Thursday, 22 November 2018 | 1 Issue 1 | Thursday, 22 November 2018
HealthCentral.nz/FutureFocus An NZME custom publication
Health Future Central Focus
Let’s get physical Spotlight on men’s health
Getting the most from your GP
Informs. Inspires. Educates. | HealthCentral.nz/FutureFocus
Thursday, 22 November 2018 | 3
Contents Editor’s note
4: The sabre tooth tiger that’s still here – anxiety, masculinity and men’s health
6: An insider’s guide to getting the most from your GP
7: Fussy eaters and night wakers: solving the parenting puzzle
10: Coping with the big C
14: Supplements – do we really need them?
15: Winning the war against acne at any age
16: Time to take action on diabetes
17: Simple lifestyle changes reduce the risk of dementia
18: Let’s get physical
19: Patient portal opens door to personal health management
20: Keeping dental decay at bay
20: Respecting the hole in our sky: preventing melanoma
lzheimer’s, blood tests, cancer, diabetes, exercise … our first edition of Health Central Future Focus is a veritable ABC of health issues! The overarching theme of ‘managing your health’ gave us huge scope and we have picked the brains of several health advocates to deliver an issue that is hopefully as useful and interesting as it is varied. Amid the topics covered is a feature on men’s health. While November is typically a time when Kiwi males ditch the razors to raise awareness of prostate cancer, we thought it was timely to look beyond the prostate and acknowledge some other significant men’s health issues. Also of note is Dr Tracy Chandler’s ‘Insider’s guide to getting the most from your GP’. As a GP herself, as well as a mum of seven and a former patient, Tracy is well placed to give some sage advice on this topic. Enjoy! And keep an eye out for more editions of Health Central Future Focus next year.
Jude Barback, Editor
Jude Barback P 07 542 3013 E email@example.com
Fiona Reid E firstname.lastname@example.org
The next issue of HealthCentral FutureFocus will be published on 25 April 2019.
Health Media Specialist
Rob Tuitama P 04 915 9783 E email@example.com
Aaron Morey E firstname.lastname@example.org
21: Getting feet summer-ready
A new quarterly guide for health-conscious Kiwis
An NZME publication, HealthCentral FutureFocus has a print run of 90,000 copies and is inserted into the NZ Herald, Northern Advocate, Bay of Plenty Times, Daily Post, Hawke’s Bay Today and Wanganui Chronicle, attracting a combined average issue readership of 525,000 Monday–Friday readers.
Issue 1: 25 April
Family Health y y y y y
Before the baby – pre-natal health and wellbeing Pre-school and the bugs – keeping toddlers (and their families!) healthy How to get the most out of your family doctor Managing allergies and intolerances Sex, screens and teens – navigating adolescent health
Issue 2: 25 July
Diet & Exercise y y y y y
Issue 3: 28 November
Find out more
04 915 9783
Or contact your local NZME media specialist
Moodfood and mindfood – the foods that affect the way we’re feeling and thinking The fitness trends – from F45 to power yoga and everything in between Pilates – the benefits to your body and mind Coffee, wine and chocolate – the truth about our guilty pleasures The rise of veganism
y y y
Dental health – navigating the costs and systems of looking after your teeth Physiotherapists, chiropractors, osteopaths – what’s the difference and who should you see? The Green Prescription – how does it work? Depression – recognising the signs Superfoods to the rescue – the foods that pack a healthy punch
4 | Thursday, 22 November 2018
“For every young man who is clinically depressed or suicidal, there is a busload of young men out there struggling with low-grade anxiety.”
The sabre tooth tiger that’s still here – anxiety, masculinity and men's health Jaylan Boyle caught up with Dr Graeme Washer from Men’s Health Trust New Zealand and some of his own peers for a chat about anxiety, masculinity and the modern world.
ven men for whom middle age seems like a remote and abstract concept know that prostate cancer is something we’re all going to have to think about sooner or later, and while things like diabetes are may not be quite as well known, most will have some idea that the lifestyle we choose now is going to affect our health span. But Dr Graeme Washer says that the issue men still aren’t talking about isn’t as simple as a check-up. As a species, we’ve pretty much dealt with the threat of large and hungry animals as a day-today menace – at least in the world’s more affluent societies. Yet, as with so many areas of the modern human experience, our ability to usurp evolution and shape the world we live in has far outpaced the brain structures that helped us get there in the first place. The ‘fight or flight’ response, and its related physiological and emotional side effects, is one example. Washer says that the evolutionary echo of this hormonal threat response is by far the most debilitating ‘other’ men’s health issue he sees on a day-to-day basis. It’s an insidious modern disease that, because it so often stops short of acute and visible manifestation, is massively under-diagnosed, both by health professionals and sufferers. “Stopping short of depression and suicide, which we know is a huge issue, pervasive anxiety in young men is a massive problem. For every young man who is clinically depressed or suicidal, there is a busload of young men out there struggling with low-grade anxiety – or sometimes not so low-grade and issues around that, and that’s an area that’s not talked about nearly enough.
“In so many cases, these young men haven’t been able to identify that what they’re suffering from is an anxiety problem. It can express itself as social phobia, for example, which can be incredibly paralysing. Some men cover it up with things like alcohol, which of course doesn’t work very well, and it gets in the way of their relationships; it gets in the way of their work and their enjoyment of life.”
Instant gratification a contributor Washer pins the blame for this epidemic of men suffering through a fog of nervousness, tension, and non-specific worry on the society in which we live. He points to a culture of instant gratification, where we’re all expected to have achieved great things by yesterday, and we judge ourselves harshly when we fail to live up to Instagram expectations (as one aspect of this modern malaise). The constant, grating dissonance between what we are and what we think we need to be triggers some of the same response mechanisms that put us on high alert when we heard a growl in the night thousands of years ago. The problem is that this modern, very judgemental sabre tooth tiger never seems to tire of hanging around our metaphorical cave. “The world is an incredibly unsympathetic place for men who feel that they aren’t performing,” says Washer. “I think modern masculinity is in chaos. I think that our fathers and our grandfathers modelled masculinity for us – role models and expectations were clear, and those generations just put their heads down and got on with it. I think the world these days is a much more challenging place, particularly for young men – it’s
okay now to talk about masculinity, but nobody knows what that means. It’s come to mean a whole lot of different things to different people. “There’s no guidebook anymore, and I think a lot of young men really struggle with what society expects of them, and what they expect of themselves, what they’re comfortable with, and what is truthful for them.”
How is ‘being a man’ changing? The sheer pace of change in our world is compounding the conundrum of modern masculinity out of sight, says Washer. When trying to get a feel for the ways in which ‘being a man’ is changing, it’s not necessary to go beyond our own circles – that’s where ‘men’ are. For myself and my peers, approaching middle age, it’s tempting to think that we’re some sort of bridging generation – a link between the archaic ‘Marlborough man’ exemplar behind us, and the ‘woke’ generation of sleek chests and kale smoothies in front. Maybe it’s just so much poor-me gencentricity (it’s a word), but men of my age might sometimes feel as though they’re looked down on from the past and the future. One of my own most cherished social circles is the sailing team/social club/Facebook banter group that is the crew of Prime Mover, a (highly competitive) boat in Wellington’s local weekend racing competition. I sat down with two of my crewmates to express our feelings (have a whinge) about our generational place in the masculine world, and our view of the changing shape of masculinity. It’s hard to say whether we’re a representative sample of men our age, but it turns out that in many respects, we all find a lot to admire in the idealised bloke of the past.
Thursday, 22 November 2018 | 5
“Sorry, but when I see one of those shavenchested young guys, I just think ‘try-hard’,” says jib trimmer, classic stubbies enthusiast and entrepreneur Nic Ammundsen, 37. “I try my best not to, but I get frustrated with all of that. I definitely lean more toward the stoic ideal of the past, the guy who just gets the job done without complaining. With the exception of communication, I think – guys need to talk about stuff more – I aspire to that whole thing way more than I do the more modern masculine ideal.” French immigré and tactician/NIWA fisheries scientist/liberal employer of mid-race insults à la française Yoann Ladroit leans the same way as Nic, but says that it’s not just the grumbling of a generation no longer leading the way – he sees it as an erosion of aspirational humility. “When I see someone like that, I think: ‘Well, this guy is probably self-centred, he probably spends way too much time looking in the mirror’.” British spinnaker trimmer, construction abseiler and punk rock survivor Matt Chalker, 47, stresses that he doesn’t want to be understood as hankering for some kind of retrograde gender dynamic. “I don’t think it’s a slide toward femininity, I think it’s a slide toward egocentricity that we see, and that annoys us.”
Competitiveness adds to the mix Perhaps because he has sons who are articulating their own ideas of manhood, Washer sees a lot more to like in the generation currently reaching physical maturity. “I’m actually pretty hopeful. When I think of my father and my peers, and then I look at my millennial sons, I think they’re doing pretty well. My younger son is 26, and I think he and his ‘team’ are doing as well as they can do. They’re not accepting anything that’s a given, that’s been handed to them, they’re looking at the whole thing for themselves – ‘This is what we’re happy with, this is what’s true for us’. “But men are still terrified of being judged by their peers, and we’ve got to learn how to talk to each other, in ways that we don’t end up judging each other. That competitiveness prohibits us from talking about what all of this means.” Washer estimates that around 30 per cent of younger men have some degree of anxiety getting in the way of their lives. And of course, men being what they commonly are, that percentage is just those who have been able to give doctors some kind of clue as to what they’re going through, the tip of an iceberg. “I saw a young man the other day; big strong healthy lad, has no problem talking to girls, he’s
in demand socially. He told me that he’s too afraid to walk into a café and order a coffee. If he said that to his mates, they might be tempted to think, ‘Come on, you’ve got to be joking’, but it’s true. He operates at such a level of anxiety and social phobia that in groups of more than two or three he simply can’t cope. He can’t go to the pub, he can’t go to parties, he really can’t do much at all. “It’s usually not as clear as something specifically traumatic that happened to [sufferers of anxiety], a particular event that you can trace it back to. It’s a pattern of thinking that your brain has learned in a maladaptive way, and what you really need is to understand what’s happening, and to train yourself out of it.”
Shutting off the negative chatter “Men I know have done some incredible things with tools like mindfulness. Once you learn to shut off all of that negative chatter in your brain, that can resolve the anxiety. For some people who are deep in a big hole, it can take a lot of effort, but it’s doable. “You say you’re too busy to introduce yet another thing into your life? We’re all doing more than we can reasonably be expected to do. Well, my first response is to sit down with you and say ‘Ok, tell me about your life, and let’s declutter it.”
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6 | Thursday, 22 November 2018
An insider’s guide to getting the most from your GP Dr Tracy Chandler (aka Dr Wellness) explains how a preventative medicine approach can change your health.
ur GPs are truly the proverbial unsung heroes. Trying to solve a patient’s health issues in the standard 10–15 minutes allocated for the conventional GP appointment is a huge challenge, especially when that patient sees a different doctor each time. How do I know this? As a mum of seven children, an integrative GP (ex-conventional GP), a Health and Disability Commission expert and an ex-patient, I have first-hand knowledge. But I’m not going to regurgitate the usual blurb out there, such as ‘take a list with you’. This is my integrative (aka preventative) medicine spin on how to REALLY change your health.
15 minutes is not long enough My integrative medicine training quickly showed me that to truly turn your health around, GPs must spend much more time with you then they currently do. This seems simple, but unless you have multiple 15-minute conventional GP appointments (with the same GP), your only other option is to see a private integrative GP, who will spend 60–90 minutes going through extensive medical questionnaires. To really help you, your GP needs to know everything about your life, not just about your one symptom.
Find a GP who understands biochemical pathways Biochemical pathways are all the processes that drive our bodies. Most GPs have had very little biochemistry training and even less training on how nutrition and environment affect these pathways. The only way to help prevent or heal diseases is to detect and treat biochemical issues. These multiple pathways all interact so if there is an issue in one pathway, it will affect all other pathways. For example, if you have issues with the energyproducing pathway, you’ll also have problems making brain chemicals. The conventional medical model of compartmentalising patients into ‘heart’, ‘gut’ or ‘brain’ issues, for example, can’t possibly provide any effective or lasting changes to your health.
Discuss important problems first Along with untangling your biochemical pathways, there are around 30 reasons why you may have chest pain, for example. This takes time, so please discuss important problems first. The most challenging thing for your GP is the ‘hand-on-the-doorknob’ scenario. This is where you mention the chest
pain that could be a heart attack after most of your 15-minute appointment has been about managing your wart.
Ask for more local lab testing than the basics Being an independent GP, I test for more health markers than conventional GPs usually do. For example, because of the cost, GPs don’t generally check vitamin D levels unless the patient has specific conditions. This is despite the fact that low vitamin D levels have been linked to cancer, depression and low immune function.
Access specialised overseas functional testing Ask if your GP is willing to access specialised overseas functional testing to look at things like hormonal or gut health, and chemical or heavy metal exposure like mercury, in a much more comprehensive way. If not, these are available from integrative GPs.
Be honest with your GP about medicines and complementary therapies Tell your GP about your desire to try complementary therapies such as acupuncture and nutritional supplements/herbs. Most will be supportive and it’s important they are aware of everything you take, including over-the-counter medications, as it is possible that these could interact with any medications you are on or about to be prescribed.
Ask to see your blood test results And ask an integrative medicine doctor to interpret them for you properly. Integrative medicine doctors interpret your blood tests results in a much more individualised way. We don’t accept the reference ranges that labs give us and we have a lower threshold for treating results like vitamin D. An example of why we do this is a patient I saw who had hormone and gut issues and tiredness. We tested her extensively and discovered a range of slightly abnormal markers. Even more disturbing was that conventional medicine would not have done anything about these results as they would not have been considered abnormal enough! Treating slightly abnormal results is essential to integrative medicine doctors. Be assured, much more can be done to prevent and treat disease than is offered by conventional medicine alone.
Your GP needs to know everything about your life, not just about your one symptom.
Thursday, 22 November 2018 | 7
Fussy eaters and night wakers: solving the parenting puzzle Karitane Mothercraft Nurse Dorothy Waide offers sage advice for parents of little ones – but warns there is no ‘one size fits all’ guideline for parenting.
arenting is rather like a puzzle – it’s getting the pieces to fit together. Every family has its own unique puzzle to work through. How do we avoid fussy eaters and how do we create good sleepers? For some families, eating and sleeping is not an issue, but for others it is a struggle. I always say that there is no right or wrong way to parent – but there are easy and hard ways. Parenting is a lifelong journey and encouraging both good eaters and sleepers is part of this.
How to create good sleepers... In my experience, if babies and toddlers sleep well, they feed well. Routines are debated around the world and the question is: what makes a routine? To me it is about flexibility and listening to your baby. I encourage parents when working towards a routine to try and work 30 minutes either side of what your ‘desired’ times are. In my experience, it is the start of the day that sets the routine, not the evening routine, and if the last wake cycle is longer than the others this can or may contribute to night waking. My recommendation is that the wake cycles are kept consistent (80 per cent of the time) and, if there is a variance, the last wake cycle is no longer than the longest wake cycle. Naps will vary in length but the goal here is to encourage in most cases two sleep cycles per nap. There are many reasons why babies and toddlers wake at night. There is no simple answer but in my experience it is the daytime routine that makes the night routine.
…and good eaters When introducing solids, the biggest concern I have is that we have too many professionals or professional charts showing fruit as the first foods. If you want a veggie-eater then get those vegetables in first. As well when
introducing veggies, you need to offer a wide variety and in the beginning this will include the non-seasonal veggies as I find if you wait for them to come into season some babies will not easily accept them as one of the yummy ones. If you are feeding purees to your baby, my suggestion is to offer the same food cooked as finger food next to their purees so that they can learn texture, taste and smell – this is important for when you stop pureeing as quite often the change from purees to finger food can stop a baby loving their veggies. How long a baby or toddler can eat purees is a question I am often asked. My answer is as long as they want, as long as they are eating or seeing the finger food, too. If parents are concerned then I suggest they have the baby/ toddler checked by a paediatrician to ensure nothing else is going on. If your baby will not take the food from a spoon, use your finger and also ensure your baby isn’t over-tired or over-hungry – or just over it! – when introducing solids. Solids should be given in a calm environment; making a mess and doing just one clean-up at the end of the meal. Remember, fussiness can encourage irritability and babies not wanting to try eating. Also, when starting with veggies, a lot of babies are put off by the taste of one veggie on their own, so I always encourage parents to start with one carb (like kumara, for example) and one other veggie, like pumpkin. Then when you are adding the yummy greens, add a smaller portion to the mix so that it adds a different taste but doesn’t overpower the base mix. For older toddlers and children who have started to refuse their food at mealtimes, check out what foods and how much they are eating for snacks. More often than not they are processed, and by lunchtime most have had their two fruit servings. Remember, the
guideline for fruit is two servings per day and for adults one serving. If working with reflux babies who There are having digestive issues, I tend to remove the following are many foods: apple, banana, kiwifruit, reasons why babies avocado, potato and carrot. This is a guideline only, and toddlers wake but it is amazing how if one at night. There is no or more of these these is a trigger we can end up with simple answer but in a happy, well-rested baby. my experience it is the Older reflux babies can daytime routine that seem like fussy eaters as they become toddlers; however, makes the night often this is because they routine. associate food with a sore tummy. One way that I find works for the fussy feeder when they are older is to pop them in their bathtub, take a container like an old ice-cream container and fill it with food so that they can learn through play to enjoy food. For night wakers, I also look at the foods they eat after lunch and often suggest removing fruit, processed sugars, yoghurt and cheese. Many parents who do this find their children are sleeping through the night before they know it.
One size doesn’t fit all What works for one family won’t necessarily work for another. It is often a case of working with both sleep and food as these are the two nutrients that babies and toddlers need. Once children are on solids, their night nutrient is sleep and their day nutrients are a mixture of food and sleep. Remember to enjoy it; parenting is the toughest job in society – but is also the most rewarding. Dorothy Waide is a Karitane mothercraft nurse and the author of You Simply Can’t Spoil a Newborn.
8 | Thursday, 22 November 2018
Why humans need optimal daily doses of vitamin C John Appleton points out that humans are one of the very few species that don’t produce their own vitamin C – yet it is vital to our health and wellbeing.
ven though for most New Zealanders the flu season is over and summer is on its way, it’s very important to understand that we all need optimal vitamin C every day of the
year. Did you know that the only mammals on the planet that don’t make vitamin C in their bodies are humans, primates, guinea pigs and fruit bats? In the body of a vitamin C-making mammal, the vitamin C molecule is made from a few small modifications to the glucose molecule. While glucose is in abundant supply in humans and animals, four enzymes are required to convert glucose into vitamin C. Humans have only three of these enzymes, having lost the ability to make the fourth L-gulonolactone oxidase somewhere throughout evolution. Of the four mammals mentioned above, the human is the only one that eats meat and is unable to produce vitamin C. Primates, guinea pigs and fruit bats seem to know instinctively that to stay healthy they must ingest large quantities of foods containing vitamin C. Fruit bats are so named because they favour fruit as a primary source of food. In mammals that retained the ability to make vitamin C, it is made in response to all sorts of stress, especially the stress of infection. Under
stress, that amount can be very significantly increased. A goat, for instance, can make up to 200 mgs/kg on a daily basis but will make up to 100,000 mgs of vitamin C daily if under stress. Why is it then that the RDA (recommended daily allowance) for humans is 1 mg/kg – approximately 60 to 90mgs per day? If vitamin C is so important to animals why do humans require so little? This is a very important question. Anyone who takes even the slightest interest in vitamin C would soon realise that humans have been significantly short-changed. RDA, in my opinion, should stand for Ridiculous Daily Allowance and it’s almost certainly the reason why diseases so prevalent in humans are almost non-existent in animals that make large amounts of vitamin C. It is very interesting to note that mammals that make their own vitamin C can live 8-10 times beyond their age of physical maturity. Mammals without this ability have difficulty reaching 3-4 times. It is even more interesting to contemplate the impact on mankind if it were possible to reinstall the L-Gulonolactone Oxidase enzyme in humans. In a study conducted by Sato et al. in 1966, researchers administered this enzyme (harvested from chickens or rats) to guinea pigs on a vitamin C-deficient diet.
The guinea pigs survived and Dr Thomas Levy in his fascinating and thought-provoking book Vitamin C – Curing the Incurable suggests that this research “should stimulate further research into the feasibility of giving such direct enzyme replacement therapy to humans”. It is incredibly rare, according to Dr Levy, for an inborn error in metabolism to be shared by all humans. Considering anecdotal evidence of a certain individual living to 100 while smoking and drinking daily, Dr Levy agrees that one can be blessed with a very efficient immune system, but he suggests that the ability to synthesise L-Gulonolactone Oxidase, at least to a limited degree, could also be the reason for an otherwise long and healthy life. To support this, a UCLA study in 1992 involving 11,348 participants over 10 years showed that men with the highest blood levels of vitamin C lived for up to six years longer than those with the lowest levels. Albert Szent Gyorgyi, who is credited with discovering vitamin C, said: “If you don’t take ascorbic acid with your food you get scurvy, so the medical profession said that if you don’t get scurvy you must be all right. I think this is a very grave error.”
GOATS AND HUMANS ... 185 mg/kg/day (13,000 mg/day) in health and up to 1,400 mg/kg/day (1000,000 mg/day) when stressed or ill
Makes none of his own: RDA 75 mg/day = 1.2 mg/kg/day For more information, visit www.johnappleton.co.nz
LYPO-SPHERIC VITAMIN C This is a very special form of vitamin C that encapsulates the vitamin C in Liposomes. New Zealanders Can Take Lypo-Speric Vitamin C: • When travelling abroad by air or sea to support their immune defences while away from home. • When going into hospital and when they come out to support immunity, a healthy recovery and normal healing. • To support recovery and to improve overall quality of life during difficult times. • When seeking to achieve a healthy response to stress. • When seeking to support the synthesis of collagen which is the key to healthy glowing skin. Vitamin C is essential for collagen synthesis. • To support the function and integrity of healthy arteries, blood vessels and cartilage. Collagen is the reinforcing and load bearing element in artery walls. Collagen makes up 10-20% of cartilage around joints. Lypo-Spheric Vitamin C committed to supporting the wellbeing of New Zealanders To find out why Lypo-Spheric Vitamin C is so highly regarded. Get yours today Ask for it by name at pharmacies and health-food stores nationwide or online at John Appleton Auckland For more information phone: 0800-754-673
Always Read the label and take as directed. Vitamins are supplementary to a balanced diet. Appleton Associates, Auckland
10 | Thursday, 22 November 2018
Coping with the big
Cancer Society chief executive Mike Kernaghan talks to Rebekah Fraser about supporting friends and loved ones with cancer.
eceiving a diagnosis of cancer can be overwhelming, but no one needs to go through the experience alone. Cancer Society chief executive Mike Kernaghan says that there are various types of support for a person with cancer – practical, physical, emotional and spiritual. “You may not see yourself as a supporter, rather as someone simply taking care of a person who needs you.” He says a supporter’s role may be a natural extension of a relationship, or it might mean adjusting the relationship you have with the person already. Each situation, and each diagnosis, is different, he says. “Everyone handles things differently. No two people are the same. Listening is key. By listening, you can help your loved one to talk about their concerns, which could help them to put them in perspective. You don’t have to be a brilliant conversationalist. You don’t have to know all the answers, or even any of them. Just being there and listening is all that may be needed.” He says one of the most difficult things many people with cancer face is isolation. “Don’t avoid them. People avoid them because they don’t know what to say. The key is to tell your friend, loved one, colleague, ‘I don’t know what to say in support; however, I’m here to listen or help out where I can’.” Kernaghan says that silence is also an underrated tool. “It’s actually okay. Your friend may want to be silent for a while to think about things, or merely to rest from talking. If you can be quiet, this may be the right response as there may not be anything to say.” He suggests avoiding telling the stories of other people you have known with cancer. “Your role is to be a friend and support them in making contact with those who can help.”
Don’t become an ‘expert’ Kernaghan says supporters should try to avoid becoming experts in medical terminology. “Definitely avoid Google. We recommend speaking with those in the know and getting your friend or family member to write down a list of questions for their treatment healthcare professional before appointments.” Going to appointments alongside the person is also a good idea, he says. “Often they do not take on board everything that is said.” The Cancer Society has an up-to-date online glossary, as well as hard-copy publications, that can help explain medical terms.
Around 23,000 new cancer diagnoses are made each year in New Zealand. Survivorship rates – the number of people surviving for five years after initial diagnosis – are increasing each year and are currently sitting at 67 per cent.
“Also avoid giving people information about nonevidence-based treatments. This is not helpful and could cause further distress.” He says sometimes people find that what is most important is to remain the person you were before the diagnosis. “Cancer does not define the person. If you used to watch rugby with them before, then continue to offer to do this.” However, supporters should be wary of over-committing and under-delivering. “Be realistic about what you can do. Keeping in regular contact, even via phone, can be enough.” Treatments can take a toll on cancer patients, he said. “Your friend may not be as available as they were before. Don’t give up on them. They may actually need you more after treatment has finished.” The Cancer Society has a range of resources to support those with cancer, or those helping loved ones through cancer. “We know how a cancer diagnosis can affect every aspect of your life and we are here to help you through.”
You don’t have to know all the answers, or even any of them. Just being there and listening may be all that’s needed.” Cancer Connect peer support Cancer Connect, operated by the Cancer Society, provides peer support for those dealing with a cancer diagnosis. “We can put you in touch with someone who can relate to what you’re going through.” Every Cancer Connect peer supporter has had cancer, or cared for someone living with cancer, says Kernaghan. The Cancer Society website also offers a wide range of support services, and local divisions allow people to speak to someone within the Society directly. “If you want to talk, we are here to listen. No one should face cancer alone.”
INTERNATIONAL VITAMIN C SYMPOSIUM 15-16 February 2019 AUT – AUCKLAND – NZ Vitamin C for Cancer and Infection from Bench to Bedside A Symposium to share the latest scientific and clinical research on the potential use of vitamin C for cancer and infectious diseases FULL PROGRAMME INCLUDES •
ONE DAY SCIENCE AND MEDICINE SYMPOSIUM
Featuring scientists and clinicians from Universities in Europe, the USA and New Zealand Who should attend? Doctors, Nurses, Pharmacists, students and trainees, biomedical and clinical researchers, hospital administrators, policy makers. •
PUBLIC SESSION Saturday 16th February
Featuring speakers from the Friday Symposium Who should attend? Anyone with an interest in finding out more about vitamin C and its potential for use in treating human illness.
To find out more and to register for this special event Visit vitaminc2019.co.nz
The “Vitamin C for cancer and infection – from bench to bedside Symposium” activity has been endorsed by The Royal New Zealand College of General Practitioners (RNZCGP) and has been approved for up to 8.4 CME credits, for the General Practice Educational Programme (GPEP) and Continuing Professional Development (CPD) purposes. The College of Intensive Care Medicine of Australia and New Zealand (CICM) has registered the ‘Vitamin C for cancer and infection – from bench to bedside’ activity for CPD accreditation: Lectures – Category 2A: Passive Group Learning – 1 point per hour.
12 | Thursday, 22 November 2018
High performance requires energy E
A world-first, mitochondria-targeted CoQ10 antioxidant can keep us fighting fit – even as our mitochondria start to slow down as we age.
very action our body takes requires energy: our heartbeats, our muscle movements, our ability to chew, digest and absorb nutrients – all rely upon a constant and steady supply of energy. And energy is produced by our mitochondria, the tiny, bean-shaped power plants working hard inside each of our 37 trillion cells. Mitochondria combine the food we eat with the oxygen we breathe and turn this into the essential fuel our cells need to work – and, ultimately, survive.
For our bodies to perform properly, we need our mitochondria working like finely-tuned engines. When we are young and healthy, our mitochondria work at maximum efficiency, giving our cells all the energy they need. We can run and jump, fall and get back up again. We bounce back quickly from injury and illness. Once we hit our thirties, mitochondria naturally start to decline in performance – around 10 per cent per decade. We don’t notice it immediately, but over time, we start to have less energy; we don’t recover as quickly from injury or illness; our organs age; and we start to look and feel older. What causes mitochondria to slow down? The cellular energy generation process produces potentially damaging by-products called free radicals. In a way, free radicals are like polluting exhaust emissions generated by fuel-burning engines. Mitochondria are 10 times more exposed to free radicals than any other parts of cells, and as a result they start to suffer from wear and tear (see Figure 1).
A word about free radicals: they might be free, but they can be costly. The good news is that mitochondria are clever: they stack themselves with a naturally produced antioxidant called CoQ10 and use it to line the mitochondrial walls with a defensive barrier that neutralises the corrosive free radicals and minimises any negative impacts on energy production. However, as we age, the level of CoQ10 produced inside our mitochondria declines. This means that fewer free radicals are neutralised and the defensive barrier is less secure. Free radicals escape into the cells, looking for trouble, and the damage starts to accumulate. When the level of CoQ10 declines to a point where it cannot counteract the damaging effects of free radicals, our cells are placed in a state of oxidative stress and we start to feel the negative effects.
Reducing oxidative stress should be your #1 health goal. Oxidative stress is a big deal. Not only is it thought to be a major cause of the aging process, but it can also cause some serious health issues downstream. In fact, oxidative stress is known to be a precursor to many serious health conditions. It has become increasingly evident that our overall health and wellbeing are closely related to how well our mitochondria are performing. Minimising oxidative stress starts with looking after your mitochondria, helping them to keep performing at their best. It should could come as no surprise that all the components of a healthy lifestyle – a good diet, regular exercise and adequate sleep – all combine to create an environment in which your mitochondria can thrive. But it’s important to note that even if you look after your mitochondria through a healthy lifestyle, they still slow down naturally with age. That is why, along with making healthy choices, taking a supplement that
actively supports mitochondrial performance is a smart strategy to help you maintain energy levels, protect your cells and support your ongoing wellbeing and longevity. MitoQ® is a world-first, mitochondria-targeted CoQ10 antioxidant, which is absorbed through the mitochondrial membrane directly into the body of the mitochondria, hundreds of times more effectively than regular CoQ10 supplements. The mitochondria use MitoQ® to reline the mitochondrial membrane, helping to maintain its structural integrity and strengthen the defensive barrier. This means that free radicals can be neutralised and their levels can be contained,
meaning normal energy production continues unaffected and the risk of harm to our delicate cell equipment is reduced (see Figure 2). MitoQ® is one of the most-studied mitochondrialtargeted antioxidants. To date, over $60m of independent research and over 350 peer-reviewed articles have been published, testing MitoQ® across a range of health-related applications. Research has shown that after oral administration, MitoQ® rapidly accumulates in mitochondria-rich tissue such as the heart, brain, skeletal muscle, liver and kidney, helping to guard against oxidative stress and maintain healthy function and performance.
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– do we really need them? Jody Hopkinson talks to naturopath Yolande Waho about which supplements and vitamins we need at different stages of our lives.
limate change was once considered the mad mumblings of a few crackpots. Now we know that, alongside glaciers melting and crazy weather patterns, climate change is a real threat. Similarly, taking vitamin supplements has been refuted for many years, being seen as a ‘have’ by those in the alternative medicines industry. However, we now know that today’s soil lacks many of the vitamins and minerals necessary for our healthy growth and survival. These days it is believed we need to eat five times the amount of vegetables daily than our grandparents did to get the same benefits. What is more, recent studies suggest that not only is the soil depleted but also the glyphosates in some pesticides now stop the plants themselves from producing the same nutrients and phytochemicals they once did. One of the ways we can remedy this deficiency is via supplements, but which ones, and when? As Yolande Waho, a naturopath in Papamoa in the Bay of Plenty, explains, herbs on their own aren’t always powerful enough to compensate for what we no longer receive from our food.
“You can add things like molasses, which has many vitamins and minerals all working synergistically together.”
Three important supplements
Food-based supplements best
“In general, the three most important supplements I recommend are zinc, vitamin D and magnesium. Zinc is really limited – it’s very hard to get from our diet. Our vitamin D is depleted due to the lack of sunshine on our skin because we’re using sunblock and sitting in the shade. And we’re not eating full-fat dairy products – we are being depleted of vitamin D by low-fat diets.” Yolande says the way we operate in the western world is inherently stressful. “Magnesium in our bodies is depleted by stress and if we live in the western world we have a stressful lifestyle – so it’s always being depleted. We get magnesium from dark green vegetables and we’re not getting enough of those in our diet. “And calcium actually depletes our levels of magnesium. A problem of Western medicine has been, until recently, an overemphasis on our need for calcium. So many people are supplementing with calcium and we’ve been doing it for decades – the calcium is depleting the magnesium and now we know it’s vitamin D that makes our bones strong – it’s a vital factor in bone strength. We now know you can’t just add heaps of calcium and you’re sorted – too much calcium can cause a whole lot of other problems like heart problems.”
Yolande says that while the soil and quality of our food isn’t ideal, it is still better to have food-based supplements than to take one vitamin in isolation. “You can add things like molasses, which has many vitamins and minerals all working synergistically together. Liver is another thing more people have begun eating more of recently because it has so many dense nutrients in it.” So if we need to take vitamin supplements to stay healthy, which vitamins should we take, and at what time in our lives? “It doesn’t so much depend on what age or gender you are but more on what conditions you’re presenting with,” says Yolande. “When it comes to vitamins and supplements, it is better to go to a professional – firstly because you don’t want to blow hundreds of dollars on your journey to sort out your health. A practitioner can assess whether it is, say, adrenal fatigue or depression. Or perhaps it is something in their diet they are reacting to.”
Yolande’s tips yy For kids: Vitamin C for extra immune boosting, and vitamin D for bone growth. yy For working people: Magnesium and a vitamin B complex to combat stress. yy For seniors: Zinc and selenium, to guard against the diseases of old age.
Thursday, 22 November 2018 | 15
Winning the war against acne at any age Dermatologist Dr Victoria Scott-Lang says acne is a medical condition and should not be accepted as the norm – at any age. As she outlines here, there is lots that can be done about it.
cne has been a big part of my life, both professionally and personally, for many years. As a consultant dermatologist with over 10 years’ experience of caring for patients with skin disease, I see hundreds of patients a year with acne, ranging from tweens and teenagers to men and women in their 50s and 60s who have battled with their skin for years. Being a fellow acne sufferer since I was 14, I have a real personal insight into this condition, which helps the way I approach my consultations. Acne is often a lifelong battle, with ages and stages of our lives determining its activity. Acne can have a significant impact on self-esteem, confidence and personal relationships, and even dermatologists are not exempt from this. Over the years I have had patients commenting to me about my acne, questioning why my own skin is so bad, asking me if I can really be trusted to treat theirs. This has been difficult to swallow. As a hormonally driven process, we know that acne has peaks and troughs at different times of our lives. Puberty, pregnancy and the menopause are notorious culprits for flare-ups. My own acne has been particularly bad through my two pregnancies (both boys) resulting in scarring, and at times of stress when studying for pivotal physician exams. Medical management for women is often dictated by their family planning intentions, pregnancy and breastfeeding, and so having a good approach to self-management is particularly helpful for many patients.
Does diet affect my acne? This is probably the most commonly asked question from patients. One study in the US found an increased incidence of acne in teenagers who drank low-fat milk compared with those who drank full-fat milk. No other study has demonstrated a conclusive link with dairy consumption, and I do not routinely recommend elimination of dairy from diets. There is, however, more evidence to suggest that following a low-GI diet can be beneficial.
High carbohydrate foods results in blood sugar spikes and the production of insulin, and IGF-1 (insulin growth factor 1). These in turn can increase oil production and promote the production of male hormones (androgens), which exacerbate acne. Making good carbohydrate choices like wholemeal bread rather than white, incorporating pulses and vegetables into your diet, and minimising sugar intake can be helpful for some patients.
Making good carbohydrate choices like wholemeal bread rather than white, incorporating pulses and vegetables into your diet, and minimising sugar intake can be helpful for some patients. What skincare should I use? Skincare is an important aspect of acne management and often overlooked. It can be overwhelming to know which products to use and I generally aim to keep things simple for patients with oil-prone skin. Morning: Cleaning the skin in the morning is recommended for all patients. You may wish to consider using an antioxidant serum in the morning, if skin ageing is a concern. Next apply a light moisturiser and sunscreen, either combined or separately. Try to build sunscreen into your everyday skincare routine, to prevent sun damage and premature ageing. An ultra-light sunscreen is recommended, rather than heavy products that can cause further breakouts and congestion.
A low-GI diet Evening: For those who wear make-up, includes foods such as double cleansing at night, firstly fresh fruit and vegetables, with micellar wholegrains, lean meats water and then a and seafood, and excludes, cream cleanser is recommended or keeps to a minimum, Avoiding facial processed foods, such as oils and heavy creams is important biscuits, cakes, chips, as these will block pastries, sweets. pores. Instead look for products labelled as noncomedogenic. For those with very oily skin, a toner containing glycolic acid can assist with improving congestion. Next up are serums; these are products that contain active ingredients and are an important tool in acne management. Good ingredients to look for are niacinamide, retinol and retinyl palmitate. I recommend exfoliating twice a week, ideally with a product containing alpha hydroxy acids and beta hydroxy acids, which will refine pores and enhance overall skin texture. Patients with oily skin do not usually require a moisturiser at night. When should I see a GP or dermatologist? If you are struggling with acne, either with the physical or emotional impact or both, please do make an appointment with your GP or see a dermatologist. Many patients will need to move onto prescribed medications, for example strong topical retinoids, oral antibiotics, the combined oral contraceptive pill, spironolactone or isotretinoin. Acne is a medical condition and should not be accepted as the norm – lots can be done about it and we take it seriously. Seek professional help if you are battling this condition and not winning, at any age. Dr Victoria Scott-Lang is a dermatologist at KM Surgical and Dermatology Associates, Christchurch.
16 | Thursday, 22 November 2018
Time to take action on diabetes With November being Diabetes Action Month, Diabetes New Zealand is challenging all Kiwi families to act now to live well.
t’s the condition that affects nearly a quarter of a million New Zealanders and is growing at an unprecedented rate. In 2017 the Ministry of Health estimated more than 245,000 Kiwis have diabetes, approximately 90 per cent of whom have type 2 diabetes. Over the past five years, this number has grown by an average of 5,000 per year, and the Ministry of Health estimates that a further 100,000 Kiwis have type 2 diabetes but are undiagnosed.
What is type 2 diabetes? Diabetes occurs when the pancreas is no longer able to make insulin, or when the body cannot make good use of the insulin it produces. Unlike type 1 diabetes, which occurs suddenly due to an autoimmune reaction, type 2 diabetes is a slow-onset metabolic condition in which the body progressively fails to produce insulin and body cells resist insulin action. Symptoms usually include feeling tired and lacking energy, feeling thirsty, going to the toilet often, getting frequent infections, poor eyesight or blurred vision and often feeling hungry. However, not everyone with type 2 diabetes has symptoms, which is why it’s important to know if you’re at risk. Everyone is at risk of type 2 diabetes, some more than others. An early diagnosis means you can take action to manage the condition and help reduce the chances of developing complications such as blindness, kidney disease, limb amputations or heart disease due to nerve or blood vessel damage.
Act now to live well During Diabetes Action Month this November, Diabetes New Zealand is challenging all Kiwi families to act now to live well. Whether you have diabetes, are at risk of diabetes, or support someone with diabetes, you can act now to make a difference to your health and live well. Here’s how: Eat healthy food Making healthy food choices can help reduce your risk of developing diabetes. Eating healthy food is also an essential part of managing diabetes as it helps with blood glucose control. Visit diabetes.org.nz for more information on healthy eating, and the new Eat Well, Live Well recipe book from Diabetes New Zealand for delicious, affordable and family friendly meals.
Do regular physical activity Exercise is great for everyone, especially those with diabetes, as it can help manage blood glucose levels. Thirty minutes or more of moderate physical activity each day can also reduce the risk of developing type 2 diabetes. Keep your weight in a healthy range Excess weight can add pressure to your body's ability to use insulin properly and control blood glucose levels. Keeping your weight at a healthy range can help reduce your risk of type 2 diabetes, or help manage the condition if you have it. The good news is that eating a healthy diet and exercising regularly can help you achieve and
maintain a healthy weight. Check out Diabetes New Zealand’s Take Control Toolkit (on the Diabetes New Zealand website or in your app store), for helpful tools and tips on food and nutrition, physical activity,and health and wellbeing. Find your circle of support With support, it’s possible to reduce your risk of type 2 diabetes or live well with diabetes if you have it. Connect with friends and wha-nau to take action together to reduce your risk of diabetes, manage diabetes, or support someone you know with diabetes.
What is your risk of developing diabetes? Awareness of your level of risk of developing type 2 diabetes is a good starting point to know if you need to visit your health professional for appropriate testing. Just answer the quick questions below and you will receive a score that will help with understanding your level of risk and next steps.
I am overweight for my height
I do very little physical activity
I often eat foods high in fat
There is, or has been diabetes in my family
I’m of Ma-ori, Pacific Island, South Asian or Middle Eastern descent
I have had a baby weighing more than 9lbs (4kg) or high blood glucose during pregnancy
I am between 35 and 64 years of age
I am over 65 years of age
Family – origin
Total Score 3-5: You are probably at low risk for having type 2 diabetes now. However, you may be at a higher risk in the future. Score 6 or more: You are at greater risk of having type 2 diabetes. Act now by visiting your health care provider to find out if you could have diabetes.
Thursday, 22 November 2018 | 17
Simple lifestyle changes reduce the risk of dementia When it comes to reducing the risk of developing dementia – and living well if you have a diagnosis of dementia – the general rule of thumb is that what’s good for the heart is good for the brain.
According to Alzheimers New Zealand, almost 70,000 Kiwis are living with dementia today and more than 170,000 will be living with dementia by 2050.
eeping an active mind and body is crucial to helping you continue to get the best out of life. “If we enter old age with better developed, healthier brains, we are likely to live longer, happier and more independent lives, with a reduced chance of developing dementia,” says Alzheimers New Zealand chief executive Catherine Hall. “Living a healthy lifestyle, keeping our brains active and remaining socially engaged can help keep our brains healthy. These are of great benefit too for people who have or are showing signs of dementia, as they may help to slow the progression of their dementia.”
Social engagement and activities Social engagement is also beneficial to brain health because it stimulates our brain reserves, helping to reduce the risk of developing dementia and depression. Remaining socially engaged and an active part of the community is important for people with dementia, so try and make time for friends and family. You can even combine your social activities with physical and mental exercise through sport or other hobbies. Activities that help to keep the brain active include: yy reading yy listening to the radio yy visiting museums yy taking a course in something you’ve always wanted to learn yy learning a new language yy playing musical instruments yy artistic and other hobbies
yy participation in leisure activities, such as sports, hobbies, dancing, gardening, shared interest groups, cultural activities yy conversation yy board games yy crosswords yy puzzles like Sudoku.
Mental exercise can and should be fun. Almost any type of mental activity you do can help, but try to keep it varied, interesting, and do it as much as possible.
Exercise and diet Along with keeping an active and social mind, maintaining a healthy lifestyle and eating well can significantly contribute to brain health. Keeping active and involved in social activities can help to manage the symptoms of dementia. So, rather than giving up the things you love to do, see if they can be modified to suit your abilities. Thirty minutes of gentle exercise such as brisk walking five days a week is all you need to improve your health. But if you have any health conditions that limit your ability to exercise, make sure you talk to your doctor first. Eating a well-balanced, nutritious diet is also beneficial. While more studies into the benefits of specific foods or supplements are needed, we do know that eating lots of fatty and processed foods, which are high in saturated fat, sugar and/or salt, is associated with a higher risk of heart disease and is best avoided. There is good evidence that eating a Mediterranean-style diet can reduce the risk of developing some forms of dementia. As yet, no single factor has been identified as the cause of dementia, and there is no cure. But there are ways to reduce your risk of developing dementia, but also to live well with a diagnosis of dementia, by making a few simple lifestyle changes.
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Let’s get physical Exercise Association of New Zealand chief executive Richard Beddie says the biggest challenge with physical activity is getting started.
t’s now well known that exercise is ‘good for you’ – with countless research articles proving exercise helps not only with body transformation, but also with mental wellness, as well as providing numerous health benefits both now and long term. While knowing this helps, the real challenge isn’t what to do, but how to start, so read on for some top tips. Most importantly, start your exercise with the intention of building a habit, and focus on how you feel after a workout as a measure of success. While you may have specific goals in mind when starting physical activity, by focusing on how you feel after exercise, it will reinforce your psychological need for an instant result. That feeling might be as simple as “I feel good I did it” or “I slept better that night” or eventually “My body feels better afterwards”. Do this every time you exercise and you will be creating a positive feedback cycle. In the short term it’s really useful to make attendance your first goal, and to set it at a level you will achieve in reality. Many people want to exercise three times a week, and when they only go twice they feel they have failed. Going twice a week is actually a fantastic result for anyone who hasn’t been exercising before and should be recognised as such. Over time, this attendance goal can increase, but in the short term, make it all about what you can commit too.
Five top tips when starting 1. Find an activity you enjoy. This might be something you have done in the past, or something you have always wanted to try, but whatever it is, if you enjoy it this will dramatically increase the likelihood of sticking with it. If you find you really don’t enjoy any physical activity, pick the thing you dislike the least. 2. Do it with a friend. Pick a friend with an interest in similar activity and at a similar fitness level. This provides external motivation to each other, along with accountability too. 3. Get some expert help. This might be a yoga teacher, a personal trainer or an exercise professional at your local gym to give advice and support on what to do. (And just to be clear, while online can be a great place to find useful information, it’s also full of lots of half-truths, and individuals selling snake oil.) 4. It’s OK to stop – just focus on restarting. We all fall off the bandwagon. 5. Quit smoking. There is really good research that shows people who start exercising and quit smoking at the same time are actually more likely to stick to both than someone who does just one of these. Plus you can use the saved money to pay for any costs of joining the gym or doing a yoga class.
Busting some myths yy You have to workout hard to get a result. Almost any level of physical activity will get results. Intensity is something that can help certain goals, but so can duration, and so can the type of activity. Focus on doing the thing you enjoy and let intensity come in time if it’s not your thing. yy You have to go three times a week. While exercising frequently is a good idea (the World Health Organization recommends five times a week), even going once or twice a week will still provide significant health benefits, as well as making your body feel a lot better too. yy You have to be fit to go to the gym. Many people who go to gyms are there to improve the way they look and feel, and like everyone else, haven’t got there yet. While gyms and exercise facilities in general aren’t the only places you can do physical activity, they can provide lots of options. If you’re considering one, make sure you not only look at what it offers, but also feel comfortable with how it feels – after all, this is a place you intend to visit regularly, right? A final reminder: your body is one of your greatest assets, and you only get one. Give your body the gift of physical activity and it will love you for it. But make sure when getting personalised advice about what’s right for you, it’s from a registered exercise professional who is not only qualified to do so, but is also bound by a professional code of conduct.
While you may have specific goals in mind when starting physical activity, by focusing on how you feel after exercise, it will reinforce your psychological need for an instant result.
Thursday, 22 November 2018 | 19
Patient portal opens door to personal health management
ManageMyHealth is a secure website that allows users to access thier personal health information from anywhere in the world.
Rebekah Fraser looks at how one online patient portal is changing the way we manage our health.
anaging your health and medical records online is becoming a reality with the development of patient ‘portals’. ManageMyHealth is one such system that allows people access to their health information wherever there is an internet connection. The programme is currently used by about 410,000 people around the country and can be accessed via desktop or a mobile app. Medtech Global chief architect Sanjeewa Samaraweera says the portal also allows patients to communicate with their doctor virtually. “The online patient portal gives patients the freedom to manage their health needs anytime, anywhere.”
Access to records and results Through ManageMyHealth, patients can access lab results, immunisation records, allergies, prescriptions and medical records. It also provides online tools to improve their health, track their progress, and email their practice team. Users could add their own ‘health indicators’, allowing them to record measurements and readings like blood glucose and blood pressure. Samaraweera says users can set and keep track of health goals, such as weight loss, fitness, or quitting smoking, through the system. He says it allows
patients and medical professionals to streamline existing practice procedures and therefore cut costs. Medical records can be shared between the patient’s practice and other professionals such as after-hours care, pharmacy and emergency departments. “It ensures patients receive the right information, in the right place, at the right time, in a format they understand and provides direct consistent and managed communication between the patient and their health professional.”
Enhanced patient safety Samaraweera says the system leads to reduced medication errors and enhanced patient safety through the sharing of information. It can also be used for video consultations, with healthcare providers able to video call patients. “Today we keep in touch with family and friends using video calls with programmes like Skype, FaceTime or WhatsApp to stay in touch. Patient care is constantly evolving and the use of video consultations is growing in healthcare.” He says people are already familiar with the technology and like the convenience of talking from home or work. “Video appointments also improve access to primary care for those who are homebound
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or can’t travel, like rest home residents.” A calendar to keep track of appointments and recalls, a community forum and health news is also available within the portal.
Privacy paramount Samaraweera says the company has taken privacy seriously. The entire infrastructure is hosted in a secure data centre in Auckland, with nothing hosted outside the country. The system fully complies with the New Zealand Health Information Privacy Code and the Privacy Act. Extensive privacy impact assessments had been conducted, and when a user accesses the portal it displays data using a secure encrypted channel. “This is the same as your internet banking,” says Samaraweera. Data on the platform can only be accessed by patient consent and all access is automatically audited. “The platform was designed from the ground up with privacy and security as the core foundation.”
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20 | Thursday, 22 November 2018
Keeping dental decay at bay P
The New Zealand Dental Association says how well you look after your teeth on a daily basis has a greater impact than what happens at the dental surgery.
Respecting N the hole in our sky: preventing melanoma
eople are unaware that tooth decay is the most prevalent disease in our society, yet it is one of the most preventable. Dentists are trained to manage the consequences of tooth decay, providing fillings to fix cavities, but most prevention of dental decay takes place in the home. It is what you do on a daily basis that has much more impact on your oral health than what happens at the dental surgery. The two most important things to consider are diet and brushing with fluoride toothpaste. In recent months there has been an increasing focus in the media about the importance of a healthy diet. Tooth-friendly foods and drinks are good for your general health as well as your oral health. Foods and drinks that are high in sugar can contribute to health problems such as weight gain and diabetes, as well as tooth decay. Children and adults should be discouraged from drinking sugary drinks; water and plain milk are the best options for children, while adults who drink tea and coffee should not add sugar. Other factors contributing to the harmfulness of foods include the consistency and the acidity of foods and drinks. Sticky foods stay on the teeth for longer and are more likely to cause tooth decay, while acidic food and drinks such as fizzy drinks, juices and sour sweets are also harmful to teeth. If you enjoy an occasional indulgence it should be just that – occasional. It is best to eat sugary treats only once a week – not every day! All adults and children who have their own teeth need to brush them twice a day with a fluoride toothpaste. Children usually need to have their teeth brushed for them until they are about eight years old. Some older children and adults, such as those with special needs, may also require ongoing assistance with tooth brushing.
ew Zealand has the world’s worst rates of new melanoma diagnoses and deaths. Because of our population growth and ageing population, the number of New Zealanders diagnosed with melanoma is expected to increase over the next two decades. Melanoma is a serious type of skin cancer, because cancer cells spread from the skin to important organs such as the brain, liver and lung. It is caused by UV exposure in fair-skinned people. Older men in New Zealand are at particularly high risk due to occupational and lifestyle exposure in the past, but rates of melanoma among young people are starting to decline. This is almost certainly due to changing public behaviour, such as avoidance of sunburn through shade, protective clothing including hats and sunglasses, and regular application of broad spectrum sunscreen. Advanced melanoma is now treated in New Zealand with immunotherapy agents called PD-1 inhibitors, funded since 2016. ‘Richard’, 73, is a typical New Zealand patient who has had successful treatment with one of these drugs, pembrolizumab. After having a melanoma removed from his back in 2016, he quickly developed tumours in the brain, lung and liver. Two years later, his scans are clear and he is living a normal life. Many others have not been as fortunate and furthermore, treatment of metastatic (secondary) melanoma is hugely costly; the drugs and associated hospital care are very expensive, and patients carry the physical and psychosocial burdens of treatment
Prevention and early detection crucial
Early detection and sun-smart behaviour plays key roles in reducing the impact of melanoma.
At the recent Melanoma Summit, experts from New Zealand Australia agreed that prevention and early detection of melanoma are much more effective strategies than treatment of advanced cancer. “The general feeling was that we are complacent about the huge melanoma problem that we have in New Zealand,” says Dr Rosalie Stephens, oncologist and Melanoma New Zealand spokesperson. “We concluded the meeting with a plan to refocus efforts on government policy relating to and public awareness of sun safety including the dangers of tanning beds, and the dramatic consequences of melanoma.” Early detection plays a key role in reducing deaths from melanoma. Melanoma that is detected when it is less invasive can be treated effectively by simple surgery. Regular skin checks for those considered at high risk – fair skin and/or Over 4000 blonde/red hair, large numbers of moles, a family history of melanoma – are people are essential. diagnosed with either New Zealanders should consider using the free sun protection alert on their phones or company websites, and sharing this information with melanoma in situ or family, staff and customers (www.sunsmart.org.nz/sun-protection-alert), or invasive melanoma every downloading the uv2Day free smartphone app, which indicates UV status for the area (www.niwa.co.nz/node/111461). year in New Zealand – As well as being vigilant about the sun, we need to be aware of our that’s around 13 every skin, checking it regularly and visiting a GP or skin specialist if a mole is new or changing, such as bleeding, crusting or becoming raised. It is day. Melanoma New recommended that those New Zealanders considered to be high risk for Zealand melanoma have whole-body skin checks every six to 12 months.
Thursday, 22 November 2018 | 21
Toothpastes ineffective without fluoride
“Each healthy tooth we have is a jewel”
The Ministry of Health and the New Zealand Dental Association recommend that toothpastes contain at least 1000 parts per million (ppm) fluoride. With the emergence of new toothpastes on the supermarket shelves in recent months, it is essential that consumers check that their toothpaste contains fluoride. A recent study concluded there is no evidence that tooth brushing using a toothpaste without fluoride is effective in reducing tooth decay. Conversely, fluoridecontaining toothpastes have been found to be beneficial in strengthening tooth surfaces and preventing tooth decay. If you are unsure whether your toothpaste contains fluoride, you may wish to ask your dental professional. Your oral health professional will also be able to advise about other ways to manage your oral health, such as flossing your teeth or using additional products, such as tooth mousse or mouthwashes and, of course, getting your teeth checked regularly. It is much easier to manage problems if they are detected early, rather than once they become severe.
Health Minister Dr David Clark says he’s pleased the sustained investment in children’s oral health is paying off with the proportion of children free of tooth decay at age five increasing from 51 per cent to 60 per cent.
Foods and drinks that are high in sugar can contribute to health problems such as weight gain and diabetes, as well as tooth decay. For those aged 12 to 13 the improvement is even better, going from 47 per cent to 65 cent. This is significant, given that evidence shows that oral health at age five predicts oral health at age 26. “Each healthy tooth we have is a jewel,” says Clark. “It’s fantastic that more of our children are growing up free from painful tooth
Nearly half of adults (47%) with natural teeth visited a dental health care worker in the past year, down from 52% in 2006/07.
decay. However there is more work to do. The improvement among Maori and Pasifika children, while good, does not match the gains among other children.” New Zealand Health Survey, The Ministry of Health is working with District Health Ministry of Health, 2016/17 Boards to grow the proportion of preschool children enrolled and receiving publicly funded care from the Community Oral Health Service. They are also working to keep them enrolled until age 18. “We know there is unmet need for oral healthcare among adult New Zealanders. Working on the oral health of our tamariki now is one way we can reduce that unmet need over time.” Clark is keen to get wha-nau and communities on board. On Oral Health Day, 2 November, the Dental Association asked New Zealanders to give up sugary drinks and consume only water during November. Those who registered for the Switch to Water challenge went into a draw to win hightech, bluetooth-equipped toothbrushes, while schools could win sports equipment, cash and a visit from Olympic pole vaulter Eliza McCartney.
Getting feet summer-ready Chief executive of PodiatryNZ Jennifer Pelvin offers some tips and tricks to keep Kiwis on their toes this summer.
aintaining an active lifestyle is great for improving and maintaining overall health; however, being active can take its toll on your feet. Blisters, sprains and strains, pain and fungal infections should all be managed when symptoms first arise to ensure that minor problems do not become major health issues. Do visit your podiatrist before you embark on a new exercise regime to ensure your feet are in good shape and there are no corns, excessive calluses or issues with your toenails. Podiatrists can also provide advice on appropriate footwear. It’s a good idea to take your shoes on a trial run. With summer approaching and the opportunity to spend more time outdoors being active, here are some tips to get and keep your feet in shape.
Protect your feet You should always wash your feet every day in warm soapy water and dry thoroughly, especially between the toes. Fungal
organisms love moisture, so depriving them of any wetness will make it more difficult for them to thrive. Toenails should be trimmed regularly with proper nail clippers. Cut them straight across, not too short and not down at the corners as this can lead to ingrowing toenails. Don’t hide ‘ugly’ toenails with polish. A discoloured, thick, cracked, or crumbling nail could signal a nail fungus. Applying nail polish to an infected nail could make the problem worse. If you have dry skin, applying moisturiser before going to bed will help keep your skin supple and more resistant to injury. Protect feet by wearing shower shoes in public showers, in the changing room at the gym and around pools. These places tend to be breeding grounds for fungi that can lead to infections. Do not forget to apply sunscreen to the tops of your feet when they are exposed to the sun.
Choose the right footwear Shoes that are too tight can cause long-term foot problems. To help keep your feet dry and healthy, wear shoes that are breathable and allow air to circulate. It is essential to wear the appropriate shoes for each type of sport you participate in (tennis shoes for tennis, running shoes for running) as these shoes are specifically designed to function well on the surface you will be exercising on. Socks need to be good quality and well fitting. Wearing socks that keep feet dry will help your feet stay healthy.
Keep your feet resilient While we don’t think twice about dedicating a whole exercise or gym session to our arms or legs, most of us don’t bother with exercises that are foot-specific. The following foot exercises are great, particularly if you have a desk job or are embarking on a long-haul flight: Circle your feet 10 times in each direction, keeping your legs as still as possible. Consciously straighten your toes and wiggle them around. Raise, point, then curl your toes for five seconds each, and repeat 10 times – this is particularly good for toe cramps.
Know when to stop exercising If your feet hurt during exercise, it's important to act on this rather than simply ignoring the problem; 'powering through' pain could just end up making things worse.
Have a recovery plan If you have completed an endurance sport such as a marathon or mountain hike, your feet are probably hurting and in need of some attention, so make sure you have a game plan in place. To find a podiatrist in your area, visit the PodiatryNZ website. PodiatryNZ is the professional association for registered podiatrists.
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