother eats. The fetus can detect these tastes and flavours – forming memories of these flavours and will prefer flavours that were previously experienced in the amniotic fluid. It was shown that if mothers who consumed carrot, anise or garlic flavoured food during pregnancy, their infants would be more accepting to flavours later in life. The flavour learning continues when infants experience the flavours of mother’s diet transmitted in breast milk, especially flavours such as anise, garlic, carrot, mint, vanilla. When babies start solids they showed greater liking for and acceptance of flavours to which they had early exposure. This means you can teach your baby to like broccoli from an early age! This varied experiences with food flavours increase food acceptance and may help explain why children who are breastfed are less picky during childhood. Formula tastes the same day-in and day-out. If you plan to formula feed your infant, and worry about the lack of variants in flavours just make sure you introduce your baby to the largest variety of solid food and flavours early on in the weaning period. To conclude, if you want your children to eat a healthy diet (e.g. their broccoli) or more adventurous diet, you should expose them to all the right, healthy flavours early on. Will WHAT I eat during pregnancy affect what diseases my child may have in later life? There are some studies that show that the mother’s diet may affect whether children have the risk for developing diabetes, heart disease, obesity or high blood pressure later in life. During the war, when pregnant women were exposed to very little food, especially in the first trimester, their children were more likely to be born heavier, taller and develop heart disease in adulthood. Some studies suggest that when an expectant mother has too little protein and too many carbohydrates in her diet, the child may have a risk of high blood pressure later in life. This also applies to when you do not supplement your diet with the recommended vitamin and mineral supplements e.g. folic acid, iron calcium and vitamin D. “Over nutrition” during pregnancy also has detrimental effects and may cause the fetus to grow faster than the fetus’s organs and can lead to liver, heart and kidney disease in adulthood. There is also a suggestion in research that if your diet is rich in omega 3 fatty acids (mainly available in oily fish and seeds) during pregnancy it can protect the baby against ailments such as high blood pressure and heart disease in adult life. Should I avoid certain foods during pregnancy to prevent my child from having food allergies? Many scientific studies have been done to investigate whether mothers who avoid certain foods in the diet during pregnancy can control the presence of allergies and eczema in their babies once they are born. They all concluded that babies might or might not present with food allergies and eczema, regardless of the mother’s diet, especially when there is a strong family history of food allergies. They also concluded that avoiding certain food in the pregnant mother’s diet have shown to affect the mother and the baby’s nutritional status. Both may run the risk of missing out on essential vitamin and minerals contributing to an inadequate nutritional intake and is therefore not recommended. You can actually do more harm than good by avoiding anything in the diet for instance nuts, fish, eggs, milk, citrus fruits to prevent allergies in your baby. If you as expectant mother do suffer from food allergies and need to avoid certain foods it would be of benefit to consult a dietitian who would be able to provide you with a nutritionally balanced diet and ensure both you and your baby get all the nutrients you require. Super foods for pregnancy Eggs: It contains choline that helps to reduce the risk of neural tube defects, such as spina bifida. In addition, studies suggest that choline is key to the

February 22, 2018

Hearing in the young child

Hearing ability is crucial for development of speech and language in the young child. In South Africa especially, hearing loss in children often goes undetected until the child has passed the critical period of language and speech development. The hearing loss is usually only picked up when the child is about to enter school and has no little communication skills. Even a mild hearing loss can inhibit a child’s ability to development communication and language skills severely! Late detection has detrimental problems on the child’s mental, cognitive, developmental and social aspects of life. The key to avoid late detection is awareness of the fatal implications of undetected hearing loss and the signs and symptoms that parents and care giver should look out for in a child’s early life. There are many factors that put a child at risk for hearing loss. These factors can be categorized into: hearing loss that is present at birth (congenital) or hearing loss that developed after birth (acquired hearing loss). Parents and caregivers should be vigilant if the following risk factors are identified: Indicators for a high risk of hearing loss present at birth (Congenital Hearing loss) Family history of permanent hearing loss in childhood Maternal infections during pregnancy or delivery these include: Toxoplasmosis, Syphilis, HIV, Hepatitis B, Rubella, CMV, Herpes simplex. Physical problems of the head, face, ears, or neck (cleft lip/palate, ear pits/tags, atresia) Ototoxic medications given in the neonatal period Born with any Syndrome associated with hearing loss (Pendred, Usher, Waardenburg, neurofibromatosis) Admission to a neonatal intensive care unit greater than 5 days Prematurity (< 37 weeks) Hyperbilirubinemia Low Agar score (0-3) Disorder of the brain or nervous system Indicators for a high risk for acquired hearing loss after birth: Childhood diseases such as mumps or measles Untreated middle ear infections Perforated eardrum Excessive loud noise such as gunshots, fireworks or loud music Severe injury to the head Ototoxic medication Otitis media / Ear infections (explained later in article) With these risk factors there are also many signs and symptoms that parents and caregivers can look out for: Child isn’t startled by loud sounds Child is inattentive during interactions Doesn’t respond to parents voice Doesn’t make babble sounds Doesn’t imitate sounds or words like ”bye-bye”, “mama” Fails to respond to their name Fails to turn his/her head to a sound source Fails to follow simple instructions With these signs and symptoms it is also important for parents and caregivers to take note of speech and development milestones from 12 – 36 months which are related to receptive language ( ability to understand words and speech) and expressive language ( ability to use speech and gestures to make meaningful communication) Age groups Receptive Language Expressive Language 12 – 24 months Recognize names of family members and familiar objects Use hand gestures to signal something such as finger pointing to toys Understand simple phrases e.g. ‘give me’ , ‘no’, ‘ all gone’ Make one-two syllable sounds that stands for something they want e.g. ‘nana’ for a bottle By 18months know names of body parts , objects and places By 18 months – use of made up language- mixture of made up and understandable words Follow simples instructions like ‘ put the ball down’ or ‘come to mommy’ Between 1-2 years old has a vocabulary of at least 20-50 words which are understood by family members 24-36 Months Know and point to at least 7 body parts Tend to start speaking a lot and questioning surroundings and environment Follow simple requests like ‘ pick up the shoes’ Use pronouns such as ‘ me, you, yours’ but often get it mixed up Understand questions and points to pictures when asked what it is e.g. where is the rabbit or show me the balloon Make simple phrases such as ‘ want more food’ or ‘ no sleep time’ By age 3 should have 150-200 words in vocabulary and stranger should be able to comprehend their speech Another major risk factor that parents should be on alert for is Otitis Media with Effusion (OME) or better known as ‘glue ear’. It is described as build-up of non-infected fluid in the middle ear. OME is common among children between 6 months and 3 years of age. The fluid could sometimes resolve itself however if OME is left untreated or last more than 6 days it can to fluid becoming infected and causes a temporary decrease in hearing. OME can sometimes go undetected due to the lack of obvious or acute symptoms. OME is usually caused by a poor functioning Eustachian tube (ET), this tube is a link between the middle ear and the throat. The ET helps us to equalize the pressure between the air around you and the middle ear. When the ET doesn’t function correctly it stops normal drainage from the middle ear causing an accumulation of fluid behind the child’s eardrum The following are also risk factors for your child developing OME: Drinking from a bottle while lying on their back- this causes milk to seep into child’s ears Developing a common cold 2nd hand smoke Not breastfeeding Craniofacial abnormalities ( cleft palate , cleft lip ) OME can be very subtle and sometimes hard to detect however your child may show the following signs: Continued tagging of ear Hearing difficulties Loss of balance Delayed speech development The only way to correctly diagnose an OME is to visit an Audiologist. The Audiologist will perform a Tympanometry test. This test will reveal findings of the status of the middle ear, giving information about any fluid present in the ear, mobility of the middle ear and volume of fluid in the ear. Tympanograms can be read off graphs and normative data of pressure and volume, the Audiologist can make a diagnosis from any abnormalities in the results. If a fluid build-up in the middle ear is detected it should be monitored to determine whether it clears up by itself. Should the fluid build-up not

February 22, 2018

Alcohol Myth Buster

How much alcohol is recommended for a person (women) a day? For many people drinking alcohol is a pleasant social activity. Alcohol has long been an integral part of celebrations and other happy social gatherings for centuries. However, it should be done in moderation. The South African Heart Association recommends a maximum of 2 drinks per day for males and 1 drink per day for females. The South African Food-Based Dietary Guidelines (FBDG) recommends that if you drink alcohol, drink sensibly and define low risk drinking as no more than 4 units of alcohol per day for men and no more than 2 units for women, with at least 2 alcohol-free days per week. However, people who do not drink alcohol are not advised to start drinking in an attempt to gain any health benefits. Many experts are of opinion that this recommendation is still too high and should be changed. New international guidelines (UK Chief Medical Officers’ Low risk drinking guidelines, August 2016) for both men and women to keep health risks from alcohol to a low level – is safest not to drink more than 14 units a week – equivalent to six glasses (175ml) of wine or fourteen (25ml) shots of spirits per week. Ideally women should be having up to a maximum of 1 drink per day. An additional recommendation is not to ‘save up’ the 14 units for 1 or 2 days, but to spread them over 3 or more days. People who have 1 or 2 heavy drinking sessions each week increase the risk of death from long term illnesses, accidents and injuries. A good way to reduce alcohol intake is to have several alcohol free days a week. These new guidelines for alcohol consumption, warn that drinking any level of alcohol carries a health risk for anyone and increases the risk of a range of cancers and liver disease. This is supported by a new review from the Committee on Carcinogenicity (CoC) on alcohol and cancer risk. The guidelines for pregnant women have also been updated to clarify that no level of alcohol is safe to drink in pregnancy. The previous advice for pregnant women to limit themselves to no more than 1 to 2 units of alcohol once or twice per week has been removed to provide greater clarity as a precaution. Although the risk of harm to the baby is low if they have drunk small amounts of alcohol before becoming aware of the pregnancy, there is no ‘safe’ level of alcohol to drink when you are pregnant. So what does 1 unit of alcohol look like? 218ml cider or 76ml wine or 25ml whiskey or 250ml beer or 250ml alcopop. What type of alcohol is the best option for a person? Individual reactions to alcohol vary, and are influenced by many factors, such as age, gender, race or ethnicity, physical condition (e.g. weight, fitness level), amount of food consumed before drinking, how quickly the alcohol was consumed, use of drugs or prescription medicines and family history of alcohol problems. The intensity of the effect of alcohol on the body is directly related to the amount consumed and how fast the alcohol was consumed. For example one 340ml beer has about the same amount of alcohol as one 150ml glass of wine. The faster you drink the higher blood alcohol levels. There are some similarities in how alcohol affects men and women, but there are differences too. If a woman and a man drink the same amount, the woman’s blood alcohol level will almost always be higher than the man’s. There are several reasons for this…. Women tend to be smaller than men. That means, the same amount of alcohol is going into a smaller body. Even if a woman is the same weight as a man, she will have a higher blood alcohol level if she drinks the same amount as that man. Alcohol is held in the body in body water, not in body fat. Women generally have a higher proportion of body fat than men, so have less body water. That means the alcohol is more concentrated. Other factors have also been reported that can make women more sensitive to alcohol, such as enzyme differences. So to answer the question….. It is the amount of alcohol consumed that affects a person most, not the type of alcoholic drink. Does alcohol make ones blood glucose drop? If yes, what does it mean? Yes, alcohol affects blood glucose levels each time it’s consumed, regardless of the frequency of consumption. The primary hormones involved in maintaining a healthy blood glucose level are insulin and glucagon. Normally, when your blood sugar begins to drop, your body can respond by making more blood sugar or burning up stored sugar. And when your blood sugar begins to rise, additional insulin is secreted to bring your levels back to a healthy range. When a person drinks alcohol, it is considered a poison or toxin by the body and the body channels all energy into expelling it. This means that other processes are interrupted – including the production of glucose and the hormones needed to regulate healthy blood glucose levels. Alcohol consumption causes an increase in insulin secretion, which leads to low blood sugar (otherwise known as hypoglycaemia). It can also impair the hormonal response that would normally rectify the low blood sugar. This causes light headedness and fatigue, and is also responsible for a host of longer-term alcohol-related health problems Should one eat in between the drinking? Yes, to prevent your blood glucose levels from dropping to low. We know eating is cheating, but you will be cheating your body and depriving it from much needed glucose and nutrients as well. Is it important to eat before drinking alcohol? If so, why? And what should one eat? Eating limits the effects of the alcohol. Research has shown that alcohol consumption increases insulin secretion, causing low blood sugar (hypoglycemia). Drinking as little as 60ml of alcohol on an empty

February 21, 2018

Words can make or break

What you say, and how you say it Your words, (and how you say them), are being absorbed by your kids all the time. Neuroscientist, Louis Cozolino, tells us that the amygdala (that part of our brain that is activated in fear situations) pays special attention to anger signals, while positive, warm encouragement increases serotonin (a feel-good hormone). This means that simply through words (and how we say them), we literally have the power to change everything! Words can build your child up, or break him down. It takes much more effort to undo the negative effects of our words, than it does to start speaking positively. So why not give positivity a go. Remember : young children take words literally – their logic and reasoning isn’t well developed yet kids take things personally and misinterpret – often making wrong assumptions they believe what we tell them – adults are powerful, be careful of sarcasm they remember negative comments easily – in comparison to praise children become what you tell them – be encouraging and speak “as if” they’re already co-operating (e.g. “nice listening”) “yes” motivates – “no” makes kids defensive (e.g. “Yes, you can have that after supper”) Speaking consciously is an ongoing learning in self-awareness. Yet words can change lives, so be patient with yourself and watch how your new way of talking easily wins their co-operation and starts to change how they view themselves.

February 21, 2018

Should We Be Giving Our Teens Condoms?

I don’t think there is a parent on the planet who wouldn’t cringe at the thought of their 12 year old having sex. And so when, last year, our education department proposed to hand out condoms to kids aged 12 and up, without any parental consent needed, it made many parents feel a little uneasy. It is understandable that a lot of people oppose this idea, regardless of the thought processes behind it. And yet, just because kids having sex makes us uncomfortable does not mean that it isn’t happening. And I’m not just talking about lower class, uneducated youth either. Just last year there was a case in a very wealthy neighbourhood where a family tried to immigrate to Oz and on doing their final medicals discovered that their 11 year-old daughter was HIV positive. It turns out she and a group of her friends were having sex with the security guards in the complex where they lived. We like to assume it isn’t happening and if it is happening it isn’t in our neighbourhoods or our schools or with our children. We have to get our heads out of the sand. Teen pregnancies are on the increase in South Africa and we have one of the highest HIV rates in the world. Teenagers are sexual by their very nature and by making sex taboo or keeping it as an unspoken in our homes and schools, we are not helping them to deal with the very real pressures and dangers that they are going to face in the real world. I applaud this move by the education department. Around the world there is evidence that having more open, relaxed conversations with teens about sex, by supplying them with contraceptives and helping them to understand how and why to use them, and giving them the opportunity to explore their sexuality safely reduces teen pregnancies, sexually transmitted diseases and abortions. This completely contradicts the fears that most parents have that if they start handing condoms out to kids that there is going to be more teen sex and all the issues that go along with that. Nobody is running around encouraging children to get it on with each other. The department of education is simply looking at the facts and taking action. And the fact is… Kids are going to have sex whether we talk about it or not. Kids are going to have sex whether we want them to or not. Kids are going to have sex whether we educate them on it or not. Kids are going to have sex whether we supply them with condoms or not. Let’s do the right thing and make sure that if they have sex they are able to do this safely and that they understand the risks involved. Let us give our children both condoms and the education that goes along with that. An educated, aware child has a greater chance of survival than one who is kept in the dark. Handing a child a condom does not ensure that they are going to have sex. But not making condoms available ensures that if they do have sex the consequences are much more likely to be tragic. Let’s keep pregnancies for the adults!

February 16, 2018

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