Ukuqonda i-Gastroparesis: Izimpawu, Izimbangela, Nokwelashwa

I-Gastroparesis yisimo lapho imisipha yesisu yakho ingasebenzi kahle khona, okubangela ukuba ukudla kuqhubeke kancane kakhulu ngesistimu yakho yokugaya ukudla kunokujwayelekile. Cabanga ngakho njengokungqubuzana kwesikhathi esijwayelekile sesisu sakho, njengodansa olulahlekile izingoma zalo.

Lesi sifo sokuqeda ukudla sithinta indlela isisu sakho esikhulula ngayo ukudla esibindini sakho esincane. Esikhundleni sokuhlanganiswa okujwayelekile kwemisipha okuqhutshwa ukudla, isisu sakho siyaba buthakathaka noma siye siqale siqale. Nakuba lokhu kungase kuzwakale kuyesabekayo, ukuqonda i-gastroparesis kungakusiza ukuthi uyilawule ngokuphumelelayo ngendlela efanele.

Ziyini izimpawu ze-gastroparesis?

Izimpawu ze-gastroparesis zivame ukuvela kancane kancane futhi zingase zihluke kumuntu nomuntu. Ungase uqaphele ukuzizwa ugcwele ngokushesha lapho udle, ngisho nalapho udle izicucu ezimbalwa zokudla.

Nazi izimpawu ezivamile ongazihlangabezana nazo:

• Ukuphefumula nokugabha, ikakhulukazi ukudla okungagayiwe amahora ngemva kokudla
• Ukuzizwa ugcwele ngokushesha ngesikhathi sokudla (ukugcwala okusheshayo)
• Ukukhukhumela nobuhlungu besisu
• Ukushisa kwesisu noma ukubuyela emuva kwesisu
• Ukulahlekelwa ukulangazelela ukudla
• Ukulahlekelwa isisindo ngaphandle kokuhlose
• Ukuguquguquka kweswekile legazi (ikakhulukazi uma une-diabetes)

Abanye abantu nabo bahlangabezana nezimpawu ezingavamile njengokugqwala kwesisu noma ukuzizwa sengathi ukudla kunamathele esifubeni sabo. Lezi zimpawu zingase ziye ziye, okwenza i-gastroparesis kube nzima ukuyibona ekuqaleni.

Ubunzima bezimpawu bungase buhluke, ngezinsuku ezithile zizizwa zilungile kunokunye. Lolu daba olungenakuqagelwa lujwayelekile nge-gastroparesis, nakuba kungase kuzwakale kuyadumaza lapho uzama ukuhlela imisebenzi yakho yansuku zonke.

Yini ebangela i-gastroparesis?

I-Gastroparesis kwenzeka lapho inzwa ye-vagus, elawula imisipha yesisu yakho, yonakele noma iyeka ukusebenza kahle. Le nzwani isebenza njengomqondisi we-orchestra yakho yokugaya ukudla, futhi lapho ingasebenzi kahle, yonke i-system ingase iphume.

Izimbangela ezivamile zihlanganisa:

• I-Diabetes (ikakhulukazi i-diabetes yesikhathi eside, engalawulwa kahle)
• Ukuhlinzwa kwesisu noma esiswini ngaphambili
• Ukutheleleka yi-viral okuthinta isistimu yokugaya ukudla
• Imithi ethile (ikakhulukazi eminye imithi yokulwa nokucindezeleka neminye imithi yokwelapha ubuhlungu)
• Izimo ze-neurological njenge-Parkinson's disease
• Izifo ze-autoimmune
• Izifo ze-thyroid

Ezimweni eziningi, odokotela abakwazi ukubona imbangela ethile, okuthiwa yi-gastroparesis ye-idiopathic. Lokhu akusho ukuthi akukho lutho olungalungile noma ukuthi konke kukuphefumulweni kwakho. Kusho nje ukuthi isithintelo esingaphansi sihlala singaziwa, okwenzeka ngezimo eziningi zezokwelapha.

Ezinye izimbangela ezingavamile zihlanganisa izifo ze-connective tissue njenge-scleroderma, izifo zokudla, nezinye izimo ze-genetic. Nakuba lezi zingavamile, udokotela wakho uzocubungula uma izimpawu zakho zingafani nesibonelo esijwayelekile.

Ziyini izinhlobo ze-gastroparesis?

I-Gastroparesis ngokuvamile ihlukaniswe ngokusekelwe kulokho okuyibangela, okusisiza odokotela ukuba bakhethe indlela yokwelapha efanele isimo sakho esithile.

Izinhlobo eziyinhloko zihlanganisa:

• I-Gastroparesis ye-Diabetic - ebangelwa yiswekile legazi eliphezulu isikhathi eside elilimaza izinzwa
• I-Gastroparesis ye-Idiopathic - akukho sizathu esingabonakala esingatholakala
• I-Gastroparesis ngemuva kokuhlinzwa - ithuthukiswa ngemuva kokuhlinzwa kwesisu noma esiswini
• I-Gastroparesis ebangelwa imithi - ebangelwa imithi ethile

I-Gastroparesis ye-Diabetic yilona hlobo oluvamile, oluthinta cishe ingxenye yesithathu yabantu abane-Type 1 diabetes nabanye abane-Type 2 diabetes. Izindaba ezinhle ukuthi ukulawulwa kangcono kweswekile legazi ngezinye izikhathi kungasiza ekuthuthukiseni izimpawu ngokuhamba kwesikhathi.

I-Gastroparesis ye-Idiopathic, nakuba kuyadumaza ngoba akukho sizathu esicacile, ngokuvamile iphendula kahle ekuguqulweni kokudla nasemithini. Udokotela wakho uzosebenza nawe ukuthola ukuxuba okulungile kokwelapha kungakhathaliseki ukuthi yiluphi uhlobo olulokhu unalo.

Nini kufanele ubona udokotela nge-gastroparesis?

Kufanele uxhumane nodokotela wakho uma uhlangabezana nokuphefumula okuqhubekayo, ukugabha, noma ukuzizwa ugcwele ngemva kokudla izinto ezincane kakhulu zokudla. Lezi zimpawu, ikakhulukazi lapho zihlala izinsuku ezimbalwa, zidinga ukunakekelwa kwezokwelapha.

Funani ukunakekelwa kwezokwelapha ngokushesha uma une:

• Ukugabha okukhulu okukuvimbela ekuqondeni ukudla noma izinto ezincelisayo
• Izimpawu zokulahleka kwamanzi (ukukhathala, umlomo owomile, ukunciphisa ukuphuma kwamanzi)
• Ubuhlungu besisu obukhulu
• Igazi ekuhambeni kwakho
• Ukulahlekelwa isisindo ngokushesha, ngaphandle kokuhlose
• Ubunzima bokulawula amazinga eswekile legazi (uma une-diabetes)

Ungalindi uma ubunzima bokuthola ukudla okufanele noma uma izimpawu zakho zithinta impilo yakho yansuku zonke kakhulu. Ukuxilongwa kwasekuqaleni nokwelashwa kungasiza ukuvimbela izinkinga nokuthuthukisa ikhwalithi yempilo yakho.

Uma une-diabetes futhi uqaphela lezi zimpawu zokugaya ukudla, kubalulekile ukukhuluma nazo nodokotela wakho. Ukulawula i-gastroparesis kanye ne-diabetes kudinga ukuhlanganiswa ngokucophelela ukuze ugcine iswekile legazi lakho lizinzile.

Ziyini izici ezingasenza ube sengozini ye-gastroparesis?

Ezinye izici zingandisa amathuba akho okukhula kwe-gastroparesis, nakuba ukuba nezici ezingasenza ube sengozini akusho ukuthi uzokhula ngokuqinisekile ngalesi simo.

Izici eziyinhloko ezingasenza ube sengozini zihlanganisa:

• Ukuba ne-diabetes, ikakhulukazi iminyaka eminingi
• Ukuba owesifazane (i-gastroparesis ithinta abesifazane kakhulu kunamadoda)
• Ukuba uke wahlinzwa esiswini noma esiswini ngaphambili
• Ukuthatha imithi ethile isikhathi eside
• Ukuba nezimo ze-autoimmune
• Ukutheleleka yi-viral ngaphambili okuthinta isistimu yokugaya ukudla

Ubudala bungase futhi bube nomthelela, njengoba i-gastroparesis ivame kakhulu kubantu abadala abaseminyakeni emaphakathi. Noma kunjalo, ingase ibonakale kunoma yiliphi iminyaka, kufaka phakathi ezinganeni nasezikhulile.

Ezinye izici ezingavamile ezingasenza ube sengozini zihlanganisa ukuba nezifo zokudla, ukuthola ukwelashwa nge-radiation esiswini, noma ukuba nezinye izimo ze-genetic. Nakuba lezi zingavamile, zisabalulekile ukuthi udokotela wakho azicabangele lapho ehlola izimpawu zakho.

Ziyini izinkinga ezingase zibe khona ze-gastroparesis?

Nakuba i-gastroparesis ilawuleka, ingase iholele ezinkingeni uma ingalashwa noma ingalawulwa kahle. Ukuqonda lezi zinkinga ezingase zibe khona kungakusiza ukusebenza neqembu lakho lokunakekelwa kwezokwelapha ukuze uzivimbele.

Izinkinga ezivamile zihlanganisa:

• Ukondleka okungalungile ngenxa yokungagayi kahle kokudla
• Ukushona kwamanzi ngenxa yokugabha okuvamile
• Ukuguquguquka kweswekile legazi (okuyinkinga kakhulu kubantu abane-diabetes)
• Ukwenziwa kwe-bezoars (amaqembu aqinile okudla okungagayiwe)
• I-Gastroesophageal reflux disease (GERD)
• Ukulahlekelwa isisindo ngaphandle kokuhlose

I-Bezoars ikhathaza ngokukhethekile ngoba ingavimba isisu sakho, idinga ukungenelela kwezokwelapha ukuze isuswe. Ziyenziwa lapho izicucu zokudla okungagayiwe zihlangana ndawonye, okuvamile lapho isisu sakho singakhululi kahle.

Izinkinga ezingavamile kodwa ezinzima zihlanganisa ukungalingani okukhulu kwama-electrolyte ngenxa yokugabha okuqhubekayo ne-aspiration pneumonia uma izinto zesisu zingeniswa emaphashini. Lezi zinkinga zibonisa ukubaluleka kokulawulwa kahle kwezokwelapha.

Izindaba ezinhle ukuthi izinkinga eziningi zingavimbeka noma zinciphisiwe ngokwelashwa okufanele nokuguqulwa kokudla. Iqembu lakho lokunakekelwa kwezokwelapha lizokulandela eduze ukuze liqaphele noma yiziphi izinkinga ezingase zibe khona ekuqaleni.

I-Gastroparesis ingavimbeka kanjani?

Nakuba ungakwazi ukuvimbela zonke izimo ze-gastroparesis, ikakhulukazi izimo ze-idiopathic, ungathatha izinyathelo zokunciphisa ingozi yakho nokuvimbela isimo ukuba singabi sibi.

Uma une-diabetes, ukulawula kahle iswekile legazi kuyithuluzi lakho elikhulu kakhulu lokuvimbela. Amazinga eswekile legazi aphezulu ngokuhamba kwesikhathi angalimaza inzwa ye-vagus, ngakho ukugcina amazinga akho e-glucose amaphethini avikelekile isistimu yakho yokugaya ukudla.

Ezinye izindlela zokuvimbela zihlanganisa:

• Ukuthatha imithi ngokuqondile njengoba kulotshiwe nokuxoxa ngemiphumela emibi nodokotela wakho
• Ukulawula izimo ezingaphansi njengezifo ze-thyroid noma izifo ze-autoimmune
• Ukudla ukudla okuqondile okunama-nutrients amaningi
• Ukuhlala unamanzi
• Ukuqapha ukusetshenziswa kokudla okunamandla
• Ukulandela imiyalo ngemuva kokuhlinzwa ngokucophelela uma uke wahlinzwa esiswini

Ukuhlola okujwayelekile nodokotela wakho kungasiza ekutholeni izimpawu zokuqala ze-gastroparesis, ikakhulukazi uma unezici ezingasenza ube sengozini. Unganqikazi ukubika izimpawu zokugaya ukudla, ngisho noma zibonakala zincinci.

Uma usuvele uphila ne-gastroparesis, ukulandela uhlelo lwakho lokwelapha ngokuqhubekayo kungavimbela izinkinga nokusiza ekuqondeni ikhwalithi yempilo yakho.

I-Gastroparesis ixilongwa kanjani?

Ukuxilongwa kwe-gastroparesis kuhilela ukuhlolwa okuhlukahlukene ukuze kuqale ukuthi isisu sakho siyakhulula kangcono kanjani futhi kuvimbele ezinye izimo. Udokotela wakho uzoqala ngengxoxo eningiliziwe yezimpawu zakho nomlando wakho wezokwelapha.

Izivivinyo ezivamile zokuxilongwa zihlanganisa:

• Isifundo sokuqeda isisu - udle ukudla okunezingxenye ezincane zezinto ezibonakalayo, futhi isithombe siqapha ukuthi kuhamba kanjani ngokushesha esiswini sakho
• I-Upper endoscopy - umqhele omncane, onobuningi, onenkhangelela uhlola umgca wesisu sakho
• Isifundo se-Smart pill - uginya idivayisi encane ye-electronic ealinganisa ukucindezela ne-pH njengoba ihamba ngesistimu yakho yokugaya ukudla
• Izivivinyo zegazi ukuhlola i-diabetes, izinkinga ze-thyroid, nokuntuleka kokudla
• Izivivinyo zomoya ezingase zithole ukukhula kwe-bacteria

Isifundo sokuqeda isisu sibhekwa njengendlela engcono kakhulu yokuxilongwa. Uzodla ukudla okuqondile (ngokuvamile amaqanda ahlanganisiwe ne-toast), futhi ochwepheshe bazokuthatha izithombe zesisu sakho ngezikhathi ezithile ukuze babone ukuthi kukhona malini ukudla okusele.

Udokotela wakho angase futhi enze izivivinyo ukuze avikele izithiyo noma ezinye izinkinga zesakhiwo. Lezi zingase zihlanganise i-CT scans noma i-barium swallow studies, lapho uphuza khona isisombululo esibonakalayo esibonakala ku-X-rays.

Inqubo yokuxilongwa ingathatha isikhathi esithile, kodwa kubalulekile ukuba uqonde. Ukuthola ukuxilongwa okuqondile kuqinisekisa ukuthi uthola ukwelashwa okufanele isimo sakho esithile.

Yini ukwelashwa kwe-gastroparesis?

Ukwelashwa kwe-gastroparesis kugxile ekulawuleni izimpawu, ekuthuthukiseni ukuqeda isisu, nasekugcineni ukudla okufanele. Udokotela wakho uzokwenza uhlelo oluqondene nawe ngokusekelwe ebunzimeni besimo sakho nesizathu salo esingaphansi.

Ukuhlukahluka kokudla ngokuvamile kuyindlela yokuqala yokwelapha:

• Ukudla izicucu ezincane, eziningi ngosuku lonke
• Ukukhetha ukudla okune-fiber encane, okune-fat encane okuhlwabusayo
• Ukuphuza amanzi amaningi, ikakhulukazi ngesikhathi sokudla
• Ukuqapha iziphuzo ezinobisi nokudla okune-fat eningi
• Ukudla ukudla okuhlanganisiwe noma okune-liquid ngesikhathi se-flare-ups

Imithi ingasiza ekuqhubeni ukugqwala kwesisu nasekunciphiseni ukuphefumula. Izinketho ezivamile zihlanganisa i-metoclopramide, i-domperidone (lapho itholakala khona), neminye imithi yokulwa nokuphefumula njenge-ondansetron.

Ezimweni ezinzima, ukwelashwa okuthuthukile kungase kudingeke. Lezi zihlanganisa ukukhuthaza ugesi kwesisu (i-pacemaker yesisu sakho), ukugqwala kwe-botulinum toxin, noma izinqubo zokuhlinzwa ukuze kusize ukudla ukuhamba kalula.

Uma une-diabetes, ukuthuthukisa ukulawulwa kweswekile legazi kubalulekile ekusebenzeni kahle kokwelapha. Udokotela wakho angase alungise imithi yakho ye-diabetes noma uhlelo lwe-insulin ukuze usebenze kangcono ne-gastroparesis yakho.

Indlela yokulawula i-gastroparesis ekhaya?

Ukulawula i-gastroparesis ekhaya kuhilela ukwenza izinqumo eziqondene nalokho, nini, nokuthi udle kanjani. Ukuguqulwa okuncane emikhwenyeni yakho yansuku zonke kungenza umehluko omkhulu endleleni ozizwa ngayo.

Qala ngokudla izicucu ezincane kaningi ngosuku lonke. Esikhundleni sezindlu ezintathu ezinkulu, zama eziyisithupha ezincane. Lokhu kubekela isisu sakho ukucindezela okuncane futhi kwenze kube lula ukudla ukuhamba.

Gxilisa ukudla okulula ukuhlwabusayo:

• Imifino ebilisiwe kahle (qapha imifino eluhlaza noma enama-fiber amaningi)
• Amaprotheni alula njengenkukhu, inhlanzi, noma i-tofu
• Urayisi omhlophe, i-pasta, nama-grains ahlanzekile
• I-Soups ne-broths
• I-Smoothies nama-protein shakes
• I-Applesauce nezinye izithelo ezihlanganisiwe

Hlala unamanzi ngokuphuza izinto ezincelisayo usuku lonke, kodwa qapha ukuphuza amanzi amaningi ngesikhathi sokudla njengoba lokhu kungakwenza uzizwe ugcwele ngokushesha. Izinto ezincelisayo ezingaphezulu noma ezishisayo ngokuvamile zibekezeleleka kunokuba zipholile.

Gcina idayari yokudla ukuze ubone ukuthi yiziphi izinto ezikwenza ube nezimpawu. Izinto ezikwenza ube nezimpawu zihluke kumuntu nomuntu, ngakho-ke lokho okusebenza kwabanye kungase kungasebenzi kuwe.

Ukuzivocavoca okuthambile njengokuhamba ngemva kokudla kungasiza ekuqhubeni ukugaya ukudla. Noma kunjalo, qapha ukuwela phansi ngokushesha ngemva kokudla, njengoba lokhu kungase kwenze izimpawu zibe zimbi.

Kufanele ulungiselele kanjani i-appointment yakho nodokotela?

Ukuza ulungile kwi-appointment yakho kusiza ukuqinisekisa ukuthi uthola okuningi ngesikhathi sakho nodokotela wakho. Qala ngokubhala zonke izimpawu zakho, kufaka phakathi lapho zenzeka khona nokuthi yini ebonakala iyibangela.

Letha uhlu oluphelele lwemithi yakho, kufaka phakathi imithi yokuthengwa ngaphandle komthetho kanye ne-supplements. Eminye imithi ingenza izimpawu ze-gastroparesis zibe zimbi, ngakho-ke udokotela wakho udinga ukwazi konke okuthathayo.

Gcina idayari yokudla nezimpawu okungenani isonto ngaphambi kwe-appointment yakho. Qaphela ukuthi yini oyidlayo, lapho uyidla khona, nanoma yiziphi izimpawu ezilandelayo. Lolu lwazi lubaluleke kakhulu ekuxilongweni nasekuhleleni ukwelashwa.

Lungisa imibuzo okumele uyibuze udokotela wakho:

• Yiziphi izivivinyo engidinga ukuze ngiqinisekise ukuxilongwa?
• Yini ebangela i-gastroparesis yami?
• Yiziphi izinketho zokwelapha ezitholakalayo?
• Lokhu kuzothinta kanjani impilo yami yansuku zonke?
• Kufanele ngibone ochwepheshe wokudla?
• Ingabe kukhona ukudla engingakufanele ngikuphephe ngokuphelele?

Uma une-diabetes, letha ama-log akho eswekile legazi ukubonisa ukuthi i-gastroparesis ingase ibe yithinta kanjani ukulawulwa kwakho kwe-glucose. Lokhu kusiza udokotela wakho ukuhlanganisa ukwelashwa kwakho kwe-diabetes ne-gastroparesis.

Ungakhohlwa ukukhuluma nganoma yimuphi umlando womndeni wezinkinga zokugaya ukudla noma izimo ze-autoimmune, njengoba lezi ngezinye izikhathi zingase zibe nobudlelwano ne-gastroparesis.

Yini okufanele uyikhumbule nge-gastroparesis?

I-Gastroparesis yisimo esilawuleka esithinta indlela isisu sakho esikhulula ngayo ukudla, kodwa ngendlela efanele, ungagcina ikhwalithi enhle yempilo. Nakuba kungase kudinge ukuguqulwa kokudla kwakho nemikhuba yempilo, abantu abaningi balawula izimpawu zabo ngempumelelo.

Into ebaluleke kakhulu okumele uyikhumbule ukuthi i-gastroparesis ithonya wonke umuntu ngokuhlukile. Lokho okusebenza komunye umuntu kungase kungasebenzi komunye, ngakho-ke bekezela njengoba wena neqembu lakho lokunakekelwa kwezokwelapha nifuna ukuxuba okulungile kokwelapha kuwe.

Ukuxilongwa kwasekuqaleni nokwelashwa kungavimbela izinkinga nokusiza uzizwe ukhulu ngokushesha. Uma uhlangabezana nezimpawu njengokuphefumula okuqhubekayo, ukugcwala okusheshayo, noma ukugabha okungachazeki, unganqikazi ukukhuluma nodokotela wakho.

Khumbula ukuthi ukulawula i-gastroparesis kuyimisebenzi yeqembu ekuhilela wena, udokotela wakho, kanye ngezinye izikhathi ochwepheshe wokudla noma omunye ochwepheshe. Ngokunakekelwa okufanele kwezokwelapha, ukuguqulwa kokudla, kanye ngezinye izikhathi imithi, abantu abaningi abane-gastroparesis bangaphila impilo egcwele, esebenzayo.

Imibuzo evamile ebuzwa nge-gastroparesis

Ingabe i-gastroparesis ingaphela yodwa?

Ezinye izimo ze-gastroparesis, ikakhulukazi lezo eziholelwa imithi noma ukutheleleka yi-viral, zingase zithuthuke ngokuhamba kwesikhathi. Noma kunjalo, izimo ezingapheli njenge-gastroparesis ye-diabetic ngokuvamile zidinga ukulawulwa okuqhubekayo kunokuba ziphele ngokuphelele. Ngokwelashwa okufanele, izimpawu ngokuvamile ziyathuthuka kakhulu ngisho noma isimo singapheli ngokuphelele.

Ingabe i-gastroparesis yisimo esinzima?

I-Gastroparesis ingaba nzima uma ingalashwa, ingase iholele ekondlekweni okungalungile, ukushona kwamanzi, nezinkinga zeswekile legazi. Noma kunjalo, ngokunakekelwa okufanele kwezokwelapha nokuguqulwa kwemikhuba yempilo, abantu abaningi balawula izimpawu zabo ngempumelelo futhi bagcina ikhwalithi enhle yempilo. Okubalulekile ukusebenza eduze neqembu lakho lokunakekelwa kwezokwelapha ukuze uvikele izinkinga.

Yiziphi izinto engingafanele ngizidle nge-gastroparesis?

Ngokuvamile, kufanele ubekezele ukudla okune-fiber eningi (njengomifino eluhlaza nama-grains aphelele), ukudla okune-fat eningi (okunciphisa ukugaya ukudla), neziphuzo ezinobisi. Ukudla okunzima ukuhlwabusayo, njengamantongomane, imbewu, nenyama eqinile, kungase futhi kubangele izinkinga. Noma kunjalo, ukudla okukwenza ube nezimpawu kuyahlukahluka kumuntu nomuntu, ngakho-ke ukugcina idayari yokudla kusiza ekutholeni ukululama kwakho okuthile.

Ingabe ukucindezeleka kwenza i-gastroparesis ibe zimbi?

Yebo, ukucindezeleka kungenza izimpawu ze-gastroparesis zibe zimbi ngokuthinta umsebenzi ojwayelekile wesisu sakho. Izinqubo zokulawula ukucindezeleka njengokuphefumula okujulile, ukucamngca, noma ukuzivocavoca okuthambile kungasiza ekuthuthukiseni izimpawu zakho. Abantu abaningi bathola ukuthi ukulawula ukucindezeleka kuyiyingxenye ebalulekile yohlelo lwabo lokwelapha i-gastroparesis.

Ingabe ngizodinga ukuhlinzwa nge-gastroparesis?

Abantu abaningi abane-gastroparesis abadingi ukuhlinzwa futhi bangalawula isimo sabo ngokuguqulwa kokudla neminye imithi. Ukuhlinzwa ngokuvamile kugcinelwa izimo ezinzima ezingaphenduli kweminye imithi. Izinketho zingase zihlanganise ukukhuthaza ugesi kwesisu noma izinqubo zokusiza ukudla ukuhamba kalula esiswini, kodwa lezi zicubungulwa kuphela lapho ezinye izindlela zingasebenzi.