Navigating Perimenopause

While trying to get this post going, I spent a good few minutes taking my brain back almost 20 years ago. I was trying to remember what exactly I was taught in medical school about menopause. I came up with nothing, other than its when estrogen decline, things dry up and a woman stop menstruating. But even then, we had to wait another 5 years to actually classify the patient as menopausal according to the textbook definition (back then). We were taught to simply medicate this with a oral synthetic hormone replacement tablet and that was it.

I am so glad things have changed in the 20 years since I started medical school.

So let’s get to it – what happens to our hormones as we age?

Perimenopause is the period in a woman’s life when the hormonal equilibrium starts disrupting itself due the aging process closely influenced by our lifestyle, diet, genetics and environment. Science says this starts at the median age of 51 years, yet we have seen these changes in ladies as early as in their 30’s. In reality, most of my patients are in their 40s when these typical symptoms start presenting themselves and they find themselves in my office.

It is a tumultuous time for a woman and for treating physician. Typically, conventional medicine focuses on the waning estrogen levels when in fact, progesterone as well as testosterone changes all play a role in the typical symptoms seen in the perimenopause. Symptoms include:

  • shortening of your menstrual cycle
  • heavier bleeding
  • anxiety
  • mood disturbances
  • insomnia
  • loss of libido
  • vaginal dryness and pain with intimacy
  • weight changes
  • hair loss
  • dry and aging skin
  • breast tenderness
  • expanding waistline
  • hot flashes

These symptoms often persist for years until they are adequately managed or even brought to a doctors attention.

The 3 sex hormones take front center in this menopausal drama. Their action is so intimately linked to what’s happening with our adrenal glands and the stress response with their sibling hormone, cortisol. Cortisol, also known as the stress hormone, gradually increases as we get older. Cortisol dysregulation wreaks havoc on the hormonal balance in perimenopause. You cannot address hormonal disturbances, without addressing cortisol. To make things even more complicated, thyroid dysfunction in females also tends to present itself in the menopausal years. There is a symbiosis with ovaries, adrenals and thyroid – you cannot manage one without addressing the other.

How do we manage this?

Conventional medicine falls short in managing women in this time of their life. In 2001, a clinical trial known as the Women’s Health Initiative, was halted prematurely into 2002. The otherwise healthy substrate of the trial had an increase in breast cancer diagnoses and thrombotic events such as strokes, heart attacks and DVT. This trial investigated the effects of a synthetic estrogen (derived from urine of pregnant equines) and a synthetic progesterone, or progestin.

It is this trial which created the universal fear of HRT in general. However, that was 20 years ago and science has advanced for the better. Safer treatment options are available – both conventional and in orthomolecular (integrative) medicine.

The answer to menopausal management lies in integrative medicine… not in the “one sized fits all” approach we were taught many years ago. Perimenopause is difficult to manage – both as a patient and for us as doctors. Post-menopausal on the other hand, much easier to manage once you get over the hurdle.

The answer to improvement in symptoms lies with how you eat, how you move, how you think, your environment, easing symptoms and only then, replacing hormones and only if needed. HRT is never the first line approach.

Hormone replacement can be prescribed in bioidentical form or synthetic form. I personally stick to bioidentical HRT for my patients. These hormones are derived from plant origin and more identical in structure to those hormones found in the human body. We use smaller doses, individualise them according to the patient’s symptoms and most will be administered via the transdermal route – via the skin with patches or creams. No woman’s symptoms is the same as the other, the BiHRT caters to just this – tailoring your dose for you. Assisting the way to metabolise and detoxify your hormones, is just as important.

No HRT – synthetic or bioidentical – is without risk. Regular follow ups, surveillance and keeping to screening programs is essential.

Perimenopause is manageable and relief of symptoms is safely achievable with integrative medicine.

 

Dr Allison Blair.

 

 

Posted: Jun 5, 2021 By: Comment: 0

Ergonomics in the workplace II

Hopefully you’ve already made your posture adjustments and worked your little breaks into your daily work routine. Today I will go into depth regarding your workstation setup.

Desk and chair placement

Keep in mind that your posture should still be correct with both standing and sitting at your desk.

Your desk should always be placed in such a way that your elbows can rest comfortably at 90°. With a standing desk it is easy, if your elbows are bent too much you need to lower your desk, if your elbows are almost straight you need to lift the desk with blocks or bricks until the desired height has been reached.

It becomes tricky with sitting as it can be incorrect desk height, chair height or posture but if you remember the correct posture, the rest will fall into place:

  • Elbows bent at 90 ͦ – This can be adjusted with either the chair or the desk height or sitting on a firm pillow to lift yourself up.
  • Hips bent between 60 ͦ and 90  ͦ and feet always supported – use either a supporting block under your feet or adjust the chair height.

Placement of objects

In the past I have had many people tell me they experience pain that is dominant to either the left or right side. After we contemplated all possibilities the solution was right in front of our eyes – or in their case a little to the left or right. It turns out their computer was placed off center to the left, causing spasms on the left, or placed to the right, causing spasms on the right. Thus, placement of the objects is important.

Place your computer in the center of your body placement and at eye level. Lower placing can cause neck and shoulder pain and higher placing can cause headaches. If you use papers or a tablet on the side, place it as close as possible to the center, avoiding to bend in awkward positions to a side.

Now it is time to adjust your workplace, find a work-rest balance and keep a healthy and happy posture!

Chantel Burger – physiotherapist

Posted: May 10, 2021 By: Comment: 0

Ergonomics in the workplace I

Every one of us has been there – “just one more hour and then I will be done” or “Just one more article” and when you check the time four hours have passed and you end up having a painful back, neck or shoulder.

The setup of your workplace is an extremely important aspect in your life and can prevent onset or progression of pain in certain areas. Most people have the following in a workplace: a desk, a chair, a laptop or computer and papers to work from. I know, not all people sit and work, so then standing at a desk is another option.

 

Let’s address the most important factor – posture!

Posture is a pretty straight forward thing that we grew up with always having to correct. My grandmother used to say: “Sit up straight, you are nearly folded in half” but what does sitting up straight and standing up straight really mean?

When you are sitting down your ear, shoulder, elbow and hip should be aligned. This doesn’t mean you should push your chest out, pull the shoulders back and cramp up your back, no. All this means is to activate your back muscles to help support your weight. When you look more in depth, the chin is slightly down, the shoulders completely relaxed, pulled away from the ears and the elbows bent at a 90° angle. The hips are bent at 90° or between 60° and 90° if you have hip or lower back aches. It is important for the feet to always stay supported. The same goes for standing up: ear, shoulder, hip, knees and ankles are in line. The chin is pulled slightly down and the shoulders are relaxed. Activate the deep core muscles for extra lower back support.

Tips and tricks

When sitting for long periods, try taking breaks every 30min-1hour. The break doesn’t need to be long, all you can do is have a glass of water, roll your shoulders back, stretch your legs and back and let your eyes rest. This rest totals up to 2min at a time and your will be set to work for another hour.

Painful lower back and legs are common with sitting even in the correct posture. Put a small neck pillow behind your lower back for extra support.

If you have a painful lower back when standing, placing your one leg on a small step in front of you will assist a neutral pelvic tilt and therefore help ease the pain.

Keep an eye out for the next blog post about placement of objects in the workplace. If you in any way have consistent pain, please do not hesitate to contact your doctor or physiotherapist here at Elan Healthstyle!

 

Chantel Cronje – team physiotherapist

Posted: May 4, 2021 By: Comment: 0

Optimise your immune health

With the COVID pandemic still with us in 2021, everyone would like to know how they can boost their immune system. Unfortunately, it is not as easy as just taking a magic pill a day or a handful of pills as it stands today. A healthy immune system is directly linked to a balanced lifestyle with nutraceuticals supplementing where our diet is not sufficient.

At Elan Healthstyle our goal is to treat patients holistically and to assist them with the lifestyle changes and supplementation needed to achieve this.

There are some common causes of a compromised immune system which often require medical intervention. These can be divided into categories:

  • Lifestyle related e.g. smoking, alcohol abuse, poor nutrition, lack of sleep
  • Disease related e.g. HIV, diabetes, auto immune disease, cancer
  • Medication related e.g. cortisone, methotrexate
  • Primary immune deficiency which means the person is born with a weak immune system

There are some simple lifestyle changes you can make to strengthen your immune system (as well as boost your mood).

  1. Ensure you get 7-8 hours of sleep. The total amount of sleep is not the only important component. Improving deep sleep should be the focus. This can be done by implementing a fixed bedtime routine every night with electronic downtime at least 2 hours before you even attempt to fall asleep. At times hormonal disturbances need to be corrected to improve your sleep quality. Discuss this with your doctor. A magnesium supplement can also help you get some much-needed ZZZZ’s.
  2. Exercise regularly. This does not mean you should run a half marathon daily. On the contrary running tends to raise cortisol levels which is a natural stress hormone. Pilates and yoga are great at reducing that gnawing stress that keeps you up at night.
  3. Quit the bad habits. Obviously, we cannot do a lifestyle post without preaching about reducing alcohol intake and kicking the nicotine addiction.
  4. Stress and anxiety management. Meditation should form part of everyone’s nighttime sleep routine.
  5. Eat a healthy diet. Reduce sugar intake!!! Eat food rich in minerals and vitamins. Supplement with nutraceuticals to cover the gaps in your diet as discussed with your doctor/dietician. Make sure you are not consuming food groups that are detrimental to your gut health (a topic on its own).
  6. Ensure all chronic disease are well controlled!

Dr Nadine Stewart

Posted: Mar 3, 2021 By: Comment: 0

Returning to exercise after COVID-19

Exercise remains a key component of rehabilitation for patients recovering from COVID-19. However, there is limited guidance on how to start and progress exercise in non-athlete populations in the post-acute period of infection. Getting back into training after recovering from a COVID infection is not as clear cut as it is after other viral infections. In this case, regardless of your activity level, with walking, running, cycling or gardening we advise you to be extremely cautious as you return to activity.

We discuss if specific “return to exercise” protocols could help to solve this problem and return patients in the general population back to normal function.

There are a couple of reasons and I’m only going to highlight a few:

  • It is possible for someone with mild coronavirus symptoms to get worse on around day 7 post infection
  • Cardiologists are seeing a higher incidence of heart issues in people infected with the virus.
  • The nephrologists are seeing that post COVID patients returning to early start to complain of muscle pain and when investigated, present with renal dysfunction.

Our patients post COVID is struggling with the following symptoms:

  • Elevated resting heart rates more than 6 weeks post COVID
  • Poor saturation
  • Heart rate recovery slower than usual
  • Chronic headaches
  • Muscle pains
  • Shortness of breath – more so than you normally would be during or after a training session.
  • Dizziness
  • Chest pain
  • Palpitations

If you are experience any of these symptoms while or after your workout, it is best to stop. Review these symptoms with your treating doctor.  The best way to go about getting going again, is to start with a very low intensity session and gradually build yourself up over a 3 – 4-week period while monitoring your heart rate and perceived levels of exertion (how tired you feel).

COVID-19 POSITIVE & Asymptomatic
Wait 2 weeks before resuming training.

COVID-19 POSITIVE & Mild Symptoms
Wait for all symptoms to clear, then rest for a further 14 days before you try a workout.

COVID-19 POSITIVE & Severe Symptoms/Hospitalised WITHOUT heart issues
Wait for all symptoms to clear, rest for 2 weeks then be evaluated by your doctor.

COVID-19 POSITIVE & Severe Symptoms/Hospitalised WITH heart issue
Evaluation and clearance from a cardiologist once the 2-week rest period has been completed, is necessary.

The more high-level athlete you are, the more it is advised to go for a formal check-up which would include an ECG and cardiac enzyme level checks.

Knowing that the virus can cause complications in many systems of the body, the best practice is to resume training in a slow and steady way. You need to pay attention to both the physical and psychological effects of a workout.

 

Dirkie Coomans – physiotherapist

Posted: Feb 23, 2021 By: Comment: 0

What have we learnt from COVID-19?

It’s tough to find any rays of sunshine beaming through the storm clouds of what is the pandemic of our lifetime.

It is almost contagious to get caught in the wave of negativity that surrounds us all – one person says something, we agree, we commiserate and so it goes on and on… I don’t know about you but for me, it’s exhausting.

I find myself avoiding these people and these conversations. Quickly skipping over those posts in my Facebook newsfeed. It’s not ignorance nor is it avoidance behaviour. Instead, it’s a conscious decision to make better choices all around me. I cannot change the greater problem at hand but I would like to be part of the solution in any small way I can.

There is a very subtle ripple of anxiety streaking the waters of society and it’s touching all of us.

Having said that, there are so many wonderful things to come to the forefront in this pandemic. Let’s highlight a few:

  • Our health has never been more important
    Are you taking any of the following – vitamin c, zinc or vitamin D3? In the past, this question was met with some skepticism. But now… it is scarce to find someone who isn’t proactively taking control of their health with the form of some sort of supplementation. People want to be healthy and want to stay healthy. This makes me happy because I love helping people do just that – optimising their health.
  • Functional and integrative medicine is gaining traction
    As mentioned above, the importance of supporting your own immune system with certain supplements is well known. This is a primitive and yet important example of functional and integrative medicine.
    Patient infected with COVID-19 are also being treated with the above – vitamin and minerals. This is done in hospital in the mainstream setting… how exciting!
  • We really can survive without our daily nightcap
    The alcohol ban was annoying (I need my Friday wine!) but the impact it had on our hospitals and ERs over New year is clear evidence that changes need to be made to our system.
  • Lifestyle changes have more of an impact on your health than any medication would.
    Managing stress, sleeping well, having healthy relationships, a colourful and organic diet and non-exhaustive exercise are the building blocks to the immune system
  • We are resilient and adaptive humans beings
    I never thought ever that I would be living in these surreal times but here I am – surviving! Where I would usually worry about the loss of income and quiet periods at work, I have tried to find the joy in having more ease of time. I remind myself that this too will pass. When it does, I will wish for the slower days, the later starts and the weekends of not working.

As we push through this second wave, let us remind ourselves that a year ago, this current situation seemed completely surreal and inconceivable. Yet here we are, surfing this second wave of COVID-19. We’re all doing so well!

Dr Allison Blair 

Posted: Feb 8, 2021 By: Comment: 0

The sunscreen post!

Dr Nadine Stewart speaks to us about sunscreen…

With the holidays just around the corner, let’s talk about sunscreen.

Why sunscreen?

We all know spending time in the sun increases our risk for skin cancers such as basal cell carcinoma and melanoma. But did you know that sun exposure directly contributes to photoaging of your skin? In fact, when you dive into the world of anti-aging medicine your doctor will advise that your first purchase should be a good sunscreen.

Now naturally, the next question is – which sunscreen?

It can be quite daunting walking into the store and trying to choose the correct sunscreen for your skin. To make matters worse, once you have chosen the brand you now need decide on SPF 15 or 50. Lately you would have noticed that sunscreens no longer just protect against UVA and UVB rays but also have added protection against visible light and infrared radiation. Understanding what this means is crucial to ensure that you buy the correct product.

UVB rays are mainly responsible for inflammation and accumulation of the mutations in your skin which results in melanoma and nonmelanoma cancers. UVA rays are known as the aging ray but also cause oxidative stress which increases your risk for development of skin cancers. Visible light is largely responsible for induction of pigmentation problems. Infrared rays cause loss of collagen and elastin which causes premature aging of the skin.

SPF (sun protection factor) refers to protection from harmful UVB rays. It basically measures how long you can be in the sun before the skin reddens with the sunscreen on vs. without any sunscreen. So, if your skin reddens within 5 minutes of sun exposure without sunscreen and you apply an SPF 30 you should theoretically be protected for 2 hours and 20 minutes. Unfortunately, due to sun intensity variation during the day this is not an exact amount but rather an estimation.

To summarize, your sunscreen should cover you against UVA, UVB, infrared and visible light rays if you want the anti-aging and anti-pigmentary on top of the protection against skin cancers. SPF 50 would be recommended for most skins.

When sunscreen?

This one is quite simple. ALWAYS!!!! You should be applying your sunscreen daily and if you have more than 2 hours direct sun exposure, you should reapply. It is a good idea to get your kids into the routine of daily sunscreen application as research shows that one blistering sunburn in childhood or adolescence can more than double your risk of melanoma later in life. If your child does not like the daily fuss of rubbing in sunscreen there are many spray and new brush on options (available at Elan Healthstyle) available that are suitable for face and body application.

Last thing to remember is that applying sunscreen will not protect you completely. It is still advisable to avoid sun exposure between 10:00-15:00 by remaining in the shade and wearing protective clothing and a wide brim hat.

Pop in to bulk up on your summer protection!

 

Dr Nadine Stewart

Posted: Nov 27, 2020 By: Comment: 0

What IS Integrative Medicine?

Before I start with what it is, I’d like to give you a brief background as to how I found this thing called functional and or integrative medicine.

My background in medicine in the private sector started 10 years ago working in emergency units. I loved it. You came in with a problem. I fixed it. You went home or you stayed.

What I didn’t love however, was repeat customers. “Why are they here again?” I would ask myself (especially at 03h00).

In time, the emergency medicine field took its toll on my own health and wellness. I didn’t do any clinical work for a few months after resigning.  Not knowing what to do next as I was disillusioned in the medical system, I was given the opportunity to work at a general medical practice and joined them.

The traditional approach to treating patients in a general medical practice didn’t sit well with me – bluntly, it killed my soul. As doctors, we’re taught to just give a pill for a symptom.  For example, an antidepressant for feeling sad, an anti hypertensive for high blood pressure, metformin for type 2 diabetes or a proton pump inhibitor for your heart burn.

And while this is what we are taught and it isn’t wrong, you often end up with polypharmacy due to side effects of these meds.  For example, muscle cramps and osteopenia from your heart burn meds, so we give you something for that. Diarrhea and stomach cramps from your metformin, so we pop you another prescription for that as well.

When I delved into aesthetic medicine and then anti-aging medicine and hormonal health, the whole functional medicine approach to health care across my path and I loved it – it made sense!

Functional medicine focuses on root cause. In essence, what is making you feel the way you do and how do we start fixing it. You fix it, we help you do it. Here you use diet and lifestyle as the big “medications” but at times we also incorporate vitamins, minerals, plant extracts and nutraceuticals as complementary treatments. The result is something sustainable which you can follow lifelong without the use for chronic medication. Investigations and treatments are evidence based and not simply sucked from thin air for us to help you.

Integrative medicine believes in the best in both worlds – finding root cause and using the “natural” treatment options while not completely forgoing the use and need for conventional medicine. Here I’ll use hypothyroidism as an example – thyroid symptoms may never be stabilized with hormone replacement without the investigation and treatment of vitamin D and iron levels, not to mention addressing autoimmune factors…. I wasn’t taught this in medical school (and I was a nerd).

It is this that we opt for at our practice, Blair and Camphor INC at Elan HealthStyle. Our appointments are long with the first consult being at least an hour. Follow ups are adjusted as needed starting at 30 mins. The usual consult time for traditional GP practice is every 15 minutes.

Quality over quantity.

Lastly, I’d like to end off by defending this approach to health before criticism comes our way. Let’s take our current 2020 situation with COVID-19 – how are we treating these patients at home?  With vitamin C, vitamin D and zinc together with paracetamol. These treatments are evidence based and now used in mainstream medicine. Vitamins work.  Minerals work.  Integrative medicine works…

It’s a treatment journey and Dr Camphor and I love walking it with you. It’s not a sprint but it is so rewarding.

 

Dr Allison Blair 

Posted: Aug 12, 2020 By: Comment: 0

Back Pain Tips

Lockdown may be responsible for back pain flaring for many of our patients.  Dirkie Coomans shares some tips below on how to manage this yourself and prevent it from causing more distress.

TIPS FOR CLEANING HOUSE

Cleaning your house, doing laundry, dishes and let’s not forget about the men in the garden, can be a pain in the butt but it can also be a literal pain in the back and neck! During these unprecedented times I decided to give a few tips on how to protect your back and neck during lockdown and still have a neat home and garden. Unfortunately, none of these tips involve “DON’T DO IT” – sorry!

Tip 1: How to avoid pain during sweeping, mopping, vacuuming, raking, and shoveling.

While it may not look like hard work, these chores are the main reason behind back pain flare ups. The reason for it this is that all five of these activities include repeated movements that require you to bend at the waist.

To avoid the pain and strain on your muscles:

  • Keep your shoulders and hips moving in the same direction of work
  • Use one foot stepping forward and slightly bend your knee (half a lunge) – this will help to keep your upper body straight
  • Avoid twisting backwards
  • Avoid bending at your waist

Invest in good quality brooms, vacuums, mops and garden equipment.  The items:

  • should be light
  • easy to grip
  • have an adjustable height where possible

Tip 2: How to avoid pain during dishwashing

Since lockdown has forced us to make every single meal (that is perhaps the only fun thing that we could do), you would agree with me that the sink is just empty and the kitchen cleaned, before the next meal is even about to start. It’s a never-ending story!

To avoid back pain while doing endless dishes:

  • Stand up straight
  • Put your one foot on the bottom of the opened cabinet – will help to squat and keep you straight
  • This may seem awkward, but you will avoid back and neck pain and get a little toning in for the behind.
  • A padded floor mat underneath the sink will help cushion your feet
  • A dishwasher is a good investment

 Tip 3: How to avoid pain while doing laundry and picking up toys

While washing doesn’t seem like hard work, the hanging up and taking down does take its toll on your back and neck. Picking up after the kids is also an endless reality.  The pain from laundry and picking up is stimulated by the same repeated constant bending motion.

  • Try to keep your back as straight as possible
  • Reach for your clothes using your right hand and balance your body by lifting the left leg into the air
  • You can put your left hand on a surface that’s nearby. If you end up reaching with the left hand, simply reverse directions. This will help to reduce the strain on the back muscles.
  • Instead of bending down over and over again to pick up kids’ toys, try crawling on the ground while picking them up to avoid the repetitive bending motion.

Lockdown has a few fun elements but cleaning the house isn’t fun, but someone has to do it. Keep these tips in mind.

If not, come see us!  We’ll gladly assist in alleviating that pain.

Dirkie Coomans.

Posted: May 25, 2020 By: Comment: 0

Antiwrinkle Injections

Let’s talk tox!

We are all completely overwhelmed by COVID19 information of late.  I’ve decided to take a step back and write an educational post on one of my favourite in office procedures, that of antiwrinkle injections or botulinum toxin.

Also known as BOtulinum TOXin, this treatment is the world’s number 1 in-office aesthetic procedure and definitely the one that peaked my personal career interest back in 2011.

Botulinum toxin injections have been used in medicine since 1973.  The FDA approved the used of them in 1989 to treat strabismus (squint eyes) and facial spasms. In 2001, it finally gained approval for cosmetic use, first for treating brow wrinkles, frown lines and for excessive sweating.

Botulinum toxin reduces the appearance of wrinkles by causing muscle paralysis.  It prevents the release of a chemical which tells the muscle to contract.  If the muscle doesn’t contract, it doesn’t make lines or wrinkles.  The results are not permanent as the body starts to recover this muscle function after 3 months.  I personally think this is not a bad thing as most people prefer treatments which are not permanent or can potentially be reversed.

When done correctly, antiwrinkle injections soften facial expressions and do not always lead to the frozen look so typically frowned upon. One should look refreshed and happy and not as if you’ve had “work done”.

In the face, the top treatment areas include lines around the eyes (crow’s feet), frown lines and forehead lines.  We can also use botulinum toxin to treat down-turned mouth corners, bunny lines on the nose, pebbling skin of the chin and platysmal bands in the neck.  The masseter muscles of the jaw can also be treated to help in bruxism or jaw clenching – this helps with alleviating pain and has the additional effect in slimming the lower face when the muscle is overdeveloped.  In the body, the treatment of excessive sweating in areas such as under the arms, has amazing results in eradicating sweating in those who struggle with it.

Antiwrinkle injections cannot be given to ladies who are pregnant and breastfeeding.  For new patients, I prefer a more conservative approach with a follow up appointment to ensure that the results are in line with expectations or to make adjustments if necessary.

Continued treatments over time help prevent those wrinkles from becoming more permanent and has a beneficial effect on skin quality.  Prevention is better than cure and subtle treatments in our younger years (even from mid 20’s – 30’s) is a great antiaging investment.

 

Stay beautiful,

Allison Blair.

 

Posted: May 11, 2020 By: Comment: 0