PUBLISHED IN THE INTEREST OF YOUR HEALTH BY
PUBLISHED IN THE INTEREST OF YOUR HEALTH BY LIFE HEALTHCARE
WHEN HE HAS THE PROBLEM
GET SMART ABOUT
COLDS AND FLU
QUIZ: ARE YOU AFRAID OF COMMITMENT?
RECHARGE Getaways that restore mind, body and soul
FOUR CANCER SURVIVORS ON WHAT PULLED THEM THROUGH
SAMANTHA PAGE EDITOR
PUBLISHED IN THE INTEREST OF YOUR HEALTH BY
PUBLISHED IN THE INTEREST OF YOUR HEALTH BY LIFE HEALTHCARE
‘FILMING HELPED ME FORGET’ One patient puts a creative spin on his cancer
• AUTUMN 2017
SIMPLY DELISH DISHES
(minus the carbs)
FEED YOUR MIND
• healthy food • ﬁtness strategies • healing holidays
LESS SALT DOESN’T MEAN LESS TASTY
THE AUTUMN 2017 ISSUE OF LIFE HEALTHCARE MAGAZINE IS AVAILABLE AT WWW.LIFEHEALTHCARE.CO.ZA ‘MAKING LIFE BETTER STARTS HERE’
A PUBLICATION BROUGHT TO YOU BY THE LIFE HEALTHCARE GROUP
IMAGE ANGIE LAZARO
Each season has its own unique beauty, its own reason to be anticipated, and winter is no different. To live fully, you must pursue opportunities for growth and renewal, the chance to learn something new and gain a fresh perspective. Change, whether good or bad, teaches you that you are entering a different season of your life and that the status quo, while altered, is helpful to your overall health and wellbeing. The four cancer survivors we feature on page 32 share their experiences, including what they learnt from their disease and how they have grown stronger and more resilient because of it. A key component to transitioning through the various phases in your life is learning to let go of everything that no longer serves you or helps you grow. Sometimes it’s hard to discern exactly what you need to move forward, which is why it helps to take time out to get away. From meditation weekends and silent retreats, to short breaks that teach you a skill, we’ve rounded up seven of the best to suit your needs on page 28. One of the great joys of cooler temperatures is the wealth of fresh, delicious fare that makes you feel instantly healthier. Author Leanne Katzenellenbogen has compiled a recipe book of meals for diabetics (and anyone who enjoys eating good food) that are modern, tasty and uncomplicated, and include nutritional values per serving to help you monitor your carbohydrate, protein and fat intake. We have a few dishes on page 54 that you can add to your list of winter meals. Transformation is part of life and as the poet Anne Bradstreet once remarked, ‘If we had no winter, the spring would not be so pleasant. If we did not sometimes taste of adversity, prosperity would not be so welcome’. So here’s to change, growth and healing.
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 EDITORIAL COMMITTEE Yvonne Motsisi, Dr Sharon Vasuthevan, Janette Joubert, Liesel van Oudenhove, Lucy Balona (CANSA), Professor Pamela Naidoo (Heart and Stroke Foundation South Africa) 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
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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.
PLUS WHAT REALLY HAPPENS
WHEN YOU HAVE AN EPIDURAL
2017/02/17 7:36 AM
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
Contents THIS MONTH’S FOCUS: CARING FOR MIND, BODY AND SOUL
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 P RIORITISING MENTAL HEALTH Expert care can be found at Life Healthcare facilities
12 J OINT DECISION
Questions to ask before having hip or knee surgery By Meg de Jong
14 ‘MIRACLES DO COME TRUE’
Jean Stephenson’s son suffered a traumatic brain injury, so she had to fight for them both As told to Lynne Gidish
16 D EALING WITH INFERTILITY WHEN HE HAS THE PROBLEM
But what is the cause? Here’s what you need to consider By Charlene Yared-West
20 S TAY NOURISHED DURING CHEMOTHERAPY
If you’re undergoing treatment, stay as healthy as possible, starting with nutrition By Sam Brighton
23 WHY YOU NEED A LIVING WILL
This document is an important practical part of dealing with death By Samantha Page
24 DIVORCE MEDIATION COULD BE THE ANSWER
Mediation can make things easier for you and your children By Lisa Lazarus
THE FACTS ABOUT HIP OR KNEE SURGERY
26 ARE YOU AFRAID OF COMMITMENT? Commitment strikes fear in the hearts of men and women everywhere. Test the relationship waters with this quiz
28 GO WELL
Wellness holidays can heal your soul By Tracy Melass
IT’S A NEWBORN THING
WHAT’S HIS PROBLEM?
TAKE A WELLNESS BREAK
HEALTH 32 CANCER SURVIVORS CELEBRATE THEIR JOURNEYS In a salute to cancer survivors everywhere, four men and women share their stories By Glynis Horning
38 NEW WARD PUTS SMILES ON CHILDREN’S FACES
Take a tour of the new paediatric ward at Life The Crompton Hospital By Melanie Farrell
CARE 40 MAKING IT EASIER TO TREAT TB
Innovative TB treatment is changing the lives of people with the disease By Mandy Collins
42 RELAX, IT’S JUST A REFLEX
Dr Dewald Buitendag’s useful advice helps put new parents at ease during the early days of parenthood
44 EVERYBODY’S TALKING ABOUT… MEASLES
Our experts explain the risks and how to effectively protect your family By Pippa Naudé
46 C OLONOSCOPY: WHAT YOU NEED TO KNOW
Get to grips with the before and after of this procedure By Raadiyah Abrahams
47 A PASSION FOR PAEDIATRICS
What does a paediatric neurologist do? By Sam Brighton
50 C ONSIDER NURSING AS A CAREER
This profession offers growth and the satisfaction of serving patients in need of care By Catherine Eden
52 BEHIND THE SCREENS Regular checks for early detection ensures optimal health and wellbeing By Pippa Naudé
54 H EALTHY COOKING FOR DIABETES
Leanne Katzenellenbogen’s new cookbook proves you don’t have to give up all your favourite foods if you’re trying to manage your condition
61 LIFE HEALTHCARE HERO
Former porter, now enrolled nurse, Hector van Deventer
62 MIND GAMES
Take a break with our puzzles and crossword
64 LOSING COULD BE A WIN-WIN
The surprising value of setbacks – they could help you emerge stronger than before By Samantha Page
OVER TO YOU We’d love to hear from you
THE JOY OF SIGHT With great trepidation, I had to agree to have cataracts removed on both my eyes. On 7 March 2017, I arrived at Life Entabeni Eye Clinic and Tammy was my angel. She took me under her wing when it felt like 444 different eye drops were being administered, and when I put on my ‘exquisitely designer theatre apparel’. I had no idea I would be in the waiting room with half a dozen other cataract patients, but we became instant friends. What a miracle to wake up the next day with my bad eye now my good eye, not one iota of pain, and rearing to go for my next op. Thank you to the kind, dedicated medical professionals who work tirelessly to change the lives of people like me. Gail George, Durban
CARING FOR HEARTS AND HEALTH On 24 February 2017, my 14-year-old son’s school informed me that he was in severe pain. He was rushed to Life Chatsmed Hospital and diagnosed with testicular torsion, resulting in the removal of his right testicle. The doctor and theatre staff briefed us, then took him to theatre. I thought it would be a long process, but 30 minutes later we were informed that the operation was a success, and that my son would lead a normal life. Life Chatsmed Hospital clearly understands what parents go through when their kids undergo an operation. They made us comfortable and reassured us everything would be fine.
TWEET OF THANKS
WHICH WAY TO THE GYM? I was diagnosed with rheumatoid arthritis (RA) some 12 years ago, but rejected the diagnosis and went into complete denial, preferring to attempt to handle the swelling, inflammation and pain using over-the-counter medication. After changing my doctor many times, I was finally referred to rheumatologist Dr Rehana Bhorat at Life Vincent Pallotti Hospital in Cape Town. It was a match made in heaven. Instead of treating the symptom, she treated me. Dr Bhorat suggested starting monthly infusions of a drug called Actemra to be administered in the daycare ward once a month using an IV drip. Desperate to find relief, and despite being reluctant to drive two hours to the hospital every month, I agreed and was admitted to Acacia Ward in February 2014. The care shown by staff allayed my apprehension and within three hours I drove back to Caledon. I experienced no side effects and was pain free in three months. My monthly visit has become a highlight – love and laughter in the ward, friendly nurses and new friends among those who are Friday regulars. After three years of care, I no longer refer to myself as an RA patient. I returned to my studies and graduated in October, with a doctorate in literature and philosophy – not bad for a 72-year-old! Everyone in Acacia Ward shared my pleasure in achieving this academic milestone, only made possible by dedicated staff, Actemra and a remarkable rheumatologist Dr Rehana Bhorat. Marilyn Holloway, Cape Town
PS: I am back at the gym and I think I could show the youngsters a thing or two!
MULTITASKING MIRACLE It was my first visit to Life Westville Hospital and I was so amazed by the hospital and services offered in the paediatric ward. All three of my children were admitted at the same time, in the same ward. First it was the baby, two days later, my middle son, and the next day, my eldest. Having three kids in hospital at the same time is no joke, but the nurses in the paediatric ward made life a little easier. My husband and I had to sleep there and the nurses made sure we were comfortable. They also did an excellent job attending to all three little patients, especially when it came to medication and injections – so much patience. I admire the dedication and will recommend Life Westville Hospital to anyone who wants extra special care.
Rajan Moodley, Durban
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Safiyya Abbas, Durban
WHY BACK-UP POWER IS VITAL There’s no denying that power is critical to your well-being – whether you are in hospital, running a business or at home. Medical facilities are proliﬁc users of energy and ensuring a continuous power supply to critical environments such as operating theatres and intensive care units, where power outages could have dire consequences, is a key priority. In South Africa, power failures are not uncommon, particularly during the winter months when consumption is at its highest. There are also routine maintenance outages, which make the need for reliable back-up power vital. While blackouts could cost businesses millions of rands, it can cost lives in hospital if those facilities can’t guarantee power continuity to medical equipment as well as data storage and communications. “A doctor simply cannot give a reliable service without an excellent support system, which includes electronic equipment that can function in the event of an interrupted power supply,” says Dr Botha, a maxillofacial and oral surgeon. Cummins is a global energy leader that provides both diesel- and gas-powered generators and parts, backed by a comprehensive warranty and immediate professional support from the local dealer network. A recent innovation is remote monitoring of generators, via cloud computing, which provides real-time information from a Cummins generator, allowing for timeous planning of potential interventions. “Back-up power is a strategic asset to any hospital, business or residence, and Cummins can perform a health check on your generators to ensure the capacity needs, technicalities and maintenance requirements are adequately met,” says Kenny Gaynor, Director Power Generation. “No one wants to ﬁnd out in a crisis that their back-up power is inadequate.”
Cummins Ad.indd 1
A CLEAN BILL OF HEALTH Does your medical facility or business have adequate backup power? Cummins offers a *free assessment to determine the state of health of your generator. Call Cummins on +27 11 321 8713, email Kenneth.email@example.com or visit www.cummins.com *Terms and conditions apply
2017/05/24 11:38 AM
We speak German! We speak German!
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Raise up recliner: R 15950 Fromup Raise recliner: From R 15950
3 Crank Hospital bed: R 9750 R 14500 3 Crank Hospital bed: R 14500 R 9750
M4 Bubble Overlay 1950 R 3250 M4 BubbleROverlay R 3250 R 1950
Standard commode R 1250commode R 699 Standard R 1250 R 699
Rollator with loop brakes: R 1999 R 1195 Rollator with loop brakes: R 1999 R 1195
Electric Home Care Bed: R Care 19950 R 24950 Electric Home Bed: R 24950 R 19950
M6 Ripple mattress: R 4850 9960 mattress: M6R Ripple R 9960 R 4850
Shower chair: 799 R 1050 R Shower chair: R 1050 R 799
Healthsmart Rollator: 1999 R 3299 R Rollator: Healthsmart R 3299 R 1999
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Electric Bath Lift: R 9950 R 20550Bath Electric Lift: R 20550 R 9950
EZ Adjustable Bed Rail R 2199 R 1550 EZ Adjustable Bed Rail R 2199 R 1550
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Tel. SA : 0861 PRIMACARE 0861 77462 2273 Tel. SA : 0861 PRIMACARE 0861 77462 2273
Prices are subject to change without prior notice Prices are subject to change without prior notice firstname.lastname@example.org
LIFE JOINT SURGERY / WHAT TO EAT DURING CHEMO / MALE INFERTILITY
‘THE TRUE SECRET OF HAPPINESS LIES IN TAKING A GENUINE INTEREST IN ALL THE DETAILS OF DAILY LIFE.’ WILLIAM MORRIS
Medical innovations and Life Healthcare news SPOTLIGHT ON
JUICY, DELICIOUS NAARTJIES It’s citrus season and the pleasure of eating and cooking with winter’s flavourful fruits is one many people relish. While oranges, lemons and grapefruit are popular, along with newer varieties such as Cara Cara navels and blood oranges, here in South Africa, it’s the humble naartjie that is the ultimate fast food. Here’s what you need to know:
NUTRITIONAL SUMMARY Energy (230kJ) Fat (0g) Carbohydrates (10g) Protein (0.9g) [per 100g serving]
#1 #2 #3
Studies show that citrus flavonoids may improve blood flow through coronary arteries and reduce the ability of arteries to form blood clots. The juicy citrus fruit contains high levels of magnesium and potassium. Naartjies are also a rich source of folate, vitamin C and beta carotene.
A whiff of wellness Did you know that certain scents can improve your wellbeing? Choose: • Eucalyptus to clear your head and invigorate your mind. • Chamomile to promote relaxation. • Pine to stimulate creativity. • Orange to refresh the mind. • Tea tree to ground your thoughts. • Thyme to refresh and strengthen your immune system. • Cucumber to calm nerves.
1692 BOTTOM LINE: Slip one into your child’s lunch box or keep a fruit on your desk for a delicious boost of vitamins and energy. 8
Kilojoules you could burn weekly from three high-intensity 10-minute skipping sessions
FACE THE FACTS
WINTER IS COMING While colds and flu are never pleasant and can make you feel miserable, very often you’ll recover in a week or two without serious complications. According to the Department of Health, it is estimated that influenza causes between 6 000 and 11 000 deaths in South Africa every year. So how do you know when you should tough it out at home and make bed rest a priority or seek help? Get immediate help for: • Difficulty breathing • Blue lips • Unconsciousness
COMPILED BY SAMANTHA PAGE IMAGES GETTY/GALLO IMAGES, ISTOCK, SHUTTERSTOCK AND SUPPLIED
Get emergency care for: • Pain in the chest or abdomen • Sudden dizziness or confusion • Stiff neck, severe headache, earache, very sore throat • Fever in a young child that lasts more than 24 hours • Severe vomiting
BIG FOOT CARE TIPS FOR DIABETES
When you have diabetes, proper foot care is essential. Here are five of the most critical tips to keep up with, according to Dr Vernian Nadar at Life Entabeni Hospital. 1. Examine your feet daily. Use a mirror for the hard to reach places, or get help from a family member. You’ll want to ensure you’re not seeing any areas of pressure or calluses forming, which could turn into an open sore. 2. After bathing, dry between your toes. This can keep tissue from breaking down and causing a sore. 3. Maintain tight glucose control and haemoglobin A1c levels. 4. Don’t ignore burning, tingling or numbness, which can be the start of neuropathy. 5. See a podiatrist regularly. Most medical aids provide coverage to be seen by a podiatrist every three months for preventative care.
KNOWLEDGE IS POWER Do you know the difference between the nutrition of a vegan, vegetarian and pescatarian? It can be difficult to define because there are many levels to choosing a vegetarian diet, but these are the basics. Red meat
Fish and shellfish
On government imposing a sugar tax on sugary drinks: ‘The Heart and Stroke Foundation South Africa supports the Sugar Sweetened Beverage Tax as one of the many important interventions to reduce obesity. There is sufficient evidence to demonstrate that excessive sugar intake is a definite contributor to weight gain and obesity. Obesity in turn is a risk-factor for non-communicable diseases (NCDs) onset. These NCDs include diabetes, cardiovascular disease and certain forms of cancer.’ Pamela Naidoo, CEO Heart and Stroke Foundation South Africa
BITS & BY TES
PREVENTION IS BETTER THAN CURE
WHAT IS PULSE OXIMETRY SCREENING? It’s a simple, non-invasive test that should be administered to newborns within the first 24 to 48 hours after birth. The test determines the amount of oxygen in a newborn’s blood as well as the baby’s pulse rate. Low levels of oxygen in the blood can be a sign of a congenital heart defect (CHD) in a baby that appears healthy. If your hospital does not offer this as a standard test, you can request that it be administered. There are no additional costs involved in this test.
A SITE TO SEE
Are you consuming too much salt? You may be increasing your risk of heart disease and stroke. Health experts recommend no more than five grams of salt per day, yet most of us double this. Visit the website below and take the test to find out how much salt you eat. The site will deliver an estimate and suggest practical tips to help you lower your intake. www.saltcalculator.co.za 10
PRIORITISING MENTAL HEALTH Life Healthcare offers excellent care and hope to those who struggle with mental illness
Mental illness has increased in prevalence in South Africa and domestic violence, work-related stress, disease, abuse and poverty are huge contributors. In a 2005 study, conducted by the Mental Health and Poverty Project at the Department of Psychiatry and Mental Health at the University of Cape Town, it was found that 16.5% of South Africans suffer from mental illness such as depression and anxiety. In addition, approximately a third of the population is likely to suffer mental illness in their lifetime. Even more staggering is that 9.5% of all unnatural teen deaths in South Africa are due to suicide.
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
HELP AT HAND
Life Healthcare is a leading provider of private psychiatric services in South Africa, offering expert care by leading psychiatrists and multidisciplinary teams at eight dedicated facilities in Gauteng, KwaZulu-Natal, the Western Cape and Eastern Cape. General psychiatry, treatment for substance dependence or other addictions associated with psychiatric disorders are provided, as well as post-discharge support. Treatments range from evidence-based drug therapy and individual psychiatric consultations to psychotherapy and group therapy, and physical therapy. Specialised adolescent programmes are also offered at selected Life Mental Health facilities.
EXPANDING OUR REACH
‘Life Healthcare has been actively expanding mental health facilities to deal with the demand from the local community as well as the broader population,’ says Dr Riyas Fadal, National Manager Acute Rehabilitation and Mental Health. Two new units have opened since September 2016 – Life St Vincent’s in Cape Town and Life Carstenview in Midrand – which demonstrates Life Healthcare’s commitment to make their specialised services available in every region of the country. ‘All our mental health units have been specifically designed to create an environment that fosters respect, dignity and safety and aims to de-stigmatise mental health so that it’s more accessible and more acceptable to seek help.’
1 Western Cape • Life St Vincent’s at Life Vincent Pallotti Hospital: 021 506 5298 2 Eastern Cape • Life St Marks Clinic: 043 707 4400 • Life Hunterscraig Private Hospital: 041 586 2664 3 Gauteng • Life Poortview Hospital: 011 952 3000 • Life Riverfield Lodge: 0860 748 373 • Life Carstenview at Life Carstenhof Hospital: 011 655 5500 • Life Glynnview Hospital: 011 741 5460 4 KwaZulu-Natal • Life St Joseph’s Hospital: 031 204 1470
Are you considering hip or knee surgery due to chronic pain or discomfort? Here are some of the questions to consider before going ahead. By Meg de Jong
JOINT decision How do I know that my hip, hip arthritis or knees are the problem?
If your hip or knee is leaving you in so much pain that it’s disrupting your quality of life, it could be time to consider surgery. The first step is to locate the cause of the issue. If your hip is responsible, pain in your buttock, side of your leg, groin area and inside of your knee can all be indicative of hip arthritis, says Dr Riaan Jacobs, an orthopaedic surgeon at Life Bay View Private Hospital in Mossel Bay. If knee arthritis is the problem, it will often present in the inside of the knee, swelling around the knee and a bowed leg (condition in which knees stay wide apart even when the ankles are together). 12
Should I undergo surgery?
When your quality of life has deteriorated to the point where you are no longer able to enjoy life, it’s time to consider your surgical options, says Dr Garth Grobler, an orthopaedic surgeon at Life Vincent Pallotti Hospital in Cape Town. Dr Robert Nicholas, a hip and knee specialist orthopaedic surgeon at Life Vincent Pallotti Hospital adds that you need a consultation ‘when the pain is severe, more than just stiffness or limping, and you have night pain that disturbs your sleep’. He explains, ‘It does not depend on how ugly your X-ray is; it entirely depends on how much pain you are experiencing’.
FIT FOR LIFE
Doctors recommend being as fit as possible for the procedure and losing weight, if necessary
Depending on age and ability, patients will be discharged three to six days after the procedure. Fragile patients may be referred to a step-down facility. In both cases, a course of physiotherapy will follow the operation. Most patients are only on two crutches for a week, and use a single crutch for around six weeks, after which they should be able to resume day-to-day activities such as driving. After four months they should be able to do more strenuous activities, such as golf, and by 12 months complete recovery is expected.
MEET OUR EXPERTS
Do I need to have surgery?
Your orthopaedic surgeon will decide on your treatment based on a clinical examination and X-rays. ‘Operations are always a last resort after all conservative measures have been taken,’ explains Dr Grobler. ‘Just because you have pain in the hip or knee, that doesn’t mean you need an operation,’ he says. More conservative treatments include lifestyle modification (for example, cutting out certain activities if they are aggravating the condition, as well as losing weight, if necessary), injections, analgesic and anti-inflammatory medication and physiotherapy. If these measures prove ineffective, your orthopedic surgeon will determine whether your pain is due to factors such as inflammation, gout or loose cartilage, or if the pain is due to advanced arthritis, in which case you will need a joint replacement, explains Dr Nicholas.
I MAG ES GETTY/GALLO IMAGES, SUPPLIED
What potential surgery complications should I be aware of?
‘Thousands of hip and knee replacements are performed throughout the world on an annual basis,’ Dr Jacobs assures. ‘These procedures can now be offered to patients with a great deal of success and low complication rates.’ The worst fear for these procedures is hospital-acquired infection, says Dr Nicholas. ‘The figures vary from one in 300, to one in 100 incidents of it occurring.’ The second concern is deep vein thrombosis, with possible embolism to the lungs. ‘This is very low because we follow an anti-coagulation regime, but it can be fatal – though it’s extremely rare,’ he adds. Other extremely rare complications include a difference in leg length following the operation and sciatic nerve damage with drop foot.
When will I be back on my feet?
Recovery after joint replacement is becoming faster and faster, and surgeons aspire to have their patients up and walking on the same day as the surgery.
How can I improve my outcome? Dr Riaan Jacobs is an orthopaedic surgeon at Life Bay View Private Hospital in Mossel Bay.
Doctors recommend being as fit as possible for the procedure and losing weight if necessary. Following surgery, strengthening exercises under the care of a physiotherapist are recommended, as well as check-ups with a physician to eliminate possible cardiac and renal and respiratory complications.
LIFE PLUS Dr Robert Nicholas has been in practice since 1987, at Life Vincent Pallotti Hospital, as an orthopaedic surgeon, specialising in hips and knees.
Dr Garth Grobler has been a specialist orthopaedic surgeon (hip and knee) for 27 years, and was head of the joint replacement unit at UCT hospital until last year.
After-surgery tips for at home
• T ake pain medication as prescribed. Preventing pain is key. • C ontact your surgeon if the pain does not gradually improve within the first two weeks. • C onsult your surgeon if you are unsure about taking other medication. • A nti-coagulants must be taken as prescribed. It prevents serious life-threatening complications. Make sure you keep the incision clean and dry and follow your surgeon’s instructions on wound care. Inform your surgeon immediately if you have the following signs or symptoms: • R edness, increased pain, swelling or drainage from the incision area • S igns of an infection (for example, a sore throat poses an infection risk) • Signs of fever or chills • N ew or severe swelling (this may be the warning sign of a blood clot) WWW.LIFEHEALTHCARE.CO.ZA
with his therapy Jean assisting Nicholas facility pool in the rehabilitation
On 19 June 2016, 21-year-old Nicholas Stephenson, a third-year finance student, sustained a traumatic brain injury (TBI) after a five-storey fall. His mother, Jean Stephenson, describes the journey to reclaim their lives... 14
received the call that every parent dreads at 3:30am that morning and rushed to the hospital, arriving just behind his ambulance. I had no idea, at the time, how blessed we were. Nicholas could have been taken to any hospital in the local area (in fact, there was a closer one), but because they found his medical-aid card they deliberately chose Life Vincent Pallotti Hospital, which has one of the best neuro units in Africa. I wasn’t allowed to see him for hours while they tried to stabilise him, but strangely enough I wasn’t scared. In times like that you go into survival mode and live in a different state of consciousness. I felt completely cocooned, surrounded by family and friends, and as we held hands and prayed I knew my son would be okay. Right from the start, I ran away from all the doctors’ tales of doom and left
others to deal with them. I would not hear any details; I refused to hear the negatives and at that stage that was all they had. I understood he had suffered a TBI and that they had no idea whether he’d pull through. But I was his mother: I knew he would. I’d given him life once and I could give it to him again as I was convinced he was there. I instructed that he was to be included and not spoken over, during each and every conversation. My job was to be with my son and I was committed to surrounding him with all the love and prayer in the world to enable him to heal himself. I also knew that with brain injury no one could predict the outcome, and firmly believed that there is always the possibility of miracles. It helped that he was in the best possible hands and place.
Nicholas spent one month in ICU – three weeks of it in a coma – before being moved to the hospital’s acute rehabilitation unit. Miraculously, despite the height of the fall, he had only sustained two cracked ribs, but the brain injury had taken its toll. It was extremely difficult to see my son, who had completed 10 subjects during matric and achieved nine distinctions, unable to communicate. I clawed at every form of rehabilitation available, Western and complementary. He started acupuncture as soon as he was moved to the Life Rehabilitation Unit and his acupuncturist brought her dog to see him. He was taken outside, in his bed, to see the horses that live next to the hospital grounds and when Botox® was suggested, I agreed. I trusted his medical team implicitly and though he was wheelchair-bound, when they told me it would help relax the increased tone (spasticity) in his right arm and leg, I gave my consent. The doctors were thrilled with the results as he had far more mobility and less contraction. We initially started communicating with Nicholas through blinking, even though we had no idea whether he understood us. Later, we progressed to a ‘yes’ and ‘no’ board. The first time he spoke, about 10 weeks after the fall, I was so excited that I ran up and down the hospital, pushing his wheelchair, screaming at the top of my voice. We were in the cafeteria and I asked him a question. Since we didn’t have the board, he simply replied, and he’s been talking ever since. It was an amazing day for us all.
There is still a long road ahead but Nicholas has made a dramatic recovery There’s no doubt that a huge part of his healing was the incredible medical team at Life Vincent Pallotti Hospital. Every single one of them – from his doctors to his therapists and nurses – contributed to his healing, as did all the treatments. The rehabilitation team believes the support and love our family and friends showered on him played a major role too. We know the next two years are critical in getting him back to where he was and finishing his degree, so we’re totally focused on using every single available form of rehab to give him the best possible chance. It’s time- and incredibly money-consuming but we have no choice: Life Vincent Pallotti Hospital gave him the best possible start; we’re doing everything we can to ensure he gets there. Looking back now I can honestly say that miracles do come true. There is still a long road ahead but Nicholas has made a dramatic recovery. The doctors cannot believe that the Nicholas today is the same Nicholas they saw on his first two CT scans.
FROM TOP Nicholas during his rehabilitation sessions; Jean is determined that Nicholas live a full life of varied opportunities
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
IN HIS REHABILITATION THERAPIST’S WORDS Rehabilitation for traumatic brain injury (TBI) is multifaceted and requires the input of a multidisciplinary team, says Elmarie du Preez, a physiotherapist who was on Nicholas’s team. ‘As a result of his TBI, he suffered from spasticity in his right arm and leg. In our rehabilitation centre, we are successfully treating this condition, which can interfere with mobility and daily living activities, with Botulinum Toxin (Botox®) therapy. Botox® is a nerve impulse “blocker” that attaches to nerve endings and prevents the release of chemical transmitters that activate muscles. If the message is blocked, the muscle doesn’t spasm. It is administered by injection directly into the affected muscles and once the muscle starts to relax (about three days after), it is slowly stretched as far as possible (depending on pain and resistance) and the limb is wrapped in a well-padded plaster cast for three to five days for prolonged stretching. The cast is then removed so the skin can be checked for pressure concerns. The muscle is stretched further and another cast is applied in a more stretched position and kept on for another three to five days. The process is repeated until full mobility is achieved or a plateau reached. Nicholas had one set of injections in his right arm and right calf, followed by two sets of serial casts, and the results achieved played an important role on his road to recovery. Nicholas’s rehabilitation team are planning another round of Botox® treatment since his mobility has been vastly improved, and so has his quality of life.’
DEALING WITH INFERTILITY
WHEN HE HAS THE PROBLEM If a male factor is making it tough for you and your partner to conceive, itâ€™s important to understand what may be the cause. Charlene Yared-West speaks to the experts
Infertility affects approximately 15% of couples globally, amounting to about 48.5 million
truggling to fall pregnant? Usually, women are first to seek help when trying to conceive. However, if she’s been found to be fertile, it falls to the male partner to be tested. According to a study by the National Center for Biotechnology Information published in 2015, infertility affects approximately 15% of couples globally, amounting to about 48.5 million. The study also found that males are solely responsible for 20–30% of infertility cases and contribute to about 50% of cases overall. Furthermore, at least 30 million men worldwide are infertile with the highest rates in Africa and Eastern Europe.
INFERTILITY AND FEELINGS OF INADEQUACY AND IMPOTENCE
‘Research indicates that the male partner is less willing to seek medical advice about infertility. They feel embarrassment about not being able to conceive naturally and suffer guilt, self-blame and shame,’ says Dr Liezel Anguelova, counselling psychologist at Life Roseacres Hospital. ‘Many men do not feel comfortable with the testing procedure as it includes the examination of their testicles and penis, and the production of a sperm sample. As such, men often associate infertility with impotence, when they are actually unrelated.’ Dr Anguelova explains how infertility can be devastating to the man who experiences the failure of
his procreative nature, as it is so intrinsically linked to his sexuality. ‘It is often an assault on the masculinity of the male partner and it is not uncommon for him to develop sexual problems such as the loss of sexual desire or erectile dysfunction, which can leave him feeling that he is “less of a man”,’ she says.
GETTING TO THE BOTTOM OF IT
Dr Daniël Andréas Petrus Louw, a urologist at Life Beacon Bay Hospital, says the physical assessment entails a general exam, evaluation of the testes (volume, masses, varicocele, infections) and a prostate exam if needed. ‘The evaluation starts with taking a thorough medical history. We normally do a pelvic and scrotal ultrasound as well to check the testicular tissue and look for signs of sperm transport blockage. Other more invasive diagnostic methods can be used, especially when there is little or no sperm seen in the ejaculate. This would then be aimed at distinguishing between abnormal sperm production or blockage of sperm transport,’ he says.
WHAT TREATMENTS ARE AVAILABLE?
Dr Louw explains that treatment is aimed at the underlying problem, whether that is advice on a healthier lifestyle, surgical correction of a
Dr Sulaiman Heylen, a specialist in reproductive medicine at the Cape Fertility Clinic at Life Kingsbury Hospital, says it is diagnosed by an abnormal semen analysis. ‘We always start fertility testing with semen analysis. This is easy and inexpensive.’ The three parameters important in semen analysis based on 2010 World Health Organization criteria: 1 Sperm count – more than 15 million sperm per millilitre. 2 Sperm motility (how they move) – 32% must be motile. 3 Sperm morphology (their shape): at least 4% must have normal morphology. ‘If one parameter is abnormal, we speak of male infertility in combination with an inability to conceive,’ Dr Heylen explains. He lists the following as possible causes:
1 Varicocele. These are varicose veins
of the testis and can contribute to up to 30% of all cases of male infertility. 2 Trauma of the testicles, related to accidents or sports injuries. 3 Sexually transmitted diseases, which can lead to testis infection and blockage of the epididymis (tubes of the testis). 4 Mumps of the testis. 5 Pollution and environmental factors (oestrogen-like factors in the environment, called xenoestrogens). Oestrogen is the female hormone, whereas xenoestrogens, chemical compounds, mimic oestrogen. Evidence shows environmental factors and pollution can contribute to male infertility. 6 Unhealthy lifestyle. Excessive alcohol, obesity, smoking and drugs. Anabolic drugs are known to cause a low sperm count. 7 Antibodies attack sperm. Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to destroy them. 8 Undescended testes. During foetal development, testicles may fail to descend. 9 Genetic. Defects in the chromosomes or small defects of the Y-chromosome. 10 Unknown. Sometimes the cause is unidentifiable.
GR OWING LIFE
CAN A COUPLE SURVIVE TREATMENT? Infertility can be a relationship maker or breaker says counselling psychologist Dr Liezel Anguelova. ‘It’ll put your relationship to the test but if you focus on the importance of your partnership, it could be an opportunity to make you stronger together.’ She shares some tips for surviving infertility. 1 Stay in the moment, because it can be very overwhelming. Wait until you’ve attended each doctor’s visit to gather information on the process before making decisions and planning ahead. 2 Communicate openly and honestly to address unmet expectations, frustrations, fears and stress. 3 Seek professional assistance and counselling if you and your partner are not communicating effectively. 4 Do not get caught in a blame game of resentment – become committed as a team. 5 Remain positive about yourself and your partner. 6 Keep your sexual relationship spontaneous and full of fun. Nurture intimacy by touching, hugging and kissing each other outside of a sexual connotation. 7 Do not let your entire life be merged into the fertility treatment process. Continue with other hobbies and keep other dreams alive. 8 Build a support system. Support each other and include friends and family in the process.
– medical treatment, sperm washing with artificial insemination, in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI).’ Dr Louw always emphasises to his patients that 20–30% of sub-fertile couples do end up falling pregnant without any further help, which is positive as nature is on their side. ‘Anxiety about infertility also plays a significant role and it is important to explain the normal conceiving time of six to 12 ovulatory cycles,’ he says. ‘It does unfortunately happen that our patient is unable to have children, meaning the couple would need to discuss alternate options such as sperm donation or adoption.’
● ifaasa.co.za ● mayoclinic.org/diseases-conditions/ low-sperm-count/basics/causes/con20033441 ● capefertility.co.za ● www.urologyhealth.org/urologicconditions/male-infertility
Do not get caught in a blame game of resentment – become committed as a team
MEET OUR EXPERTS
Dr Sulaiman Heylen is a specialist in reproductive medicine at Life Kingsbury Hospital. He has been certified as a reproductive endoscopic surgeon by the European Society of Human Reproduction and Embryology (ESHRE 2015).
Dr Daniël Andréas Petrus Louw is in private practice at Life Beacon Bay Hospital. He has completed a European urological qualification and is a fellow of the European Board of Urology (FEBU 2009).
Dr Liezel Anguelova is a counselling psychologist at Life Roseacres Hospital. Her practice, MindSense Counselling and Learning Centre, is accredited as a training institution for Counselling Psychology and Psychometrist Interns.
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testicular abnormality, or medically treating an underlying infection, sexual dysfunction or hormonal abnormality. ‘When there is no urological correctable contributing cause to the infertility, I then prefer to take a multidisciplinary approach and get the infertility specialists and/or gynaecologists involved,’ says Dr Louw. ‘Together we can decide on further optimal treatment, considering their hormonal levels, semen analysis and female factors. These vary
Stay nourished DURING CHEMOTHERAPY
The side effects of chemotherapy can make mealtimes unpleasant. However, eating healthily is key to your recovery, says Sam Brighton
T H E WA Y W E E A T
Chemotherapy can affect patients in various ways. Nausea is common, but constipation, mouth ulcers, loss of appetite and changes in taste and smell are also prevalent. Any combination of these side effects can be taxing on your already strained body, so here are some measures Amanda suggests to help with your nutrient intake.
Nausea will most certainly affect your appetite. If you can stomach it, stick to small portions of bland foods such as boiled potatoes, plain pasta or rusks. If you’re feeling a little perkier, have a piece of sponge cake or Swiss roll. Additionally, sip on some mint or ginger tea throughout the day as these ingredients are known to help fight nausea.
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he influence that chemotherapy has on your ability to eat – and enjoy food – is perhaps not talked about as often as other side effects such as hair loss or nausea. But your body is fighting a disease every day, so it needs fuel. Why does chemotherapy wreak havoc on your appetite? Amanda van Huyssteen, a registered clinical dietitian at Life Flora Hospital in Johannesburg, explains: ‘Chemotherapy involves taking medication, either in the form of pills or a drip. The aim of treatment is to kill cancer cells, which are fast-producing cells – that is how the medication identifies the cell. Unfortunately, any other fast-producing cells in the body also suffer under the treatment. These are the white blood cells that help with hair growth, and the mucous membrane cells found in the digestive tract.’
Some chemotherapy patients talk about a metallic taste in their mouth, likely due to the increase of chemicals in their body. If you’re experiencing this, try avoid red meat, which can intensify the taste. If you don’t have mouth ulcers, try sour foods, such as lemon, which will help with the aftertaste. Another handy tip from Amanda: use plastic utensils instead of metal when eating.
WHEN MOUTH ULCERS MAKE IT DIFFICULT TO SWALLOW
If eating feels like rubbing salt into a wound, you can easily end up losing weight and compromising your immune system. Stick to soft foods at cold or room temperature, as well as nutritional supplement drinks to increase your calorie and nutrient intake.
Stress and strong pain medication are two sure-fire ways to clog your digestive system – and you’ve most likely had your share of both. You need plenty of water and fibre if you’re constipated. Make sure to eat enough non-soluble fibre (vegetable and fruit skins, seeds and bran) as well as soluble fibre (fleshy, ripe fruit and oats). Rooibos tea (black) is also recommended.
Amanda emphasises the importance of antioxidants. ‘Antioxidants are the scavengers for free radicals in the body. Chemotherapy causes a dramatic increase in the amount of free radicals in the body, which suppresses the immune system.’ Beta-carotene, vitamin A, E and C and the minerals selenium, zinc, copper and manganese are the main antioxidants you can get from fresh fruit and vegetables.
A weakened immune system due to a low white blood cell count leaves you more susceptible to getting sick. Food safety becomes paramount for chemotherapy and stem cell transplant patients. Amanda recommends a neutropenic diet. ‘This excludes all food that may be contaminated with microbes. In short, all food must be cooked and eaten while fresh.’ However, eating what you feel like eating is the most logical way to keep up your calorie intake. Just keep the portions small but regular. If eating has become an arduous chore, consider seeing a registered dietitian who can recommend foods and practices that will ensure you’re getting what your body needs while it’s in the ring with the Big C.
Amanda van Huyssteen is a registered dietitian at Life Flora Hospital and Life Wilgeheuwel Hospital in Johannesburg. She has been in practice since 1985 and helping oncology patients with varied needs for nutritional intervention is a regular part of the service offered at the West Rand Oncology Centre at Life Flora Hospital.
MEET OUR EXPERT
L I F EH O MTA TTTOEPRI C S
WHY YOU NEED A
Nobody likes to talk about end-of-life plans, but it’s an important practical part of dealing with death and can bring comfort and reassurance to you and your family. Here’s what you need to know
LIVING WILL What is a living will?
Sometimes referred to as an advanced healthcare directive, a living will is a legal document that details your wishes for your end-of-life medical care, in the event you are unable to communicate your decisions due to a grave medical condition. Unlike a last will and testament dealing with your directives after death, a living will relates to medical care while you are still alive. For example, you may decide to state that if there is no reasonable chance of recovery, you do not wish to be kept alive through artificial life support.
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
Why do you need one?
Many prefer not to be kept in a vegetative state if there is no reasonable chance of survival, hope of recovery or quality of life and are therefore opposed to being on artificial life support. Having a formal
For more info, visit the following URL: samedical.org/images/ attachments/guidelineswith-regard-to-livingwills-2012.pdf
document is not just a support to you and medical staff, but also to your family who would otherwise be left with the agonising decision of whether to prolong your life given that the medical costs may place a financial burden on your family.
How do I go about getting a living will?
The procedure is relatively easy. You can write down your end-of-life plans and have it signed and dated by witnesses or you can ask a lawyer to draw up a more formal document. However, the latter will cost you more. Alternatively, visit www.samedical.org, click on the ‘Governance & Legal’ tab, ‘SAMA Law and Ethics’ and then ‘SAMA Guidelines’ to view an example of a living will you can use.
What does a living will state?
In South Africa, you can’t include a directive to have a physician assist you to die or stipulate any other kind of euthanasia. You can specify that should you be in a vegetative state with no chance of survival, doctors have your permission to withhold treatment. You can also choose not to be resuscitated or placed on a ventilator if those interventions become necessary.
DIVORCE MEDIATION COULD BE THE ANSWER Divorce is a traumatic experience, which is why mediation – particularly when children are involved – is encouraged. Lisa Lazarus finds out what you need to know
or Rachel Kruger*, who went through a divorce when her child was 11, mediation proved worthwhile. ‘Everything about mediation was helpful to me,’ she says. ‘We were able to reach agreement, especially about the amount for child maintenance and how often my ex-husband sees our child. Because he lives two hours from Cape Town, it’s only once every six weeks or so.’ Divorce mediation, as opposed to litigation or fighting it out in court, can ‘significantly reduce the trauma associated with divorce, not only for the parents, but, most importantly, the children,’ says Sandi Raath, clinical psychologist in private practice at Life St Marks Clinic, East London. Mediation, says Sandi, is a voluntary process. Parties meet face to face in the presence of a trained facilitator (attorney, psychologist, social worker) to discuss areas of dispute relating to: • Concerns about the other’s parenting style • Residence • Access, including access to extended families • Education • Medical care • Religious upbringing • Communicating with the children • New partners The mediator needs to facilitate constructive problem solving that is creative, accommodates the needs of both parents and is in line with the best interests of the children. The mediator does not: • Give advice • Force the parents to adopt a particular decision • Engage in therapy or counselling Mediation, when it works, explains Cape Town lawyer and mediator Belinda Palmer, ‘is a much better process for the resolution of parental conflict than litigation’. The level of conflict, which is universally acknowledge by psychologists to be the main cause of harm for children, is reduced between parents. The parents can also agree to a plan rather than have one imposed by the court, and this increases the likelihood of buy-in and compliance from both parents. 24
The parenting plan is required by law, states Belinda. It sets out the rights and obligations towards their children, she says. Custody, which is more about guardianship issues than about where the child lives, child contact (when and where the child sees each parent), maintenance and how decisions are made about the child (for example, education, religion, medical intervention) will be included in the plan. But mediation doesn’t always work. ‘My divorce was (and continues to be) high conflict,’ says Anna Mendes*. Her daughter, only four months when the couple separated, will be eight soon. ‘My ex-husband and I have almost always failed to reach an agreement through mediation. This means that almost all decisions regarding our child have been made by facilitators.’ Facilitation, explains Belinda, is not the same as mediation. It puts the mediator in the role of the judge and occurs when mediations fail, leaving the facilitator to make a ruling. ‘The mediation frequently involved a lot of accusations from both sides, and always resulted in failure to reach an agreement, so the facilitator would then issue a directive,’ says Anna.
Ideally, mediation assists children to stay emotionally anchored and safe during divorce proceedings. Nina Mensing, divorce mediator, counsellor and author of A Manic Marriage, explains that mediators concentrate ‘on the family system as a whole’. Parenting plans are age-appropriate and specific to the family situation. In addition, interim agreements are made during the process to ensure smooth running of the family. Routines are maintained to keep children secure, and ‘children feel more secure knowing their parents are making decisions together about their future, rather than strangers and the courts,’ says Nina. Nobody can pretend that divorce isn’t hard on children. After all, family is both the bedrock on which a child depends and the springboard from which a child is launched into the world. But realistically, families mutate: a different formation follows a break-up. And mediation provides a practical solution to navigating this rocky terrain while keeping in mind the best interests of the child.
MEET OUR EXPERT
Sandi Raath is a clinical psychologist based at Life St Marks Clinic. She has a special interest in divorce mediation, psychological assessments, forensic/ addictions and ADHD.
*Names have been changed.
LIFE PLUS What is a child custody evaluation?
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• A specialised, psycho-legal assessment selected by the parents, or court-ordered
when mediation fails or in high-conflict divorces. • Conducted by a neutrally appointed forensic psychologist to determine what is in the child’s best interests. This includes primary residence, nature and frequency of contact, and other decisions unique to a family/child’s circumstances. • The evaluator has no prior contact with either party and ensures that the assessment is fair, objective and unbiased. • ‘Best interests’ can be interpreted differently by different professionals as well as by the parents. In South Africa, it is defined by the Child Care Act 38 of 2005. In essence, children should be protected from harm, abuse and neglect, and have an equal and fair opportunity for their needs to be met (physical, emotional, social, spiritual, etc.). • The evaluation consists of interviews with parents, children, significant role players and collateral sources. It includes observations of parent-child interactions, as well as home and school visits. It may include psychological testing, if appropriate and relevant.
ARE YOU AFRAID OF COMMITMENT?
Commitment can strike fear in the hearts of men and women everywhere. Are you ready to take the plunge or are there some lingering doubts at the back of your mind? Test the relationship waters with this quiz
Read every statement carefully and indicate which option applies best to you. Respond with your typical thoughts, feelings and behaviour in mind. After finishing the test, sum up your points using the scoring table and view the relevant results for you.
D Disagree E Strongly disagree
1. I am willing to accept that in a committed relationship, I may occasionally have to sacrifice my own needs/dreams. A Strongly agree B Agree C Somewhat agree/disagree
3. The thought of spending the rest of my life with my partner makes me uneasy. A Strongly agree B Agree C Somewhat agree/disagree D Disagree E Strongly disagree
2. Once a relationship gets more serious, I believe there’s a bigger chance that I’ll get hurt. A Strongly agree B Agree C Somewhat agree/disagree D Disagree E Strongly disagree
4. Being in a relationship interferes with the goals I want to accomplish. A Strongly agree B Agree C Somewhat agree/disagree D Disagree E Strongly disagree 5. It’s hard for me to picture my life without my partner. A Strongly agree B Agree C Somewhat agree/disagree D Disagree E Strongly disagree 6. Committing to one person will prevent me from meeting someone better.
A Strongly agree B Agree C Somewhat agree/disagree D Disagree E Strongly disagree 7. I’m afraid that I won’t be able to live up to my partner’s expectations. A Strongly agree B Agree C Somewhat agree/disagree D Disagree E Strongly disagree 8. I’m worried that a committed relationship won’t be as good as I imagine it to be. A Strongly agree B Agree
C Somewhat agree/disagree D Disagree E Strongly disagree 9. Being in a committed relationship involves a lot of responsibility that I don’t think I want on my shoulders. A Strongly agree B Agree C Somewhat agree/disagree D Disagree E Strongly disagree
I M A G E S I S T O C K 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. Once I make a commitment to a partner, I will lose my freedom. A Strongly agree B Agree C Somewhat agree/disagree D Disagree E Strongly disagree
S C O R IN G YO U R S E LF QUESTION 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
A 0 10 10 10 0 10 10 10 10 10
B 2 8 8 8 2 8 8 8 8 8
C 5 5 5 5 5 5 5 5 5 5
D 8 2 2 2 8 2 2 2 2 2
E 10 0 0 0 10 0 0 0 0 0
You seem to generally be ready to take the plunge and officially commit to your partner. In fact, you appear to be very eager to bring your relationship to the next level. As long as both you and your partner are happy with the idea of committing to each other in the long-term and are willing to take on the responsibility that comes along with it, then you are on the right track. This would be a good time to sit down with your partner and discuss the next step for your relationship (if you haven’t already). However, if the feeling is not mutual, you will need to take some time to consider your options. Are you willing to wait for your partner to come around? Are there any fears that he or she has that you can work through together? These are important questions that you will need to ask yourself and discuss with your partner if you are committed to making your relationship a long-term endeavour.
Although you may very well love your partner, there seems to be a few things holding you back from making a wholehearted commitment to him/her. This can become a serious issue in your relationship if you don’t address the underlying reasons behind your hesitation. One way to get to the root of commitment issues is to ask, ‘Why, What, Is’. In essence, ‘Why am I in this relationship? What am I getting out of it? Is sticking around worth it?’ If you can’t come up with a definitive answer or your responses are not very positive, then you may need to reconsider whether the person you are with is right for you. If you aren’t sure about what you really want in a partner or in a relationship, then making a commitment despite uncertainties is like building a house without a foundation: at some point, things will collapse and you’ll both end up getting hurt.
At this point, you are not quite ready to make an exclusive commitment to your partner and to the long-term future of your relationship. This doesn’t necessarily mean that you will never be ready. You may be perfectly content with your relationship the way it is now and see no point in changing things. If your partner is happy with this arrangement as well, then there is no need to mess with a good thing. However, if your lack of commitment has become a source of tension in your relationship, it’s time to get to the root of your relationship fears. Have issues in past relationships changed your view of commitment? Were you in a committed relationship that left you hurt? Have you experienced first-hand, through parental divorce or the dissolution of a loved one’s marriage; how painful unsuccessful commitment can be? With the help of a therapist, you can gain insight into relationship fears and work through these issues to build a strong, long-lasting relationship.
Commitment implies more than just ‘sticking it out’. It means having the dedication to foster the relationship’s growth, the determination to protect it, and the strength to fix it when it starts to crack. Unfortunately, for some people, commitment goes far beyond ‘cold feet’ and into the realm of absolute fear. It means countless sacrifices, loss of freedom, or a risk that can only result in hurt. For commitmentphobes, the image of a ball and chain is a potentially haunting reality. In these cases, it’s important to get to the root of such fears, preferably with a professional.
Go well Wellness holidays can heal more than just your body, they’re also good for your soul. By Tracy Melass
‘C MAIN IMAGE AND ABOVE Take a ride on the wild side with Wild Coast Horse Riding Adventures RIGHT Buddhist Retreat Centre, Ixopo OPPOSITE Rocktail in Maputaland
almer, grounded, super relaxed … more in touch with my authentic self.’ Asked by a friend recently to describe how I felt after attending a five-day silent retreat, this nugget best summed it up. I had been through a particularly stressful patch at work and was feeling emotionally and psychologically depleted. The salve, I knew, would be to get away from it all, to turn down the sound on the world, meditate, eat more purely and reboot. It was the best investment in my heath I could make. Two months later and I am still reaping the rewards, tapping into my calmer centre when the world starts unravelling. Going on a wellness retreat (including anything from a fitness weekend or digital detox vacation to a spa break) to proactively manage your health pays huge dividends.
‘For many hard-working and stressed professionals, a wellness retreat can be a powerful way to help restore physical and mental wellbeing,’ agrees Steve Peralta, corporate wellness consultant and founding member of Unmind. ‘I would suggest using the break to disconnect from tech and reconnect with nature to really revitalise your body and mind. You’ll be able to recommit to work and life with renewed energy and focus.’ Vegetarian food and chanting ‘om’ three times a day aren’t for everyone, but wellness breaks come in many forms and cater to a variety of tastes. These seven will soothe, relax and energise.
BEST FOR: HEALING REJUVENATION, HEALTHY WEIGHT LOSS
The Hydro, Stellenbosch (Western Cape) The famed Hydro operates on five basic principles: diet to cleanse, treatments to rejuvenate, exercise, relaxation and lifestyle motivation. And it’s underwritten by professional health practitioners covering medicine, therapy and exercise science. Quite simply, you’re in excellent hands. Founded in the early 1970s, the retreat, set in the stunning Idas Valley, is world renowned for its holistic approach to health and wellbeing. You will start with an in-depth consultation in naturopathy with one of the resident doctors, during which you’ll discuss your medical history and wellness objectives. The programme and nutritional guidelines are tailored to your personal goals, and your progress is monitored throughout the stay. Visit thehydro.co.za for more.
Vegetarian food and chanting ‘om’ three times a day aren’t for everyone, but wellness breaks come in many forms and cater to a variety of tastes meditation and activities associated with Buddhist culture. And what a setting it is: think ancient cycads, pine-scented paths, undulating valleys… It’s also home to around 160 bird species, a feast for avid birders. The centre has received accolade after accolade for its beauty, vegetarian cuisine, inspiring teachers and eclectic line-up of retreats and courses, including yoga, meditation, pottery, photography and t’ai chi. Visit www.brcixopo.co.za for more info.
BEST FOR: TIME IN NATURE, WALKING, SCUBA DIVING
Rocktail, Maputaland (KwaZulu-Natal) This idyllic coastal escape offers a paradise of ancient dunes, the sanctuary of the lush Maputaland coastal forest, and a chance to observe sea turtles in their natural habitat. Rocktail beach and diving resort is a stone’s throw from the Maputaland Marine Reserve meaning there’s no shortage of beach adventures. If you’ve never gone scuba-diving, this is the place to learn – with its reefs and teeming marine life, Rocktail is considered one of the best diving sites in the world. Plunge beneath the surface and you’ll be rewarded with a dazzling kaleidoscope of colours. The endless golden beaches are also a lure for walkers who enjoy physical meditation, isolated and never-ending. Visit www.wilderness-safaris.com/ camps/rocktail-beach-camp for more.
BEST FOR: DE-STRESSING, DIGITAL DETOX, IMMERSION IN NATURE Kurisa Moya Nature Lodge, Magoebaskloof (Limpopo) One of the most scenic parts of Limpopo and sometimes referred to as South
BEST FOR: SPIRITUAL CONTEMPLATION, MEDITATION, SILENCE
Buddhist Retreat Centre, Ixopo (KwaZulu-Natal) The Buddhist Retreat Centre sits on a 121 ha property, overlooking pristine valleys, forests and the rolling green hills for which the area is known. You’ll be hard-pressed to find a more tranquil setting for the study and practice of philosophy, psychology,
BEST FOR: HEALTH TREATMENTS, DETOX
Namaste Detox Retreats, Midlands (Kwa-Zulu Natal) This centre skilfully blends steam rooms with five-star accommodation, daily guided meditation and yoga. But don’t get the wrong idea. This is not a spa holiday. It’s a way of achieving optimal health through goal-oriented detox programmes. Choose between the four- or seven-day detox, or 10-day weight-loss package combining juice fasting, colonic hydrotherapy, lymph drainage massages and exercise. A specialist team will design and monitor your eating, supplementation and activities to help achieve optimal 30
BEST FOR: LEARNING OR PERFECTING A SKILL, NATURE ESCAPE, STRESS RELEASE BOTH IMAGES Rustic and restful Kurisa Moya Nature Lodge in Limpopo
Don’t get the wrong idea. This is not a spa holiday. It’s a way of achieving optimal health results. The aim: to motivate you to find your own formula for long-lasting health and longevity. Visit www.namaste-retreats.com for more.
BEST FOR: QUIET, TIME IN NATURE, YOGA RETREATS HEALTH TREATMENTS,
Temenos, McGregor (Western Cape) Veterans of the Temenos retreat centre are guaranteed to become misty-eyed
Wild Coast Horse Riding Adventures, Wild Coast (Eastern Cape) Tap into your inner cowboy/girl, feel the wind in your hair, breathe the salty air and take a ride on the wild side. Whether you’re a pro at riding or simply a beginner, Wild Coast Horse Riding Adventures has a package to suit your needs and sense of adventure. You’ll search long and hard to find a setting as pristine and isolated as this one. Beach riding along the Wild Coast is exhilarating, with long stretches of sandy shores just waiting to be galloped and explored. Take in the stunning scenery: rolling hills, deep gorges and cliff tops that plunge into the ocean. Your adventure also offers an authentic taste of rural Africa, with routes winding through small Xhosa villages, where locals welcome you. And when rider and horse become weary, you can kick back in one of the comfy hotels en route and revel in your good fortune. Visit www.wildcoasthorseback adventures.com for more.
Africa’s Garden of Eden, Magoebaskloof is one of the country’s best-kept secrets. Characterised by cool mountain air, fresh spring water and lush subtropical vegetation, it truly is a slice of paradise. And in the heart of this is Kurisa Moya Nature Lodge, a rustic dwelling perched on the edge of the Drakensberg escarpment, with awe-inspiring views of the Lowveld and surrounds. Stressed city folk in need of digital detoxing and decompression will be seduced by its slow pace and tranquil setting. Forest walks, birdwatching, fly fishing, a variety of healing treatments – massages, specialised cranio-sacral therapy (a mild touch energy-based treatment) – are just some of the soothing R&R options on offer. Visit www.krm.co.za for more.
when asked about this magical garden hideaway in the village of McGregor. Its holistic therapies, including reflexology, reiki and aromatherapy, are legendary, and it also hosts yoga, meditation and silent retreats. But it is the stunning garden for which Temenos is best known. It is a real labour of love, lush and overgrown, with seemingly endless twists, turns, pathways, and quiet nooks. The grounds also house a multi-denominational chapel, plenty of meditation spaces and a Zen garden. Accommodation choices include traditional Cape cottages set in orchards of lavender and olive trees or Georgian suites attached to the quiet garden library. Temenos has everything you need to relax and rejuvenate. But beware, you may never want to return to normal life… Visit temenos.org.za for more.
HEALTH CANCER SURVIVORS / LIFE THE CROMPTON HOSPITAL UPGRADE / COLONOSCOPY
‘CALM MIND BRINGS INNER STRENGTH AND SELF-CONFIDENCE, AND THAT’S VERY IMPORTANT FOR GOOD HEALTH.’ DALAI LAMA
Cancer survivors CELEBRATE THEIR JOURNEYS Thanks to improved diagnosis and medical advances, what was once the Big C is becoming the Shrinking C â€“ but ignorance and fear around cancer persists. In celebration of International Cancer Survivorsâ€™ Day on 4 June, these four cancer survivors who are conquering the disease share their story and what has helped them through. By Glynis Horning
SALOSHNIE LUTCHMAN, 51, Durban teacher: breast cancer In 2015, Saloshnie felt a small lump in her breast but dismissed it. ‘I teach high school English, and it was the stressful second semester. I was setting and invigilating exams and marking at home from 2–6am to meet deadlines. I had no time to be sick. Besides, I ate and lived healthily, and had no cancer in my family. I refused to believe it could be anything serious.’ Then the pulsating pain in the lump became unbearable. ‘I went to a specialist to check out what I thought was a cyst.’ Her suspicions started only when, after a mammogram, the radiographer insisted she have ultrasound scans and told her to take the report straight to her doctor. ‘But he was away for two weeks, so I opened it in the car. I saw the words “suspicious cells” and “need for urgent biopsy”. I felt light-headed.’ Her doctor scheduled her for a biopsy. ‘A thin-needle aspiration came back positive for cancer, but I needed a deep-core biopsy to be sure. I was shaken, but didn’t tell anyone. Why worry my children when they were in the midst of exams – and it might still be nothing? ‘I prayed, and the deep-core biopsy came back negative. The surgeon said he’d never seen this before, and he’s 73!’ He booked her for surgery to examine the lump, with a pathologist in attendance. Saloshnie had stage 2 grade 3 breast cancer, aggressive and spreading significantly. The surgeon had removed 14 lymph nodes and much of her breast, saving a quadrant for reconstruction. She came around surrounded by her children and sister: ‘I’d said only that I was having a cyst removed, but it turned out my youngest discovered my ultrasound report, told her sister, and they’d been worrying themselves sick. But they know how independent I am.’ It was the support of family and positivity that carried Saloshnie through six gruelling months of chemotherapy, six weeks of radiation and 12 months of Herceptin chemotherapy. A fourth treatment regime continues orally.
Be strong, but loving support is priceless ‘I’m in remission. Sadly, my children and family remain angry with me for not confiding in them. I still think it would have been selfish. It’s just one of the tough calls cancer forces you to make. There are no easy answers, but loving support is priceless.’
LIFE DOCTOR’S VIEW Dr Poonusamy Rajaruthnam, specialist surgeon, Life Chatsmed Hospital ‘Saloshnie typifies a cancer patient in an academic profession – able to do a self-examination of their breasts, get a prompt medical opinion, come to terms with the diagnosis and its consequences, and the most important thing: get family support. Never lose hope!’
ROWEENA STEWART, 57, Randburg deputy director of an intercultural exchange programme: colon cancer
LEON VAN ROOY, 59, Pretoria human resources consultant: prostate cancer
On a Monday morning four years ago, Roweena was hard at work on a report, hoping to finish before her son’s 24th birthday that night. Suddenly she felt excruciating pain in her tummy. ‘I put it down to stress and indigestion, and popped an antacid and painkiller. But by 4pm it was so bad I had to get my daughter to drive me home and I climbed into bed.’ When Roweena saw her doctor the next day, the pain was so intense she could barely get off his exam table. ‘He got me in straight away with a surgeon who ran tests.’ The last was a colonoscopy – it showed two tumours. ‘One was 15mm across, blocking my intestine, and he estimated it had been there for two years. He couldn’t believe I hadn’t been sick or constipated!’ It was only when he said he was sending a biopsy to be tested for cancer that fear gripped her: ‘An aunt died of colon cancer.’
‘As a child, my brothers teased me for getting up often at night to pee,’ Leon says. He remembered this when he began having interrupted sleep again about three years ago. He also did the grown-up thing: while having blood drawn for a cholesterol check, he asked to send some for a PSA (prostate-specific antigen) check. ‘My father and brothers all had prostate cancer, but I’d been for PSA checks before and they’d been clear, so I’d got slack.’ The nursing sister rang and told him to see his urologist. ‘My PSA was seven when it should be less than four, so the urologist did a biopsy – I was worried.’ Getting the diagnosis was easier than dealing with the uncertainty, he says. ‘The prostate grows in size because of the cancer cells, pressing on the urethra’, which was the cause of his intermittent peeing, a common symptom. ‘But the oncologist was wonderfully reassuring. He said the cancer hadn’t spread and I had three options. Removal of prostate and surrounding tissue, which would affect sexual function and require postoperative care (hard for a single bloke who stays up a flight of stairs), “bikini cut” to remove only the prostate, or brachytherapy, during which ironising radiation rods as small as clutch pencil leads are inserted to destroy the cancer cells over time.
Watch your diet, but be kind to yourself – relish life and have faith The results showed the 15mm tumour to be cancerous. ‘I was told at noon, and wheeled in to surgery at 1pm. I had no time to think, I just put myself in God’s hands. And He delivered.’ The relief from pain was instant. But although the tumour had been successfully removed, as well as four lymph glands where the cancer had spread, she needed six months of chemo. ‘The nausea was terrible. Still, with colon cancer chemo your hair doesn’t fall out – that was a blessing, and simply being alive for my three kids. They and God’s grace kept me going. Four years later I’m clear, with a new appreciation for life.’ Roweena attributes her cancer to genes and stress, but is also watching her diet: ‘My daughter’s a dietitian, so I’ve dropped red meat and eat lots of fruits and veggies. But I also allow myself things I enjoy – life is too short to be rigid!’
Read, research, inform yourself before making any choice ‘That’s when I learned my big cancer and life lesson: read, research, inform yourself thoroughly before making any choice – it gives a sense of control and confidence.’ It pointed Leon to brachytherapy. ‘And I’m so glad! The implants were inserted under general anaesthetic and the next day I didn’t know they were there. A week later I was back at gym.’ Today Leon’s PSA is 0.27. ‘All through the grace of God. I go for regular check-ups, and every guy should: a PSA test plus a physical (digital) exam – it’s over in seconds, so man up.’
LIFE DOCTOR’S VIEW
LIFE DOCTOR’S VIEW
Dr Daleen Geldenhuys, oncologist and specialist physician, Life Flora Hospital
Dr Jakobus Bouwer, oncologist, Life Wilgers Hospital
‘Roweena did everything right: she didn’t ignore the symptoms, she relied on a loving family for support and tackled the diagnosis with a positive attitude and a balanced outlook on what is important in life.’
‘Mr Van Rooy is an excellent example of optimal response to triple modality treatment involving radioactive seeds, external beam irradiation and biochemical hormonal therapy. This compliance managed his cancer without the trauma of radical surgery and its consequences, especially erectile dysfunction.’
Gaining in strength, one step at a time. Cancer is a formidable challenge to overcome. And yet, with the right treatment and support, it is possible to do just that. Sun Pharma is proud to be associated with World Cancer Survivorsâ€™ Day. We salute all survivors and every person who is presently battling their illness, wherever in the world they might be. And we pledge our support, every step of the way. Ethical, effective, affordable medicines for the treatment of cancer. Reaching people, touching lives.
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KATHERINE BURGER, 43, Johannesburg instructional designer: skin cancer Katherine is pale-skinned, blue-eyed and freckled, and for all her adult life has been ‘boringly sun-smart – I slather on high-SPF sunscreen and sit under a big cabana on beach holidays’. So when she found a colourless lump near her elbow last year, she dismissed it until it grew rapidly and became tender. ‘My GP thought it was a lymph node infection and gave me antibiotics, but in three weeks I had a golf ball sticking out of my arm!’ Katherine was sent to a surgeon for a biopsy: ‘She too wasn’t concerned – I think she was as shocked as I was when the results came back: stage 3b melanoma. Stage 4 has around a 15–20% five-year survival rate.
LIFE PLUS CANSA offers support at 30 Care Centres and clinics in 500 communities countrywide. 0800 22 66 22, www.cansa.org.za
It’s empowering to believe you’re doing the best you can for your body ‘I wasn’t ready to die at 43 – with a 13-year-old daughter. It was hard to handle. I mourned for myself, going through the stages of grief: denial, anger, bargaining, depression. But not acceptance: I’m fighting it every step!’ The surgeon removed more lymph tissue and an oncologist put her on interferon immunotherapy. ‘I had to inject myself three times a week for a year and the side effects were harsh’. This year she learnt about a newer immunotherapy treatment, designed to boost the body’s natural defence to fight cancer. It was approved by the FDA in 2015, but not yet in South Africa. ‘I quit interferon after three months and signed up for a clinical trial of nivolumab (Opdivo) that’s gathering data on people from Africa. I have infusions every two weeks for two years. I’ve had blurred vision, lethargy and hair loss, but not the chemo nausea. It’s empowering to believe you’re doing the best you can for your body!’ Katherine is on a mission to spread a sun-smart message, especially to parents. ‘When I was a kid we didn’t know about skin cancer, we’d joke about who had the worst blisters. They say just five sunburns in life double your chance of melanoma, so I’m sure that’s where mine began. The ozone is thinning and even dark skins aren’t safe. Always wear protective gear and sunscreen, and have an annual check-up with a dermatologist.’
CONNECT WITH US ON FACEBOOK 4 June is International Cancer Survivors’ Day, but we’d like to celebrate these triumphant men and women all month long. Throughout the month of June, share your six-word memoir about your cancer journey to inspire others who have been diagnosed to stay strong. Go to Facebook (@lifehealthcare) or Twitter (@LifeHealthcare_) Here’s an example: ‘I’m stronger than I ever imagined!’ Marsha Wheatley, Age 43 Diagnosed in 2008 #SixWords
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LIFE DOCTOR’S VIEW Dr Nicola Grabowski, specialist surgeon, Life Fourways Hospital ‘Never think “it’s just skin cancer”. Your skin is the largest organ of your body. Any skin lesion that is undergoing changes in colour, shape or size must be clinically evaluated and biopsied – preferably with excision.’
I N N O VA T I O N
puts smiles on CHILDRENâ€™S FACES
The upgraded facilities improve the wellbeing of patients, parents and staff, and enhances care and outcomes 38
The new paediatric ward at Life The Crompton Hospital has brightened the outlook of patients, parents and staff with its purpose-built facilities. By Melanie Farrell
hen young patients and their parents enter the new paediatric ward at Life The Crompton Hospital in Pinetown, they are greeted by a warm, inviting space. The floors gleam, light streams through and a playroom welcomes little ones to while away the hours with toys. The decor is bright and cheerful and the layout has been designed with ease of movement and privacy (when needed) in mind. But it wasn’t always this way. The purpose-built paediatric ward that opened at the end of last year replaced a less-than-ideal space. ‘The previous facility was an adult ward converted into one for children,’ explains specialist paediatrician Dr Ridwan Omar. ‘It wasn’t very child-friendly and the furniture was old. On some occasions, parents would walk in to admit their child and walk out within five minutes, refusing to spend the night,’ says Dr Omar.
TIME FOR PLAY
Being admitted to hospital is difficult for children. They leave a familiar environment to spend time in a sometimes scary medical world. However, medical researchers from Greece have found that sick children benefit from play when in hospital. Mindful of this, Life Healthcare has ensured that this paediatric ward has a wellstocked playroom to assist children in recovery through play therapy. ‘Story time is also a favourite,’ adds RN Maharaj. ‘In addition, all beds now have overhead TVs and children are able to select their own channels. Previously, one TV was shared between six patients.’ It’s not only the children who have benefited from the new and improved space. ‘Parents are also very impressed with the facilities,’ says RN Maharaj. ‘They now have their own kitchen area and there is a separate shower for them so they don’t have to share with the kids.’ ‘Since the ward opened, the mood has improved: staff morale is up and patients are much happier because it’s brighter and has a modern look and feel – something that was lacking before,’ says Dr Omar. RN Maharaj sums it all up: ‘The best thing about the new ward is the joy and happiness it brings to my patients, parents, nursing staff and doctors’.
We are able to provide quality-based care for our patients and address parents with confidence
Take a walk around the ward today and it’s clear there’s been a clean sweep of out with the old and in with the new. ‘We now have isolation wards that are state-of-the-art,’ says Dr Omar, keen to talk about the improved medical facilities. ‘First, you encounter a specially designated wash area before entering the isolation ward, both of which are separated by electronically controlled sliding doors. This isolation chamber is crucial to preventing the spread of contagious diseases such as meningitis and tuberculosis.’ While Dr Omar shares his enthusiasm for the upgraded medical facilities, Unit Head Registered Nurse (RN) Roxanne Maharaj is delighted with the amount of space she and her team now have. ‘Previously, the area was crammed with cot beds, equipment and lockers, and ventilation
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was poor. However, because the new ward was designed specifically for children it has the luxury of space, and this means that nurses are able to efficiently carry out their work. The upgraded space has brought about a boost of confidence and a sense of pride among the nursing staff,’ says RN Maharaj. ‘We are able to provide quality-based care for our patients and address parents with confidence.’
Dr Ridwan Omar is a specialist paediatrician at Life The Crompton Hospital in Pinetown.
Registered Nurse (RN) Roxanne Maharaj is Unit Head of the new paediatric ward at Life The Crompton Hospital.
HELP The paediatric ward has been equipped with high-tech machines that have improved the experience of young patients. Specialist paediatrician Dr Ridwan Omar singles out two pieces in particular: the vein-finder and the Tecotherm Neo cooling machine. ‘The vein-finder is a great source of help when we struggle to find veins in small kids and children with severe dehydration. What could have taken hours to do in the past can now be done in just minutes. The machine uses special laser technology to highlight veins on the children’s arms,’ he says. The cooling machine is mainly used to treat birth asphyxia in newborns. But we now also have the capability to give medical attention to children with near-drowning. This is a great advancement for Life The Crompton Hospital.’
MAKING IT EASIER
TO TREAT TB
hen it comes to infectious diseases, most people would probably guess HIV/Aids is the biggest concern ... and they’d be wrong. Tuberculosis (TB) is the world’s leading infectious killer, taking a life every 18 seconds. So says Andrea von Delft, a physiotherapist at Life Beacon Bay Hospital and Life St Dominic’s Hospital in East London. She is also a passionate TB advocate at TB Proof, a non-profit organisation. ‘TB has only about half the funding necessary to develop new diagnostics, treatment options and patient support programmes to attain the Sustainable Development Goal (SDG) of ending the epidemic by 2030,’ says Andrea. However, despite this, three new drugs were introduced into the market recently, the first in 50 years. TB is difficult to cure. It requires six months of treatment with no defaulting – and that’s just for ‘ordinary’ TB. In recent years, various strains have become resistant to antibiotics, resulting in two new deadly forms of infection: multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB), a rare type of MDR-TB. ‘Antimicrobial [antibiotic] resistance is a global public health emergency,’ says Andrea. ‘Anyone can contract XDR-TB primarily and, until recently, you only had a 20% chance of being cured, with the risk of severe side effects. The new Nix-TB regimen requires only three oral drugs – bedaquiline, linezolid and pretomanid – instead of an average of eight toxic drugs in the current treatment, which can include thousands of pills,
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Bedaquiline, a new drug, has effectively reduced treatment duration of multidrug-resistant tuberculosis (MDR-TB) from around 18 months to approximately nine. Mandy Collins investigates
six months or more of daily painful injections, and debilitating side effects such as deafness and blindness.’ There’s a strong South African link to the new regimen. ‘In the Nix-TB trial, a South African study led by Dr Francesca Conradie, pretomanid, bedaquiline and linezolid were given to XDR-TB patients,’ says Andrea. ‘All are not part of the standard treatment so there’s minimal resistance. Forty patients completed the six-month trial and of 31 that had a six-month follow-up, one patient relapsed, while another was re-infected. No patients withdrew from the trial due to drug toxicity, nor extended treatment.’ All strains of TB are transmitted in the same way – via airborne bacteria spread when infected people cough. So, if you develop symptoms like coughing for more than two weeks, unexplained weight loss, night sweating and loss of appetite, you should see your doctor and have a chest X-ray and GeneXpert sputum test. ‘The GeneXpert is a new diagnostic tool that can test if you have TB and if you are sensitive to rifampicin, the most important medication used to treat drug-susceptible (DS-TB) or “normal” TB,’ says Andrea. ‘If you’re sensitive, you’ll start treatment immediately. If the GeneXpert shows you are rifampicin resistant, you are deemed to have drug-resistant TB (DR-TB). Further tests will determine MDR-TB or XDR-TB. ‘If a person is presumed to have TB, they will be isolated until test results are available. When a person with DS-TB starts treatment, they are much less infectious within 72 hours. With DR-TB patients, current treatment options are not as effective and patients stay in isolation until their culture tests are negative – this could be up to six weeks or more in a hospital, with recommended isolation at home for an additional four weeks.’ Andrea says simply coming up with new drugs and diagnostics – while vital – is not enough to fight the scourge of TB. ‘Our country also needs to address the social determinants of health through social and economic improvement, otherwise TB will remain a huge healthcare burden. It’s also vitally important to address issues around stigma associated with TB, because it creates a barrier to accessing treatment, and then it doesn’t matter if you have the best drugs and diagnostics in your healthcare facilities.’
TWO PATIENTS SPEAK Ingrid Oxley, dietitian ‘I had pulmonary TB in 2011 after being treated with immune suppressive therapy for ulcerative colitis. I completed my treatment. The next year, after being treated with immune suppressive therapy again, I was diagnosed with pre-XDR TB – a form of drug-resistant TB where the strains are more difficult to treat and needing strong medication often, which has serious side effects. I developed liver failure and was in a coma not from TB, but from the toxic treatment. ‘It made me feel very sick. I was vomiting, had diarrhoea and was very nauseous. One medication was an injectable, which was painful. I sometimes felt like giving up: that is how sick it made me feel. Fortunately, I had a lot of love and support from family and friends. If God did not provide me with that, I would have given up. You cannot get through this without support.’
Dr Thato Mosidi, medical doctor ‘I was diagnosed with XDR-TB in October of 2013 just after I had served my time as a community service doctor. ‘Initially, after hearing the diagnosis, I was shocked. Following that, and even throughout my treatment, I was scared. I was resistant to all the main forms of treatment at the time and had fortunately been approved to receive bedaquiline and linezolid as part of South Africa’s compassionate use programme. ‘I suffered from many side effects while I was on treatment. I had constant nausea, neuropathy and tendinopathy that made it difficult to walk, skin discoloration from one of the drugs and at some point I had to discontinue my treatment for a short time because of the damage it was causing to my liver. ‘It was a long and difficult journey. I stayed on treatment for just over two years. Every day I had to convince myself to take my medication, which was a challenge because at some point I was drinking up to 30 tablets a day. I don’t think I could have ever emerged out of it without the support of my family and friends. Because of them I was able to brave the days when I just didn’t feel like carrying on.’
• TB is the leading cause of death in South Africa, with more than 60 000 deaths recorded in 2010. • TB disproportionally affects males, the poor, the young and the non-white. • M DR-TB had emerged in South Africa by the 1980s, but was not thought to be a major problem at first. • X DR-TB (using the 2006 revised definition) was prevalent in the Western Cape as early as 1992.
ITâ€™S JUST A REFLEX Babies instinctively know how to root for the breast, along with several other primary reflexes your doctor will check. Dr Dewald Buitendag advises parents on what to look out for in those early days
THE BABY FILES
elcoming a newborn baby into the world is often described as one of life’s greatest blessings. But with this bundle of joy comes new-parent jitters especially when dealing with newborn reflexes. Some are spontaneous movements that occur as part of a baby’s normal activity while others are responses to certain actions. ‘Because newborn babies have limited control over their bodies, they are equipped with temporary survival skills in the form of primitive reflexes. If your newborn exhibits these reflexes, it’s an indication that they are doing just fine,’ says Dr Dewald Buitendag, paediatrician at Life Fourways Hospital. ‘These will disappear in a few months as their bodies develop and adjust.’ The following are some common newborn reflexes.
Because newborn babies have limited control over their bodies, they are equipped with temporary survival skills in the form of primitive reflexes
The startle or Moro reflex is a regularly seen primitive reflex in newborns. Paediatricians often test this during examination. It usually occurs in response to a loud noise, a sudden movement or the sensation of falling when a baby is put down in a bassinet without enough support. The reflex consists of their body tightening, flinging their arms up and out, opening their usually clenched fists, drawing up their knees and then bringing arms and re-clenched fists close to their body as if giving themselves a hug. Babies may also cry a little. It is a normal newborn reflex and parents shouldn’t be concerned. This is a remnant of human evolution, when the action assisted a baby clinging to their mother while being carried around all day. If they lost balance, the reflex caused him or her to embrace their mother and regain hold on her body. This reflex disappears by about two to three months of age.
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When you stroke the side of your baby’s cheek with your finger or breast, they will turn their head to that side, open their mouth and begin to make sucking movements. This is the rooting reflex. It disappears at about four months.
When you stroke the palm of your baby’s hand he or she will immediately grab your finger and hold on tight. This reflex is also a remainder of evolution when we had to hang on tight to our mother’s backs.
These days, the grasp reflex teaches infants how to use their hands to hold things, a precursor to feeding ourselves. This reflex disappears gradually, beginning in about the third month.
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It’s a life saver, really. This aids your baby in not choking when they first start eating solid food. It’s demonstrated when you touch the tip of your baby’s tongue with a baby spoon and they push it back out. The tongue thrust reflex disappears between four and six months of age – one of the reasons why newborns don’t usually start solids before four months.
TONIC NECK OR FENCING
When your baby is lying on his or her back and you turn their head to the right, they will extend their arm and leg on the right side while flexing their arm and leg on the opposite side, assuming a fencing position. Your baby will do the same if you turn their head the opposite side. This reflex usually disappears at about six months.
If you’re holding your baby under their armpits with their feet touching the floor, it may appear as though they want to walk. This is due to the walking reflex. Your baby will place one foot in front of the other and start to ‘walk’ in place. This reflex disappears at about two months.
Dr Dewald Buitendag is a healthcare practioner, specialising as a paediatrician at Life Fourways Hospital in Gauteng. He regularly contributes to parenting magazines to share his knowledge and expertise with moms and dads.
EVERYBODY’S TALKING ABOUT…
On 15 March, the National Institute for Communicable Diseases confirmed there had been 36 cases of measles across the country this year. Pippa Naudé explains the risks, and how to protect your family and you
PREVENTION IS BEST
The World Health Organization Africa region aims to eliminate measles in Africa by 2020, with the roll out of the Global Measles & Rubella Strategic Plan 2012–2020. A measles vaccine is available, which prevented an estimated 20.3 million deaths worldwide between 2000 and 2015. In South Africa, the government vaccination schedule provides the measles vaccine at six months and again at 12 months. In private practice, it is given at six months, and MMR (a combination vaccine for measles, mumps and rubella) is given at 15 months and again at age five or six. Dr Melinda Suchard, head of the Centre for Vaccines and Immunology at the National Institute for Communicable Diseases (NICD), says, ‘The vaccine is 95% effective at preventing measles, which means five people in every hundred may not be protected. Immunisation schedules and campaigns ensure each child receives more than one dose of measles vaccine to improve their resistance. Additional vaccines (called boosters) are advised where there is a risk of outbreak, even if all vaccinations are up to date.’ Provincial departments have rolled out vaccination campaigns in the areas affected by measles, and are encouraging everyone to be alert to possible infections.
WHAT CAUSED THE OUTBREAK?
Travel reintroduces measles where it has otherwise been eradicated. ‘About 15% of people worldwide 44
are not vaccinated,’ explains Dr Van der Watt. ‘They are vulnerable to infection, as are those people whose vaccine has not been effective.’ Most non-vaccinated people are children whose parents refuse their vaccinations due to a belief they are harmful and can cause autism. The American Academy of Paediatrics, among others, have confirmed there is no scientific evidence that vaccines are harmful or cause autism, yet unfortunately the misconception has persisted. Medical Director of Cape Medical Response in Cape Town, Dr Alan Walters, says, ‘If a child develops measles, there is a real chance they could die from complications. So, however risky a parent feels the vaccine is, it’s a no-brainer’.
SEEING SPOTS ‘Symptoms include a fever, sore throat, cough, runny nose, painful eyes and small white spots inside the mouth, followed by a rash of red spots on the body,’ says Dr Van der Watt. If you suspect you have measles, contact your doctor to confirm the diagnosis, which can only be done conclusively with blood tests. If you’ve had possible contact with measles, your doctor can check whether you are immune and, if not, administer a vaccination. Until you’re in the clear, avoid contact with others.
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Dr Hedi van der Watt is a paediatrician at Life Kingsbury Hospital. She is a member of the Paediatric Management Group, is on the Independent Paediatric Association committee, and joined Operation Smile to repair cleft lips in third world countries.
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he recent measles outbreak has been worrying. ‘According to literature, measles is the most serious viral childhood illness. It can cause diarrhoea, dehydration, pneumonia (with a risk of long-term lung damage), blindness, encephalitis (which can lead to brain damage) and death. And because it spreads via droplets, through coughing, sneezing, sharing utensils and touch, it is highly contagious,’ says Dr Hedi van der Watt, paediatrician at Life Kingsbury Hospital. Anyone can catch measles, although malnourished and immune-compromised children, and infants between six months and five years are most at risk of complications.
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ALL PROBIOTICS ARE NOT THE SAME
❖Benefi cialNOT bacteria the gutgut areare known to:to: ALL PROBIOTICS ARE THE SAME Beneficial bacteriain in the known
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• Prevent diarrhea or constipation • prevent and and stopstop diarrhoea or constipation A probiotic can be beneficial in the • digestion Aidgood digestion • aid and and breakbreak downdown toxinstoxins following ailments: • Produce vitamins B12Kand K • produce vitamins B12 and • Diarrhoea or constipation • stimulate the immune system. • Stimulate the immune system • Bad breath, gas &same, bloating Just all all probiotics areare notnot the Justasasallallhumans humansarearenotnotthethe same, probiotics • Allergies, rhinitis, lactose intolerance ® clinical documentation same. Insist on QuatroFlora®, with the same. Insist on QuatroFlora with clinical documentation • Gastroenteritis and playschool diseases in available benefi ts of of thethe strains it contains. availableonyoung onthethehealth health benefits strains it contains. children
QuatroFlora™ capsules contain the following strains of probiotic bacteria for improving gastro-intestinal health and well-being: Bifidobacterium, BB-12®, Lactobacillus acidophilus, LA-5®, Lactobacillus bulgaricus, LBY-27, Streptococcus thermophilus, STY-31
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9/12/12 4:51:52 PM 9/9/15 10:10 AM
POWER OF FIVE
COLONOSCOPY: WHAT YOU NEED TO KNOW
Questions and answers
Colonoscopies detect abnormalities in the large intestine (colon) and rectum. Dr Amal Singh, gastroenterologist at Life Roseacres Hospital, explains the basics of this procedure
Dr Amal Singh says the exam may be indicated for patients with alarm symptoms such as: • Rectal bleeding and severe loss of weight • Unexplained anaemia • History of altered bowel movements • Strong history of inflammatory bowel diseases like ulcerative colitis or Crohn’s • History of colon or rectal cancer Family members of a person with confirmed colorectal cancer are also advised to have an exam 10 years prior to the onset of that person’s symptoms. Doctors also recommend a screening every 10 years if 50 or older and at an average risk of colorectal cancer. 46
BEFORE YOU GO
Patients should remind doctors of their medications ahead of the exam. Vitamin or iron supplements should be stopped a week before going into theatre. Patients are required to empty their colon before, as any residue may obscure the view during the procedure. ‘Patients go on to a clear fluid diet a day ahead and take four sachets of PicoPrep or Colo-Prep to induce diarrhoea,’ says Dr Singh. Apply Vaseline and stay close to a lavatory. Before the exam, patients are counselled about risks, including colon perforation and possible bloating, and post-procedure rectal bleeding, he says.
First, an anaesthesiologist inserts an IV line to administer conscious sedation. The 45-minute to hour-long exam begins with the patient lying on their left side and the doctor inserts a colonoscope into the rectum. The scope has a camera, light and tube, which pumps air into the colon to provide a better view of the lining on an external monitor. The doctor may take tissue samples or decide to remove polyps (growths in the tissue lining) or other abnormal tissue. The procedure may last longer if further therapeutic interventions become necessary.
Patients return to their ward for recovery and observation. Findings and any therapeutic procedures are discussed, and if no post-procedure problems arise they are discharged. ‘If polyps had been removed or lesions were biopsied, patients are given a follow-up date to check the histology,’ says Dr Singh. A small amount of blood could be passed with the first bowel movement after the exam, but this is normal. If severe pain or ongoing bleeding occurs, consult a doctor.
RESULTS AND FOLLOW UP
A negative colonoscopy means no abnormalities were detected. If polyps or abnormal tissue are found, the colonoscopy is positive. Polyps are analysed to find out if they are cancerous, precancerous or noncancerous. Depending on size and number of polyps, a more rigorous screening schedule could be required in future. Follow-ups could be pushed to an earlier date or you may be asked to repeat the exam if the scope view quality isn’t satisfactory. If the scope couldn’t pass through your entire colon, a barium enema or virtual colonoscopy may be recommended, says the Mayo Clinic.
C O M P I L E D BY R AADIYAH AB R AHAMS I M A G E ISTOCK
WHO SHOULD BE SCREENED?
A PASSION FOR PAEDIATRICS The work of a paediatric neurologist is steeped in delicate care and empathy. Dr Amith Keshave, who recently joined Life Entabeni Hospital in Durban, knows that it takes more than book smarts to be good at his job. By Sam Brighton
aediatric neurologists ‘care for children that have disorders affecting the nervous system – muscles, brain, spinal cord, nerves,’ Dr Keshave explains. Life Healthcare magazine chats with him about the highlights and challenges of his profession, his passion and the emotional dynamics he faces in his job.
What type of disorders do you help manage?
Paediatric neurologists see children that present with a range of disorders and assist with managing their complications. Typical disorders of the brain are seizures, headaches, strokes, learning disabilities and behavioural disorders. We also manage diseases affecting the spinal cord – spinal muscular atrophy, polio, or disorders of the peripheral nerve such as Guillain-Barré syndrome. Furthermore, we work closely with neurosurgeons, treating patients with nervous system tumours or children born with congenital defects, like that of the spine (spina bifida).
Describe your average work day.
At the beginning of the day, I see my inpatients, ensure they are well and parents are kept up to date on their child’s progress. Thereafter, I see patients at my practice. I believe we can uplift people through education, so every patient that I interact with doesn’t leave my office until they feel they have been enlightened. The better patients understand what they are up against, the more equipped they are to deal with their condition and any complications.
What led you to paediatric neurology?
I’ve always wanted to do neurology and at the time there were no training posts in this stream, so I took up my second
passion of paediatrics. While rotating through the sub-specialities I was exposed to paediatric neurology and I felt like I had the best of both worlds.
What is the most rewarding part of your job?
That’s an easy one – the children! They don’t know what a bad day is. I feel I have learnt more about medicine from the children that I have seen than any textbook will ever teach.
What is the most challenging aspect of your job?
We see some disabling diseases, so to break that news to parents and children is a challenge. However, in that also lies strengths; I have seen children give strength to parents rather than the other way around.
As a paediatric neurologist, is it accurate to say that you often have two patients – the child and the parents? How do you handle this situation?
There are two patients and sometimes even more – grandparents, aunts and uncles all get involved. But the key is that they all want the same thing; what’s best for the child – which is what I want too.
Which personality traits help you to fulfil your role as a paediatric physician?
I believe my light spirit and open, honest nature, as well as my desire to listen to patients and parents, are traits that have helped me thus far.
LifeMag_ProcreationDental_Mar17_276x210mm5mmbleed.pdf 1 2017-02-27 04:52:55 PM
CARE NURSING CAREERS / HEALTH SCREENINGS / RECIPES FOR DIABETES
‘SUCCESS MEANS WE GO TO SLEEP AT NIGHT KNOWING THAT OUR TALENTS AND ABILITIES WERE USED IN A WAY THAT SERVED OTHERS.’ MARIANNE WILLIAMSON
espite the range of career choices open to matriculants today, nursing holds great appeal, says Peggy Naicker, National Education Manager at Life College of Learning. ‘In 2015, we had more than 2 000 applicants for the first-year programme. Job stability, high demand for nurses and funding during studies are the main draw cards. It has become a very specialised profession, with minimum undergraduate educational requirements and additional qualifications based on specialisation.’ There is a persistent belief that nursing is a woman’s job – male nurses make up less than 10% of total nursing staff – but the profession is open to all, and both men and women can benefit from a career path that offers several levels within nursing and managerial roles, up to executive positions.
A NOBLE PROFESSION
CONSIDER NURSING AS A CAREER The profession doesn’t get much positive publicity, yet it offers growth opportunities along with the satisfaction of serving others. By Catherine Eden
ICU Unit Manager Mandla Lituka at Life Faerie Glen Hospital drew inspiration from his mother and older sisters, who helped him excel at nursing. ‘It’s a noble profession,’ he says. ‘It teaches you discipline, professional conduct and to have an appreciation for cultural diversity. It’s a job that requires caring, honesty, professionalism, vision, innovation and vigilance. I am always looking for ways to improve patients’ experience.’ Although it may be considered a low-paying profession, Mandla would still recommend it as a career. ‘There are opportunities for advancement and leadership roles. I’ve been exposed to developmental programmes that have helped me grow personally and professionally.’
AWARDS AND REWARDS In 2016, Mandla and Unit Manager Jeanell du Plessis at Genesis Maternity Clinic were recipients of Discovery Excellence Awards for Nurses (DEAN). They were invited to attend the Nurse Leadership
I have been exposed to developmental programmes that have helped me grow Exchange Programme at Massachusetts General Hospital in Boston, USA, in March 2017. The awards are enormously motivating, says Jeanell. ‘Appreciation and recognition are consistently listed among employees’ top desires. I believe that we can uplift the morale in all our nursing units by giving credit where it is due.’ For Jeanell, being a nurse is more than a job – it’s a way of life. ‘We have the unmatched satisfaction of knowing we have made a difference in patients’ lives,’ she says, ‘but it is challenging to take care of others and give of yourself, your time and your empathy if your own cup is running low. You must care for yourself too. ‘Working well with multidisciplinary and support teams is crucial to offering the best possible care. Communication, respect and trust are the building blocks, along with continuous upskilling to deliver excellence.’
GIVE AND TAKE
Training programmes include both classroom education and experience at clinical facilities. But despite years of study, and the fact that nurses provide more therapeutic interventions to patients than any other healthcare team member, the vital role they play is not adequately recognised, says Peggy Naicker. ‘Salaries vary between private and public sectors, but low pay is an ongoing issue. I’d like to see nurses command the same respect as doctors, pharmacists and physiotherapists, and be included in discussions about public health. Our focus must be to build our reputation as a respected profession.’
I MAG ES GETTY/GALLO IMAGES, SUPPLIED
Nursing can be studied at university (degree course) or college (diploma
course). Candidates at Life College of Learning need a National Senior Certificate (NSC), with proficiency in English, maths, life sciences and computer sciences. ‘They should be mature and goal oriented,’ says Peggy Naicker. ‘We look for problemsolving, planning and organisational strength, as well as self-awareness and good interpersonal and communication skills.’ In return, students are offered life skills training in stress and time management, assertiveness and communication. Reflective practice sessions help them process feelings, so that they can cope better with difficult situations. All students are enrolled in the Life Healthcare Employee Wellness programme from registration and have access to psychologists, counsellors, financial and legal advisers.
Where? Head office in Illovo, Johannesburg. Learning Centres are situated in: •C ape Town •P ort Elizabeth •E ast London • KwaZulu-Natal • Pretoria •W est Rand •E ast Rand What is offered? Currently, the following courses are available for enrolled nurses, but new qualifications and professional registration categories will be phased in from 2018. The college also offers courses in health sciences. •D iploma Bridging Course for enrolled nurses leading to registration as a general nurse •P ost Basic programmes For specialised training in areas such as intensive care, operating theatre, trauma nursing and occupational health How much? Fees are adjusted annually, but bursaries are available. External students can receive sponsorship or a monthly stipend. Contact Head office Luke Cheketri 011 219 9885 Luke.email@example.com
BEHIND THE SCREENS Prevention is better than cure. But when prevention fails, regular check-ups for early detection are the next best thing to promote optimal health. By Pippa Naudé
creening for warning signs of disease gives you the advantage of early detection, quicker interventions and improved recovery. As such, healthcare providers have recommended the following regular tests, depending on various factors, such as health, gender, age and personal risk factors (due to lifestyle or family medical history), so make sure you know your needs. Of course, whenever you have concerns, you should see your health practitioner.
Dr Colin de la Harpe, general practitioner at Life Kingsbury Hospital, explains that at a check-up, you will receive a full physical exam: the GP will listen to your heart, test your blood pressure, check that your organs and skin are healthy, and do routine blood tests to test your cholesterol (high cholesterol is associated with heart attacks and strokes), glucose (results can indicate diabetes), liver function, full blood count (also called FBC, tests for general health), and urine and electrolytes (test kidney function). From age 40, additional tests are required. In your forties: • Test for vitamin D deficiency • Prostate screening for men starts at 45, and PSA testing is added to blood tests (which screens for prostate cancer) 52
In your fifties, sixties and seventies, continue doing what you’ve done in your forties, but include: • Colonoscopy, every five to 10 years (detects ulcers, polyps and cancer) • BMD bone density test (tests for osteoporosis) In your eighties, do as you’ve done in your seventies, except, you can: • Consider the shingles vaccine Zostavax if you previously contracted chickenpox • Stop testing for prostate cancer if you are male, unless requested to do so
‘An annual visit to the gynaecologist is recommended for females 20 years and older,’ says Dr Kofi Kwaw-Asante, a gynaecologist at Life Fourways Hospital, or for women who have had their first sexual experience. At each check-up you’ll have a Pap smear to screen for cervical cancer, a transvaginal ultrasound to rule out any pelvic masses, and a breast exam and mammogram to rule out breast cancer. You’ll only start getting mammograms from age 40, unless you have a family history of breast, ovarian, tubal or peritoneal cancer, in which case you should begin in your thirties.
Dr Zubie Hamed, a dermatologist at Life Westville Hospital, recommends that people who are at a high risk of skin cancer – fair-skinned with lots of moles or a family history of melanomas – have at least one initial check-up with a dermatologist and thereafter, annual check-ups with their GP or dermatologist, so that any changes to their moles can be tracked.
The South African Optometric Association advises an annual eye examination for all ages. There are, however, a few exceptions where more frequent testing may be required. These include people who have: • A family history of glaucoma and are over 40 • Diabetes • Glaucoma • Ocular hypertension • Any condition which may affect the eyes and vision
The South African Association of Audiologists recommends every adult over the age of 50 visit an audiologist to undergo a baseline hearing test. Subsequently, you can go for annual screening, to monitor any changes against your baseline.
It’s important that dental checks are carried out every six months
‘It’s important that dental checks are carried out every six months,’ says Dr Nosipho Mzobe, head of education for the South African Dental Association. At each check-up, your dentist will examine your teeth for signs of tooth decay or cavities, gum disease, malocclusion (misalignment of teeth) and oral cancer.
YOUR CHECKLIST FOR CHECK-UPS Keep track of appointments you need. Remember, these are general guidelines. If your healthcare provider has concerns, they may suggest more frequent screenings. Age
General Practitioner (general)
Every 3 – 5 years
Every 3 years at least
Yearly, if at risk
Yearly Baseline test
Not needed Yearly
40s I MAG ES GETTY/GALLO IMAGES
Every 6 months
HEALTHY COOKING FOR
Many South Africans are affected by type 2 diabetes, but Leanne Katzenellenbogen’s new offering, Delicious, Modern, Healthy Recipes for Diabetes, proves you don’t have to give up all your favourite flavours if you’re after a healthy diet (in combination with exercise) to manage your condition. Her collection of uncomplicated, easy-to-prepare recipes cover every occasion, from big family-style lunches to breakfasts and light meals for a small soirée, and even delicious classic desserts with a wholesome spin. Take note of her tips to make your job in the kitchen easier, then gather round for everyday healthy meals that friends and family can enjoy.
Roast Paprika Chicken with Cauliflower Rice, Onion and Lemon Stuffing
Sri Lankan Kingklip Curry with Yellow Basmati Rice
Roast Paprika Chicken with Cauliflower Rice, Onion and Lemon Stuffing Serves 4–5 STUFFING • 2 teaspoons canola oil • 1 medium onion, finely chopped • 400g cauliflower rice • Salt and black pepper to taste • 1 teaspoon crushed garlic • Finely grated zest of 1 lemon • 1 egg white CHICKEN • 2 teaspoons canola oil • 1 whole chicken (1.2–1.5kg) • 2 teaspoons garlic salt • 4 teaspoons paprika • 4 teaspoons mustard powder • 2 teaspoons ground black pepper • 2 lemons, sliced • 10 small (pickling) onions, peeled but left whole • ¾ cup water CAULIFLOWER RICE, ONION AND LEMON STUFFING 1. Heat the oil in a pan and sauté the chopped onion until it is soft and a light golden colour. 2. Add the cauliflower rice, seasoning, garlic and lemon zest. Cook for 3–4 minutes, then take the pan off the heat and leave to cool slightly. 3. Place the mixture in a bowl and add the egg white (there is no need to beat it first) and stir through, to bind the mixture. 4. Place the stuffing in the fridge until completely cool.
ROAST PAPRIKA CHICKEN 1. Rub the canola oil over the chicken. 2. Season the underside of the chicken with half the garlic salt, paprika, mustard powder and black pepper. 3. Place half the lemon slices in an ovenproof dish and place the chicken on top, seasoned side down. 4. Stuff the chicken with the stuffing. Close the cavity by threading a toothpick through the skin at the base of the cavity. 5. Sprinkle the remaining seasoning over the chicken and top with the remaining lemon slices. 6. Scatter the pickling onions around the chicken. 7. Roast in a preheated oven at 180°C for 20 minutes. Turn the chicken over (leave the lemon slices on the bottom of the dish, but remove them from the chicken, or they will burn). 8. Roast for another 20 minutes, then add the water. Cook for a further 30–40 minutes, until the chicken is cooked through and golden brown (this will depend on the weight of the chicken). TIP: To preserve flavour, roast the chicken with the skin on, but remove it before eating. For a lower kJ count, choose lean breast meat and leave the other cuts to the rest of the family.
Sri Lankan Kingklip Curry with Yellow Basmati Rice Serves 4 • 1 tablespoon canola oil • 1 large onion, finely chopped • 1 tablespoon dried curry leaves • 1 teaspoon ground turmeric • 1 teaspoon ground cumin • 1 teaspoon ground coriander • ¼ teaspoon ground cinnamon • 1 teaspoon crushed garlic • 2 teaspoons freshly grated ginger • 2 large, ripe tomatoes, chopped or 8–10 cherry tomatoes, halved • 4 green cardamom pods • 1 large can (400ml) lite coconut milk • 4 portions kingklip or firm white fish (±100g each) • Salt to taste • 1 cup uncooked basmati rice • 5 cups boiling water • ½ teaspoon ground turmeric 1. Heat the oil in a pan. Add the onion, curry leaves, spices, garlic and ginger and cook for about 3 minutes, stirring. 2. Add the tomatoes, cardamom pods and coconut milk and stir through. 3. Place the kingklip in a single layer on top of the curry mixture. Season lightly with salt. 4. Simmer on a low heat for 20 minutes, stirring occasionally, but taking care not to break up the fish. When the fish flakes easily with a fork, it is cooked. Remove from the heat and keep warm, if necessary. 5. While the fish is cooking, place the rice, boiling water and turmeric in a large heatproof dish and microwave on high for 15 minutes (or cook the rice according to the package instructions). 6. Drain the rice in a colander, then return to the dish and microwave for a further 5 minutes, to steam. Fluff with a fork to loosen the grains.
PER SERVING Energy (kJ) 1324 Protein 40.2 Carbohydrate 11.6 Fat 8.5 GI negligible GL negligible
PER SERVING Energy (kJ) 1040 Protein 23.6 Carbohydrate 30.9 Fat 8.4 GI 50.2 GL 15.5
Ratatouille Roast Shin This rich meaty, veggie-laden stew is just the thing for a cold winter’s night. Shin is a lean cut, making this a perfect choice if you want to manage your fat intake.
Serves 3 • 2 teaspoons canola oil • 4 celery sticks, sliced into thick chunks • 2 medium carrots, sliced into thick chunks • 1 medium onion, chopped • 4 baby brinjals, sliced and then halved • 2 leeks, finely sliced • 3 cloves garlic, crushed • Black pepper to taste • 1kg meaty beef shin • 2 tomatoes, chopped • 4 sprigs rosemary (each ±8cm long) • 8 sprigs thyme • 7 sage leaves • 1 cup red wine • 1 cup reduced-salt chicken stock, preferably home-made 1. Heat the canola oil in a large ovenproof saucepan or casserole. Add the celery, carrots, onion, brinjals, leeks and garlic. Season with black pepper and sauté until the vegetables are soft. Remove from the pan and set aside. 2. In the same dish, sear the meat until well browned on both sides (add a little more oil if necessary). 3. Return the cooked vegetables to the pan and add the tomatoes and fresh herbs (tuck the herbs around the meat). 4. Add the wine and the stock. 5. Cover the pan with a lid or a layer of heavy foil. Place in a preheated oven at 180°C for 90 minutes, turning the meat every 30 minutes to ensure it cooks evenly. Remove the lid and cook, uncovered for a further 45 minutes, or until the meat is tender. PER SERVING Energy (kJ) 16.8 Protein 48.7 Carbohydrate 16.0 Fat 5.9 GI negligible GL negligible
I M A G E S D E N V E R H E N D R I C K S © P E N G U I N R A N D O M H O U S E S O U T H A F R I C A ( P T Y ) L T D 2 0 17, L A U R E N M U L L I G A N
Blonde Malva Pudding Using light coconut milk instead of regular cream makes this lower in fat than a regular malva pudding.
Serves 12 MALVA PUDDING • ½ cup Huletts SUGAlite • 1¼ cups cake wheat flour • 1 teaspoon bicarbonate of soda • 1 teaspoon baking powder • 1 tablespoon Flora Extra Light reduced-fat spread • 1 tablespoon NaturLite apricot fruit spread • 1 teaspoon white spirit vinegar • 1 egg • 1 cup lite coconut milk
SAUCE • ½ cup lite coconut milk • ¼ cup xylitol • 1½ tablespoons Flora Extra Light reduced-fat spread • ½ teaspoon vanilla extract MALVA PUDDING 1. Combine the dry ingredients in a bowl. 2. Place the margarine and apricot fruit spread in a small bowl and microwave on high for about 1 minute. 3. Stir the vinegar into the melted margarine mixture, then add to the dry ingredients, stirring through. 4. Add the egg and coconut milk and stir to combine. 5. Pour the mixture into a square ovenproof dish (22 × 22cm).
6. Bake in a preheated oven at 180°C for 35 minutes or until golden brown and a skewer inserted into the centre comes out clean. SAUCE 1. Place all the ingredients in a small saucepan and heat, stirring, until combined. Keep warm. 2. As soon as the pudding comes out of the oven, pour over the hot sauce. PER SERVING Energy (kJ) 538 Protein 2.7 Carbohydrate 32.2 Fat 3.1 GI 47.20 GL 15.2
Giveaway! Life Healthcare magazine is giving away three copies of Delicious, Modern, Healthy Recipes for Diabetes. Email lifehealthcaremag@ johnbrownmedia.com with ‘Delicious, Modern, Healthy Recipes for Diabetes’ in the subject line by 31 July 2017 and stand a chance to win. Extracted from Delicious, Modern, Healthy Recipes for Diabetes by Leanne Katzenellenbogen, published by Struik Lifestyle, RRP R230.
MEDIREST TOP CHEF COOK-OFF A CUTTING-EDGE HEALTHCARE SOLUTION Medirest is more than just a hospital food catering services company. From providing carefully prepared meals that support and aid a patient’s recovery, to hospital restaurants and cafés that keep medical staff alert and healthy and visitors relaxed and nourished, our company leads the market in providing food and support services to healthcare and senior care locations in the public and private sectors. As the specialist healthcare division of Compass Group SA, Medirest is renowned for delivering unrivalled global innovation and best practice to healthcare sites throughout the 56 countries in which Compass operates. Over the past 30 years, our company has supported the Medical Industry and has proven to be a sustainable and reputable business partner. Our retention rate, which is used to measure our success, is extremely high with an average contract period of more than 14 years. Our team is committed to consistently delivering quality and value to clients and continue to improve our service levels. Our employees are our most valuable assets and Medirest affords staff the opportunity to draw on global learning and best practice to enhance their development. Our moto, Performance with Heart, is backed by our management team and supported by our global resource of dedicated specialists.
n 24 February, Medirest hosted Life Healthcare Group in a fun-filled cookoff at the Peermont Hotel School at Emperors Palace in Johannesburg. The challenge was to set the participating Life Healthcare teams – made up of departmental heads and service managers – against each other in tasks that our caterers engage in every day. Armed with recipes that ranged from light, fluffy muffins to a diabetic friendly meal or a dish for a renal patient, the teams grabbed their spatulas and whisks and got cooking. While the intention of the exercise was to create an energetic and exciting day of team and relationship building, it was clear that the teams were also serving up some friendly competition and soon the heat in the kitchen started to rise. As if the teams from Life Flora Hospital, Life Wilgeheuwel Hospital, Life Anncron Hospital and Life Bedford Gardens needed more pressure, the impressive judging panel
presented a formidable challenge too. Celebrity Chef Reuben Riffel was joined by Compass Group Executive Chef Ryan Neill and Compass HSE coordinator Vimal Tuckooriah. Time ticked away quicker than the amateur chefs anticipated and soon the teams realized they needed to whip and mix a little faster if they hoped to finish. As the judges counted down the last few seconds of cooking time, food was hurriedly plated and then it was all over. The proof was now in the eating. As the teams presented their dishes, it was clear they gave their very best since much of the food was excellent and the contestants represented their hospitals well. Chef Reuben congratulated everyone’s efforts and then announced the final standings: 1st place: Life Bedford Gardens Hospital 2nd place: Life Wilgeheuwel Hospital 3rd place: Life Flora Hospital Medirest would like to thank Life Healthcare Group for their participation and for the long and happy relationship between our two companies. We look forward to many more years in partnership.
Tel: 011209 2400 www.compass-group.co.za/medirest
HECTOR VAN DEVENTER
Determined Hector van Deventer knew he wanted to be a nurse. There were obstacles in his way but he didn’t let them stop him from achieving his goal. By Melanie Farrell
ur hero, former hospital porter Hector van Deventer, knew that he wanted to become a trained nurse on his first day working in Accident & Emergency at Life Cosmos Hospital in Witbank. ‘I saw a doctor putting skin clips on an injured patient. I watched everything closely and I was impressed by how everyone treating the patient was so organised and knew exactly what to do,’ explains Hector. ‘I immediately applied to do the nurses’ training offered through the Life Hospital Group.’ A lot has changed in Hector’s life since that first day at work in February 2013 when he was 20 years old. ‘In January 2015, I began a two-year study programme. The course combined theory and practice and this meant splitting my time between being in class and working in the different units in the hospital. ‘I managed by having a tight schedule for all theoretical work while still showing up for work the next day. ‘The highlight of my first year of study was when I got married. Many people told me I wouldn’t cope with the wedding and final examination preparations. I took it as a challenge and felt proud after the exams, passing with a distinction. It proved that hard work pays off and if you set your mind to something and do your best, you can achieve anything. ‘There were times when I struggled with studying. And the hardest part of nursing training is when you treat a patient for some time, get to know their likes and
I approach all my patients with a smile and involve them in my care. I want them to be as comfortable as possible while I treat them and I make them feel important at the same time
dislikes, and then they pass away. However, I have a great support system, including my wife, colleagues and family. I always tell my colleagues I have a “Cosmos family” and no matter what time of day or night they are always willing to help. ‘I was very fortunate to receive a bursary from the hospital, and they assisted me through my studies by being supportive and interested in what I was doing,’ he says. Hector’s passion for nursing has been recognised by his colleagues, who describe him as dedicated and hard-working. ‘Nursing is a calling for Hector. Plus, he is very creative, encouraging everyone to get involved in Life Healthcare initiatives such as the CARE Programme,’ said co-workers. ‘The appeal of nursing is that, even when you do not know someone personally, you can still make a difference,’ says Hector. ‘Just being able to hold a patient’s hand and reassure them – I think that makes a difference. ‘I approach all my patients with a smile and involve them in my care. I want them to be as comfortable as possible while I treat them and I try to make them feel important at the same time. ‘I have learnt that when a patient trusts you, they cooperate much more and, after all, we as nurses are here for them. Without our patients we are nothing. ‘My motto is that you need to treat everyone with the same respect,’ he says. ‘From the hospital manager to the cleaners and patients. If you do that, then they will all assist you no matter what you need to do.’
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Difficulty level *** ACROSS
1 Polygraph finds 5 Jewel 8 Emoji 12 Against 13 Floral neckwear 14 Winter forecast 15 Yellowtail fish 17 Roll call reply 18 Hasten 19 Chest component 21 Fire 24 Bruin 25 Ripped 26 Fun-loving women of 1920s 62
30 Common Mkt. 31 One-on-one exams 32 Compete 33 Coverings 35 Arizona city 36 Kegler’s pathway 37 Talk show group 38 Mexican entrée 41 Cribbage scorer 42 PC symbol 43 Hide seekers 48 Gaelic 49 Charged bit 50 Nastase of tennis lore
51 Whatever’s left over 52 NCIS network 53 North Sea feeder DOWN
1 Part of UNLV 2 Hostel 3 Greek vowel 4 Gas thief’s device 5 Merriment 6 Always, in verse 7 Slip-ups at the poker table 8 One of the black keys 9 From the beginning
10 Heart 11 Basin accessory 16 Trench 20 Knocks 21 Mulligan, e.g. 22 Gardener, at times 23 Killer whale 24 Loud sound 26 Wild 27 Still 28 Get up 29 Cachet 31 October stone 34 Pluto, once 35 Heckle or Jeckle
37 Energy 38 Layer 39 Farm fraction 40 Rolling stone’s lack 41 Cookware 44 Plagiarize 45 Right angle 46 Cage component 47 Get a glimpse of
3 WORD SLEUTH
Find the hidden words in the diagram. They run in all directions
Looted Nerved Pairs Poke at
Salvages Same Shout on Sob not
Test ale Torn too Worn key 2
BANANAGRAMS WOMEN, MEOW, WOE, OW Spring:
Rearrange the tiles to spell a five-letter word that fits in the first row. Continue removing one letter until you complete all four words. One tile has been placed in each row.
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
All sad Diagnose Hens villa Land oak
LOSING COULD BE A WIN-WIN
ost people experience loss or failure in a thousand different ways every day. Whether you’re dealing with hair loss, a relationship break-up, a job you didn’t get, a deal gone wrong, a potentially life-changing diagnosis or even death, though inconvenient and painful, life will hand you lemons and it might be the greatest gift you’ll ever get. In Sam Weinman’s latest book, Win at Losing: How Our Biggest Setbacks Can Lead to Our Greatest Gains, he suggests society has been conditioned to believe that failure is the end of our story, and many people never outgrow that notion. Thus, a fear of failure impacts your choice of work, relationships and myriad other decisions when instead failure could be the beginning of your success story. So why the desire to win at all costs? Historically our most ancient ancestors saw winning as coupled with survival, says Weinman. Winning was about securing food and shelter, and not allowing a pack of wolves to make off with your conquest or harm your family. It was about the simple struggle to survive, hence ‘everything in our DNA has taught us to want to win and hate to lose’. 64
Everything in our DNA has taught us to want to win and hate to lose But failure and loss teach you about who you are and what drives you, and successful men and women have demonstrated through their own lives that no one wins without losing many times. JK Rowling, author of the popular Harry Potter series, says that some failure in life is inevitable. ‘It is impossible to live without failing at something, unless you live so cautiously that you might as well not have lived at all – in which case, you fail by default.’ Weinman concludes that this is the paradox people find uncomfortable: that success requires a willingness to risk failure or loss. It’s not uncommon to emerge wiser and stronger from a setback; to gain a deeper
sense of self and a more enlightened perspective that you never would have had if everything went swimmingly all the time. Flawed characters in books and movies hold more appeal because their sometimes undignified failures and unplanned trials are so true to life that their experience resonates on a more authentic level than those whose lives are perfect and appear to have it all. Weinman believes that there are key lessons everyone can learn when life hands them lemons. Here are a few: • You start to identify with failure in a healthy way. • You learn to approach failure honestly and constructively. • You see the transformative power of vulnerability. • You are grounded and humbler. • You become unencumbered by fear. Not everyone fails on an epic scale, but when you experience a setback, you need to know that life doesn’t make you who you are, it reveals who you are and you might very well emerge stronger than you ever imagined. As Rowling told the Harvard class of 2008, ‘rock bottom can become the solid foundation on which you rebuild your life’.
IMAGE GETTY/GALLO IMAGES
Life will hand you lemons, say the experts, but it could be your ticket to success. By Samantha Page
Published on Jun 2, 2017
Published on Jun 2, 2017
This issue of Life Healthcare magazine is focused on caring for your mind, body and soul. During this quarter, Life Healthcare encourages yo...