Bone health – what is osteoporosis?

Understanding osteoporosis

When I went for my annual bone-density test for osteoporosis, I noticed that the graph reading had dipped into the red. Not a good sign. Neither was the report that noted severe deterioration of the hips and spine. So I made up my mind to do a few things. Walk every day, eat healthy, take my calcium and Vitamin D supplements and not pick up extra weight.

What is osteoporosis?

Osteoporosis is when bones become weak and porous and can break easily. 

How do people get is?

Most often, osteoporosis is one of the down-sides of growing older. Women especially risk osteoporosis after menopause. 

Those in the higher risk bracket are light-skinned petite women, smokers, drinkers, office workers who don’t exercise, and people (like me) on chronic medications like cortisone, barbiturates, anticonvulsants or thyroid meds.

Men and women with a family history of osteoporosis need to be more vigilant as do women who have never been pregnant, started their periods late and ended them early.

Idiopathic juvenile osteoporosis is fortunately rare and happens in children and young adults.

Can osteoporosis be prevented?

Space exploration has taught us a lot about osteoporosis. We’ve learned that when astronauts are weightless because there is no gravity, their bones become weaker. Weight-bearing exercises like walking and climbing the stairs helps to build-up and strengthen bones.

Walking in the sunshine also means getting extra Vitamin D that’s essential for the absorption of calcium.  Without vitamin D, vitamin K, and magnesium, bone will lose calcium.

Our bones are constantly breaking down and building up. To do this they need blood, sustenance and oxygen. In babies, bones are mostly cartilage. These calcify during childhood and adolescence. Calcified bones are a mixture of connective tissue called collagen, and these are filled with calcium and phosphorus. Nearly 99% of body calcium is found in the bones, and 80% of phosphorus in bones and teeth. 

There is about 1% of calcium in the blood that’s needed for nerve and muscle health (especially the heart). The balance of blood calcium is controlled by Vitamin D and parathyroid hormones. When blood calcium is low, it’s drawn from bones. When it’s in good supply, this helps to strengthen bones and teeth.

Calcium is found in just about all fruits and vegetables, especially almonds, digestive biscuits, bran, whole wheat bread, buckwheat, milk, dark chocolate, cheddar cheese, cream cheese, custard made with milk, egg yolk, dried figs, soya flour, dairy ice cream, guavas, kale, lamb, Horlicks, milk, molasses, muesli, olives, onions, parsley, pizza, quiche, sardines, scallops (steamed), shrimps, spinach, sultanas, walnuts, watercress and yogurt. (Source: Adelle Davis ‘Let’s Stay Healthy’)

     

During a woman’s reproductive years, oestrogen helps to keep bones strong by improving the absorption of calcium from the gut. Low oestrogen levels means low absorption of calcium. This puts menopausal women more at risk for osteoporosis.

What can you do if you have osteoporosis?

• Join (or start) a walking group. There’s safety in numbers, and you’ll enjoy the motivation and the company.
• Visit your dentist regularly. Osteoporosis can lead to gums problems and weaker teeth.
• See your doctor regularly for blood tests, bone density tests, advice and meds. In severe cases, the Zometa drip may be prescribed. This is used when there are high blood calcium levels and for some types of cancer. In osteoporosis, Zometa works by slowing down the breakdown of bones to prevent fractures. It can be repeated annually for a maximum of five years.
• Take supplements: Vitamin D (this is a fat-soluble vitamin and should only be taken once a week).  Also take calcium supplements, and daily magnesium and Omega 3 - especially if you’re on chronic cortisone.
• Don’t take unnecessary risks – like standing on a chair or walking on slippery floors! 
•  Focus on eating healthy. Quit smoking and excessive drinking. 

Understanding endometriosis

Volumes has been written about endometriosis – but what is it? What causes it and what can be done about it?

Endometriosis is when cells of the womb lining – called endometrial tissue – gets into the pelvis and other parts of the body. Under the influence of oestrogen, this tissue grows and bleeds with every menstrual cycle, and cannot escape. Over time, it interferes with the functioning of surrounding organs like the womb, ovaries, bladder and bowel. This mostly causes pain – painful periods, ovulation, sex, defecation and urinating. Women with endometriosis also struggle to get pregnant.

Because endometriosis is most common in childless (usually working) women in their 30’s and 40’s, it’s been called a career-woman’s condition, but this is not strictly true. Endometriosis can happen to young girls. Not all women have the same symptoms. Pregnancy can put endometriosis on pause (especially if the woman breastfeeds) and menopause usually brings welcome relief.

What causes endometriosis?

Harvey J. Kliman, M.D., Ph.D., a research scientist in the Department of Obstetrics and Gynaecology and lead author of the study published in the June issue of Gynaecological and Obstetric Investigation suggests the following possible causes of endometriosis:

• Retrograde menstruation. In retrograde menstruation, menstrual blood containing endometrial cells flows back through the Fallopian tubes and into the pelvic cavity instead of out of the body.
• Transformation of peritoneal cells. In what's known as the "induction theory," experts propose that hormones or immune factors promote transformation of peritoneal cells — cells that line the inner side of your abdomen — into endometrial cells.
• Embryonic cell transformation. Hormones such as oestrogen may transform embryonic cells — cells in the earliest stages of development — into endometrial cell implants during puberty.
• Surgical scar implantation. After a surgery, such as a hysterectomy or C-section, endometrial cells may attach to a surgical incision.
• Endometrial cells transport. The blood vessels or tissue fluid (lymphatic) system may transport endometrial cells to other parts of the body.
• Immune system disorder. It's possible that a problem with the immune system may make the body unable to recognize and destroy endometrial tissue that's growing outside the uterus.
• Klimin’s research also found that douching did not appear to decrease the risk of endometriosis, but sexual activity (period sex), orgasm and tampon use (at night) did.

What are the symptoms?

Painful periods:

Women with endometriosis struggle with very painful periods. This pain is usually felt in the lower part of the abdomen, pelvis or back. It may begin before a period starts and lasts until her period ends.

Painful sex:

This pain happens during sex, especially when there is pressure or vigorous sex.

Abnormal periods:

Periods may be heavy, light and/or irregular with a period between periods.

Bladder problems:

Women experience urgency and the need to pass urine more often. It may also be bloodstained.

Bowel problems:

Feeling bloated with alternating diarrhoea and constipation and painful defecation.

Who is more at risk?

According to Klimin, the following women are more at risk:

• Those who have never giving birth
• Starting your period at an early age
• Going through menopause at an older age
• Short menstrual cycles — for instance, less than 27 days
• Having higher levels of oestrogen in your body or a greater lifetime exposure to oestrogen your body produces
• Low body mass index
• Alcohol consumption
• One or more relatives (mother, aunt or sister) with endometriosis
• Any medical condition that prevents the normal passage of menstrual flow out of the body
• Uterine abnormalities

Making a diagnosis:

Diagnosing endometriosis is mostly according to symptoms and a medical history. A laparoscopy (looking into the pelvis and abdomen with a laparoscope) can help identify patches of endometriosis.

Mild endometriosis is when patches of endometrium are found, but there is no scarred tissue.

Moderate endometriosis has larger, widely spread patches. There may look like ‘spider-webs’ joined to the ovaries, fallopian tubes and ligaments. Cysts (fluid-filled bubbles) may also be found.

Severe endometriosis is when most of the organs in the pelvis are affected by patches of endometrium with scarred tissue. The fallopian tubes are often also blocked.

Treating endometriosis:

This depends on the diagnosis and severity:

Hormonal – usually progesterone. While the contraceptive pill (combined oestrogen and progesterone) may relieve symptoms, these have side-effects that affect fertility.

Surgical – removing the endometrial tissue. In extreme cases, a hysterectomy (removing the womb) may be unavoidable

Natural therapies – herbs and natural progesterone

A combination of the above.

It is important to have endometriosis diagnosed and treated by a gynaecologist – ideally one who specialises in endometriosis.  

For more information about periods, go to the Kotex website: www.kotex.co.za/what-girls-are-asking/

moving your toddler from a cot into a bed

Bye-bye cot, hello big bed

Last week’s blog was all about bed wetting. I thought that for this week I would featuring Tracy Tucks contribution on behalf of Protect-A-Bed® about changing your toddler into a bed. See my face-book page for more about mattress protection. 

“YouTube is crammed with videos of ingenious toddlers scaling the bars of their cots in gymnastic bids for freedom. Adorable as these pint-sized Houdini’s may be, once a toddler gets the hang of flying the coop, it’s time to deal with yet another childhood milestone: the move to a big bed.

Even if your toddler hasn’t yet risked a nasty fall in his or her quest to ‘escape’, a big bed might still be necessary if the cot is becoming too small, is needed for a new baby, or is preventing a toilet-training toddler from getting up to go to the loo.

While there are no hard and fast rules, most toddlers make the move to their own beds any time between 18 months and three and a half years.

With a little preparation, you can minimise the tears that often ensue ... both your toddler’s and yours.

CHOOSING THE RIGHT TIME

Plan to move your toddler to the big bed during a stable time in your family life. Moving to a new bed can be very stressful for both you and your toddler, so it’s best not to make the move during periods of upheaval, such as starting nursery school, when you’re going back to work, or when you or your child is sick.

If your toddler is leaving the cot because of a new baby, it’s best to make the move at least six weeks before or a few months after the birth, so that she doesn’t feel as if she’s being booted out by baby.

PREPARING THE NEW NEST

If your child is old enough, create excitement around the change by going shopping together for new bed linen or a new soft toy to share the big bed. Create a sense of continuity by moving over some familiar items from the cot, such as a favourite blanket or teddy, or reposition a much-loved cot mobile over the new bed.

It’s also imperative to invest in a mattress protector to ensure easy cleaning after inevitable nappy leaks and toilet-training accidents, and to prevent staining of the new mattress. (Remember that unlike a foam cot mattress, you can’t wash a bed mattress.)

SA’s leading mattress protector brand, Protect-A-Bed®, advises parents to choose a mattress protector that’s super absorbent, with a waterproof layer that won’t crinkle noisily every time your toddler shifts. It’s also a good idea to invest in two mattress protectors, so there’s always a spare on hand so that middle-of-the-night linen changes can be dealt with quickly and calmly.

SAFETY STEPS

Now that the new bed’s taken care of, it’s time to prepare the rest of the house. Your toddler will no longer be confined to the safety of the cot, so reassess your home for potential dangers.

If the new bed has no sides, you can install bed rails, or place cushions, pillows, or folded duvets and blankets onto the floor beside the bed to soften any night-time rolling mishaps.

To stop your toddler coming to any harm while wandering about unsupervised, install a baby gate across the bedroom door, and ensure stairs are barricaded. (Check that your toddler can’t use his cot-climbing skills on these gates.)

Check that all plug points are covered, tidy up electrical cords and wind up blind cords that could be a strangling hazard.

If there are items of furniture which your toddler could pull over, such as book and toy shelves, secure these to the wall with brackets.

Check that windows, especially upstairs windows, can’t be opened wide enough for your toddler to fall out.

IT’S D-DAY

You’ve prepared the new bed, secured your house, and talked up the change until even the family dog is vibrating with excitement. All that’s left now is to make the switch.

Some children are quite happy to wave goodbye to their cot and never look back, moving in one jump from cot to bed.

Others cope better if allowed to move over in stages. Consider starting with daytime naps in the big bed, sleeping in the cot only at night. Or have your toddler spend a few nights sleeping on the cot mattress on the floor beside the bed before making the final move.

Whichever route you choose, stick to your toddler’s usual bedtime routine to lessen the upheaval.

COPING WITH THE FALLOUT

Despite your best attempts to make the move an exciting and positive one, your toddler may still struggle to adjust. Moving from the security of their familiar cot can be extremely stressful for little ones, no matter how excited they might have been about that new Frozen duvet cover or Buzz Lightyear bed.

Whether it’s true distress at being in a new bed, or simply the novelty of being able to hop out of bed whenever they choose, many toddlers struggle to stay put and will initially get up repeatedly. Here are two methods that can be used to keep your toddler in bed.

The first is to immediately return your toddler to bed, making as little fuss as possible. Preferably don’t even talk to your child, and definitely don’t get angry; any response from Mom and Dad – be it positive or negative – simply rewards the behaviour. Be prepared to have your patience sorely tried, as you will likely have to return your toddler to bed twenty, thirty, even a hundred times in an evening. With perseverance and consistency however, this method usually sorts out the problem within a few days.

Otherwise try the gradual approach; it generally takes longer, but is less taxing on the nerves. Begin by sitting silently next to your child’s bed at night until he or she falls asleep. Over the following nights, gradually move closer and closer to the door until your child falls asleep without you in the room.

If both these methods fail, your toddler may not be ready for the move. If you’re able to, consider bringing back the cot for a short period. Don’t see this as a defeat, or that you’re giving in to your child; some littlies just need more time, and may move over without fuss when you try again in a few weeks.

Be patient and give your toddler time to adjust to what is a major milestone in his or her life, and before you know it, the cot will be a distant memory.

Night-time woes for little children - bed wetting

Bed wetting

It’s a relief when toddlers are potty-trained and you’re spared the expense of nappies, but frustrating when your once-dry child starts wetting the bed again. It’s is called enuresis.

For the most part, enuresis is a temporary setback so don’t get too hung up about it. Secondary enuresis (bed wetting after a child has been dry at night) is common and treatable. Primary enuresis (always needing night-time nappies) needs more investigating.

Some children take longer to be potty-trained than others. It’s wise to wait until your child is dry at night for at least two weeks before you take off the night-time nappy. Don’t make a big deal of it. This will only make your child anxious.

Causes of bed wetting:

• Big changes in their little world: going to a new school, a new baby in the house, divorce, death, moving  
• Infections: bladder or urinary tract infections, thrush (happens more often in little girls) or an infection on the tip of the penis means that it burns when passing urine. This makes the child reluctant to empty their bladder and they may go to bed with it full
• Pinworm infections cause uncomfortable itching around the anal and/or genital area
• Constipation makes children thoroughly miserable. Impacted faeces could block urinary output so that urine trickles through during the night or it could dull sensation to the urinary sphincter that warns the child when their bladder is full
• Primary enuresis can be caused by severe emotional upsets (especially for adopted children) or urinary-tract abnormalities that may have missed diagnosis. A specialist psychologist or urologist should be consulted.

Tips for parents/caregivers:

Bed wetting is involuntary. Children don’t do this deliberately. It makes them cold and wet and uncomfortable and they feel humiliated. Adults get frustrated, but it’s best to blame it on the ‘naughty wee’ and not the child

Bed wetting is treatable. Ask your family doctor for help. S/he will check for infections and underlying medical problems, and may be able to suggest techniques, treatments or even devices that have been developed to help children stay dry at night

You may not remember it, but bed wetting tends to run in families. Most children stop bed wetting on their own at about the same age their parent did!

Bed wetting after the age of 3 is quite common today because children are allowed to outgrow their need for nighttime nappies. This has its pros and cons. Children learn to sleep without a nappy in their own time and they’re truly ready when they’re consistently dry at night. But wearing a nighttime nappy can also make them ‘lazy’ and prolong nighttime ‘incontinence.’  

Cut down on liquids in the late afternoon and take your child to the toilet before you go to bed (sometimes this works, sometimes it doesn’t)

Leave a night-light on in the bathroom or passage so that your child is not frightened to get up and go to the toilet on their own

Don’t make a big fuss about being wet or dry the next morning. Take each day as it comes. 

But when your child has been consistently dry in the mornings for a few weeks, celebrate or reward your child appropriately.