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`I LET GO OF BEING A
ISSUE 14 l AUTUMN 2013 FOUR FUNNY GUYS on what makes them laugh FEIT OF FIKSIE? Vier kosmites in die kollig THE FIRST 15 MINUTES for you and your baby ‘I LET GO OF BEING A hero’ WILMA VAN DER BIJL SHARES HER JOURNEY WITH BREAST CANCER R YOUEE FR PY CO Like us on Facebook www.phonak.co.za ISSUE 14 | AUTUMN 2013 D I D YO U K N O W ? YOU CAN READ MEDICLINIC FAMILY ONLINE AT WWW.MEDICLINIC.CO.ZA ............................................................................................ ............................................................................................ ............................................................................................ ............................................................................................ ............................................................................................ ............................................................................................ CONTENTS 12 CHECK UP 2 WELCOME From the editor. 5 MAILBOX Your news, views and letters. 6 MEDICAL NEWS Groundbreaking procedures at Mediclinic hospitals. 8 DIE KWELPUNT Goeie handhigiëne kan verhoed dat kieme versprei. 10 ASK US We take your questions to the experts. 12 FEIT OF FIKSIE? Ons ondersoek vier algemene kosmites. 14 THEN AND NOW Here’s how cancer treatment has evolved over the years. 32 16 BEDERF ’n Paar pragtige geskenkidees. 18 THE FIRST 15 MINUTES What those first few minutes of life mean for everyone involved. 16 CHECK IN 20 ‘MY JOURNEY WITH BREAST CANCER’ Miss SA 1987 Wilma van der Bijl shares her story, plus tips for managing treatment. 24 BEAT THE ODDS A mammogram is essential for all women after 40. Here’s what you can expect. 26 THE ORGAN YOU CAN LIVE WITHOUT Did you know your body can survive without its gall bladder? 28 BE BLISSFULLY UNAWARE All you need to know about anaesthetics. ‘The simple things in life get me laughing.’ 30 ALIVE AND KICKING The day football player Fabrice Muamba should have died. 32 LAUGHTER IS THE BEST MEDICINE Four local comedians share what they find funny. 38 EGGS-TRAORDINARY! All about eggs – let’s give breakfast a makeover. 42 JUST A MINUTE Exercise your mind with these fun puzzles. 44 STAR NOMINATIONS Some of the Mediclinic staff who go the extra mile. 47 MY HOSPITAL Our tips for hassle-free admission. 48 BEFORE YOU GO Award-winning chef Margot Janse pays tribute to her adoptive homeland. – Joey Rasdien ................................................................................................................................................................................................................................................................................................. ................................................................................................................................................................................................................................................................................................. ................................................................................................................................................................................................................................................................................................. ................................................................................................................................................................................................................................................................................................. ................................................................................................................................................................................................................................................................................................. EXPLORE OUR INFO HUB www.mediclinicinfohub.co.za ON OUR COVER COVER MODEL Wilma van der Bijl PHOTOGRAPHER Danie Nel HAIR & MAKE-UP Alet Viljoen from Supernova Creative Management STYLING Megan Perks AUTUMN 2013 | WELCOME MAKE THAT CALL ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... IN THIS ISSUE Mediclinic at the forefront Groundbreaking procedures that save lives. See page 6 ERIKA BORNMAN Editor Gesondheidsgeheim Wie sou kon dink dat handewas jou gesond kan hou? Sien bladsy 8 Winning the war A look at how far we’ve come in the fight against cancer. See page 14 ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... LIKE US ON FACEBOOK www.facebook.com/ MediclinicSouthernAfrica 2 I MEDICLINIC FAMILY I MAAK DAARDIE OPROEP E k was glad nie bang om 40 te word nie – tot my dokter my gedurende my jaarlikse ondersoek gesê het dit was tyd om vir my eerste mammogram te gaan. Paniek het ingetree (‘Dit gaan seer wees!’), asook vrees (‘Wat as daar iets fout is?’) en uitstellery (‘Dit kan sekerlik nog ’n maand wag, of ’n jaar?’). Maar toe ek ons inspirerende voorblad-ster Wilma van der Bijl ontmoet, het haar storie (bladsy 20) my aangespoor om daardie oproep te maak en die afspraak na te kom. En so het ek weereens aan myself bewys dat ‘vrees meer pynlik is as die pyn wat dit vrees’ (bladsy 24). Ons bring hulde aan ’n hele paar kreatiewe mense in hierdie uitgawe. Margot Janse vertel roerend wat Afrika haar geleer het (bladsy 48), en vier plaaslike komediante deel met ons wat hulle laat lag (bladsy 32). Ons kyk ook na die merkwaardige storie van sokkerspeler Fabrice Muamba, wie se hart voor ’n wêreldwye gehoor gaan staan het (bladsy 30). Kom ons wees proaktief en maak daardie oproep vandag nog. Wie weet? Dit kan jou lewe red. ERIKA BORNMAN Redakteur AUTUMN 2013 EDITOR Erika Bornman ART DIRECTOR Sean Robertson FEATURES EDITOR Mandy Freeman BRAND ASSISTANT Luyanda Ceketwane ACCOUNT DIRECTOR Jason Curtis CONTENT DIRECTOR Adelle Horler Published in association with Health24 and the Faculty of Health Sciences, Stellenbosch University PUBLISHED BY New Media Publishing New Media House 19 Bree Street Cape Town 8001 Tel 021 417 1111 Fax 021 417 1112 ADVERTISING Head office – Cape Town 021 417 1111 NATIONAL ADVERTISING DIRECTOR Aileen Lamb 021 417 1228 [email protected] BUSINESS MANAGER Debbie Johnson 021 417 1266 [email protected] SALES EXECUTIVE Zak Swartz 021 417 1515 [email protected] FINANCE MANAGER Mark Oaten CREATIVE DIRECTOR Crispian Brown GROUP ACCOUNT DIRECTOR Maria Tiganis PRODUCTION DIRECTOR Lucrezia Wolfaardt EXECUTIVE DIRECTORS GROUP CONTENT DIRECTOR Irna van Zyl GROUP COMMERCIAL DIRECTOR John Psillos MANAGING DIRECTOR Bridget McCarney PRODUCTION MANAGER Nadiema Eid CIRCULATION MANAGER Neilton Adams ADVERTISING COORDINATOR Michelle Koetenberg REPRODUCTION New Media Repro PRINTING CTP Web Published on behalf of Mediclinic Southern Africa, Strand Road, Stellenbosch 7600 www.mediclinic.co.za MEDICLINIC EDITORIAL BOARD CORPORATE COMMUNICATION MANAGER Tertia Kruger CORPORATE PUBLICATIONS Gerda Pretorius Editorial submissions may be sent to [email protected]. A response is not guaranteed. For all new business enquiries, contact Andrew Nunneley on 021 417 1143. Copyright © New Media (Pty) Ltd. All rights reserved. While all precautions have been taken to ensure accuracy of information, neither the editor and publisher, nor New Media can be held liable for inaccuracies, injury or damage that may arise. Subscribe to our digimag Email [email protected] if you would like us to send you a link to the digital version, so you can read Mediclinic Family cover to cover on your computer screen. PHOTOGRAPH Sean Laurénz T urning 40 didn’t scare me at all until my doctor told me during my annual checkup that I now needed to go for my first mammogram. Cue panic (‘It’s going to hurt!’), fear (‘What if they find something wrong?’) and procrastination (‘Surely it can wait a month, a year?’). Until I met our inspirational cover star Wilma van der Bijl, whose story (page 20) motivated me to make that call and go to the appointment. During which I proved yet again that ‘fear is more pain than is the pain it fears’ to myself (page 24). We celebrate a number of creative people in this issue. Margot Janse talks movingly of what Africa has taught her (page 48) and four local comedians tell us what makes them laugh (page 32). We also take a look at the remarkable story of football player Fabrice Muamba who suffered cardiac arrest in front of a worldwide audience (page 30). Here’s to being proactive and making that call today. Who knows? It could save your life. Love them . . . Cherish them . . . Protect them against Whooping Cough CONGRATULATIONS! You’re about to bring a new life into the world As you prepare to take care of your new baby, did you know that; • Close contacts of infants, especially parents and siblings are responsible for 71% of whooping cough transmission to babies 1 • Most whooping cough related hospitalisations and deaths occur in children under the age of 6 months 2 • A prolonged cough may be the only manifestation of whooping cough in adults 3,4,5 Ensure your family is vaccinated before your baby is born. Speak to your baby clinic sister about the whooping cough booster vaccine. www.kiddivax.co.za References: 1. Wendelboe A, Njamkepo E, Bourillon A, et al. Transmission of Bordetella pertussis to young infants. Pediatr Infect Dis J.2007;26. 2. Wood N et al. Pertussis in infants : Preventing deaths and hospitalisations in the very young. J Paediatr Child Health 2008;44:161-5. 3. Crowcroft NS, Pebody RG. Recent developments in pertussis. Lancet. 2006;367(9526):1926-36. 4. Hay JW, Ward JI. Economic considerations for pertussis booster vaccination in adolescents. Paed Infect Dis J. 2005:24 S44-47. 5. Hewlett EL, Edwards KM. Clinical Practice Pertussis – Not Just for Kids. N Engl Med. 2005; 352:1215-22. Sanofi Pasteur, Division of Sanofi South Africa (Pty) Ltd. 2 Bond Street, Grand Central Ext 1. Midrand, 1685. Private Bag X207, Midrand 1683. Company Registration No: 1996/010381/07 ZA310.12.12.02 OLESCENTS & ULTS Pertussis Booster Vaccine LETTERS | AUTUMN 2013 MAILBOX We enjoy hearing from you! Send us your letters and stand chance to win a cooler bag. Email your letters to [email protected] or post them to Family magazine, PO Box 440, Green Point, 8051. PHOTOGRAPHS Shavan Rahim, Gallo/Getty Images, iStockphoto FAMILY reserves the right to edit letters as we deem necessary. Please note, main photograph is a stock image. GROOT VERLIGTING Ek is vroeg die oggend van 8 Januarie by noodsentrum by Mediclinic Hoogland opgeneem. Ek wil graag baie dankie sê aan die personeel by eenheid B en C en ook by die teater vir hulle vriendelike en flink diens. Su-Mari Scholtz EXCEPTIONAL CARE WINNING LETTER LIKE FAMILY I would like to express my gratitude towards the staff of Nursing Unit B at Mediclinic Highveld. I was admitted with a lot of pain and needing an operation. During my stay at the hospital, I met wonderful, loving and caring people who show passion for what they do. On my birthday, I woke up to the night-shift staff singing to me. It made me feel very special. I believe that nursing is not a just career but a calling. Every member of staff deserves praise and gratitude. They are people you can rely on, they are always there for you and, when you look up, there’s always a smile. They made me feel like part of the family. I’ve lived in Secunda for 32 years and have visited many hospitals in Pretoria – but I have never found the same warmth and care that I experienced at Mediclinic Highveld. This hospital is in our town and it is our home. So thank you to everyone who contributed to my 10-day stay at the hospital – you’re all great! Sandra Coetzee We are so grateful to the staff at Mediclinic Paarl for taking such good care of Shaundre Jacobs. The competency of the team is awe-inspiring and we couldn’t have been more lucky to have chosen Mediclinic to deliver her baby boy, Jade. The work you do is so important and you excel at it in every way possible. The Jacobs family INNIG DANKBAAR Ek wil Mediclinic Panorama graag komplimenteer met hul diens. Ek het oor Kerstyd baie swaar gekry tot ek op 26 Desember na die noodsentrum gebring is. Ons het die vriendelikste behandeling gekry en my vrae is geduldig beantwoord. Baie dankie. Hendrika Lambert ............................................................................................................................................................................................................................................................................................... ............................................................................................................................................................................................................................................................................................... ............................................................................................................................................................................................................................................................................................... ............................................................................................................................................................................................................................................................................................... ............................................................................................................................................................................................................................................................................................... A WORD FROM OUR PATIENTS What essential items would you advise patients take with them to hospital? Brian Fourie Zola Hartnick Terry May Gilbert Rhenis Ras Nompi Siyoko Mediclinic Milnerton Mediclinic Milnerton Mediclinic Sandton Mediclinic Welkom Mediclinic Sandton Your cellphone (and charger). Don’t forget to pack your pyjamas! A cellphone charger and a two-prong adapter. You’ll be miserable when your phone battery dies. Definitely a cellphone charger. This way you can communicate with family and friends. My top essential would be a toothbrush. The verdict? Your cellphone charger! AUTUMN 2013 I MEDICLINIC FAMILY I 5 CHECK UP | MEDICAL NEWS NEWS Mediclinic Family brings you groundbreaking medical developments that are changing the lives of our patients every single day. ....................................................................................................................................................................................................................................................... ....................................................................................................................................................................................................................................................... ....................................................................................................................................................................................................................................................... ....................................................................................................................................................................................................................................................... Words Michelle Coburn ....................................................................................................................................................................................................................................................... ....................................................................................................................................................................................................................................................... ....................................................................................................................................................................................................................................................... HEART-VALVE REPAIR A WORLD FIRST DEXTROCARDIA SITUS INVERSUS OCCURS IN ABOUT ONE IN 12 000 PEOPLE. MOST HAVE NO SYMPTOMS OR COMPLICATIONS RESULTING FROM THE CONDITION. Marianna Cronje (59) of Stellenbosch was born with dextrocardia situs inversus, an unusual physical anomaly that means the heart is an exact mirror image of a normal heart and is positioned on the right side of the chest, rather than the left. As a result of rheumatic fever, she had undergone four open-heart operations over a period of 40 years. Her last operation, a valve replacement in 2000, was successful but scar tissue and other complications meant this was considered her final surgery. However, this valve developed a leak and her condition deteriorated to the point where she could do little for herself. She was referred to Dr Hellmuth Weich at Mediclinic Panorama as a possible candidate for a non-surgical heart-valve repair operation. The six-hour, non-invasive procedure was performed through a needle puncture in the patient’s groin. A tube was fed through a vein into the right atrium of the heart and a hole was made in the wall of the heart to provide access to the left atrium. The leak in the mitral valve was then closed with two disc-like devices, which are usually used to close birth defects in children’s hearts. ‘This procedure is technically difficult in a patient with normal anatomy and had never been done on someone with dextrocardia,’ says Dr Weich. For this reason he called on the expert advice and assistance of two international experts, Professor Eric Eeckhout and Dr Alain Delabays, who flew to Cape Town from Lausanne, Switzerland. The operation was considered a success and the improvement of Marianna’s quality of life once she has made a full recovery will be significant. IMAGES Getty/Gallo Images, iStockphoto International medical history was made at Mediclinic Panorama earlier this year when a team of doctors performed the first ever nonsurgical closure of a leaking heart valve on a transposed heart. .................................................................................................................................................................................................................................................................................. .................................................................................................................................................................................................................................................................................. .................................................................................................................................................................................................................................................................................. .................................................................................................................................................................................................................................................................................. .................................................................................................................................................................................................................................................................................. .................................................................................................................................................................................................................................................................................. .................................................................................................................................................................................................................................................................................. 22 Of the 784 multiple births at Mediclinic hospitals last year there were: MEDICLINIC BY NUMBERS 6 I 761 MEDICLINIC FAMILY I sets of twins AUTUMN 2013 sets of triplets 1 set of quadruplets ................................................................................................................................................................................................................................................................................................................. ................................................................................................................................................................................................................................................................................................................. ................................................................................................................................................................................................................................................................................................................. ................................................................................................................................................................................................................................................................................................................. ................................................................................................................................................................................................................................................................................................................. ................................................................................................................................................................................................................................................................................................................. ................................................................................................................................................................................................................................................................................................................. HOPE FOR BRAINCANCER PATIENTS A drug new to neurosurgery in South Africa is helping to lengthen the lives of brain-cancer patients. The removal of a brain tumour is complicated by the fact that tumour cells look very much like normal brain tissue, which often means only parts of a tumour are removed during surgery. However, a drug called Gliolan (5-Alanine) makes tumours appear pink under purple light, meaning it’s much easier for doctors to identify the cancerous cells and remove them all. Hester Erasmus (56) of Fichardtpark was one of the first South Africans to benefit from this advance in neurosurgery when she had a second malignant tumour, or glioblastoma, removed at Mediclinic Bloemfontein by Dr Wynand van Jaarsveld. After suffering from headaches and epileptic fits, Hester was diagnosed with brain cancer at the end of September 2011 and had a 4 cm tumour removed. However, a year later another 5 cm tumour had developed. This was successfully removed in a fivehour operation, thanks to the use of Gliolan and a special microscope imported from Switzerland. ‘Conventional surgery and treatment result in a survival rate of 20 % after a year, and zero percent after two years,’ said Dr Van Jaarsveld. ‘This more advanced surgery could see lives lengthened by up to seven years. However, repeat surgeries are possible, as this type of tumour recurs in 100 % of cases.’ A JOINT COLLABORATION The life of a young woman with a rare bone disease has been transformed with a jaw prosthesis – the first of its kind in South Africa – created via an international medical partnership. Fibrous dysplasia was a fact of life for Anika Behrendt (24), who had been coping with the effects of this painful condition since childhood. The disease is caused by a defective gene in the cells that form bone – in her case, the bones on the right side of her lower jaw and the associated joint complex, causing significant physical impairment. But Anika’s consultation with maxillofacial surgeon Dr Hermann Kluge at Mediclinic Kloof would ultimately end years of suffering in one complicated six-hour operation. Different treatment options were discussed but it was decided to do a complete resection of the jaw and the joint complex. Such a large defect would normally be reconstructed by placing a bone graft in the affected area and later adding dental implants. However, Dr Kluge decided an all-in-one approach would be the best option – the first time this has been done in South Africa and one of the few worldwide. After scans of the patient’s jaw were taken, web-based meetings were arranged with product specialists Selective Surgical in South Africa and Biomet Fixation in the US, as well as design engineers from US company Medical Modeling. The result was a custom-made prosthesis, manufactured from hi-tech materials similar to those used in hip or knee replacements, that incorporated Biomet 3i dental implants. ‘The patient was restored to a fully functional level with optimal jaw movement and teeth,’ Dr Kluge said after the operation. ‘Her pain is gone and she can now continue her life without disability and disfigurement. Her prognosis is excellent and she probably won’t need any other surgery to this area in the future.’ .................................................................................................................................................................................................................................................................................................................................... .................................................................................................................................................................................................................................................................................................................................... .................................................................................................................................................................................................................................................................................................................................... .................................................................................................................................................................................................................................................................................................................................... .................................................................................................................................................................................................................................................................................................................................... .................................................................................................................................................................................................................................................................................................................................... .................................................................................................................................................................................................................................................................................................................................... 4 340 1,8 The new Mediclinic Gariep in Kimberley will take m3 of concrete million bricks 8,45 AUTUMN 2013 I km of copper piping for water supply MEDICLINIC FAMILY I 7 CheCk UP | die kwelpunt Die een hanD was die ander Speel klaar met gevaarlike kieme en aansteeklike siektes: was jou hande gereeld – en maak seker jy weet hóé! Hoe dit werk Mikro-organismes groei blitsvinning op jou hande wanneer jy aan besmette oppervlakke raak. Dink net aan die deurknop by die werk of die oefenfiets by die gim... Hiervandaan versprei kieme vinnig na jou oë, neus en mond, en kan jy jouself en ander gou infekteer indien jy nie jou hande was nie. Só kan griep byvoorbeeld blitsvinnig sommer ’n hele gesin of ’n handjievol kollegas gelyktydig plattrek. Goeie handhigiëne kan egter verhoed dat kieme van een mens na ’n ander, en dwarsdeur ’n gemeenskap, versprei. drie goue reëls Volgens die Amerikaanse Centers for Disease Control and Prevention kan handhigiëne diarree-verwante sterftes met tot 50 % verminder. Hierbenewens toon Britse navorsing dat ’n miljoen sterftes jaarliks voorkom kan word as almal gereeld hande was. En goeie handhigiëne kan selfs voorvalle van respiratoriese siektes met 16 % verminder. Bly gesond deur die volgende stappe te doen: Was jou hande gereeld met seep en lopende water. In die huis is gewone seep en water, en die wrywing van jou hande teen mekaar, genoeg om van kieme ontslae te raak. (Vermy antimikrobiese seep wat tot antimikrobiese weerstand kan lei.) 1 2 gebruik lopende water, aangesien jou hande weer gekontamineer kan word as jy dit in ’n wasbak met vuil water afspoel. 3 droog elke keer jou hande af – met ’n skoon handdoek, papierhanddoek of warm lugdroëer. Die wrywing tussen jou hande en die materiaal help om enige oorblywende mikro-organismes te verwyder. goeie tydsberekening Hoe jy jou hande was is net so belangrik as hoe gereeld jy dit doen: • Voor, tydens en ná jy met kos gewerk het. • Voor etenstyd. • Ná jy buite gespeel of in die tuin gewerk het. • Ná jy aan diere gevat het. • Ná jy die toilet besoek het. • Ná jy jou baba se doek omgeruil het. • Ná jy na siek gesinslede omgesien het. • Voor en ná jy snye en wonde behandel het. • Ná jy aan enige liggaamsvloeistof geraak het. • Ná jy jou neus geblaas, gehoes of genies het. ............................................................................................................................................................................................................................................................................................... ............................................................................................................................................................................................................................................................................................... ............................................................................................................................................................................................................................................................................................... ............................................................................................................................................................................................................................................................................................... ............................................................................................................................................................................................................................................................................................... ’n leWensBelangrike les • Kinders luister nie graag wanneer ons hulle leer om hande te was nie, maar dis belangrik om die boodskap te herhaal en só ’n roetine vas te lê. • ’n Slim plan is om kinders twee keer 8 i Mediclinic faMily i autumn 2013 ‘Veels geluk, liewe maatjie’ te laat sing terwyl hulle skrop. Die singery sal 15–20 sekondes duur – lank genoeg om van vuilheid en mikro-organismes ontslae te raak. • ’n Alkohol-handjel is ook ’n doeltreffende manier om met mikro-organismes klaar te speel – mits hande nie sigbaar vuil is nie. Dis boonop maklik om in ’n handsak rond te dra. foto Gallo Images/Getty Images ie beginsels van handhigiëne is iets wat ons van kleins af leer, maar, soos ons ouer raak, dikwels vergeet. Hou in gedagte dat dit ’n uitstekende manier is om siektes te vermy veral as jy kontak gehad het met iemand wat verkoue, griep of ’n onaangename maagkiem onder lede het. Op 5 Mei loods the Wêreldgesondheidsorganisasie hul ‘Red lewens: was jou hande’ veldtog. Hoewel dié dag veral op handhigiëne in gesondheidsorg gemik is, gee dit ons almal kans om weer krities na ons eie roetine te kyk. Bladder Control Break taboos. Take control. Get treatment. InterStim® Therapy has shown to be of benefit for patients who suffer from various urinary voiding and bowel disorders or so called pelvic floor disorders. InterStim® Therapy involves stimulation of the sacral nerves, which regulates pelvic floor function, with mild electrical pulses. InterStim Therapy involves two phases: the test stimulation and the permanent implantation of a neurostimulator. If you have had a test stimulation and experienced a marked improvement in your symptoms then a permanent implantation can be carried out. InterStim® Therapy has been successfully prescribed in more than 100 000 patients* over the years. It has been approved in Europe since 1994. (Medtronic Inc. data: May, 2011) amazing solution indeed! Interstim Therapy’s effect was almost immediate - increasing my bladder’s capacity to retain urine and allowing me to reach the toilet in time – with an increase in volume of up to 3000ml without any bedwetting or embarrassing moments! Interstim Therapy was without a doubt the best decision I could have made and thanks to this I completed my B.ED Degree with flying colours. I want to thank Dr A. Cronje and Medtronic for changing my life. Interstim truly is a lifechanging Therapy! Nadia Janse van Renburg (25) Schweizer-Reneke (North-West Province) B ED Degree North West University, Potchefstroom Still living with urinary incontinence? For more info on InterStim® Therapy, ask your doctor or contact: Medtronic: +27 11 260 9300 Website: www.medtronic.com UC201106532EE ©2011 Medtronic. All rights reserved. Printed in Europe. I was born a Spastic Diplegic. Since birth I have had absolutely no control over my bladder because of the severe urological problems this caused. Bedwetting and soaked clothes were an everyday occurrence – even as an adult - and if I was lucky enough to reach the toilet in time, it would be for a mere 20ml! In 2009 my journey to recovery began. I was referred to a Urologist, Dr A. Cronje at the Medi-Clinic in Potchefstroom and have not looked back since. After several tests he concluded that Interstim Therapy could be a solution to my long-awaited problem and I agreed to go forth with the implant. What an CHECK UP | ASK US Earache is common during descent, when the pressure between your middle ear and the air outside your ear differs. If you have a cold or infection, it’s much more difficult to equalise the pressure by swallowing or sucking sweets. Flying when Eustachian tubes are blocked can actually cause the eardrum to burst, although this is not common (and they tend to heal spontaneously). Severe allergies can also lead to an inability to equalise pressure. Make sure your ears and nasal passages are not congested next time you fly by taking prescribed antihistamines and nasal spray. – DR CHRIS HOFMEYR, ENT surgeon, Mediclinic Milnerton My ears have been ringing ever since I went to a music concert – when will it stop? Do I have permanent damage? You have what’s called noise-induced tinnitus, which is caused by loud music damaging the nerves in your ear. This ringing should fade over time as noiseinduced tinnitus is usually temporary. However, it can be permanent if the exposure was severe (for example, a gunshot next to the ear) or repeated (for example, from working in a very noisy factory). Needless to say, you should have it evaluated by your doctor. And next time, take some earplugs along to the concert – you won’t enjoy it any less and you’ll protect your ears from permanent damage. – DR CHRIS HOFMEYR, ENT surgeon, Mediclinic Milnerton DID YOU KNOW? WHILE PREGNANT, WOMEN HAVE 50 % MORE BLOOD IN THEIR BODIES. Ears won’t stop ringing? Tired legs? Our experts answer your questions. Words Lisa van Aswegen DOES STANDING TIRE YOU MORE THAN WALKING? This is not as odd as it may sound: standing places more demands on the same set of muscles for a long time, which can be tiring for the body. My husband constantly kicks me in his sleep. Is this restlessleg syndrome and can it be cured? Restless-leg syndrome is a neurological disorder that causes a pulling or tugging sensation in the legs with an urge to move. It occurs mostly at rest and the feeling is improved by movement. Some people respond to an increased iron intake but this can cause constipation and should only be used if the blood iron and/or transferrin levels are decreased. Medication like pramipexole (pexola) can also be used. Speak to your doctor about visiting a sleep laboratory where a professional can identify the cause and treat your husband. – DR KEVIN ROSMAN, neurologist, Mediclinic Morningside Email your questions to [email protected], write to us at Mediclinic Family, PO Box 440, Green Point 8051, visit our Facebook page at www.facebook.com/MediclinicSouthernAfrica or our info hub at www.mediclinicinfohub.co.za 10 I MEDICLINIC FAMILY I AUTUMN 2013 PHOTOGRAPHS Thinkstock, Getty/Gallo Images SOURCES babyexpert.com, healthaliciousness.com, health24.com, rls.org, livestrong.com, patient.co.uk Last time I flew in an aeroplane I had a cold and my ears hurt so much during the descent. They wouldn’t ‘pop’ and I’m scared my eardrums could be damaged. What can I do to prevent this pain in future? PROMOTION Make colon screening an easy choice 1. FAECAL OCCULT BLOOD TEST Taking a sample of your stool and sending it to a laboratory for analysis. 2. FLEXIBLE SYGMOIDOSCOPY A slender tube is inserted inside your rectum and up to 60cm into the colon to look for polyps. C olon cancer is the second biggest cancer killer in South Africa. Although it’s understandable that many people feel embarrassed to talk about their intestinal tract, colon and rectum, the health choices you make will have a dramatic outcome on your quality of life. The disease knows no social boundaries – celebrities such as actresses Farah Fawcett-Majors and Audrey Hepburn succumbed to colon cancer, as did musician Robin Gibb of the Bee Gees. Yet the fact is that colon cancer is preventable if it’s detected early by a doctor specialising in the gastrointestinal tract. While 40% of patients diagnosed with colon cancer will die of the condition, up to 90% of colon cancers, if caught in the early stages, are curable. WHEN ARE YOU AT RISK? Don’t wait longer than six weeks to see your doctor if you experience a change in bowel habits, for example, having loose stools, bleeding from the bottom when having bowel movements, persistent rectal bleeding or abdominal pain. You should be screened the first time at age 50, as 90% of colon cancers are detected after this age. If one or more members of your family has or had colon cancer, have a colonoscopy at least 10 years earlier than the age at which the family member was diagnosed. If your doctor detects polyps (small, benign, flat or finger-like growths) you will be advised when to have a follow-up colonoscopy. HOW IS THE SCREENING DONE? Bowel tumours begin as harmless polyps. The purpose of screening is to detect and remove them. Doctors know more about the molecular biology of bowel tumours than almost all other malignancies. Taking your risk profile into consideration, the doctor would recommend you have one or more of the following procedures done: 3. DOUBLE-CONTRAST BARIUM ENEMA This test is done by a radiologist in the X-ray department. Liquid barium is put into your colon and the X-ray helps the doctor to detect polyps or abnormal growths. 4. COLONOSCOPY The colonoscope is a modern aid in the diagnosis of colon cancer. This flexible tube has a light source that makes it possible to explore the full length of the large intestine. It’s equipped with air to inflate the colon for good visualisation, a tweezer and snare to snip off polyps, and a digital camera to show the doctor on a screen exactly what’s going on in the colon. It’s crucial that the patient follows the doctor’s instructions for the colon-cleansing procedure. A clean colon enables the doctor to detect all the polyps and other abnormalities, and to make an accurate diagnosis. The good news is that patients no longer have to dread colon cleansing, and intestinal flora can be quickly restored by taking QuatroFlora capsules after the procedure. So make the right health decision now by having your colon screened. Sodium Picosulphate Oral Powder for Solution S0 Each sachet contains: Sodium Picosulphate 10mg, Magnesium Oxide Ph Eur 3.5g, Citric Acid Ph Eur 12.0g, Aspartame 36mg. Reg. No A38/11.5/0389 CHECK UP | FEIT OF FIKSIE? REG OF WEG? ONS VERKLAAR VIER KOSMITES Kan wortels jou die sig van ’n kat gee? Sal jy gesonder wees as jy jou mikrogolfoond uitgooi? Tracy Ugarchund, ’n dieetkundige by Mediclinic Constantiaberg, plaas hierdie en ander bekende opvattings wat ons al jare vir soetkoek opeet, onder die loep. Woorde Brent Smith MITE Pomelo’s laat jou gewig verloor Die pomelo-dieet het in Hollywood in die 1930s sy debuut gemaak en sedertdien elke nou en dan weer gewild geword. In die sewentigs het mense geglo dat pomelo’s vet letterlik laat wegsmelt. In die tagtigs het die dieet bekend geword as die ‘10-’n-dag, 10-pond-minder dieet’. MITE .......................................................................................................................................................................................... .......................................................................................................................................................................................... .......................................................................................................................................................................................... .......................................................................................................................................................................................... .......................................................................................................................................................................................... MITE Wortels verbeter jou sig Gedurende die bomaanvalle in die Tweede Wêreldoorlog het Brittanje ’n radar ontwikkel wat kon bepaal presies waar Nazi-bombardiers snags was. Om hierdietegnologie geheim te hou, het die regering beweer dat Koninklike Lugmag vlieëniers in die donker kon sien omdat hulle baie wortels eet. Dit het wortels gewild onder Britte gemaak. FIKSIE ‘Wortels is ryk aan betakaroteen, wat omgesit word in vitamien A, ’n voedingstof wat noodsaaklik is om gesonde sig te onderhou,’ verduidelik Tracy. ‘Maar dit sal nie help om verswakte sig te verbeter nie!’ So moenie jou bril vir ’n sak wortels verruil nie. Onthou, vitamien A kom ook in melk, eiergeel, kaas en lewer voor. 12 I MEDICLINIC FAMILY I AUTUMN 2013 MITE Om groente in ’n mikrogolfoond gaar te maak, vernietig voedingstowwe Vandag sal jy ’n mikrogolfoond in byna elke kombuis kry. Maar mense het hulle nog altyd teësinnig gebruik omdat hulle glo die bestraling wat hulle afgee, die voedingstowwe in kos uitwis. ‘Bestraling’ is natuurlik ’n gelaaide woord. FIKSIE As gerief in die kombuis vir jou belangrik is, sal jy bly wees om te weet hierdie mite is onwaar. ‘Hoe langer kos aan hitte blootgestel word, hoe meer neem die voedingswaarde daarvan af,’ sê Tracy. ‘Mikrogolfoonde stel kos vir baie korter tye aan hitte bloot as konvensionele prosesse – dit is dus eintlik beter vir die behoud van voedingstowwe.’ Spinasie maak jou so sterk soos Popeye Die strokiesvisserman wat wonderbaarlik sterker word as hy spinasie eet, was die rede hoekom verkope van díe blaargroente die hoogte ingeskiet het. Daar word vertel dat Popeye se skepper, Elzie Crisler Segar, die groente gekies het na aanleiding van ’n studie in 1870 wat beweer het dat spinasie dieselfde hoeveelheid yster as rooivleis bevat. Dit was natuurlik onwaar. ’n Verdwaalde desimaalpunt was waarskynlik die skuldige. FEIT Daar steek egter waarheid in hierdie opvatting. ‘’n Blikkie spinasie sal dalk nie jou armspiere binne sekondes laat rys soos Popeye s’n nie, maar navorsers het bevind dat die nitraat in spinasie spiere help sterk maak,’ verduidelik Tracy, ‘en dít help met krag en uithouvermoë.’ FOTO’S Getty/Gallo Images BRONNE guardian.co.uk, livestrong.com, scienceblogs.com MOONTLIK ‘Alhoewel dit afgemaak is as bloot nog ’n foefie-dieet, wys die jongste navorsing dat daar ’n verbinding in pomelo’s is wat die insulienvlak kan verlaag om verslanking aan te moedig,’ sê Tracy. Vrugte vorm deel van ’n gesonde eetplan, dus is dit goed om pomelo’s te eet. Maar om net van pomelo’s te lewe, of pomelo’s as deel van ’n ongesonde dieet te eet, sal sekerlik nie gesonde gewigverlies tot gevolg hê nie. CHECK UP | THEN AND NOW WAGING THE Improved diagnosis and treatment are producing encouraging results in the fight against cancer. THEN… Look back into the past at how little was really known about cancer, and you might be shocked – and relieved that you weren’t a patient in those days. It was only in the 16th century that scientists, such as Galileo Galilei in Italy, began to glean some understanding of the human body – and of the progress and effects of illness. The first autopsies carried out in the 17th century helped people understand that blood circulated through the heart and body, but when tumours were first observed, there was little understanding of what they were. In fact, there was no way of identifying a tumour in a living patient and successfully treating it. For a very long time surgery was extremely primitive, and it wasn’t until the 19th and early 20th centuries that, with the development of anaesthesia (see page 28 for more), major advances were made. Even then, diagnosing cancer often required ‘exploratory surgery’, in which a surgeon would open a patient’s abdomen or chest to take tissue samples to be tested for cancer – an invasive and unsatisfactory procedure. As recently as the 1960s, medical oncology didn’t exist as a clinical speciality. There was controversy about whether cancer-fighting drugs caused more harm than good, so they were seldom used. And when chemotherapy and radiation were developed, they tended to blast all the tissue within reach, meaning that many perfectly normal, healthy cells were casualties along with the ‘rogue’ cells. SINCE THE 1950s, CANCER MORTALITY RATES HAVE FALLEN FROM 45 IN EVERY 100 000 MEN TO NINE. FOR WOMEN, RATES HAVE FALLEN FROM 25 IN EVERY 100 000 TO FOUR. A TIMELINE FOR CANCER 14 I MEDICLINIC FAMILY .................................................................................................................................................................................................................................... .................................................................................................................................................................................................................................... .................................................................................................................................................................................................................................... .................................................................................................................................................................................................................................... 1 500BC Mid-1700s 1761 The first documented case of cancer – a breast tumour – is recorded in ancient Egypt. Scottish surgeon John Hunter found that some cancerous growths could be removed by surgery. In Italy, Giovanni Morgagni carried out the world’s first known autopsies to examine the possible reasons why a patient’s illness led to death. I PHOTOGRAPHS Getty/Gallo Images, iStockphoto SOURCES Cancer.org; Health24.co.za, Newyorker.com Words Deborah Louw SUMMER 2012 CANCER WAR THE FIVE MOST COMMON TYPES OF FATAL CANCER: …AND NOW Today the picture is very different and the good news is that cancer survival rates have doubled in the last 40 years. More accurate detection techniques, the targeted use of drugs and radiation therapy, and improved surgery are among the reasons. Surgeons have now developed techniques to minimise the amounts of normal tissue they remove during cancer operations. Thanks to improvements in ultrasound techniques and scans like computed tomography (CT) and magnetic resonance imaging (MRI), invasive exploratory surgery has been reduced. In addition, the targeting of cancerous cells is far more precise – like a guided missile that hits only its destined target, not the surrounding healthy tissue. (Read more about the advancement in brain-cancer detection on page 7). Of the many different types of cancer, breast cancer has the most advanced diagnosis and recovery system, says Dr Jill Harris, an oncologist at Mediclinic Constantiaberg in Cape Town. The norm for most women with breast cancer is now less extensive surgery: a full mastectomy is hardly ever performed. Instead, most women with breast cancer have the primary tumour removed, and then undergo radiation therapy. Promising work that is being done overseas could hold more good news in future in South Africa too: cancer vaccines are being tested, including vaccines to treat a type of lung cancer, pancreatic cancer, ovarian cancer and melanoma. The efficiency of hormone therapy is particularly encouraging: with DNA profiling, the same cancer can be treated differently – in a way that is specific to each individual. In the future, says Dr Harris, oncologists will be able to predict a particular individual’s response to cancer by testing medication on the tumour and prognosticating its response and outcome – that is, by ‘tailoring the treatment’ for each patient. ‘This is a most exciting time to be an oncologist,’ she says. LUNG BREAST STOMACH LUNG LIVER STOMACH COLORECTAL OESOPHOGEAL COLORECTAL CERVICAL RAYS OF SUNSHINE ............................................................................................................................................. ............................................................................................................................................. ............................................................................................................................................. In 1999 Chris Corlett, an 18-year-old leukaemia sufferer, became the symbol and spearhead of a South African initiative to combat cancer of the bone marrow and other life-threatening blood disorders. Although Chris lost his own battle after a long, determined struggle, his courage caught the attention – as well as the respect and affection – of people around the country. Before he died, he painted a colourful picture, ‘Sunflowers of Hope’. As a result, The Sunflower Fund was launched in his memory to further the work of the South African Bone Marrow Registry (SABMR). The picture now hangs in the Sunflower Unit at Mediclinic Constantiaberg, and replicas adorn similar units in Johannesburg, Durban and even Auckland, New Zealand. A non-profit organisation based in Cape Town, the fund’s aim is to support the SABMR as a source of potential bone-marrow donors – of all races and income groups – to improve the chances that blood-disorder sufferers will find a matching donor for a life-saving transplant. Visit www.sunflowerfund.org.za for more information on how to become a bone-marrow donor. ............................................................................................................................................. ............................................................................................................................................. ............................................................................................................................................. ................................................................................................................................................. ............................................................................................................................................................... ................................................................................................................................................................................................................................................................................................................. ................................................................................................................................................................................................................................................................................................................. ................................................................................................................................................................................................................................................................................................................ 1800s 1971 The invention of the modern microscope enabled the study of diseased body tissue. US President Richard Nixon launched the ‘War on Cancer’. As a result, more than US$200-billion has been spent on cancer research in the US. 2013 Researchers are discovering new carcinogens, explaining how they cause cancer and providing insight into ways to prevent it. Research is also helping us understand how hormones influence cancer growth – and how we can counteract it. AUTUMN 2013 I MEDICLINIC FAMILY I 15 I N KO P I E S The Secret Keeper R204 Exclusive Books Hemp Hand Protector R110 The Body Shop Nougat Assortment R24,95 Woolworths Pantoffels vir haar R110 Woolworths ‘Word gou gesond’ kaartjie R39 Typo Rainforest Shine Shampoo R75 The Body Shop BEDERF Orgideeplant R99,99 Woolworths Pot R49,99 Mr Price Home Wys jou ondersteuning en streel die sintuie met iets spesiaals. Spa Wisdom Africa Honey & Beeswax Hand And Foot Butter R165 The Body Shop Kamerjas R499,99 Woolworths Rainforest Moisture Hair Butter R95 The Body Shop Aloe Vera Body Wash R220 Crabtree & Evelyn iPod Classic 160GB R2 799,95 kalahari.com Pantoffels vir hom R180 Woolworths 16 I MEDICLINIC FAMILY I AUTUMN 2013 FOTO’S Shavan Rahim PRODUKSIE Lizl Jackson BESKIKBAAR BY Woolworths www.woolworths.co.za, Mr Price Home www.mrpricehome.com, Typo 021 552 2635, The Body Shop www.thebodyshop.co.za, Exclusive Books www.exclus1ves.co.za, Crabtree & Evelyn www.crabtree-evelyn.co.za, Kalahari www.kalahari.com CHECK UP | CHECK UP | MOM’S CORNER THE FIRST 15 MINUTES OF LIFE You’ve waited nine months for your baby. Here’s what happens in those first crucial moments. Words Lisa Templeton rom the moment your baby first enters the world it’s all systems go. ‘The first breathing movement and the establishment of adulttype blood circulation are surely the most important events in the first 15 minutes,’ says Dr Francis Elemva, gynaecologist and obstetrician at Mediclinic Sandton. ‘And the meeting between mom and newborn is probably one of the most touching moments you can witness – it’s one of the things that inspired me to become an obstetrician.’ WHAT WILL HAPPEN TO YOUR BABY… As soon as your baby’s head emerges, fluid will be cleared from her mouth and nose with a bulb syringe to clear her airways and help her take her first breaths. Next your baby should bellow, which happens spontaneously or with a little encouragement by rubbing her back or tapping her feet. This helps to get her breathing and get oxygen flowing around her body. Once delivered, her umbilical cord will be clamped and cut, and a sample of her blood taken from the cord for analysis. Next it’s time for the Apgar test, which is performed at one minute and again at five. She’ll be scored between one and 10 on heart rate, muscle tone, respiratory effort and reflexive response to stimulation and colour. It’s a quick way to assess how she is adapting to life outside the womb. She’ll also be weighed and measured; and she’ll get an identifying band on her wrist or ankle. If necessary, she’ll be placed in an incubator. 18 I MEDICLINIC FAMILY I AUTUMN 2013 WHAT MOM CAN EXPECT… AFTER A NATURAL DELIVERY: PHOTOGRAPHS Getty/Gallo Images, iStockphoto SOURCE www.babyzone.com The placenta comes next, and the doctor may press your stomach to make sure it is delivered completely. If you’ve had an episiotomy (a small, controlled cut to make it easier for the baby’s head to emerge) the doctor will stitch the cut. Once your baby is breathing and free of her umbilical cord, you’ll be introduced to her. You may want to breast-feed your baby. Your breasts will hold colostrum initially, which is full of immunising power, proteins and fats for your new baby. DID YOU KNOW? In the old days babies were dangled upside down by their feet and spanked on the bottom to bring on crying, but now we know that that just isn’t necessary. AFTER A CAESAREAN SECTION: WHAT THE DOCTOR DOES… Once your baby has been delivered, the amniotic fluid will be suctioned out and, with the cord cut, your doctor will remove the placenta and close the incision. This may take up to 30 minutes because of the layers of muscles that must be closed. Now’s the time to meet your baby (this happens while the doctor closes up your cut). Don’t be alarmed if your baby coughs and splutters – it’s normal for Caesarean babies. During natural childbirth, fluid would have been squeezed out of the baby’s lungs, but a baby born by Caesarean may take shallower, quicker breaths until their airways are clear. You’ll now be wheeled into a recovery room, where you’ll be monitored closely for a few hours. If your baby doesn’t require further attention, she’ll join you here. The doctor is in charge of seeing you and your baby through childbirth safely. A paediatrician will also be on hand to check your newborn. WHAT THE BIRTH PARTNER CAN EXPECT... In natural childbirth you may be invited to cut the cord – this is not for everyone, but very meaningful to some. With a Caesarean you won’t actually see the operation but will get the first glimpse of your baby over the screen. After your baby has been cleaned, you’ll get to hold her. WHAT THE NURSING PRACTITIONER DOES… It’s generally the nursing practitioner who will get your baby to cry, wipe away the vernix (the greasy deposit that covers your baby’s skin at birth) and dry off the amniotic fluid, before placing your baby on a warming table for a quick check by the paediatrician. She may also give your baby eyedrops and a shot of vitamin K, which prevents internal bleeding that was once common in newborns. Then she’ll wrap your new baby in a nappy and blanket, and hand her to you or your birth partner. ............................................................................................................. ............................................................................................................. ............................................................................................................. ............................................................................................................. Fast fact How aware is your newborn? Babies can be amazingly alert and keen to socialise in their first hour of life. Reseachers have proven that new babies can see, hear, taste and smell better than we thought, and respond to the sight and touch of their parents. ............................................................................................................. ............................................................................................................. ............................................................................................................. ............................................................................................................. AUTUMN 2013 I MEDICLINIC FAMILY I 19 CHECK IN | SPOTLIGHT ‘MY JOURNEY WITH BREAST CANCER’ When South African beauty icon Wilma van der Bijl discovered cancer in her breast, her life took a turn in a surprising direction. She shares her tough but ultimately triumphant race against the seemingly impossible. Words Rose Cohen Photographs Danie Nel o-one is immune to cancer. We hear this all the time and yet it’s always a tremendous shock when someone we see as untouchable is diagnosed with ‘the big C’. We try to justify the inevitable ‘why’ with reason. We tell ourselves: ‘Oh, but he had a pack-a-day habit,’ or ‘She had it coming, she was overweight’ but Wilma van der Bijl had none of these things. The former Miss South Africa (she won the title in 1987) has always been the picture of health. She was fit, had no risk factors and no direct family history of the disease when she was diagnosed. ‘I’ve always stayed in tune with my body,’ says Wilma. ‘I was a purist when it came to my health.’ Sure, she was stressed at times, and perhaps a little highly strung, but what busy, hard-working mother-of-two isn’t? THE BOMB DROP Just before she was diagnosed, Wilma went through a period of feeling utterly exhausted. She also had that nagging feeling something was wrong. ‘It was like I knew all was not well with me,’ reflects Wilma. ‘I had strange shooting pains, similar to the letdown feeling breast-feeding mothers get, in my right breast. I had a mammogram scheduled and I asked the radiologist please to check the right side thoroughly.’ And there it was, the evidence of what she’d suspected. What happened next was all a bit of a blur. Wilma was scheduled for a biopsy, during which a small needle was inserted into the area in question to extract a tissue sample for testing. ‘I didn’t tell my husband,’ she says. ‘I didn’t want to worry anyone until it was certain.’ The biopsy was tougher than Wilma had anticipated. ‘It’s a tricky procedure,’ she says. AUTUMN 2013 I MEDICLINIC FAMILY I 21 LEFT Wilma van der Bijl during her reign as Miss SA in 1987. ‘I was given a local anaesthetic and had to sit very still while they used a sonar to locate the exact spot under suspicion. I drove myself home after the procedure, which is not advisable [after any procedure].’ Wilma waited two very long and nerve-racking days for the results. Her gynaecologist called her in, confirmed it was cancer and sent her to a surgeon, who advised a bilateral mastectomy. ‘That was a shock!’ says Wilma. ‘I was expecting a lumpectomy [surgical removal of the lump in her breast] but I remained calm.’ She told the surgeon to do whatever he had to do to make sure she was fine. Her husband had had four heart bypasses in recent years and with her children (then aged five and six) top of mind, she decided she had to survive. Declaring war The pace picked up after that. Wilma broke the news to her husband, who was reassuring and very supportive. He was composed and said, ‘Wilma, it is what it is.’ She had to see a chain of specialists who would form her core treatment team. Wilma opted for breast reconstruction to take place immediately after her bilateral mastectomy. ‘It’s essential to be cOVeR Me Wilma’s top biopsy tip ‘Tell a friend what’s happening and take her with you to the procedure. you’ll need her to drive you home because you’re likely to be sore and emotional afterwards.’ Wilma’s top theatre tip Once Wilma knew she had cancer, she felt like she had a tick on her body that she couldn’t get rid of fast enough. ‘But there is seldom a need to rush into the operating theatre,’ says Wilma. ‘i would advise taking a few days to wrap your head around what’s happening to you and prepare yourself mentally. don’t be panicked. There are many options you need to weigh up and consider before you can move forward.’ ..................................................................................................................... ..................................................................................................................... ..................................................................................................................... ..................................................................................................................... ..................................................................................................................... informed and to feel safe and empowered, so do your research,’ advises Wilma. ‘There’s nothing wrong with a second opinion. Seek out doctors who are encouraging and sensitive, but don’t compare yourself with others who’ve had cancer. There are many different types of cancer and no two treatment plans are the same.’ Wilma also felt the need to have a woman on her medical team, so she requested a female anaesthetist. ‘A woman’s breasts are the greatest expression of her femininity. They’re a fully formed part of our bodies from about the age of 13. We wear them like accessories and they shape us. I needed someone on my side who would understand the psychological as well as the practical impact of what I was going through.’ One battle at a time Looking back, Wilma realises that although surgery is a big deal, it wasn’t as challenging as the chemotherapy and radiation treatments that followed. ‘It’s not like a 10-step programme,’ she explains. ‘You have to remain flexible because the goal posts keep changing.’ Although chemo was every bit as unpleasant for Wilma as we would all imagine, knowing that ................................................................................................................................................................................................................................................... ................................................................................................................................................................................................................................................... ................................................................................................................................................................................................................................................... ................................................................................................................................................................................................................................................... Wilma van der Bijl has graced many magazine covers over the years. Her confidence has always been inspiring. 22 i Mediclinic FaMily i autumn 2013 CHECK IN | SPOTLIGHT STYLING Megan Perks HAIR AND MAKE-UP Alet Viljoen from Supernova Creative Management PHOTOGRAPH Gallo Images WILMA’S TOP 10 TIPS FOR CONQUERING CHEMOTHERAPY AND RADIATION it had a purpose to fulfil helped to make her resilient. Being informed about what’s happening to your body and why, is the secret Wilma cites to enduring the unpleasant side effects (such as fatigue, nausea and compromised immunity) successfully. ‘Let go of being a hero,’ is Wilma’s advice to anyone undergoing cancer treatment. ‘You need support. Accept and ask for help, call in those favours your friends owe, because you never know when you’re going to need it.’ Radiation, while still uncomfortable, was a lot more manageable for Wilma. Skin sensitivity (similar to sunburn) is a common side effect but a minor discomfort in the grander scheme of things. ‘Some individuals do report shortness of breath and a dry throat from radiation treatment,’ says Wilma, but she cautions that no two people’s experiences are exactly the same. THE NEXT CHAPTER Since her brush with breast cancer, Wilma has a new perspective. She tries to live in the present, aware of every single moment. She goes for annual checkups but avoids fretting about the future. Her experience has made her an avid campaigner for breast-cancer awareness. ‘Have you had a mammogram?’ Towards the end of the interview Wilma turns the tables on her interviewer. ‘Uh, no,’ I responded, a bit guiltily. ‘I’m too young.’ But I know better now. Wilma’s story teaches us all that cancer does not discriminate. Everyone is at risk and it doesn’t pay to be blasé. ABOVE Wilma’s advice is simple: ‘Let go of being a hero’, and ask for help when you need it. 1 Try to eat. Your appetite may be gone but you need to keep up your strength. Healthy, fresh and green should be the mainstay of your diet. 2 Drink lots of fluids. It may make you nauseous but try to find a drink that’s soothing. A mix of Coca-Cola and water worked for me. 3 4 5 6 Rest. You need lots of sleep. Your body is taking a knock and needs time to recover. Avoid using body lotion, deodorant or talcum powder on areas affected by radiation. Wear loose-fitting shirts to avoid aggravating skin irritation from radiation. Be quiet, slow down. This is your chance to pause and seek out the positives in your life. 7 Your family suffers as much as you do through the process. Find a good counsellor and support network for them. 8 Where possible, schedule any treatment for a Friday so you have the weekend to recover. 9 Stay away from crowds and sick people. Your immunity will be at an all-time low and you can’t afford to get an infection. 10 Hang on to your sense of humour. There are times when laughter really is the best medicine. AUTUMN 2013 I MEDICLINIC FAMILY I 23 CHECK IN | TA K E T H E T E S T BEAT THE ODDS A routine mammogram could be your best defence against breast cancer. Don’t delay because you’re unsure of what it involves – make an appointment today. Words Erika Bornman Approximately one in 27 South African women will develop breast cancer in her life. But early detection saves lives – especially when the cancer is still small and less likely to have spread to other parts of the body. A Swedish study found that high-quality mammograms can locate some breast cancers when they are very small, about two to four years before they would have been felt in a manual examination. Ask any woman who has never had a mammogram, and the chances are high that she thinks of the procedure as painful and unpleasant. I walked around with my doctor’s letter prescribing the mammogram for a full six months before making my first appointment. And walked out thinking that all my procrastination and nervousness had been so unnecessary. In my experience, a mammogram really is no big deal. WHAT YOU CAN EXPECT On the day, don’t wear deodorant or powder, or apply body lotion on and around your breasts. And wear a top with jeans or a skirt rather than a dress as you’ll be asked to remove your top and bra – don’t worry, you get a gown to cover up. 24 I MEDICLINIC FAMILY I 1 ..................................................................................................................................................................................................................... ..................................................................................................................................................................................................................... ..................................................................................................................................................................................................................... ..................................................................................................................................................................................................................... ..................................................................................................................................................................................................................... The mammographer will take you to a room where you’ll stand in front of a machine used only for mammograms. Your breast will be positioned on a flat plastic plate that is placed against you ribcage. AUTUMN 2013 2 A second plastic plate is lowered onto the breast, and with pressure evens out the breast tissue. This allows the machine to get as clear a picture as possible. (I found this to be only mildly uncomfortable.) 3 The moment the low-dose X-ray is taken, the pressure lifts. This is then repeated on the other breast. A similar procedure is followed on both breasts for the side view. (It was all over in seven minutes for me. And I felt very silly for having been so scared.) QA WITH DR TOM DICKER, A RADIOLOGIST AT MEDICLINIC MILNERTON At what age should a woman have her first screening mammogram? We generally recommend that all women aged 40 and over have an annual mammogram. However, it is imperative that you discuss when to start and how regularly to have one with your own doctor. Together, look at your risk profile by taking into account family history, lifestyle and any hormone-replacement therapy you may be on. Also, a general rule of thumb for women whose mother or grandmother had breast cancer is this: deduct 10 years from their age when they were diagnosed and start your screening mammograms at that age. In other words, if your mother or grandmother was diagnosed with breast cancer at the age of 41, start your screening at 31. When is the best time to make the appointment? Don’t schedule your mammogram in the week before your period if your breasts are usually tender during this time. It’s probably best to make your appointment one week after your period. I had an additional ultrasound examination because of dense breast tissue. What is that? Breasts contain different types of tissue: fatty, fibrous and glandular. Fibrous and glandular tissues appear white on a mammogram, while fatty tissue shows up dark. Because cancer cells also appear white on a mammogram, it may be harder to identify disease. So, if most of the tissue is fibrous and/or glandular, the breasts are considered dense. Younger women usually have denser breasts – as women age, their breasts tend to become less dense. Does the size of the breasts matter when reviewing the data? No. What matters is the breast density when viewing a mammogram (see above). In very large breasts, multiple views maybe required, meaning more than two X-rays per breast. And what about breast implants – how do they affect clarity? Breast implants may obscure a cancer, which is why we usually follow up with an ultrasound examination. Also, there is a small theoretical possibility that implants may rupture during the test. The benefits of mammography in the early detection of breast cancer outweigh this risk. Think pink PHOTOGRAPHS Corbis, iStockphoto The PinkDrive’s two mobile screening trucks are becoming a familiar sight on South Africa’s roads. Together with three cars, they travel to semi-urban and urban areas around our country to give disadvantaged communities access to free mammograms, physical examinations and education. Visit www.pinkdrive.co.za for more information and a list of fundraising events. PINKDRIVE BY NUMBERS* *From inception to 24 January 2013 4 464 free mammograms 41 759 51 604 clinical breast examinations women educated about breast health ............................................................................................................................................................................................................................................................................................................... ............................................................................................................................................................................................................................................................................................................... ............................................................................................................................................................................................................................................................................................................... ............................................................................................................................................................................................................................................................................................................... ............................................................................................................................................................................................................................................................................................................... 4 You will then be asked to wait before you get dressed, so they can check the images to make sure they’ve got a good picture. 5 That’s it for most mammograms. In my case, however, the radiologist reviewing the mammogram decided to perform an ultrasound as well. I immediately panicked, thinking he had found something wrong. Luckily this was not the case: he wanted a second look as my breast tissue was quite dense (see more on this in the Q&A above). I found the thoroughness of the whole screening procedure to be hugely reassuring. 6 You’ll get dressed and wait a few minutes in the waiting room, where they’ll give you a disc containing the images and a report to the referring doctor, with a recommendation of when you should return for your next routine mammogram. AUTUMN 2013 I MEDICLINIC FAMILY I 25 CHECK IN | STEP BY STEP The organ we can You probably don’t think about your gall bladder very often (if at all). But what happens when it stops working? Words Lisa Templeton ost of us don’t give a thought to the welfare of our gall bladders – until they go wrong. A humble little pear-shaped organ just below the liver on your right-hand side, it plays the important role of collecting and storing bile to help us digest fatty foods. And while we might take good care of major organs such as our hearts, brains and skin, we tend to pay little attention to our gall bladders. But – unlike with other major organs – we can live without it, should things go wrong. Gall bladder What is my gall bladder and why might I need it removed? This little sac stores bile produced by your liver. After you’ve eaten, the gall bladder contracts and bile is released into your small intestine to help break down the foods you eat, especially fatty foods. This hardy little organ can develop gallstones. It’s estimated that some 90 % of people with gallstones won’t develop symptoms. Yet, in some people, they can cause nausea, vomiting, bloating and pain. Should you suffer repeated symptoms such as severe discomfort and pain or inflammation of the gall bladder, it would typically be removed surgically. Why can I live without a gall bladder? ‘We can live without it because the normal flow of bile can still go to the duodenum (the first part of the small intestine) without a gall bladder,’ says Dr Dirk Pretorius, general surgeon at Mediclinic Sandton. In other words, through surgery, the flow of bile is simply redirected straight to the small intestine and bypasses the missing gall bladder. My gall bladder has to be removed – what can I expect? In 1990 doctors began to remove gall bladders laparoscopically through a tiny incision. ‘A gall bladder removal is a commonplace, straightforward procedure that takes about 40 to 60 minutes,’ says Dr Pretorius. What can I expect afterwards? ‘You’ll probably only be in for an overnight stay, and you can expect some discomfort initially, but it’s not painful and you shouldn’t show any symptoms within 10 days,’ says Dr Pretorius. You also won’t need to change your diet, although a healthy balanced diet and exercise are still the best way to protect your health! Should I be worried? ‘A gall bladder removal is one of the most common surgeries performed,’ says Dr Pretorius. ‘Complications are very rare but can include injury to the common bile duct.’ The risks, however, are less than they would be if you left a problem gall bladder where it is. 26 I MEDICLINIC FAMILY I AUTUMN 2013 Large intestine Small intestine live without Liver Stomach Pancreas .......................................................................................................... .......................................................................................................... .......................................................................................................... .......................................................................................................... .......................................................................................................... .......................................................................................................... HERE IS WHAT YOU CAN EXPECT DURING THE OPERATION: 1 2 Firstly, you’ll be anaesthetised and won’t feel a thing. Surgeons will typically make four small incisions in your abdominal wall. One near the bellybutton, one just under the xiphisternum (this is the notch where your lowest ribs meet) and two below the ribs on the right-hand side of your body. 3 Carbon dioxide will be pumped into your body through the incision near your bellybutton to inflate your abdomen, making access and visibility much easier. PHOTOGRAPH Gallo/Getty Images ILLUSTRATIONS Gallo/Getty Images SOURCE everydayhealth.com 4 MY GALL BLADDER HAS BEEN REMOVED – AND I DON’T MISS IT AT ALL! ‘My gall bladder problems began so subtly,’ says James*, 69, of Fish Hoek, Cape Town. ‘I felt small levels of discomfort around meal times that imperceptibly grew worse until I suffered a massive feeling of indigestion, such that I sometimes could not sit still. ‘One night when we were visiting the Waterfront I had such a huge discomfort in my chest that we went straight to Mediclinic Cape Town. After various tests a radiologist diagnosed it as a gallstone. It was such a relief. My gall bladder was then removed. On the first night I felt a little uncomfortable, but gall bladder ever since then I’ve been fine. Initially I was nervous about eating high-fibre foods, but now it seems to be no problem at all, and I can eat anything I like.’ * Name changed at his request to protect his privacy. 5 6 cystic duct The laparoscope – a tube with a camera and a highintensity light – will be inserted via another cut near the bellybutton. This will allow the surgeon to see what is happening. The cystic duct and cystic artery will be severed. Once your gall bladder is free, it is removed via the xiphisternum port. 7 After a check that all is well, each of the little incisions will be stitched up. You’d generally only need one to three stitches per incision. common bile duct AUTUMN 2013 I MEDICLINIC FAMILY I 27 CHECK IN | HOW IT WORKS BE BLISSFULLY UNAWARE Anaesthetics allow a patient to undergo surgery and other procedures without experiencing distress and pain. Our experts explain the different types of anaesthesia and answer some common questions. Words Michelle Coburn naesthesia is a pharmacologically induced reversible state, created by either a single type of drug or a combination of drugs, that results in some or all of the following effects: amnesia, loss of awareness, pain relief, loss of responsiveness, loss of skeletal muscle reflexes and a decreased stress response. 1 CHOOSING THE TYPE OF ANAESTHESIA ANAESTHETIC PLAN: Anaesthesiologist Dr Christo de Jager at Mediclinic Brits explains that an anaesthetic plan will be formulated before the operation. ‘This will accommodate the patient’s baseline physiological state, age, weight, any medical conditions, previous operations, the planned procedure, drug sensitivities, previous anaesthetic experiences, current medication and psychological make-up.’ The patient’s airway and condition of his or her teeth will be examined should tracheal intubation be required. Patients must also reveal whether or not they smoke, drink alcohol or have any allergies. PREMEDICATION: The doctor will decide on the need for a premedication sedative, which can help eliminate anxiety, reduce secretions and minimise post-operative nausea. 1 IN 10 000 The approximate number of patients that experience serious complications, such as a lifethreatening allergic reaction, after receiving a general anaesthetic. This is therefore extremely unusual and not a reason to decide against surgery. It’s estimated that there is one death for every 100 000 general anaesthetics administered, also a rare occurrence. 2 GENERAL ANAESTHETIC This is used for major operations where the patient enters a controlled state of unconsciousness after receiving medication to inhibit sensory, motor and sympathetic nerve transmission at the level of the brain. These are injected into a vein or sometimes given as an anaesthetic vapour inhaled by mask – used more often for children. A combination of anaesthetic vapours and gases keeps patients ‘under’, while the anaesthesiologist monitors the patient through these stages: STAGE 1 (INDUCTION): The patient progresses from absence of pain without amnesia to absence of pain with amnesia before losing consciousness. STAGE 2 (EXCITEMENT STAGE): Shortly after losing consciousness, the patient enters a phase of excited, delirious activity. Breathing and heart rate can be irregular. STAGE 3 (SURGICAL STAGE): Once the muscles relax, breathing is shallow and eye movements stop, the patient is ready. During surgery, the bloodoxygen level is monitored along with heart rate, blood pressure, brain activity, breathing and body temperature to ensure that the patient is stable. When the anaesthetic drugs are withdrawn, the patient recovers quickly. ........................................................................................................................................................................................................ ........................................................................................................................................................................................................ ........................................................................................................................................................................................................ COMMONLY ASKED QUESTIONS ........................................................................................................................................................................................................ ........................................................................................................................................................................................................ Could I wake up during surgery? Anaesthesia awareness is rare, experienced by 0,1 – 0,2 % of those who undergo surgery with general anaesthetic. It can happen if one or more drug is not administered in the correct amount. However, monitoring brain activity, which indicates the patient’s awareness level, reduces this risk dramatically. 28 I MEDICLINIC FAMILY I AUTUMN 2013 Why do some people wake up crying or fighting? Dr Hugo van Rensburg at Mediclinic Limpopo says everyone responds differently. ‘Just as it’s difficult to predict how someone is going to act when they have consumed alcohol, it’s hard to know how a patient will behave after a general anaesthetic. Some are hysterical, aggressive or delirious; some are not. However, this does not last for long.’ 4 LOCAL ANAESTHETIC 3 PHOTOGRAPHS Getty/Gallo Images, iStockphoto REGIONAL ANAESTHETIC This is used often during Caesarean sections, where patients remain awake but are also frequently sedated. A large area of the body, such as a limb or the entire lower half of the body, is without sensation because the transmission of impulses from the nerves in that area, the spinal cord and the brain have been blocked by means of an epidural or spinal block. This is injected into the cerebrospinal fluid or epidural space just outside the spinal canal (pictured right). ‘A regional anaesthetic is also sometimes given in conjunction with general anaesthetic so that a patient wakes up with no pain, in the case of a hip replacement, for example,’ explains Dr Van Rensburg. Local anaesthesia makes a specific location on the body numb, for example the area around a tooth, while the patient remains conscious. Anaesthestics are administered topically in the form of gels, creams or sprays, or via injection. Local anaesthetics work by blocking nerve impulses to the brain, although patients usually feel pressure and sensation. They are commonly used for dental work, wound suturing and medical examinations that might be painful. 5 CONSCIOUS SEDATION This is used for relatively minor procedures such as setting broken bones. The same drugs used for general anaesthesia are administered – either orally, by injection or inhalation, or a combination of all three – but in much smaller quantities to calm the patient. They provide pain relief by inhibiting the transmission of nerve impulses between the higher and lower centres of the brain. The patient is sleepy but responsive to instructions. He or she most likely won’t know what is happening or remember the procedure afterwards. ................................................................................................................................................................................................................................................................................................................. ................................................................................................................................................................................................................................................................................................................. ................................................................................................................................................................................................................................................................................................................. ................................................................................................................................................................................................................................................................................................................. ................................................................................................................................................................................................................................................................................................................. Will I be nauseous? Around 33 % of patients experience nausea and vomiting immediately after surgery. This is more common following gas-administered anaesthetics and is easily treated. Will I be shivery? A small group of people do experience shivering during recovery but this usually only lasts for up to 30 minutes post surgery and is carefully monitored to ensure hypothermia does not occur. Why should one not drive for 24 hours after having anaesthetic? Residual effects, such as drowsiness, may linger. Legally, therefore, you may not operate machinery or drive for one day after surgery for safety reasons. AUTUMN 2013 I MEDICLINIC FAMILY I 29 CheCk in | w h at h a p p e n e d n e x t ? alive and kicking Halfway through an Fa Cup soccer match, Fabrice muamba felt a sudden dizziness and a blinding headache. What happened next would forever change his life – and nearly end it. Words Will Sinclair he night of 17 March 2012 was the biggest one of Fabrice Muamba’s life. It was the night of his Bolton Wanderers team’s FA Cup quarterfinal match against Tottenham Hotspur. It was also the night he died. It happened 43 minutes into the game. With the score tied at 1 – 1, Fabrice dropped back into defence when he suddenly suffered a splitting headache. He couldn’t run. He couldn’t see. His head was spinning. And then he fell. Just like that. He’d suffered cardiac arrest. Within seconds, he was surrounded by both the Bolton and Spurs medical teams, who were quickly joined by Dr Andrew Deaner, a cardiologist who happened to be at the game as a fan, and who ran onto the pitch to help. They found Fabrice suffering the textbook signs of cardiac arrest: unlike with a heart attack (where blood flow to the heart muscle 30 i Mediclinic FaMily i autumn 2013 aBOVe Fellow players look on distraught as Fabrice Muamba of Bolton Wanderers receives CPR treatment on the pitch after collapsing suddenly during an FA Cup match last year. The game was abandoned. is impaired), his heart had simply, suddenly, stopped pumping. He required immediate CPR, and urgent hospital treatment. And with every minute that passed, his chances of survival dropped perilously. SHOcK TReaTMenT The medical teams spent six minutes trying to resuscitate Fabrice on the pitch. It felt like an eternity for the millions of fans watching on TV, for the 35 000 spectators at the stadium, for the players on the field and for the doctors at the scene. As his team-mates watched in horror, Fabrice was stretchered off the field and rushed to London Chest Hospital. He wasn’t responding to treatment. Fabrice received two defibrillator shocks on the field, one in the players’ tunnel, and 12 more as the ambulance sped to the hospital. Adrenaline injections, heart massage… Nothing worked. Fabrice’s heart was showing lots of electrical activity but no muscular activity. ‘It’s something that HEART ATTACK VS CARDIAC ARREST PHOTOGRAPHS Getty/Gallo Images ............................................................................................ ............................................................................................ ............................................................................................ ............................................................................................ ‘There’s a big difference between the two,’ explains Dr Shirley Middlemost, a cardiologist at Mediclinic Hermanus. ‘With cardiac arrest, the heart stops beating. So it’s not pumping, not ejecting blood. This could happen to anybody – even a young patient or an active sportsman.’ A heart attack, meanwhile, happens when an artery is blocked or occluded. ‘Here your heart could be pumping away, but the blood can’t move through the artery,’ Dr Middlemost explains. ‘A heart attack is usually caused by risk factors like high cholesterol, smoking or family history, and we’ll treat it with a clot buster or arterial stent, which opens up the artery and lets the blood flow again.’ Dr Middlemost points out that a heart attack could lead to cardiac arrest. ‘So while they’re completely different, that’s where you can find a connection.’ ............................................................................................ ............................................................................................ ............................................................................................ ............................................................................................ often happens in response to drugs and shocks,’ Bolton team doctor Jonathan Tobin would later tell the BBC. ‘Now, heaven knows why, but Fabrice had, in total, 15 shocks.’ Then, 78 minutes after it had stopped, Fabrice’s heart suddenly started beating again. And within three days, against all expectations, he’d regained consciousness. As Dr Deaner would later recall: ‘I whispered in his ear: “What’s your name?” He said: “Fabrice Muamba.” I said: “I hear you’re a really good footballer.” And he said: “I try.” I had a tear in my eye.’ THE MIRACLE RECOVERY Fabrice was discharged almost a month later, with a newly fitted pacemaker. Miraculously, despite being deprived of oxygen for almost two hours, he’d suffered no brain damage. But his soccer career was over. In August 2012 Fabrice – who was born in the DRC and moved to England as a child – officially announced his retirement. He now spends his time visiting schools to raise awareness about heart conditions. As he learnt the hard way, cardiac arrest can happen to even the healthiest of young hearts. In November he paid an emotional return visit to Spurs’ White Hart Lane stadium. ‘I wanted to go and see where I fell down,’ he said. ‘I had to go and look at that spot again. I felt better afterwards. For me, that was closure.’ ‘I’m just an ordinary dude who had a cardiac arrest,’ he recently told the Manchester Evening News. ‘It happened to be televised around the world. I’m still the same old Fabrice. I still sit around watching movies and playing Call of Duty until 2 am. I’m no different than any other 24-year-old. I just want to enjoy my life and spend time with my family. ‘To be alive is more than I could wish for. Living, breathing, being with my family… Nothing else matters.’ BELOW An emotional Fabrice Muamba waves to the crowd before a Barclays Premier League match in November 2012. This was his first public visit to White Hart Lane stadium since his cardiac arrest. CheCk in | p h o t o e s s ay laughter is the best Medicine Researchers at the mayo Clinic in the uS have found scientific evidence that laughter is indeed good for our health. in the short term, laughing stimulates your heart, lungs and muscles, and increases the endorphins released by your brain. Long-term benefits include improving your immune system and pain relief. We chat to four local comedians who are doing their bit to keep South africa healthy. Compiled by Mandy Freeman Photographs ivok studio and Morné van Zyl 32 i Mediclinic FaMily i autumn 2013 a Funny one-liner? ‘i hate being bipolar. it’s brilliant!’ alan coMMittie What makes you laugh? ‘When Australia loses cricket test matches! I like the wit of Woody Allen as much as the physical comedy of Peter Sellers. And I love laughing at the discomfort as portrayed in “mockumentaries” where tiny, real, everyday moments are milked for all their comic possibilities.’ What do you do when you’re not being funny on stage? ‘Then I’m looking for it. I try to write funny stuff and plan funny shows. I also just relax, which often means not talking at all, watching mindless TV, reading or just spending time with friends – allowing them to be funny instead.’ autumn 2013 i Mediclinic FaMily i 33 CheCk in | p h o t o e s s ay a Funny one-liner? ‘“There is no need To panic.” John vlisMas What makes you laugh? ‘Real life. it’s much funnier than anything you could make up. Bad comedy is often too forced – great comedy just unfolds. What do you do when you’re not being funny on stage? ‘i’m a dad and run the production side of my business. i’m also qualified to train scuba divers. i try to spend as much time as possible doing different, non-comedy things. i think that helps to keep my comedy interesting.’ 34 i Mediclinic FaMily i autumn 2013 it gets me every time.’ joey rasdien What makes you laugh? ‘It’s the simple things, like a one-year-old’s expression when accidentally passing gas.’ What do you do when you’re not being funny on stage? ‘Like anyone else, I enjoy spending time with my family and playing sport: golf, cricket or soccer.’ a Funny one-liner? ‘Well, that’s like asking a doctor, what’s the worse case of symptoms he’s ever been presented with, isn’t it?’ autumn 2013 i Mediclinic FaMily i 35 CheCk in | p h o t o e s s ay tshepo Mogale What makes you laugh? ‘Guys who use complicated political english to say the simplest thing. People with perms who sleep with plastic bags on their heads. The face wipe people do when they get out of a pool. People who sing along to songs when wearing headphones but who don’t know the words so they “remix” it…’ What do you do when you’re not being funny on stage? ‘i like to think i’m a normal guy – i play sport, work and just get on with life.’ a Funny one-liner? ‘FroM My accent people can tell that i grew up in the states. the Free State…’ 36 i Mediclinic FaMily i autumn 2013 CHECK IN | NUTRITION EGGS-TRAORDINARY! Here’s how to make a delicious and healthy breakfast with eggs. Recipes and styling Abigail Donnelly Photographs Jan Ras Nutritional information Irene Labuschagne EGG-WHITE OMELETTE WITH SCRAMBLED-EGG FILLING, SERVED WITH BABY SPINACH AND MUSHROOMS 38 I MEDICLINIC FAMILY I AUTUMN 2013 STUFFED EGGS WITH PEACH AND BASIL AUTUMN 2013 I MEDICLINIC FAMILY I 39 STUFFED EGGS WITH PEACH AND BASIL For the perfect poached egg WHAT YOU NEED Serves 2 500 ml water 1 T white vinegar 1 free-range egg WHAT YOU NEED 4 free-range eggs, boiled and halved 1 T fat-free smooth cottage cheese 1 T chives, chopped 1 T parsley, chopped ½ red chilli, deseeded and finely chopped Salt and freshly ground black pepper 1 ripe peach ¼ cucumber, thinly sliced 10 g fresh basil leaves ½ t red chilli, finely chopped WHAT YOU DO SPICY KEDGEREE WITH SOFTBOILED EGGS AND TROUT SPICY KEDGEREE WITH SOFTBOILED EGGS AND TROUT Serves 2 ½ red onion, thinly sliced 1 T red Thai curry paste 250 g brown rice, cooked 50 g mangetout, julienned Freshly ground black pepper 150 g trout 2 free-range eggs, soft-boiled 2 spring onions, finely sliced WHAT YOU NEED Heat a non-stick pan over medium heat. Brown the onion and then add curry paste, cooking for one minute before adding the rice and mangetout. Season with freshly ground black pepper. Blanch the trout for three minutes in a simmering pan of water, then remove and allow to rest. Add the spicy rice to a serving dish and flake the trout over it. Top with the soft-boiled eggs and garnish with spring onions. Per serving 1 548 kJ 30,8 g 11,4 g 32,1 g 3,3 g 106 mg 2,84 g 3,86 g 2,94 g 285 mg 1 ½ t extra-virgin olive oil 75 g white button mushrooms, halved 100 g baby spinach 2 free-range eggs, separated Salt and freshly ground black pepper 50 ml milk 2 T parsley, chopped Preheat the oven to 180 °C. Heat ½ t olive oil in a non-stick pan and fry the mushrooms till brown and cooked. In a pot of simmering water, blanch the baby spinach for about 20 seconds till wilted, then remove from the heat and drain off any excess water. Heat ½ t olive oil in a non-stick pan. Season the egg yolks with salt and black pepper, add the milk and whisk well before softscrambling. In a separate non-stick pan heat ½ t olive oil. Whisk the egg whites till soft-peak stage, season with salt and pepper and add to the pan. Leave it on the heat and brown the bottom of the omelette slightly before finishing in the preheated oven. Bake for two to three minutes or till the egg has cooked. Fill it with the scrambled egg yolks, browned mushrooms and baby spinach, and then fold. Garnish with parsley. N U T R I T I O N TA B L E WHAT YOU NEED Energy Protein Total fat Carbohydrates Total dietary fibre Sodium Saturated fatty acids Monounsaturated fatty acids Polyunsaturated fatty acids Cholesterol Boiling water 1 free-range egg WHAT TO DO Bring the water to a boil before placing the egg in it. Boil for exactly five minutes before removing the egg and allowing it to cool on its own before shelling it. MEDICLINIC FAMILY I AUTUMN 2013 N U T R I T I O N TA B L E Energy Protein Total fat Carbohydrates Total dietary fibre Sodium Saturated fatty acids Monounsaturated fatty acids Polyunsaturated fatty acids Cholesterol WHAT TO DO For the perfect soft-boiled egg 40 I Remove the yolks from the boiled eggs and add to a mixing bowl along with the cottage cheese, chives, parsley and chilli, season and mix well. Spoon the mixture back into the halved eggs. Cut the peach in half and remove the pip before slicing into wedges. Arrange the eggs and peaches on a serving dish, along with the cucumber slices, and scatter with basil leaves. Garnish with chilli. Serves 1 WHAT TO DO Energy Protein Total fat Carbohydrates Total dietary fibre Sodium Saturated fatty acids Monounsaturated fatty acids Polyunsaturated fatty acids Cholesterol WHAT TO DO EGG-WHITE OMELETTE WITH SCRAMBLED-EGG FILLING, SERVED WITH BABY SPINACH AND MUSHROOMS WHAT YOU NEED N U T R I T I O N TA B L E Bring the water to a gentle simmer over medium heat. Add the vinegar and use a whisk to create a whirlpool in the centre. Crack and gently drop the egg in the centre of the circulating water. Don’t poke or fiddle with the egg; allow the circulating water to hold it together. Poach for three minutes or till the egg white is fully cooked. Remove using a slotted spoon. QA Per serving 1 453 kJ 27,4 g 20,6 g 8,3 g 5g 1 113 mg 5,09 g 10,29 g 2,39 g 464 mg Per serving 1 096 kJ 15,9 g 11,7 g 16,1 g 4,1 g 928 mg 3,41 g 4,46 g 1,58 g 462 mg Is it true that eggs are high in cholesterol? The South African Heart and Stroke Foundation recommends: ‘Those at risk, who have a family history of high cholesterol, have established atherosclerotic disease or are suffering from type I or II diabetes, should not consume more than 200 mg of cholesterol per day.’ So it’s not a good idea to cook an egg every morning. However, if you’re not at risk you can happily enjoy an egg a day, provided that it replaces a portion of meat for the day and the rest of your day’s dietary intake is healthy and well balanced. Irene Labuschagne adds: ‘The best cooking methods for eggs are to boil or poach them.’ NUTRITION | CHECK IN SWEET-POTATO CAKES WITH POACHED EGG, ASPARAGUS AND MUSTARD VINAIGRETTE Serves 2 WHAT YOU NEED 2 sweet potatoes 2 T chickpea flour ½ red onion, grated 15 g fresh coriander leaves, chopped Salt and freshly ground black pepper 1 T extra-virgin olive oil 75 g asparagus spears 2 free-range eggs, soft-poached micro-herbs DRESSING 1 t Dijon mustard ½ t honey ½ t white-wine vinegar OATMEAL AND PINEAPPLE Salt and freshly ground black pepper LOAF, SERVED WITH FRESH ½ t extra-virgin olive oil FIGS AND RAW HONEY Abigail Donnelly is Eat Out’s editor and group food editor of Woolworths TASTE magazine. She’s won the Galliova Award for Best Food Writer four times and appeared as a guest judge on MasterChef SA. Irene Labuschagne (RD SA) is a part-time principal dietitian at the Nutrition Information Centre of the University of Stellenbosch (NICUS). She’s written several publications and co-authored two chapters in a textbook. Preheat the oven to 180 °C and roast the sweet potatoes for 45 minutes till cooked. Spoon the flesh into a mixing bowl with the chickpea flour, onion and coriander, season with salt and freshly ground black pepper and then mix well. Mould into two patties and allow to rest for five minutes. Heat the olive oil in a non-stick pan and fry the patties till golden. Blanch the asparagus till just cooked and cut each spear into four pieces. Plate each patty on a serving dish, scattering the asparagus around it. Top the patty with a soft-poached egg and season. For the dressing, place the mustard, honey and white-wine vinegar in a mixing bowl and season. Whisk well while adding the olive oil. Top the poached egg with micro-herbs and drizzle with the dressing. N U T R I T I O N TA B L E Per serving Energy Protein Total fat Carbohydrates Total dietary fibre Sodium Saturated fatty acids Monounsaturated fatty acids Polyunsaturated fatty acids Cholesterol 1 386 kJ 14,6 g 15,8 g 27 g 5,6 g 757 mg 3,05 g 9,09 g 2,04 g 233 mg Last thoughts SWEET-POTATO CAKES WITH POACHED EGG, ASPARAGUS AND MUSTARD VINAIGRETTE AS UP TR U IMNNG 22001132 II MEDICLINIC MEDICLINICFAMILY FAMILY II 41 41 CHECK OUT | JUST A MINUTE G ME TIME Compiled by Ellen Cameron ................................................................................................................................................................................................................................................................................................. ................................................................................................................................................................................................................................................................................................. ................................................................................................................................................................................................................................................................................................. ................................................................................................................................................................................................................................................................................................. ................................................................................................................................................................................................................................................................................................. CLASSIC SUDOKU Complete the grid by filling in the numbers 1 to 9. A number may not repeat in any row or column, nor in any of the demarcated 3 x 3 cell groups. 9 1 4 2 7 5 9 9 5 6 2 3 3 3 6 7 2 9 SEPIA BRAND TAPER STORE CAMEL 7 2 3 2 9 2 SPASM 1 8 8 9 RESIN 6 9 4 Fit the following five-letter words into the grid so that five words run horizontally and the remaining two run vertically (as indicated by the shaded columns): 8 5 5 5 8 CROSSWORD 7 4 4 5 ................................................................................................................................................................................................................................................................................................. ................................................................................................................................................................................................................................................................................................. ................................................................................................................................................................................................................................................................................................. ................................................................................................................................................................................................................................................................................................. ................................................................................................................................................................................................................................................................................................. MUSIC TO MY EARS Each of the six groups of letters represents a sevenletter word related to music. Each group, however, is missing the same letter. Decipher the missing letter and unscramble the musical words. 1 2 3 6 5 T R M U T E R A S 4 O NO 4 5 6 O S C E M O ? I O C O C L 3 42 I MEDICLINIC FAMILY I AUTUMN 2013 G P 1 A B E I E E L D 2 R U Create one enclosed shape by filling in the sides of the cells. Each number in a cell indicates the number of sides that are filled in. The example on the right shows how this works. 1 1 2 2 3 3 1 2 2 1 3 1 3 2 1 2 2 3 1 1 2 1 3 1 1 0 1 3 1 3 1 3 3 3 1 0 1 0 1 2 3 2 3 1 1 2 1 2 3 2 3 2 1 2 2 3 1 1 2 2 2 3 0 2 2 2 3 2 2 2 2 2 3 1 2 3 TRAFFIC COUNT 2 2 3 1 1 0 2 2 2 0 2 2 1 3 2 2 1 0 1 1 1 3 1 3 3 2 3 1 2 3 1 3 2 2 3 0 1 1 0 1 3 2 1 1 1 2 3 2 2 2 2 2 1 2 3 2 1 3 2 2 3 2 BOXED IN TRAFFIC COUNT On a stretch of gridlocked highway, a traffic count reveals the number of vehicles in summarised form: 5. Trumpet 4. Soprano buses + trucks = 25 3. Piccolo trucks + cars = 23 6. Compose cars + buses = 28 3 ............................................................................................................................................................................................................ ............................................................................................................................................................................................................ ............................................................................................................................................................................................................ ............................................................................................................................................................................................................ ............................................................................................................................................................................................................ 2 2 (13 cars, 15 buses and 10 trucks) 3 Total = 38 vehicles 2 CROSSED OUT 0 SOLUTIONS R E M O C O N T R O L E BOXED IN 2. Prelude 1. Bagpipe The missing letter is P. MUSIC TO MY EARS What is the total number of vehicles on this particular section of the highway? 7. Resin 6. Taper ............................................................................................................................................................................................................ ............................................................................................................................................................................................................ ............................................................................................................................................................................................................ ............................................................................................................................................................................................................ ............................................................................................................................................................................................................ 5. Brand 4. Sepia CROSSED OUT 3. Spasm 2. Camel Place these letters into the grid to create the name of a common household device. 1. Store CROSSWORD 7 9 8 7 6 8 5 1 6 9 8 5 3 2 4 7 7 8 5 4 6 2 9 1 3 3 1 2 5 4 7 2 4 6 1 9 3 3 6 9 5 7 4 2 1 8 1 7 4 6 9 8 3 5 2 4 2 3 9 1 5 7 8 6 2 4 8 1 3 9 7 6 5 CLASSIC SUDOKU PHOTOGRAPHS iStockphoto 6 8 2 4 T 1 HINT: 3 5 9 C N O R E T O L M E O T R AUTUMN 2013 I MEDICLINIC FAMILY I 43 CheCk OUT | S TA R N O M I N AT I O N S STAr noMinations We celebrate outstanding Mediclinic staFF. noMinate your star and tell us Why. Email [email protected] or write to Family magazine, Po Box 440, Green Point, 8051. With coMpliMents coMpassion and care I’d like to congratulate you on the compassionate nursing staff at Mediclinic louis leipoldt. My daughter, Inge, was admitted for a procedure. Needless to say, I was one nervous mom! They were fantastic and worked with confidence and efficiency. I want to commend nursing auxiliary Magdalene Raphael for helping me so much with Inge. Annelise Strauss AR ST F THE O MONTH Thank you is not sufficient here, but professional nurse Miemie Baan at Mediclinic sandton deserves our compliments and appreciation for taking such special care of my husband earlier this year. We appreciated her professionalism and friendliness at all times. Miemie and the rest of the team are shining stars – they always do their best and make a difference in difficult times! Heidi van Nieuwenhuizen DID YOU KNOW? Mediclinic louis leipoldt is one of the oldest and best-known private hospitals in the Western cape and offers a panoramic view of table Mountain. professional nurse Mimie baan regte engele outstanding help Ek het nou selfs nog meer respek vir verpleegpersoneel nadat my dogtertjie vroeg in Februarie ’n naweek lank in die pediatriese afdeling by Mediclinic durbanville was. Baie dankie aan Kim Johnson, Cindy Bakker, Jo-Anne Smuts en Sakkie Isaacs: ek was baie gestres maar die manier waarop hulle ons hanteer het, het my soveel beter laat voel. Boonop was hulle professioneel, mooi gegrimeer en uiters netjies. Ek wil opreg dankie sê vir hul absoluut fantastiese diens. Hulle was soos regte engele. Laastens ook net ’n dankie aan George Mentoor – dis te pragtig hoe hy almal op hulle gemak laat voel en die kleingoed so mooi hanteer. Baie dankie! Helena van der Merwe I’d like to nominate Christine Williams from Unit D at Mediclinic panorama. She was a breath of fresh air after a long day of surgery. She was loving and caring as only a true nurse could be; she is my star. Thank you, Mediclinic, for the exceptional service. Judy Hendra Baie dankie aan die personeel by die noodsentrum by Mediclinic potchefstroom, en meer spesifiek Daniel Ntshewula, vir sy flinke, vriendelike diens. Ons seun Dewan is onlangs daar opgeneem terwyl hy by sy oupa en ouma gekuier het, so dit was stresvol vir ons as ouers aangesien ons nie self by hom kon wees nie. Ons wil ons dank betuig aan die betrokke personeel wat hom bygestaan het. Julle is puik! Neels en Lizélle Olivier enrolled nurse christine Williams ontvangsadministrateur daniel ntshewula 44 i Mediclinic FaMily i AUTUMN 2013 Family reserves the right to edit star nomination submissions as we deem necessary. potch is puik! nursing auxiliary Magdalene raphael CHECK OUT | M Y H O S P I TA L YOUR HOSPITAL STAY MADE EASY 1 IT’S BEST TO COMPLETE THE PRE-ADMISSION PROCESS BEFOREHAND. + Visit our website at www.mediclinic.co.za. Click on ‘Patients’ to access and complete the pre-admission form online. + Or you can download and print the pre-admission form from the website. Click on ‘Patients’ to download the form. Complete the form and fax it to the relevant hospital. The fax numbers are listed on the website. 2 ON ARRIVAL AT THE HOSPITAL… + Make sure you have your ID and medical-aid card. + Go straight to the admissions desk. If you completed a pre-admission form online, you will have to confirm your details and sign to confirm that you accept the conditions of admission. + If you have not completed a pre-admission form, our staff will assist you. 3 YOU CAN NOW SETTLE IN. + After the paperwork has been completed, a porter will take you to the nursing unit. + A nursing practitioner will take down your medical history and brief you on the procedure and what you can expect at each step of the process. + It is advisable to send any valuables, such as cellphones or wallets, home with the person who brought you to the hospital. IT’S A GOOD IDEA TO... Visit the hospital pre-admission centre. Staff can advise you on: + the procedure and/or the treatment related to your admission. + the financial aspects of your hospitalisation, including how to obtain pre-authorisation from your medical aid. + the amount of cover authorised by your medical aid and any exclusion of benefits that applies to you. MEDICLINIC HOSPITAL CARE – ON YOUR DOORSTEP OR ON THE MOVE Visit www.mediclinicinfohub.co.za or www.facebook.com/MediclinicSouthernAfrica GAUTENG Mediclinic Emfuleni 016 950 8000 Mediclinic Gynaecological Hospital 012 400 8700 Mediclinic Heart Hospital 012 440 0200 Mediclinic Kloof 012 367 4000 Mediclinic Legae 012 797 8000 Mediclinic Medforum 012 317 6700 Mediclinic Morningside 011 282 5000 Mediclinic Muelmed 012 440 0600 Mediclinic Sandton 011 709 2000 Mediclinic Vereeniging 016 440 5000 Wits Donald Gordon Medical Centre 011 356 6000 KWAZULU-NATAL Mediclinic Howick 033 330 2456 Mediclinic Newcastle 034 317 0000 Mediclinic Pietermaritzburg 033 845 3700 Mediclinic Victoria 032 944 5061/2/3/4 LIMPOPO Marapong Private Hospital 014 768 2380 Mediclinic Limpopo 015 290 3600 Mediclinic Thabazimbi 014 777 2097 Mediclinic Tzaneen 015 306 8500 MPUMALANGA Mediclinic Barberton 013 712 4279 Mediclinic Ermelo 017 801 2600 Mediclinic Highveld 017 638 8000 Mediclinic Nelspruit 013 759 0500 Mediclinic Secunda 017 631 1772 NAMIBIA Mediclinic Otjiwarongo 00264 67 30 3734 Mediclinic Swakopmund 00264 64 41 2200 Mediclinic Windhoek 00264 61 43 31000 NORTHERN CAPE Mediclinic Kathu 053 723 3231 Mediclinic Kimberley 053 838 1111 Mediclinic Upington 054 338 8900 NORTH WEST Mediclinic Brits 012 252 8000 Mediclinic Potchefstroom 018 293 7000 FREE STATE Mediclinic Bloemfontein 051 404 6666 Mediclinic Hoogland 058 307 2000 Mediclinic Welkom 057 916 5555 WESTERN CAPE Mediclinic Cape Gate 021 983 5600 Mediclinic Cape Town 021 464 5500 Mediclinic Constantiaberg 021 799 2911 Mediclinic Durbanville 021 980 2100 Mediclinic Geneva 044 873 6200 AUTUMN 2013 Mediclinic George 044 803 2000 Mediclinic Hermanus 028 313 0168 Mediclinic Klein Karoo 044 272 0111 Mediclinic Louis Leipoldt 021 957 6000 Mediclinic Milnerton 021 529 9000 Mediclinic Paarl 021 807 8000 Mediclinic Panorama 021 938 2111 Mediclinic Plettenberg Bay 044 501 5100 Mediclinic Stellenbosch 021 861 2000 Mediclinic Strand 021 854 7663 Mediclinic Vergelegen 021 850 9000 Mediclinic Worcester 023 348 1500 I MEDICLINIC FAMILY I 47 CHECK OUT | B E F O R E YO U G O THE LESSONS AFRICA HAS TAUGHT ME I am Dutch by birth and South African by choice. I came to South Africa on 6 April 1990, 338 years after fellow Dutchman Jan van Riebeeck did the same, except that I arrived by train with R250 in my pocket. The African light amazed me and I instantly understood the power of this continent – of how it gets into one’s soul. I discovered many things I had never seen or experienced before. I encountered the culture of the braai; the South African love affair with sweet food; chutney, witblits and even mampoer (and boy, was I sick for two days after that one). I discovered gem squash with butter and salt, and I still love it, although I’ve learnt that it’s better to pierce the squash before boiling it. I got to know the yellow brick and the red ball in the supermarket dairy section – so-called cheddar and gouda cheese. I even met Peppermint Crisp and its cousin, the fridge tart. A bit of a culinary culture shock, really. But I settled into it, for anything new is exciting. The greatest revelation of all? My love for food and cooking became an obsession and eventually my career. Southern Africa, with its abundance of incredible produce, is the source of my inspiration. It has also been my education. And this is what I have learnt. Africa has taught me integrity and honesty. It’s about cooking what is grown here and now, using the best available produce and honouring the farmer. For me, honesty is not about mentioning the trendy name of some feedlot where the beef comes from. I am talking about real food and honest products. That’s where it starts. Then we get creative. Then we play. Africa has taught me to be unique. Just as every region has its own special 48 I MEDICLINIC FAMILY I AUTUMN 2013 flavours, history and culture, so do I speak my own culinary language. I have been able to create my own path while at Le Quartier. I will never forget going on an eating splurge in London once, when four restaurants all served their own version of corn cakes with foie gras. Tell me, how exciting is that? Africa has taught me to stay excited at all times. It is possible to reinvent, to push forward, to recreate, to improve constantly, powered by the enthusiasm of the people around me. Both in my kitchen and outside it, there’s an infectious creative energy that feeds me. I feel it when I discover produce I’ve never known before, or when each season deliver its own bounty. I don’t want strawberries all year round. I want them when they taste real. Africa has also taught me how to fight. I fight for what I believe in, whether it’s the freshest, the biggest, the smallest. I fight for the right level of service and, especially, against inferiority. But I don’t do so unreasonably, for this goes hand in hand with honesty and integrity. I will fight against injustice and I will fight for my staff. Africa has taught me humility and how to share. Creating fantastic food and experiences for our guests takes on a deeper meaning when balanced with feeding the needy. Life is tough for so many around us. We can’t do our job with blinkers on. At Le Quartier we cook lunch for 120 children every school day. Guests donate money when we tell them the story. Some also knit scarves and mittens for winter every year. Last year we held a fundraising dinner in The Netherlands and raised almost R1-million. Unbelievable! Now we are also funding breakfast for another 770 children in two local schools. You see, anything is possible when everybody chips in. If anything, Africa has taught me to be resourceful. Ons maak ’n plan. On my culinary missions, I’ve learnt to travel the less obvious roads, to conduct research and find inspiring indigenous ingredients. One of them is the !nara oil from Namibia. It’s a nutty, fruity oil pressed from seeds of a melon-like fruit that grows in the desert, just beautiful with fish. Then there’s Baleni salt, which local women harvest from a hot spring in the Lowveld using ancient traditional methods. It is a sacred site where salt has been harvested for the past 2 000 years. I also keep my eyes open for the red num-num fruit when I drive around Franschhoek. I love its tartness. And what about buchu, the amazing sour fig, varkkos, surings, mebos, sorghum? I can go on for hours. What we have here is so special. Yes, every continent, every land, every person has baggage. So do we. But, gosh, when I open my eyes in the morning and see the African light, I thank my lucky stars that, through my chosen career, I can conquer it all right here. This is an extract from the speech Margot Janse delivered at the Eat Out Conference 2012 in Cape Town the day before winning the Eat Out 2012 Chef of the Year award. ILLUSTRATION Sean Robertson The award-winning executive chef of The Tasting Room at Le Quartier Français hotel in Franschhoek, Margot Janse, was born and educated in The Netherlands but she came of age personally and professionally in South Africa. Here, she pays tribute to her adoptive homeland. *smith&nephew offers a comprehensive range of woundcfare dressings for: • Pressure Ulcers • Diabetic Foot Ulcers • Cuts & Grazes • Burn Wounds • Surgical Wounds • Leg/Foot Ulcers Logon to: www.woundwise.co.za for more information.
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