Sur­geon and lec­turer Dr Sarah Rayne dis­cusses the 12-step pro­gramme, weighs in on what may be caus­ing an on­go­ing post­nasal drip and ex­plains the causes of di­a­betes.


Q: I re­cently read an ar­ti­cle that pointed out that the Al­co­holics Anony­mous (AA) 12-step pro­gramme doesn’t have as high a suc­cess rate as a Fin­nish sys­tem that doesn’t in­sist upon to­tal ab­sti­nence. What do you think?

A:Al­co­hol-use dis­or­ders (AUDs) af­fect about 10 per­cent of men and 1,5 per­cent of women in South Africa. The AA’s 12-step pro­gramme has been suc­cess­ful since the 1930s in pro­vid­ing emo­tional, spir­i­tual and phys­i­cal sup­port to those with ad­dic­tion is­sues. But nowa­days, we un­der­stand much more about the brain and how ad­dic­tion works, and we know that one size doesn’t fit all.

Be­cause we know more about AUDs, we also know that we can use med­i­ca­tion to switch off the phys­i­cal ef­fects of al­co­hol, which stops crav­ings. We also now un­der­stand that AUDs go hand in hand with other men­tal health prob­lems, and that these can be treated with psy­cho­log­i­cal ther­a­pies and med­i­ca­tion.

Other pro­grammes have started to chal­lenge the 12-step as­ser­tion that the suf­ferer is pow­er­less against their ad­dic­tion. In­stead, they em­power peo­ple to make choices about their al­co­hol use. We don’t wait for an asth­matic to stop breath­ing be­fore we start treat­ing them, and the same goes for AUDs: if we re­duce the stigma of men­tal health and ad­dic­tion prob­lems, it will help peo­ple seek treat­ment early – be­fore they hit rock bot­tom.

Q: About a month ago I took an­tibi­otics to treat a sore throat and it went away, but I can’t shake the post­nasal drip – at night I some­times feel as if I’m choking. Is there any­thing other than an­tibi­otics that you could rec­om­mend?

A:It sounds like you may be suf­fer­ing from catarrh, which de­scribes the feel­ing of mu­cus build­ing up at the back of the nose and throat. It com­monly devel­ops after a si­nus or throat in­fec­tion, but it isn’t re­lated to on­go­ing in­fec­tion, so you’re right: more an­tibi­otics will not help. It seems to be more re­lated to a change in the way the lin­ing of your nose and throat feel.

Some­times the best so­lu­tion is to treat the symp­toms to pre­vent thicker mu­cus. Drink lots of wa­ter to stay hy­drated, and avoid smok­ing, smoky places or air con­di­tion­ing. Also, try to avoid cough­ing to keep the throat clear as this will cause more ir­ri­ta­tion. Some peo­ple find sparkling wa­ter helps to clear the catarrh; sleep­ing propped up also helps.

Gas­tro-oe­sophageal re­flux (acid re­peat­ing on you from your stom­ach) can also cause a cough and that choking feel­ing, es­pe­cially while ly­ing flat. It might be worth chat­ting to your doc­tor or an ENT sur­geon.

Q: I met two peo­ple who’ve been di­ag­nosed with type 1 di­a­betes: one in her late twen­ties; the other in her fifties. How can this be – I thought late-on­set di­a­betes was al­ways type 2?

A:These two peo­ple have joined the 10 per­cent of South Africans who live with di­a­betes.

Di­a­betes mel­li­tus is a state of high blood sugar which slowly poi­sons the cells of the body, caus­ing heart at­tacks, kid­ney fail­ure, in­fec­tions and blind­ness. When you eat, the body breaks down starch and sugar into glu­cose, and uses in­sulin to tuck this away to use as fuel later. Di­a­betes oc­curs when you stop pro­duc­ing in­sulin or when your cells be­come re­sis­tant to in­sulin.

Young peo­ple tend to stop pro­duc­ing in­sulin (type 1), while type 2 di­a­betes is re­lated to in­sulin re­sis­tance caused by diet and other life­style fac­tors. But there is an over­lap – young peo­ple can de­velop in­sulin re­sis­tance as a ge­netic dis­or­der, and older peo­ple can stop pro­duc­ing in­sulin as an au­toim­mune dis­ease.

If you’re drink­ing lots, pee­ing of­ten and feel­ing tired, see your doc­tor. Blood tests will help diagnose the prob­lem.

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