PRIVATE HOSPITAL
CURING BLINDNESS THROUGH YOUR TEETH! JESSICA SK ARR ATT SHARES HER PREGNANCY JOURNEY
Complimentary Pindara Magazine ISSUE TEN 2017
The Foodie’s Guide to
NEW ZEALAND EAT YOUR WAY AROUND THE SOUTH ISLAND
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RECEPTION 07 5591 2111 SALES ENQUIRIES 0488 006 677 70 Marine Parade, Southport, Queensland, 4215 www.thehenley.com.au *Whilst all details have been carefully prepared, no warranty given either expressly or implied by the vendors or their agents in respect of the accuracy of the photographs, information and illustrations. Photographs, information and illustrations are indicative only for presentation purposes and are subject to change. They should not be relied upon as an accurate representation of the final product. Specification may change at any time. TOTO40681. Produced by www.totoandco.com.au
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PERFORMANCE. IT’S WHAT WE DO. BRUCE LYNTON JAGUAR
Life. It’s not about figures. It’s about feelings. The moments that feed your soul. The occasions that take your breath away. The instances that leave you speechless. These are the moments we live for. That’s why our designers and engineers at Jaguar develop a blend of responsive performance that gets your pulse racing, dramatic design that makes you stop and stare and a sense of theatre that stirs your emotions. Our cars are a manifestation of our passion. Performance that cannot be measured, only felt. That’s why we call it art. Discover the full Jaguar range today. Bruce Lynton Jaguar Corner of Southport-Nerang Road and Bailey Crescent, Southport 07 5655 2222 jaguarsales@brucelynton.com www.brucelyntonjaguar.com
THE ART OF PERFORMANCE
CONTENTS
2017
34
37
21
50
Contents
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REGULARS From the CEO Editor’s Desk Pindara News Finance
6 8 10 99
GENERAL HEALTH The dreaded flu season How to protect yourself
14
Going for gold 2017 Commonwealth Games
21
Humans of Pindara Dr Scott Blundell
26
Curing Blindness Through your teeth
29
Back pain study Major milestones
46
32
Unravelling the cancer genome 34 A map of many turns Chronic Kidney Disease The lowdown
37
Weight Loss An affordable option
40
Vaginal Laxity The latest technology
42
Outside the Eye Extraocular surgery
46
Pregnancy Journey Jessica Skarratt
50
Homegrown Health Nutrition for kids
64
Head and neck surgery Latest technological advance
70
LIFESTYLE Travel New Zealand South Island
74
Motoring Aston Martin unveils the RBR Vantage
82
Gizmo Guide Gadgets and more!
88
2017
2017
Top Reads Books for mum
CONTENTS
74
94
82
90
At the Movies 92 Picks and pans from the latest movie releases Dining Autumn Recipes
64
94
88 Gizmo Guide The perfect gadgets for autumn
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FROM THE CEO
2017
Pindara Private Hospital Trish Hogan CEO Pindara Private Hospital Katriya De Vincentiis Nude Publishing Executive Group Editor Published by Nude Publishing a division of Nude Creative Pty Ltd www.nudepublishing.com.au Art Direction, Editorial & Production Nude Creative hello@nudecreative.com.au www.nudecreative.com.au National Advertising Manager Peter Wastie peter@nudepublishing.com.au Assistant Editor Elizabeth Kennedy Marketing Coordinator Pindara Private Hospital
From the CEO Trish Hogan CEO Pindara Private Hospital
Pindara Private Hospital is the Gold Coast’s largest private hospital and this year is shaping up to be one of our busiest. Excitingly, three famous Gold Coast mums have welcomed their first babies into the world at Pindara Maternity in the last few months, including Channel 7 presenters Jessica Skarratt and Liz Cantor, and gold medal winning Olympic swimmer Melanie Wright. It was a pleasure having them at the hospital - as it is with all new mums - and we wish them all the best with their new families. That is not all in the world of maternity, furthering our focus on patient experience, the majority of our Regal Suites also now have a king-sized bed adding a further touch of luxury to the Regal experience at Pindara and facilitating partners’ wishes to sleep alongside new mums during their time in hospital. The redevelopment of the Birth Suites is also progressing with construction due to begin shortly. These improvements will add extra space and modern touches to the facilities, creating a homelike and luxurious environment to assist women in labour to be as comfortable as possible. Our operating theatres have had some exciting new technology delivered making Pindara one of the most advanced surgical facilities on the Gold Coast. We are the first hospital in Australia to implement the Artemis Robot system, which we trialled last year with great results. The Artemis is assisting in some prostate biopsies making them safer and more accurate. Adding to our focus on teaching 6
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and research, we will also be a training site for hospitals who are interested in this technology in the future. The Mako robotic arm assisted technology has also been introduced at Pindara and is the latest apparatus used by orthopaedic surgeons for a range of hip and knee replacement surgeries. From the bones to the organs, interventional gastroenterologists at Pindara have begun to use a double-balloon enteroscope to see further into the small intestine. Previously, patients would have to travel to Brisbane for this type of procedure or undergo a more invasive operation to explore any issues in this area. However, our biggest project this year will be opening The Southport Private Hospital. This will be a brand-new 66-bed facility located on Spendelove Avenue, Southport. The hospital will provide much-needed comprehensive mental health and medical rehabilitation services to the Gold Coast and wider community. The building has had a complete redevelopment and patients will be able to enjoy deluxe, brand-new facilities including spacious, private rooms with ensuites, a large gymnasium, a hair-dressing salon and the Gold Coast’s only indoor hydrotherapy pool. The first stage of the hospital is due to open in April and doctors have begun consulting from the site. Until next time, take care. Warm regards Trish Hogan
MEDICAL CONTRIBUTORS Dr Scott Blundell, Paediatrician Ms Liz Cantor, Channel 7 Presenter Dr Jacobus Jordaan, General and Bariatric Surgeon Dr Mohamed Khafaji, Nephrologist Dr Marco Matos, Medical Oncologist Dr Kylie Mills, Research Data Analyst Dr Drew Moffrey, Obstetrician and Gynaecologist Dr Sharon Morris, Ophthalmic and Oculoplastic Surgeon Ms Jessica Skarratt, Channel 7 Presenter Dr Leong Tan, Neurosurgeon Dr Shannon Webber, Oral and Maxillofacial Surgeon Mr Curt Werner, Infection Control Coordinator, Pindara Private Hospital EDITORIAL CONTRIBUTORS Angela Metohianakis Amanda James Anna Musgrove
Disclaimer. No part of this publication may be reproduced or copied in any form by any means without prior written permission from the Publisher. Opinions expressed in this magazine are those of the authors and not necessarily those of Pindara Private Hospital or Nude Publishing. Every issue of Pindara Magazine is prepared with careful attention to accuracy. Please use this magazine as a general guide. Pindara Magazine expresses the views of the authors and is based on the information available at the time of publication and it is not to be taken as advice. All prices quoted in this publication are correct at time of printing. All editorial material is accepted in good faith. We welcome editorial and photographic contributions.
2017
Obesity affects every system in the body. Surgery can stop weight related health problems in their tracks and reverse the damage within 12 months. Migraines 57% resolved
Depression 55% resolved
Pseudotumor Cerebri 96% resolved
Obstructive Sleep Apnoea 74-98% resolved
High Cholesterol 63% resolved
Asthma 82% improved or resolved
Non-Alcoholic Fatty Liver Disease 90% improved
Heart Disease 82% risk reduction
Metabolic Syndrome 80% resolved
High blood pressure 52-92% resolved
Type II Diabetes 80% resolved
Heartburn 72-98% resolved
Polycystic Ovarian Syndrome 79% resolution of hirsutism 100% resolution of menstrual dysfunction
Stress Urinary Incontinence 44-88% resolved Degenerative Joint Disease 41-76% resolved Gout 77% resolved
Venous Stasis Disease 95% resolved Quality of Life improved in 95% of patients
Mortality 89% reduction in 5-year mortality
Dr Jacobus Jordaan is a Specialist Upper Gastrointestinal and Endocrine surgeon with 25 years of experience. Having performed many thousands of laparoscopic surgical operations, he is among Australia’s most experienced specialists in minimally invasive bariatric surgery. Dr Jordaan is professionally known for his meticulous surgical technique and attention to detail, exceptionally low complication rate, ethical conduct and warm welcoming manner. He has established a strong multidisciplinary team of dietitians, psychologists, nurses, anaethestists and medical specialists to ensure excellent long-term patient results.
MB ChB MMed Surg(Pret)(Hons) FCS(SA) FRACS
E: info@jordaansurgical.com.au T: 07 5556 8888 Suite 14 (Level 2) Pindara Place, 13 Carrara St, Benowa QLD 4217 www.surgicalweightlosscentre.com.au | www.jordaansurgical.com.au
E: info@surgicalweightlosscentre.com.au
2017
Hello and welcome to your Autumn 2017 issue of Pindara Magazine. As the weather finally begins to cool down, we hope you are all taking those extra precautions to keep well this autumn. Don’t let the cool mornings deter you from getting outdoors and exercising – just rug up and go for a walk or run. Not only will your body feel revived, but so will your mind and soul. Autumn is also personally my favourite time of year to be out and about – I love the cool change in the air, and the changing colours of the landscape; the Gold Coast is truly beautiful! If you’re prone to illness during the cooler months, now may also be a good time to consider getting a flu shot. In this issue of Pindara Magazine we have plenty of great content. New mums Jessica Skarratt and Liz Cantor share their pregnancy journeys with us (page 50 and 58), and Drew Moffrey talks about some exciting new technology for post-childbirth rejuvenation (page 42.
Speaking of motherhood, we have a great guide to the latest book releases for Mum this Mother’s Day on page 90. On page 94 there’s also some great autumn recipes for you to cook at home, so maybe you can treat Mum to a home-cooked meal this Mother’s Day too! We hope you enjoy this issue of Pindara Magazine. Until next time … The team at Nude Creative Ask any question ask@pindaramagazine.com.au
Send your letters to letters@pindaramagazine.com.au
Taking care of your greatest asset together.
SERVICING HOSPITALS • JOHN FLYNN • GOLD COAST PRIVATE • PINDARA
Dr Ben Anderson
Cardiothoracic Surgeon MMBS BMedSci FRACS
• Adult Cardiac & Thoracic Surgery • Minimally Invasive Valve Surgery • Minimal Access Sympathectomy for Hyperhidrosis • Minimal Access Lung Resection • Nuss Bar for Pectus • Percutaneous Valve Surgery
Suite 3A, John Flynn Medical Centre Inland Drive, Tugun Qld 4224
Gold Coast Private Hospital Suite 3, 14 Hill Street, Southport Qld 4215
Phone (07) 5598 0789 Fax (07) 5598 0790
heartsurgerygoldcoast.com.au
The Southport Private Hospital The Southport Private Hospital is a brand new healthcare facility located at Spendelove Street, Southport. The new hospital will provide comprehensive mental health and rehabilitation services to the Gold Coast and wider community.
Southport Specialist Suites 25 Spendelove Avenue Southport QLD 4215 T (07) 5671 8999 F (07) 5671 8890 E Psych.TSP@ramsayhealth.com.au
southportprivate.com.au
Gold Coast’s newest specialist mental health facility. Opening from April 2017, a 44-bed rehabilitation unit will offer a range of orthopaedic, neurological and pulmonary rehabilitation inpatient and day programs. Patients will have access to a full suite of services including a multidisciplinary team of medical professionals, onsite gymnasium, the Gold Coast’s only indoor hydrotherapy pool as well as dining and common areas purpose built to make the transition to a home environment as seamless as possible. A range of mental health day programs will also commence in April and a 22-bed inpatient mental health unit is due to open from the end of May 2017, offering acute inpatient mental health programs. These programs are designed by a qualified and experienced team of psychiatrists located onsite at The Southport Specialist Suites. With dedicated group therapy rooms and inpatient facilities, patient experience and privacy has been at the forefront of all design decisions at The Southport Private Hospital. The newly renovated and refurbished facility will house the latest technology and equipment to assist the caring team of medical professionals in providing top-quality comprehensive services onsite. Patients will feel at home in a warm and comfortable environment including facilities such as spacious courtyard, hair dressing salon and balanced, gourmet meals developed by a nutritionist. An onsite café and plenty of parking will also make friends and family feel welcome.
NEWS
2017
A Special Patient for Pindara Private Hospital Turns 21
Transforming Surgery at Pindara
Turning 21 is a big milestone in anyone’s life but for Hannah Calcino she gets to share this momentous occasion with a special milestone in the life of Pindara’s Special Care Nursery, where she spent some of her first days. One of Pindara’s youngest ever patients, Hannah Calcino, was born ten-and-a-half-weeks prematurely at Brisbane’s Mater Hospital in February 1996. After two weeks in Brisbane, Hannah was transferred to the Special Care Nursery in Pindara’s Maternity Unit to be closer to her family home in Nerang. Recently, Hannah turned 21. In 1996, Hannah shared the Special Care Nursery with two sets of premature twins and another premature baby. This was a first for the hospital. Midwife Sandra Logue was working at Pindara at the time and remembers Hannah in the nursery. “I was working here then, and have been here since 1991. At the time Hannah was born there were two sets of premature twins born and another single premature baby also, which made it six premature babies in our. This was the most babies that we’d ever had at any one time in the nursery,” said Ms Logue. There was growing demand for the service on the Gold Coast with Midwife Megan Archer-Jones saying that, “at the time, staff including myself were obtaining higher qualifications so we could care for more premature babies.” A photo of Hannah, along with the other five children, has been displayed on the wall in the Pindara Maternity Unit ever since. This is accompanied by a photo of the same six children on their first day of school.
Pindara Private Hospital is revolutionising arthroplasty surgery at the hospital with the introduction of the latest Mako robotic-arm assisted technology. The Mako robotic-arm assisted technology is used in total hip replacements and partial knee replacements to provide a personalised surgical plan for each patient based on their unique anatomy and assist surgeons to perform these procedures. A total hip replacement is a procedure designed for patients who suffer from noninflammatory or inflammatory degenerative joint disease of the hip while a partial knee replacement is a procedure designed for patients who suffer from degeneration due to osteoarthritis in one or two compartments of the knee. Using Mako technology, a 3D model of a patient’s hip or knee is created based on the CT and MRI scans for an individual, which is then used to assist the surgeon in pre-planning and performing the procedure. Orthopaedic Surgeon Dr Andrew Letchford is fully qualified to use the new technology and said that the Mako is a tool used to increase the accuracy of surgery, specifically in positioning the relevant implant. “Information from a patient’s CT and MRI scans are entered into computer software which is tethered to the robot and increases accuracy of navigation during surgery for the most optimised position,” said Dr Letchford. During surgery, the orthopaedic surgeon can use the Mako to selectively target the damaged part of the knee or hip and replace the diseased part while helping to spare the healthy bone and ligaments surrounding it. The surgeon then guides the robotic arm based on the surgical plan to size and position the implant. “Using a patient’s individual anatomy and morphology increases a patient’s long-term results for joint arthroplasty,” said Dr Letchford. Trials are currently underway to use Mako for total knee replacements.
Hannah Calcino, pictured with photos in the Pindara Maternity Unit of her time in the Special Care Nursery and her first day of school.
The Special Care Nursery has undergone several upgrades in the last 21 years and can now allow leading Gold Coast obstetricians and paediatricians to care for up to 16 babies at a time in a large, comfortable environment with the very latest in equipment and technology. Currently studying a post-graduate degree, the Gold Coast local said she has led a fulfilling life with no residual health issues. “At 5’9”, having played representative netball for the past nine years and travelled overseas on mission programs with my school (Emmanuel College), I like to think that I’m a little reminder to all those parents with tiny, sick babies that from little things, big things grow,” she said.
The Ramsay Rule Pindara Private Hospital recently implemented The Ramsay Rule as part of an Australia-wide initiative by Ramsay Health Care. This excellent patient safety policy provides patients and families in hospital with the steps to call for clinical assistance or review when they are concerned with the clinical condition of the patient. The Ramsay Rule is a three-step process where the patient, their family or carer can escalate their concerns and call for rapid assistance when they believe that something is ‘not right’ with the clinical condition of the patient. Initially, concerns are raised with the nursing staff and the nurse in charge. If the patient or family is still concerned about the patient’s clinical condition, the final step is to ring a dedicated hospital phone number which alerts a senior clinical staff member. This call initiates a clinical review of the patient. The aim of this process is to provide the patient with a timely clinical review by an experienced clinician. In addition, the objective of the program is to acknowledge the patient’s and family’s concerns and take appropriate action. The Ramsay Rule is about keeping our patients safe. The Ramsay Rule is based on the REACH program developed by the Clinical Excellence Commission and Ryan’s Rule developed by Queensland Health.
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FIXING A R ATE OF CHILD SUPPORT BY AGREEMENT - TR ADING CERTAINTY FOR FLEXIBILITY Craig Nicol
C
hild support is a simple enough concept on its surface. The law compels parents to each contribute towards their children’s daily cost of living. The amount payable is calculated by a default formula, ensuring that there are basic rights and obligations for separated parents across the country. The concept of a child support agreement is also simple enough at first, there being mandated types of agreements that enable parents to create their own obligations to pay support and by doing so, replace the default formula with their own agreed entitlements and obligations. Parents can agree upon the amount to be paid, when payments are made, or the method of payment (lump sums, payment of school fees and so on). A child support agreement can be appealing to both parents, as it provides fixed and certain arrangements, unlike the default
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formula, which changes to reflect each parent’s circumstances over time. Parenting, however, is a journey for parents and children alike. Kids grow older and circumstances change. Because of this, locking in long-term child support obligations via an agreement needs to be thought through. What happens if things radically change down the track? This was the case for Mr Cheyne in the recent Full Court case of Masters & Cheyne, where a binding Child Support agreement compelled the father to pay $240 per week to the mother. That agreement was struck when the parents’ son lived with the mother and spent five nights per fortnight with the father. Circumstances changed when the mother moved interstate. The child commenced living with the father, leaving him with an unwanted, ongoing obligation to pay the mother support pursuant to their agreement.
2017
Despite seeking relief from the court, the Full Court of the Family Court decided that Mr Cheyne remained liable to pay the mother – or more accurately, that there were no grounds to set the agreement aside. Let’s look at why. Firstly, the three judges who heard the case had different views as to when obligations pursuant to a child support agreement come to an end. One said that such an obligation could only end in the manner described in the legislation – which is one of three ways: i) per the terms of the agreement itself; ii) a further agreement; or iii) the court setting the agreement aside where there is “exceptional circumstances” and “hardship”. Another judge said that there was a fourth option, being when the default formula ends. This includes the death of parent, the child turning 18, or the child becoming a member of a couple. The third judge said that this particular issue did not need to be decided. Secondly, all members of the Full Court held that there was no evidence that the changed circumstances created hardship for Mr Cheyne, particularly when his superior financial position was considered. Passages of the judgment stress that binding agreements are necessarily difficult to set aside. There is no requirement for an agreement to provide for a “fair deal” or that the agreed obligations reflect the default
formula in any way. Further, parents entering into binding agreements can be assumed to have elected for “certainty” over “flexibility”, such that a parent wishing to rely upon a later change of circumstances can expect firm resistance, if they have not explicitly made provision for their agreement to end in particular circumstances. Mr Cheyne’s tale is one with lessons for all parents who receive or pay child support, or are considering a child support agreement. Where the vicissitudes of life itself make changes foreseeable – be it care arrangements; work and unemployment; salary; children’s expenses; or a parent’s financial position generally – a parent choosing to proceed with a binding agreement must carefully consider when they want an agreement to end – in effect, trading certainty for flexibility. As highlighted in Masters & Cheyne, the benefits of locking in an arrangement are accompanied by some potentially onerous obligations if circumstances change. Ideally, parents should obtain legal advice around their child support options and any proposed agreement, as one size does not fit all. The second point to take from the case is that the law as to child support agreements is still developing. Specialist legal advice can assist parents keep up with the latest trends.
Craig is an Accredited Specialist in Family Law, a Partner at Small Myers Hughes Lawyers and Co-editor of ‘The Family Law Book’ - a publication for family lawyers across Australia.
Specialist Legal Advice Our team of Specialists has provided successful outcomes to the medical industry for over 25 years. Tax, asset protection, commercial advice and relationship advice pertaining to: • Medical practice startups • Mergers • Admission of practice partners • Capital Gains Tax & revenue advice on practice sales • Personal asset protection • Succession • Estate Planning • Family & Relationship Law • Commercialisation of medical opportunities
Leading Family & Divorce Law Firm 2014 - 2016
Leading Tax Law Firm 2015 - 2016
David Hughes & Jodie Mills
Michael Small & Craig Nicol
Col Myers
Contact us today to find out how we can assist you 07 5552 6666 | info@smh.net.au | www.smh.net.au
the dreaded
FLU season
Mr Curt Werner, Infection Control Coordinator, Pindara Private Hospital.
The fact that it’s colder in winter doesn’t explain why the flu is more prevalent. So why do we have ‘flu season’ and what can be done about it?
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FIRSTLY, WHAT IS INFLUENZA? Influenza, or ‘the flu’, is a highly contagious acute respiratory illness caused by influenza viruses. There are three main types of influenza viruses that cause infection in humans - types A, B and C. Influenza is not the same as the common cold. While a common cold is considered quite mild - people’s immune systems are able to fight it off within a few days without any intervention influenza can be a dangerous illness, regardless of age. Young and healthy people can take up to two weeks or more to fully recover, and those 65 and older are in the high-risk group.
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A SMALL, RELATIVELY PAINLESS NEEDLE IS THE ONLY DISCOMFORT, AND THE POSITIVES FAR OUTWEIGH THE NEGATIVES WHEN IT COMES TO VACCINES.
How do I catch influenza? People catch influenza through exposure to the influenza virus, usually from another person already infected. Winter is the peak activity time for influenza, and it all comes down to the air getting drier in the winter. When a person carrying the virus sneezes or coughs, the virus becomes airborne in tiny droplets of water, which can then infect anyone they come into contact with. In humid weather, like the Australian summer, the droplets containing the virus pick up water and grow larger making them more likely to fall to the ground quickly. In colder weather, the droplets stay airborne longer, making it more likely to be picked up by a passer-by. Spending more time indoors with people who may be carrying the virus during the winter - for instance on public transport - also increases infection rate. The shorter days during these cooler months also lead to less sunlight exposure and lower vitamin D, which can help boost the body’s immune system, making people more vulnerable to infection during this time. The good news is that influenza is a vaccinepreventable illness, however a new vaccine is needed each year as influenza viruses change and mutate constantly. The virus can change so much in one year that the vaccine given the previous year is no longer effective. A new influenza vaccine is prepared each year to best match the strains predicted for the coming season.
Should I have an influenza vaccination? A seasonal influenza vaccination given each year before winter is the best way to prevent the flu. People at higher risk of complications from
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influenza are strongly recommended to have the annual vaccination. The most high-risk group of people are those over 65 years of age, and especially those suffering from a repository condition. People of any age who have respiratory conditions such as asthma or emphysema are also encouraged to get a yearly vaccination. Contrary to popular belief, the influenza vaccine does not contain any live viruses and therefore cannot cause the illness. The vaccine, however, can take two to three weeks to reach its full potential and consequently the flu can still be caught in this time. Serious adverse reactions to the influenza vaccine are rare, with the most common reactions being local redness and swelling of the injection area. Other mild symptoms can include headache, mild fever and sore muscles, which may occur in 1-10% of people vaccinated - but these symptoms are limited to a 24 to 48 hour period. If you have had the flu, you know how hard it can hit. It can take two weeks or more to recover, and you will likely need time off work. Plus, you’re at risk of spreading the flu to family and friends, so it’s a good idea to consider a yearly flu shot.
What if I don’t like needles? A small, relatively painless needle is the only discomfort, and the positives far outweigh the negatives when it comes to vaccines. The phenomenal outcomes from vaccines are well and truly documented. Smallpox has been eradicated, and the last death in Australia from measles was in 1995.
2017
INFLUENZA
COLD
Duration of symptoms
Typically 1-2 weeks minimum
Few days
Fever
Often high fevers
Mild
Muscular aches
Common
Rare
Recovery time
Several weeks
Days generally
Severe illness
Reported serious consequences including hospitalisation and death
Rare
IN ADULTS, THE MAIN SYMPTOMS OF INFLUENZA INCLUDE: Fever, dry cough, muscle and joint pain tiredness/extreme exhaustion, headache, sore throat
FLU MYTHS 1. You can catch the flu from the flu vaccine. A flu shot cannot cause the flu illness. The vaccine is made from an inactivated virus that can't transmit infection. It takes a week or two to get protection from the vaccine so it is still possible to get sick during this time until the protection reaches its full potential.
2. Healthy people don't need to be vaccinated. Healthy people can benefit from getting the flu vaccine. It is recommended that children aged six months to 19 years old, pregnant women, and anyone over the age of 65, be vaccinated each year. In addition, the flu shot is recommended for healthy people who might spread the virus to others who are particularly susceptible.
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3. Getting the flu vaccination is all you need to do to protect yourself from the flu. There are a number of steps you can take to protect yourself during flu season besides vaccination, such as avoiding contact with people who have the flu, and washing your hands frequently.
4. It is better to get the flu than the flu vaccine. The flu can be a serious disease, particularly among young children, older adults, and people with certain chronic health conditions, such as asthma, heart disease or diabetes. Therefore, getting vaccinated is a safer choice than risking illness to obtain immune protection.
5. The flu is just a bad cold. The flu and a cold are different illnesses. Influenza may cause bad cold-like symptoms, like a sore throat, runny nose, sneezing, and a cough, but it is a much more serious illness. Dr Cary has 24 years experience in assisting women with pregnancy, gynaecology and IVF issues. He is able to assist with all women’s issues
• • • • • •
6. You can't spread the flu if you're feeling well. Many people carrying influenza virus have no symptoms.
Infertility Painful and heavy periods Pregnancy care Day Surgery Gynaecological surgery Contraception
7. Once you have had the flu vaccine, you’re protected for life. The influenza virus changes (mutates) each year. Getting vaccinated each year is therefore important to make sure you have immunity to the strains most likely to cause an outbreak.
8. You can catch the flu from going out in cold weather.
reception@drcary.com.au 07 5597 3770 www.drcary.com.au
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SUITE 10, PINDARA PLACE CARRARA ST, BENOWA, QLD, 4217
The only way to catch the flu is by being exposed to the influenza virus. Flu season coincides with the cold weather. People often associate the flu with a cold, drafty environment. However, they are not related. 2017
9. Pregnant women should not get the flu vaccine. The flu vaccine is safe for all stages of pregnancy. Getting the flu while pregnant can be dangerous for both mum and baby.
10 Feed a cold, starve a fever. If you have the flu (or a cold) and a fever, you need more fluids. There's no reason to increase or decrease how much you eat, however poor nutrition will not help recovery.
11 The flu can be cured with antibiotics. Antibiotics work well against bacteria, but they aren't effective for a viral infection like the flu. It may still be a good idea to get checked out if your symptoms are persistent or worsen.
12 The flu includes gastrointestinal symptoms. As miserable as symptoms of the flu are, digestive distress is rarely one of them. The colloquial term "Stomach Flu" refers to a group of separate viruses that primarily cause vomiting and diarrhea.
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going for
GOLD HEALTH CARE DURING THE GOLD COAST 2018 COMMONWEALTH GAMES
I
just about a year’s time, the eyes of the world will be on the Gold Coast as the n Queen’s Baton approaches Carrara Stadium and the 21st Commonwealth Games gets underway. The Gold Coast 2018 Commonwealth Games (GC2018) is the largest event ever hosted in Queensland, and the largest in this country for a decade. More than 6,600 athletes and team officials from 70 nations and territories will be on the Gold Coast with an international media contingent of close to 3,000 photographers and journalists. Athletes will compete in 18 sports and seven para-sports - the largest integrated sports program in Commonwealth Games history across 24 Games venues made up of 18 competition venues, the main media centre and Games Village. GC2018 will be delivered with the help of 15,000 volunteers. Up to 1.5 million spectators are expected to attend events with the Games broadcast to a cumulative television audience of 1.5 billion people. This scope of this event is unlikely to
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WHAT WILL BE CONCEPTUALLY DIFFERENT AT THE GC2018 FROM PAST EVENTS IS THE WAY MEDICAL SERVICES ARE DELIVERED.
ever be seen on the Gold Coast again and the approach to the delivery of medical services will play a crucial role in Games operations.
A NEW-AGE APPROACH TO GAMES MEDICAL SERVICES A new integrated approach to better deliver medical services during the GC2018 is set to deliver a new blueprint for future events. The provision of medical services has long been a deliverable of the relevant organising committee – in this case, the Gold Coast 2018 Commonwealth Games Corporation (GOLDOC) – as set out by the Commonwealth Games Federation Medical Commission. What will be conceptually different at the GC2018 from past events is the way medical services are delivered. In a move to improve integration of Games time medical services with business-as-usual local health
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services, a project manager from the local health service has been appointed to lead the GC2018 medical team. Where in the past, the duplication of existing medical services has been the norm for Games organisers, this strategic approach is already showing success by reducing the complexity of layers, streamlining the delivery approach and working in partnership with local health service providers. Working closely with key partners Queensland Health and Queensland Ambulance Service (QAS), the GOLDOC medical team are working to create a collaborative and integrated ‘whole of health service’ model for the Games. GOLDOC have developed a comprehensive medical program that will deliver safe, appropriate healthcare to all persons across official Games venues during the Games period of 20 March to 18 April 2018. Services will be delivered by experienced and skilled volunteer healthcare professionals at official training, competition and non-
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The medical program details a range of medical and healthcare services available for accredited Games client groups and spectators, including: • • • • • • • • • •
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Commonwealth Games Village Polyclinic Athlete medical services at competition and training venues, including Field of Play medical teams First-aid at training, competition and non-competition venues Medical clinics at selected non-competition venues Team physiotherapy program Wheelchair and prosthetic repair service Support for Commonwealth Games Association medical teams Access to hospital and emergency care Access to public health information Communicable disease and public health incident response
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GUIDED BY THE UPTAKE OF MEDICAL SERVICES IN GLASGOW, FORECAST AND CAPACITY PLANNING ANTICIPATES OVER 6,000 MEDICAL ENCOUNTERS AT GC2018
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competition venues, with the key objective of reducing hospitalisation rates and the impact on business-as-usual for local health services and the Queensland Ambulance Service. Under the program, access to medical services will be prioritised accordingly with competing athletes receiving the highest priority care – outside of medical emergencies – to ensure that the competition schedule and athlete participation is not impacted.
COMMONWEALTH GAMES VILLAGE (CGV) POLYCLINIC A multidisciplinary polyclinic will be located within the CGV to provide an extensive range of medical and healthcare services for all Village residents, including sports medicine, sports physiotherapy, massage & podiatry, radiology, optometry, dentistry, and pharmacy. Emergency medical services will be provided 24 hours a day. Historically, the polyclinic experiences the highest demand for medical services during the Games, catering for up to 80 per cent of all medical encounters. Demand for these services is growing with each Games, with 250 encounters per day recorded at the 2006 Games in Melbourne, growing to over 400 encounters per day at Glasgow 2014. Guided by the uptake of medical services in Glasgow, forecast and capacity planning anticipates over 6,000 medical encounters at GC2018, of which two-thirds will most likely be injuries. Sports and exercise physicians and emergency physicians will be on hand to respond to injuries and medical emergencies, with support provided by an onsite satellite pharmacy from the local health service. Within the polyclinic itself, Sports Massage Services are anticipated to be in high demand, with a predicted 2,000 encounters planned for. There will be also approximately 700 radiology and imaging investigations – some of which will be carried out by x-ray and ultrasound at the polyclinic, with MRI and CT services being provided off-site. Despite sports massage services being in such high demand within the polyclinic, physiotherapy is historically the most sought-after service at the Games. Essential dentistry, sports podiatry and optometry services will also be provided at the Village Polyclinic to ensure that athletes have ready access to the services they need to be able to compete at their optimum level.
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TRAINING AND COMPETITION VENUES Medical and healthcare services at training and competition venues will range from first aid through to emergency response, and will be delivered on the Field of Play, in the Athlete Medical Facility or through the first response service. A multi-disciplinary team of volunteer medical and healthcare professionals will be based on the Field of Play to provide immediate medical response for illness and injury sustained in the course of competition. The Field of Play team will be staffed according to the risk level of the sport, the number of participating athletes and International Federation requirements and will differ from event to event. All competition venues, and many training venues, will also have an Athlete Medical Facility onsite. These facilities will be located back of house, and staffed by sports physicians, emergency doctors, sports physiotherapists, sports massage therapists and nurses. Athletes, team officials and technical officials will be able to seek medical treatment within these facilities.
CARING FOR SPECTATORS A first response model of care focuses on optimising spectator experience and maximising safety. This will be achieved through a three-tier team structure, which will see teams of experienced Advance First Aiders supported by the Queensland Ambulance Service (QAS) and a Medical Response Team of doctors. Low acuity patients will be managed on venue and discharged back to the event, or referred to other allied health services. The front of house team will be adequately skilled and equipped to provide suturing where required, with a recommended GP follow up for further treatment. For high acuity patients, the Medical Response Team will provide advanced management in collaboration with the QAS. This will result in patients being assessed and treated earlier and the appropriate triage and transport of patient to the right facility for timely treatment. In terms of legacy for the Gold Coast, it is already clear that improved collaboration, integration and cooperation between the local medical and healthcare delivery sectors will leave nothing but a positive legacy.
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HUMANS of Pindara
SCOTT BLUNDELL GENER AL PAEDIATRICIAN Dr Scott Blundell studied medicine at the University of Sydney before training in paediatrics at Royal Children’s Hospital, Brisbane.
D
uring this time he worked in Paediatric Intensive Care and Neonatal Intensive Care as well as renal and neurological specialty areas. In addition to his medical qualifications, Dr Blundell is a qualified physiotherapist, winning the prestigious University Medal for Physiotherapy at Sydney University and working for two years as a paediatric physiotherapist at the Children’s Hospital at Westmead before starting medical training. Dr Blundell is currently part of the paediatrician team with the Leading Steps Paediatric Clinic, located in Pindara Specialist Suites.
What does a paediatrician do? A paediatrician looks after the physical and mental health needs of children and their families from birth through to early adulthood. My day usually starts with checking on newborn babies on the ward, some sick newborns or growing premature babies in the special care nursery, and some sick kids on the kids' ward. I then usually spend the day seeing children in my rooms who have a mix of medical or developmental problems. Why Paediatrics? Kids are awesome. They are usually so positive and motivated to get better. They love having fun and there would rarely be a day where one of my patients doesn’t put a smile on my face. As a general paediatrician I never know what is going to walk through the door and the range of things I can see in one day is amazing. Ultimately, the most rewarding part of my job is being involved in some of the most memorable moments of people’s lives, the highest of highs and the lowest of lows. It’s an honour as a general paediatrician to be invited to walk that journey with children and their families
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KIDS ARE AWESOME. THEY ARE USUALLY SO POSITIVE AND MOTIVATED TO GET BETTER. THEY LOVE HAVING FUN AND THERE WOULD R ARELY BE A DAY WHERE ONE OF MY PATIENTS DOESN’T PUT A SMILE ON MY FACE.
When did you know you wanted to be a paediatrician? Before I studied medicine I worked as a physiotherapist at a large children’s hospital, so there was always a good chance that I would become a paediatrician. During my first two years as a doctor I noticed in my emergency terms that I much preferred to see the kids than the adults, so I asked for some paediatric terms and it all fell into place from there. How long have you been doing this? I started my paediatric training in 2007 and finished my specialist training at the end of 2012. I’ve been working the last four years as a consultant paediatrician at Pindara Private Hospital. Tell us about the teaching you do? I love teaching, and I find that most doctors, nurses and allied health are very receptive to learning about looking after sick kids. In addition to teaching at education events, I also teach medical students and junior medical staff in the public health care system. I also instruct on the Advanced Paediatric Life Support (APLS) course, which teaches doctors and senior nurses how to resuscitate and stabilise critically unwell children.
What do you like best about working at the hospital? The staff are the best thing about working at Pindara. Not only is everyone very professional, they are all friendly and caring towards their patients. It’s a genuine community. What advice would you give to anyone wanting to start out in this field? It’s a long road, but nothing worth doing was ever easy. What do you like to do in your spare time? Since coming to the Gold Coast I’ve really gotten back into fitness. I go regularly to a boot camp and do a few obstacle course races a year. I did my first marathon last year and am currently training for a half marathon on the Great Wall of China in May. I’m also a rabid supporter of the mighty Canberra Raiders and love coffee. What do you like the most about living on the Gold Coast? The outdoors lifestyle. You can go to the beach before work and wear shorts all year round. What more do you want?
DR SCOTT BLUNDELL
If you weren't a paediatrician, what would you be doing? Possibly a professional stuntman, though my lack of hand-eye coordination might end my career prematurely. What brought you to the Gold Coast? I am originally from Queanbeyan, just outside of Canberra and studied in Sydney before doing my junior years in Canberra. I eventually ended up on the Gold Coast by chance. I came here for six months in my last year of training, loved it and was lucky enough to have an opportunity to work here at Pindara.
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Special interests: • • • • •
Endocrine disorders Renal conditions Neurological conditions Neonatology All aspects of general paediatrics
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curing
blindness with teeth
AN AUSTR ALIAN FIRST
Dr Shannon Webber, Oral and Maxillofacial Surgeon
In a remarkable first for the Australian medical industry, Pindara Oral and Maxillofacial Surgeon Dr Shannon Webber restored the eyesight of patients using a tooth transplant inserted into the eye.
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he story is certainly making waves nationally, and with good reason. Two patients, who have collectively spent 50 years without sight, have been able to see their families again in an extraordinary procedure that was first performed in Europe, and modified by Dr Webber and Ophthalmologist Dr Greg Moloney at the Sydney Eye Hospital just recently. The operation involved taking tissue from the mouth, as well as a tooth with an “optic” glued into it, and sewing it into the front of the eye, creating a new cornea (surface of the eye) that allows light to enter the eye and restore sight. “After completing the procedure for the first two patients in Sydney, they both have extremely good vision with minimal scarring,” said Dr Webber. “You wouldn’t know they had surgery aside from a slightly pink-coloured surface to the eye. It’s amazing to think that days after we completed the surgery, both patients had excellent vision after being blind for decades.” “With the aid of some glasses, both were reading the newspaper with no assistance, which is simply astonishing,” he said. Called Osteo-odonto-keratoprosthesis (OOKP), this procedure was first developed by Italian doctor Benedetto Strampelli in the 1960s with the aim to restore the vision of those who were blind due to scarring of the cornea most commonly from a burn, autoimmune disease or splash injury. “The rest of the eye needs to be functioning normally and essentially the operation changes up ‘the windscreen’ or surface of the eye,” said Dr Webber.
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According to Dr Webber, the procedure is performed in two stages: 1a. The first stage involves preparing and “tidying up” the front surface of the eye. A mucosal tissue graft is then harvested from inside the patient’s cheek and secured to the surface of the eye by draping it over the cornea and sewing it to the muscles that move the eye. 1b. A tooth, usually the third or “canine” tooth, is then delicately removed as a block, with the surrounding bone and tissue left intact. The tooth and surrounding bone is then cut down in size, shaped and contoured before drilling a fine hole through the centre of the tooth allowing a small optical cylinder to be cemented into place. 1c. The tooth is then placed into a pocket created in the cheek under the person’s opposite eye. It stays in the cheek for approximately three months until a tissue covering grows onto the tooth and its surrounding bone. 2a. During the second stage, the mucosal tissue that was previously draped and sewn over the surface of the eye is raised up allowing the surface of the eye (cornea) to be seen. A hole is then made in the cornea and some volume along the lens is removed from the front of the eye. 2b. The tooth, with the optic cylinder glued into it, is removed from the cheek pocket and then placed into the front eye. It is sewn into place “watertight” by utilising the tissue that has grown around it.
Osteo-odonto-keratoprosthesis is generally seen as a last resort option for cases where patients are unsuitable for synthetic grafts or where corneal grafts/transplants haven’t survived in the eye due to extensive scarring or rejection. “While there is not a large demand for the surgery in Australia due to the low number of cases of corneal blindness, the extremely difficult and technically challenging surgery is a wonderful gift to give to Australians who have been without sight for many years, sometimes, their entire life,” said Dr Webber. Both Dr Webber and Dr Moloney modified and adapted the procedure after watching it performed in Europe – technically making their procedure a world-first. The modification involved creating a better blood supply to the tissue placed onto the front of the eye, by rotating some tissue, with its own blood supply, from the patient’s scalp into the damaged eye. The aim was to prevent the bone around the tooth dissolving and reducing the failure rate of the surgery even further. “The reason this operation usually fails is because the tooth extrudes itself from the eye due to a lack of blood supply,” he said. The success of both procedures means Dr Webber is hopeful that his adaptation will be an improvement of the already high success rate of the surgery for deserving Australians. After the recent second stage of surgery, and a week in hospital, both patients have successfully returned to their respective homes and will be followed closely for the rest of their lives.
2c. Once complete, the mucosal graft is returned to its original position by draping it over the tooth and making a small hole so that the optic penetrates the mucosa and “pokes through”, allowing light to enter the eye and thus creating vision. 30
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TECHINCALLY MAKING THEIR PROCEDURE A WORLD-FIRST.
DR SHANNON WEBBER, ROSS COULTHART AND DR GREG MOLONEY
Dr Brent McMonagle MBBS, PhD, FRACS (ORL) Dr Brent McMonagle is an ENT surgeon on the Gold Coast with sub-specialty training in otology, neurotology, sinus and skullbase surgery. He has strong research and teaching interests at Griffith and Bond Universities. He has just commenced work on olfactory cell transplants in spinal cord repair, continuing the pioneering work of Prof Alan Mackay-Sim, Australian of the Year 2017, as well as further research in peripheral nerve repair and regeneration.
SPECIALISING IN Hearing Loss • Tinnitus • Otitis Media • Exostoses • Mastoidectomy • Myringoplasty Dizziness • Otosclerosis • Cochlear Implants • Cholesteatoma • Stapedectomy Ossiculoplasty • Nasal Obstruction • Acoustic Neuroma • Facial Palsy • OSA • Rhinitis Adenotonsillectomy • Nasal Polyps • Sinusitis • Pituitary Tumours • Parotidectomy
A. Suite 4, AHC House, 14 Carrara St, Benowa, 4217
E. office@drbrentmcmonagle.com.au
F. (07) 5539 1581
W. drbrentmcmonagle.com.au
(07) 5539 2399
MAJOR MILESTONE REACHED FOR INTERNATIONAL
BACK PAIN STUDY
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BELOW: DR TAN WITH PATIENT OPPOSITE: DR STEPHENSON WITH PATIENT
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ow back pain is one of the most common symptoms patients visit their doctor for on the Gold Coast. From long-term, severe pain to ‘putting your back out’ from a sneeze, there are a variety of conditions associated with the complex network of muscles, nerves, bones, discs and tendons which may be involved in causing low back pain. Pindara Private Hospital’s international research into surgery for this common ailment has proven popular among patients, with more than 100 participants signed up to complete the study since it was launched last year. The study focuses on tracking the outcomes of spinal surgery treatment undertaken by some of Queensland’s leading neurosurgeons and benchmarking these outcomes against other international organisations or, in other words, compiling information to help surgeons accurately predict the expected improvement for the patient from different spinal surgeries. Pindara was the first hospital in Australia to launch this world-class research ten months ago, which is part of the International Consortium for Health Outcomes Measurement (ICHOM) global collaboration to measure patient outcomes. Lead investigator on the study, Neurosurgeon Dr Leong Tan said people with low back pain need the best information to make informed decisions about the expected outcomes of spinal surgery. “The data gathered in this project focuses on what matters most to patients. Patients want to know how they will fare after treatment, can they return to work and whether they will need pain medication, require additional treatment, be able to take care of themselves and most importantly, will their symptoms improve? “This study will help to guide the medical profession globally in choosing the best types of surgery for specific spinal conditions because benchmarking articulates what treatment works best for the various types of conditions,” he said. Data Analyst for the study Kylie Mills says that the use of technology such as tablets and online forms has allowed for such a positive response. “We have a unique use of technology in the study which has been used to enable patients easy and fast capture of data.” “It has been fantastic to get feedback from our patients about their experiences at the hospital and how their lives have been changed by their treatments. “We have entered the follow-up phase of our study and our initial results are looking promising. We are happy to see improvements in many aspects of patients’ lives including pain, pindaramagazine.com.au
physical health outcomes and most importantly in quality of life indicators. “We follow up with patients several times after surgery within a two-year time frame so this study will continue for several years to get a really good picture of our patients’ lives before and after surgery,” said Dr Mills. CEO of Pindara Private Hospital, Trish Hogan, said outcomes that matter most to patients are the ultimate success in health care. “There can be a considerable difference between what a health professional considers a successful treatment outcome, compared to the patient. When we can achieve what matters most to the patient, we deliver true value. “Taking part in this international research is very exciting for Pindara,” she said.
“It enables Pindara to contribute to important global research in low back pain, and to share with specialists from around the world in order to make improvements in the treatment of low back pain.” Pindara Private hospital has specialist expertise in spinal surgery. The hospital has a dedicated Neurosciences Unit which is serviced by an excellent team of neurosurgeons and orthopaedic specialists. Pindara Neurosurgeon Dr Leong Tan leads the study and is joined by colleagues Drs Ellison Stephenson, Chris Schwindack and Anna Chang. As an ICHOM partner, Pindara Private Hospital is in the good company of leading medical institutions, including the Boston Children’s Hospital, Great Ormond Street Hospital in London, and Erasmus MC in the Netherlands. Pindara Magazine
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UNR AVELLING THE CANCER GENOME: A MAP OF MANY TURNS AND TARGETS
Dr Marco Matos, Medical Oncologist
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eoxyribonucleic acid or DNA is the building block of life. Every human is made up of cells containing DNA and a combination of a person’s entire DNA contained in their cells is their genome. In most cells, the genome is packaged into two sets of chromosomes: one from each parent. These are the genetic instructions which determine a person’s appearance, function and biology. Thinking about the population on the planet, it is easy to see how many variations and combinations can be expressed from DNA. Not only does this genetic code determine how a person looks and acts, but it can also determine disease in that individual. For over 15 years, scientists have been working on mapping the human genome to discover what each part of DNA controls. In 2003, the Human Genome Project published the final sequencing of the human DNA at a cost of three billion dollars. One by one, every base pair of the 3.3 billion chemical units (base-pairs) forming the human genome was revealed. This opened up a range of incredible opportunities in the field of molecular medicine and human evolution. The beginning of a huge new world of discoveries commenced. The first human genome did not belong to a specific individual donor but from a mix of a small group of European donors. Since then, studies of DNA variation have started in the international HapMap Project involving 270 individuals of different ethnic races. The DNA alphabet only contains four letters;
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A, C, G and T (Adenine, Cytosine, Guanine and Thymine). These letters form pairs. The sequence of these base pairs composes a book of six billion individual letters. As a comparison, the Encyclopaedia Britannica has 300 million letters. Imagine the task ahead; letters after letters is only the beginning, making sense of the words and the sentences (genes) is an even more enormous challenge. We have a huge book of six billion characters. Now we have to understand how these pages work together to create life, health and disease. Two years after the final sequencing, at a cost of over 270 million dollars, The Cancer Genome Atlas (TCGA) program was established to start unravelling the most common genetic alterations (mutations) of the 25 most common cancers. In cancer cells, small changes in the genetic letters can change what a genomic word or sentence means; these are mutations. For example, it can cause the cell to make a protein that doesn’t allow the cell to work as it should, such as making cells grow quickly and cause damage to surrounding cells. By studying the cancer genome, scientists are able to discover what letter changes cause a cell to become cancer. Since 2003, when the Cancer Genome Project started, the altered words (mutations) that contribute to the formation, growth and spreading of cancers have been found. Genes that protect the DNA (tumour suppressor genes) and genes that can cause cancer (oncogenes) have also been described. The genome of a cancer cell can also be used to tell one type of cancer from another. However, many mutations occur for a
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cancer to form, acquire selfsufficient growth, have resistance to the different body-control mechanisms, and finally cause disease by spreading and invading other tissues. These mutations also contribute to creating pathways responsible for the behaviour of mutated cells. There are pathways that lead to cell growth: cell proliferation, cell invasiveness and cell survival or death. The connection between mutations and pathways remains incompletely explored, leaving many answers yet to come. The challenge is even larger in that reading the 22,300 genes discovered, scientists need to understand the message contained in all the other molecules (proteins) that regulate, accelerate or inhibit gene function in order to fully understand the mutations that cause cells to become cancer. The information we have gained in the last 15 years means that at the personal level, we now have technology that allows doctors to individualise treatment by targeting abnormal “mutated� genes. There are a number of drugs available in daily practice, which are proven to have incredible activity against specific mutated genes.
WE HAVE A HUGE BOOK OF SIX BILLION CHAR ACTERS. NOW WE HAVE TO UNDERSTAND HOW THESE PAGES WORK TOGETHER TO CREATE LIFE, HEALTH AND DISEASE.
TARGET
DRUG
CANCER TYPE
Her 2
Herceptin Trastuzumab Pertuzumab Lapatinib Ado-trastuzumab emtasine Dabrafenib Vemurafenib Trametinib Tamoxifen arimidex Letrozole Exemestane
Breast stomach
Cetuximab Panitumumab Imatinib dasatinib
Bowel cancer Head and neck cancers Leukemia Gastrointestinal stromal tumour Dermatofibrosarcoma protuberans Colorectal, ovarian, cervical, gastric
BRAF MEK ER/PR
RAS Bcr-Abl fusion c-KIT VEGF Hedghog
This table shows the targeted molecules, the
PDL1
available drugs and the
CTLA4
most common cancers
mTOR
carrying these targets.
Personalised medicine is a reality for some of those people suffering from cancer. Many more therapeutic options are now available to treat these diseases and more are being developed every day. However, many questions remain unanswered and many new questions arise all the time. But the future looks promising and hope is at hand. 36
PD
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CDK4 and CDK6 RANKL EGFR
ALK and ROS BRCA AR cMET VEGFR1 - 3 RET PDGFR, EGFR VEGFR cKIT
Bevacizumab Aflibercept Ramucirumab Vismodegib Sonidegib Nivolumab Pembrolizumab Atezolizumab Durvalumab Ipilimumab Tremelimumab Everolimus Temsorilimus Palbociclib Denosumab Erlotinib Gefitinib Afatinib Osimertinib Crizotinib Ceritinib Olaparib Rucaparib Enzalutamide Abiraterone Cabozantinib Vandetanib Lenvatinib Pazopanib Sunitinib Sorafenib Regorafenib
Melanoma Melanoma Breast cancer
Basal cell carcinoma Melanoma, lung, bladder, kidney, Lung and bladder Melanoma Breast, kidney, neuroendocrine Breast Ginat cell tumor Lung
Lung Ovarian Prostate
Kidney, liver, gastrointestinal stromal tumour
2017
CHRONIC KIDNEY
DISEASE Dr Mohamed Khafaji, Nephrologist
Chronic kidney disease (CKD) is a condition characterised by gradual decline of kidney function over time that becomes permanent.
K
idney disease is a growing health issue with one in three Australians having an increased risk of developing this condition and one in ten currently having chronic kidney disease (Kidney Health Australia). With effective management of kidney disease at an early stage, the rate of deterioration of kidney function can be markedly reduced or even reversed. Innovative products and therapies for treatment of patients with chronic kidney disease have now allowed improved quality of life for many individuals. Early detection of chronic kidney disease and timely specialist referral is vital to effectively manage the stages of chronic kidney disease and achieve the best possible outcomes. Multiple risk factors such as diabetes, high blood pressure, smoking, being over 60 years old, a family history of the disease and heart problems will increase the likelihood of developing kidney disease. With diabetes and high blood pressure as the dominating causes, effective management and control of these conditions will greatly reduce the time it takes to develop kidney disease to end stage. To help improve the effectiveness of treatment for people with declining kidney function, the National Kidney Foundation (NKF) developed a guideline to help identify the degree of kidney disease. Chronic kidney disease is divided into five stages with stage one being mild kidney disease, up to stage five being end-stage kidney disease. Early detection is vital to offer optimum care and best outcomes for individuals diagnosed with the disease. A simple urine or blood test can show early signs of kidney disease. Glomerular Filtration Rate (GFR) is the best measure of kidney function. The GFR is a number to determine the stage of kidney function and is derived from a formula using age, gender and serum creatinine. Further tests such as an ultrasound, CT or kidney biopsy will help confirm the cause of chronic kidney disease and the best management plan to slow or reverse the deterioration of kidney failure. The majority of people won't display any symptoms until the advanced stages of kidney disease. Up to 90% of kidney function can be lost before any symptoms are obvious. Although, notable small changes such as lethargy, poor concentration, sleep disturbances, reduced appetite, cramps and itchy skin may well be present earlier.
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HEALTH PROMOTION IS THE MAIN OBJECTIVE OF KIDNEY DISEASE.
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Testing for chronic kidney disease when any associated risk factors are present should be part of an annual health check. General practitioners will promote this and offer timely specialist referral to a nephrologist for ongoing and collaborative management of individuals identified with kidney disease. The timing of a referral for these patients to a nephrologist may have an impact on the timing of dialysis initiation. Referral currently occurs at various stages of kidney disease. An early referral allows the opportunity for a specialist to assess the rate of disease progression, exclude any reversible causes and allow for adequate dialysis planning to optimise patient outcomes. With late stage chronic kidney disease, the decision of when to initiate dialysis therapy is multifactorial. There is a large variability in the timing due to nonspecific and vague symptoms of uraemia (urine in blood) and the speed of kidney decline. Dialysis should be considered when the benefit from relieving these symptoms outweighs the risks and their associated effect on quality of life. Preparation for dialysis is integrated into patient care in the late stages of chronic kidney disease. Ideally, the decision to start dialysis is made after careful consideration for kidney transplant, a chosen dialysis modality and once a functioning access has been created. Various international guidelines assist with the approach and timing of dialysis initiation. Some guidelines recommend dialysis to commence once symptomatic with GFR between 5-10, others recommend to initiate when GFR is over 15 or to initiate just with the presence of uraemic symptoms irrespective of kidney function level.
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The Initiating Dialysis Early and Late (IDEAL) study which examined mortality related to the timing of dialysis initiation found no difference in survival between early or late initiation of dialysis. The IDEAL study did reflect that the majority of patients had displayed symptoms of uraemia at or below GFR 10 so timely dialysis initiation from this point more likely. Haemodialysis is the predominant dialysis modality for renal replacement therapy. It is simply a process of purifying the blood using an artificial filter. A range of filters and dialysis fluid is used to meet the specific requirements of dialysis and individual patient needs. The other two forms of renal replacement therapies are peritoneal dialysis and kidney transplant. The haemodialysis clinic at Pindara Private Hospital offers treatments that are managed by nephrologists, specialised nurses and technicians. The most advanced dialysis equipment is used to ensure safety and comfort during dialysis. Holiday dialysis is also available for Australian and overseas tourists. Health promotion is the main objective of kidney disease. Careful management of declining kidney function and effective dialysis, once required, allows for improved quality of life and the best outcomes for individuals. The therapeutic environment is improved through better communication, positive attitudes, and more active participation of patients in care. With optimal health as the focus and effective communication between healthcare workers, the delivery of quality care will be optimised to offer the best possible outcomes for individuals with chronic kidney disease.
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AFFORDABLE WEIGHT LOSS SURGERY
If January found you resolving to lose weight and get healthy once and for all but March had you feeling like you were not making any progress, you are not alone.
Dr Jacobus Jordaan, General and Bariatric Surgeon
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Duodenal Switch
T YPICAL WEIGHT LOSS AT 12 MONTHS
Gastric Bypass
BY A PERSON WITH A
Gastric Sleeve
BMI OVER 35
Gastric Band Diet & Exercise 0
50
100
PERCENTAGE OF E XCESS WEIGHT
O
nce an adult develops obesity, which is a recognised medical condition, it becomes unlikely that they will attain a healthy weight without the help of weight loss surgery. A 10-year UK study showed that for women who have a BMI above 35 (severe obesity), each year only one in 430 would achieve a healthy body weight without surgery. Men fared worse, with each year only one in 701 achieving a healthy weight without surgery.
ANNUAL PROBABILITY OF ATTAINING A HEALTHY BMI INITIAL BMI
Men
Women
30 – 34.9
1 in 210
1 in 124
35.0 – 39.9
1 in 701
1 in 430
40.0 – 44.9
1 in 1290
1 in 677
Clearly, current non-surgical programs are not helping the majority of people with a BMI above 30 to lose weight and maintain that weight loss. There is overwhelming evidence that weight loss surgery is the only effective treatment for people with a BMI above 35 to achieve and maintain substantial weight loss in the long term. With a similar level of safety as having a gallbladder operation, and better safety profile than a joint replacement, people with severe obesity can now lose 50 - 100% of their excess weight within 12 months and keep it off. pindaramagazine.com.au
Despite the proven safety and efficacy of bariatric surgery, it is not typically a publically funded procedure in Australia. For those who need it most, accessing a high quality bariatric program that includes structured multi-disciplinary support and long term follow up may not be financially feasible, despite being the most effective treatment available. Eliminating this financial barrier allows people who do not have the financial resources to access full service programs to secure effective treatment, achieve their weight loss goals and turn their health around. At the Surgical Weight Loss Centre we have been able to overcome the barrier of cost by developing a more affordable “Streamlined Sleeve” program for patients with private health insurance, equating to roughly the same out of pocket cost as a one-years gym membership or personal training. This program delivers high quality surgical care at a reduced cost by combining online and group multidisciplinary education in conjunction with GP management, with the safety net of our full individualised program, should the need arise. The Streamlined Sleeve program has been designed for selected medically lowrisk people who have a pro-active regular GP and private health insurance, and require a tool to assist them to lose a significant amount of weight to improve their health and well-being. Our aim is to maximise accessibility and minimise the outof-pocket expenses without compromising our high standard of care. This subset of people do not require intensive pre-operative assessment and post-operative support to achieve good results from surgery. Over the years, we have developed an understanding of the patients who tend to achieve good long term results with a sleeve gastrectomy without requiring the intensive pre-operative surgical assessment, peri-operative medical management and post-operative allied-health micromanagement provided by our full bariatric program package. In the Streamlined Sleeve program, investigations are adequate and relevant without being excessive and treatments follow accepted and medically safe protocols. Not all patients are suitable for the streamlined program of course, and the priority is selecting the right program for each individual to achieve maximal results.
If you want to make this the year you lose weight and keep it off, contact the Surgical Weight Loss Centre on (07) 5556 8888 or email info@surgicalweightlosscentre.com.au Pindara Magazine
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NEW technology
FOR VAGINAL LAXITY
Dr Drew Moffrey, Obstetrician and Gynaecologist
More than 50% of women are concerned about their vaginal laxity (or vaginal ‘looseness’) following childbirth. This number rises to over 80% of women in the post-menopausal age group. It’s a rarely spoken about topic that can affect sexual sensation and satisfaction. Now, a new treatment option is available.
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V
aginal laxity is an under diagnosed and under recognised medical condition that can negatively impact sexual function, self-esteem, and quality of life. Unfortunately, it is also very poorly discussed and managed by medical professionals. The reason these discussions have been so difficult to have is that, until now, there has not been a safe and effective treatment for vaginal laxity. Recently, a new treatment option has become available. The Geneveve System is a non-surgical, non-ablative medical device that remodels collagen and restores tissue with only one treatment session. Dr Drew Moffrey has the first machine of its kind in Australia: a monopolar radio frequency-based energy system that restores collagen to a deeper level to provide optimal structural support. This machine is different to other energybased systems on the market, as it targets just the introitus (entrance) where the majority of fit and friction occur during intercourse, to enhance a woman’s sexual function. The ideal patient is a post-partum woman with vaginal laxity and who is experiencing an associated decrease in physical sensational and sexual satisfaction during intercourse. For a lot of post-partum women, the decrease in sensation is a result of traumatic overstretching and “loosening” of the tissue at the vaginal introitus during childbirth. Not only can this lead to a persistent decrease in genital sensation in this area, this trauma can cause a reduction in sexual satisfaction, and negatively impact a woman’s sexual relationship.
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FORMER METHODS Previously, the options to attempt to repair vaginal laxity were surgery, which carried high risks of complications, Kegel exercises, which often increased pelvic floor function but resulted in no change to sexual function, or injections of fillers, which gave very limited effect, if any, as described below. • Vaginoplasty involves surgery with removal of some of the tissue and tightening of the vagina. This is done under general anaesthetic and has a downtime of several weeks, in terms of recovery. Surgery can improve sexual function but there are significant risks involved. Unfortunately there is a high complication rate of women who will experience pain during intercourse post vaginoplasty. There are also a significant number of women that will experience chronic pain post surgery. • Kegel exercises are exercises to help strengthen the pelvic floor. These exercises need to be performed daily and the effect ceases as soon as they are stopped. While some women swear by Kegel exercises to keep them taut and happy, it’s time consuming with dismal results for many. Kegel exercises basically help to strengthen the pelvic floor muscles but do not address the tissues within the vagina or the vaginal opening. As such, the general consensus seems to be preventive rather than curative with regards to true vaginal laxity. • An unproven approach has been to inject lipofillers, hyaluronic acid and other bulking agents into the vagina to increase the volume. This practice has very scarce evidence of improved sexual function and also carries risks. The risks include vascular occlusions and nerve damage.
SO WHAT IS THE GENEVEVE SYSTEM? Geneveve System is the application of low-dose, nonablative radiofrequency energy. This causes activation of fibroblasts, a type of cell that produces new collagen fibres in the vaginal tissue, leading to an initiation of tissue response with collagen remodelling. These changes occur at the cellular level so there are no visible marks or telltale signs left on the vaginal tissue. A thumb-sized treatment tip is placed just inside the vaginal opening and circumferentially moved around by the attending physician to deliver pulses of energy to the collagen fibres that make up the underlying tissues. It is a 30-minute, outpatient treatment that is pain-free and doesn’t require anaesthesia, with little to no downtime. As such, the woman is able to resume normal activities immediately following the procedure. With just one treatment, the regenerative process is initiated, but the full effect will build gradually over time, with optimal results continuing to improve up to 90 days. In clinical trials to date, almost 90% of the women treated reported significant, sustained tightening at 12 months after treatment, with an average improvement of 68%. Dr Drew Moffrey has over a decade of experience working in women’s health and is very excited to be at the forefront of such an innovative procedure that will significantly impact women’s lives. 44
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“The main area of my practice until now has been obstetric services and I am so passionate about helping women birth their babies safely. Now with Geneveve I can also help them after they have birthed their baby to restore sexual function to what it once was,” Dr Moffrey said. The Geneveve System is approved for use in over 50 countries and there have been numerous studies that prove the effectiveness of the Geneveve System and its safety. The studies showed that women who have had the treatment are three times more likely to report no vaginal laxity than those that have had no treatment done. The study also showed that nine out of ten patients had significant improvement in sexual arousal or significant improvement in achieving orgasm. As with any procedure, the safety profile is extremely important and the Geneveve System has been through vigorous testing, with minimal side effects. In the randomised placebo controlled study, the number of adverse events were equal in both the treatment and placebo group. In fact, there were no significant adverse events to report. Of those adverse events, many are typically mild, temporary, and resolve shortly after treatment. Reported complications and side effects include: slightly elevated white discharge; redness or swelling; focal, transient “altered sensation” and “tingling” following treatment. The unique part of the Geneveve System is the redundancy of several treatments like other energy-based treatments on the market. All that is needed is one, half-hour treatment.
IT IS A 30-MINUTE, OUTPATIENT TREATMENT THAT IS PAIN FREE AND DOESN’T REQUIRE ANAESTHESIA, WITH LITTLE TO NO DOWNTIME. It does not need to be repeated and the collagen deposits have long-term benefits, because of the deeper penetration of the monopolar radio frequency. Patients will have a noticeable difference in vaginal laxity from one-month post treatment, and will continue to have improvements for up to six months. In the long term, the results are still present at 12 months. The treatment does not need to be repeated but it can be if there are subsequent vaginal deliveries that cause vaginal laxity to return. Dr Drew Moffrey has over a decade of experience in women’s health and has had a private practice at Pindara for over four years. Previously, Dr Moffrey was the deputy director of Logan Hospital. Dr Moffrey specialises in Obstetrics and Gynaecology with a special focus on gestational diabetes and sexual health and function.
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O UT
SIDE
THEEYE
EXTRAOCULAR SURGERY
Dr Sharon Morris, Ophthalmic and Oculoplastic Surgeon
The eye region of the face is a key area that expresses our mood and emotions to the outside world. After all, they say the eyes are the window to the soul.
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s we get older, we may become conscious of how this area starts to look and respond differently such as the appearance of under eye bags or an increase in wrinkles. While these are just some examples of cosmetic differences that may change our appearance, they are - for most part - harmless. However, there are many other changes or problems which may arise in this area surrounding the eyes that can occur and which may need specialist attention.
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Whilst most people are familiar with seeing their ophthalmologist for their cataracts and concerns within the eye, a vast array of injury, illness or changes to anatomy can affect the supporting structures around the eye – the adnexal or extraocular tissues. These conditions can be very debilitating for patients and may even lead to blindness. The following conditions are some of the more common presentations for extraocular eye specialists.
Eyelid function The eyelid is an extremely important part of the eye anatomy. Without healthy functioning eyelids, the eye cannot serve well as a visual organ – the corneal surface of the eye gets exposed and dry, becomes scarred or is at risk of serious infections. The eye can ultimately lose vision, become painful and sometimes cannot be preserved. If the eyelids function but are droopy, a person’s field of vision can be significantly reduced.
Watery eyes Patients may experience annoying watery eye symptoms if the eye surface is dry, the eyelids are lax or the tear duct drainage system through to the nose is blocked. Imagine looking through a water level when trying to play golf, drive a car or read a book and it gives you some indication of how frustrating a condition like this can be.
Cancer Skin cancer is another issue that ophthalmologists are faced with, especially in Queensland. Statistically, people living in Queensland have the highest chance in the world of developing a skin cancer. Approximately 50% of skin cancers are found on the face or neck, due to sun exposure, and many are around the eyelid region. This can be a delicate procedure to remove and due to the skin cancer’s location, patients are often worried about visual scarring and defects as a result.
Trauma On the Gold Coast, ophthalmologists see a broad range of trauma. Any problem that changes the volume of the bony orbital socket, or any changes within the orbit, can cause the eye to become altered in position or misaligned with the other eye. This can cause significant visual distress.
Orbital Conditions Common conditions which occur in the eye socket (or orbital conditions) include thyroid eye disease, orbital inflammations, tumors and secondary traumas. Sometimes these conditions need surgery to fix the problem. Oculoplastic and reconstructive surgery includes a wide variety of surgical procedures that deal with problems in the eye socket, eyelids, tear ducts, some areas of the face and any extraocular tissues.
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Some of the most common conditions which need oculoplastics are: • Droopy eyelids and excess skin (ptosis or dermatochalasis). • Upper and lower lid malpositions (entropion and ectropion). • Skin cancers requiring eyelid reconstructive work. Whilst the majority of small lumps on the eyelid are benign, sometimes eyelid tumors can be aggressive and spreading. Patients with extensive cancers require the combined approach of a multidisciplinary specialty head and neck team to provide the overall best care. • Occasionally, when an eye has had complex problems either due to trauma or pathology and becomes blind and painful, removal of the eye (enucleation or evisceration surgery) may allow pain relief and a speedier rehabilitation back into normal activities. Whilst often a very distressing decision for a patient to make, the end result and cosmetic outcome can be markedly superior to the prior non-sighted scarred and painful eye. • Watery eye symptoms require a thorough examination as to the cause of the symptoms and may require simple lid hygiene or tear film measures, eyelid tightening procedures or nasolacrimal surgery, either via external or endonasal approaches.
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As a general eye specialist/ophthalmologist with a special interest and fellowship in oculoplastics, Dr Morris offers complete care for ocular and extraocular concerns. She strives to individually tailor patient care on a case-bycase basis. Dr Morris is part of the local Head & Neck MDT cancer group for complex cancer assistance. She also offers a combined approach to nasolacrimal surgery alongside an ENT specialist, Dr Dan Robinson, for patients with particularly complex nasolacrimal pathology.
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MY PREGNANCY
journey:
JESSICA SKARRATT
Channel 7 Queensland Weekender and Gold Coast Suns TV presenter, Jessica Skarratt, talks about her pregnancy journey and how she has found being a first-time mum. Five days overdue, Jessica and husband Dave welcomed daughter Halliday into the world world at Pindara on 8 January 2017. 1. What are your most vivid thoughts and feelings when the pregnancy test came back positive? I was away working for Queensland Weekender and I had to film a scene sipping cocktails by the pool. I was pretty sure I was pregnant but I wanted confirmation so I could sneakily ask the bartender to make mine a mocktail. I quickly ducked out and bought a pregnancy test and when the result came back positive I was beyond ecstatic but it was frustrating because I couldn’t be openly excited and I had to wait four days to get home and share the news with my partner in person. I struggle to contain my excitement at the best of times so it was a real challenge keeping the secret from my partner on the phone when I was just so happy and busting to tell him.
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2. Did anything happen during pregnancy no one had told you about, any surprises? Yes, I didn’t know how bad heartburn could be. I had it daily from 20 weeks and it caused me excruciating pain, especially at night. I also wasn’t prepared for my immune system to drop so low in the first trimester. I was really susceptible to getting run down and I had never had a cold sore before but I developed a really bad one. 3. How did you stay fit and healthy during pregnancy, any tips? I am usually a very fit and active person. Up until 20 weeks, I trained with a personal trainer who specialises in pre and postnatal training. I went to her mums and bubs small group sessions, which were great. The mums and bubs classes also gave me a good idea of what it would be like to train once I had the baby. From about the 20 week mark, I suffered from pubic symphysis which caused me a lot of pain so I started going to reformer pilates with a physiotherapist who specialises in women’s health instead. For me, the biggest thing I learned was to listen to my body and adapt my training to what I needed. 4. What did you think would be challenging about pregnancy but wasn’t? And what didn’t you think would be challenging but was? From what I had heard, I thought I would be desperate to have the pregnancy over by the end, especially as I was due during the middle of summer. I thought towards the end I would be less mobile and more uncomfortable but I was actually still pretty active and I had a surprising amount of energy despite the lack of sleep and heartburn. One thing I did find really challenging and didn’t think would be so challenging, was to be diligent with my nutrition. I am normally a really healthy person but I found it incredibly hard to control food cravings. 5. What advice do you have about what to bring to hospital when planning the birth? The best thing I did was pick the brains of my mum friends and ask them their advice. There are the usual suspects like baggy, dark granny undies, nipple cream, nursing bras and singlets. For me, what I found handy was a lavender essential oil to calm the nervous system and help with sleep. I also found a mobile phone extension cord handy so I could be in bed and still reach my phone while it was charging. I also brought a big drink bottle to sip from while feeding to re-hydrate and my own pillow because I struggle to sleep without it (not that you get much sleep, let's face it).
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6. Did you do ante-natal classes? If so, were they helpful? I found the classes beneficial because it was priceless to be able to share the experience and grow in confidence with my partner. And I think it definitely made Dave feel more connected with the initial stages of parenthood. It’s also a great opportunity to ask questions and listen to the questions of other partners and the classes reinforced my confidence in the hospital. The classes were also a wonderful opportunity to make friends with some of the other mums-to-be and now we catch up for walks and coffee and play dates. 7. I understand that the birth didn’t go as expected; do you have any advice for first time mums about creating a birth plan or anything you learned you could share with first time mums who are anxious about labour? I had these grand plans of a drugfree, natural labour but always with the safety of my baby and I as the priority. At five days overdue I went in for a check-up and it turned out that my waters had started to break very slowly and the baby was in foetal distress. I ended up having an emergency caesarean. That taught me that it’s good to have an idea of an ideal birth plan but not to get too attached to expectations. It’s important to listen to your gut and your instincts and to trust the advice of the professionals. In the end, you can’t really plan it and I personally just tried to stay very calm for the baby. 8. What should friends and family buy as presents for a mum who has just given birth? Food! When you get home from the hospital, home-cooked meals are the best gift. For the first few weeks, having someone cook for you, stock the fridge or bring you a meal is the biggest help.
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9. Biggest surprise about being a new mum? On top of the support network from all my friends and family, I was surprised at the overwhelming and instant support from other new mums you may have just met. There is instant comradery and it’s surprising how easily you exchange numbers with women who were strangers five minutes ago. 10. What is the best part of being a mum? That’s hard to answer because there are so many amazing parts to being a mum. I guess the overwhelming bond and love you feel is just so intense. It’s so special to marvel with your partner at the phenomenal human you have created together. 11. How have you found breastfeeding? I have found breastfeeding surprisingly challenging, which I never anticipated. I love the feeling of breastfeeding and I love the bond you have with your baby, but I have had to work really hard to establish breastfeeding. I found a really amazing lactation consultant who has been an amazing support. It’s surprised me how many women have also struggled with breastfeeding. I think it’s important for women to talk openly and know about the potential challenges of breastfeeding so that new mums don’t feel like they are failing if they are having trouble. 12. What have you found is the best gadget as a new mum? The things I have found the best are a quality breast pump and a baby monitor for peace of mind. I would also recommend a proper nappy disposal bin. I also use a salt lamp for feeding in the middle of the night. It gives off a nice, low light and I love it.
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13. Did you redecorate a room for the baby’s nursery? I like upcycling so I tried to do that where I could but I pretty much got all my furniture second-hand from friends and family. We also have beautiful photos in the nursery of Dave’s family and my family with us as babies, just for a sentimental touch. At my baby shower I was also given some meaningful wall hangings. I have a beautiful dream catcher and blessing beads from the important women in my life, which I treasure. 14. Anything you want to say to your mum now that you are one? Becoming a mum has given me a greater appreciation for my mum. I have a new level of understanding of her selflessness and devotion, and what she went through as a single mother.
I ENDED UP HAVING AN EMERGENCY CAESAREAN. THAT TAUGHT ME THAT IT’S GOOD TO HAVE AN IDEA OF AN IDEAL BIRTH PLAN BUT NOT TO GET TOO ATTACHED TO EXPECTATIONS.
15. How has your relationship changed with your husband/partner? This is a whole new level of love for us. We do everything as a team and I think it has really strengthened our relationship. For me, I have been blown away by how incredible he is as a father and how much he supports me. He is next level phenomenal and it melts my heart when I see him with our daughter. 16. Anything about your childhood or the way you were brought up that you can’t wait to pass on? I grew up in the country on a small farm so I would love to teach Hallie a real appreciation of nature and the environment. I also grew up with a love of animals and being really sporty so I want to offer her those experiences as well. I was brought up to be really compassionate and to feel connected to the local community. I hope that she too can feel a sense of community. And Dave and I both come from musical families so we would like Hallie to grow up in a household filled with music. 17. Anything else you want to say about pregnancy, birth and being a new mum? You are given so many opinions and advice during pregnancy and as a new mum and I think you need to sift through all the information and take it with a grain of salt. Choose what works for you and trust your own instincts. Also, for me, I have always loved kids and have always looked forward to becoming a mum. I have six nephews and nieces and being an aunty has been one of the greatest joys of my life. The love I feel for my nieces and nephews is so intense, it is insane. And now that I have my own child, I have that love on a whole different level. It’s just so beautiful and means the world to me that I can share this experience with my sisters and also my Mum.
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SKIN HEALTH ○ New York Facial ○ Microdermabrasion ○ Transdermabrasion ○ Acne Peel ○ Hydration Peel ○ Pigmentation Peel ○ Anti-Ageing Peel ○ Dermapen Skin Needling
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DR DILIP GAHANKARI M.Ch., F.R.C.S (Edin), F.R.A.C.S (Plast)
Dr. Dilip’s commitment is to provide outstanding care to his patients with assurance of safety and quality in all aspects of their Plastic Surgery management. It is with this sincere philosophy that he performs every procedure.
Pindara Specialist Suites, Level 3, Suite 305, 29 Carrara St, Benowa | P: 55 39 46 11 | www.iplasticsurgeon.com.au
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MY PREGNANCY
journey:
LIZ CANTOR
Channel 7 television presenter, Liz Cantor, talks about her pregnancy journey with son Kit and all the tips and tricks she has found helpful as a first time mum on the Gold Coast. Due on New Year’s Eve 2016, Liz and her husband Ryan welcomed baby Kit into the world at Pindara a little ealier than expected on 13 December 2016.
1. What are your most vivid thoughts and feelings when the pregnancy test came back positive? I was actually one of the unlucky ones and got really bad morning sickness. I thought I had food poisoning from eating some oysters when I was in Mackay and had been vomiting for four days straight. When I did the pregnancy test and it came up positive, my initial reaction was ‘well that explains it’. It was a bit of a funny one because it wasn’t really the fairy-tale, ecstatic, romantic comedy moment I was imaging. 2. Did anything happen during pregnancy no one had told you about, any surprises? The morning sickness was the biggest shock for me. I had seen movies where the main character is pregnant and she throws up into the bin under her desk and then carries on looking fabulous. My morning sickness wasn’t like that at all. Every time I travelled to Brisbane I had to pull over by the highway and throw up out of the car. I spent a lot of time lying on the cold tiles of the bathroom floor but it was all worth it in the end and when I got to 21 weeks the sickness finally stopped. I actually think my first trimester was more distressing than my third trimester or giving birth. The other thing I found hard was not telling people in the first 12 weeks. That was when I was the most sick and I found it really difficult being around people and not being able to explain to them why I couldn’t talk or crack a smile or I wasn’t myself. It is frustrating because you hear yourself saying to people, ‘I am just a bit under the weather at the moment’ and you feel weak always having to give excuses.
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I am usually quite an open and honest person so I found it quite challenging. I definitely think looking forward that I’d love to help try and create more awareness for support of women in the first trimester. I think for some women that can be the hardest time and they are reluctant to ask for help. 3. How did you stay fit and healthy during pregnancy, any tips? Trying to stay fit and healthy during pregnancy ended up being so different to how I had envisioned it. I thought I would do tonnes of yoga, eat all organic food and go to the markets all the time. In reality, the only thing I could stomach was maybe a can of soup. At one stage, I remember getting chicken nuggets from McDonalds - I just needed something as bland as possible. My second trimester, I went back to doing yoga three times a week and I surfed until I was about 17 weeks. I love being active so the minute I stopped vomiting I was thrilled to be out and about and moving again. For me, it was really great to keep my body strong throughout pregnancy because it gave me confidence leading up to the birth that my body could handle it. I think it is nice to know that you are strong enough physically to make the experience a bit easier. Also, look after your feet. My feet were just so painful by the end of the third trimester from carrying around the extra weight. It is a very short period of time to put on 17 to 20 kilos and I had a big baby so I really, really felt it. 4. What did you think would be challenging about pregnancy but wasn’t? And what didn’t you think would be challenging but was? I am a bit of an adrenaline junkie and I love doing extreme sports and activities. I have skydived and I have done crazy things but nothing compared to the excitement and the adrenaline of having a baby. In that moment, when you are in the hospital and you know that it’s about to happen, that was just the biggest rush of my life and that is something I hadn’t expected. I knew I would be happy and thrilled and scared but I just didn’t expect it to be such an adrenaline rush and such a thrilling moment. I will never forget the sound of my husband’s voice when he said ‘it’s a boy’. Hearing those words, nothing compares. The other thing that caught me off guard is just how physically hard breastfeeding can be. I am quite an active person so I didn’t prepare myself to feel like I have run a marathon every day just from producing breast milk. I have been lucky in that Kit is great at breastfeeding and latching and I produce plenty of milk but it is just so physically draining. I thought I would have enough energy to be going for jogs but I wake up pretty exhausted every morning.
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LIZ BEATING THE HEAT AT FAVOURITE SPOT TALLEBUDGERA CREEK AND CLIMBING THE CLIFFS AT NOOSA WHILE PREGNANT.
THE OTHER THING I WILL FOREVER BE GR ATEFUL FOR IS THE MIDWIVES; THEY TAUGHT ME SO MUCH AND SENT ME HOME WITH SO MUCH CONFIDENCE.
5. What advice do you have about what to bring to hospital when planning the birth? I was given a pair of long comfortable pyjama pants and five pairs of black underwear by a friend and that was such a gift. I didn’t get out of them the whole time I was in hospital. 6. Did you do ante-natal classes? If so, were they helpful? This being my first baby, I had absolutely no idea what I was getting myself into so it was really very eye-opening. I am grateful that I did do ante-natal classes, as I had no idea how to swaddle a baby and I had never even changed a nappy in my life until my son was born. Kit was a lot of firsts for me, so knowing I could walk out of there and care for the baby was important for me. Having that prior knowledge helped, even though I think with some things, ignorance is bliss. The other thing I will forever be grateful for is the midwives; they taught me so much and sent me home with so much confidence. They were absolutely incredible and both my husband and I were both just incredibly grateful with how much knowledge they shared with us. 7. I understand that the birth didn’t go as expected; do you have any advice for first time mums about creating a birth plan or any advice for first time mums who are anxious about labour? I personally didn’t really have a birth plan because Kit came early. What really helped me was the morning before Kit came I had managed to go down to Tallebudgera with my husband and have a swim in the ocean which is something I love doing. When I was at the really awful points of birth - the scary moments - I just closed my eyes and went back to that place and time in my mind. I think its nice do something you love in the days leading up to giving birth, whether that is go for a meal at your favourite spot or a swim at the beach, and then when you’re in an uncomfortable place, close your eyes and take yourself back there. The other thing is a good music playlist. If there are songs that you really love and make you really happy, having that playlist is very helpful during the experience so you can just zone out. 8. What should friends and family buy as presents for a mum who has just given birth? I am not very good with air-conditioning so I bought an Evian water spray and a rose water spray to hospital. During the nights I would
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just spray water on my face and in my airways to try and rehydrate which I found really helpful. Nice hydrating products are just a gift at that time, especially if you have a caesarean and you are literally bed bound for the first few days. 9. Biggest surprise about being a new mum? The love you feel. You are told about it but you don’t understand it until you feel it and I wasn’t expecting it to happen so immediately for me. The second I was handed Kit, I just was so overwhelmed by the feeling of love; it is probably hormonal or a primitive thing, but it is just absolutely incredible to experience it. 10. What is the best part of being a mum? The milestones are really special to experience, their first smile, their first giggle, the first time they roll over, they are all incredible moments. 11. What should/shouldn’t people say to a new mum? Kit was a very big baby and I remember quite early on in my pregnancy, I went shopping one day and I had six different people say to me,’ you must be due soon’ or ‘are you due any day?’ I still had three or four months to go so I think people should just leave the whole ‘are you due soon?’ alone. 12. What have you found is the best gadget and the most useless gadget that you have as a new mum? Kit being born in December, we had so many clothes for him and he just wanted to be nude. We now have all these outfits that have never been worn because he was happy to get around in just a nappy all day, every day. So that is a tip for summer babies. I did get a tip from a friend to have a comforter for him. This is a little piece of blanket that I put on my chest after breastfeeding so that it smells like me and then when I put Kit down, I leave him to self-settle with the comforter. He has really enjoyed having that and it has been a really helpful tool for putting him down to sleep. 13. Did you redecorate a room for the baby’s nursery? Yes, it is African themed. At the moment he still sleeps in our room but will move into there when he is around five months old. Because we didn’t know if we were having boy or girl, we had to keep it very gender neutral but every time we went into the nursery while we were decorating we could see it was such a boy’s nursery. It is just as well we had a boy.
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14. Anything you want to say to your mum now that you are one? You never need your mum so much in your life as you do when you have a newborn baby. You also never appreciate them or love them as much as you do when you have your first child. I’m so grateful to have my mum’s help and for her to be part of the journey. 15. How has your relationship changed with your husband/partner? We definitely work well as a team together and that has extended into co-parenting because I am already back at work. The sleep deprivation is very tricky and I think all couples will struggle with moments of exhaustion but it does take your relationship to a deeper, less superficial level. This was especially the case for me having had a caesarean and having my partner help wash and care for me until I was back on my feet. It really brought a whole new level of trust and rawness to the relationship. 16. Anything about your childhood or the way you were brought up that you can’t wait to pass on? I was a very outdoorsy kid. My parents took me camping at four weeks old. I am definitely excited to share a Queensland outdoors lifestyle with Kit like surfing, camping and skiing for the first time. I can’t wait to experience all the adventures and activities I loved doing with my parents as a child with my son. 17. How do you feel about going through this in the public eye? Are there any advantages or disadvantages? It has been really sweet. I remember the first time I was home and I went for a walk along the beachfront and total strangers were coming up to me and saying congratulations. It did make me realise how many people had shared the journey with me. From seeing me through the different stages of pregnancy, presenting the weather on Channel 7 Gold Coast News to seeing me re-emerge back into the public after maternity leave, it was just so wonderful to have people say congratulations and give me their heartfelt messages. We are so lucky to live here where everyone is so warm and friendly and I feel like I have a big extended family within the Gold Coast community.
KIT ON HOLIDAY AT THE BEACH, HIS FIRST SWIM AND WITH HIS DOG AND BEST FRIEND BEAR.
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FURTHER IS NEVER FAR ENOUGH The McLaren 650S will move you like no other car on earth. With the awe-inspiring twin-turbo V8 engine behind you and nothing but the open road ahead, relish the freedom afforded by the extraordinary panoramic view from the uncluttered driver’s cabin. Wherever you choose to go, the spine-tingling acceleration is sure to take your emotions to a place they’ve never been before. We’ve pushed it as far as it would go. Then we pushed it further. McLaren Super Series. For more information, contact Brand Manager James Read on 0412 653 624
McLaren Gold Coast
179 Nerang Road Southport QLD 4215 Tel: +61 (0)7 5509 7110 Official fuel consumption figures in UK mpg (l/100km) for the McLaren 650S (3,799 (cc) petrol, 7-speed Seamless Shift dual clutch Gearbox (SSG)): urban 16.1 (17.5), extra urban 33.2 (8.5), combined 24.2 (11.7). Official combined CO2 emissions: 275g/km. The efficiency figures quoted are derived from official NEDC test results, are provided for comparability purposes only, and might not reflect actual driving experience.
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HOMEGROWN
health
Food gardening is foolproof these days, and getting the kids in on the action can establish healthy habits for their future.
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etting the facts on nutrition can be overwhelming. In an age of information overload, it’s become hard to separate fact from fiction, trend from truth. It’s no longer a case of making a quick dash to the grocery store, especially when you and countless others are pausing between aisles to read the fine print. One thing we can be sure of? There’s never been a better time to grow your own food. We know now, that chemical preservatives are applied to fruits and vegetables to sustain shelf life. We know that a lot of what you can purchase – while looking shiny and edible – may not be free from genetic modification, fertilisers, herbicides and pesticides. And we know these aren’t great for your health. Organic, homegrown fruit, vegetables and herbs are fresher, more nutritious and delicious than conventionally farmed fruit and veggies. It’s getting back to basics, paddock to plate. Or do one better: pot to plate. The benefits go on and on. Consider that growing, processing, packing and transporting what we eat is leaving behind a considerably large eco-footprint. The veggies plucked from your backyard travel a few metres, not hundreds or thousands of kilometres. The more we choose to grow ourselves, the more we can improve the health of Australia’s soils and waterways by lessening our demand for agricultural chemicals and practices that can affect our fragile environment. What’s more, you can help save water. Homegrown food uses significantly less water relative to the amount of food harvested. Essentially, growing your own food is about nutrition and a sustainable future. And the future and kids go hand in hand.
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GARDENING FOR KIDS
What can kids gain from growing their own food? A lot. We’ve heard the stats – in Australia, by the time children enter prep or kindergarten, 20% are already overweight or obese, and those same kids are four times more likely to be obese by grade eight. Battling the bulge becomes a lifelong burden for these kids, and the best way to tackle this growing epidemic is teaching them where it all starts: outside, hands deep in the soil. Food gardening is a gentle, stress-lowering form of exercise (and good for mental health too) and it can help kids appreciate how food gets to their plates. It’s about forming a good relationship with food from an early age, educating them on healthy habits and learning to support sustainable methods of consumption for their future. There are lots of activities associated with gardening that can be worked into kids’ daily routines. Watering, digging and planting are just the start. It goes all the way through to picking the produce, and helping to prepare healthy foods for dinners and school lunches. Before you succumb to the “too hard” basket, getting into the garden with the little ones is actually not that hard. From apartments to acreage, just about any family can create their own Eden. Whether you’re starting out or you’re a seasoned green thumb, there are tools out there to make growing your own food with the kids as easy as one, two, three. 66
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EASY-PEASY
A good garden is all about sun, soil and easyto-grow veggies and herbs. Keeping it simple in the beginning is the key, and container gardening is as simple as it gets. These manageable garden beds keep everything in a separate environment and away from the ground. Products on the market like the Vegepod are customised for any space, whether that’s apartment balconies, townhouse gardens, spacious backyards, or even indoor lofts. Once it’s set up, you’ve got a go-to grocery store in your home.
1. Select a sunny spot and set up Locate the sunniest spot in your house or outdoor area. If you have a space that gets a few hours of sun in the morning, start there; as little as two hours in the morning will suffice. Planting indoors? Same rule applies. Sun via a window in the morning is best, and if afternoon sun is all you can get, that’s ok too, it just means you will need to keep your watering up. Then set up. Container gardening is designed to be foolproof. In Vegepod’s case, it’s just a slide and click together mechanism and you have a 2m x 1m container ready in under an hour. There’s also a built-in protective canopy to shield the garden from pests and inclement weather – upping the success rate of your veggie patch. pindaramagazine.com.au
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2. Get some quality soil It’s all about the soil. Good quality bagged potting mixtures can be found at all the wellknown house and gardening meccas, or your local gardening shop. Your soil will really determine the success of your planting as well as the nutrient content. You want to look out for certified organic potting mix. Quality soil means you can grow anything if you’re planting in season. Which brings us to step three.
3. Start with easy plants Start small and make your selection based on year-round seasonality. Some of the easiest herbs to grow are mint, rosemary, basil and parsley. For veggies, year-round lettuce, beets, kale and beans can grow in abundance. Plant what you enjoy eating, and plant it in mass to avoid disappointment if one happens to fail. When you’re planting in a small space, look out for companion plants – the ones that will support their neighbours’ growth. A quick search on Google will help you with this. For instance, if you like spinach, then beans, lettuce, peas and strawberries are good companions. As for ongoing maintenance, Vegepods come with self-watering wicking beds (which is great for minimal effort, but of course you can keep the kids interested with a little daily watering too). Growing your own food is not only an investment in your family’s health and the environment’s, it can cut the grocery bill in half. The money you spend on the initial set up and maintenance of your garden is easily made back on savings from produce you would normally buy on a weekly basis. Nutritious, environmentally friendly and economical. It seems that, despite all the hype, the best thing we can do for ourselves is take it right back to basics with a little homegrown health.
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SPECIAL OFFER Pindara readers can receive a special discount on Vegepods. Simply make a purchase at www.vegepod.com.au and use the code pindara10 at checkout.
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TECHNOLOGICAL ADVANCES IN ENT / HEAD AND NECK SURGERY
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As we push deeper into the 21st century our surgical armamentarium is being continuously expanded. Never more true has this been than in the area of ENT / Head and Neck Surgery. Remarkable technological progress coupled with creative clinical thinking has led to the development of surgical advances that ultimately aim to improve patient outcomes and reduce morbidity.
NEUROMONITORING AND HEAD AND NECK SURGERY Quoting a highly respected mentor, the head and neck certainly provides “anatomy for the connoisseur�. It is an extremely complicated region of the human body with a plethora of structures vital for both form and function. When operating within the head and neck region protecting these structures is paramount. Cranial nerve neuromonitoring is now widely used in head and neck surgery. Its broadest application has been in the monitoring of the facial nerve in both intracranial as well as extracranial surgery. Intracranially, surgical procedures on the temporal bone can place the nerve at risk - specifically acoustic neuroma surgery and tympanomastoid surgery. Extracranially, the nerve is most at risk during parotid surgery but also submandibular gland surgery and neck dissections, specifically the marginal mandibular nerve branch. In all of these instances the neuromonitor can be useful to facilitate the safe dissection of these nerves and predict post-operative outcomes with intraoperative stimulation at the completion of the procedure. The more recent application has been to thyroid and parathyroid surgery. By using monitoring electrodes placed on a correctly positioned endotracheal tube the recurrent laryngeal nerves can be monitored during surgery. This can certainly be useful in cases where one nerve may already be affected by the disease or in cases of revision surgery where the nerve may be difficult to dissect in scarred tissue planes. Beyond simple identification and preservation of gross function, subtle neuropraxia injuries and resultant changes in voice outcomes can be monitored for, and avoided, with use of the neuromonitor.
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MICROVASCULAR FREE FLAP IMPLANTABLE DOPPLER MONITORING
IMAGE-GUIDED ENDOSCOPIC SINUS SURGERY Over the last two decades advances in computer processing and optics technology has led to a significant improvement in visualisation during functional endoscopic sinus surgery (FESS). High definition camera heads and monitors, LED light sources, infrared technology, multi-angled scopes and voice-activation functions are now readily available. Similarly, the endoscopic instrumentation has improved dramatically to facilitate safer dissection particularly within areas close to the orbit and skull base. Paralleling these advances has been the advent of image guided surgery (IGS). Its application to endoscopic sinus surgery has been revolutionary. For cases including advanced sinonasal polyposis, revision ESS, and sinus surgery for both benign and malignant neoplasms of the sinonasal cavities and skull base, IGS has helped to improve patient safety and outcomes and in some cases opened up a world of endoscopic options in patients who may have had traditional open transfacial surgical procedures. Earlier methods of IGS relied on line-of-sight infrared technology, however more recent systems now use electromagnetic technology. This is much more convenient in the head and neck region due to avoidance of instrument registration problems that can occur with the crowding of large amounts of equipment into a small surgical field. With the electromagnetic systems, several of the “work horse” sinus instruments such as the microdebrider and the endoscopic drills now also have image guided functions, which provide for a safer, and faster, surgical dissection.
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Reconstruction of defects within the head and neck region often require free tissue transfers. In principle, defects are reconstructed with the simplest possible option that restores form and function, but in head and neck cases involving high volume tissue loss or both bone and soft tissue requirements, often the only viable option is a free flap. Traditionally the monitoring of free tissue transfers has been via transcutaneous handheld doppler. This allows monitoring of arterial supply, with venous monitoring generally performed by inspecting the colour of the flap which is most often a paddle of cutaneous tissue. In cases where the flap is “buried” (ie, pharyngeal reconstruction) the surgical method of monitoring has been to have a portion of the flap brought to the skin surface for monitoring. These methods, although reasonably reliable, have had issues. They require the flap to be constantly palpated which can create issues with healing. They also require a reusable handheld doppler which has raised issues with regards to infection control. Additionally, monitoring for venous congestion relies on experienced staff being present to be able to appreciate the subtle early signs of venous congestion which is by far a greater risk than loss of arterial supply. Implantable doppler probes largely solve the issues mentioned above with the non-implantable monitoring options. A simple silicone cuff, which has a doppler probe attached, is placed around the vessel at the time of surgery. This can be placed on both the donor artery and vein. The doppler leads are then brought through the skin and secured to the patient’s neck. During the postoperative course these leads can be attached to the processing unit which gives both an auditory and visual reading of blood flow in the monitored vessel. The use of this simple but ingenious technology has been steadily increasing. Implantable dopplers are reliable, relatively inexpensive, and potentially critical to providing the opportunity to salvage a free flap in the rare instance of vascular failure.
TRANSORAL ROBOTIC SURGERY Transoral robotic surgery (TORS) was developed in the mid-2000s. The initial feasibility studies were performed in Philadelphia (USA) and since this time its application to the treatment of both benign and malignant conditions of the head and neck has been ever increasing. There are various aspects of this unique technology that facilitate its use in transoral surgery. The dual endoscope creates threedimensional imagery at the surgical console and allows for unrivalled visualisation within the narrow laryngopharyngeal conduit. Angled scopes and magnification options can improve this visual access even further. Combined with the freedom of movement of the instrument arms, this creates safe surgical access to areas beyond what was previously possible with lineof-sight surgical options such as transoral laser microsurgery. With a bedside surgeon able to pass instruments around the robot, two-surgeon access is effectively created. The bedside surgeon helps with tissue manipulation and adjustment of robot positioning. The robotic endowrists articulate in 270 degrees throughout seven different planes and can have their movements both scaled as well as tremor filtrated. This precision of movement is particularly important in head and neck surgery given the close approximation of many critical neurovascular structures in close approximation. In Queensland the TORS program was founded in 2013. Tonsil and base of tongue cancers have primarily been the treatment focus with surgical management in these cases aiming to save the patient requiring high-dose radiotherapy or chemoradiotherapy. Additionally, benign conditions of the head and neck can potentially be treated with TORS including tongue base and supraglottic surgery for the management of obstructive sleep apnoea.
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SUMMARY The technological advances outlined have been developed with improving patient care as the driving force, whether it be: ● use of the image guidance system in a case of severe sinonasal polyposis to enable complete dissection and avoidance of skull base or orbital injury; ● the da Vinci robot to en bloc resect a virally-mediated tonsillar cancer in a young patient in an effort to spare them radiation treatment; ● use of the neuromonitor during thyroidectomy on a professional voice user; ● or using the implantable doppler in a buried pharyngeal reconstruction following pharyngolaryngectomy.
Dr Sam Dowthwaite is an ENT / Head and Neck Surgeon who enjoys all aspects of general ENT surgery with sub-specialty interest in head and neck oncology, thyroid / parathyroid disease, robotics and microvascular reconstruction. He treats paediatric and adult patients privately through ENT Clinics Pindara and Robina as well as being a VMO at Gold Coast University Hospital.
The use of these available technologies can assist the surgeon to carefully plan their patient’s management through all stages of their treatment to guarantee the best possible outcome.
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NEW ZEALAND T H E F O O D I E ’ S G U I D E TO
S O U T H
I S L A N D
Amanda James
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Based on the following essential requirements, it’s quite probable that New Zealand’s South Island is the ultimate travel destination.
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ncredible food and wine? Tick. Outdoor activities - some of which are extreme? Present. Day spas for relaxation sessions? You’ll find them too. All served with a side of incredible scenery? Most certainly. Yes indeed, this pristine nook of the world is all it’s cracked up to be. Via two towns, Queenstown and Arrowtown, it delivers on every expectation and exceeds its reputation.
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Choose your town, choose your adventure.
QUEENSTOWN DAYTIME EATING
AMISFIELD BISTRO CELLAR DOOR FOOD SELECTION
This is base camp for your South Island exploration. It’s supremely picturesque, up in the ‘alpine’ and no matter the time of year, populated with people from all over the world and walks of life. No day on a holiday should start without a good and proper breakfast, and the best in town is Vudu, where deliciously wholesome ones featuring fine local produce are dished up with gusto. You’ll find a few locations, but head for the spot affording views of Lake Wakatipu. Coffee savouring and scenery? Oh, so good. For those on the go, head to Fergburger’s bakery where all good dough-based delights live. From donuts to pies. It’s all here. Speaking of Fergburger, no trip to Queenstown would be replete without one of their revered burgers. This is an institution, hence the line out the front (regardless of time). What is it about fresh clean air that works up an appetite? This will cure the most famished of folk. Just out of Queenstown is Amisfield Winery; put this on your list. On their own, the food, wine and service are all excellent, but when combined, the experience is just exceptional. Either order share plates or fully commit and opt for the seven course degustation with matched wines. Ordering a box of their pinot noir to be shipped to your residential address back home is non negotiable.
NIGHT-TIME DINING Regardless of budget, you’ll find something delicious. Those looking to spend a little more and treat themselves, should head for Botswana Butchery. There’s certainly an air of extravagance to it, which is only intensified by the indulgent food. Bottom line? Don’t have a big lunch. At the more casual end of the spectrum is Madam Woo, where contemporary Asian food and cocktails delight. The atmosphere is unmatched, and the service strong. Those looking to appease pizza cravings will enjoy The Cow it’s hidden within a brick facade making it not too dissimilar to an English pub.
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WHERE TO DRINK When the sun is out, and the sky is clear head to The Sundeck. You’ll find it up two flights of stairs - a short workout before settling in to savour world-class wines with views of Queenstown best described as stunning. Stemming from the town’s reputation the world over, Queenstown is filled with travellers and backpackers. Ergo, awesome nightlife, which if you’re looking to head out into the early hours is excellent. Head for Searle Lane where live music, clubs and bars collide. As the name suggests, Havana is great for rum cocktails and Cuban beats while those seeking a performance or pool will enjoy Zephyr.
WHAT TO DO
KAWARU BUNGY IN QUEENSTOWN THE SHOTOVER JET
That you will overindulge on your vacation is a most likely. Counteracting that with outdoor activity however, is easily possible. Fun fact walks around Lake Wakatipu and through the Queenstown gardens will help ease the guilt on your consumption. Those looking to hit the green can book in and tee off at the Queenstown Golf Club (amazing views and affordable entry), while players seeking a glamorous backdrop can choose Jack’s Point Golf Club. Reckless and daredevil behaviour is rewarded in Queenstown. There’s the famous AJ Hackett Bungy – either the Ledge Bungy overlooking Queenstown or the Kawarau Bungy. Those still thrill seeking, but in a slightly less bold manner might enjoy taking the gondola to Bob’s Peak followed by a luge ride down. Want to get wet? The Shotover Jet definitely gets the blood pumping, without having to jump off the side of a cliff.
WHERE TO SLEEP Airbnb is a top choice, with many gorgeous houses and apartments available that can prove to be really cost effective for groups and families. Seeking luxury? Resting your head on the divine and highly threaded count sheets at Hotel St Moritz comes well recommended. 78
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ARROWTOWN Twenty minutes by car you’ll find a cool and rather quaint little village, which is somewhat not too dissimilar to a village found in the English countryside. A little less punchy that Queenstown, it’s definitely the place for those to ‘clock off’ in some capacity.
DAYTIME EATING There is a very strong chance that you will have possibly the most delicious ever breakfast eaten at Chop Shop. This cafe is hidden (all the trendy ones are), but follow the stairs off the main street. Everything is excellent, but the ‘Turkish Eggs’ will not disappoint - flavourful because of the premium ingredients and just a real win. If you’re off on a hike, then the bakery is an excellent option for carb-loading. Bagels with copious fillings abound. Alternatively, Gibbston Valley is one hell of a cheese shop come cafe.
NIGHT-TIME DINING There are some real hidden gems in Arrowtown, and just like Queenstown, all answer to different budgets and tastes. Lazy nights are well spent at Fork and Tap Alehouse where gastro pub fare, craft beers and local pinots abound. It’s pretty much the village pub, but one supremely executed. Saffron answers the call for special occasions. Local produce and seasonal fare reign in a creative manner. A little way out of Arrowtown you’ll find Millbrook Resort, which houses many restaurants. The best? Kobe where fresh dishes with epic flavours abound. Sashimi from the finest fish off the coast or Wagyu? All good.
DON’T MISS Arrowtown is great for trail walking and hiking. It’s also very close to Gibbston Valley where Central Otago’s best pinot noir and cheese lives. The combination of the two is excellent. Follow the Arrow River, or seek out other trails where you can venture out for the whole day and get the heart racing. pindaramagazine.com.au
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LOOKING FOR ACCOMMODATION IN ARROWTOWN? Millbrook Resort is truly special and you can really relax. On average, everyone here is over 55 - and this is a good thing. Partly because it screams relaxation. There’s a restored wheat mill come restaurant (cool, huh?) and the cabins and hotel rooms are super slick. This is the place to get your R&R on while wearing a robe. Or, fill your hours with day spa visits, restaurant outings or a hit of tennis. Arrowtown for the win!
GET OUT, GET A DAY TRIP WANAK A Think of Wanaka as a quieter version of Queenstown, but one that’s equally impressive. If clear skies are on your side, then buy up big on cheese, fresh bread and a few other local delights for a picnic overlooking stunning Lake Wanaka. You’ll be devouring these in the presence of snow-capped mountains. Enough said. Another spot to settle is found where the road meets the waterfront at Beacon Point Road. If it’s warm, a dip will most definitely beckon. Rippon Vineyard is worth a visit for their top-shelf pinot noirs.
CROMWELL AND BANNOCKBURN Cromwell is a picturesque historic village in the heart of Central Otago, with buildings dating back to 1860. The weekend is an excellent time to visit, mostly so that when Sunday morning arrives you can take a stroll through the markets. Gourmet pies, locally produced lavender hand cream and more await. Across Lake Dunstan in Bannockburn you’ll find Mt Difficulty, which while known for their pinot noir, produced an excellent sauvignon blanc in 2014. Their restaurant is another excellent spot for a long lunch littered with local produce.
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LAVENDER FIELDS VINEYARDS
2017
THINGS TO REMEMBER WHILE PLANNING • • •
Pack smart, but pack for all seasons Wine tastings are often free, but making a contribution comes well advised … or, buy a bottle of your favourite Check out the rosés and whites, well worth a taste
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hey baby ASTON MARTIN WELCOMES THE LATEST ADDITIONS TO THE VANTAGE FAMILY
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n celebration of the 2017 FIA Formula 1 World Championship, which kicked off on 26 March, Aston Martin recently introduced motoring enthusiasts to its expanded Vantage range. Joining the existing fleet of V8 and V12 models are the V8 and V12 Vantage S Red Bull Racing Editions.
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These true collectibles have been created by the marque’s in-house personalisation service, Q by Aston Martin. Celebrating the two brands’ unique ‘Innovation Partnership’, Aston Martin’s latest global offering takes approval from Red Bull Racing drivers Daniel Ricciardo and Max Verstappen, with their signatures adorning both sill and inspection plaques. Available with Aston Martin’s characterful V8 and V12 naturally aspirated power units, both Vantage Red Bull Racing Editions are equipped with a range of distinguishing features for the most devoted Formula One enthusiast. Building on the appeal of the sports-focused Vantage range, the models deliver a blend of eye-catching looks and an engaging and visceral experience for the perfect cruise along the Great Ocean Road, Adelaide Hills or even Melbourne’s Albert Park. Taking inspiration from Red Bull Racing’s distinctive race livery, owners will be treated to a deep Mariana Blue paint finish as standard. For those wanting a slight twist, gloss Tungsten Silver or satin Mariana Blue exteriors are also optional. Complementing Aston Martin’s signature paint finish is a race-inspired carbon fibre splitter, diffuser, grille and side strakes. Red infills on the carbon fibre grille and yellow calipers complete the iconic colour scheme. Inside, customers can expect further sporting features, including Red Bull Racing headrest embroidery, carbon fibre trim inlays, diamond quilting and an alcantara steering wheel complete with 12 o’clock accent stripe.
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v8 & v12 naturally aspirated power units
2017
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Motorsport is and will always be a key part of Aston Martin’s DNA
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Customers may opt for their sill and final inspection plaques to be signed by either Daniel Ricciardo or Max Verstappen, providing the ultimate seal of approval and cementing their exclusivity. “Motorsport is and will always be a key part of Aston Martin’s DNA, and both the V8 and V12 Vantage S Red Bull Racing Editions bring that ethos straight to our customers. With the 2017 FIA Formula 1 World Championship® set to begin soon, I hope that the purchase of these models will bring the racing season that little bit closer for those lucky few customers who can’t wait for it to begin,” says Aston Martin President & CEO, Dr. Andy Palmer. The striking new design makes its public debut at the 2017 Formula 1 Rolex Australian Grand Prix. The V8 Vantage S Red Bull edition is available to order immediately with customers in Australia and New Zealand receiving priority for the first global allocations. Drive away prices start at $AUD 259,995 in Australia, and deliveries are set to take place from the second quarter of 2017.
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GIZMO GUIDE
2017
gizmo Guide Keep occupied this autumn with this selection of fun gadgets, brought to you by Anna Musgrove, the self-proclaimed implementor, problem solver and doer of many things at CoolThings.com.au
Marshmallow Extreme Blaster RRP $59.45 In the world of marshmallow warfare, the Marshmallow Extreme Blaster is a booming success with kids of all ages! The single-action, pump blaster fires one large marshmallow at a time, and is the sweetest blasting mechanism in the great outdoors!
Koolface Ping Pong Balls RRP $7.95 These Koolface Ping Pong Balls feature six of the best emoji faces - they make the perfect addition to any crazy party!
UGears Mechanical Flower $89.95 The UGears Mechanical Flower is a wonderful and uniquely cool gift idea that you can give to that special someone in your life.
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GIZMO GUIDE
2017
Tabletop Air Hockey RRP $29.95 The whoosh and blow of an air hockey table is a staple in any arcade, and it’s easier than ever to bring the fun right into your own home with this fantastic tabletop version of the popular game. All you need is a table (or any flat surface). Set up your goals, grab your paddle and get sliding!
Marshmallow Bow Classic RRP $54.95 Your Marshmallow Bow Classic certainly hits the target for FUN! It's perfect for the whole family. Inspired by a real bow and arrow design.
UGears Pneumatic Engine RRP $69.95 The Pneumatic Engine may be small but it gives you a sneak peak inside a fully functioning steam engine.
Rock Tumbler RRP $89.95 Have you ever picked a pebble up out of the river and wondered why it was so smooth? The action of water over time slowly wears away the surface of the pebble until it's flat and smooth - perfect for making jewellery or adding to your collection!
UGears Mechanical Box RRP $69.95 With the UGears Mechanical Box you get a dash of mechanical magic added to your home or office desk.
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All items pictured are available now at www.coolthings.com.au
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TOP READS
2016
Mother's DAY
Best Laid Plans
Into the Water
Congo Dawn
Kathy Lette
Katherine Scholes
Paula Hawkins
This riotous yet heartrending novel about a mother raising an autistic son tackles the taboo subject of sex for the ‘differently abled’ – and shows us that when it comes to love, we all have special needs.
Inspired by real events, Congo Dawn combines epic drama with an intimate journey into the heart of a fractured family. It is a landmark novel about good and evil set against the 1960s Simba rebellion.
With the same acute understanding of human instincts that captivated millions of readers around the world in her explosive debut thriller, The Girl on the Train, Paula Hawkins delivers an urgent, satisfying read.
A Dangerous Crossing
Kitchen Garden Companion: Cooking
The Girl Who Was Taken
Rachel Rhys
Stephanie Alexander
With its intoxicating mix of murder mystery and a fateful love story, A Dangerous Crossing is an enthralling novel in the great tradition of Agatha Christie and Patricia Highsmith.
In this new paperback edition, Stephanie has added more than 20 new delicious and reliable recipes, in addition to the 250 recipes first published in her landmark book.
Charlie Donlea Two women – one the sister of a missing girl and the other a victim who escaped – come together to unmask a killer in this heart-stopping thriller from a sensational new voice in suspense fiction.
Same hotel. DIFFeReNt PRIceS. 90
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2016
TOP READS
Pamper Mum this Mother’s Day with breakfast in bed, followed by time to relax with a good book. It will cost you next to nothing but we guarantee it’s a gift she will love! Here are our top picks.
Anything is Possible
Death by Dim Sim
A Mindfulness Guide for the FRAZZLED
Elizabeth Strout
Sarah Vincent
A novel in stories by the No. 1 New York Times bestselling and Man Booker long-listed author of Olive Kitteridge and My Name is Lucy Barton.
The hilarious, honest and inspiring memoir of a woman who lost 40 kilos and won her lifelong battle with her weight.
Ruby Wax
Cruden Farm Garden Diaries
The Woolgrower's Companion
The Extraordinary Life of Pikelet
Michael Morrison & Lisa Clausen
Joy Rhoades
Calley Gibson
Morrison worked alongside Dame Elisabeth Murdoch for many years to create one of Australia's finest gardens. His diaries reveal how the garden was developed, but it's also a look into a wonderful friendship.
Set over ten tumultuous months in 1945, The Woolgrower's Companion is the gripping story of one woman’s fight against all odds, and a sweeping tribute to Australia's landscape and its peoples.
All it took for a tiny, no-name pup from the pound was someone to believe in him and an internet sensation was born. With his signature style and good humour, Pikelet shares the highs and lows of pet rescue and foster care.
Outrageously witty, smart and accessible, Ruby Wax shows ordinary people how and why to change for good.
Finding the right Hotel just got a whole lot easier. Compare and Book 100’s of travel sites at once.
www.CompareandBook.com.au
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At the movies AT THE MOVIES
2017
We round up the season’s best flicks, hitting cinemas this autumn.
The Fate of the Furious
CHiPS
Snatched
Starring Vin Diesel, Dwayne Johnson, Charlize Theron, Jason Statham, Jordana Brewster, Michelle Rodriguez
Starring Michael Peña, Dax Shepard, Jessica McNamee
Starring Amy Schumer, Goldie Hawn, Ike Barinholtz
The classic 70s television series comes to the big screen in this modern adaptation written and directed by Dax Shepard. For those of you unfamiliar with the show’s concept, a rookie police officer is teamed with a hardened pro at the California Highway Patrol, though the newbie soon learns his partner is really an undercover Fed investigating a heist that may involved some crooked cops.
After her boyfriend dumps her, Emily - a spontaneous woman in her 30s - persuades her ultra-cautious mother to accompany her on a vacation to Ecuador. At Emily's insistence, the pair seek out adventure, but suddenly find themselves kidnapped. When these two very different women are trapped on this wild journey, their bond as mother and daughter is tested and strengthened while they attempt to navigate the jungle and escape.
Now that Dom and Letty are on their honeymoon, Brian and Mia have retired from the game, and the rest of the crew has been exonerated, the globetrotting team has found a semblance of a normal life. But when a mysterious woman seduces Dom back into a world of crime that he can't seem to escape, the crew will face trials that will test them as never before.
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AT THE MOVIES
2017
Going in Style
The Zookeeper’s Wife
Starring Morgan Freeman, Michael Caine, Alan Arkin
Starring Jessica Chastain, Daniel BrĂźhl, Johan Heldenbergh, Iddo Goldberg, Michael McElhatton
After their pension funds become a corporate casualty and with nothing to do but feed the birds, lifelong buddies Willie, Joe and Albert decide to veer off the straight and narrow and regain their retirement. Desperate to pay the bills, one of them comes up with the idea to rob a bank, and the three men risk it all by embarking on a daring adventure to knock off the very bank that absconded with their money.
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Set in Poland in the 1930s, locals Antonina Zabinski and her husband Dr. Jan Zabinski are running the thriving Warsaw Zoo. When their country is invaded by the Nazis, Jan and Antonina are forced to report to the Reich's newly appointed chief zoologist, Lutz Heck. The Zabinskis covertly begin working with the Resistance and put into action, plans to save the lives of hundreds from what has become the Warsaw Ghetto.
King Arthur: Legend of the Sword Starring Charlie Hunnam, Annabelle Wallis, Katie McGrath, Jude Law When young Arthur's father is murdered, Vortigern, Arthur's uncle, seizes the crown. Robbed of his birthright and with no idea of who he truly is, Arthur comes up the hard way in the back alleys of the city. But once he pulls the sword from the stone, his life is turned upside down, and he is forced to acknowledge his true legacy whether he likes it or not.
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autumn recipes
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ANZAC COOKIES • • • • • • • • •
½ cup butter 2 tablespoons golden syrup 1 cup rolled oats 1 cup unsweetened dried shredded coconut 1 cup all purpose flour ½ cup caster sugar ¼ cup brown sugar 1 tablespoon boiling water ½ teaspoon baking soda
1. Preheat oven to 280 degrees Celsius (fan forced) and line two baking sheets with baking paper. 2. Place butter and golden syrup in a small saucepan over low heat. Stir until melted and remove from heat. 3. Combine oats, coconut, flour and sugar in a large bowl. 4. Combine baking soda and boiling water in a small bowl and then stir into butter mixture. 5. Add the wet ingredients to dry ingredients and stir until well combined. 6. Roll big tablespoons of the mixture into balls and place 2 inches apart on the trays. Flatten slightly and then bake for 15 – 20* minutes or until the cookies are a light golden brown colour. *If you like them chewy, bake for just over 15 minutes. If you like them crisp, bake for 20 – 22 minutes.
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D’S SUPER DIET BREAD
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Based on the ezekiel bread recipe, this recipes produces a heavy, dense bread with a slightly peppery, nutty flavour and is just delicious spread with smashed avocado, fresh sliced tomato and some cottage cheese for breakfast. YUM!
• • • • • • • • • • •
1 cup lukewarm water 1 tablespoon olive oil 3 tablespoons honey ¼ cup cooked, mashed lentils, tightly packed 2 cups wholemeal flour ½ cup oat flour 2 tablespoons millet flour ¼ cup soy flour 1 tablespoon rye flour 1 teaspoon sea salt flakes 1 x 7g sachet active dry yeast
1. Attach the dough hook to your kitchen mixer. Add all the dry ingredients except the yeast to the bowl and then make a well in the centre. 2. Add the water, olive oil, honey and yeast and then mix on low speed until all ingredients are combined. 3. Add the mashed lentils and mix on medium-high speed until the dough forms a tight ball. If the dough is too wet, add some more rye flour. If it is too dry, add some more water, one tablespoon at a time. The dough should be firm but elastic and somewhat moist. 4. Transfer the dough to a lightly oiled bowl and cover with plastic wrap. Allow to rise for 1 ½ hours. 5. Turn the dough out onto a lightly floured surface and knock the air out and then shape the dough (I make two smallish round loaves). 6. Transfer the loaf/loaves to an oiled/ floured baking tray and cover with a damp teal towel. Allow to rise for 45 minutes. 7. Bake for 45 minutes to an hour in a preheated oven at 190 degrees Celsius.
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THAI CHILLI LIME BARRAMUNDI • • • • • • • •
2 x skinless Barramundi fillets 1 lime, sliced ¼ cup coriander leaves, roughly chopped 1 tablespoon grated palm sugar Juice of one lime 2 teaspoons fish sauce ¼ cup lite coconut milk Chopped red chilli, to taste
1. Tear two large squares of foil off the roll and lay flat on your counter top. Inside each foil square, place a square of baking paper, slightly smaller in size than the foil. Place one piece of Barramundi in the centre of each piece of baking paper. 2. In a small jug, whisk together the palm sugar, lime juice, fish sauce, coconut milk and chilli together until the palm sugar has dissolved. Pour half of the mixture over the top of each piece of fish. Top with the lime slices and chopped coriander. 3. Fold the foil to make a tent shaped parcel. Bring a pot of water with a steamer insert in it to the boil. Reduce to a rapid simmer and then place the fish parcels in the steamer insert and steam for 20 minutes. 4. Serve with brown rice and garlic ginger snow peas.
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GARLIC GINGER SNOW PEAS • • • • • •
300 grams snow peas, topped and tailed with strings removed 1 tablespoon peanut oil 4 cloves garlic, chopped ¼ teaspoon sea salt flakes 1 thumb size piece of ginger, peeled and finely julienned 1 tablespoon light soy sauce
1. Heat the oil in a wok over high heat. Add the chopped garlic along with the ginger and salt and stir-fry until the garlic only just begins to colour. 2. Add the snow peas and stir-fry for 30 seconds before adding the snow peas. 3. Stir-fry for another minute and then quickly transfer from wok to serving plate.
2017
ROASTED SALMON PARCELS • • • • • • • 1. 2. 3. 4.
2 x 200 gram salmon fillets 6 baby potatoes, steamed and halved 2 tablespoons chopped dill 1 lemon, thinly sliced 2 teaspoons olive oil 2 tablespoons white wine Salt & pepper to taste
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Tear two large squares of foil of the roll and lay flat on your counter top. Inside each foil square, place a square of baking paper, slightly smaller in size than the foil. Lay some slices of lemon in the middle of the baking paper, top with the potatoes and then the salmon fillet. Drizzle with the olive oil, season with salt & pepper and sprinkle the chopped dill on top. Pour one tablespoon of wine over each salmon fillet and then fold the foil to make a tent-shaped parcel. Place the parcels on a baking tray and roast in preheated oven at 200 degrees Celsius for 20 minutes or until salmon is cooked to your liking.
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Once a dream. Now a reality. From $357,900 drive away.* The McLaren Sports Series features a 3.8 litre mid-mounted turbocharged V8 engine, with a lightweight carbon fibre MonoCell II chassis. All combining for a class-defining, game-changing, thrill-enhancing, power-to-weight ratio and a sense of control that makes driving pure fun. No serious competitor. Unless you need to follow the pack?
Visit goldcoast.mclaren.com McLaren Gold Coast 179 Nerang Street Southport QLD 4215 T/ (07) 5509 7110
TRP McL0062 QLD
DN3603578
*Model shown: 54OC from $357,900 drive away in QLD.
FINANCE
2017
Tax Consequences OF THE SHARING ECONOMY
The ATO has recently released guidance on various sharing-economy services. This article examines the tax consequences of two of the most popular aspects of this economy ridesharing and accommodation sharing. Given the rapid growth and projected growth of this part of the economy, it is important to know what those consequences are.
BACKGROUND The sharing economy describes an emerging business model that connects users and providers who wish to share resources including the provision of services. Sharing economy arrangements are generally booked through a facilitator (such as Uber or Airbnb) using a website or app. Although many people consider sharing economy transactions to be private transactions (between the driver and passenger, and the home owner and renter) they have very real tax connotations for both the supplier and user.
RIDE-SHARING Ride-sharing is a relatively new phenomenon and has, for many commuters, replaced taxi travel. Ride-sharing involves a driver (just a normal member of the public) making their car available for public hire. Users wanting a ride make a request through a phone app or website provided by a third-party facilitator such as Uber. The provider/driver of the car used to transfer the passenger is then paid a fare by the customer requesting the ride. The provider/driver then in turn may be charged a fee/commission by the facilitator. pindaramagazine.com.au
For the driver, the tax consequences are as follows:
ACCOMMODATION SHARING
• GST – Early in 2017, the Federal Court dismissed Uber’s appeal of the ATO’s inclusion of ride-sharing as a ‘taxi service’ for GST purposes. The effect of this inclusion is quite profound in that drivers providing ride-sharing services (as with taxi drivers) must register for GST as soon as they start driving (rather than first needing to have a turnover of $75,000). Having registered, they must charge GST on the full fare, and they or Uber must provide a tax invoice to the passenger where the passenger requests it and the value of the fare is over $82.50 (including GST). On the upside, drivers are entitled to claim the GST component on business purchases associated with the travel such as fuel, servicing, registration, depreciation on the vehicle etc. However, these claims must be apportioned to take account of any private usage of the vehicle.
The sharing economy provides a great opportunity for individuals with spare rooms or spare entire properties to rent out space and earn rental income using facilitators such as Airbnb. It is the ATO’s view that the tax law applies in the same way to income received in this way as it does to a standard rental arrangement, for example, through a real estate agent. That is, the amounts received from the customers/tenants must generally be declared as income. Deductions relating to making the room/property available can also be claimed, such as all or part of the interest on a mortgage, insurance, council water and rates etc. Note that if the room/property is let out at less than commercial rates, your deductions allowable may be capped by the ATO to the amount of rent you received. Likewise, the GST rules apply in the same way as normal. Renting a residential property is an input taxed supply, so no GST is charged on the rent, and no GST credits can be claimed on any associated expenses that the owner incurs in making the property available for rent (e.g. electricity, insurance etc.). When you rent out all or part of your home (whether through the sharing economy or through a real estate agent) you will only be entitled to a partial exemption from capital gains tax (CGT) when you later dispose of the property – this is irrespective of whether you actually claim deductions for any interest on a mortgage held over the property.
• Income Tax – The fares received by drivers must be included in their assessable income on their tax return. Any commission charged by the facilitator (Uber) can be claimed as a deduction, as can the costs associated with the vehicle (see above). For the passenger, like taxi travel, businessrelated fares can be claimed as a tax deduction. From a GST standpoint, you are entitled to claim the GST on work-related fares. Where the fare is below $82.50 (most cases) you will not need a tax invoice to claim GST. Where it exceeds this amount, you should request a tax invoice.
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2017
FINANCE
EXAMPLE
Although many people consider sharing economy transactions to be private transactions they have very real tax connotations for both the supplier and user.
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Brock is an employee teacher who is not otherwise registered for GST. He enters into an arrangement with Airbnb to have two spare rooms in his house advertised to guests who can rent the rooms on a nightly basis. The tenants also have access to the toilet and shower in the house. In return, Airbnb charge Brock a facilitator fee. For GST purposes, the rent of each room is an input taxed supply – the nature of the property is residential (it has a shower, and sleeping and cooking facilities etc.). Therefore, no GST is charged on the rent, and no GST can be claimed on expenses incurred in renting out the rooms (e.g. linen, electricity etc.). Indeed, even where the rental income exceeded $75,000 there is no requirement for Brock to even register for GST, as the rental income does not count towards the turnover threshold. Brock must however include the rental income in his tax return as it constitutes assessable income. Offsetting this, deductions can be claimed for the Airbnb facilitator fee, and a proportion of other expenses incurred in letting out the rooms such as mortgage interest and electricity. When Brock eventually comes to sell the property, he will only be entitled to a partial Main Residence CGT exemption. This will be calculated on a floor area basis, excluding from the exemption the parts of the house that were made available to the tenants for the period of their occupation. 2017