Supplementing the diet
As the youngster grows, the demand for specific nutrients may vary. The following will give us a better understanding of their supplementation needs:

• Babies
The best food for babies is breast milk – and this is only true where the mother’s diet is adequate. Breast milk supplies the correct proportion of all the necessary nutrients, but in cases where breast-feeding is impossible or not feasible, milk replacement formulas serve as an alternative. At the age of 4 to six months, solids can be introduced to the baby’s diet. Vi-daylin drops supply all the needed vitamins and minerals for the young infant.

• Toddlers
At this stage of development, the toddler is on a wide range of foods. Make sure that the baby receives the following groups of foods:

o Dairy products will supply the calcium requirements for a healthy skeletal system.
o Oily fish will provide the essential fatty acids to feed the growing brain.
o The toddler will need iron to prevent anaemia. Lean red meat, iron fortified cereals and iron supplementation are sources of iron.
o A variety of fruits and vegetables will provide the vitamins, minerals and fibres.
Sportron’s Whizz Kidz gummyz are a fruit flavoured Foodstate multivitamin and mineral supplement. This will supply the nutrients in a form which will be better absorbed and utilised in the body. Whizz kidz can be taken from one year of age. Viral Choice Junior and Junglevites also contain all the vitamins and minerals needed for the development of the toddler Chocaton syrup will also supply the toddler’s vitamin requirements.

• Young children
The essential fatty acids (EFA’s – better known as the Omega-3 and Omega-6 oils) are essential for proper brain functioning, which is important during the long school days! Dietary supplements containing EFA’s include Sportron’s Melotone, ADDvance, Eye Q Liquid and Scotts Emulsion. ADDvance Chewy fruit bursts have a delicious lemon flavour and are gluten and wheat free. Eye Q liquid is also rich in marine fish oil and virgin evening primrose oil. This combination helps to maintain eye and brain function. Vitamin C is an important supplement for the immune system. It also protects us against the damaging free radicals and is crucial for proper brain functioning. The vitamin B-complex group of vitamins should also be supplemented. Probiotics are essential for a healthy gastro-intestinal tract. Probiflora Junior contains L acidophilus and can be recommended for the restoration and maintenance of the intestinal balance. Lactobacillus reuteri produces an antibacterial substance “reuterin”. Reuterin is effective against rotaviral diarrhea in children. Reuteri Straws and chew tablets are easily and conveniently administered to kids. Inteflora 250 contains the yeast Saccharomyces boulardii as its active ingredient, which can be taken simultaneously with antibiotics.

General advice

The following advice will assist you in adding value to every interaction with your clients:
o The importance of a healthy diet and lifestyle cannot be overemphasized.
o Foods from different food groups should be included daily. Include fresh fruits, vegetables, whole grains, nuts, milk and cheese.
o Limit the intake of fast foods and pre-cooked meals.
o Children should not leave home without a proper breakfast.

Conclusion
Babies, toddlers and kids who do not eat well, should take children’s dietary supplements as a way to ensure that they get all the required vitamins and minerals. Supplements are not a cure-all for an unhealthy diet, so parents should continue offering healthy food choices to their children.

References: Available on request

Symptoms
The pain/discomfort and swelling of the gums before a tooth comes through is the cause for the pain and fussiness a baby experiences during this change. These symptoms usually begin about three to five days before the tooth shows, and they disappear as soon as the tooth breaks the skin. The level of pain that a baby can handle will be different for each child. Some babies are not even bothered by teething.
Common symptoms include drooling or dribbling, mood changes, irritability or crankiness, and swollen gums. Crying, sleeplessness, restless sleep at night, and mild fever are also associated with teething. In some cases, the area can be filled with fluid and appears over where a tooth is coming out and causes the gums to be even more sensitive. Pain is often associated more with large molars since they cannot penetrate through the gums as easily as the other teeth.

Some noticeable symptoms that a baby has entered the teething stage include chewing on their fingers or toys to help relieve pressure on their gums. Babies might also refuse to eat or drink due to the pain. Pulling on the ears is another sign of pain; the pain in the mouth throbs throughout the baby’s head so they pull their ears believing that it will provide relief. Mild rash can develop around the mouth due to skin irritation that is caused by excessive drooling or dribbling.
Symptoms will generally fade on their own, but a healthcare provider should be notified if they worsen or are persistent.

Order of appearance
Teething may start as early as three months or as late as twelve months. The first teeth (the deciduous teeth, often called “baby teeth” or “milk teeth”) typically appear between six and nine months. It can take several years for all 20 teeth to complete the emergence through the gums.

The baby teeth tend to come out in pairs – first one lower incisor emerges then the other lower incisor emerges before the next set begins to emerge. The general pattern of emergence is:

1. Lower 2 central incisors at around 6 months
2. Upper 2 central incisors at around 8 months
3. Upper 2 lateral incisors at around 10 months
4. Lower 2 lateral incisors at around 10 months
5. First 4 molars at around 14 months
6. 4 Canines at around 18 months
7. Second 4 molars at around 2-3 years

Milk teeth tend to come out sooner in females than in males. The exact pattern and initial starting times of teething appear to be hereditary. When and how teeth appear in a baby has no relation to the health of the child.

Misdiagnosis
Teething has not been shown to cause fever or diarrhoea; however the belief that teething causes fever is extremely common among parents. Whilst there is some evidence that teething can cause an elevated temperature, it does not cause fever (temperature over 38-38.2°C). There is a risk that fever around the age of teething is dismissed as a result of teething when it is actually due to illness, particularly infection by herpes viruses. Primary tooth eruption begins at approximately the time that infants are losing maternal antibody protection against the herpes virus. Reports on teething difficulties have recorded symptoms which are remarkably consistent with primary oral herpetic infection such as fever, irritability, sleeplessness, and difficulty with eating. Younger babies with higher residual levels of antibodies experience milder infections and these are more likely to go unrecognized or be dismissed as teething problems. The symptoms of elevated temperature and facial rash could be explainable by infection with the Human Herpes Virus 6 (HHV-6) agent, which often occurs among infants of teething age and infects 90% of children by age two. Other viruses may also cause fevers which may be misattributed to teething.

Treatment
Before treating a baby for teething, it is important to know what is causing the baby to be upset. Rubbing a finger gently along the gums in search for swollen ridges or the feel of a tooth below the gums is one way to be certain. Not all parents are comfortable with the idea of using medications. Instead to treat the pain, parents can use teething rings and gum massage.
Babies chew on objects to aid in the teething process by breaking down some of the gum tissue which promotes the growth of the teeth out of the gum. This can be dangerous if the baby is allowed to chew on objects which are small enough to be swallowed or which could break while being chewed and cause choking. Teething rings are often designed to be strong and unbreakable with textures that will appeal to an infant during teething.
Some infants gain relief from chewing on cold objects. Some children respond well to chilled foods. Suggestions for chilled foods that might appeal to a baby include applesauce, yogurt, and pureed fruits. Placing a wet washcloth in the freezer for a few minutes and then applying it gently to the gums can be effective. Drawing water into a dummy and freezing it as another way to offer a teething child relief. The cold pressure on the gums gives relief without making the child’s fingers cold. Care should be taken not to expose a baby’s gums to intense cold for too long.

Medication
In cases where the infant is in obvious pain, analgesics, non-steroidal anti-inflammatories or child-safe pain-relief treatments containing local anaesthetics can be administered.

Teething gels applied to the babies gums, work as a numbing agent to dull the nerves in the gums so that the pain is less noticeable.Teejel®, rubbed on the gums, contains choline salicylate a soluble painkiller that is absorbed from the gums and cetalkonium chloride, an antibacterial to protect the baby from germs. Vidol® powders contain paracetamol for the pain, benzocaine, a local anaesthetic and pepyramine an antihistamine. Ashton and Parsons Powders® are a herbal remedy containing Tinct Matricaria duplex known for its calming effect for upset stomachs and unsettledness.

Paracetamol (Panado® or Calpol®) and ibuprofen (Nurofen®) are also recommended to treat the pain and swelling. These should not be administered to babies younger than three months of age. They should only be used a few times a day so that it does not mask symptoms that are being experienced due to other medical conditions and not because of teething. Products that contain aspirin should never be given to a child unless directed by a paediatrician, due to the risk of Reye’s syndrome.

Excessive dribbling caused by teething can irritate baby’s chin, neck and chest which may become dry, chapped and sore. The skin should be kept as dry as possible (a bib will help). Wet clothing should be changed. Applying a simple barrier cream can also help keep their skin soft and smooth.

Conclusion
Teething is one of the great milestones of a baby’s development and memories of the baby’s first big toothy grin are treasured forever. Brushing infants’ teeth should start as soon as they appear. Some babies sail through the process and are showing off their first teeth with smiles, but for others it can be a more uncomfortable time, causing distress to both parents and the baby.

Refreshments will be available from 18h30 and training will start at 19h00 sharp

Johannesburg
23 May 2012
3M
The auditorium
146A Kelvin Drive, Woodmead

Durban
30 May 2012
Protea Hotel Edward
OR Tambo Parade (Marine Drive)
Durban

Cape Town
31 May 2012
Grand West Casino
1 Van Guard Road
Cape Town

RSVP
Joy Carmichael
Email: joybuitekant@gmail.com
Fax: 086 732 7124
Cell: 082 620 3499

Contact Us
Have any queries please contact us:
Tel: 011 217 3210
Cell (Nadia): 082 909 9916
Cell (Isabel): 082 826 1819
Cell (Bavin): 076 439 4850
Web: www.frontshop.co.za
Email: nadia.jonker@media24.com

This training session is made possible by sponsorship from the following companies:
• Equity Pharma
• Homemed
• Novagen Pharmaceuticals
This training session is proudly brought to you by:

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Menopause is the time in a woman’s life when her periods (menstruation) eventually stop and the body goes through changes that no longer allow her to get pregnant. It is a natural event that normally occurs in women aged 45 – 55 years.

During menopause, a woman’s ovaries stop producing ova and produce less estrogen and progesterone. Changes in the levels of these hormones cause menopause symptoms. Not all women experience symptoms of menopause and the onset of these menopausal symptoms also vary between women; sometimes this happens suddenly but most of the time, periods slowly stop over time and menopausal symptoms gradually appear. Menopause is complete when a woman has not had a period for 1 year. This is called post-menopause.

Symptoms

Symptoms of menopause are divided into four specific groups:
• vasomotor instability such as hot flushes
• psychological symptoms such as anxiety and night sweats
• urogenital atrophy with vaginitis, dyspareunia, menstruation loss
• miscellaneous symptoms including loss of libido, breast atrophy and loss of skin turgor.
The most common symptom is the hot flushes that are experienced by up to 85% of postmenopausal women. It may appear at any time of the day or night, last for a few seconds or some minutes and may recur frequently. Typically women complain of a sudden onset of an uncomfortably warm sensation spreading to the face and the head.

Other symptoms of menopause may include:
• Heart pounding (palpitations) or racing
• Sleeping problems (insomnia)
• Forgetfulness (in some women)
• Headaches
• Mood swings including irritability, depression and anxiety
• Urine leakage
• Vaginal dryness and painful sexual intercourse (dyspareunia)
• Vaginal infections
• Irregular heartbeat (arrhythmias)

Treatment
Treatment for menopause depends on many things, including how bad the menopausal symptoms are, the patient’s overall health and their preferences. It may include lifestyle changes or hormone therapy.
Diet and lifestyle changes
Hormones are not always needed to reduce symptoms of menopause. Lifestyle changes known to minimize the effect of menopausal symptoms include.

Dietary changes
• Avoid caffeine, alcohol and spicy foods
• Eat soy foods. Soy contains phhuto-estrogen
• Get plenty of calcium and vitamin D in food or supplements

Exercise and other remedies
• Get plenty of exercise.
• Do Kegel exercise every day to strengthen the muscles around the vagina and in the pelvic floor
• Use water-based lubricants or a vaginal moisturizer during sexual intercourse.

Hormone therapy
Hormone replacement therapy (HRT) is a system of treatments for menopausal, perimenopausal and postmenopausal woman. They prevent health problems and discomfort associated with diminished circulating estrogens and progesterone hormone levels. This series of drugs, designed to artificially boost hormone levels, consist mainly of estrogen, progesterone or progestins and sometimes testosterone.
Several major studies have questioned the health benefits and risks of hormone therapy, including the risk of developing breast cancer, heart attacks, strokes and blood clots. Current guidelines support the use of HT for the treatment of hot flashes. Specific recommendations:
• HT may be started in women who have recently entered menopause.
• HT should not be used in women who started menopause many years ago, except for estrogen vaginal creams.
• The medicine should not be used for longer than 5 years.
• Women taking HT should have a low risk for stroke, heart disease, blood clots or breast cancer.
To reduce the risks of estrogen therapy, your doctor may recommend:
• A lower dose of estrogen or a different estrogen preparation (for instance, a vaginal cream or skin patch rather than a pill)
• Frequent and regular pelvic exams and Pap smears to detect problems as early as possible
• Frequent and regular physical exams, including breast examinations and mammograms

Hormone Replacement Therapy (HRT) preparations
Most HRT is prescribed as tablets as they are highly effective in combating physical and emotional symptoms and they are easily available. Some of the best known products include Prempak®, Trisequens®, Climen® and Kliogest®

Transdermal skin patches have recently become more popular. These patches release low dosages of hormones that are absorbed through the skin. Estraderm TTS® and Evorel® patches are available; they are applied to a soft part of the skin twice a week and left in place for three to four days. Pellets containing a six-month supply of oestrogen can also be implanted under the skin of the abdomen or the buttocks and be left in place for three months. These pellets are only available for patients who have had a prior hysterectomy.
Other over-the counter medications include Femular®, which is an extract of the Cimicifuga recemosa rhizome, Phytol plus® and Primeve plus® capsules which can be taken to help relieve most menopausal symptoms. Phyto Soya® capsules or vaginal cream can also be taken for symptomatic relief in patients suffering from severe symptoms.

Conclusion
It is important that any woman who is considering HRT should talk to her doctor, who can help her, evaluate her health risk profile and make an informed decision about HRT.

It is now disproportionately affecting poorer families, possibly leading to disability, premature death, and worsening poverty, warns the HSF.

Dr Vash Mungal-Singh, CEO of HSF says the country is facing a major health crisis with rates of heart disease among the poor reaching epidemic levels.

“If CVD continues to rise among the poor at current rates, the treatment costs of CVD and complications associated with the disease will soon begin to impact heavily on the South African taxpayer.”

She ascribes the dramatic rise in CVD incidence in poorer communities to the adoption of a more westernised diet without the healthier options easily accessible to higher income groups.

“Urbanisation and the adoption of a ‘westernised’ diet have seen our poorer communities eating a diet high in animal proteins, saturated fat, salt and sugar, while eating less fruit and vegetables and obtaining inadequate fibre and unrefined carbohydrates.

“Combine this with a lifestyle that is increasingly physically inactive, add high alcohol consumption and cigarette smoking to the mix, and you create a scenario that opens the floodgates to hypertension, high cholesterol, diabetes, obesity and the resultant increased risk of heart attacks and stroke,” says Dr Mungal-Singh.

In an attempt to address this urgent need, the HSF has joined hands with CVD generic medicine provider, Pharma Dynamics and Chronic Diseases Initiative Africa (CDIA), to launch a full-scale national research and education programme in under-privileged communities.

Complementing their annual Heart Awareness Road Shows, which provide comprehensive heart screenings combined with an education programme, the partners are now also compiling a multi-cultural, budget friendly recipe book.

The Cooking from the Heart recipe book is being produced by Pharma Dynamics in conjunction with the HSF, and aims to serve as an easily accessible manual to healthier living, taking into account constraints associated with the user’s socio-economic circumstances, including limited budget and food choices.

Mariska Fouche, Public Affairs Manager at Pharma Dynamics, says The Cooking from the Heart recipe book will be compiled following a nationwide call for the public to submit favourite family recipes, which will be adapted into healthier recipe versions by dieticians from the HSF, without compromising on the original recipe’s taste. The book will be launched in September to coincide with National Heart Awareness Month.

“The aim of the project is to produce and test a resource package for primary healthcare providers and community healthcare workers to enable them to offer behavioural change counselling for South African communities in a variety of settings. Cooking from the Heart will be one of the educational and motivational tools contained in the resource package.”

Fouche says the book will make it easier for previously disadvantaged communities to incorporate healthy choices into their diets.

“Cooking from the Heart will be distributed free of charge by the HSF to economically stressed communities across South Africa. We hope that it will also provide much-needed support to healthcare workers who promote healthy living as part of disease prevention and management.

“The Department of Health has also recognised healthy food choices as an integral part of a healthy society, which the Cooking from the Heart initiative aims to achieve in order to assist in preventing the growing epidemic of non-communicable diseases, such as CVD,” says Fouche.

The initiative also forms part of a larger research project called ‘Putting Prevention into Practice’ which is being undertaken by the CDIA.

Prof Krisela Steyn, Associate Director of the CDIA says, “Healthy living intervention programmes such as Cooking from the Heart, which are realistic for the poorer sector of our society are essential to help all South Africans to protect themselves against the ever growing local CVD epidemic.”

The disease is named for the characteristic sound produced when affected individuals attempt to inhale; the whoop originates from the inflammation and swelling of the laryngeal structures that vibrate when there is a rapid inflow of air during inspiration. The whoop noise is rare in patients under six months of age and in adults.
In the 20th century, pertussis was one of the most common childhood diseases and a major cause of childhood mortality.

Causes
Pertussis or whooping cough is an upper respiratory infection caused by the Bordetella pertussis or Bordetella parapertussis bacteria. The bacteria attach to the cilia of the respiratory epithelial cells, produce toxins that paralyse the cilia and cause inflammation of the respiratory tract, which interferes with the clearing of pulmonary secretions. It is a serious disease that can cause permanent disability in infants and even death.

When an infected person sneezes or coughs, tiny droplets containing the bacteria move through the air and the disease is easily spread from person to person. People contaminate their hands with respiratory secretions from an infected person and then touch their own mouth or nose. The infection usually lasts six weeks. Although whooping cough is considered to be an illness of childhood, adults may also develop the disease.

Symptoms

CATARRHAL STAGE
The first stage of whooping cough is known as the catarrhal stage. Initial symptoms, similar to the common cold, usually develop about a week after exposure to the bacteria.
This stage is characterised by:
• Runny nose
• Low-grade fever
• Mild, occasional cough.

PAROXYSMAL STAGE
It is during the second stage that the diagnosis of whooping cough usually is suspected. The following characteristics describe the second stage:
• There are bursts (paroxysms) of coughing, or numerous rapid coughs, apparently due to difficulty expelling thick mucus from the airways in the lungs. Bursts of coughing increase in frequency during the first one to two weeks, remain constant for two to three weeks and then gradually begin to decrease in frequency.
• At the end of the bursts of rapid coughing, a long inspiratory effort (breathing in) is usually accompanied by a characteristic high-pitched “whoop” sound.
• During an attack, the individual may become cyanotic (turn blue) from lack of oxygen.
• Vomiting and exhaustion commonly follow the episodes of coughing.
• The person usually appears normal between episodes.
• Paroxysmal attacks occur more frequently at night, with an average of 15-24 attacks per 24 hours.
• The paroxysmal stage usually lasts from one to six weeks but may persist for up to ten weeks.

CONVALESCENT STAGE
During the third convalescent stage, recovery is gradual. The cough becomes less paroxysmal and usually disappears over two to three weeks; however, paroxysms often recur with subsequent respiratory infections for many months.

Diagnosis
The initial diagnosis is mostly based on the symptoms. However, when the symptoms are not obvious, pertussis may be difficult to diagnose. In very young infants, the symptoms may be caused by pneumonia instead.
Cultures grown from the bacterium Bordetella pertussis taken from nasal secretions can establish the diagnosis.

Treatment
Early treatment of pertussis is very important. Antibiotics such as azithromycin, clarithromycin or erythromycin directed against Bordetella pertussis can be effective in reducing the severity of whooping cough when administered early in the course of the disease. Antibiotic therapy can also help reduce the risk of transmission of the bacterium to other household members as well as to others who may come into contact with an infected person. Unfortunately, most patients are diagnosed too late, when antibiotics are not very effective.

A reasonable guideline is to treat persons aged older than one year within three weeks of cough onset and infants aged younger than one year within six weeks of cough onset. Infants younger than 18 months need constant supervision because their breathing may temporarily stop during coughing spells. Infants with severe cases should be hospitalised.

Complications
• Pneumonia
• Convulsions
• Seizure disorder (permanent)
• Nose bleeds
• Ear infections
• Brain damage from lack of oxygen
• Bleeding in the brain
• Mental retardation
• Slowed or stopped breathing.

The most common complication and the cause of most whooping cough-related deaths is secondary bacterial pneumonia. Data indicate that secondary pneumonia occurs in about one out of every 20 infants with whooping cough and one out of 100 affected infants develop convulsions.

Take the patient to an emergency room if any of the following symptoms are noticed:
• Bluish skin colour (this may indicate a lack of oxygen)
• Difficulty breathing
• Convulsions or seizures
• High fever
• Persistent vomiting.

Prevention
Whooping cough commonly affects infants and young children but can be prevented by immunisation with the pertussis vaccine. The pertussis vaccine is most commonly given in combination with the vaccines for diphtheria and tetanus. DTaP vaccination (P is for pertussis), one of the recommended childhood immunisations, protects children against pertussis infection. The South African immunisation schedule presently prescribes four injections at ages 6, 10 and 14 weeks and 18 months.
Reactions to DTaP are usually mild, although in rare events cases of allergic reaction to DTP vaccine have been observed. In such cases, vaccination should be discontinued.

Common side-effects include:
• Pain and swelling at the site of injection
• Fever that usually disappears within a day
• Irritability and loss of appetite.

Prevention is always better than cure and therefore it is important to make sure that children are vaccinated against pertussis which can be a fatal disease that can lead to death, especially in small children.

Osteoarthritis (OA) or degenerative arthritis, is the most common form of arthritis. It is caused by the breakdown and eventual loss of the cartilage of one or more joints. Cartilage is a protein substance that serves as a “cushion” between the bones of the joints. It can affect any joint, though it most commonly affects joints in the hands, feet, spine and large weight-bearing joints, such as the hips and knees.
As the disease progresses, the affected joints are stiff and painful and usually feel worse, the more they are used throughout the day, thus distinguishing it from rheumatoid arthritis.

Types

Most cases of osteoarthritis have no known cause and are referred to as primary osteoarthritis. When the cause of the osteoarthritis is known, the condition is referred to as secondary osteoarthritis.
• Primary
Primary osteoarthritis is mostly related to ageing. With time, the water content of the cartilage increases and the protein makeup of cartilage degenerates. The smooth surface of the cartilage becomes rough, causing irritation. Eventually, if the cartilage wears down completely, bone may be rubbing on bone — causing the ends of the bones to become damaged and the joints painful.

• Secondary
Secondary osteoarthritis is caused by another disease or condition. Conditions that can lead to secondary osteoarthritis include obesity, repeated trauma or surgery to the joint structures, abnormal joints at birth (congenital abnormalities), gout, diabetes and other hormone disorders.
Obesity causes osteoarthritis by increasing the mechanical stress on the cartilage.
Crystal deposits in the cartilage can cause cartilage degeneration and osteoarthritis. Uric acid crystals cause arthritis in patients suffering from gout.
Hormone disturbances, such as diabetes and growth hormone disorders are also associated with early cartilage wear and secondary osteoarthritis.
Injuries, such as those that occur when playing sports or from an accident, may increase the risk of osteoarthritis.
Osteoarthritis often affects multiple members of the same family, suggesting that there is hereditary susceptibility to this condition.

Symptoms

Symptoms of osteoarthritis vary greatly from patient to patient. Symptoms also can be intermittent.
Osteoarthritis of the cervical spine or lumbar spine causes pain in the neck or low back. Bony spurs, called osteophytes, that form along the arthritic spine can irritate spinal nerves, causing severe pain, numbness and tingling of the affected parts of the body.

Signs and symptoms of osteoarthritis include:
• Pain in a joint during or after use, or after a period of inactivity
• Tenderness in the joint when light pressure is applied
• Stiffness in a joint, usually in early morning or after a period of inactivity
• Loss of flexibility may make it difficult to use the joint
• Grating sensation when using the joint
• Bone spurs, which appear as hard lumps, may form around the affected joint
• Swelling in some cases.

Diagnosis

A careful analysis of the location, duration and character of the joint symptoms and the appearance of the joints helps in diagnosing osteoarthritis.
• X-rays
X-ray images of the affected joint may reveal a narrowing space within a joint, which indicates that the cartilage is breaking down. An X-ray may also show bone spurs around a joint.
• Blood tests
Blood tests may help rule out other causes of joint pain, such as rheumatoid arthritis.

• Joint fluid analysis
During arthrocentesis, a sterile needle is used to remove joint fluid for analysis. Joint fluid analysis is useful in excluding gout, infection and other causes of arthritis.

• Arthroscopy
Arthroscopy is a surgical technique where small incisions are made around the joint and a tiny camera is inserted to see inside the joint. Abnormalities of and damage to the cartilage and ligaments can be detected and sometimes repaired through the arthroscope.

• Bone enlargement
During OA bony enlargements form in the joints of the fingers and big toes. These nodes may not be painful, but they are often associated with limitation of motion of the joint. They are characteristic of osteoarthritis and can be useful in diagnosis.

Treatment

The main aim of treatment in osteoarthritis is to:
• Improve and maintain joint function
• Keep a healthy body weight
• Control joint pain
• Achieve a healthy lifestyle.

Lifestyle modification

No matter the severity or location of OA, conservative measures such as weight control, appropriate rest, exercise and the use of mechanical support devices can be beneficial.
• The use of knee braces, a cane or a walker can reduce pressure on the involved leg joints which can be helpful for walking and support.
• Regular gentle exercise such as walking or swimming, or other low impact activities are beneficial. Exercise can increase the endurance and strengthen the muscles around the joint, making the joint more stable.
• Applying local heat before, and/or cold packs after exercise, can help relieve pain. Heat relieves stiffness and cold can relieve muscle spasms.
• Even a small amount of weight loss can relieve some pressure, joint stress and reduce the pain.

Medication

Analgesics
Paracetamol (Panado) is commonly used to treat the pain from OA. It can relieve pain, but does not reduce inflammation. It has been shown to be effective for people with osteoarthritis who have mild to moderate pain.

Non-steroidal anti-inflammatory drugs (NSAIDs)
In more severe cases, it may reduce both the pain and inflammation; it acts by inhibiting the formation of prostaglandins, which play a central role in inflammation and pain. Most prominent drugs in the class include Diclofenac (Voltaren), ibuprofen (Brufen), naproxen (Naprosyn) and Ketoprofen (Ketoflam). New treatments include other dosage forms such diclofenac gel (Panamor Gel) and flurbiprofen patch (Transact).

Corticosteroids
Injections of glucocorticoids (such as hydrocortisone) lead to short term pain relief that may last between a few weeks and a few months.

Visco-supplementation
Injections of hyaluronic acid derivatives may offer pain relief by providing some cushioning in the knee.

Topical
Creams and lotions containing capsaicin, are effective in treating pain associated with OA if they are applied with sufficient frequency.

Surgery
If the abovementioned management is ineffective, joint replacement surgery may be required. Individuals with very painful OA joints may require surgery such as fragment removal, repositioning bones or fusing bone to increase stability and reduce pain.

Alternative treatments
Some studies, but not all, have suggested that alternative treatment with the food supplements glucosamine and chondroitin can relieve symptoms of pain and stiffness. Chondroitin sulfate has become a widely used dietary supplement for treatment of osteoarthritis in combination with glucosamine and alone.
Vitamin D deficiency has been reported in patients with OA and supplementation with Vitamin D3 is recommended for pain relief.
Fish-oil supplements have been shown to have some anti-inflammation properties and increasing the dietary fish intake and/or taking fish-oil capsules (omega-3 capsules) can sometimes reduce inflammation of arthritis.

Hopefully in the future, these patients will be helped if science improves to such an extent that medications can become available that protects the cartilage from the deteriorating consequences of osteoarthritis.

Definition

Colds and flu are upper respiratory tract infections causing sinusitis, pharyngitis, laryngitis, otitis media and tonsillitis. The vast majority of these infections are caused by viruses such as rhinovirus, corona virus, adenovirus, para-influenza virus, respiratory syncytial virus and influenza virus.

The viruses are normally transmitted from one person to another by inhalation of air-borne virus-containing droplets or nose-hand-surface contact. Symptoms take 24 to 48 hours to develop after initial exposure.

Children can experience as many as 6six to eight infections per year. Colds and flu are a major cause of work absenteeism and is one of the most common reasons why patients seek professional advice from their doctor or pharmacist.

A small percentage of patients contract a secondary bacterial infection requiring antibiotics. Children are at risk of pharyngitis caused by Group A Streptococcus – which without appropriate antibiotics, could result in rheumatic fever and heart disease as a long term complication. You should always consider referring paediatric clients to their doctor for primary treatment.

Symptoms

There are several symptoms your clients might experience when they have a cold or flu including:

• Blocked nose: Their voice may sound “nasal” when they speak to you and they may complain of difficulty in breathing, resulting in noisy breathing or snoring.
• Sneezing, runny nose: Colds and flu may result in sneezing and increased nasal secretions leading to a runny nose. Secretions tend to become thicker and take on a yellowish or greenish appearance when a bacterial infection appears.
• Headache: A headache which worsens when bending forwards or when your client presses on their jaw bones is a sure sign sinusitis.
• Sore throat: A sore throat on awakening in the morning and throughout the day is a sure sign of ongoing infection.
• Blocked or painful ears: If your client cannot equalize their ear pressure and feel that their ears are blocked or painful it’s often a sign that they have swelling of the lymph nodes or a middle ear infection.
• Cough: Colds and flu tend to cause an irritating dry cough due to post nasal drip. This can become a more serious productive cough if bronchitis or pneumonia develops as a complication of the infection.
• Fever: Both colds and flu can cause a fever, particularly with a flu infection. Flu is also typically associated with symptoms like muscular and joint aches, tiredness and loss of appetite.

General measures

Unfortunately there is almost always a spike in colds and flu in the autumn and winter season, however there is a lot your clients can do to both reduce their chances of infection and control symptoms when they arise.
• Flu vaccine: The flu vaccine is one of the most highly recommended interventions to prevent the development of flu. It is recommended on an annual basis for any client with a chronic condition (e.g. diabetes, COPD), who is immune-compromised, who works in a hospital or healthcare environment and in children younger than 5 years of age. The annual flu vaccine can be given anytime from March to June although the earlier in the season clients get it, the better.
• Humidifier: Cold dry air in winter can make cold and flu-related symptoms worse. Recommend that your client considers using a humidifier at night time to help reduce unpleasant sinusitis symptoms. Most pharmacies stock a supply of humidifiers including Vicks Ultrasonic Paediatric Humidifier®, Carmen Health Electrode Humidifier®, Laica Humidifier® and many more.
• Hygiene basics: Most sinusitis infections are contracted from close contact with other infected people. Infections are normally passed on when you touch a surface which an infected person has touched. Advise clients to wash their hands frequently or to keep disinfectant hand sanitizer handy to regularly clean their hands.
• Quit smoking: Smoking damages the lining of the sinuses and basically makes people more prone to infections like colds and flu. Quitting smoking will reduce the number of viral attacks your client experiences.
• Immune system boosters: Herbal immune boosters such as elderberry, grape seed, Echinacea, propolis, olive leaf extract and plant sterols are natural immune system stimulants. These are found in a variety of supplements designed for both children and adults including Viral Guard®, Viral Choice®, VirAway®, ChrecheGuard®, Phyto Nova®, ImmunoChoice Complex®, Airimmune®, Nativa Immune Complex®, Propofot Junior®, Moducare®, Holford ImmunoC® and Solal Olive Leaf Extract®. Immune boosters need to be taken daily to be effective.
• Minerals to fight infections: Zinc supplements have been shown to boost immune function and can help prevent and fight viral sinusitis infections. A daily dose of Zinc such as Vital Zinc Complex®, Natrodale Zinc 15mg®, Bettaway Zinc®, Fit Health Chela Zinc® of 15mg per day will help prevent viral sinusitis infections.
• Vitamin C: A daily vitamin C supplement can help prevent cold and flu infections for those clients who are prone to infections. Some of the vitamin C options available include Cal-C-Vita®, Natrodale Vitamin ®C, Vital Chewable Vitamin C®, Bettaway Mega C 1000®, Jungle Vites Chewy C®, Fit Health Super C 1000® and Solal Double Vitamin C®. Advise your adult clients not to take doses above 2000mg per day of vitamin C as this can lead to kidney stones.

Treating infection

Since viral infections are the most common cause of winter sniffles, symptom control is considered the first-line of treatment. Should this approach fail, review the condition and antibiotics May be indicated.

Symptomatic treatment of your clients can include the following:
• Pain relievers: Simple oral analgesics can help control fever and pain. A sore throat can be treated by locally acting agents such as throat lozengers (Medi-keel A®, Strepsils®, Cepacol®, Woods Lozengers®), throat sprays (Medi-keel A®, Andolex®) and gargle solutions (Medi-keel A®) to help control the pain and swelling.
• Decongestants: Medications which reduce nasal secretions help in controlling nasal blockage, post nasal drip and headaches. These agents usually contain a combination of an antihistamine along with a sympathomimetic agent.
o Nasal spray decongestants: Over-the-counter nasal sprays and drops such as phenylephrine (e.g. Adco-Nasdro®, ENT®, Napghensyl®, Vibrocil-S®), oxymetazoline (e.g. Drinasal®, Dristan®, Drixine®, Iliadin®) and xylometazoline (e.g. Sinutab nasal spray®) are all just some of the available brands. Children under 6 years should only use paediatric versions of these sprays and drops. Decongestant nasal sprays and drops should only be used for up to a maximum of five days otherwise they can cause rebound worsening of sinusitis symtoms.
o Oral decongestant medications include combination capsules, tablets, effervescent tablets and syrups. For the most part these contain a sympathomimetic stimulant such as pseudophedrine or phenylpropanolamine, often in combination with an antihistamine, analgesics such as paracetamol or aspirin as well as an antihistamine. Some also present with added vitamin C. Check whether you client can take aspirin or has uncontrolled hypertension before prescribing. Decongestants with paracetamol (e.g. Acuflu®, Adco-Flupain®, Adco-Sinal NS, Benylin, Colstat, Corenza Para-C, Sinugesic, Sinumax, Degoran®, Dequa-flu®, Flustat®, Flutex®, Grippon®, Histacon®), decongestants with ibuprofen (e.g. Nurofen®, Advil®), decongestants with codeine (e.g. Adco-Sinal Co®, Sinustat Flu®, Sinutab®, Cofendyl®) and decongestants and aspirin (e.g. Coryx®). Specifically ask your client if they need an agent which won’t make them drowsy as there are oral decongestants designed with this in mind (e.g. Sinutab ND®, Demazin ND®)
• Cough suppressants: Often clearing up nasal secretions will help reduce the dry irritating cough which accompanies colds and flu. If these are insufficient consider recommending a cough suppressant such as pholcodeine (Pholtex®, Pholcolinct®), diphenhydramine (Dilinct®), noscapine (Nitepax®) or dextrometmorphan (Dilinct Dry®). For wet coughs recommend agents containing guaifenesin (Benylin Bronchospect®, Dilinct Junior®). Where there is wheezing associated with the cough recommend an agent containing theophylline (e.g. Alcophyllex®).
• Pregnant and breastfeeding women: Colds and flu do fairly frequently affect women while they are pregnant. It is safe to recommend a saline nasal spray. Other than home remedies like lemon and honey tea, the only cough syrup considered safe during pregnancy is Expigen®. Paracetamol is considered the safest analgesic to be used during pregnancy.

Effective symptom control is most often all patients with colds and flu require. Choosing the right medications to control their condition will ensure a speedy and pain-free recovery.

Areas of itching that are only on one part of the body are more likely caused by a problem of the skin. The area of the body that itches may give a clue as to the cause of the itch. When there is a rash that accompanies the pruritus, the cause is usually easily determined and treated. However, the most difficult cases of pruritus are those without an associated rash.

Pruritus ani, sometimes referred to as anusitis is the irritation of the skin around the anus, causing the desire to scratch. The intensity of anal itching tends to increase due to moisture, pressure (i.e. sitting for long periods of time) or chafing caused by clothing. At worst, anal itching that is accompanied by severe scratching causes intolerable discomfort, burning and infection.

Pruritus and pain
Pruritus and pain are closely related sensations, since the same nerves transmit both signals to the brain. When the area of skin is scratched, that same area may become even itchier, leading to more scratching. This is called the itch-scratch cycle. In general, pruritus can be related to a problem with the skin or another underlying disease of the body (systemic disease). When itching is localised to a particular area of skin, it usually is not caused by a systemic disease.

Generalised pruritus
In more than 50% of people suffering from generalized pruritus a systemic disease may be the cause. Symptoms also may be caused by medication use, various infections (including parasitic infections of the intestines), iron deficiency, liver disease, kidney disease, high or low thyroid function, as well as certain cancers such as lymphoma. Chronic urticaria and systemic forms of contact dermatitis are also common causes of generalized pruritus, even if no visible rash is present.

Causes of Pruritus Ani
The irritation can be caused by intestinal parasites, anal perspiration, frequent liquid stools, diarrhoea, residual stool deposits, or the escape of small amounts of stool as a result of incontinence or flatulence. Another cause is yeast infection or candidiasis. Some diseases increase the possibility of yeast infections, such as diabetes mellitus or HIV/AIDS. Treatment with antibiotics can bring about a disturbance of the natural balance of intestinal flora, and lead to peri-anal thrush, a yeast infection, affecting the anus. Psoriasis can also be present in the anal area and cause irritation. Abnormal fistulas from the small intestine or colon to the skin surrounding the anus can form as a result of disease (such as Crohn’s disease), acting as channels which may allow leakage of irritating fluids to the anal area. Other problems that can contribute to anal itching include pinworms, haemorrhoids, tears of the anal skin near the mucocutaneous junction (fissures) and skin tags (abnormal local growth of anal skin). Anal itching is conjectured to be possibly caused by irritating chemicals in foods consumed, but no clinical evidence based on scientific enquiry has demonstrated this.

Treatment
For pruritus ani of unknown cause, treatment typically begins with measures to reduce irritation and trauma to the perianal area. Anusol® (available as suppositories, ointment and pain relief ointment) or topical corticosteroids, i.e. Mylocort® may relieve some of the discomfort. If it is due to a fungal infection or candidiasis, an antifungal cream, i.e. clotrimozole may be effective. Stool softeners can help prevent constipation. If the itchiness is secondary to another condition such as infection or psoriasis these are typically treated.

A strong immune system guarantees that a person is healthier and less likely to be affected by niggling diseases and infections, which in itself is great, because it is one less thing to worry about.

The body’s first line of defence against germ invasion is made up of the skin and mucous membranes, but when a foreign invader does enter the body, the immune system gears up for battle to fight off infections

Causes
A weak immune system can be the result of daily stress, emotional or physical. Physical stress can be as simple as lack of sleep or physical over- exertion, but it can also be as a result of radiation, viral and bacterial infections, certain medicines or when a person has undergone surgery. A diet high in fat and sugar and lacking in lean protein, vegetables and fruit does not provide the necessary vitamins and minerals to help maintain a healthy immune system. In addition the very process of ageing slows down the body’s metabolism, which can compromise the immune system function.

Symptoms
The symptoms associated with a weakened immune system is a general feeling of being unwell, perhaps lacking in energy, listlessness and when a person seems to be prone to every infection that might be doing the rounds. A client ay not even be aware that their immune system is not working at its full potential, and that a good balanced supplement could help towards re-establishing their zest for life.

Stress in itself does not make a person ill, but it does increase the risk of being sick because of what it does to your immune system. Although the biological mechanisms are not fully understood, the theory is that the hormones that gear a person up for action when stress is present can interfere with the immune system’s function. If stress is ongoing and intense, a person can thus become more susceptible to contracting disease.

Treatment
A healthy lifestyle, combined with balanced meals, regular exercise and a good supplement could go a long way towards remaining healthy and energetic.

Free radicals are molecules that are produced when the body breaks down food, or by environmental exposure such as tobacco smoke and radiation. Free radicals can damage healthy cells. Antioxidants are substances in food that may protect against the effect of free radicals and one’s diet should contain plenty of these good foods.
The following vitamins and minerals have been identified as immune boosters and one should ensure an adequate intake of these:

Vitamin C (tomatoes, citrus fruit, strawberries, broccoli)
Vitamin C supplements are inexpensive and available naturally in many fruits and vegetables.
• It increases the production of infection-fighting white blood cells and antibodies (antibodies coats cell surfaces thus preventing viruses from entering).
• It also reduces the risk of cardiovascular disease by raising the levels of HDL (good cholesterol) while lowering blood pressure and has many other beneficial effects in the body.
RDA (Recommended daily allowance) is 60 mg and the body will use as much as is needed and excrete the rest. Smoking severely depletes vitamin C reserves and should be avoided. (Bettaway Mega C 1000mg®, Scorbex®, Sandoz CA-C®)

Vitamin E (nuts, vegetable oils, whole-grains)
• Vitamin E stimulates the production of natural killer cells that seek out and destroy germs and cancer cells.
• It may also reverse some of the immune response decline as one ages and has been implicated in lowering the risk of cardiovascular disease. For smokers and drinkers a higher dosage is recommended. The RDA is18 mg it is a fat soluble vitamin which means the body can store it. Do not take excessively high quantities.

Garlic
This member of the onion family stimulates the production of infection fighting white cells, boosts natural killer cell activity and increases antibody production. In cultures with a garlic-rich diet there seems to be a lower incidence of intestinal cancer. It is heart-friendly as it keeps platelets from sticking together and clogging tiny blood vessels. In tablet or capsule form at least there is no odour!

Zinc (meat protein, beans, oysters, etc.)
Zinc increases the production of white blood cells that fight infection and increases killer T-cells that help fight against cancer. Zinc is helpful for elderly people who often have weakened immune systems. It helps in the healing of the skin and plays a role in the activities of enzymes and is said to help prevent respiratory infections.

Bioflavonoids (fruits and vegetables)
Protects the body against environmental pollution and helps reduce cholesterol’s ability to form plaques in arteries.

Selenium (chicken, whole grains, tuna, egg yolk, brown rice)
Increases natural killer cells and mobilizes cancer-fighting cells. Vegetables grown in selenium rich soil does contain more of this mineral.

Carotenoids (carrots, tomatoes)
The four important carotenoids are beta-carotene, lycopene, lutein and zeaxhanthin. These strengthen the immune system by developing lymphocytes. Apart from carrots, tomatoes, pumpkin and leafy green foods contain carotenoids.

Omega 3 Fatty Acids (nuts, salmon, tuna, flaxseed oil)
Omega 3 fatty acids increases the activity of phagocytes, which are the white blood cells that engulf bacteria. Essential fatty acids help protect the body against damage from infection. Add some flaxseed oil to a yoghurt smoothie! (Several Omega 3, Flaxseed Oil and combination Omega 3 & 6 products are available)

Iron (meat, liver, dried beans, tofu)
Helps maintain healthy red blood cells which play a role in oxygen transportation. (Eezy-Fer® caps contains iron and some vitamins)

Multivitamins and Multiminerals
A balanced multivitamin/multimineral will contain all or at least most of the above supplements. It is a lot easier to take a tablet or capsule that contains all that is needed in one formula, than it would be to take a handful of supplements.

- Centrum and Centrum Select® is a very popular supplement, contains it all from A-Z and is widely available..
- Pharma Natura’s Bettaway® range of products has a time release formula and have specialised formulas for males, females and kids.
- Multibionta®, DS-24 Vegi ®, Dynamisan®, Emvit®, Multi-Vitchoice®, Pharmaton® and Vitaforce® are just some of the other good formulas available and the consumer will make their purchase according to their needs.
- Cellfood® is an oxygen mineral supplement that does not contain ‘traditional’ immune boosters, but users of the product rate it high.

Handy Tips
A final few tips to avoid all the nasties that humans are exposed to every day:
• Washing hands thoroughly and often with soap and warm water, particularly before eating and after using the bathroom. This reduces the number of organisms that can enter the body.
• Meat should be cooked thoroughly to kill dangerous bacteria and other microorganisms.
• Get eight hours of sleep every day – sleep stimulates and energizes the immune system.
• Maintaining a healthy weight – obesity can lead to a weakened immune system and has many other health risks.
• Exercise at least three days of the week as physical activity stimulates the immune system and helps with weight maintenance or reduction.
• Use alcohol sparingly – three or more drinks in a short period starts to impair white blood cells’ functioning.
• Use less sugar – 100 grams of sugar is the amount found in a can of cold drink and can reduce the ability of white blood cells to kill germs by 40 percent for up to five hours!
• Stop smoking it is bad for a person’s health, and also weakens the immune system.
• Reduce and manage stress as long periods of feeling stressed weaken the immune response.

Have more fun, laugh out loud, watch a good comedy and de-stress whenever possible. Combine this with a balanced diet, healthy lifestyle and life won’t look quite as bleak as we sometimes think it is.