ASK THE DOC
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.