PUBLISHED IN THE INTEREST OF YOUR HEALTH BY
PUBLISHED IN THE INTEREST OF YOUR HEALTH BY LIFE HEALTHCARE
BEAT THE HEAT
YOUR WATER-SAFETY CHECKLIST
THIS MONTHâ€™S FOCUS
Ability vs Disability Real-life inspiration
BRIGHT DAYS AHEAD STAY HEALTHY AND HAPPY ALL SUMMER LONG
QUIZ: SOCIAL ANXIETY OR JUST SHY?
Life is… A PUBLICATION BROUGHT TO YOU BY THE LIFE HEALTHCARE GROUP
IMAGE ANGIE LAZARO
Don’t you find that life is a little sweeter in the summer? There’s joy in the air with longer days, sunny skies and quality time with family and friends, and the prospect of a new year filled with incredible possibilities is simply exhilarating. If you’ve decided to take a road trip, we have compiled advice and information on page 28 to keep you safe and help you make the right kind of holiday memories. And you can find health tips for travelling to a malaria zone on page 40. While there is so much to be excited about, for many people the holidays are stressful. Not everyone is a social butterfly and if the thought of yet another party fills you with dread, perhaps you should take our social anxiety test on page 26 and see how you can dial down your angst. No matter how difficult the road ahead seems, you must keep pushing past your fear. That’s what Tasha and Wayne McKenzie did after six unsuccessful rounds of IVF only to discover that surrogacy would make their dream of becoming parents come true. You’ll want to read their remarkable story on page 16. Looking to the new year, you might decide that 2018 is the year you are going to improve your wellness habits, eat healthier, find a way to include exercise in your day or even just treat yourself with more respect. All that matters is this moment and your next choice, so here’s to good health, a new year and choosing life.
EDITORIAL COMMITTEE Yvonne Motsisi, Dr Sharon Vasuthevan, Janette Joubert, Dr Trevor Frankish, Liesel van Oudenhove, Lucy Balona (CANSA), Professor Pamela Naidoo (Heart and Stroke Foundation South Africa)
SAMANTHA PAGE EDITOR
MANAGEMENT Managing Director Lani Carstens Business Development Director Rebecca Smeda Group Account Director Joanne Hope Account Manager Delicia Krause Production Director Nina Hendricks Financial Director Megan Paulse Human Resources Director Aashiqa Petersen
ADVERTISING Advertising Sales Director (Johannesburg) Moyra Beeming email@example.com 011 507 9123; 082 375 4446 Advertising Sales Manager (Cape Town) Estelle Dietrich firstname.lastname@example.org 021 486 7609; 073 224 4996 PRODUCTION Production Manager Tessa Smith Reproduction Resolution Colour Printing Paarl Media Cape Life Healthcare magazine, 2nd Floor, Block A, North Side, Black River Park, Fir Street, Observatory, 7925 / PostNet Suite #2, Private Bag X11, Mowbray, 7705 Email: email@example.com Tel: 021 486 7600 Fax: 021 486 7614 www.johnbrownmedia.com For magazine-related queries, contact John Brown Media. Tel: 021 486 7600 Fax: 021 486 7614 PostNet Suite #2, Private Bag X11, Mowbray, 7705
Life Healthcare magazine is published by The Life Healthcare Group to provide patients, their families and the public with the most readable, interesting and relevant health and wellbeing journal available. Life Healthcare magazine is distributed quarterly to patients at all Life Healthcare hospitals and to privatesector doctors. It has a guaranteed print order of 90 000 per quarter, with an estimated readership of 240 000. Life Healthcare magazine can now also be read online. Visit www.lifehealthcare.co.za Disclaimer: the opinions expressed by the authors of the articles published in this magazine do not necessarily reflect the views of The Life Healthcare Group Ltd or John Brown Media. The Life Healthcare Group Ltd or John Brown Media do not accept any responsibility for information given in the articles featured in Life Healthcare magazine.
Visit our brand-new website at www. lifehealthcare.co.za to access previous issues of Life Healthcare magazine, get information about Life’s hospitals and specialists and all the latest Life Healthcare news. Making life better starts here.
EDITORIAL Editor Samantha Page firstname.lastname@example.org Senior Designer Anelia du Plessis Managing Editor Masechaba Mkefa-Hausen Copy Editor Raadiyah Abrahams Managing Editor (Life Healthcare Group) Tanya Bennetts
Whilst The Life Healthcare Group Ltd has agreed to advertise products in this magazine, the Group makes no representations or warranties as to the efficacy or use of the products. The products are advertised on condition that readers will make their own determination, including seeking advice from their medical practitioner or healthcare professional as to the suitability of the product for the intended purpose, prior to use. Life Healthcare Group Ltd does not accept any responsibility for any loss or damage suffered by the reader as a result of use of the advertised products.
LOOK OUT FOR LIFE PLUS BOXES IN OUR MAGAZINE FOR EXTRA INFORMATION AND HEALTH TIPS FROM OUR EXPERTS
THIS MONTH’S FOCUS: HAPPY, HEALTHY SUMMER
LIFE 01 LIFE IS…
A note from the editor
04 OVER TO YOU
Letters from our readers
Medical innovations, what’s new at Life Healthcare and latest reads
11 HEALING YOUR HEART
Life Healthcare is delivering world-class treatment to cardiac patients at Life Flora Hospital’s new Coronary Care Unit
12 WATER GIVES A HELPING HAND Aquatic physiotherapy can aid physical rehabilitation By Gillian Warren-Brown
16 ‘SURROGACY GAVE US THE GIFT OF TWINS’
When all seemed lost, a couple’s friend offered to carry their babies As told to Charlene Yared-West
18 SEVERAL SHADES OF BLUE
There’s a difference between a little weepiness after giving birth and a persistent feeling that you can’t cope By Catherine Eden
20 S UPPLEMENTS: NUTRITIONAL NECESSITY OR PRICEY PLACEBO? Do you need additional vitamin and mineral supplements to get all your nutrients, or will a balanced diet do? By Sam Brighton
23 PATIENTS, STAY SAFE
ROAD SAFETY 101
When patients can protect themselves in hospital, they feel empowered By Samantha Page
24 SPECIALISED GERIATRIC CARE
Respectful and dignified care is at the heart of this new medical specialty By Lynne Gidish
54 TIPS FOR A SUGAR-FREE MOUTHFUL
DOUBLE THE JOY
26 DO YOU HAVE SOCIAL ANXIETY?
Find out how to cope with what could be a limiting condition, especially during the holidays. Take our quiz
28 YOUR GUIDE TO A SAFE JOURNEY With thousands of South Africans travelling on our country’s roads this festive season, these tips could save your life By Lisa Witepski
HEALTH 32 ‘MY ABILITY IS STRONGER THAN MY DISABILITY’
An inspiring look at three Life Healthcare patients who are thriving despite their disabilities By Glynis Horning
38 L IFE-CHANGING SURGERY FOR LYMPHOEDEMA
A ground-breaking microsurgery opens the door for the many affected patients in the country By Carla Hüsselmann
ASSISTANCE AT THE READY
40 PREVENTION IS BETTER THAN CURE
What you need to know if you are planning on visiting a malaria-risk area By Mandy Collins
50 GAINING BACK INDEPENDENCE
42 HOW TO GET MORE THAN 40 WINKS
52 3 CANCER TYPES MEN NEED TO KNOW ABOUT
A paediatrician and gynaecologist’s advice for getting your baby (and you) some much-needed sleep By Melanie Farrell
44 EVERYBODY’S TALKING ABOUT… STEM CELLS
Valuable resources assist visually impaired children to navigate their world By Melanie Farrell
How men can reduce their risk By Pippa Naudé
54 GIVE SUGAR A PASS
Monique le Roux Forslund has the recipes for a carb-conscious menu
Doctors could use your own biology to heal you ... but this new medical discipline is a controversial topic By Pippa Naudé
61 LIFE HEALTHCARE HERO
46 IN DEEP WATER
62 MIND GAMES
47 JOB PROFILE
64 DISCOVERING COURAGE
Water-safety tips you’ll want to use By Raadiyah Abrahams What does a gynaecological oncologist do? By Erin Coe
Nurse Doreen Shikhibana from Life Flora Hospital As told to Lynne Gidish Take a break with our puzzles and crossword
How can you use the lessons you learn from your illness to enrich your life? By Lauren Segal
OVER TO YOU We’d love to hear from you
PROUDLY SOUTH AFRICAN My fiancé went to casualty and then for a minor operation at Life The Glynnwood in Benoni. I cannot say how impressed I was with the service and care provided. Reception staff were extremely helpful, and nurses and doctors were professional but also courteous and friendly, showing genuine concern for their patients. My partner was terrified to have his first-ever general anaesthetic but came out of the operation smiling and told me how reassuring the anaesthetist and surgeon had been. He is healing well and was back at work with only one day needed to recover. Coming from the UK, I’m used to NHS standards, so I was amazed by Life The Glynnwood. You do South Africa proud and are a credit to healthcare. Martin Fouche, Benoni
FINALLY PAIN-FREE On 29 August 2017, my daughter was admitted to Life Westville Hospital with severe earache that her GP tried to manage unsuccessfully for five weeks. When we arrived at the hospital, staff administered analgesia, drew blood and admitted her. When she reached the ward, the pain was back. She requested analgesia and her doctor took care of the pain. The next morning, she received a wholesome breakfast and was referred to an ENT surgeon. She was treated and discharged by 9am. She only missed one day of university. Well done Life Westville Hospital, I will certainly recommend you. Yodhi Naidoo, Durban
WINNING LETTER FRIGHTENING DAY TURNED INTO A HOLIDAY Saturday 29 July 2017 turned out to be the most memorable and frightening day of my life. My husband and I planned the day not knowing we were in for a big surprise when my water broke at 33 weeks. As we entered the hospital, the security guards quickly directed us to the maternity section. Although I didn’t have a bed booked, they accommodated me without any hassles. The doctors told us that our son was in distress so they had to perform an emergency c-section. The baby was taken to NICU for monitoring and I was taken to the maternity ward where it felt like I was on holiday. I didn’t have any pain and the nurses checked on me regularly (providing me with painkillers before the pain even started). This could have been an extremely stressful and traumatic experience but the team at Life West Coast Private Hospital made it easier. Their skill and expertise put my mind at ease knowing my son and I were in good hands.
LIFE IN SHORT… ‘One of my more pleasurable experiences…’ Hettie Jakobi, East London
‘Life Suikerbosrand Hospital you are a cut above the rest…’ Lorine Masiwa, Gauteng
‘Before I could even ask [the porter] for help he was already asking me who I was visiting and trying to direct me to where I needed to go…’ Noxolo Happy Gxumisa, Pretoria
Siphosethu Legoabe, Vredenburg
AMAZING MOSSEL BAY
The staff of Yellowwood ward at Life St George’s Hospital in Port Elizabeth are the friendliest staff ever...
My husband John Edward Lester was in Life Bay View Private Hospital from 16 to 18 July 2017 with a bacterial bug. Although he was tired and grumpy, Dr Derksen and the nursing staff, especially nurse Charmaine Ellis, made his stay comfortable and pleasant. We are so proud we have an establishment of this high quality in the town of the year, Mossel Bay.
Karen de Goede, Port Elizabeth
Isabelle du Plessis, Mossel Bay
Win an Interflora hamper valued at R1 000 Interflora is the world’s largest flower delivery service. Supported by a network of professional florists, we proudly deliver beautiful hand-crafted floral arrangements and hampers to most areas in South Africa via our same-day flower delivery service. This hamper contains Wedgewood Angels biscuits, delicious preserves, snack-time nibbles and a variety of delectable chocolates. www.interflora.co.za | 0861 468 373 Email email@example.com about how you experienced life, health and care at a Life Healthcare hospital or facility and you could win. Prize is non-transferable and cannot be exchanged for cash. 4
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3 Crank Hospital bed: R 14500 R 9750
Electric Home Care Bed: R 24950 R 19950
Standard commode R 1250 R 699
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Shower chair: R 1050 R 799
Electric Bath Lift: R 20550 R 9950
Prices are subject to change
Raise up recliners: From R 14950
Standard commode R 1250 R 699
M4 Bubble Overlay R 3250 R 1950
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Avanteâ€™ Adjustable Bed R 22000 R 16500
ST1 Mobility Scooter: R 22999 R 15950
M4 Bubble Overlay R 3250 R 1950
3 Crank Hospital bed: R 14500 R 9750
Raise up recliners: From R 14950
ST1 Mobility Scooter: R 22999 R 15950
Healthsmart Rollato R 3299 R 1999
EZ Adjustable Bed Rail R 2199 R 1550
Electric Bath Lift: R 20550 R 9950
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firstname.lastname@example.org Prices are subject to change without priorwww.primacare.co.za notice
LIFE AQUATIC PHYSIOTHERAPY / NUTRITIONAL SUPPLEMENTS / PATIENT SAFETY
‘YOU ARE THE SUNSHINE THAT CAN LIGHT UP THE WORLD.’ UNKNOWN
Medical innovations and Life Healthcare news
ASKED AND ANSWERED
TRY IT OR
People are busier than ever but that hasn’t diminished the need to stay fit and healthy – they simply have to do it in half the time. High intensity interval training (HIIT) is one way to improve fitness and build lean muscle mass in less time. ‘Physiologically, the combination of cardiovascular and strength exercises in a high-intensity workout can be more beneficial to the body than cardio alone,’ says Shannon Slovensky, exercise physiologist and researcher at the University of Virginia Exercise Physiology Core Lab. However, while you’ll burn more calories in a shorter period of time and build lean muscle that boosts metabolism, you’ll need a higher level of fitness, core strength and endurance and if you’re older than 55 you’ll definitely have to get the all-clear from your doctor before you begin. The experts recommend caution, especially if you have a pre-existing heart condition, high blood pressure or heart palpitations. However, if you’re physically fit and up for a challenge, give it a try. GOOD FOR YOUR HEALTH
PET SCIENCE If you own a pet, you’ll know all about unconditional love and furry cuddles, but according to research conducted at the University at Buffalo of the State University of New York system, there are wellness benefits too. Researchers found that when conducting stressful tasks, people experienced less stress when their pets were with them than when a spouse, family member or close friend was nearby. A pet also decreases depression, stress and anxiety as well as lowers blood pressure and boosts immunity.
IS IT SAFE TO EAT SUSHI DURING PREGNANCY?
There’s no shortage of advice when you are pregnant and mothers-to-be are often warned about sushi, but how can it be bad when in Japan sushi is considered healthy during pregnancy? While there’s no evidence that raw fish increases complications during pregnancy, it’s important to be mindful of the mercury levels in the fish you eat since a high mercury count can be dangerous. Parasites and tapeworm also pose a potential threat in raw fish, so it’s best to eat frozen rather than fresh. As a rule, ocean fish, such as tuna and sole, is safer than river and lake varieties. Before ordering, ask the restaurant how the fish has been prepared. To be safe, ask for your fish to be lightly seared and have it served rare instead of raw. Some varieties of sushi, such as California rolls with steamed crab, are usually fine to eat, so you may choose to avoid the kinds that have raw seafood.
DID YOU KNOW? Men’s sperm count is falling sharply in the developed world, according to a new study. While sperm count is currently considered the best measure of fertility, there has been a notable decline of 50% in less than 40 years. Researchers are attributing the drop to environmental changes, stress, smoking, lifestyle, diet and weight.
PRESCRIPTION FOR GOOD HEALTH
SIGNS YOUR THYROID MAY BE UNDERPERFORMING
Hormonal changes in women around 50 can often be attributed to perimenopause, but the chances of developing hypothyroidism (low thyroid hormone) increase during midlife as well. Here are five tell-tale signs: #1 You’re cold when others aren’t. #2 You tire more easily. #3 You’re constipated without cause.
#4 Your skin is dry. #5 You’re forgetful and depressed.
IN A NUTSHELL
Skin cancer 101 TYPE
Basal cell carcinoma
• Most common form of skin cancer • Typically occurs in locations exposed to the sun • Occurs in basal cells (in the lowest part of the epidermis)
About 8 in 10 skin cancers
Usually grows slowly, and rarely spreads to other parts of the body. However, this can occur if the cancer is left untreated, so early detection and treatment is important
Squamous cell carcinoma
• Occurs in the squamous cells, which are flat cells in the top or outermost part of the epidermis • Likely to develop in areas exposed to the sun
About 2 in 10 skin cancers
Usually grows slowly and rarely spreads, but more likely than basal cell carcinomas to invade fatty tissue beneath the skin
Cancer that starts in the melanocytes, specialised cells that make the pigment (melanin) that gives skin its colour
Melanomas are far less common but far deadlier
Highly curable if caught early, but much more likely than other forms of skin cancer to spread if left untreated
Malignant tumours of other skin structures
Cancer from the glands, hair follicles or blood vessels
Very rare – about 1–2% of all cancers
Pose unique challenges in diagnosis and treatment
The K53 test app
Loose and/or fungal-damaged nails need Fix-4-Nails® to recover
Recovery takes time START NOW!
One of the first things a learner driver should know is how to keep themselves and other drivers safe on the road. This app improves your chances of passing your learner’s licence test and focuses on how to prepare for life as a driver. It includes 255 multiple-choice questions similar to those asked in the official test. Available for iOS (The K53 Learner’s Test App) and Android (K53 Test: Learner’s Licence). www.k53-test.co.za
www.loosenails.co.za email@example.com Tel: 0861 999 907 GREAT GIVEAWAY
DATE TO DIARISE
A message from the heart of South Africa
The ideal conditions created by Fix-4-Nails® under the nail is the secret of its success in ‘restoring by regrowth’ of loose and fungal-damaged nails
Available at and participating pharmacies and salons
Visit our Facebook page
The Heart and Stroke Foundation of South Africa (HSFSA) recently opened a branch in Johannesburg, based in Life Fourways Hospital, and we are incredibly grateful for the Life Healthcare Group’s support. We offer employee wellness packages, Mended Hearts support meetings, health community, health-risk assessments and much more. You can find out about all our services and the work we do on www.heartfoundation.co.za or contact Emmah Siluma in our Johannesburg office at firstname.lastname@example.org or 011 875 1403. Post a selfie that shows how you enjoy a cup of tea and you could win the delicious Carmien tea hamper pictured above. Upload your image on @HeartStrokeSA and tag @CarmienTea and as many friends as you like to stand a chance to win.
IT’S TIME TO INSPIRE ACTION AND TAKE ACTION! This year’s World Cancer Day is the third to fall within the three-year (2016–2018) World Cancer Day ‘We can. I can.’ campaign. The theme highlights how everyone, together or individually, can help reduce the global burden of cancer. ‘We sometimes hold the mistaken belief that cancer is a dread disease that other people experience’, says CANSA CEO Elize Joubert. ‘However, the reality is that we’re all affected by cancer in some way. If you think about it, most of us know at least one person who has been affected by cancer. The good news is that we all also have the power to take action to reduce the impact of the disease on individuals, families and communities.’ www.cansa.co.za
C O M P I L E D BY SAMANTHA PAG E I M A G E S G ET TY/GALLO I MAG ES, ISTOCK, SH UT TE RSTOCK, SU PPLI E D
4 FEBRUARY IS WORLD CANCER DAY
HEALING YOUR HEART A new cardiac unit at Life Flora Hospital makes excellence a priority. By Samantha Page
n June 2017, Life Flora Hospital in Florida, Gauteng, opened a state-of-the art Coronary Care Unit to meet the needs of their growing patient population. ‘For many years, cardiology has been a part of the services offered by Life Flora Hospital, but as the hospital and the complement of cardiologists grew, the need for a dedicated coronary unit was identified,’ says Unit Manager Dumay Joubert.
I MAG ES GETTY/GALLO IMAGES, SUPPLIED
WHICH CONDITIONS DOES THE UNIT TREAT?
Cardiology is the branch of medicine that involves disorders of the heart and cardiothoracic surgery covers both the heart and wider chest area, including the lungs. The new unit is equipped to provide diagnosis in these areas as well as treat a range of heart problems, including heart failure, myocardial infarction (heart attack), valve disorders, congenital and ischemic heart disease, hypertension, arrhythmias (abnormal heart beat) and others. According to the Heart and Stroke Foundation of South Africa, of the non-communicable diseases (diabetes, cancer, chronic respiratory disease and mental disorders), cardiovascular disease (CVD) is the leading cause of disabilities and death, killing around 17 million people annually, therefore it is high on the local and global health agenda.
A MODERN APPROACH
A multidisciplinary team, consisting of six cardiologists, five physicians, three cardiothoracic surgeons and a supportive and expertly trained nursing team that
includes ICU trained specialists on both day and night shifts, ensures that each patient is assessed, treated and cared for with a combination of clinical insight and compassionate care. ‘With a contemporary approach to treatment, the unit prioritises noninvasive cardiology and interventional cardiology, and all our cardiac surgery patients receive post-operative treatment at the cardiothoracic ICU,’ explains Unit Manager Joubert. There are also several benefits to a dedicated unit, such as staff training specialised to cardiology and a more patient-centric approach. ‘The patients are provided with specialised treatment focused on their specific needs, which helps to put the patient and their family at ease. Our patients feel safe in our care and they leave our unit with the confidence to re-integrate into society equipped with the necessary health information and post-operative management plan,’ explains Unit Manager Joubert.
EDUCATION TO HEAL
An important part of the care provided at the unit is health education around managing a heart condition and ensuring that the necessary lifestyle adjustments are made. While there are life-long implications, cardiovascular disease is treatable if it’s detected early and the patient is willing to partner with a treatment team to prevent future attacks or events such as a heart attack or stroke. Life Flora Hospital has always focused on delivering a high quality of care and this unit is no different. The specialists are renowned for their pioneering spirit and
patients can rest assured they will receive first-class care. ‘Over the years, we have built a strong facility, and now we are able to refer to Life Flora Hospital as a centre of cardiac excellence,’ says Dr AC Becker, one of the unit’s cardiologists.
LIFE PLUS Life Healthcare offers specialised cardiac care throughout the country. Eastern Cape • Life St Dominic’s Hospital, 043 707 9000 • Life St George’s Hospital, 041 392 6111 Free State • Life Rosepark Hospital, 051 505 5111 Gauteng • Life Eugene Marais Hospital, 012 334 2777 • Life Fourways Hospital, 011 875 1000 • Life Flora Hospital, 011 470 7777 or Coronary Care Unit, 011 758 6510/6381 • Life The Glynnwood, 011 741 5000 • Life Wilgers Hospital, 012 807 8100 KwaZulu-Natal • Life Entabeni Hospital, 031 204 1300 • Life Westville Hospital, 031 251 6911 Western Cape • Life Bay View Private Hospital, 044 691 3718 • Life Vincent Pallotti Hospital, 021 506 5111
FIT FOR LIFE
WATER GIVES A HELPING HAND Certain exercises are safer and more effective in a pool. Gillian Warren-Brown discovers how aquatic physiotherapy can aid physical rehabilitation and pain relief
hen you were a child, did you ever play a game in which you’d ‘fall’ off balance in a swimming pool just so you could experience the sensation of being buoyed up by the water? For anyone who is partially paralysed due to a stroke or an accident, or has lost the use of a limb, exercising in water instead of on land helps to overcome the fear of falling while working to regain some functional movement. Buoyancy is just one of the properties of water that aids aquatic physiotherapists during exercise therapy in a specially designed, heated swimming pool.
WHAT IS AQUATIC PHYSIOTHERAPY?
Aquatic physiotherapy usually takes place in a pool. The water is comfortingly warm and kept thermoneutral (a temperature at which the body can maintain its core temperature without using energy above normal basal metabolic rate) at 33.5–34.5˚C so patients maintain their body temperature. The warmth encourages relaxation, a psychological benefit, while reducing muscle spasms and increasing circulation, which assists with pain relief. Patients may have individual therapy or take part in group exercises under instruction of a physiotherapist trained in aquatic physiotherapy (formerly hydrotherapy). Kirsty Marot, a physiotherapist based at the rehabilitation unit at Life Entabeni Hospital in Durban, provides an example: when there’s 12
increased muscle tone in the trunk, as in some neurological conditions, a therapist can work with a patient lying horizontally in the water by moving them in specific ways. If required, flotation devices can be attached to the patient to keep them buoyant. ‘This movement and the warm water helps reduce stiffness in the trunk, and buoyancy enables the therapist to move the patient, which couldn’t be administered as effectively on land.’ Aquatic physiotherapy can be incorporated into a patient’s treatment programme to help them achieve a goal, such as improving standing balance in order to walk safely on land, explains Carina Basset, a rehabilitation clinical specialist at the rehabilitation unit at Life St Dominic’s Hospital in East London. It includes an assessment of the patient and design of an individualised treatment plan to facilitate these outcomes. This is what sets it apart from other water-based activities such as water aerobics, swimming or spa therapies. As per Life Rehabilitation recommendations, pools used for aquatic physiotherapy should be approximately 4×6m, with safe wheelchair access and a minimum of 1m depth or a sloped floor of 1.2m to 1.8m.
WHO WILL IT HELP?
Aquatic physiotherapy is effective in acute physical rehabilitation of patients who have neurological damage or musculoskeletal conditions (involving muscles, bones and joints) such as osteoarthritis, rheumatoid arthritis or fibromyalgia, says Kirsty. It is also used
THE BENEFITS Aquatic physiotherapy harnesses certain properties of water to help achieve therapeutic goals. These include: BUOYANCY: the upward force exerted on an object in water. Clinical rehabilitation specialist Carina Basset, based at the rehabilitation unit at Life St Dominic’s Hospital, says it reduces the weight carried by submerged joints, making it easier and less painful for patients to walk or exercise in water.
I MAG ES GETTY/GALLO IMAGES, SUPPLIED
HYDROSTATIC PRESSURE: the pressure exerted by water in a confined space. It is evenly distributed over the body’s surface and is greater in deeper water which, with the feeling of weightlessness it provides, makes it easier to exercise in the deeper end of the pool.
for cardio-pulmonary patients as well as for maintaining a level of function and preventing deterioration in a range of conditions. It also supports recovery from surgery, such as hip or knee replacements. Other conditions that benefit include: • Spinal injuries • Parkinson’s disease • Peripheral nerve lesions • Chronic pain • Balance disorders. ‘Patients who respond especially well include those with orthopaedic and muscular conditions, those who’ve had strokes or head injuries, those who are partially or completely paralysed, and those with multiple traumatic injuries,’ she says. For a patient who has pain and stiffness in their joints post surgery or trauma for example, underwater exercises are incredibly helpful. ‘A combination of the properties of water (see ‘How does it work?’) brings about pain relief, improved mobility in the tissue, and enhanced range of movement. We can then work on strengthening the area,’ says Kirsty. However, there are some absolute contraindications, such as acute vomiting or diarrhoea, resting angina, unstable diabetes or hypertension and open infected wounds. It isn’t recommended if a patient has acute systemic illness, irradiated skin from radiotherapy, aneurysm or poorly controlled epilepsy. But for many patients, aquatic physiotherapy provides a supportive, safe addition to a rehabilitation programme.
TURBULENCE: the eddies that follow in the wake of a person moving through the water. Michelle van Nes, a physiotherapist at the rehabilitation unit at Life St Dominic’s Hospital, says this principal can be used to increase resistance, helping to build muscle strength. Turbulence also creates drag, which is used to improve balance and coordination.
MEET OUR EXPERTS
Kirsty Marot, based at the rehabilitation unit at Life Entabeni Hospital, has eight years’ experience as a physiotherapist and completed a post-graduate course in orthopaedic manual therapy (OMT).
GOOD FOR YOU
In addition to boosting mood and aiding pain relief, Michelle says the list of benefits includes: • Increased range of movement (especially joints) • Strengthening of weak muscles • Re-education of paralysed muscles • Maintenance and improvement of balance, coordination and posture • An increase in exercise tolerance • Improved cardiovascular fitness
Life Rehabilitation offers aquatic physiotherapy at Life Entabeni Hospital, 031 204 1300, Life St Dominic’s Hospital, 043 742 0723, and Life Vincent Pallotti Hospital, 021 506 5360.
Carina Basset, based at the rehabilitation unit at Life St Dominic’s Hospital, has 11 years’ experience as a physiotherapist. She has received advanced and basic neuro-developmental therapy (NDT/Bobath) training.
Michelle van Nes, who has four years’ experience as a physiotherapist, is based at the rehabilitation unit at Life St Dominic’s Hospital in East London. WWW.LIFEHEALTHCARE.CO.ZA
A history of pharmaceutical excellence and innovation. DRIVEN BY INNOVATION
Sun Pharmaceutical Industries Ltd is the fourth largest speciality generic pharmaceutical company in the world. We provide high-quality, affordable medicines which are trusted by healthcare professionals and patients in over 150 countries globally.
GLOBAL FOOTPRINT Our global presence is supported by 42 manufacturing facilities, designed, equipped and operated to meet world class quality standards. As far as sales volumes are concerned: USA accounts for 48% of revenue, India for 26%, developing countries 13% and the rest of world, 13%. EMERGING MARKETS SUN PHARMA is present in over 100 markets with a focus on highgrowth emerging markets such as Brazil, Mexico, Russia, Romania, and South Africa and other markets. Our network of over 2 300 sales representatives has enabled us to develop strong relationships with medical professionals and a strong customer focus.
SUN PHARMA invests 6-7% of global revenues into Research and Development. R&D initiatives are led by a strong team of around 2000 scientists based at our R&D facilities around the world. SOUTH AFRICA SUN PHARMA acquired Ranbaxy in 2014 and today SUN PHARMA South Africa employs 500 people and is made up of four entities: SUN PHARMA (PTY) Ltd, Ranbaxy SA (Pty) Ltd, Ranbaxy Pharmaceuticals (Pty) Ltd and Sonke Pharmaceuticals (Pty) Ltd – the largest supplier of ARV medicines to the South African Government, and an essential partner in controlling the AIDS epidemic. We have a state-of-the-art production facility in Roodepoort equipped with the latest technology. This facility is designed to meet local Medicines Control Council regulatory requirements and complies with PIC/S (Pharmaceutical Inspection Convention & Pharmaceutical Inspection Co-operation Scheme). The Roodepoort plant manufactures a diversity of medicines including ARVs, anti-histamines, anti-infectives, anti-fungals, anti-emetics, antihelmentics, cough and cold remedies, central nervous system products, corticosteroids, multivitamins and products to treat pain and inflammation. SUN PHARMA has the only sterile facility in SA that manufactures corticosteroid tablets. We remain committed to providing affordable pharmaceutical products of global quality standards to patients all over the world.
Sun Pharma is ranked among the top seven generic pharmaceutical companies in South Africa, and provides prescription medicines to treat disorders and diseases of the gastro intestinal tract, cardiovascular system, central nervous system as well as anti-infectives, pain products, oncology therapies, ARVs – and a range of Over The Counter products.
DIVERSIFIED SPECIALITY AND GENERICS PORTFOLIO
We manufacture and market a large basket of pharmaceutical formulations covering a broad spectrum of chronic and acute therapies.
SUN PHARMA’s multi-cultural workforce, comprises more than 45,000 team members of over 50 nationalities, and is highly motivated in creating additional value for all stakeholders.
Touching the lives of every South African under the Sun.
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‘SURROGACY GAVE US THE
GIFT OF TWINS’
After four years of trying to fall pregnant naturally and six unsuccessful rounds of IVF, Tasha and Wayne McKenzie’s friend said she would be their surrogate. Charlene Yared-West sat down with them to learn more about their journey
ayne and Tasha believed they had exhausted all their options, save the adoption route. Their friend Lee-Ann Laufs worked closely with a safe house for abused and abandoned children called Miracle Kidz Safe House in Cape Town. ‘I emailed her to get the details,’ recalls Wayne, ‘and she called me back saying she had been telling my wife for months that she would be our surrogate – and that she really meant it. I was blown away by what she said and wanted to laugh and cry simultaneously. I knew this could finally be it... We could have our baby!’ SURROGACY CHOSE US Tasha recalls how she became friends with Lee-Ann in her beauty salon: ‘When she came for treatments, we got to know each other and would start chatting about where I was in fertility treatment. She always mentioned being our surrogate, but sometimes people say things they don’t really mean, and I wasn’t sure if this was one of those times. She gave birth to her second son and after the caesarean she messaged me from the hospital saying she would do this for us. She told us to be patient and wait a little
MAIN IMAGE Bo th eggs su ABOVE Lee-Ann off rvived and beautiful baby girls were born ered to 16
be Tasha and Wayne’s surrogate just as they thought they’d exhausted all their options
A S T O L D T O LY N N E G I D I S H I M A G E S S U P P L I E D
while longer until she had healed and was ready to be pregnant again. We left it at that and remained sceptical.’ It was only after Lee-Ann and Wayne had spoken that the offer of surrogacy became real to Tasha. ‘Unless you have been through the process, you will never know the heartache of infertility and I was terrified to allow someone else to carry my baby.’ She continues, ‘It was the best news to hear that both eggs survived and we were expecting twins. Professor Thinus Kruger from the Aevitas Fertility Clinic dealt with the embryo transfer’. Lee-Ann recalls how during the pregnancy, Wayne started calling her ‘Smeg’, which was a code word for oven. ‘That was exactly how I viewed the pregnancy; I was an oven for their babies. Simply put, their sperm and eggs, my uterus. The babies don’t receive anything from the surrogate except food and a warm comfy womb. This is known as gestational surrogacy,’ explains Lee-Ann. ‘There were no feelings afterwards of “I wish they were mine”. The joy it gives others is so worth it and helps erase all the heartache they went through to finally have their babies.’ TECHNICAL TALK ‘The surrogate and the commissioning mother need to sync their monthly cycle,’ says Professor Kruger. ‘Hormone injections are administered to the surrogate to stop her from ovulating at this time. Her uterine lining also needs to be a certain thickness so that the embryo can be transferred into the lining to grow.’ He explains how the commissioning mother’s eggs are stimulated to get as many as possible and are then grown until they are mature enough to be harvested, then fertilised with the father’s sperm. ‘The laboratory scientist selected eight eggs to fertilise based on quality. They are then grown and allowed to undergo cell-division outside the body for between three and five days. Not all the eggs will go through these stages of cell division and then another selection process takes place where only two embryos are transferred into the surrogate’s uterus at this time. After the transfer, there is a waiting period of 10 days to gauge if the pregnancy is viable.’ Professor Kruger explains that there are variations to this process and it is not successful at every stage. Gynaecologist and obstetrician Dr Gary Groenewald was chosen by Lee-Ann to continue as her primary caregiver. ‘Lee-Ann is an extremely giving person and to do this for friends, to undergo pregnancy and surgery via caesarean section, is a major sacrifice. It really takes a special, generous person to do this for someone else,’ he says. Since the McKenzies’ case, Life Healthcare has developed a very practical and sensitive protocol to deal with future surrogacy cases. Wayne shared how special the caesarean was at Life Kingsbury
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Professor Thinus Kruger led the team for the first ‘testtube baby’ in South Africa born in 1984. He and his team are world-renowned for their work on sperm morphology and the development of clinical thresholds to predict fertility – which were accepted as the international standard by the World Health Organization in 2010. Professor Kruger obtained a higher doctorate based on his work in male infertility.
• According to the Surrogacy Advisory Group, women who want to be a surrogate need to have given birth to a child of their own. • A surrogate needs to be in good physical, emotional and mental health. A thorough medical and psychological examination is carried out to ascertain suitability of the surrogate and the parents. • Since 2010, new laws about surrogacy have been passed and potential surrogates may not gain financially from the process. But all medical bills for the pregnancy must be footed by the commissioning parents. You may only be a surrogate for altruistic reasons. • Commissioning parents opt for surrogacy because they are unable to conceive their own child. Many LGBT couples who want a child of their own look to surrogates for help. • As a surrogate, you have no rights to the child after birth. • A contract is drawn up with the surrogate lawyer so that your surrogate does not run away with your unborn child. In the contract it also states how many IVF processes the surrogate is willing to do and how many IVF processes the parents-to-be can afford before cancelling the contract.
Go to surrogacy.co.za for more info.
Dr Gary Groenewald is a board-certified gynaecologist and obstetrician who has spent the years subsequent to his specialist qualification pursuing excellence in minimally invasive gynaecological surgery. He has been in private practice at Life Kingsbury Hospital for the last three years and is still actively involved in academic medicine at Groote Schuur Hospital.
Tasha, Wayne and Lee-Anne’s husband Shaun were all present for the birth at Life Kingsbury Hospital. Hospital and that he and Tasha were allowed to be there as well as Lee-Ann’s husband Shaun. ‘It was the best day of our lives and we are forever grateful to Lee-Ann for what she did for us. We are adjusting to life as parents to our baby girls, Lea and Madi,’ says Tasha. ‘It has been an amazing journey and all the pain and disappointment of infertility is slowly fading. But it still feels like a dream until I see my daughters, and I am so proud and happier than I could ever have imagined possible.’
OF BLUE It’s common to feel weepy after having a baby, but what if you don’t get over it? Catherine Eden takes a look at postpartum depression
s every new mom knows, childbirth can trigger a roller coaster of emotions. However elated she might be, she is dealing with hormonal changes and a lack of sleep. She might be worried about her baby, struggling to establish breastfeeding, or concerned that she just won’t cope. She’s not alone. Most new moms experience a wave of blues three to four days after birth. They may feel tearful, anxious, overwhelmed and unable to concentrate. These symptoms are normal and usually pass after a few days.
WHEN DOES THE BLUES BECOME POSTPARTUM DEPRESSION?
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Sometimes, however, symptoms persist and intensify. Or they may only kick in weeks after delivery. Postpartum depression is a complex mix of physical, emotional and behavioural changes that occur after giving birth, including mood swings, weeping, withdrawal, inability to bond with the baby, irritability, sleep and appetite disorders, overwhelming fatigue, anxiety, feelings of inadequacy or despair, and even thoughts of harming yourself or your baby. Because the blues are so common, this more serious condition may not be diagnosed at once. Women may feel guilt and shame for not living up to the expectation that they should be ‘natural’ mothers, loving their babies on sight. Many lack information and don’t understand why they feel as they do. But prompt treatment is essential as undiagnosed postpartum depression has a damaging effect on the whole family, affects mother-infant bonding, puts the baby at risk and can lead to chronic depression or suicide for the mother, explains Dr Nadira Khamker, psychiatrist at Life Riverfield Lodge.
relationship problems, lack of support and financial instability, giving birth to a child who has health issues or special needs, or teenage or unwanted pregnancy.
WHAT ARE THE TREATMENT OPTIONS?
The first step is to talk to your doctor or healthcare professional about your symptoms, particularly if they persist and are affecting your ability to care for the baby and complete normal tasks. If you’re a partner, family member or friend who is concerned about the new mother, don’t wait to see an improvement. It is not a betrayal to seek medical help in these cases; it could be life-saving. A doctor may recommend blood tests to check thyroid function as well as other hormone levels. While counselling may be sufficient in the milder cases, anti-depressant medication is often prescribed but must be weighed against possible effects on the breastfed baby. In suicidal patients, electroconvulsive therapy is considered safe and effective. With appropriate treatment, postpartum depression dissipates within six months, on average. It’s important to continue treatment after you begin to feel better – stopping too early can result in relapse and re-occurrence of symptoms.
•E at well, avoid alcohol, cut back on sugar and caffeine. • Walk, even if it’s just around the block with your baby in the stroller. •A ccept offers of help. Let someone babysit while you catch up on sleep. •L et go of the need to be perfect. Just do your best. •C onnect with other moms. Being home with a newborn can be isolating. It often helps to share experiences. •R emember that vulnerability is not a weakness. Speak up if you are struggling. •W atch Brené Brown’s inspirational TED Talk ‘The power of vulnerability’ on www.ted.com. Above all, acknowledging the problem and asking for help is the quickest road to recovery.
POSTPARTUM PSYCHOSIS Up to three in 1 000 women without a previous psychiatric diagnosis and up to nine percent of women who have had a previous psychiatric diagnosis develop a rare, extreme mood disorder called postpartum psychosis. The symptoms include confusion, hallucinations, deluded thinking, irrational or obsessive fears and mania. ‘The onset of psychosis is rapid, occurring three to five days after delivery and lasting between one week and several months in the absence of treatment,’ says psychiatrist Dr Nadira Khamker. Treatment may involve anti-psychotic drugs, counselling, hospitalisation or electroconvulsive therapy. Seek immediate treatment if these symptoms occur.
WHO IS SUSCEPTIBLE?
Postpartum depression can affect anyone, in any situation, however, you may be more at risk if you have bipolar disorder or a history of depression, or have been anxious or experienced stressful life events during or after the pregnancy. Other predictors include a range of vulnerable circumstances:
HELPING YOU COPE
Dr Nadira Khamker is a psychiatrist practising at Life Riverfield Lodge and Life Fourways Hospital. She has a keen interest in women’s mental health and is currently completing a PhD in this field.
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NUTRITIONAL NECESSITY OR PRICEY PLACEBO? Sam Brighton asked a Life Healthcare dietitian to break through all the hype and give us the A to zinc of nutritional supplements
T H E WA Y W E E A T
ou’re standing in the supplements aisle wondering if a multivitamin could take away that heavy fatigue you feel first thing in the morning. But which one do you pick? The price difference between seemingly equal products can sometimes be tenfold. According to Insight Survey, the vitamins and supplement market in South Africa grew from R2.9 billion in 2014 to R3.8 billion in 2016, showing an annual growth rate of 13.5%. You are consuming all these supplements, but what are they really doing for your health? Kelly Francis, a registered dietitian at Life Westville Hospital in Durban, explains that supplements are nonfood sources of micronutrients taken to increase the intake of one or many vitamins and/or minerals. ‘[They] are designed to either supplement a nutrient-poor diet or correct a known nutrient deficiency.’
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VITAMIN OR MINERAL? The body requires adequate levels of vitamins and minerals to function properly. Certain vitamins and minerals work in tandem. Kelly elaborates: ‘Vitamin C improves the absorption of iron (a mineral), while vitamin D aids the absorption of calcium.’ This symbiotic relationship between certain vitamins and minerals illustrates the importance of a balanced diet – it’s more than just a catchphrase. IT’S ABOUT BALANCE If you suspect you have a nutrient deficiency, your first port of call should be a doctor or dietitian. There you’ll be examined and possibly sent for a blood test to check levels of vitamins and minerals in your body. The results will provide clarity on whether you require a particular supplement. The reason for this exact approach, as opposed to a one-size-fits-all method of taking a multivitamin, is because the body is designed to carefully regulate levels of vitamins and minerals. ‘The less you need of a nutrient (the less deficient
Your eating plan should include at least five portions of a variety of vegetables and fruit every day, and wholegrain products rather than refined versions you are), the more of that nutrient is excreted in the urine,’ says Kelly. In fact, high levels of certain nutrients can be toxic, so the body cleverly excretes whatever it can’t use for normal functioning. PLATE VS PILLS Kelly confirms that it’s possible to achieve an adequate micronutrient intake with a nutritionally complete diet, except for vitamin D, which is synthesised by the skin in the presence of sunshine. Your eating plan should include at least five portions of a variety of vegetables and fruit every day, and wholegrain products rather than refined versions. The body is unable to synthesise vitamin D through sunscreen or clothing, so a supplement is often recommended as the dangers of excessive sun exposure are well documented. There aren’t many food sources of vitamin D, therefore some cereals and dairy products have been fortified with the nutrient to achieve a balanced diet.
NUTRIENT VALUE The abundance of supplements on the market makes it difficult for consumers to spot quality and value, or the lack thereof. The bottom line is: ‘The quality of commercially sold supplements should, in theory, not be questionable, as research studies are required before sale,’ says Kelly. She does advise one to check the dose between brands on the nutritional info label on the packaging. If you’ve received a prescription from your doctor, it’s best to stick with that product. CHEMOTHERAPY WOES Supplements have been known to help with some of the uncomfortable side effects of chemotherapy, such as lethargy and mouth sores as well as skin sensitivity. However, Kelly says, ‘No supplements should be taken during chemotherapy unless it has been prescribed or approved by the treating doctor. Each patient is different.’ Good nutrition and sufficient energy intake is vital during cancer treatment to stave off muscle wasting and unintentional weight loss, and ensure malnutrition doesn’t hamper the treatment process. ‘Supplementing with vitamins and minerals will not make up for poor food intake,’ says Kelly. Supplements do not compensate for bad eating habits either, and they cannot prevent disease. Kelly recommends cooking at home with your family as the best way to make sure you’re consuming all your vitamins and minerals.
Kelly Francis is a registered dietitian who earned her BSc in Dietetics at the University of KwaZulu-Natal. She has been practising independently at Life Westville Hospital in Durban since 2010. Kelly enjoys educating both adults and children about good nutrition for optimal health, disease management and quality of life.
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There are 7 billion reasons why we do what we do. At Mylan, we are committed to setting new standards in health care. Working together around the world to provide 7 billion people access to high quality medicine we: • • • •
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Knowing and understanding how you can stay healthy when you are in hospital will help you feel empowered, says Samantha Page
very South African will need to access healthcare services at some point in their life. Being informed and knowledgeable about the safety of your treatment makes you a partner in your own care. World Patient Safety Day, 9 December, is a campaign for all stakeholders in healthcare systems around the world to raise awareness about patient safety. While hospitals and medical facilities always make safety a priority, patients also have an important role to play to keep themselves healthy during the time they are hospitalised. The most effective method to prevent the transfer of bacteria is good hand hygiene. Whether you are a patient, visitor or hospital staff, keeping your hands clean is one of the most important steps you can take to avoid getting sick and spreading germs to others. In recent years, antimicrobial stewardship, or the responsible use of antibiotics, has also become a focus of patient safety. Most hospitals have strategies in place to promote the appropriate use of antibiotics, reduce microbial resistance and decrease the spread of infections caused by multi-drug-resistant organisms.
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What can patients do to stay safe?
• Always ensure that the information you give your doctor or healthcare provider is accurate, including any allergies. • Don’t be afraid to ask questions if you have any doubts about your diagnosis, prescribed medication or treatment regimen. You are always within your rights to seek a second opinion. • Ask your doctor about the pros and cons of any medical procedure and request that they are clear about the side effects. • Ask friends or relatives who have colds, a cough, respiratory symptoms or contagious illnesses not to see you or anyone in hospital. You should also minimise visits from children under 12 as
LIFE PLUS they frequently have colds or other infections that are easy to pass on. • Falling is a common cause of patient injury in hospitals. Always ask for assistance, especially after an operation or at night when ward lighting might be low.
What can hospitals do to keep you safe?
• Make sure your doctor hasn’t used abbreviations when writing out your prescription. Capital letters are easier to understand and won’t cause confusion. • It’s important that hospitals engage you and your family in your own care by communicating effectively. If you feel this is not being done, bring it to your doctor’s or caregiver’s attention. • Doctors or pharmacists should carefully explain all prescribed medication, including how it should be taken and the possible side effects.
Handwashing can save your life
Washing your hands is one of the easiest and most effective ways to prevent infection. While you can’t wear protective gloves all the time, you can wash your hands regularly and properly. For more information about hand hygiene, visit www.lifehealthcare. co.za/patient-information/ infection-prevention
In line with the rest of the world, South Africans now have access to much-needed specialised geriatric care such as the programme at Life St Vincent’s in Cape Town. By Lynne Gidish
ne of the biggest challenges associated with growing old is learning how to cope with memory loss, a natural part of the ageing process according to Dr Faheema Parker, a specialist geriatrician at Life St Vincent’s. ‘In the ageing brain there are physiological processes that affect the brain’s ability to store and retrieve recently acquired information. So as you age – usually from 60 years onwards – you will experience a degree of memory impairment or forgetfulness.’ She continues: ‘Normal forgetfulness is when forgotten information is easily recalled. Misplacing your keys or forgetting a conversation is a very common form of forgetfulness. These “senior moments” are usually simply rectified by retracing your steps to find your keys or being reminded what the conversation entailed to recall what was said. It’s only when there is no recollection of a memory or event that could indicate the presence of a more serious problem, especially if this memory loss is impacting on your ability to do daily tasks’. If this is the case, it’s important not to jump to the assumption that you have Alzheimer’s disease (see ‘Symptoms of Alzheimer’s disease’). ‘There are many medical and mental conditions that could cause memory loss aside from dementia,’ says Dr Kathleen Ross, a specialist geriatrician at Life St Vincent’s. ‘This is why you should have a check-up with your doctor if you think you are becoming forgetful. The common treatable and reversible causes for cognitive impairment are thyroid disease, vitamin B12 deficiency and strokes. Medication, alcohol and drugs often impair cognition, so first check with your doctor before starting anything new, especially over-the-counter medication. Any acute illness, such as an infection or a fall, can cause confusion, which is often mistaken for dementia, while depression is very common in older persons and can resemble dementia.
The good news is that it’s treatable so seek professional advice if you are feeling negative, hopeless or less interested in your life.’
RISING TO THE CHALLENGE
It’s estimated that by 2050, the majority of people over the age of 60 will be found in the developing world. Dr Surita van Heerden, a specialist psychogeriatrician at Life St Vincent’s maintains that there’s already a critical shortage of healthcare workers who are interested in and trained to provide care and assessment to the elderly, and unfortunately the need versus available expertise gap is expected to be ever-widening. With people now living longer, optimisation of health, independence and quality of senior life is regarded as one of the most challenging issues facing health professionals globally and this is where multidisciplinary team-based clinics such as the one based at Life St Vincent’s are proving to be invaluable.
The need versus available expertise gap is expected to be ever-widening
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SYMPTOMS OF ALZHEIMER’S DISEASE Dementia is a general term used for brain disorders that cause memory problems, explains specialist geriatrician Dr Faheema Parker. Alzheimer’s disease is the most common cause of dementia. Symptoms can start mildly and progress slowly, including: • Forgetting things (for example, conversations, what you had for breakfast, misplacing objects) • Confusion • Trouble concentrating and reasoning • Language problems – struggling to find the right words • Getting lost in familiar places • Problems with tasks such as paying accounts and keeping track of expenses
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The Specialist Geriatric and Memory Clinic at Life Vincent Pallotti Hospital is one of the first of its kind in the country with its network of elderly care specialists. It’s based on similar services elsewhere in the world and is headed up by the doctors below.
Dr Faheema Parker is passionate about optimising the care of the elderly living with dementia and diseases unique to the aged.
Dr Kathleen Ross has an interest in dementia management and care, and helping people with multiple illnesses and medications.
Dr Surita van Heerden works with patients presenting with neuro-psychiatric and psychiatric disorders, including those with dementia, anxiety and depression.
OR LOSE IT Staying physically and mentally active should be a priority as you age. The specialised geriatric care programme team has the following brain-boosting tips: • Aim for 30 minutes of cardiovascular activity at least five times a week – exercise is important to maintain cognitive function. •S timulate your brain by doing crossword puzzles, word or number games, reading etc. •K eep socially/spiritually active. Isolation is bad for your brain. •M aintain a healthy weight and diet, especially the Mediterranean diet with lots of fruits, vegetables and good fats. • Ensure you get enough sleep. • Don’t smoke. •A void any brain suppressants, (sedatives, sleeping pills and alcohol) although a moderate amount of red wine (one glass for women; two glasses for men) is associated with better cognitive outcomes. • Avoid stress. •G et help if you suffer from anxiety or depression. •M anage chronic health/medical conditions, especially high blood pressure and diabetes. ‘Older populations suffer from a complex interplay of medical and neuropsychiatric conditions, which include chronic pain, cardiovascular diseases, cancer, dementia, anxiety and depression,’ says Dr Van Heerden, ‘and our clinic provides a comprehensive geriatric assessment to evaluate, diagnose and investigate geriatric medical and psychiatric conditions in a patient-centred way that restores health and independence. Where this isn’t possible, we aim to optimise function, minimise dependence and improve quality of life by treating and managing these conditions with the older person and his or her family’. Life Rehabilitation offers acute physical rehabilitation to specialised geriatric care patients. Visit lifehealthcare.co.za for rehabilitation unit details.
DO YOU HAVE
SOCIAL ANXIETY? Getting nervous in social situations limits your ability to make friends and expand your network. Find out how to cope with what could be a limiting condition â€“ especially during the holidays
Read each statement carefully and indicate which option applies best to you and your feelings, attitudes, behaviours and life in general. After finishing the test, you can sum up your points using the scoring table and view the relevant results for you. 1. I become nervous and/ or agitated when I meet someone for the first time. A Completely true B Mostly true C Somewhat true/false D Mostly false E Completely false 26
2. I feel paralysed and/or speechless when someone I donâ€™t know starts talking to me. A Completely true B Mostly true C Somewhat true/false D Mostly false E Completely false 3. I blush frequently when talking to others. A Completely true B Mostly true C Somewhat true/false D Mostly false E Completely false 4. If most people are already seated in a room, Iâ€™m highly reluctant to enter it.
A Completely true B Mostly true C Somewhat true/false D Mostly false E Completely false 5. I become distressed that people might hear my voice tremble when speaking in front of a group. A Completely true B Mostly true C Somewhat true/false D Mostly false E Completely false 6. I go to great lengths to avoid social gatherings. A Completely true B Mostly true C Somewhat true/false
D Mostly false E Completely false 7. Having to endure social situations causes me an intense amount of stress. A Completely true B Mostly true C Somewhat true/false D Mostly false E Completely false 8. My fear of group activities causes problems in my relationships. A Completely true B Mostly true C Somewhat true/false D Mostly false E Completely false
9. My life has been disrupted or negatively impacted because of my anxiety in social situations. A Completely true B Mostly true C Somewhat true/false D Mostly false E Completely false
I M A G E S G E T T Y / G A L L O I M A G E S T E S T C O P Y R I G H T 2 0 17 – W W W . Q U E E N D O M . C O M
10. I feel that my fear of social contact is excessive. A Completely true B Mostly true C Somewhat true/false D Mostly false E Completely false
S C O R IN G YO U R S E LF QUESTION 1 2 3 4 5 6 7 8 9 10
A 10 10 10 10 10 10 10 10 10 10
B 8 8 8 8 8 8 8 8 8 8
C 5 5 5 5 5 5 5 5 5 5
D 2 2 2 2 2 2 2 2 2 2
E 0 0 0 0 0 0 0 0 0 0
You display few, if any, worrisome symptoms of social anxiety. Even if you do get a little nervous interacting with people, your discomfort is unlikely to be excessive. Overall, you can generally navigate most social interactions quite well. The key factor to remember when it comes to socialising is that practice makes perfect, so if you’re a bit worried about a big presentation you have to make in front of a group of people, why not ask one or two friends to act as your audience in a role-playing scenario? This will help you become more familiar with the situation, easing nervousness you may feel when it’s time for the real presentation. You can go even further and have your friends ask questions so you can plan how to handle that scenario. Make sure, however, to choose friends that will take your situation seriously.
At the present time, your social anxiety is not extreme, but it could still be causing problems for you. It is advisable that you address this issue while your anxiety is still at a moderate level, preferably with the help of a speech coach, life coach or therapist. Think back to specific situations when your anxiety got out of hand – are there any patterns? Is it worse when you meet someone new, or only when you speak up in front of a group? It also helps to identify the exact moment when you start to feel anxious. Is it when someone you don’t know asks you a question or when you have to make a presentation in front of an authority figure? This information can help you determine what triggers your anxiety and from there, plan how to prepare yourself for these social situations.
Your level of social anxiety has reached a point where the intervention of a therapist may be required. You seem to have a great deal of difficulty navigating social situations with ease and this has likely caused problems in your life. While social anxiety can be overwhelming, it is a fear that can be conquered. The key is to develop an exposure programme. To master a situation that causes you discomfort, break it down into small steps. If, for example, you feel anxious about approaching a group of people at work/school, set small goals for yourself that lead up to that behaviour. First, say ‘Hi’ to someone different each day. Then move on to making small talk about something in the news that day. Slowly but surely you will make progress. And remember, you don’t have to do this alone – a therapist can guide you through the entire process.
Most people experience some discomfort when they deal with social situations. Maybe you get butterflies before you have to make a speech, or perhaps you’re worried about getting tongue-tied when you’re being introduced to someone new. It might be that you just consider yourself to be a little shy. These are natural reactions to potentially stressful situations. Social phobia (also known as social anxiety disorder) is a persistent and obsessive fear of social situations, in which a person feels that their anxiety is beyond their control and is interfering with their life. This is one of the most common mental health problems in the world, yet most of us know little about it. According to SADAG (South African Depression and Anxiety Group), optimal treatment includes psychotherapy and medication.
Your guide TO A SAFE JOURNEY Thousands of South Africans will be travelling on our country’s roads this festive season, so it’s important to buckle up, drive sober and abide by the rules of the road. Lisa Witepski has some tips 28
or chips in your windscreen. If you have young children, check that their car seats have been properly installed.
THE LONG ROAD
Before you get behind the wheel, it’s crucial to be physically and mentally prepared. This means making sure you are well rested from the night before, and that you haven’t been drinking or taking drugs, including medication which might make you feel drowsy. Once on the road, follow the basic rules: don’t operate your cellphone while driving, obey the road signs, stick to speed limits, stay buckled up and avoid distractions. It’s easy to submit to road aggression if those around you are driving recklessly. If you feel your temper sliding, fall back a little and try to focus on your own driving. Taking deep, even breaths or counting to 10 also help to keep you calm. Better still, schedule stops every two hours or 200km, and use the time to have a snack and rehydrate (low blood sugar levels are a sure recipe for a tetchy mood). The kids will be especially glad to stretch their legs and, as any driver with a family knows, fidgety, bored children in the back seat can be a terrible distraction.
ccording to the Road Traffic Management Corporation, 14 071 people died on South Africa’s roads in 2016. Pedestrians, the most vulnerable of all road users, accounted for 5 410 of those deaths.
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One way to avoid becoming a victim is ensuring that your car is in sound running order. It’s vital to maintain your vehicle’s mechanical condition throughout the year, so service it regularly and check oil and water every time you fill up. Complete a more thorough check of the car before you leave to ensure that tyres and brakes are in good condition and don’t need replacing. Make sure that the rubber on your windscreen wipers hasn’t perished, and that there are no cracks
If you’ve had a collision in spite of your precautions, your first step should be to switch on your hazard lights, move the vehicle to a safe place on the curb, and get out once it is safe to do so. Make sure that no one has been hurt. If there are injuries, call the police or an ambulance. Take photographs of the damage from different angles (for insurance purposes) and swap information (contact details, ID numbers) with the other drivers. Make a note of the driving and visibility conditions – this will prove useful when you report the incident to the police later. Remember that it is a criminal offence to not stop if people have been injured in an accident in which you are involved. On the other hand, unless you’ve completed a first-aid course, it’s best to leave treatment of the injured to the professionals.
Keep standard safety equipment in your car: a fire extinguisher, warning triangle and torch, as well as a phone charger and umbrella. Familiarise yourself with your route before you leave. Instead of relying solely
on your GPS, read a map ahead of time and save contact details for nearby accommodation and hospitals. Hijacking is a reality in South Africa, so remember to keep your valuables out of sight. If you come across any hostile individuals who could potentially pose a threat to you or your family, try to remain calm. You can attempt to defuse tensions by explaining everything you are doing; for example, ‘I am going to use my right hand to undo my seat belt. Now I am using it to open my front door’. Don’t fight for your car – it’s not worth your life. Remember, your holiday should be memorable for all the right reasons.
WHEN CALLING EMERGENCY MEDICAL SERVICES (EMS)… •K eep your EMS number in an easy-to-find place and on your phone. •O nce connected, state your name and the number you’re calling from. •D escribe the emergency. •P rovide as much information about the location. •W ait for the call taker to end the call – they can assist while you wait for the paramedics to arrive.
LIFE PLUS Seven of Life Healthcare’s emergency units employ paramedics in fully equipped response cars and offer Advanced Life Support (ALS) paramedic assistance to their communities. There is only a cost if an ambulance is dispatched. • L ife Flora Hospital, 011 470 7744 • L ife Kingsbury Hospital, 0860 532 532 • L ife Fourways Hospital, 0860 444 044 • L ife Rosepark Hospital, 0800 22 22 22 • L ife Springs Parkland Hospital, 082 504 8500 • L ife The Glynnwood, 078 137 4304 • L ife Vincent Pallotti Hospital, 0860 532 532 WWW.LIFEHEALTHCARE.CO.ZA
Major illness? Stroke? Traumatic injury? Your journey of recovery starts here
Let Life Healthcare’s Acute Rehabilitation Team of dedicated experts assist you to prioritise and develop your care journey to recovery Life Rehabilitation is a specialised healthcare service dedicated to providing rehabilitation care to patients recovering from:
■ Head injury ■ Spinal cord injury ■ Severe orthopaedic injury as a result of injury on duty or car accident ■ Stroke and nerve related injury or illness that has resulted in weakness or paralysis ■ Traumatic injury, amputation and/or joint replacement
We also support:
■ Elderly patients with weakness and inability to walk ■ Unsteadiness and weakness following a severe medical illness ■ Cancer recovery ■ Post-surgery for strengthening and stabilisation
Life Rehabilitation has extensive knowledge in managing the rehabilitation requirements of our patients. Each patient has unique needs and we develop care treatment plans tailored towards the individual in collaboration with families. Our interdisciplinary team includes:
■ Rehabilitation doctors ■ Rehabilitation nurses ■ Physiotherapists ■ Occupational therapists
■ Neurocognitive psychologists ■ Speech and language therapists ■ Social workers ■ Dieticians
Will my medical aid pay for the treatment?
Most medical aids pay for acute rehabilitation to facilitate return to function and reduce complications. Life Rehabilitation offers you a global fee tariff which is inclusive of hospital, doctor and therapists costs. This ensures that patients are protected from medical savings being depleted.
What do I do next?
We can assist you in obtaining the referral to our facility to further facilitate recovery. Please contact us for further assistance. For more information please contact us on Tel: 011 219 9626 or email: Rehab.Headoffice@lifehealthcare.co.za www.lifehealthcare.co.za
HEALTH LIVING WITH DISABILITY / GUARD AGAINST MALARIA / THE STEM CELL DEBATE
‘IDENTIFY YOUR PROBLEMS BUT GIVE YOUR POWER AND ENERGY TO SOLUTIONS.’ TONY ROBBINS, AUTHOR AND LIFE COACH
is stronger than
To celebrate International Day of Persons with Disability on 3 December, three former Life Healthcare patients offer an inspiring look at ability vs disability. By Glynis Horning
isability takes many forms, physical and mental, and it could affect you or your loved ones at any time in our accident-filled and often violent society. Neither of the three people who have shared their stories expected to be among those affected. But after the initial shock and grief, they found acceptance and new strength. The most recent census (2011) showed that 7.5% of South Africans are living with a disability – defined by Article 1 of the UN Convention on the Rights of Persons with Disabilities as ‘those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others’.
Sadly, the census data shows eight out of 10 people with disabilities are unemployed. Tendai Khumalo is the MD of Qunu Workforce, which provides disability solutions for corporate and government organisations. He reports that although the Employment Equity Act states that at least three percent of the workforce should be employees with disabilities, there is little compliance. The consequences for employers are limited ‘if any’, unlike failure to meet B-BBEE targets. This is one of the biggest problems facing the ‘able disabled’, therapists explain, as independence, purpose and self-respect are key to healing and living one’s best life – and many have a wealth of insights and experience to offer. Their ability is far stronger than their disability.
THE DISCLOSURE DILEMMA There is no legal obligation to disclose a disability to an employer or potential employer, provided it doesn’t affect your work or the employer’s production or put anyone at risk. ‘Disclosure can have risks – ignorance, unfair stereotyping, prejudice,’ says Peter Strasheim, owner of DLM Labour and HR Management Consulting. However, it can bring benefits too. ‘Many employers will welcome your application as the Employment Equity Act requires them to increase their number of employees with a disability.’ The act also states that companies should provide medically recommended ‘reasonable accommodations’ to help you, such as time off for medical appointments and flexi-hours.
THOMAS MASHIA, 42
RANCHAD JOSEPH, 29
‘My life changed one afternoon in March 2003, when I went to collect my wife at the hair salon. Waiting in my car outside, I was hijacked and shot by two thugs who had robbed the salon. ‘As I lay bleeding in the road, I was shocked to find I couldn’t move my legs. Then I passed out. I regained consciousness only six days later in the ICU of Life Eugene Marais Hospital in Pretoria. Doctors said a bullet had entered the right side of my neck and exited my left shoulder blade, damaging my spinal cord. Both my legs were paralysed… ‘My first reaction was anger – at the criminals, and at life for giving me this burden. But thanks to God and the support of my family, I’ve come to see it as a challenge. To accept it and work with it. Yes, I will never have use of my legs, but there is so much I can offer the world. Physiotherapy, occupational therapy and psychological therapy at the rehabilitation unit at Life Eugene Marais Hospital assisted me to reshape my life and focus on the positive things, which I didn’t always do before the accident. I can cook, clean and drive myself, and fulfil my responsibilities as a family man and father. I have regained self-confidence. ‘The therapists also encouraged me to socialise and get back to my work, not sit around and mope. I am grateful, because from being a teacher, I am now working with the district office of the Mpumalanga Department of Education as the assistant director for the employee health and wellness programme. I provide intervention for employees experiencing psycho-social and other problems. When I tell them they can push past challenges, they can see it’s possible. It’s given my life new meaning. ‘In 2005, I also started a radio programme on IkwekweziFM (9.30pm on the last Thursday each month) to educate and motivate people living with disability. It won me an award as Disabled Activist of the Year. ‘There is life beyond disability – confidence builds a strong character and positive energy breaks barriers!’
‘This April, I was driving home from the mine where I work in the Northern Cape when I lost control of my car. I have no memory of it, but apparently my car plunged through bush and hit trees, triggering the airbag – and throwing me through the rear window. ‘When I came to six hours later I couldn’t use my legs, but I thought it was temporary. After 10 days in the ICU, doctors told me it was permanent. I said “My head is still fine, so I’ll force my legs to walk.” It took another week to realise I could not. ‘At first I wished I had died. It was very hard – I blamed myself and there were many tears. But my family stuck by me, and so did my fiancée Jozandré. I told her she could move on with her life. But she said she was with me not because I could walk, but because of the person I am. We are now closer than we ever were. ‘There are many challenges, but at the rehabilitation unit at Life Pasteur Hospital in Bloemfontein I am mastering the worst, and also starting to explore different ways to be intimate.
OCCUPATIONAL THERAPIST’S VIEW
My biggest lesson has been not to push people away. You need to understand that they really care for you ‘I can no longer work as a plater welder, but Jozandré motivated me to apply for a different post within the company, and I’ve begun work as a resource coordinator. I remind myself many able-bodied people struggle to find work. ‘Physiotherapy has helped a lot, and meeting others in wheelchairs. When I struggle, I remind myself what someone told me: “You can still make jokes and laugh and enjoy other people’s company.” My biggest lesson has been not to push people away. You need to understand that they really care for you, no matter what. Thank them every day, and tell them you love them.’
Christi-Mari Botes, rehabilitation unit at Life Eugene Marais Hospital
‘We educate patients and their families about their condition, and teach techniques to achieve independence and a quality life. Thomas is a good example. We assess their seating needs because the correct wheelchair and cushion are extremely important, and start the return-to-work process, advising the workplace on modifications. It’s important for patients to continue jobs and hobbies that are meaningful to them, and to try adaptive sports. Thomas is an inspiration to many.’
Mari Labuschagne, rehabilitation unit at Life Pasteur Hospital
‘We help patients like Ranchad strengthen the muscles that are still innervated, improve balance and provide techniques to do their daily tasks for optimal quality of life. As we’ve told him, rehabilitation doesn’t stop on discharge – it will continue as he gains strength and is able to do even more tasks.’
INTERACTING WITH THE DIFFERENTLY ABLED Working or socialising with someone who has a disability should be no different than with anyone else, but if you’re unfamiliar with their problem, you may fear giving offence. •D on’t be afraid to look at someone in case it seems you’re staring. ‘Make eye contact as you would for anyone and smile,’ says Thomas Mashia, who is disabled. ‘See the person, not the chair.’
OUR SERVICES Life Rehabilitation provides quality, cost-effective, acute, outcomes-driven physical and cognitive rehabilitation for patients affected by stroke, spinal cord injury, brain injury and other disabling conditions.
Our reach by the numbers
acute rehabilitation units
•U se ‘person first’ language, emphasising the individual and not the disability, says communications officer Sihle Gqirana from the National Council of and for Persons with Disabilities. ‘X has paraplegia/has partial sight’ not ‘X is a paraplegic/blind’. •U nless the disability is severe hearing or cognitive impairment, don’t speak louder or slower than normal, use simplified language or talk through someone else. It’s disrespectful and patronising. If the person has a speech impediment, don’t hurry him or her or complete their sentences. •D on’t agonise over common terms. Saying ‘I’ve got to run’ when someone is in a wheelchair is not offensive – apologising just draws attention to your awareness of the person being disabled, says Thomas.
FOR MORE INFORMATION, CONTACT A UNIT CLOSEST TO YOU: Eastern Cape Life St Dominic’s Hospital, 043 707 9000 Free State Life Pasteur Hospital, 051 522 6601 Gauteng Life Eugene Marais Hospital, 012 334 2777 Life New Kensington Clinic, 011 538 4700 Life Riverfield Lodge, 086 074 8373 KwaZulu-Natal Life Entabeni Hospital, 031 204 1300 Western Cape Life Vincent Pallotti Hospital, 021 506 5111
•D on’t be afraid of giving offence by offering help. But don’t help without asking first – grabbing a wheelchair or taking someone with impaired vision by the arm and steering them is rude (offer the latter your arm to hold and lead them).
‘I was on my way to a funeral with colleagues last year in July when our car was rammed from behind. We spun off the road and crashed – there was blood everywhere and terrible pain and I couldn’t move. I was in the back seat and my door jammed, so I was dragged out of the other one. No one thought of a spine injury… ‘At Life Midmed Hospital, my wife was waiting with our two-month-old baby. When she saw me, she cried. I told her I didn’t think I’d live. But she said I had to – they needed me. She gave me courage and I’ve held on to it. ‘My spinal cord was broken and I was told I’d never walk. But I wouldn’t accept it. I moved to Life Riverfield Lodge for acute physical rehabilitation, and after four months of intense
While my life is much harder, in some ways it is better. I am better
therapy I was out of my wheelchair, balancing on calipers. The first steps were agony, but wonderful! The next challenge I gave myself was to bath, not shower – staff thought I was crazy, but I insisted. It was so great to soak in the hot water. And the feeling of achievement! ‘I am now back home and driving myself with hand controls fitted to my car. ‘I’m still in pain and can’t sit more than four hours, but when I get past that I will return to my work with a security company. Fortunately, they are supportive. ‘My biggest problem is my temper, but I’m working on it, and my wife tells me I am nicer than before the accident. She loves that I no longer go out drinking and spending money – I am there for her and our two kids like I wasn’t before. While my life is much harder, in some ways it is better. I am better.’
SOCIAL WORKER’S VIEW Matome Moremi, Life Riverfield Lodge ‘Patients like Sizwe need to work through the stages of grief for their old selves (denial, anger, depression, acceptance) and we support that in individual and group discussions, and help them adjust to their new reality. We bring in sex educators and driving and other specialists, who show ways to do things they fear they might not manage again. And where someone is in a job, like Sizwe, we call in the employer and discuss how they can accommodate his limitations. Most employers are supportive. And some patients receive payment from their insurance, and use it to start their own businesses. We’ve just had a man start his own taxi operation!’
MEET OUR EXPERTS
Matome Moreni has a Bachelor of Social Work from the University of the Witwatersrand. He has been working as a social worker for four years and is currently at Life Riverfield Lodge.
Christi-Mari Botes has a BEd Honours (educational psychology) and taught for four years before doing her Bachelor in Occupational Therapy. She joined the rehabilitation unit at Life Eugene Marais Hospital in 2014.
Mari Labuschagne received her BSc Physiotherapy degree from Stellenbosch University in 2012 and has been working at Life Pasteur Hospital since 2014. 36
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SIZWE MNCINA, 28
5 reasons to visit our new website We’ve launched our new website and we’d like to introduce you to some of its features www.lifehealthcare.co.za has been designed with you, the patient, in mind. It’s fast, easy to navigate and offers an enhanced experience on your mobile device. You can:
#2 Download a pre-admission form
#4 Search for a hospital and their specialists and services
#1 Get a list of what to pack for your hospital stay
#3 Read Life Healthcare magazine
#5 Learn more about patients rights and responsibilities
If you know you are going to be in hospital overnight – or a little longer – it is helpful to have all you need to make your stay as comfortable as possible.
Pre-admission ensures that you are as prepared as possible for your hospital stay. Make sure all relevant documentation has been completed on the day of your admission.
The latest issue of our quarterly publication is available online. You can also access all previous issues so you can catch up on health news and lifestyle advice.
Life Healthcare has 64 facilities from which to choose, as well as physicians and staff who are committed to caring for your health and wellbeing.
Our patient rights and responsibilities informs our patients and their families of their basic rights with regard to care in our facilities.
Making life better starts by clicking on www.lifehealthcare.co.za You can also find us on Facebook (@lifehealthcare) and Twitter (@LifeHealthcare_)
Success of a groundbreaking microsurgery to treat lymphoedema now opens the door for the treatment of the many affected patients in the country. By Carla Hüsselmann
LIFE-CHANGING SURGERY FOR
e needed any glimmer of hope following, at first, a long battle with malignant melanoma, and then a shock diagnosis of the incurable condition lymphoedema. In 2015, Johan van Wyk, 58, a retired farmer from Paarl in the Western Cape, became distressed when his left arm suddenly started swelling shortly after surgery for removing cancerous lymph nodes. ‘My arm became uncomfortable and heavy due to fluid accumulation, and I struggled to move it,’ explains Johan. ‘My doctor diagnosed lymphoedema, and I was treated conservatively with physiotherapy, manual lymph drainage, bandaging and pressure garments, but unfortunately there was minimal improvement.’ He even enrolled in a US clinical trial to try experimental medication to control the chronic condition. Then earlier this year, hope finally came in the form of a pioneering surgery
by leading plastic and reconstructive surgeons, Dr Conrad Pienaar and Dr Clare Neser from Life Vincent Pallotti Hospital in Cape Town. Known as vascularised lymph node transfer (VLNT) surgery, this state-of-the-art microsurgery would improve the severity of lymphoedema and reduce the disease’s complications, Johan was promised. On 19 July this year, Dr Pienaar and Dr Neser successfully performed what Johan calls ‘a life-changing operation’. Johan can finally use his arm properly again and is relieved that his future will see a better quality of life overall.
WHAT IS LYMPHOEDEMA?
The main functions of the lymphatic system are to help fight infection and drain excess lymphatic fluid (containing water, protein, white blood cells, waste and other materials) from tissues. ‘Lymphoedema is caused by a problem with the lymphatic system which leads
to insufficient lymphatic drainage and the abnormal accumulation of fluid within your soft tissues,’ explains Dr Neser. This dysfunction results in abnormal swelling most commonly in one or both arms or legs. If not treated effectively, its consequences can include recurrent infections and long-term disability. ‘Its prevalence is difficult to establish as it’s under-recognised and often misdiagnosed, however, it’s estimated at approximately 90 million people worldwide,’ says Dr Neser. There are two main types: primary and secondary. Primary is caused by faulty genes adversely impacting the lymphatic system’s development. Secondary is caused by damage from cancer treatment, infection (for example, with the parasitic disease filariasis), injury and inflammation of a limb. ‘Any cancer that requires treatment of the lymph nodes with surgery and/ or radiation has the risk of secondary
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I N N O VA T I O N
lymphoedema,’ explains Dr Neser. ‘It’s not per se the cancer, but the intervention to treat the cancer that causes it. It most frequently presents in breast cancer patients, followed by gynaecologic malignancies, melanoma, sarcoma, lymphoma, prostate cancer, urologic cancers, and head and neck malignancies.’
THE INTRICACIES OF VLNT SURGERY
Johan underwent a four-hour procedure in the expert hands of Dr Neser and Dr Pienaar, a South African pioneer in the field of microsurgical reconstruction. Microsurgery is a highly specialised procedure during which a microscope, specialised instruments and small needles with fine sutures are used to repair damage to blood vessels. ‘VLNT surgery using microsurgery is a relatively new option for the treatment of lymphoedema and was first performed in Taiwan a number of years ago,’ says Dr Pienaar. ‘Secondary lymphoedema patients are predominantly the best candidates, but there have been successful primary lymphoedema cases. It’s best for early stage rather than late-stage lymphoedema; late-stage sees persistent fibrosis and scarring, which will prevent improvement,’ he explains. Dr Pienaar says that although they’d never performed VLNT surgery before 19 July 2017, they weren’t nervous: ‘VLNT surgery is basically a modified free flap surgery, which is something we as plastic and reconstructive surgeons have been doing for 20 years.’ (A flap is a unit of tissue that’s transferred from the donor site to the recipient site, while maintaining its own blood supply.) ‘We performed an incision in Johan’s groin with the aid of loupe magnification [a magnification device]. Using careful dissection, we removed the healthy lymph nodes in his groin, including veins,
Hope came in the form of a pioneering surgery by Dr Conrad Pienaar and Dr Clare Neser the artery and surrounding tissue. We then transferred the flap to his wrist, where his blood vessels were reconnected under microscopic magnification using specialised micro-instruments and tiny sutures.’ These healthy transplanted lymph nodes are now acting as a physiologic ‘sponge’ that drains
MEET OUR EXPERTS
Dr Conrad Pienaar (conradpienaar.co.za) and Dr Clare Neser (clareneser. co.za) are a husband-andwife team who share a busy practice at Life Vincent Pallotti Hospital. They are long-term volunteers with Operation Smile.
Dr Clare Neser’s passion lies in microsurgical reconstruction and nasal reconstruction with clinical interests in blepharoplasty, rhinoplasty and breast surgery. She has also participated in Operation Smile missions to Madagascar, Malawi, DRC, Rwanda and Jordan.
Dr Conrad Pienaar specialised in microsurgery at the Medical University of Groningen in the Netherlands. His clinical expertise: head and neck reconstruction, breast reconstruction, orthopaedic bone cancer reconstruction, lymphatic surgery, cleft lip and palate surgery and skin cancer reconstruction.
• Lymphoedema Association of South Africa www.laosa.co.za • International Lymphoedema Framework, a dedicated platform for the lymphoedema community lympho.org • Lymphatic Education & Research Network lymphaticnetwork.org/about
the excessive lymphoedema fluid from Johan’s arm and diverts it to his venous system to be drained away. The surgery wasn’t painful and his arm isn’t as swollen and heavy, says Johan, who is also winning his battle against melanoma. ‘I was in hospital for three days and my post-op recovery was made easier thanks to Dr Pienaar and Nurse Konni Kruger. The operation’s success rate is 98% and I won’t have to undergo surgery again. I’m still continuing with conventional treatment to prevent possible swelling, but I am not using a pressure garment.’ Dr Pienaar says that he expects ongoing improvement in Johan’s arm. The risks of this surgery include the potential of developing lymphoedema in the limb where nodes were removed and ‘unrealistic expectations’, says Dr Pienaar. ‘Treatment is aimed at alleviating severity of the condition – it isn’t curative,’ he says. ‘Patients will see a significant improvement in symptoms, including a reduction in the limb’s size, a reduced sense of “heaviness”, a reduction in infection (cellulitis), increased range of motion, and a reduced need for a compression garment.’ Due to the success of this operation, which is covered by some medical aids, the doctors will be performing this surgery again this year.
PREVENTION IS BETTER THAN CURE
Visiting a malaria-risk area this holiday season? Mandy Collins shares what you need to know to protect yourself
t’s summer ... and mosquito season. More often than not, they’re simply a whiny disturbance that keep you awake and leave you with an itchy welt in the morning. Get bitten by the wrong mosquito though, and you could find yourself with a life-threatening disease: malaria. South Africa is largely malaria free, but certain parts of the country are risk areas. Sonique van den Berg, a pharmacist at Life Peglerae Hospital, says danger areas include the north-eastern side of KwaZulu-Natal, the Lowveld of Mpumalanga and Limpopo, and the parts of the country bordering Zimbabwe, Mozambique and Swaziland. ‘Kruger National Park is included, but Mbombela is not,’ she says, adding that the danger period lies between September and May each year with January to April being the highest risk time for transmission. ‘If you are travelling elsewhere on the continent, it’s best to consult your closest travel clinic on malaria-risk countries,’ says Sonique. ‘They will have the most accurate information and can also advise you if you need
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vaccines for other diseases such as yellow fever.’ There is currently no commercially available vaccine for malaria, but that doesn’t mean you do not have options for prevention. ‘For malaria there is oral prophylaxis available in the form of tablets,’ says Sonique. ‘They are Schedule 4 drugs, so you will need a prescription from your doctor.’ Sonique says there are three different oral medications for malaria prevention and each is administered slightly differently: •M efloquine is taken one to two weeks before travel, then weekly while at your destination, and for four weeks after you leave the malarial area. • Doxycycline is taken daily. You can start one or two days before travel, during exposure, and for four weeks after leaving the malarial area. •A tovaquone-proguanil is taken daily. You start one to two days before you leave, take it throughout exposure as well as for seven days afterwards. She cautions that children and pregnant women are two of the most vulnerable groups affected by malaria. Sonique explains that it’s vital to allow enough time to see your doctor or a travel doctor before taking your trip. Some people are more at risk due to pre-existing medical conditions, so you need to communicate your medical history clearly and provide a full list of medication you are on, including over-the-counter and natural medication. Some people choose not to take malaria prevention at all because they worry about side effects. But Sonique cautions that all medicines have adverse effects and the risk of developing serious side effects must be weighed against the risk of contracting malaria. ‘No prophylaxis is 100% effective,’ she says. ‘However, The Guidelines for the Prevention of Malaria in South Africa 2017 edition tells us that the disease in those taking prophylaxis is likely to be milder and less rapidly progressive.’
The key is to prevent being bitten at all.
THE BASICS Malaria is a disease caused by a parasite, and is carried and transmitted by the female anopheles mosquito. If an infected mosquito bites you, the parasite is transmitted into your blood stream. Malaria produces recurrent attacks of chills and fever. It is a very serious disease killing thousands each year and an estimated 429 000 people in 2015. Once you’ve been bitten, the parasites travel to your liver. When they mature, they leave the liver and infect your red blood cells. This is when people typically develop malaria symptoms. Malaria presents with flu-like signs and symptoms typically present within a few weeks after being bitten by an infected mosquito. However, some types of malaria can lie dormant in your body for up to a year. Because the parasites that cause malaria affect red blood cells, you can also contract malaria from exposure to infected blood, including: • From mother to unborn child • Through blood transfusions (you can’t donate blood if you’ve been in a malaria area) • Sharing needles used to inject drugs.
• Stay indoors, especially from dusk to dawn. • Wear long-sleeved shirts, long trousers, shoes and socks. • Cover doors and windows with screens. • Use insect repellents that contain DEET (diethyl toluamide) for adults and children over two months old on all exposed areas of the body. • Sleep under mosquito nets. • Use mosquito pads and coils. • Treat your baggage and clothes with insecticides when leaving the malarial area.
LIFE PLUS The ABC of malaria prevention A: Awareness and assessment of malaria risk B: Avoidance of mosquito bites C: Compliance with prophylaxis when indicated D: Early detection of malaria E: Effective treatment
Source: The Guidelines for the Prevention of Malaria in South Africa 2017
MEET OUR EXPERT
Sonique van den Berg is a pharmacist who studied at North-West University, Potchefstroom Campus. She has a special interest in clinical pharmacy and has worked at Life Peglerae Hospital for the last seven years.
Navigating the sleep situation between you and your baby doesn’t have to be a nightmare. Melanie Farrell shares some sound advice from a paediatrician and a gynaecologist
How to get
MORE THAN 40 WINKS
abies sleep differently from adults,’ explains Dr Natasha PadayacheeGovender, a paediatrician at Life Fourways Hospital in Johannesburg. ‘Understanding the physiology of sleep and the difference between infant and adult sleep patterns is important.’ It’s complicated because babies have shorter sleep cycles than adults. They spend only 45 minutes in REM (rapid eye movement or active sleep) compared to an adult’s cycle of 90 minutes. It can be exhausting, particularly for the first six weeks when it may feel as 42
if you and your baby are on different sleep schedules. ‘A sufficient amount of sleep is essential for optimal physical health, immune function, mental health and cognition,’ explains Dr Padayachee-Govender. ‘It’s important for babies to sleep well because it is an active, dynamic physiological process with far-reaching benefits.’ The American Academy of Sleep Medicine recommends babies need 12 to 16 hours of sleep (including naps) while toddlers need 11 to 14 hours. Dr Abigail Lukhaimane, an obstetrician/gynaecologist at Life
Fourways Hospital, says: ‘Sleep is very important for a new mother. Whether it was a natural delivery or a caesarean, birth takes it out of you and your body needs time to rest and heal’.
SURVIVE SLEEP DEPRIVATION
The experts are agreed: sleep is vital for both babies and parents, but how to get enough when your infant is waking regularly during the night? It’s important to remember that the unpredictable sleeping patterns of newborns doesn’t last long, and at about six to eight weeks most babies begin to sleep for shorter periods during the day
THE BABY FILES
and longer stretches during the night. ‘The best advice I give every new mother is that in the beginning they should sleep when the baby sleeps. Drop everything else and focus on healing,’ says Dr Lukhaimane. ‘I also advise moms to use the hands around them – ask a friend or partner to feed the baby so that you can get six to eight hours of uninterrupted sleep to recharge and regain perspective.’
SLOW DOWN, SLEEPYHEAD
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So what can be done to encourage babies to sleep longer at night? Establishing a consistent, calm bedtime routine is a good place to start, recommends Dr Padayachee-Govender. • Keep it short, approximately 30 minutes. • Start the routine with a bath. • Feed baby prior to bath time. • Keep it fun. • Keep it consistent – always at the same time and in the same order. • Ensure sufficient day-time sleep and adequate awake time. Avoid overstimulating baby’s brain – it makes it harder to switch off and sleep. • An early bedtime (7–8pm) is better. • Give baby a chance to fall asleep on his or her own – avoid sleep aids such as rocking and dummies. Although it’s tempting to rock a baby to sleep, this may lead to a situation where the baby isn’t able to self-soothe and can’t fall asleep without rhythmic rocking. ‘If you want to teach your baby to self-soothe, you need to set the stage for baby to learn to settle down on his own once he is old enough (generally around 12 weeks),’ says Dr Padayachee-Govender. ‘It takes practise and consistency.’ Dr Lukhaimane continues, ‘Sleeping routines are something to keep in mind but I always say it’s important to find a routine that works for you and your baby. And the rest of the family too.
MEET OUR EXPERTS
‘Sometimes it’s just not practical to stick to sleeping routines and some babies adjust better than others so it’s a case of trial and error.’
Sleep training is a structured way of helping a baby to learn how to fall asleep and stay asleep through the night. It generally involves a degree of ‘controlled crying’, during which the baby is left to cry for short periods of time to determine whether he or she settles independently. ‘The cry-it-out technique may only be attempted after six months of age and only if your baby has a normal clinical and developmental assessment,’ explains Dr PadayacheeGovender. ‘Certain medical conditions, such as reflux or ear infections that may be affecting baby’s sleep, need to be excluded first.’ Although it’s not for everyone – listening to a crying baby can be hard – it may offer solutions for a baby or toddler who wakes frequently during the night, disrupting the household. ‘Co-sleeping or sharing the parents’ bed is not advised because it is a risk factor for SIDS (sudden infant death syndrome). I recommend that baby sleeps in the same room as mom and dad on a separate baby-safe sleeping surface, on his or her back, for at least the first six months,’ adds Dr Padayachee-Govender. Whether you opt for sleep training or a more organic approach, bear in mind that each baby is different and there’s no one-size-fits-all sleep solution. You need to find what works for you and your baby so that you both get enough shut-eye to stay happy and healthy.
Dr Natasha Padayachee-Govender is a paediatrician who has worked at Life Fourways Hospital since October 2015.
LIFE PLUS Safeguard against SIDS
Any parent’s biggest fear in the early months is that their baby will succumb to sudden infant death syndrome or SIDS. ‘SIDS is a term used to describe any sudden and unexpected death occurring during infancy,’ says paediatrician Dr Natasha Padayachee-Govender. ‘I recommend that parents follow the American Academy of Pediatrics (AAP) guidelines for preventing SIDS. The AAP guidelines include: • Infants should be placed for sleep in a supine position (wholly on the back) for every sleep until one year of age. Side sleeping is not advised. • Infants should be placed on a firm sleep surface (for example, mattress in a safetyapproved crib) covered by a fitted sheet with no other bedding or soft objects. • B reastfeeding is associated with a reduced risk of SIDS. • It is recommended that infants sleep in the parents’ room, close to the parents’ bed, but on a separate surface designed for infants, ideally for the first year of life, but at least for the first six months. • K eep soft objects and loose bedding away from the infant’s sleep area to reduce the risk of suffocation, entrapment and strangulation. Source: The American Academy of Pediatrics (AAP)
Dr Abigail Lukhaimane is a specialist gynaecologist and obstetrician and has worked at Life Fourways Hospital since 2014.
STEM CELLS Stem cells have created a new medical discipline using our own biology to heal ourselves. But some ethical considerations have emerged... By Pippa Naudé
began roughly 50 years ago when haematopoietic cells (blood stem cells) were used to treat blood disorders like leukaemia or anaemia, and later given to cancer patients to replenish their blood supply after chemotherapy. These treatments are still effective today.’ Although it’s believed stem cells are present in all tissues, they can be hard to locate. The success of haematopoietic therapies is partly because they’re relatively easy to obtain, either from bone marrow transplants or peripheral blood or, more recently, cord blood banking.
tem cells enable a single fertilised egg cell to develop into a person with a complex biology made up of billions of cells. This is possible because they have two unique characteristics: they can create identical copies of themselves and can specialise into different types of cells. It’s these abilities that make them therapeutically powerful. Research shows they could one day treat diabetes, cerebral palsy, rheumatoid arthritis, osteoarthritis, Parkinson’s disease, Alzheimer’s, Crohn’s disease, brain and spinal cord damage, and loss of hearing and eyesight. Dr Gerhard Sissolak, a clinical haematologist at Life Vincent Pallotti Hospital, says, ‘Stem cell treatments
BANKING FOR YOUR BABY’S FUTURE Cord blood is found in the umbilical cord and can be extracted painlessly and safely after birth. Cryogenically freezing it preserves it for at least 20 years – likely longer as research continues to prove its efficacy. This ensures stem cells are available for medical therapies, if needed. Cord blood banking is only available privately in South Africa. The donor has access to their blood at any time and it will be a perfect genetic match for own use. There is also a one in four chance that siblings will be a match. EMBRYONIC STEM CELLS The most controversial way to obtain stem cells is to harvest them from excess embryos initially destined for IVF and donated by consenting parents. ‘Unlike
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STEM CELL TOURISM Another controversial area is stem cell tourism, where unethical companies offer expensive treatments that have not been scientifically proved safe or effective. This has also surfaced in SA, despite the fact that the Medicines and Related Substances Control Act prohibits advertisement and sale of unregistered medicines like these. Marietjie says, ‘In the well-known Biomark case in 2006, two South Africans were indicted in the US for administering unregistered stem cell treatments. The average spend per patient was $10 000 to $32 000. None of the patients receiving these untested treatments were cured and many died.’ She adds, ‘Selling unregistered medicine in SA is a statutory offence.’
To better understand the healing potential and limitations of stem cell therapies, and your rights as a patient, visit the International Society for Stem Cell Research website. www.isscr.org Dr Gerhard Sissolak is a clinical haematologist at Life Vincent Pallotti Hospital. He has practised at several international tertiary teaching hospitals and is a senior lecturer at Tygerberg Academic Hospital. His specialisation is haematological diseases, and he has done award-winning research on Aids.
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haematopoietic cells, embryonic stem cells can be manipulated to become any cell in the body, making them scientifically invaluable,’ says Dr Sissolak. Because the embryo is destroyed in the process, some deem the use of embryonic stem cells unethical. However, globally and locally it is accepted for research purposes. The standard is to only use embryos up to 14 days after fertilisation, says Marietjie Botes, an expert in medical and biotechnology law. After then, the embryo starts organising itself and develops a nervous system.
POWER OF FIVE
IN DEEP WATER It’s holiday season and the intense sunny days will send scores of South Africans to the water for a cool down. But with an average of more than 1 500 drownings annually, we need to be extra vigilant. Use these water-safety tips as a guide. By Raadiyah Abrahams
Of the 315 people rescued by the NSRI during the festive season last year, 22 people had been caught in rip currents. If you’re heading to the beach, make sure you and your kids are informed. • If caught in a rip current, let it carry you out to sea while waving one arm to alert people on the beach that you are in danger. As soon as you get the chance, swim parallel to the shoreline until out of the current and let the waves help carry you back to the beach. • Know surf conditions before you go. • Stay in lifeguardpatrolled areas (and take their instruction). • Look out for jellyfish, stingrays and coral. • Never swim under the influence of alcohol.
AT THE DAM
If you’re spending the day at a dam, Lifesaving South Africa advises: • Always enter a dam feet first. The bottom can be changeable and may have submerged objects. • The water below surface is often colder than expected and the sudden reduction in temperature can cause shock and lack of mobility. Exit the water immediately if this happens. • A rising wind can easily and suddenly cause choppy waves making swimming dangerous. To find out if a dam is safe for swimming or fishing, you can visit eonemp.cyanolakes.com. The interactive map reports on health risks for 105 dams in South Africa.
According to Arrive Alive, research in the US names drowning as the second most common cause of accidental injury, with children younger than one likely to drown in bathtubs, buckets of collected water or toilets. All it takes is 2.5cm of water and 60 seconds. Arrive Alive suggests the following: • Learn CPR. • Always close the bathroom door. • Supervise bath time – never leave another child in charge. • Drain bath water immediately after. • Install childproof locks on toilet lids and shut them. • If you are collecting rainwater, store buckets safely and away from children.
AT THE RIVERSIDE
Remember that rivers are often not patrolled by lifeguards. It’s important to note that even in shallow water, constant supervision of children is still necessary. • Never swim alone. • A floating toy or lilo can be swept away very quickly with your child still on it – avoid using these at a river or beach. • Make sure kids are wearing life jackets if they’re getting into watercraft such as canoes or boats, even if they can swim. Anyone can drown. • Never turn your back on the water when fishing.
AT THE POOLSIDE
Children should learn to swim as soon as possible and practise with their clothes on. Teach them not to panic if they get into a stressful situation. Whether you’re at a public pool or around the one you have at home, keep the following in mind: • Teach kids to always ask before going in the water. • Empty paddling pools when not in use. • At home, make sure your pool is properly fenced off and has a cover. Don’t allow water to collect on top of the cover. • Children should never be unsupervised. • Remove toys from the pool when you’re done to avoid children trying to get them.
LIFE HEALTHCARE EMERGENCY MEDICAL SERVICES If you happen to find yourself in a harrowing situation, call a Life Healthcare emergency unit. They offer fully equipped response cars and free Advanced Life Support (ALS) paramedic assistance to their communities. There is only a cost if an ambulance is dispatched. Life Flora Hospital, 011 470 7744; Life Fourways Hospital, 0860 444 044; Life Kingsbury Hospital, 0860 532 532; Life Rosepark Hospital, 0800 22 22 22; Life Springs Parkland Hospital, 082 504 8500; Life The Glynnwood, 078 137 4304; Life Vincent Pallotti Hospital, 0860 532 532
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AT THE BEACH
WHAT IS A GYNAECOLOGICAL ONCOLOGIST? Dr Elize Wethmar is a gynaecological oncologist at Life The Glynnwood in Gauteng, where she specialises in the treatment of gynaecological cancers. She spoke with Erin Coe about the challenges, rewards and emotional component of treating cancer patients What types of cancer do you treat?
As a gynaecological oncologist, I treat all cancers of the female genital tract. This includes cancer of the vulva, vagina, cervix, uterus and ovaries, as well as gestational trophoblastic disease, which is cancer or abnormal growth of the placenta. It’s a surgical discipline so my main role in the treatment process is to decide which cancers are operable and then perform the necessary surgeries. I also screen for pre-cancers and, even though I do not perform surgery for breast cancer, I am also actively involved in breast cancer screening.
What training do you have?
I completed my Bachelor of Medicine and Surgery in 2006 at the University of Pretoria. I was also interested in medical ethics, so in 2007 I completed a Master of Philosophy. Then came internship training and community service, followed by 18 months in emergency medicine. In 2011, I started specialising in obstetrics and gynaecology at the University of Pretoria, where I obtained my Master of Medicine degree in Obstetrics and Gynecology and qualified with distinction as a Fellow of the College of Obstetricians and Gynecologists of South Africa. After qualifying as a general gynaecologist and obstetrician, I started training in gynaecological oncology, which I completed this year.
What is the difference between a gynaecologist and a gynaecological oncologist?
To become a gynaecologist in South Africa, you need to obtain a basic degree in medicine and complete your internship and community service. That takes eight years. If you want to practise gynaecological oncology, you have to become a gynaecologist and obstetrician first, which involves completing four more years of specialist training. Once that’s done, you need to do an additional two years of intensive training before you’re qualified as a gynaecological oncologist.
What are the challenges of your work?
As a surgeon, I find it difficult to decide when to care for a patient rather than cure them. By nature of my training, I always want to cure them by doing one more surgery. However, there comes a time when that causes more harm than good. Deciding on this moment – to care rather than cure – is often challenging for my patient and me.
What aspect of your work is most rewarding?
There is still a misconception that a cancer diagnosis is a death sentence, which is far from the truth. Early diagnosed gynaecological cancers have a very good prognosis. I am humbled by having the opportunity to play a role in the treatment of these cancers.
How do you deal with the emotional element of a speciality that sometimes has a poor prognosis?
I have an incredible support system. My parents have supported every dream I have ever had. My wonderful husband is always there to offer a word of support and a shoulder to cry on – as well as a cup of coffee if I get called out at 3am. Gynaecological oncologists are also a close-knit community, so we’re always welcome to lean on each other. I often discuss difficult cases with my mentors and colleagues to debrief with them after an emotional experience.
What personality traits do you think a gynaecological oncologist needs?
If I consider my mentors and fellow trainees, we all have very different personalities. However, characteristics we all have in common are the ability to persevere in adversity, and having sympathy for our patients while being able to make objective decisions.
Commitment Our smile is our welcome Thoughtful care is our commitment How we leave you feeling after your hospital experience is our legacy In our commitment to providing high quality care and personal attention we promise to: Greet you courteously â€“ with a smile Treat you with dignity, respect and without prejudice Provide you with a safe, clean and organised facility Be sensitive to your physical, emotional and psychological needs Listen and address, to the best of our ability, any concerns that you may have We appreciate your feedback Speak to us: You are welcome to discuss any requests or concerns with members of the hospital management team Respond to our survey: As a valued patient you will receive an email or sms survey after you are discharged from our hospital Email us: Customer.email@example.com Use the web: www.lifehealthcare.co.za â€“ follow the prompts from contact us Call us: 011 219 9111
External Governing Bodies Hospital Complaints: Department of Health Office of Health Standards Compliance
CARE GABORONE’S HELPING HAND / COMMON MALE CANCERS / SUGAR-FREE MEAL PLAN
‘LOVE IS INFECTIOUS AND THE GREATEST HEALING ENERGY.’ SAI BABA, INDIAN GURU AND PHILANTHROPIST
GAINING BACK I INDEPENDENCE Children at a resource centre for the visually impaired have benefited from equipment designed to help them navigate their world. By Melanie Farrell
magine what it’s like to be blind; everything around you has to be absorbed through your senses of hearing, smell, taste and touch. It’s even harder to imagine how a blind child learns to read and write without being able to see. Three years ago, staff at Life Gaborone Private Hospital reached out to visually impaired children living in Botswana by choosing the Mochudi Resource Centre for the Blind for its employee involvement project, Life Sizanani. The Mochudi Resource Centre offers crucial support for children who have visual impairments. Started in 1969, the non-governmental organisation provides accommodation, rehabilitation and life-skills training for up to 76 children from its modest premises in Mochudi, about 40km north-east of Gaborone.
To move freely from A to B is important to a child’s developing sense of independence Children at Mochudi attend a local primary school equipped with teachers who are qualified to educate visually impaired children. AFFIRMING INDEPENDENCE In July 2016, Life Gaborone Private Hospital employees donated equipment worth approximately R15 000 to the centre, including Braille slates and mobility canes. Without tools such as Braille slates and mobility canes, it is more likely that visually impaired people will become dependent on those around them to run their lives, leading to a loss of their independence. Although blind children face huge obstacles when it comes to moving around and learning to read, equipment 50
BRAILLE such as Braille tools and mobility canes can make a significant difference. A Braille slate is a pocket-sized or desktop-hinged device. The top TOP Life Sizanani pro ject members with the part contains rows of rectangular children of the Moch Centre for the Blind ea udi Resource rlie r this year ABOVE openings corresponding to The staff’s efforts involv dri e fund-raising ves that help to assist an individual Braille cells which guide d support the Resource Ce ntr e a stylus, while the bottom part has rows of indentations arranged in cells that allow the stylus to emboss dots on to paper. This enables children to write in Braille. Children with visual impairments may This successful Life Healthcare become frustrated by the way in which employee involvement programme their eyesight restricts their ability to has been in existence for 14 years explore the world around them. This and has touched the lives of is where mobility canes assist, enabling countless disadvantaged children. them to navigate their surroundings without hurting themselves. This Each business unit adopts and ability to move freely from A to B supports a children’s organisation is important to a child’s developing in a bid to improve their lives. sense of independence. There are 78 projects currently underway with an annual spend of ONGOING SUPPORT R1.1 million. To find out more, visit Kidwen Chasumba, senior physiotherapist www.lifehealthcare.co.za/ and member of the Life Sizanani committee about-us/sustainability at Life Gaborone Private Hospital, says I MAG ES GETTY/GALLO IMAGES, SUPPLIED
WHAT IS LIFE SIZANANI?
that the hospital’s support of the centre is ongoing. ‘We have a dedicated voluntary committee of employees who selflessly organise the Life Sizanani project. ‘Although the project receives an annual budget from Life Healthcare Group, our volunteers raise additional funds with car washes, cake sales and other events. ‘One of our paediatricians also offers free medical services to the centre.
‘Life Gaborone Private Hospital will continue to support the centre, offering help in the form of financial support, as well as other forms of assistance such as health services, educational materials and toys for the children,’ says Kidwen.
World Braille Day, celebrated on 4 January, is a tribute to Louis Braille, the inventor of the written language for the blind, Braille. The day recognises the inventor and his contribution towards helping blind and visually impaired individuals read and write. Louis, who was born in France on 4 January 1809, was blinded in both eyes in an accident when he was a child. Despite being completely blind he excelled academically, and at the age of 15 he presented a system of tactile code he’d invented. This code became Braille, a reading and writing system used by millions of blind and partially sighted people all over the world. Rather than using a 26-letter alphabet system, Braille is a six-cell dot system that represents each letter and symbol used in print. The six-cell dot system is raised, enabling the reader to feel words on a page rather than seeing the letters. Braille is recognised as an important tool for blind and visually impaired people, enabling them to not only read and write, but also offering a path to independence.
3 cancer types
MEN NEED TO KNOW ABOUT One out of every seven South African men is diagnosed with cancer. Fortunately, there are ways to reduce your risk. By Pippa Naudé
he National Cancer Registry records all cancer diagnoses in South Africa and reveals that one in seven men is diagnosed with cancer by the age of 74. According to 2013 results, prostate cancer (1:18), colorectal cancer (1:75) and lung cancer (1:76) are among the top five cancers most common for males. Alarmingly, men often avoid doctor’s visits which make a bad situation worse. ‘Most cancers have a better chance of being cured the earlier the stage they are discovered,’ says Dr Oliver McGowan, an oncologist at Life Vincent Pallotti
Hospital’s oncology unit. ‘Failing to follow up on symptoms earlier results in a diagnosis of cancer at a more advanced stage, and a worse prognosis.’ According to the World Health Organization (WHO), this is one of the reasons that the life expectancy of men is six years less than women. The good news is that men can change their behaviour and increase their chances for a long and healthy life.
PREVENTION IS POSSIBLE The Cancer Association of South Africa (CANSA) reports that environmental factors such as diet, exercise and
smoking cause 90% of all cancers. ‘This means simple lifestyle changes can limit a person’s chance of developing cancer,’ explains Dr Karen Motilall, a radiation oncologist at the new oncology unit at Life Eugene Marais Hospital. ‘These include maintaining a healthy body weight and eating a predominantly plant-based diet that includes fruit, vegetables and wholegrains. Limiting red and processed meat, salty or sugarladen food and drinks, and alcoholic drinks are also important; as is being physically active and avoiding tobacco.’ (Go to ekickbutt.org.za if you’re struggling to quit smoking.)
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Regular screening improves your chance of diagnosing cancer in the early stages, and is especially imperative if you have a high-risk profile for a certain type of cancer. Dr Motilall says, ‘Any screening tests carried out should be a shared decision-making process between a patient and their healthcare practitioner. If the tests are normal, your healthcare practitioner will decide on an appropriate testing schedule, for example, every one to two years. However, if the results are worrying, your doctor will refer you to a specialist to do further tests, which may include a biopsy.’
South Africans with cancer have a 60% survival rate according to CANSA. There are a number of cancer treatment options available. A decision on which to use will be determined by the type of cancer and how advanced it is, explains Dr McGowan. Surgery and chemotherapy are often recommended for colon cancer. Both are also used to treat lung cancer, as is radiation therapy. Interestingly, prostate cancer may not always require treatment. If it is limited to the prostate and seems unlikely to grow, your doctor may recommend active surveillance and will only intervene if it looks as if it is getting worse. Alternatively, treatment can entail surgery, hormone
USEFUL WEBSITES • cansa.org.za • isurvivor.co.za • za.movember.com • prostatecancerfoundation.co.za therapy, cryotherapy (freezing the tissue), chemotherapy, radiation therapy or biological therapy. The likelihood of a cure diminishes where cancers are more advanced, but treatment options are still available to extend one’s life, adds Dr McGowan.
• Ageing – chances increase after age 50 • African heritage • Family history
• A history of smoking – direct or second-hand (CANSA reports 600 000 non-smokers die every year from the effects of second-hand cigarette smoke) • Exposure to carcinogens (such as diesel fumes, coal smoke, asbestos, radon gas) • Family or personal history
•O ver 50 •A frican heritage •P ersonal history (polyps or inflammatory intestinal conditions) •F amily history •D iet high in red and processed meat •S edentary lifestyle • Diabetes • Obesity • Smoking •E xcessive alcohol consumption
• Trouble urinating • Weak urination • Blood in urine or semen • Discomfort in the pelvic area • Bone pain • Erectile dysfunction
• A persistent new cough • Changes in a chronic cough • Coughing up blood, even small amounts • Shortness of breath • Chest pain • Hoarseness • Infections such as bronchitis and pneumonia that recur
•A change in bowel habits lasting more than a few days •R ectal bleeding or blood in stools •P ersistent abdominal discomfort, such as cramps, gas or pain •B owels don’t empty completely •W eakness or fatigue •U nexplained weight loss
A digital rectal exam (DRE) or transrectal ultrasound (TRUS), or prostate-specific antigen (PSA) blood test
A low-dose computerised tomography (LDCT) scan of the lungs is recommended
Stool tests or colonoscopy (inserting a small camera into the colon to look for irregularities)
MEET OUR EXPERTS
Dr Karen Motilall is a clinical and radiation oncologist working at the newly opened oncology unit at Life Eugene Marais Hospital in Pretoria. She has additional qualifications in occupational medicine, and tropical medicine and hygiene.
Dr Oliver McGowan’s first exposure and consequent interest in oncology developed during his community service in Port Elizabeth. He has since specialised as a clinical radiation oncologist and now works at Life Vincent Pallotti Hospital’s oncology unit.
GIVE SUGAR A
Sugar-free and Carb-conscious Living by Monique le Roux Forslund is the ideal cooking companion if youâ€™re trying to cut down on your sugar and carbohydrate intake. The cookbook is based on low-carb high-fat principles with home-cooked nutritional meals as the focus. Monique creates a menu that reduces sugar cravings and increases satiety so that you can reduce and ultimately eliminate the need to snack between meals. Recognising the need for healthy packed lunches, she also includes suggestions for work or school and makes the prep work a breeze. Motivating success stories and useful tips round out the book, such as advice on how to incorporate exercise into your lifestyle, nutritional information, menu plans and a compact list of foods to embrace and avoid. Go sugar-free for your next mouthful! 54
Chilled coconut chia pudding Chia seeds need to absorb liquid in order to become edible, so make this the night before, for a quick start to your day.
Serves 1 • 1 cup coconut milk (or ¾ cup cream and ¼ cup water) • 2 tablespoons chia seeds • 1 teaspoon vanilla essence 1. Combine the ingredients in a bowl and chill in the fridge overnight. 2. Serve as is, or add fresh cream and some toppings, as desired. TOPPINGS • Berries: fresh or frozen raspberries, blueberries or strawberries (whole or lightly crushed) • Desiccated coconut • Flaked almonds or chopped mixed nuts • Granadilla (passion fruit) pulp and seeds • Kiwi fruit, peeled and chopped • Sprinkling of ground cinnamon
Oven-baked salmon with leek and fennel Serves 4 • 4 portions fresh salmon or other firm-fleshed fish (±125 grams each) • 2 tablespoons tomato purée • 2 red onions, thinly sliced • 1 leek, thinly sliced • 1 fennel bulb, thinly sliced • 2 cups cream • Salt and ground black pepper to taste • Pinch cayenne pepper • Freshly squeezed lemon juice 56
1. Place the salmon portions in an ovenproof dish. 2. Top each portion with half a tablespoon of tomato purée. 3. Scatter over the onion, leek and fennel. 4. Pour over the cream and season to taste with salt, black pepper, cayenne pepper and lemon juice. 5. Bake in a preheated oven at 180°C for 15–20 minutes, or until the fish flakes easily with a fork. TIP Instead of salmon, you can use any other firm-fleshed fish. Yellowtail, swordfish or angel fish would be good. Or choose lightly smoked (mild-cured) fresh snoek for an authentic local taste. (Adjust the cooking time, if necessary.)
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Oven-baked salmon with leek and fennel
Baked avocado with egg, bacon and onion Serves 1 • 50 grams butter • 100 grams diced bacon • ½ medium onion, finely chopped • ½ medium tomato, finely chopped • 1 firm, ripe avocado, halved and stone removed • 2 eggs • ½ cup finely grated cheese for sprinkling 1. Melt the butter and fry the bacon and onion until the onion is soft and the bacon starts to crisp. 2. Add the tomatoes and cook for a few minutes more, until just soft. 3. Scoop some of the flesh from each avocado half and set aside. 4. Crack an egg into each avocado half. (Before doing this, place the avocado halves in a small ovenproof dish; if necessary, use crumpled foil to keep them upright.) 5. Bake in a preheated oven at 180°C until the eggs are just starting to set. 6. Combine the scooped out avocado with the cooked bacon-onion mix. 7. Remove the avocado from the oven and top with a spoonful of the bacon-onion mix. 8. Sprinkle over some grated cheese and return to the oven for a further 5–10 minutes, or until the cheese has melted and the yolks are the consistency you prefer.
Avocado with chopped hard-boiled egg Serves 1 • 1 firm, ripe avocado, halved and stone removed • 1 hard-boiled egg, peeled and chopped • 2 tablespoons mayonnaise or crème fraîche • 1 tablespoon finely chopped onion • S alt and ground black pepper to taste 1. Scoop some of the flesh from each avocado half. 2. Combine the scooped out avocado with the egg, mayonnaise and chopped onion. 3. Fill the avocado halves with the egg mixture. Season to taste and serve.
Smoked peppered mackerel tart I got the inspiration for this lovely summer dish from my friend Kicki. You can use ready-to-eat smoked trout, smoked snoek or smoked salmon chunks instead of peppered mackerel; just remember to remove any skin and bones. You can make the tart up to a day in advance, and keep it in the fridge until ready to serve.
Makes 1 tart CRUST • 1 cup almond flour • ½ cup sesame flour or linseed flour • ¼ cup sesame seeds • 1 tablespoon psyllium husk • Salt and pepper to taste • 50 grams butter, melted • 1 egg, lightly beaten • 1 ready-made crust (see above) • 250 grams mascarpone or full-fat cream cheese • ¾ cup mayonnaise • 1 red onion, thinly sliced • 1 cup grated cheese • 4–5 hard-boiled eggs, peeled and sliced • 1 cup shredded iceberg lettuce • 100–200 grams smoked peppered mackerel, skin removed and flaked • 3 tablespoons finely chopped chives
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1. Place the cooled pie crust on a serving dish. 2. Spread the base of the crust with mascarpone cheese. 3. Spread the mayonnaise over the cheese. 4. Add half the red onion and the grated cheese. 5. Add a layer of sliced egg and scatter over some shredded lettuce. 6. Top with the smoked mackerel. 7. Garnish with the remaining onion and the chopped chives. Serve immediately, or keep chilled until ready to serve.
Giveaway! Life Healthcare magazine is giving away two copies of Sugar-free and Carb-conscious Living. Email firstname.lastname@example.org with ‘Sugar-free and Carb-conscious Living’ in the subject line by 31 January 2018 and stand a chance to win. This is an extract from Sugar-free and Carb-conscious Living by Monique Le Roux Forslund, published by Struik Lifestyle. RRP R240.
Together, we can fight leukaemia and other lifethreatening blood disorders The Sunflower Fund creates awareness around the need for blood stem cell donors and provides education as to the process of registering. We raise funds to cover the tissue-typing costs involved in adding donors onto the South African Bone Marrow Registry.
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The spirit of ubuntu was sadly lacking at a fatal accident in Limpopo earlier this year until Nurse Doreen Shikhibana arrived on the scene. By Lynne Gidish
n Sunday 30 March this year, Nurse Doreen Shikhibana, a 35-year-old ICU specialist at Life Flora Hospital, was returning home after visiting her family in Tzaneen. ‘We were on the R71 on the Magoebaskloof Pass when we came across an overturned minibus with about 15 passengers, including four children under the age of seven – the same ages as my little ones who were in the car with us. Thankfully, my
two-year-old son Fumani was asleep and I told my six-year-old daughter Katekile to hide as I didn’t want her to see what was going on. ‘The accident had just happened and I was horrified to observe people standing around taking pictures on their cellphones with no one doing anything for the injured passengers.’ Trained for years to deal with emergencies, she immediately took control. ‘I always stop for accidents and this was the most severe I’d ever encountered. My husband Dumisani was at my side as I did a quick assessment of the situation and I immediately rushed to the aid of a young woman who was trapped under the vehicle. I instructed one of the bystanders to call an ambulance after discovering that no one had bothered to do so, and roped in the assistance of others to lift the vehicle so I could get to her. I could see from the angle she was lying that she had broken her neck, and a quick check of her pulse confirmed that she’d passed away. I covered her with a towel I found in one of the bags lying around and then moved on to the other casualties.’ By that stage, Dr Riyas Fadal, Head of Clinical Support at Life Healthcare, who had also been driving home to Gauteng, had stopped at the scene to help. ‘Thankfully, he had a first-aid kit in his car, but since there was only one pair of gloves we took one hand each. For the next half an hour we worked on the injured passengers, triaging and treating those with life-threatening injuries (including a baby with a nasty
Although the legacy of a nurse is to assist others in their time of need whether on duty or not, you don’t have to be professionally trained to help someone in trouble head injury), dressing wounds to stop any bleeding, and treating for shock. Dr Fadal and I waited for the ambulance to arrive and then handed all patients over to them. Katekile was still hiding when I climbed back in the car, and as we continued on our journey home I was glad that I’d done something good for my fellow man. Sadly, accidents are so common in South Africa these days. ‘Although the legacy of a nurse is to assist others in their time of need whether on duty or not, you don’t have to be professionally trained to help someone in trouble. So instead of putting social media before others’ lives, rather call for an ambulance and do whatever you can. The spirit of ubuntu is really needed in our country right now.’
PUZZLE THIS... Test your mental agility with our brain-teasers
1 CROSSWORD PUZZLE 2 SUDOKU
Difficulty level *** ACROSS
1 Hammer part 5 Piña colada ingredient 8 Mosque bigwig 12 Dalai _______ 13 401(k) alternative 14 Unaltered 15 Elliptical 16 Showbiz job 17 Mothers and daughters 18 Mexico’s national flower 20 Big lizard 22 Young newt 23 Apiece 24 Bit of banter 62
27 Marching along 32 Khan title 33 Actress Vardalos 34 Central point 35 Unsteady 38 Lettuce variety 39 Exist 40 Shock partner 42 Manor 45 At hand 49 Grand story 50 ‘_____ Blue?’ 52 Shade of Green 53 Unrivaled 54 Skedaddled
55 Part of the loop 56 Use a wooden spoon 57 Architect I.M. 58 Early birds? DOWN
1 Nitwit 2 Stromboli spillage 3 Asian nursemaid 4 Billfold 5 Tubular pasta 6 Swiss canton 7 Creche trio 8 Dispenser 9 Hindu royal
10 Congregational call 11 Small plateau 19 Kipling poem 21 Univ. transcript no. 24 Mandible 25 ‘I’ trouble? 26 Gabriela of tennis fame 28 Diarist Anaïs 29 ‘24 Caprices for Solo Violin’ composer 30 Fix the soundtrack 31 Recede 36 Tonic 37 Allow 38 Cap with a propeller
41 Lindbergh book 42 Morays 43 Location 44 O.K. Corral hero 46 Phone call? 47 Online journal 48 Longings 51 West of Hollywood
3 WORD SLEUTH
Find the hidden words in the diagram. They run in all directions
Friends Glasses Interest Keys
Memory Messages Our cool Our shirts
Our way Wallet Weight
A bet Cellphone Emails Face
Each set of letters below is arranged alphabetically and the ‘?’ is in the correct alphabetical position. Figure out what the ‘?’ represents and rearrange the letters to spell a six-letter word. For example, in HH?RTY the ‘?’ could be an H, I, J, K, L, M, N, O, P, Q or R. Here it represents an M which can be combined with the other letters to spell RHYTHM.
3 4 BANANAGRAMS CREVICE SUBTEXT CREWMAN
I M A G E I S T O C K P U Z Z L E S P R E S S / M A G A Z I N E F E AT U R E S ( P T Y ) LT D
DISCOVERING COURAGE Four-time cancer survivor Lauren Segal recounts her harrowing journey, valuable lessons learnt and the love that has grown from her ordeal in her new book Cancer: a love story
cancer. It is about how one person decided to tackle an unexpected set of traumas; about seeking alternative healing methods; about the redemptive power of love and community; about discovering courage and different kinds of hope; about soft landings in times of distress; about writing as healing. Cancer’s greatest paradox is that it is the loneliest of diseases, despite inviting so much support. No one could have had the chemo or the radiation or the operations on my behalf. No one could have taken away the physical and spiritual pain. No one could ultimately reassure me that I would live. With hindsight, I see how easy it would have been to shut out the suffering. I am glad I found the strength to resist this deadly gravitational force, and to awaken myself to new discoveries in the face of the trauma. I am proud of what I have been able to gain along this lonely journey. I have learnt to observe the self-diminishing and destructive thoughts that cancer induces but not to cling to these as the only option before me. I have learnt to decide how to respond to trauma with a new awareness. Choosing this as a path has made me confront the nature of my relationships, both intimate and more peripheral. It gave 64
What started out as my own journey of potential destruction and self-hate has brought me more productive and intense ways to live with and love myself
me my brother back. It helped me to discover new versions of myself. It brought me inner peace, something I had not experienced before in my life. It led me to find sources of internal nourishment. It allowed me to suspend judgments of others and myself. It acclimatised me to facing life’s inevitable stresses. It is hard to say whether or not I am a better person. I know, at least, that I am better at identifying my own inhumanities and being wise about the realities facing me. I am better at releasing grudges. Having cancer this many times is like starting life anew. I choose not to live with half a heart or a blighted soul. I have learnt that I am not my cancer. What started out as my own journey of potential destruction and self-hate has brought me more productive and intense ways to live with and love myself. I have only been able to grasp the counterveiling forces of love and cancer that have been enacted inside of me. Despite – or because of – the story I have told, I am a happier and calmer person who looks forward to the next five decades of my life. This is, for me, the ultimate love story. Excerpted from Cancer: a love story by Lauren Segal, published by MFBooks Joburg, an imprint of Jacana Media.
his book is not just about
Published on Nov 29, 2017
Published on Nov 29, 2017
This issue of Life Healthcare magazine encourages readers to get set for summer. Stay healthy and enjoy those sunny days at the beach with a...