World Health Day Message

| a member of the PVH Group of companies | owned by Peter Harris Barbados

THE IMPORTANCE OF rest, exercise and good nutrition cannot be overemphasized if Barbados is to avoid the ever-increasing costs of secondary and tertiary healthcare, says Dr Brian Charles.

In giving details on the wellness programme which he is offering as managing director of Coverley Medical Centre, Charles says the public healthcare which generations of Barbadians had taken for granted was no longer sustainable; but one of the ways to reduce future costs could be via a general wellness programme.

“I spent 21 years in the public health system…and now that I’m in the private system, I see that everything has a cost. We cannot sustain the public free health care system no matter how unpleasant it will be to civil society. It’s going to have to change at some point in time.  “General wellness is a way to start, so that less people will need secondary and tertiary care, thereby reducing costs. It’s not very sexy to talk about attacking it at the base, at the primary level, but it is necessary,” Dr. Charles says in an interview on the threshold of World Health Day, April 7.

”Typically the health professional has been known as an agent to help persons when they’re sick, so we tend to concentrate on illness. We go to medical school and learn about diseases and how to cure them, and the different levels of health care, which are primary, secondary and tertiary; primary being the preventative aspect, secondary being where intervention is used to treat illness, and tertiary being hospital and specialist level care. As far as our efforts are concerned, we should be moving toward primary health care,” said Dr. Charles, who is also managing director of Sandy Crest Medical Centre.

The thinking behind Dr. Charles’ reinforced wellness plan stems from the recent Estimates debate where the expense of health care was emphasized and Members of Parliament basically reiterated that no Government could continue to support totally free health care for the general and ageing population.

“In this free environment, someone still has to pay, especially for tertiary care processes such as advanced radiological investigations, ultrasounds, CAT scans, MRIs, as well as advanced procedures like transplants, dialysis and heart and brain surgeries,” says Dr. Charles.
“Those are all very expensive. And they are targeted toward a few; so tertiary care is at the top of the pyramid where it deals with a few people, while primary care is at the bottom where the pyramid is wide. So the base of health care should be focused on primary care,” Dr. Charles explained.

Aiming for good primary health care and a reduced need for a large quantity of secondary and tertiary care in mind, the focus is on wellness medicine at Coverley.

Risk Factors
“Wellness medicine is a concept whereby the individual takes ownership of his or her health. For example, the highest morbidity and mortality – meaning the disease that causes the most death and suffering in the Western Hemisphere – comes from cardiovascular disease and strokes. So what are the risk factors for strokes and heart disease? There are risk factors that are modifiable and some that are not,” said the former head of the Accident & Emergency department of the Queen Elizabeth Hospital.

Since the non-modifiable ones are ageing, race and genetics, Dr Charles notes, the modifiable risk factors are obesity, hypertension, diabetes, smoking and alcohol consumption which can all be controlled in order to prevent the complications leading to the need for secondary and tertiary care.

“This is applicable from children right up to the elderly; so no person in the society is exempt,” he adds. “Let us take, for instance, a 23-year-old man. If he is sedentary, like a lot of jobs we have, and does nothing but desk work, and when he goes home he watches television all evening until bedtime, and repeats that in a cycle, then he, at that young age of 23, is setting himself up for dire consequences.

“That same man, when he reaches about 45, will transform into the age where heart disease and stroke, because of the risk factors that have been allowed to accumulate, will start to have effects. So, the younger person with the lifestyle I just illustrated shows no effects until he gets to what I call that magic age, where his metabolism starts to work in a different way.

“Because of the arterosclerosis, which is a process of depositing fat in the arteries, causing the arteries to narrow – although you show no outward effects at first – the space in the arteries gradually gets smaller, making the heart work harder to push blood through them to feed your vital organs.

“The heart is now working harder, so at the age of 40-45 that once-healthy 23-year-old starts to get hypertension, which is a direct risk factor for stroke and heart disease,” is how Dr Charles puts it.

Furthermore, as a result of poor eating, lack of exercise and increased weight, that man may then develop diabetes – an impairment of the metabolism of the sugar in the body. Diabetes is an imbalance between the use of sugar and the input of sugar, and if the body cannot use that sugar, it is deposited in the cells and the metabolism in the cells start to break down.

“So healing is impaired, the ability of the body to fight infection is impaired, growth and repair from injury is impaired. That 45-year-old who was a healthy 23-year-old living well now has those effects, and with those effects come the complications,” he added.

It is such a gradual process that one hardly knows it is happening; hence the term “silent killer” and the reason why Dr Charles and his team at the three-year-old Coverley Centre are targeting those from very young ages in the wellness medicine programme.

So what is so radically different about wellness medicine?
Primary or wellness medicine, addresses physical, spiritual and emotional wellbeing and is suited to any age, thereby encouraging schoolchildren to be physically active instead of spending all of their free time before a television or video console.

“They are very sharp with the eye-hand coordination but they’re not physically well. They learn from a young age that when they’re not busy they can sit and do mind games, so the physical aspect suffers. Parents may say, in these days, they don’t feel safe with their children running around on a pasture or leaving the child on the school premises after school to play. It’s a different environment that’s symptomatic of the age we’re living in,” he adds, noting that while it was a challenge, it was not impossible.

As for the busy career-oriented adults who simply “don’t have the time”, Dr Charles and those at Coverley ask for a 24-hour breakdown of their activities.
“I tell them all we need to do is spend 30 to 40 minutes a day dedicated to activity where you raise your heart rate and get a nice little sweat. And that only has to be done for four days a week. If you’re watching more than an hour of TV after work on evenings, who benefits from that,” he asks.

The need for proper nutrition and rest
“The most important meal of day is breakfast. People who want to lose weight feel that skipping breakfast is advantageous; it is not. You’ve spent the whole night not eating, you awake and your hormones have prepared the body for the day and they expect to be provided with some fuel for the day, and that fuel would be breakfast. If you don’t give fuel to the body after that long period of resting overnight, then the body interprets it as being in a stress mode. So when you skip breakfast, you automatically go into a stress mode,” Dr Charles explains.

“If you’re stressed, you are unable to perform optimally because your body is prepared for the fight-and-flight response. The body, under stress, secretes hormones that make it ready to absorb any nutrition that comes however it comes, and deposit it as storage. Storage is fat,” he adds.

He advises that the best way to handle good nourishment is not to diet, but to eat well. This would entail adequate carbohydrates, mainly starchy foods, which provide fuel and energy.
The more processed the food, however, the worse the carbohydrate content. Hence, if you go to the supermarket and look at sweet potatoes, yams and breadfruit, as well as rice, macaroni and pasta, be aware that the first three are non-processed foods and “very good carbs”, while the last three are processed and not good carbs though they can provide adequate levels of energy.

“Then there are the super-processed foods, containing sugar. Sugars are very, very bad! We should attempt to eliminate as much processed sugar from our diet as possible. It provides you with quick energy, that’s all. Flour is also processed, and most persons eat white flour. If you have to eat breads, use wholewheat or brown bread,” he says.

Proteins are also essential to build and repair muscle, while fibre in terms of vegetables and fruits, though often prohibitive in cost – should be a part of every meal.

“Fats are also important in our diet, because every single cell in our bodies is made up of a portion of fat. So we need fats in our diet to sustain good operation of the body. But there are good and bad fats. The good ones are contained in nuts and olive oil, and the bad are contained in butter and lard. Certainly not fried foods! If you must, have a fried meal once a week or less, and fry in olive oil,” is how the doctor and consultant put it.

Finally, Dr Charles advises clients to consume enough water to ensure that the urine is pale yellow. The much-touted eight litres is too much unless one is an athlete, he stresses.

As far as rest and avoidance of stress are concerned, adults ideally need between six and eight hours of sleep in a 24-hour period, since regeneration of cells and recharging of the brain are best done while resting.

“Most studies support that at least eight hours’ sleep is better. In January this year, a study was published stating that persons with less sleep tend to be more overweight,” adds Dr. Charles.

Diabetes Centre Receives Donation for Demonstration Kitchen

| a member of the PVH Group of companies | owned by Peter Harris Barbados

Bridgetown– Diagnostic MRI Services Inc. has donated $3,500 to the Barbados Diabetes Centre in Warrens towards the outfitting of its demonstration kitchen, which is integral to the Centre’s goal of becoming a total care facility for diabetics.

Podiatrist and Trustee of the Barbados Diabetes Foundation, Simone McConnie advocates for the teamed approach to diabetes care. The diabetes foot specialist said that she was happy to receive the donation from the centre’s neighbor, Diagnostic MRI as it takes the centre one step closer to its goal of becoming a haven for patients providing all the different types of treatments a diabetic would need under one roof.

“We are very grateful to the management of Diagnostic MRI Services Inc. for their kind donation. It will go towards outfitting the demonstration kitchen which will be set up to educate patients on easy ways of preparing nutritious meals, displaying appropriate portion sizes, and dispelling the dilemma that many diabetics hold on knowing what to eat to help them manage their disease. We still need some more help to get the kitchen fully outfitted, but this contribution puts us well on the way to adding to the services the centre provides.”

Radiographer, Donna Seale who presented the cheque on behalf of Diagnostic MRI said that the Diagnostic Clinics have made a number of donations to individuals and is quite passionate about helping charities in the areas that they operate.

“Our home base is at the Diagnostic Clinic, but we operate from three other locations and we try wherever possible to contribute to the communities in which we operate. We were, therefore, very happy to help the Centre with the cost of setting up their demonstration kitchen. Being in the health business we see a number of persons with diabetes everyday and we are hoping that this donation would go a long way in helping persons to manage this very debilitating disease,” Seale said.

The Diabetes Care Centre was established by The Barbados Diabetes Foundation a charitable organization. It is the first multi-disciplinary centre of its kind on the island and in the region. Opened in February of this year it is unique because it is a one-stop shop for patients with diabetes. Currently there are podiatrists, dietitians and nutritionists, a diabetes specialist nurse, and doctor, with consultative services from psychologists, exercise physiologists, ophthalmologists, surgeons and other members of the healthcare team who work together to provide an integrated service at the Centre located, in Warrens, housed within The Maria Holder Diabetes Centre for the Caribbean.

Breast Cancer Statistics

The American Cancer Society has published riveting statistics about breast cancer than underscore the importance of proper breast care.

Breast cancer is the most common cancer among American women, except for skin cancers. The chance of developing invasive breast cancer at some time in a woman’s life is a little less than 1 in 8 (12%).

The American Cancer Society’s most recent estimates for breast cancer in the United States are for 2009:

  • about 192,370 new cases of invasive breast cancer will be diagnosed in women
  • about 62,280 new cases of carcinoma in situ (CIS) will be diagnosed (CIS is non-invasive and is the earliest form of breast cancer).
  • about 40,170 women will die from breast cancer

After increasing for more than 2 decades, female breast cancer incidence rates decreased by about 2% per year from 1999 to 2006. This decrease may be due at least in part to less use of hormone replacement therapy (HRT) after the results of the Women’s Health Initiative were published in 2002. This study linked HRT use to an increased risk of breast cancer and heart diseases.

Breast cancer is the second leading cause of cancer death in women, exceeded only by lung cancer. The chance that breast cancer will be responsible for a woman’s death is about 1 in 35 (about 3%). Death rates from breast cancer have been declining since about 1990, with larger decreases in women younger than 50. These decreases are believed to be the result of earlier detection through screening and increased awareness, as well as improved treatment.

At this time there are over 2.5 million breast cancer survivors in the United States. (This includes women still being treated and those who have completed treatment.)

For more information, visit American Cancer Society Cancer Statistics.

Breast Care

Whatever your age, size or shape it’s important to take care of your breasts.

Being breast aware is an important part of caring for your body. It means getting to know how your breasts look and feel, so you know what is normal for you. You can then feel more confident about noticing any unusual changes.

How do I check my breasts?

There’s no right or wrong way to check your breasts. Try to get used to looking at and feeling your breasts regularly. You can do this in the bath or shower, when you use body lotion, or when you get dressed.

Remember to check all parts of your breast, your armpits and up to your collarbone.

The breast awareness 5-point code

  • Know what is normal for you
  • Know what changes to look and feel for
  • Look and feel
  • Report any changes to your GP without delay
  • Attend routine breast screening if you are aged 50 or over

Have you noticed something different about your breast?

Are you worried you may have breast cancer?

Being breast aware means noticing any changes that occur in the breast and having them checked out by a doctor with out delay. It is important to remember that most changes that occur in the breast are part of normal breast development.

However if you are not sure about the changes in your breast or you notice something new it is always best to see your doctor to have this checked out.

To pick up potential problems at the earliest possible opportunity, you need to be aware of any changes in your breasts, which you can see in the images below.

What is Ultrasound?

Ultrasound is a diagnostic procedure that uses high-frequency sound waves beyond human hearing capability to produce high-quality images of soft tissues and motion within the body. Ultrasound involves no x-ray and can provide medical information that, in the past, may have required surgery.

How does ultrasound work?

The ultrasound procedure is simple and painless. A hand-held transducer emitting silent, high frequency sound waves is placed against the body and slowly passed over the area being examined. The sound waves pass through the skin and into the body. The returning sound waves or echoes are separated and identified by the transducer, then changed into electrical energy. Sophisticated equipment produces images on a video monitor and then on paper or film.

 

Benefits of CT Scanning

  • Provides very detailed images of many types of tissue as well as the lungs, bones, and blood vessels.
  • Fast and simple.
  • In emergency cases, they can reveal internal injuries and bleeding quickly enough to help save lives.
  • Less sensitive to patient movement than MRI.
  • Can be performed if you have an implanted medical device of any kind, unlike MRI.
  • Provides real-time imaging, making it a good tool for guiding minimally invasive procedures such as needle biopsies and needle aspirations of many areas of the body, particularly the lungs, abdomen, pelvis and bones.
  • Diagnosis determined by CT scanning may eliminate the need for exploratory surgery
  • No radiation remains in a patient’s body.

What you will experince during a CAT Scan

Scanning itself causes no pain. You may be asked to remain still for a few minutes. (If you have a hard time staying still, are claustrophobic or have chronic pain, then a sedative may be offeredby your referring physician to assist.

You may be asked to hold your breath during the scanning. Any motion, whether breathing or body movements, can lead to artifacts on the images. This is similar to the blurring seen on a photograph taken of a moving object.

If an intravenous contrast material is used:

Injected

  • A slight pin prick when the needle is inserted into your vein.
  • A warm, flushed sensation during the injection of the contrast materials.
  • Metallic taste in your mouth that lasts for a few minutes.
  • You may experience a sensation like they have to urinate but this subsides quickly.

Most patients experience none of these sensations

Swallowed

  • Fruit flavoured oral contrast

Enema

  • A small amount of contrast is introduced per rectum. This affords enhanced visualization of the lower end of the colon and rectum.
  • You may experience mild abdominal fullness or a need to expel the liquid

Be patient, as the mild discomfort will not last long.

You should inform your physician of any medications you are taking and if you have any allergies. If you have a known allergy to contrast material, or “dye,” your doctor may prescribe medications to reduce the risk of an allergic reaction.

With modern CT scanners, you will hear only slight buzzing, clicking and whirring sounds as the CT scanner revolves around you during the imaging process.

You will be alone in the exam room during the CT scan. However, the technologist will be able to see, hear and speak with you at all times.

With pediatric patients, a parent may be allowed in the room but will be required to wear a lead apron to prevent radiation exposure.

After a CT exam, you can return to your normal activities. If you received contrast material, you may be given special instructions.

How is the CAT scan performed?

The technologist begins by positioning you on the CT examination table, usually lying flat on your back or possibly on your side or on your stomach.

Straps and pillows may be used to help you maintain the correct position and to hold still during the exam.

If contrast material is used, it will be swallowed, injected through an intravenous line (IV) or administered by enema, depending on the type of examination.

The table will move quickly through the scanner to determine the correct starting position for the scans. Then, the table will move slowly through the machine as the actual CT scanning is performed.

How should I prepare for a CT Scan?

  • Check in at least 15 minutes prior to your examination time.
  • Plan for at least 30 minutes to complete your Ct examination.
  • You should wear comfortable, loose-fitting clothing for your exam.
  • Leave home all metal objects or be sure they are removed prior to the examination – jewelry, eyeglasses, dentures and hairpins. You may also be asked to remove hearing aids and removable dental work.
  • You may be asked not to eat or drink anything for several hours beforehand, especially if a contrast material will be used in your exam. (see X-Ray safety for information on Contrast use)
  • Inform your doctor of any recent illnesses or other medical conditions, and if you have a history of heart disease, asthma, diabetes, kidney disease or thyroid problems.
  • Women should always inform their physician and the CT technologist if there is any possibility that they are pregnant. Exposing a developing foetus to radiation is avoided whenever possible.
  • If you are unsure about the instructions provided at the time your examination was scheduled, contact the clinic at least 24 hours in advance.
  • Failure to adequately prepare may result in delay or rescheduling your examination.

What is a Mammogram?

Mammography is a special type of x-ray imaging used to create detailed images of the breast. Mammography uses low dose x-ray; high contrast, high-resolution film; and an x-ray system designed specifically for imaging the breasts. Successful treatment of breast cancer depends on early diagnosis. Mammography plays a major role in early detection of breast cancers. The benefits of mammography far outweigh the risks and inconvenience.

Benefits of Mammography

Mammography can show changes in the breast well before a woman or her physician can feel them. Once a lump is discovered, mammography can be key in evaluating the lump to determine if it is cancerous. If a breast abnormality is found or confirmed with mammography, additional breast imaging tests such as ultrasound (sonography) or a breast biopsy may be performed. A biopsy involves taking a sample(s) of breast tissue and examining it under a microscope to determine whether it contains cancer cells. Many times, mammography or ultrasound is used to help the radiologist or surgeon guide the needle to the correct area in the breast during biopsy.