Polycystic Ovarian Syndrome: A lifestyle-related disease?

November 1, 2020November 2, 2020Leave a comment

Polycystic Ovarian Syndrome (PCOS) is common in South African women and affects about one in 10 women globally. It is caused by a complex imbalance of hormones in the ovaries. Charlene Yared West spoke to Life Kingsbury endocrinologist, Dr Jocelyn Hellig and gynaecologist Dr Philip Zinn to find out more about this condition.

So what is PCOS?

In a woman’s body, the ovaries release eggs each month as part of a healthy menstrual cycle. However, with PCOS the egg is not released as easily, which leads to irregular ovulation and menstruation and can impact fertility. “The ovaries are described as polycystic because there is an excess of the fluid-filled, egg-containing sacs called follicles, all of a similar size, when seen on an ultrasound image,” says Dr Zinn. “This excess occurs due to disturbance of the growth of follicles – to the size required for ovulation.”

It’s all about the hormones… or is it?

Dr Hellig explains that the exact cause of PCOS is unknown. “There is no one singular factor which causes PCOS. It is considered to be a complex trait arising from the interaction of genetic and environmental factors, usually first presenting when mature gonadotropin levels (hormones essential for reproduction)are achieved at puberty. It occurs naturally in primates as well as humans,” she says. “The disorder arises clinically by the presence of two out of three criteria: irregular periods or the absence of ovulation, features of high androgen levels (acne or excess hair growth) and a certain appearance of polycystic ovaries on ultrasound,” she says.

You could be predisposed to PCOS if…

You have insulin resistance.
You have Type 2 diabetes.
You have unhealthy eating habits.
You do not exercise regularly.
You are overweight or obese.

Trying to fall pregnant?

If you are trying to fall pregnant, but it is proving difficult, PCOS might be the culprit, says Dr Zinn. “Many women are unaware that they even have PCOS until they start trying to have a baby. Once they start treatment and their symptoms are managed, then their chances of conceiving are increased.”

QUIZ: ✓Tick the boxes below to see if you might have symptoms of PCOS

Irregular menstrual cycle
Thinning hair or hair loss on the scalp (male-pattern baldness).
Acne on the face, back and chest.
Too much hair on the face or areas where men usually have hair (hirsutism affects up to 70% of women with PCOS).
Weight gain and difficulty losing weight.
Darkening of skin pigmentation, along the neck, groin and under the breasts.
Skin tags in the armpits or neck area.

How is PCOS diagnosed?

“If you think you have PCOS, make an appointment with your gynaecologist. There is no single test to diagnose PCOS, but we take your medical history and can conduct a physical exam with a pelvic ultrasound and do some blood tests,” says Dr Zinn. Dr Hellig adds: “Of utmost importance is that PCOS is a diagnosis of exclusion and it is important for your medical professional to look for other causes of your symptoms before ascribing it to PCOS.”

Physical exam: Checks your blood pressure, BMI and waist size. Also checking for extra hair on the body, skin discolouration, hair loss and any other signs of excess testosterone such as an enlarged clitoris. It is important to exclude other health conditions.
Pelvic ultrasound: A sonogram will examine the lining of the uterus and check the ovaries for the polycystic features.
Blood tests: To check your androgen hormone levels, as well as other hormone checks, including your thyroid.

Can I be cured from PCOS?

8Dr Hellig explains that there is no cure for PCOS, but symptoms can be effectively managed and therefore treated. “We take into account if you want to conceive, your risk of long-term health problems, especially diabetes and cardiovascular disease, and will help formulate an effective treatment plan through lifestyle changes and medication where necessary,” she says.

What can I do to alleviate my symptoms?

Dr Hellig and Dr Zinn agree on the following steps that women can take to treat PCOS:

Lose weight: This will help to stabilise your blood glucose levels and alleviate insulin resistance. Even a 5 – 10% loss in body weight can improve your chances of conceiving.
Remove hair: Using facial hair removal creams, laser hair removal or electrolysis. Medication is not very effective for permanent hair removal.
Hormonal birth control for women not wanting to conceive: Can help to regulate menstruation cycles, stabilise weight, improve acne and reduce new hair growth on face and body.
Anti-androgen medicines: Although not safe for pregnancy, can help reduce PCOS symptoms.
Metformin: A drug used to treat type 2 diabetes and may help some women with PCOS symptoms in certain circumstances.

Healing from incontinence

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Urinary incontinence is common in pregnancy and is reported by about 60 percent of women. For these women, the severity of their condition can increase during the course of their pregnancy, especially peaking in the second and third trimesters. Of these women who experience incontinence in pregnancy, 70 percent go on to resolve the condition postpartum – and within the first year, the prevalence of incontinence drops down to 11 to 23 percent. Dr Bongi Makhubo, obstetrician gynaecologist from Life Anncron in Klerksdorp sheds more light on the topic.

Early incontinence is normal

Pregnancy can affect the normal way your urethra relaxes and contracts and many women, particularly those who had a vaginal birth, can experience incontinence after childbirth. “The pubic and pelvic muscles and the anal sphincter can be injured in up to 40-80% of births and so, leaking a little bit after birthing your baby vaginally is quite within the normal range, but it is not normal if it lasts for months afterwards,” says Dr Makhubo. “Directly after birth, using a thick maternity pad helps to absorb the leaks, but once you have stopped bleeding and incontinence persists, you might need a specialist appointment to discuss the problem further.”

Stress incontinence is also quite common in new mothers and affects roughly a third of women in the first year after birth. Stress incontinence leaks happen when the mother laughs, coughs, sneezes or goes for a run. Lifting heavy things can also cause these leaks, which are due to increased intra-abdominal pressure and a defective urethral support or closure.

<FACT BOX>What causes incontinence after birth? Dr Makhubo shares the facts:

Weakening of the pelvic floor muscles or injury to the nerves supplying the structures of the pelvic floor, due to a prolonged or difficult labour.
Carrying a bigger than normal baby in utero, leading to difficulty in delivering or stretching and compression of the pelvic floor.
High levels of elastin, a hormone which allows for more stretching of the skin and connective tissue, can cause prolapse and in turn, incontinence (as opposed to collagen, which is decreased during pregnancy).
Assisted delivery, especially with the use of forceps. Research shows that there is less injury and urinary incontinence noted with the use of ventouse in comparison.
Maternal age; the higher the age the higher the association with urinary incontinence.
Parity; incontinence is more common with parous women, however of note is that the highest risk of incontinence is with the first delivery, then 10% risk increase with each subsequent birth.
Vaginal delivery definitely predisposes women to a higher risk of incontinence and most women will be incontinent for a few weeks; however most will be normal within a year.

What can help?

“Pelvic floor muscle training or kegels exercise are by far the best way to combat the problem postpartum, although the research differs as to how much of the exercises should be done. However, these can be done anywhere, and one way to remember to do them is to pick an anchor which will remind you to do them. For example, when stopping at a robot or boiling the kettle: each time you do one of these activities, do some pelvic floor exercises too,” says Dr Makhubo.

She suggests that physiotherapy can also help in some cases. “A physiotherapist will give you cones or a pessary that can be used to squeeze and strengthen the pelvic floor muscle.” Dr Makhubo also encourages lifestyle modifications, such as drinking less coffee and alcolhol and stopping smoking. Decreasing BMI can also help improve incontinence issues. “If lifestyle modifications have been made and incontinence persists, then medical treatments can be offered,” she says. “The last resort is surgery.”

Medical treatment and surgical options

Medication:
- Estrogen creams, duloxetene and even botox can help to alleviate incontinence.
Medical devices:
- A vaginal pessary, which can be used for prolapses. It is a ring-like device and acts as a support for the bladder. A disposable urethral insert may also be prescribed and serves as a leakage barrier.
Bulking agents:
- Bulking agents are injected into the urethra to help plump up the tissues where urine is released from the bladder and help to hold it in.
Surgery: The underlying principle of surgery is to support the urethra, so that the bladder can work effectively.
- “Retropubic urethropexy ( Burch’s Colposuspension ) is used most common surgery for this condition. It is an abdominal procedure, where the pubocervical fascia is attached to a copper ligament or to the pubic symphysis (pelvic bone),” explains Dr Makhubo. “This helps lift the anterior vaginal wall and tissues surrounding the urethra and bladder, which helps to alleviate incontinence.
- Slings: There are various kinds of slings and they are all made of mesh. The use of mesh has been approved by the FDA and the South African Urogynaecology Society endorses and supports the use of this method for incontinence. A ‘hammock’ is created using mesh and tissue to support your urethra and can be done under local anaethesia.
  - Pubovaginal slings, mid-urethral slings, mini-slings and micro-slings are used as a means to help incontinence, but implanting mesh where it is needed, in and around the urethra. These range from being quite invasive to non-invasive. Your care provider will help you decide on the best approach for you.

Caesarean birth: Safety is the priority

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When planning for your birth, you must consider your options; an attempt at vaginal birth, which may or may not result in an emergency caesarean, or choosing to have a caesarean, also called a Caesarean Delivery on Maternal Request. Charlene Yared West spoke to Dr Jacky Searle, an obstetrician-gynaecologist at Life Vincent Pallotti about the risks and benefits of caesarean section.

Reasons for a planned caesarean include:

Placenta praevia (a low-lying placenta)
Breech presentation
Previous caesarean section
Previous shoulder dystocia
An elective caesarean delivery, also called Caesarean Delivery on Maternal Request (CDMR) in the absence of a medical or obstetric reason for avoiding a vaginal birth.

Reasons for an emergency caesarean include:

Cephalo-pelvic disproportion (baby’s head does not fit through the mother’s pelvis)
Fetal distress
Congenital malformations of the baby
Pelvic abnormalities
Infection of the mother
Situations where labour isn’t recommended such as; eclampsia (seizures resulting from high blood pressure) or prematurity of the baby

BEFORE: Preparing for a Caesarean

“For a scheduled caesarean, a protocol is followed, which includes not eating or drinking for six to eight hours before surgery and shaving the bikini area where the incision will be made.” Says Dr Searle. “On arrival at hospital, there are forms to fill out and the anaesthetist will meet you and make a pre-operative assessment before surgery. You will also meet the attending paediatrician shortly before the procedure.” Dr Searle adds that women may choose to have a doula to accompany them for their caesarean. “She will often arrive with you at the hospital and pamper you before going into theatre. This can help a mother relax and connect to her baby and the imminent birth.”

In the case of an emergency caesarean, the surgery is usually done within 30 minutes of the decision being made. The mother will be accompanied by her partner, and her doula, if she has one. “This can be stressful, and even traumatic for the parents, but an adequate explanation of the necessity of the caesarean should always be provided, enabling them to understand and process the experience. All pregnant women should understand that the outcome of labour is unpredictable, but a caring team can support her through the process of childbirth and help her to feel cared for and held throughout.”

DURING: In theatre for a caesarean

In theatre, the mother will have a drip inserted and anaesthesia is almost always regional (awake) – either spinal or epidural. A urinary catheter will be inserted once the anaesthetic is working. “Women, especially those who have not chosen a caesarean, are often pleasantly surprised to find that caesarean birth can be a truly beautiful experience for a mother and her partner,” says Dr Searle.

A gentle caesarean

A ‘gentle caesarean’refers to minimising the medicalisation of the process where possible and enhancing the gentleness. “I am proud to say that this is routine at Life Vincent Pallotti,” says Dr Searle.

A gentle caesarean includes;

Limiting unnecessary noise and chatter
Dimming the lights, playing the mother’s choice of music
Not removing the baby from its mother after birth
Early skin-to-skin contact and early latching

AFTER: Post-recovery form a caesarean

A regimen of analgesia will be prescribed to ensure that any post-operative pain is manageable, explains Dr Searle. “Mothers generally recover well post-caesarean, as they are motivated to get up and moving, and are distracted from post-operative discomfort by their baby! Breastfeeding is encouraged and assistance is provided for all new mothers in the maternity wards at all Life Healthcare hospitals. Mothers usually stay in hospital for four days/three nights after a caesarean section,” she says.

VBAC: Vaginal Birth After Caesarean

“It is appropriate for any woman who has a single pregnancy, with a baby in the head down position, and who has had one previous lower section caesarean, to consider a VBAC,” says Dr Searle. “A successful VBAC is more likely in women who have also had a previous vaginal birth, taller women, women less than 40 years old, where labour occurs before 40 completed weeks, and where birth weight is less than 4kg.”

Sam Suter’s empowering emergency caesarean

I had always wanted a natural birth, although I am hesitant to use that word now, as no birth is unnatural. A birth is birth, no matter how a baby comes. At 39 weeks pregnant, I was induced to attempt a vaginal birth, because my blood pressure reading was climbing and continued to increase to dangerous levels. This was around at 10am in the morning and at 10pm at night, although contractions had begun, they were ever so slight and my blood pressure was rising. The decision to have a caesarean was made because of the risk of a stroke.

I believe all birth experiences have an element of trauma, and this is all part of it – but for me the euphoria and the memory of seeing Tom for the first time, far outweighed any trauma. What I didn’t know is that even if you’ve had a caesarean, nature takes over and the ‘love and bonding’ hormone oxytocin is released – in both mom and baby. I was definitely feeling the oxytocin and looking back, the experience is such a happy one. Happy is in fact not the word to describe it… It was the most incredible human experience I have ever had.

The whole birth experience was not ‘perfect’ or how I had envisioned it, but I had to go with the flow, what was best for my baby and I, and I think that is a huge learning for parenthood overall.

Medication & pregnancy

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Knowing what medication is safe to take in pregnancy is very important when considering over the counter and prescription medications. There will be times in your pregnancy when you simply don’t feel well – and wonder if it’s safe to take the same medication you took before you got pregnant. Life Healthcare delves a bit deeper into this topic, making sure you and your baby stay safe during pregnancy.

Why is it important to know the facts about what’s safe and what’s not?

In the late 1950s the drug ‘Thalidomide’ was released as a non-addictive sedative, which could also effectively treat morning sickness in pregnant women. It was distributed to 46 countries and what followed was a medical disaster where over 10,000 children were born with a range of severe debilitating malformations. “That was one of the most devastatingly tragic events in medical history – one that should never be repeated. However, it is rare for something like that to happen again in our day and age, where women are more informed about what’s safe and what’s not – and do question everything,” says Dr Billy Joseph Jacobs, gynaecologist and obstetrician at Life Glynnwood. “We encourage all our patients to clear the medications they were on with us – and if they are experiencing symptoms, to check with us what medications are safe to take now that they are pregnant,” he says. “The greatest risk to the baby is in the first trimester of pregnancy when all the organs are forming. Oral medication used for acne is especially dangerous then. It is best to avoid all medication in the first trimester, unless prescribed by your doctor.”

Clinical Practice Pharmacist at Life Eugene Marais Hospital Kashmiri Ganas, agrees; “During pregnancy, many medications and supplements can be passed via the placenta directly to the foetus,” she says. “Some medications and supplements can cause harm or birth defects to the unborn child, so it is of utmost importance to consult your doctor before taking any medication or supplement. The same holds true once your baby is born and if you are breastfeeding.”

Medication to avoid in pregnancy

According to Dr Jacobs, medication containing alcohol and pseudoephrine, which is found in common cold and flu preparations, as well as aspirin and anti-inflammatory agents such as Ibuprofen and Diclofenac are not safe in pregnancy and should not be taken, unless directed under the supervision of your treating doctor. “Each medication has a risk factor classification associated with it and it is on an individual basis that safety is established,” he says.

Chronic medication in pregnancy

Pharmacist Kashmiri adds that it is very important to also inform your doctor of any chronic illness that you may have. “Your doctor will then decide on the risk benefit ratio when deciding whether to continue treatment or not. Conditions that require treatment such as epilepsy and depression must be treated adequately, as failing to do so may result in a risk to mother and baby,” she says. “The doctor will review all medication taken to treat the chronic condition and establish whether it is safe to take whilst pregnant, if it is deemed to be harmful during pregnancy an alternate drug may be prescribed or collaboration with a physician may ensue.” Dr Jacobs agrees, adding that it is imperative that all medication is taken as prescribed, at the correct dose, quantity and frequency as deviation in any way may cause harm to you or your baby. “Always read the label and look for allergic reactions, expiry dates and warnings – and be wary of side effects. In addition, be careful not to mix up your medications or skip medications when you should be taking them.”

<Sidebar> Dr Jacobs and Pharmacist Kashmiri share their advice on how to alleviate some common pregnancy conditions from A to Z.

Common Pregnancy Conditions	Safe medications and remedies	Advice:
Allergies	-Allergex-Loratadine-Nasal decongestant spray-Nasal steroid spray	May be used with caution in pregnancy, consultation with doctor is preferred. If allergic reactions last longer than a day or two, see your doctor.
Constipation	-Movicol -Glycerine Suppositories.	Increasing fibre and fluid intake may help relieve constipation, as well as adding dried fruit, prune juice and bran to your diet.
Common Colds and Flu	-Salex Nasal Spray/Rinse-Prospan Cough Syrup -Paracetamol	If a respiratory infection is suspected, your doctor should be consulted.
Diarrhea	-Kaolin-Pectin-Imodium-Smecta -Rehidrat	Contact your doctor if diarrhea is severe, if there is blood in the stools or if symptoms continue for longer than 24 hours. Most diarrheal illness last only a day or two without treatment. It is important to replace fluids lost with a rehydration solution.
Fatigue	-Prenatal vitamins-Folic acid -Magnesium.	Get plenty of rest, elevate feet, and eat a well balanced diet. If the problem is persistent, contact your doctor as this may also signal low iron levels. It is also very important to take folic to prevent a condition known as spina bifida in the baby.
Faintness and Dizziness	-Don’t self treat.	Fainting and dizziness that is not relieved by sitting down or lying down must best be assessed by your doctor. It may be a sign of either high/low blood pressure or glucose levels which may cause harm to the unborn baby.
Hemorrhoids	-Anusol-Preparation H	Constipation aggravates the symptoms of hemorrhoids, so ensure a high fibre diet and increase fluid intake. Don’t delay going to the bathroom. Sitting in a warm bath may help alleviate some symptoms.
Headache	-Paracetamol	If pain is not alleviated, contact your doctor, as this may be a sign of elevated blood pressure. It might also be an indication of dehydration so increased fluid intake may also help. If you have a fever, contact your care provider immediately.
Heartburn & Indigestion	-Gaviscon-CitroSoda-Rennies-Maalox	Steer clear of foods which can exacerbate symptoms.
Insomnia	-Antihistamines listed above for allergies have a sedative effect.-Sleep eaze	Take a warm bath before bed, try different sleeping positions or a maternity pillow, or ask your partner to give you a massage before bedtime.
Muscle Strain	-Slow Mag	Slow Mag is considered safe and is especially effective for leg cramps that are common during pregnancy.Taking a warm bath may also help.
Nausea and Vomiting, morning sickness	-Asic-After 8 weeks pregnancy; Zofer	Identify foods that may trigger these symptoms. Starting the day off with a dry bland meal such as toast may also relieve these symptoms. Eating smaller meals more frequently. Also easily digestible and less fatty meals.
Rashes	-Allergies medication-Mild steroid creams	Your Pharmacist will be able to advise on a suitable topical treatment or consult with your doctor. Identify the cause, skin irritation, food allergy, contact dermatitis. Mild steroid creams for a day or two is safe.
Urinary Tract Infection (UTI)	-CitroSoda	Contact your doctor as a UTI may cause harm to the unborn baby. Citro Soda relieves burning only. If persistent, see a doctor.
Yeast infection	-Canesten Cream	Contact doctor as a Yeast infection may cause harm to the unborn baby. Use a probiotic like Interflora when recurrent.

Dealing with infertility, when he has the problem

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It’s not just a women’s issue

Struggling to fall pregnant? Usually women are the first to seek help when trying to conceive. However, if the woman has been thoroughly examined and it is not due to her that she is unable to fall pregnant, it falls to the male partner to be tested. According to a study published in 2015, infertility affects about 15 per cent of couples globally, amounting to about 48.5-million couples. The study also found that males are found to be solely responsible for 20-30 per cent of infertility cases and contribute to about 50 per cent of cases overall. Furthermore, at least 30 million men worldwide are infertile with the highest rates in Africa and Eastern Europe. If a male factor is what’s making it tough for a woman and her partner to conceive, it’s important to understand what may be causing his infertility and what the couple’s options are. Charlene Yared West speaks to the experts to find out more…

Infertility and feelings of inadequacy and impotence

“Research indicates that the male partner is not willing to seek medical advice about infertility. They feel embarrassment for not being able conceive naturally and suffer guilt, self-blame and shame,” says Dr Liezel Anguelova, Counselling Psychologist at Life Roseacres Hospital. “Many men do not feel comfortable with the testing procedure as it includes the examination of their testicles and penis and the production of a sperm sample. As such, men often associate infertility with impotence, when they are actually unrelated.” Dr Anguelova explains how infertility can be devastating to the man who experiences the failure of his procreative nature, as it is so intrinsically linked to his sexuality. “It is often an assault on the masculinity of the male partner and it is not uncommon for him to develop sexual problems such the loss of sexual desire or erectile dysfunction, which can leave him feeling that he is ‘less of a man’,” she says.

What causes male infertility?According to Dr Sulaiman Heylen, Specialist in reproductive medicine at Life Kingsbury Hospital, male infertility is diagnosed by an abnormal semen analysis. “We always start at the beginning of the fertility testing with the semen analysis. We don’t want to do a lot of testing on the female without knowing what the male factor is. Semen analysis is very easy and inexpensive.”
There are three parameters important in the semen analysis according to 2010 WHO criteria:
1. sperm count: must be over 15 million sperm per milliliter.
2. sperm motility (how they move): 50% of sperms cells must be motile.
3. sperm morphology (their shape): at least 4% of the sperm cells must have a normal morphology.
“If one of these parameters is abnormal we speak of male infertility in combination with an inability to conceive,” he explains. Dr Heylen lists the following as possible causes of male infertility;Varicocele: These are varicose veins of the testis, they can contribute to up to 30% of all cases of male infertility. Trauma of the testicles; related to accidents or sports injuries.Sexual transmitted disease which can lead to infections of the testis and blockage of the epididymis (tubes of the testis)Mumps of the testis.Pollution and environmental factors (estrogen like factors in the environment): These are called xenoestrogens. Estrogen is the normal female hormone. Xenoestrogens are chemical compounds that mimic estrogen. There is more and more evidences that pollution and environmental factors can contribute to male infertility.Unhealthy lifestyle: Obesity, excessive alcohol, smoking and drugs. Anabolic drugs are well known to cause low sperm counts. Antibodies that attack sperm: Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to destroy them.Undescended testes: During fetal development one or both testicles sometimes fail to descend from the abdomen into the scrotum. Genetic: there are genetic defects in the chromosomes or small defects of the Y-chromosome. Unknown: We not always can identify the cause of the low sperm count.

How is male infertility uncovered?

Urologist, Dr Dap Louw from Life Beacon Bay Hospital explains how the physical examination entails a general exam, evaluation of the testes ( volume, masses, varicocele, infections, etc) and a prostate exam if needed. “The basis of the evaluation starts with taking a thorough medical history. We normally do a pelvic and scrotal ultrasound as well, to evaluate the testicular tissue and to look for signs of sperm transport blockage. Other more invasive diagnostic methods can be used especially when there is little or no sperm seen in the ejaculate. This would then be aimed at distinguishing between abnormal sperm production or blockage of sperm transport,” he says.

What treatment is available?

Dr Louw explains that treatment is aimed at the underlying problem whether it is advice on a healthier lifestyle, surgical correction of a testicular abnormality or medically treating an underlying infection, sexual dysfunction or hormonal abnormality. “When there is no urological correctable contributing cause to the infertility, I then like take a multidisciplinary approach and get the infertility specialists and/or gynaecologists involved,” says Dr Louw. “Together we can then decide on further optimal treatment, according to their hormonal levels, semen analysis and then also female factors. These can then vary from medical treatment, sperm washing with artificial insemination, IVF (in-vitro fertilization) or ICSI (intracytoplasmic sperm injection).” Dr Louw always emphasises to his patients that 20-30% of sub-fertile couples end up falling pregnant without any further help, which is positive – as nature is on their side! “Anxiety about infertility also plays a significant role and it is important to explain the normal conceiving time of 6-12 ovulatory cycles,” he says. “It does unfortunately happen where our patient is not able to have children and the couple would need to discuss alternate options like sperm donation or adoption.”

Can a couple survive infertility treatment?Infertility can be a relationship maker or breaker depending on how it is managed says Dr Anguelova. “It will put your relationship to the test, but if you focus on the importance of your relationship, it could be used as a opportunity to make your relationship stronger.” She shares some tips for surviving infertility;Stay in the moment, because it can be very overwhelming. Wait for each doctor’s visit to gather information on the process before making decisions and planning ahead. Communicate openly and honestly to address unmet expectations, fears, frustrations and stress. Find professional assistance and counselling if you are not communicating effectively. Do not get caught in a blame game of resentment, but rather become committed as a team. Remain positive about yourself and your partner.Keep your sexual relationship spontaneous and full of fun and nurture intimacy by touching, hugging and kissing outside of a sexual connotation.Do not let your entire life be merged into the fertility treatment process. Continue with other hobbies and keep other dreams alive.Build a support system. Support each other and include friends and family in the process.

Useful Resources

Working together to treat a tumour

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When it comes to cancer, patient care is a team effort and not the work of a single doctor. Life Healthcare doctors take a multidisciplinary approach and utilise good teamwork between the various specialists, which is crucial to the successful care of cancer patients from detection to treatment and follow-up.

Discovering the brain tumour

People with brain tumours present first to many different doctors due to the varied symptoms caused by brain tumours. These symptoms are mainly due either to raised pressure in the head or neurological symptoms that are caused by compression or invasion of brain tissue. “Headaches, seizures or stroke-like symptoms often cause patients to see a neurologist first, whilst blurred or double vision might prompt a visit to an ophthalmologist. For patients who are known to have other tumours that later spread to the brain the first contact is often the oncologist seeing them already. Some patients have the tumour picked up incidentally when having a scan for another reason, so see the radiologist first,” explains Dr Grant White, neurosurgeon at Life Vincent Pallotti Hospital. “Many patients will have been referred after starting with their General Practitioner for these and other symptoms.” Dr CF Kieck, neurosurgeon at Life Vincent Pallotti Hospital adds that not every headache is an indication of a brain tumour. “See your GP first if you are experiencing any problems or symptoms which are worrying and they will refer you on to the specialists.”

Referral to a neurologist
“Very often the neurologist is the first port of call after the patient has consulted a GP. Patients might present with complaints of blurred vision, headaches, weakness, slurred speech, etc. The location and size of the tumour plays an important role in how the patient might present. For instance, if the tumour is located in the left side of the brain, the patient might experience difficulty expressing themselves or might complain of right-sided weakness. If the tumour is located in the right side of the brain, their visuospatial ability might be affected and they might experience left-sided weakness. Should the tumour be located in the front part of the brain, the patient might present with behavioural disturbances or personality changes,” explains Dr A Rawoot, neurologist at Life Vincent Pallotti. Neurologists are clinical specialists who diagnose and manage neurological disorders. If a neurologist suspects a brain tumour based on the patient’s symptoms and examination, a scan of the brain would be requested to confirm the diagnosis. The patient will then be referred to a neurosurgeon for further management.”

Meeting the radiologist
When a tumour or an abnormality is detected, the first task of the radiologist is to identify the exact location of the tumour and the extent of the disease, says Dr Christian Stoyanov of Life Empangeni Private Hospital, “C Stoyanov Radiological Services Inc.” “After the detection of cancer, the radiologist interprets the cross-sectional images of the patient, makes the diagnosis and determines the stage and extent of the disease based on their findings,” he says. “Image interpretation is the most visible contribution of radiologists. Diagnosis by expert radiologists is based on the extensive knowledge of anatomy, normal variants, pathology and technical principles of the imaging modality.” In some cases, the radiologist may intervene and provide treatment using small catheters and needles under the guidance of the imaging equipment. These techniques can assist in the treatment of many conditions, including cancer, with minimally invasive interventions, thus avoiding open surgery. “With the technological advances in the field of medical imaging, brain tumour imaging has become an essential component in diagnosis, treatment planning, and monitoring treatment response as well as patient prognosis,” adds Dr Stoyanov.

Consulting the neurosurgeon

Once the tumour has been confirmed via high-tech imaging, the neurosurgeon would take on the role of decision-making regarding further treatment of the patient and this is where the collaboration with the radiologist and oncologist is essential. “Often, the specific diagnosis of the tumour may be made only after surgery when part of the tumour has been provided to the pathologist for microscopic and laboratory analysis.” says Dr White. “Distinguishing between benign and malignant tumours and between different types of tumours allows for the best treatment to be selected for a patient. The neurosurgeon’s most specific expertise is in the planning and performance of surgery for the brain tumour. This involves balancing the risks of various surgical approaches against their benefits, choosing the right tool for the job and deciding on the specific aim of the surgery and then doing the procedure as safely and effectively as possible.” Guiding and educating the patient and family is an essential preparation before any operation; brain tumour surgery is particularly challenging and everyone needs to understand the risks and limitations of surgery, adds Dr CF Kieck; “After surgery, the neurosurgeon will continue to look after the patient through their hospitalisation and will refer them for any rehabilitation needed and involve the oncologist where chemotherapy or radiotherapy is appropriate. The neurosurgeon will usually continue to check up on a patient who has had a brain tumour at intervals for the rest of their lives.” he says.

Seeing the oncologist

Once the diagnosis has been established, patients are then referred to an oncologist for treatment. “Secondary brain tumours are often diagnosed by oncologists, as we are following up patients with previously diagnosed cancers and when they present with brain associated symptoms we would proceed with a scan. We would then sometimes refer them to a neurosurgeon if we felt surgery was possible or necessary,” says Dr Jacqueline May Hall, clinical oncologist, Life Vincent Pallotti Hospital. “We also sometimes enlist a neurologist to help us with the management of associated seizures. An oncologist’s role is to perform treatment (obviously other than surgery) and would oversee, monitor and prescribe any radiotherapy or chemotherapy required. We would also support the patient holistically with for example – symptom control that includes steroids, analgesia, anti-seizure medication; referral for physiotherapy, occupational therapy, rehabilitation and we would also counsel and refer for counselling as needed. We also refer to Hospice as appropriate.”

Less is more when it comes to salt

November 1, 2020November 2, 2020Leave a comment

Cutting out or reducing sugar intake has become very fashionable over the last few years, but what about salt? Charlene Yared-West makes a strong case for the latter.

The recommended daily salt allowance is one teaspoon, but many South Africans are consuming more than that; up to three teaspoons a day because most salt is hidden in everyday foods. The Heart and Stroke Foundation aim to reduce discretionary salt intake among the public by encouraging consumers to cook with less salt and salty ingredients. Salt Awareness Week kicks off on March 20 to March 26 to encourage South Africans everywhere to eat less salt, but why is salt so harmful?

Why should we eat less salt?

Excess salt intake can result in high blood pressure, thereby contributing to heart disease, strokes and kidney disease. “High blood pressure (otherwise known as hypertension) can be very dangerous since the disease has many secondary consequences. However, at the same time hypertension doesn’t always present with symptoms. As a result, you can have a very high blood pressure and not know it. Hence you should check your blood pressure regularly,” says Lila Bruk, registered Dietitian at Lila Bruk & Associates.

In a 2012 research paper entitled Reducing the sodium content of high-salt foods: Effect on cardiovascular disease in South Africa, researchers estimated that a reduction of salt from breads, margarine, soup and seasonings would amount to a 0.85 gram daily reduction per person. Using expected improvements in blood pressure and national statistics, they calculated the expected impact on the nation’s health. This level of salt reduction is estimated to result in 7 400 fewer cardiovascular deaths and 4 300 fewer non-fatal strokes every year. “If you do have high blood pressure, it is important to have less salt in your diet, but also to have more fresh fruit and vegetables, more calcium, exercise regularly and lose weight if necessary,” adds Bruk.

Salt is hidden in everyday foods

A lot of foods that we consume already contain a generous amount of hidden salt, explains Margaret Lehobye, registered dietitian at Life Roseacres. “In general, processed foods are higher in sodium, so by reading the labels properly and by choosing fresh, unprocessed foods you can lower your salt consumption drastically.” On average, South Africans eat double the recommended limit per day and most of this salt comes from what is added during the manufacturing process. Lehobye points out that foods like biltong, stock powder, prepared sauces and marinades, soup mixes, commercially made cereals, biscuits and snack foods (e.g. crisps and pretzels, frozen and tinned foods, convenience meals, tinned meat or fish and salted nuts are examples of foods that contain a lot of hidden salt – and should be eaten in moderation or preferably; not at all.

Are there healthier alternatives?

Most people associate less salt with meals being less tasty, but flavour can come from a variety of different herbs, juices and fresh ingredients which do not contain salt. In truth, one’s pallet can be trained to require less salt. “Try eating raw, unsalted nuts, homemade sauces and marinades (for example, using more lemon juice, garlic, ginger, herbs and spices to add flavour), fresh fruit as a snack, low sodium soup mixes, oats rather than pre-packaged cereals, and fresh veggies rather than tinned wherever possible,” says Bruk. According to the Heart and Stroke Foundation, lemon is the new salt! Lemon flavours food fragrantly without the risk of pushing up your blood pressure. “Healthy food doesn’t need to be bland and boring, adds Lehobye. “Making dietary and lifestyle modifications does require an adjustment in one’s sense of taste, so gradually introduce low-sodium foods and alternatives and cut back on table salt until you reach your sodium goal. That’ll give your palate time to adjust. It also helps to try out different ways of flavouring your food, which will soon result in one appreciating the lighter, fresher taste of less salty food.”

Get Food label savvy

Ingredients are labelled in descending order. Consumers should avoid products which have salt high up in the ingredients list. “Avoid foods with a sodium content of > 600mg per 100g of that product,” says Lehobye. “Consumers should familiarise themselves with other names that are used for salt such as Monosodium Glutamate (MSG), Baking soda and baking powder.” HSFSA also encourages consumers to choose Heart Mark products as they are lower in salt as compared to other items on the shelf in grocery stores.

Helping South Africans choose less salt

Legislation reducing the salt content of commonly consumed foods came into effect on 30 July 2016. This legislation is important, but it will take more to resolve our excessive salt intake. South African consumers add on average 4 grams of salt to food at home – and this does not account for the hidden salt in bought food. “I think it’s an excellent initiative. I feel that when it comes to behaviour change, much of the resistance to change comes from being afraid of the unknown. However, if changes have been made in this gradual way, it allows the public’s taste buds to change with minimal effort in a relatively “painless” way. In addition, the legislation also creates greater awareness with regard to changing salt consumption habits. So, all round a great campaign,” says Bruk. Lehobye adds that foods affected by the legislation like potato chips and processed meats will still be very salty, but that consumers should demand less salty products – and at home, add less salt to their cooking and at the table. “It is the only way to create change is to change what we eat. The big food corporations will then change the foods to suit the healthier marketplace. That hope can become reality – but as citizens, we have to spearhead that transformation by choosing healthier alternatives.”

To dairy or not to dairy…

November 1, 2020November 2, 2020Leave a comment

Dairy does not agree with everyone, so how do you know if you’re lactose intolerant or if you have a milk allergy?

Some favour dairy and others oppose it vehemently… The Prevalence towards food allergies worldwide is increasing. Studies show an early introduction to food allergens – before six months – can increase the risk of developing food allergies and why recommendations suggest only introducing those foods after six months. We speak to two experts in the field of nutrition who shed light on the topic of lactose intolerance and milk allergy; registered dietician Marijke Pienaar at Life Robinson Hospital Randfontein and gastroenterologist, Dr Hilda Smith at Life Wilgeheuwel Hospital.

Firstly, see an expert…

“If you suspect you have a possible dairy sensitivity, see your doctor for a food allergy test,” says dietician Marijke Pienaar. “Both allergies and intolerances can be managed, but should not be done in isolation – and it is strongly advised to see your dietician to prevent any deficiencies or to properly treat the food allergy or intolerance. Do not eliminate any foods from your diet unless it has been clinically proven that you do have a milk allergy or milk intolerance by your doctor.”

How are food allergies diagnosed?

No single test can be fully depended on in the diagnosis of food allergies, explains dietician Marijke Pienaar. Testing food allergies usually starts off by taking a detailed history of a patient’s diet and also allowing the patient to do 7-day detailed food and symptom record. “Once a food has been positively identified to cause allergic symptoms, a skin-prick test can be performed. The choice of allergens to be tested should be guided by the food and symptom record. Skin-prick tests are preferred as the initial test as its low cost, convenient and relatively accurate. After a food or allergen has positively reacted with the skin (meaning the skin will inflame where the allergen was added to the skin), a serum (blood) specific IgE test can be performed to positively diagnose the food allergy,” she says. “One could simply try by diagnosing food allergy by eliminating the allergen from the diet for a set period of time (usually between 2-6 weeks) followed by planned and intentional re-introduction, but this process can be lengthy and often results in unclear answers or diagnosis.”

What is lactose intolerance?

Lactose intolerance, also known as lactose malabsorption is the inability to fully digest the sugar lactose in milk products due to a lactase deficiency, explains Dr Smith, and symptoms include diarrhoea, gas, bloating, nausea and cramps. “Most patients can manage without giving up all dairy products. Lactase breaks down the the sugar in milk (lactose) to glucose and galactose for absorption in the small intestine,” she explains.

SIDE BAR: Types of Lactose Intolerance, according to Dr SmithPrimary lactose intolerancePatient starts life with a normal amount of lactase and during childhood, the enzyme decreases as the diet changes from milk to solids. Production continues to decrease into adulthood – and if production decreases significantly, the patient will become symptomatic when consuming dairy products. Secondary lactose intoleranceIn this instance, there is a decreased lactase production by the small intestine after illness, such as celiac disease and Crohn’s disease. Once the disease is treated in the small bowel, then the lactase production usually recovers. Congenital or developmental lactose intoleranceHere, the patient is born with a complete absence of lactase, which is very rare. Premature infants may also present like this due to the immaturity of their gut – as production most often develops in the third trimester of pregnancy.

How can lactose intolerance be treated?

“Sadly, we are unable to boost lactase production, but encourage patients to avoid discomfort and symptoms by decreasing their dairy intake and also adding enzyme products to assist with the breakdown of dairy in the gut,” says Dr Smith. “Limit dairy products by taking smaller servings and experimenting with different dairy-containing products and choosing lactose free products can really make a difference. Lactase enzyme tablets or drops can also help.”

What is a milk allergy?

There are two main proteins in cow’s milk that can cause an allergic reaction and they are casein (found in the solid part of milk that curdles) and whey (found in the liquid part of milk that remains after the milk curdles.) The allergic reaction happens when the immune system identifies certain milk proteins as harmful and as a result triggers the release of immunoglobulin E antibodies to neutralise the protein allergen. “Symptoms can be mild to severe and you can break out in hives or experience wheezing or vomiting. Other symptoms also include a loose stool, often containing blood, diarrhoea, cramps, coughing, runny nose, itchy skin rashes, often around the mouth,” says Dr Smith. “Avoid milk-containing products, especially from the obvious sources like milk, butter, yoghurt, ice-cream and cheese.”

SIDE BAR: No dairy? No problem! Here are some healthy calcium-rich foodsCalcium-fortified bread and cerealsCanned salmon and sardines with the bones Fortified orange juiceBeans, legumes, chickpeasRhubarbDark green leafy vegetables like spinach, kae, broccoli and okraDried figsSoy products and tofuAlmonds

Delicious milk alternatives to try…“The most important factor to look for when purchasing milk alternatives, is to choose milk alternatives that have been fortified with calcium. In terms of what milk alternative to use from a dietetic point of view, it does not matter, it’s all about individual preferences,” explains dietician Marijke Pienaar.
Soy Milk – Soy milk is probably the most popular and recognisable alternative to cow’s milk. Like cow’s milk, soy milk is often fortified with calcium, Vitamin A, Vitamin D, riboflavin and often has the same protein amount as cow’s milk. It is therefore the most similar milk alternative to cow’s milk in terms of nutrition profile, but often patients complain of the “nutty” taste and not a favorite in terms of flavor.
Almond Milk – Almond milk contains a much lower amount of protein than dairy and soy milk, but people prefer the Almond milk above soy due to the sweet flavor and creamy texture that is similar to dairy milk. Most almond milks are fortified with calcium, but if not, almond milk is considered low in protein, vitamins, minerals and fatty acids present in dairy milk. Other common nut milks include cashew, hazelnut and walnut milk.
Rice milk – Rice milk is the most hypoallergenic of any of the milk alternatives, free from soy, gluten and nuts. Rice milk is high in carbohydrates but low in protein compared to dairy milk. Rice milk is quite thin and watery and not suited for use in cooking and baking and unfortunately if not fortified, low in calcium.
Coconut Milk – Due to the Banting craze, coconut milk became quite popular in the last couple of years. Coconut milk is relatively high in fat and therefore does appear to resemble in terms of texture closest to that of whole milk. Despite the similarities in texture, coconut milk does not have a nutritional profile comparative to that of cow’s milk. One serving (250ml) of coconut milk contains 80 calories, 1 g protein and 100 mg calcium, while 1 cup of 1% dairy milk contains 100 calories, 8 g protein and 300mg calcium.
Hemp Milk – Hemp milk is another good alternative for those allergic to soy, nuts and gluten and is made from hulled hemp seeds, water and (in most cases) sweeteners. It contains a good amount of protein and has an excellent fatty acid profile, but is relatively low in calcium, unless fortified.
Cow’s Milk alternatives for infantsBreastfeedingHypoallergenic formulasSoy-based formulas

Read the labels!

According to dietician Marijke Pienaar, The South African Food Labelling Regulations (under the Foodstuffs, Cosmetics and Disinfectants Act, No 54 of 1972) requires that all packaged food products sold in South Africa that contain milk as an ingredient, must be listed in the ingredients as ‘milk’ on the label and identified as an allergen in a separate part of the food label. “Read all product labels carefully before purchasing and consuming any item. It is part of the dietician’s education to teach patients what foods contain milk and how to read food labels properly,” she says.

Got milk? I’ll have some goat’s milk, thank you!

Goat’s milk is believed to be more easily digestible and less allergenic than cow’s milk. The fat globules in goat’s milk are smaller than in cow’s milk resulting in an easier digestion process. Goat’s milk is also naturally homegenized, as opposed to cow’s milk, which must be homogenised in a factory. Another plus is that goat’s milk contains about 10% less lactose than cow’s milk and is easier to digest for those suffering with a lactose intolerance. Goat’s milk is high in potassium, a micronutrient lacking in cow’s milk.

Yoga: Good for the mind, body and soul

November 1, 2020November 2, 2020Leave a comment

Show aging the door as you slip into your comfy yoga pants and into a yogic posture to ensure your longevity.

We all know the feeling… losing keys, forgetting names of people, places and familiar-on-the-tip-of-your-tongue words… Unnerving as it is, we all get to that point, sometimes as young as forty. A recent pilot study, which involved participants over the age of 50, explored the relationship between performance on memory tests before and after a yoga session. Results of the study showed a significant improvement in memory and levels of depression in the older adults who took part. It also showed that yoga was as effective as other memory enhancement training techniques and had additional physical benefits. Good news for our aging brains and bodies – and some might argue, good news for the soul! Biokineticist Mark Stevens, a stones throw from Life The Glynnwood Hospital and Hatha and prenatal yoga instructor Deevya Vasson Lalla share their insights into the over 5000-year-old ancient art of yoga as a form of physical exercise with multiple benefits.

Yoga is so much more than just exercise

“The combination of breath work, stretches and relaxation techniques practiced on a regular basis helps the body move out of survival mode which has many positive side effects on your health,” says yoga instructor Deevya. “You may notice a change in your state of mind, the lowering of high blood pressure, improvements in your posture with ease of movement and increased strength and flexibility.” Not only that, yoga assists with brain function and the ability to focus, enhancing concentration and memory, explains biokineticist, Mark. “Participating in regular physical activity definitely has a positive effect on the neuromuscular link between one’s brain and muscular system. From a movement disorder point of view, practicing certain movements, improving flexibility and strength, challenging balance and proprioception and correcting gait are vital in maintaining one’s independence and improving quality of life,” he says. “Exercises to help improve the neuromuscular link between one’s brain and feet can be as simple (not always that easy for some) as doing toe taps and calf raises or balancing on one leg. Often the more active one is, the slower the rate of decline in muscle strength, flexibility and proprioception as one gets older.”

What do I need to get started?
“You don’t need much to get started with your yoga practice, but it does help to find a good teacher at a venue close to home, so that it is easy and convenient to attend a class,” says Deevya. “You need a willingness to try, a good attitude, comfortable pants and t-shirt and a soft surface to do your poses on. If you don’t have a yoga mat, don’t let that stop you – a carpet will work just fine.” Biokineticist Mark adds that it is also important to ensure that if you have had a previous injury, that you first check with your physiotherapist or doctor that you may engage in the exercise of your choice. “This is determined on an individual basis – and the important thing is that you engage in some form of physical activity. Enter a race, book a yoga session, commit to doing something physical. It doesn’t have to be too big or daring or expensive. Find a partner, friend or family member to join you and motivate each other to start. Set a goal and write it down. Tell your partner, friend or family member what your goal is and commit to it. It could be walking your first 5km race, losing 5kg, entering a cycle challenge or attending at least one exercise session a week for the next three months,” he says. “Consistency is key and don’t quit too soon. Unfortunately there are no quick fixes and improving one’s fitness, flexibility or strength does take time, persistence and perseverance.”

<Sidebar> Yoga instructor Deevya shares her top five yoga practices to get you startedSukhasana – Easy Pose
Benefits: Opens the hips, lengthens the spine and prepares the body for concentration and meditation.
Method: Sit on the floor with your legs crossed at your shins and the spine elongated. If you struggle to sit up without rounding the upper body or your knees lift up above your hips then sitting on a pillow and against the wall will make this pose more comfortable. Alternate Nostril Breathing
Benefits: Helps balance the body and mind, strengthens the lungs and helps clean the lymphatic system. Method: Sit in easy pose or on a chair. Place your thumb and ring finger on either side of your nose. Press your thumb down on the right nostril and breathe out gently through the left nostril. Now breathe in from the left nostril and then press the left nostril gently with the ring finger. Removing the right thumb from the right nostril, breathe out from the right. Breathe in from the right nostril and exhale from the left. Continue for a few rounds keeping the breath smooth and relaxed. Standing Forward Bend
Benefits: A great stretch for the hamstrings, glutes and spine. Your head is also below the heart so you are getting the benefits of doing an inversion – it calms the brain, reduces stress and anxiety and relieves headaches and sinus. A great one to do before bed or when waking up in the morning.
Method: Stand with your feet hip width apart, hinge from your hips all the way down and rest your hands on the floor next to your feet. Keep the knees soft if straight legs is uncomfortable and rest the hands on a block or pillow if it doesn’t reach the floor. Don’t forget to breath and just allow the body to relax and release. Alternatively hold onto your elbows. Cat Cow
Benefits: Relieves any tightness in the muscles of your back and keeps the spine healthy and flexible. Method: Come onto hands and knees with hands underneath the shoulders, palms flat and knees underneath the hips. Keep a neutral spine and as you inhale lift the head and push the chest through the arms, arching the spine. Exhale and round the spine, tuck the chin, and tuck the tailbone. Close your eyes and try to synchronise the breath with the movement as you do a few rounds.Supine Spinal Twist
Benefits: This pose releases the lower back, helps to open your chest and shoulders, relieves any upper back tension and elongates the muscles of the spine.
Method: Lie on your back and hug your knees into your chest. Take the arms out in line with your shoulders and take both knees over to the left side, resting knees and feet on the floor. Slowly breathe as you relax the right shoulder to the ground and look over the right hand. If you struggle to get the knees to the floor, try putting a pillow between your knees. Hold for a few breaths and repeat on the other side looking over the opposite hand.

My grandmother: the yoga aunty to all who knew her
“My grandmother Jasoda ‘Bhikibhen’ Keshav, otherwise known as ‘masi’ (‘aunty’ in Gujarati) to her many regular yoga students, taught in Rylands in Cape Town for 49 years. She started her yoga classes in the early sixties making the decision to dedicate her life to sharing the gift of yoga with other women, never charging them for attending. The classes started small, once a week on a Saturday morning, but soon grew to twice a week, including a Wednesday morning as word spread. Before she died at the age of 84 she had taught hundreds of women and stayed active until her last days. One could often hear her say; ‘one day when I am not here, you girls must remember what I taught you’, alongside the motto, which became the motto of many – ‘watch your thoughts… be the observer and you will conquer the mind and its illusions.’ I believe that yoga was her life – and she inspired so many women to use yoga to nourish their bodies and minds. She was the sharpest, wittiest woman I knew and I miss her quick tongue and soft hands. She was testament to the fact that yoga keeps you healthy, fit and living mindfully.” – Rekha Chavda granddaughter to Jasoda ‘Bhikibhen’ Keshav.

For more information and to find a yoga instructor near you, visit http://za.greendock.com/directory/yoga/studios.html for a directory of practitioners.

Get kids moving

November 1, 2020November 2, 2020Leave a comment

Unplug yourself from social media, get your trainers on and get the kids moving.

There are 20-million children in South Africa and of those, 60 percent attend under-resourced schools, which often means they have little, limited or no access to physical education. Physical activity is vital for a child’s development and lays the foundation for a healthy and active life. In South Africa, every school-going child should access at least 90 minutes of physical activity per week, within the prescribed school curriculum. However, since physical education was removed from the school curriculum in 1999, children have become more sedentary, opting to spend free time connected to the internet, where it is accessible, exercising no more than their thumbs on small screens. South African children have poor physical activity levels, according to the 2014 Healthy Active Kids South Africa Report Card and as adult South Africans, we have a responsibility to inspire our youngsters to move more for better health and longevity. Charlene Yared-West speaks to the experts for some inspiring and fun ways to get kids moving…

A bleak future without exercise

Dr Claire Nicholson, founder of the Move-It, Moving it Matters™ Programme points out a sad trajectory into adult life for children who do not exercise. “Without change, we can expect to see obese adults with life spans shorter than their parents,” she says. Dr Nicholson heads the programme Move-It, Moving it Matters™ (movingmatters.co.za), a healthy, active living initiative and one of its funding partners is Life Healthcare, which is committed to quality supporting interventions. It continues to gain momentum and respect locally, nationally and internationally and is a powerful educational suite of Programmes which stimulate positive engagements in activity, for life. The programme is currently in the hands of 20,000 children in Public schools across South Africa. “Our aim is to educate adults and children about the immense value of physical activity and to make it a fun alternative so that they go out there and just do it!” she explains.

Make exercise fun and meaningful
Show your kids you care and give them the gift of your time when you set out for physical activity, explains Tracy Clifford Statt, hypnosis practitioner for the motivational exercise programme Hypnocize.co.za. “The fun factor is very important and children prefer short bursts of activity. Also, avoid nagging and negative language and be sensitive to insecurities like being overweight, or uncoordinated. Choose appropriate activities which won’t embarrass the participants,” she says. “It is also very helpful to set daily goals for activity with your children – begin with short 10 minute bursts and work up to 30 minute play sessions.”

Encouragement and support are key

Mr Kiruben Naicker, biokineticist at Life Mount Edgecombe Hospital in KwaZulu Natal notes that he is seeing more children with from obesity in his practice, from as young as seven or eight years old. “Parents often think their children will grow out of their baby-fat… until they see that children have in fact grown into obesity. Obese kids often become obese adults unless a lifestyle change is made,” he says. “Children need good examples to follow, encouragement and support – and parents play a big role in this. Whether it is washing the car together on a Sunday afternoon, taking a walk on the beach or showing them it’s a healthier choice to take the stairs instead of the lift are all good ways of imparting the importance of movement. Choose age appropriate activities and the sky’s the limit!”

Be interested in their interests

“Children should be overjoyed by their own joy – and parents should partake in that joy by showing an interest in their children’s interests,” says Dr Nicholson. “So, even if that interest is in building Legos, parents should get onto the floor and play with their children. This can be built upon and taken outdoors where it can become a more physical activity, like building with bricks for example. Pay attention to what they are drawn to for clues into what they possibly would enjoy.”

Invest in their lives

According to Andrew Wyllie, Personal Trainer and owner at personalsublime.co.za, encouraging movement in children is an investment in their lives. “Exercise builds confidence, encourages teamwork and social skills, helps build physical development and maturity, and also inspires creativity,” he says. “The bottom line is that children need to discover and explore that side of their own development and be in awe of their amazingly agile and strong bodies.”

<Sidebar> You don’t need a gym membership to move – explains Naicker. “Always ask yourself the question ‘how can I get my child to be more active?” Here are some ideas to get you started…

Play catch in the backyard.
Go riding a bike together.
Take a morning family stroll in nature.
Grab a towel and go to the beach.
Take the stairs instead of a lift.
Take a walk instead of a drive.
Ban Technology for a day – then be ready to engage children in an activity like Twister.
Go for a swim as a family.
Take it outside – indoor activity is sweaty and stifling.
Plan for Rainy Days – a novel activity like blowing up balloons and chasing them around the room.