Dr Charlize Smit

12/11/2025

Hi. Book your appointment this week to avoid disappointment 🩺

05/11/2025

We welcome Dr Piet Kotze at out practice this November 🩺

17/10/2025

Just a reminder that we are open 🫶

15/10/2025

Menopause is a broad term that includes perimenopause when ovarian function waxes and wanes.

Osteoporosis is usually addressed in the context of the menopause due the drop in ostrogen levels causeing accelerated loss of bone mass (10% the first 5 years after menopause). Loss of bone density can be largely prevented by correcting ostrogen deficiency.

In the early menopausal transition, the cycle length may vary by 7 days (e.g. a 28-day cycle becomes 21).

The late menopausal transition is characterised by two or more skipped menstrual cycles. Variability of the heaviness of periods is common and the pattern can be erratic, with longer bleeding episodes or scanty me**es,
Around 20% will have no symptoms at all, while another 20% will be severely affected, with symptoms continuing into their 60s or later

Benefits and risks of HRT
It is the most effective method for relieving distressing symptoms such as hot flushes, urogenital symptoms, sleeplessness and joint symptoms.

(NICE) guideline on menopause management concluded the following:
MHT was the most appropriate treatment for menopausal symptoms.
🦴improved bone density and reduced fracture.❤️ CVD risk was not increased among women using HRT and may be reduced (in normal target population).
🩵Venous thromboembolism (VTE) risk was increased among women using oral HRT but not among women using non-oral therapy.
🌸Breast cancer risk was not increased for women taking ostrogen but was increased with long-duration use in women taking combined ostrogen and progestin therapy. The effect reduced after ceasing therapy.
The International Menopause Society advises that HRT carries few risks when prescribed for symptomatic women without contraindications if initiated in women aged under 60 years or within 10 years of menopause.

Contraindications to HRT:

History of ostrogen-dependent tumour:
• endometrial cancer
• breast cancer.
•Recurrent thromboembolism
•active SLE
•Acute ischaemic heart disease (absolute)
•History of coronary artery disease (relative)
•Cerebrovascular disease
•Uncontrolled hypertension
•Undiagnosed vaginal bleeding
•Active liver disease

Previous hysterectomy
Women do not need a progestogen and should be prescribed continuous ostrogen in either a transdermal or oral preparation. Transdermal delivery of ostrogen has a lower VTE risk.

Side effects of therapy
In the first 2-3 months, the woman may experience ostrogenic side effects, but these usually resolve or stabilise. Starting with a lower dose may minimise these side effects.

*Nausea and breast symptoms
*bleeding symptms
*vaginal dryness

Non-hormonal therapy regimens
1. Lifestyle changes
Discuss triggers for hot flushes that might be avoidable, including spicy food, 🍺 , coffee ☕️ and emotional stressors. It is advisable to wear loose-fitting clothes and dress in layers.

2. Non-hormonal, medical options for hot flushes include gabapentin, clonidine and antidepressants.

Complementary therapy
Options include black cohosh, red clover, soy products and other phytoestrogens (plants containing oestrogen-like compounds). Black cohosh has been linked to rare cases of abnormal liver function, hepatitis and liver failure.

Each individual case and treatment needs to be discussed with your family doctor and the information provided is not for diagnosis but for education.

10/10/2025

26/09/2025

🦴🦴We don’t talk about this enough. 🦴🦴

Osteoporosis. ( skeletal with decreased bone mass and micro architecture deterioration of bone tissue resulting in less bone tension and strength and increase in fragility fracture)

🥼Since Osteoporosis is asymptomatic early diagnosis can help decide treatment strategies and prevent disease progression.

📈Prevalence: worldwide, osteoporosis causes > 8.9 Million fractures annually with the greatest number according in Europe commonly the hip, vertebrae and distal forearm. But can also affect other sites like (humerus, ribs and tibia, pelvis femoral fractures)

Women 🤷🏻‍♀️are affected more than men 🙋🏼‍♂️

However there is an increased prevalence of osteoporosis- related fractures in men, there is increased need to raise awareness and knowledge.

Here are a few tips

Sufficient Dietary Calcium + Vitamin D and sunlight ☀️
1. Hi breastfeeding mommy - remember to take 1,000-1,300 mg of calcium daily to support bone health, with the exact amount depending on age.
2. mommies with growing kids. - Don’t overuse Aspelone/betadexamine it contains cortisone which can cause osteoporosis or poor growth. Only use it when prescribed by your doctor and mention the amount of times your child has been on it if consulting a new doctor.
Side Effects of to much cortisone in children: 👦🏻
⚠️weight gain.
⚠️roundness of the face.
⚠️mood changes (irritability, hyperactivity)
⚠️ SLOWER growth rate.
⚠️loss of calcium from the bones (osteoporosis)
⚠️development of cataracts (clouding in the eyes)
3. Post menopausal women can supplement with HRT and Calcium and Vit D supplements.
4. Exercise, exercise exercise especially resistance training and bearing weights. Walking is not effective in osteoporosis prevention
5. Decrease intake in junk food as its absence of Vitamin K results in impairment of the calcium removal process and increases the risk of calcification of the blood vessels. Increase Vit K2 could be a means to lower calcium associated health risk.

Disclaimer: not for diagnosis but for educational purposes. Please consult with your family doctor.

26/08/2025

22/08/2025

Asthma
* Paroxysmal and reversible obstruction of the airways
* History of recurrent episodes of ✅wheezes✅chest tightness, ✅breathlessness, and/or ✅cough, especially at night/early morning
Specific triggers may be present: (e.g. 🌺pollens, 🐕‍🦺 pets, ❄️cold air or perfumes)

💊Symptoms may worsen after taking 💊
• beta-blockers
•aspirin
•NSAIDS → Paracetamol is safe
Side effects of atenolol (wheezing)

Evidence of variable airflow obstruction seen on tests such as peak expiratory flow measurement

Acute asthma
Bronchospasm (smooth muscle spasm narrowing airways)
Excessive production of secretions (plugging airways)

Risk factors
A combination of 🧬genetic & environmental factors 🌻

🧬Personal history of atopy (genetic tendency to develop allergic diseases) such as eczema
🧬Family history of asthma or atopy
🏠Inner city environment
🤰prematurity and low birth weight and maternal smoking
🚬 smoking

Presentation:
✅ cough
✅ shortness of breath
✅ wheezing
✅chest tightness

How do doctors diagnose Asthma
1. Symptoms of Asthma
2. PULMONARY FUNCTION TEST (SPIROMETRY) - initial diagnosis
3. Day-to-day peak flow showing diurnal cycle - treatment monitoring and adjustment
4. Post- dilator improvement of > 12% in FEV1| FVC
5. Unexplained peripheral blood eosinophilia

😷 MILD ATTACK
Slight fast heart rate above >100, slight fast breathing
Classically expiratory wheezes

😷 Acute Severe attack
* use of accessory muscles of respiration
* Inability to complete a sentence in one breath
* Intercostal retractions

In children
* HR > 125 (> 5 years) or HR > 140 (2-5) years
* RR> 30

Disclaimer: this information is for educational purposes and not for self-diagnosis please discuss symptoms with your family doctor.

13/08/2025

Dementia 🧠

The most common causes are:
•Alzheimer disease
•vascular dementia
•a mixture of the 2
•Lewy body dementia
• frontotemporal dementia.

Dementia is also recognised as a complication of Parkinson disease.

Medication history is important to rule out drug-induced cognitive impairment. 💊 doctor 👩🏻‍⚕️

* Anticholinergic side effects of medications can lead to cognitive impairment. 😷
* Having multiple prescribers, a
common occurrence in elderly patients, is a risk factor for polypharmacy with anticholinergic agents.

Examples of drug classes commonly associated with anticholinergic
effects are:
1. Drugs used for nausea and vomiting e.g antiemetics/antivertigo agents
2. antihistamines
3. antimuscarinics, e.g., oxybutynin,
4. antipsychotics e.g., tricyclic antidepressants e.g.amitriptyline,
paroxetine

An association between the long-term use of benzos and dementia incidence has been demonstrated 💤

Physical examination is needed to identify the cause

Other tests:
Laboratory tests: CBC, electrolytes, kidney function, TSH, vitamin B12, calcium, blood glucose, Thiamine.

In order to assess for prodromal dementia or “very early Alzheimer disease without dementia,”

Study 📖: researchers have
attempted to use plasma and cerebrospinal fluid biomarkers (e.g. amyloid beta, tau protein)
❎Neuroimaging (usually CT head scan) if:
✔️60 years of age
✔️new onset
✔️rapid progression
✔️post-head injury
✔️focal or lateralizing signs
✔️history of cancer
✔️use of anticoagulants
✔️early urinary incontinence and gait disorder
✔️unusual cognitive symptoms

🙏🏼 Prevention of Dementia
Most clear evidence on the work done on dementia shows, especially in old age, the risk of dementia and cognitive decline is related to overall health.

It’s important for the general health be optimized.

🫀One important aspect of this is cardiovascular health; cardiovascular risk factors increase the chance of all causes of late-life dementia, including Alzheimer disease.

Evidence from t

05/08/2025

It’s our Mental Health Awareness month. 🫶Trauma needs treatment - not all treatment is pharmacological.

Asking for help should be normalised.🤝

Today we share some symptoms or PPD.