PRIVATE HOSPITAL
Complimentary Pindara Magazine ISSUE NINE 2016
HEAD SPACE: MENTAL HEALTH DURING THE HOLIDAY SEASON SURVIVING THE SILLY SEASON: OUR DOCTORS SHARE THEIR TOP TIPS SUMMER RECIPES: FOR YOU TO TRY AT HOME HEALTH
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LIVING
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MOTORING
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CONTENTS
2016
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Contents
REGULARS From the CEO Editor’s Desk Pindara News Finance GENERAL HEALTH CPR It's not as hard as it looks
6 8 10 102
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Snakes & Ladders 16 The deadliest ways to end up in the ER The Doctor's Guide To surviving the silly season
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Under Pressure 26 The link between high blood pressure and dementia
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Immunotherapy 30 Treatment for cancer
Taking a Trip These Holidays? 56 Don't make it to the emergency room
Mental Health Matters The cost of depression
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Hanging Up His Stethoscope 60 Dr Julien de Jager set for retirement
New Year, New You Life-changing gynaecological treatment
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Humans of Pindara Neurosurgeon, Dr Christian Schwindack
Endometriosis 42 And its effects on fertility Protect Your Kids From the sun this summer
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Safe Sports For kids
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LIFESTYLE Singapore Fling An insider's guide to Singapore
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Motoring 80 Aston Martin unveils the DB11
Medicine 52 In the Amazon
2016
2016
Gizmo Guide The perfect gifts for summer
CONTENTS
At the Movies 92 Picks and pans from the latest movie releases Dining 94 Summer Recipes
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Top Reads 90 Our pick of the latest book releases
Festive Cocktails For you to try at home
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88 Gizmo Guide The perfect gifts for summer
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FROM THE CEO
2016
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
From the CEO
Art Direction, Editorial & Production Nude Creative hello@nudecreative.com.au www.nudecreative.com.au
Trish Hogan CEO Pindara Private Hospital
National Advertising Manager Peter Wastie peter@nudepublishing.com.au
It feels like each year passes more quickly than the last and 2016 has been no different. This year marked the 45th year Pindara Private Hospital has been caring for the community and after reflecting back on how far we have come, it is amazing to think that the hospital is still growing and changing as much today as it ever has. The biggest project this year has been the completion of the $12 million Emergency department expansion project. The newly-built extension and full refurbishment of the luxurious Emergency Department and South Coast Radiology facility is part of the Stage 3 project and was officially opened by Shadow Minister for Health & Ambulance Services, John-Paul Langbroek MP on 2 December. The Department has grown to three times its original size, including 27 spacious treatment bays and an exceptional paediatric area. We are proud to say that with all this new construction, we have not compromised on delivering high-quality patient care. The new department is fully equipped with the latest technology to help our specialised and experienced emergency team provide the very best care. Part of this new technology is incorporated into the tranquil Patients’ Waiting Lounge with a new interactive children’s area as well as a screen which is updated in real time allowing patients to see the expected wait time, the doctors on duty and the latest developments at the Hospital. The inclusion of iPads also allows patients to access –and even email themselves – a range of resources at the touch of a button. Pindara was the first private hospital to open an Accident and Emergency Centre in 1987 and I am delighted to say it is now one of the biggest, and certainly the newest, in the country. Another major project within the last year was the rollout of the luxury catering service now available. The Dining Host system has an attendant located on the ward to assist patients with ordering meals and ensure efficient and personalised service. Dining hosts are also available to serve light refreshments throughout the day to patients and visitors. It has been great to see the positive feedback we have been receiving from this innovative service. 6
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Research continues to be a core priority at Pindara. Earlier this year, Ramsay Health Care joined with the International Consortium for Health Outcomes Measurement (ICHOM). Part of this alliance included a Pindara study to track the outcomes of spinal surgery as reported by patients having received treatment for low back pain. This study has received a lot of interest and has now almost reached its 100th patient. This is just one of the research projects at Pindara, an area we will be expanding in 2017. However, it has been a hard year for some and I know everyone at Pindara was deeply affected by the tragedy at Dreamworld. Pindara Private Hospital, along with John Flynn Hospital, donated $10,000 to the Gold Coast Appeal to support the families of this tragedy. Anyone also looking to support the families affected by this tragic incident can donate through the Red Cross approved portal: http://www.givit.org.au Another worthwhile charity that Pindara is pleased to be supporting this year is the Gold Coast Community Fund. The annual staff raffle raised $2050 for the Community Fund’s 2016 Stocking Appeal. Executive management matched this amount and also donated a further $5000, resulting in a total of $9100 donated by the Hospital. The 2016 Stocking Appeal is giving 100% of funds raised back into the community to assist Gold Coasters in need at this time of year. You can find out more and at www.gccommunityfund.org During the holidays, Pindara will be operating as usual. The Emergency Department, as always, will be open 24 hours a day, seven days a week. At this busy time of year, it is also a good idea to make time to visit relatives and loved ones who may be in hospital during the holiday season. Don’t forget to like our Facebook page and our Maternity Facebook and Instagram pages to keep up with all the latest news at Pindara (#Pindaramaternity). Until next time, take care Warm regards Trish Hogan
Assistant Editor Elizabeth Kennedy Marketing Coordinator Pindara Private Hospital MEDICAL CONTRIBUTORS A/Professor Andrew Teodorczuk, School of Medicine, Griffith University Dr Benjamin Walters, Director Emergency Medicine, Pindara Private Hospital Dr Chris Mirakian, General Practitioner Dr Christian Schwindack, Neurosurgeon Dr Christopher Vertullo, Orthopaedic Surgeon Dr Dilip Gahankari, Plastic Surgeon Dr Erlich Sem, O & G Specialist Dr Jorrie Jordaan, General Surgeon Dr Julien de Jager, Rheumatologist Dr Marco Matos, Medical Oncologist Dr Michael Murray, Interventional Gastroenterologist Dr Mohamed Khafaji, Nephrologist Dr Suhad Hassan, O & G Specialist EDITORIAL CONTRIBUTORS Peter Harback Stacey Grims
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.
2016
2016
Welcome to the final edition of Pindara Magazine for 2016! We don’t know about you, but for us here at Nude Creative, this year has absolutely flown by. As 2017 approaches, most of us are thinking about our New Year’s Resolutions. Have you given yours any thought yet? For me personally, my resolution in 2016 was to spend more money on ‘experiences’, and less money on ‘stuff’. This year I did that by ticking a few things off my bucket list. I visited Western Australia (somewhere I’ve always wanted to go), I took my daughter to see snow for the first time and I went to my first-ever Coldplay concert (what an incredible experience that was)! I have to say all these things made 2016 an incredible year for me – my happiness and personal fulfilment are at an all-time high (despite this being one of the busiest years of my career to date), and as such, I plan to carry the resolution I made for 2016 with me into 2017.
What are your resolutions for 2017? What will you do to increase your own health and happiness? I’d love to hear all about it! Drop us a line at letters@ pindaramagazine.com.au From all of us here at Pindara Magazine, we wish you a safe and happy holiday season. Katriya De Vincentiis Ask any question ask@pindaramagazine.com.au
Send your letters to letters@pindaramagazine.com.au
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NEWS
2016
Pindara Leading the Way with New Endoscopy Procedure
“Start the Conversation” Community Health Campaign Over five million people suffer from obesity in Australia. This debilitating condition is no longer considered a cosmetic issue caused by overeating and lack of control, rather, The World Health Organisation now recognises that obesity is a chronic progressive disease that results from multiple environmental and genetic factors. Obesity has been well established as a cause of diabetes, heart disease and infertility and has now also been linked to 13 different types of cancer including colorectal and breast cancer. Husband and wife team, Dr Jacobus Jordaan and Dr Nova Jordaan, have launched a new community engagement campaign to educate the public on the dangers of obesity and help break down the barriers to seeking treatment. The “Start the Conversation” program launched with an educational social media campaign, radio campaign and free educational sessions, and aims to educate the community on the impact of obesity while encouraging sufferers to have the confidence to talk to their general practitioner about treatment. “The reality is that research has shown time and again that people suffering from obesity can’t just eat well and exercise to lose a large amount of weight. They need clinical intervention and medical treatment but often feel too judged to ask for it,” said Dr Jacobus Jordaan. The campaign was originally sparked from research presented by leading obesity researcher Professor John Dixon at the Royal Australasian College of Surgeons (RACS) symposium this year that said 98% of people who would benefit from bariatric surgery were not accessing it. 10
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“GPs tell me how hard it can be for them to start the conversation with their patients about how weight affects their health. Then patients come into my surgery and tell me how hard it was for them to start the conversation with the GP,” said Dr Jacobus Jordaan. It is the perception people have around weight loss surgery as being judged for taking “the easy way out” as well as accessibility which are the problem said Dr Nova Jordaan. “This is our opportunity to give back to community. We have made our services as accessible as possible including introducing a streamlined program for eligible patients that focuses on reducing the cost as much as possible. Now, we need to de-stigmatise this and get people to feel comfortable bringing it up with their GP,” she said. “It is a disease and you wouldn’t leave any other disease untreated. There are escalating tears of treatment starting with diet and exercise, add in medication then add in surgery. The GPs are in the best place to assess that plan for a patient,” she said. While Dr Nova and Dr Jacobus Jordaan realise they have an uphill battle, they are hoping that by providing awareness and tools for patients and GPs, the perceptions in the community start to shift. “We have a treatment that works and I would be really thrilled to go back to RACs in 5 years and see that when John Dixon puts up the pie chart of patients in Australia who are eligible and have accessed this option the numbers have doubled or tripled,” said Dr Nova Jordaan.
The small intestine is currently the most inaccessible part of the gastrointestinal tract, making it difficult to treat conditions in that area when they arise. However, this will not be the case for much longer when doctors at Pindara Private Hospital begin routinely offering the first double balloon entersocopy procedures on the Gold Coast, where previously patients had to travel to Brisbane. Double balloon enteroscopy, or push-pull enteroscopy, is an endoscopic technique that allows the visualisation of the small intestine. This technology debuted in 2001 and was the first endoscopic procedure that allowed for the entire gastrointestinal tract to be visualised in real time. Pindara Private Hospital conducted trials of this technique during 2016 and plans to begin making it available in early 2017. Interventional Gastroenterologist Dr Michael Murray said the small intestine is the ‘final frontier’ of the gastrointestinal tract. “The reason it is hard to get to is that is wriggly and mobile, and not fixed. With the two balloons, placed about a foot apart, you can anchor the scope in position as you go through.” The piece of equipment used is comprised of a long, thin scope with an over tube used to guide the scope. With the over tube, along with a technique of inflating and deflating the two balloons, the small intestine is concertinaed onto the scope. As the scope moves forward through the small intestine, the camera allows the complete examination of the small bowel. When necessary, interventional procedures can also take place using the scope. “It is used to get biopsies from the small intestine and do procedures like treating bleeding lesions, taking off polyps, putting in stents and using balloon devices to stretch narrowing,” said Dr Murray. This technology is also in high demand in an ever increasing group of patients who have an altered gastrointestinal anatomy due to weight loss surgery. Traditionally, to investigate and perform procedures in the small intestine which could not be reached from a standard gastroscopy or colonoscopy, invasive procedures such as open surgery would need to be performed. As it is a non-invasive procedure, doubleballoon enteroscopy is associated with minimal discomfort and a very low complication rate allowing patients to have a shorter recovery time. 2016
NEWS
2016
Pindara Private Hospital’s New Emergency Department Opened The first private Emergency Department in Australia is now not only going to be the newest, but also one of the biggest in the country. On Friday 2 December, Shadow Minister for Health & Ambulance Services, John-Paul Langbroek MP, officially unveiled the new Pindara Private Hospital Emergency Department expansion and the South Coast Radiology Pindara facility. The $12 million new emergency department is the final phase of Stage 3 in the Pindara 4 Stage Redevelopment Master Plan and has taken a year to complete. Pindara CEO, Trish Hogan, said that Ramsay Health Care has invested well over $100 million in Stages 1 & 2 of the Pindara Master Plan which has included the building of a five-level specialist suites tower, a multistorey free car park, a new kitchen and the 120-bed Dr David Lindsay Wing. “At Pindara Private Hospital, we pride ourselves on providing world-class facilities and services for the Gold Coast community. This latest development means that we now have a worldclass 24 hour accident and emergency centre that can support the thriving local community,” Mrs Hogan said. The Emergency Department is now a 27-bed facility which has expanded to three times its original size and is fitted out with the latest technology and equipment including cardiac monitoring capabilities for all acute beds, bedside ultrasound and video laryngoscopy. It will also be the only private emergency department on the Gold Coast to have a purpose-built isolation room for infectious disease. The newly-built, huge undercover ambulance bay is equipped with a hazardous materials shower and has direct access to the resuscitation room providing optimal conditions for the best patient outcomes. This exemplifies the way the Department has been designed with work-flow in mind so that everything a patient may require is at the fingertips of the team, including being colocated with the SCR imaging facility. Emergency Medicine Group Member, Dr Paul Pluss, said that the new spacious treatment bays and wide corridors will give patients the room they need when they are sick, and caters for the whole family. “The Patients’ Waiting Lounge is more comfortable with an interactive children’s entertainment area which compliments the separate nested paediatric emergency area with its restful and distracting animal murals,” Dr Pluss said. “The emergency paediatric facilities combined with our dedicated on-site, paediatric, inpatient beds and outpatient suites make us one of the only pindaramagazine.com.au
L-R Dr Ben Walters, (Director of Emergency Medicine, Pindara Private Hospital), Mr Danny Sims (Chief Executive Officer- Australia, Ramsay Health Care), Mr John-Paul Langbroek MP (State Member for Surfers Paradise and Shadow Minister for Health & Ambulance Services).
private hospitals to fully cater for your children’s needs,” he said. The Patients’ Waiting Lounge features calming murals of tress in autumn and a tranquil fountain to create a relaxing space. A screen has also been added which is updated in real time to display the expected waiting time, doctors on duty and the latest developments in the Hospital. IPads are also supplied for convenience and entertainment and allow patients to access a range of resources at the touch of a button. The Australasian College of Emergency Medicine has long recognised Pindara’s dedication to providing high-quality, emergency healthcare and Pindara continues to have the privilege of training new emergency specialists. Dr Ben Walters, Director of Emergency Medicine at Pindara, said that the new administrative, educational and consulting spaces will assist in facilitating the teaching program at Pindara. “We are committed to developing a stable team of specialist emergency physicians (FACEMs) and advanced emergency medicine registrars at Pindara, and the new areas will help us continue the teaching program we have, including further simulation training for all staff,” Dr Walters said. The team of doctors will still boast extensive relationships with the general practitioner community through open and comprehensive communication regarding the health needs of all patients. “The emergency team haven’t changed and neither has our objective to provide timely,
friendly, high-quality emergency care in a familyorientated fashion,” said Dr Pluss. Part of this high-quality care is recognising how stressful it can be waiting for emergency assistance. Pindara, therefore, aims to make the wait as short as possible and has gone as far as to develop a clock showing how long the wait is likely to be. This is updated in real-time and is displayed in the waiting room and on the Hospital website. “We still, however, make sure we are not rushing you out of the department before a proper assessment has been made and each bed has its own TV so that loved ones can feel as comfortable as possible,” Dr Pluss said. As part of the expanded service, Pindara will also now be offering Executive Health Checks in a dedicated area of the Emergency Department which is spacious, modern and inviting. Dr Martin Clark said this service is called the Pindara Corporate Wellness Centre and the aims to identify health risks before they become major health problems. “Corporate wellness programmes are becoming increasingly important way for companies to look after their greatest asset – their staff – with the benefits of diminished absenteeism, improved productivity and engagement,” Dr Clark said. The Health and Productivity Institute of Australia’s report on the impact of workplace health and well-being programmes assessed that companies save $5.81 for every $1 invested in employee health and wellbeing. Pindara Magazine
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CPR
It’s not as hard as it looks!
Whilst it may look complicated from afar, administering CPR is actually easier than it seems, especially with the latest updates in advice. Read on to find out how you could save a life.
Words: Dr Ben Walters, Emergency Medicine Specialist
Cardiac arrest is certainly no laughing matter, but if you are looking to educate yourself with some practical, life-saving knowledge and have a chuckle in the process, you should look up the British Heart Foundation’s spoof instructional video starring soccer player turned Hollywood ‘hard man’, Vinnie Jones. (https:// www.bhf.org.uk/heart-health/how-to-save-a-life/hands-only-cpr) In a comical yet informative manner, Vinnie runs through a sequence of steps to help you act effectively if you witness a cardiac arrest. The holiday season brings with it an abundance of cheer and plenty of celebrations, but the downside is that it is also brings a rise in tragedies such as cardiac arrest, choking and drowning. Whilst nothing can compare to a formal first aid or resuscitation course, if you find yourself a bystander in such an emergency, doing something is better than doing nothing. When it comes to adults, the most likely treatable cause for a sudden collapse or cardiac arrest is that they have had a heart attack and developed an abnormal heart rhythm as a result. In 2010 the International Liaison Committee On Resuscitation acknowledged that they needed to simplify guidelines to encourage more people to attempt bystander CPR. Without Bystander CPR survival rates were as low as 5% - 6% whereas with bystander CPR they could be as high as 60% - 70%.
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SURVIVAL
RATES ARE AS HIGH AS
60-70% WITH BYSTANDER CPR
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STEP BY STEP
CPR
The first consideration in any emergency is that there is only one casualty; if you put yourself in a dangerous situation there very rapidly could be two victims! Check that there is no threat to your own safety before acting. Secondly, we all get sleepy from time to time so it is worth checking that your patient is actually unconscious and not just ‘taking a nap’. Shout at them and give them a reasonable shake to see if they are responding. If they are unresponsive you will need to get yourself some help. Call out to raise the alarm and/or call an ambulance. When it comes to cardiac arrest in an adult the key principle is that the biggest group of survivors have an unstable heart rhythm, which requires electricity to be passed through the heart in order for it to be corrected. The piece of equipment required to do this is called a defibrillator. If you don’t have one, you will need someone to bring one to you quickly – this is why calling for help is a priority. These days AEDs, or automated external defibrillators, are situated in airports, shopping centres, sports grounds and surf clubs. Keep an eye out for them, as they can save a life. The next thing you need to do is to establish whether your ‘patient’ is breathing. You can listen for breathing, look for the chest moving and feel for breath on your cheek or back of your hand. There are techniques that can be used to open an airway that involve gently tilting the head back and pulling the jaw forward. Just imagine you are the Queen of England, leaning forward to take a sip of hot tea from a fine china teacup! These maneuvres usually require some training and no one really enjoys the thought of doing mouth-to-mouth, particularly on strangers. In the case of adult cardiac arrest, actual ‘breathing’ for the patient doesn't seem to make that much difference to outcomes where as performing cardiac compressions does. The decision was made that if people couldn't or didn't want to do mouth-to-mouth then they should just do cardiac compressions alone - hence ‘hands-only CPR’. Another important observation was that even trained professionals were not very good at finding a pulse. The ‘pulse check’ was thought to be unreliable and therefore a waste of time. 14
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The recommended rate is 100120 BPM, which ironically roughly corresponds to the beat of ‘Staying Alive’ by the Bee Gees! So now if someone is unconscious and either not breathing or not breathing normally then the recommendation is that you should just start CPR. Confusion always surrounded where to push to perform CPR and how fast and how deep to push. The worst thing that can happen is that no one pushes at all! Push on the sternum (breast bone) in the middle of the chest, push hard and push fast. The recommended rate is 100-120 BPM, which ironically roughly corresponds to the beat of ‘Staying Alive’ by the Bee Gees! It takes a number of compressions to get the blood going to the heart; every time you stop it takes a while to get the flow going again, so try not to interrupt your CPR. Keep pushing hard and fast, singing ‘Staying Alive’ until someone comes with a defibrillator to help you, or you simply can't keep going any longer. If a defibrillator arrives, don’t be afraid to use it – just open the box and follow the instructions, it’s actually quite simple. If you are able to restore the rhythm and get the heart going again, most patients then require a cardiologist to investigate the heart and open any blocked vessels. This is where we come in! Our specialised cardiac catheterisation lab is open 24 hours a day, seven days a week – we’re even open on Christmas Day! Drowning, on the other hand, is a completely different kettle of fish. Usually the victims are children with good hearts and the problem relates to breathing. Checking for danger and calling for help still apply obviously, but in this case it is recommended that you breathe for your patient. Sometimes people drown because they have injured their neck or back, so taking care not to move them vigorously is important. However if you are too worried about the neck to actually breathe for them then the outcome is likely to be bad anyway. Move them carefully but get on and resuscitate them as quickly as possible! Again there is no replacement for proper training, but in principle, tilting the head back, lifting up the chin and breathing over the mouth - or both the mouth and the nose - is the aim. Cardiac compressions are performed in the same fashion as described above and at the same rate (100-120 per minute). Changing the ratio of compression to breaths for adults and children was previously confusing, so now we just use two breaths to 30 compressions for everyone! The final common scary event you might encounter this silly season is a choking episode. The respiratory tract really doesn't like having foreign objects in it and has a tremendously pindaramagazine.com.au
effective safety mechanism called a cough, which it uses to expel things it doesn't like. If someone appears to have inhaled a foreign object and is still coughing they should be encouraged to cough but closely observed while they do so. If they are unable to cough and their windpipe appears to be obstructed, they are choking and attempts must be made to externally dislodge the blockage. If your patient remains conscious then attempting to remove the blockage by hitting them firmly in the centre of the upper back is the first recommended step. These “back blows” can be repeated five times but with the aim being to dislodge the foreign body with each blow. This can be done with adults standing or sitting. Smaller children and infants can actually be picked up and supported upside down - along one’s leg for example - whilst delivering back blows. If five back blows have been unsuccessful then up to five chest thrusts should then be employed. Chest thrusts are similar to the manoeuvre used in CPR with hands placed in the centre of the breast bone but should be done with more vigour to try and express the object. If your attempts prove unsuccessful and your patient becomes unconscious then one should start standard CPR with two breaths to 30 compressions. The worldwide Advanced Paediatric Life support algorithm for choking can be found at this link. https://apls.org.au/sites/default/files/ uploadedfiles/Algorithms%20-%20Choking%20 Child.pdf Traditionally the Heimlich Manoeuvre was promoted as a way of removing a lodged foreign body. This involved placing a clenched fist in the upper abdomen then pulling up under the ribs from behind. Unfortunately there were a number of case reports of fatal abdominal organ injuries due to this technique and its use is no longer encouraged. Interestingly, in May this year at the age of 96, the retired surgeon Dr Henry Heimlich used the technique that he had developed. This was the first time he had the opportunity in real life to use his famous technique and was able to save the life of a fellow nursing home resident, Patty! Have fun this holiday season but try and stay safe. If however you do have a mishap of some description the doctors and nurses at our brand new state-of-the-art Emergency Department will be there 24/7 to help patch things up! Pindara Magazine
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Snakes
&LADDERS The deadliest ways to end up in the ER!
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2016
Words: Dr Ben Walters, Emergency Medicine Specialist
I’m sure many of you would agree with me when I say we live in paradise! Australia has one of the best climates, highest standard of living, lowest unemployment rates and easy access to the very highest standards of health care in the world. There must, however, be some down side. I guess as an expat Pommy, I can attest that the rest of the world lives in fear of the vast array of deadly creatures that share a home with us here in ‘paradise’. Whilst it is true that we do boast a fearsome array of deadly creatures – and it seems that a life threatening encounter with a snake, spider or shark is only metres away at any given time – I would argue that you are way more likely to injure yourself putting up Christmas decorations on a ladder than you are to come-a-cropper with a passing snake. The Australian Museum in Sydney have put together a list of the most dangerous creatures in Australia. They based this on the nature of the injury/toxin the creatures can produce combined with the likelihood of us meeting one! The top 10 might be relatively predictable. There are two jellyfish, three snakes, a crocodile, a shark, a spider, and a cute little octopus. But would you believe that the second most deadly animal in Australia is actually the humble honey bee!
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Jellyfish The jellyfish in question are the dreaded Box Jellyfish (Chironex fleckeri) and the Irukandiji Jellyfish. The Box Jellyfish is found in tropical waters around Australia. It has caused approximately 80 deaths since records began. It is a big, box shaped – hence the clever name – jellyfish and tends to be a seasonal visitor. Exposure is limited by keeping out of the water or with the use of stinger suits. Fatalities are usually from rapid onset cardiovascular collapse and whilst there is an antivenin available, often this occurs before victims make it to the hospital. Usually pain is felt immediately and tentacles form a characteristic pattern on the skin. The toxin cells or Nematocysts remain adherent to the skin and need to be carefully removed to prevent them from ‘firing’ and releasing more venom. Vinegar can be used to deactivate them and/or then manually scraping them off with a razor or credit card. Irukandiji syndrome is rarely fatal, with only about 10 recorded deaths. It is caused by a group of different small jellyfish. The pain in this case is delayed but is severe. Deaths are rare but when they occur are caused by over activation of the adrenalin “fight” reflex, which causes heart failure and cardiovascular collapse. Again, vinegar is a reasonable first aid measure as it deactivates nematocysts then in hospital we would manage the pain and high blood pressure that results. 18
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Crocodiles Crocodiles are up there but not as common a killer as you would think, with slightly over 10 fatal attacks in the last 15 years. Approximately 50% of attacks are fatal, so here first aid advice is relatively fruitless - prevention is the key! Most attacks occur in areas where crocodiles are known to be endemic, so pay attention to warning signs posted in these areas.
Sharks Sharks have been getting a bad rap recently, partly due to a spate of attacks on the local Northern New South Wales coast. In recent weeks, work began to install shark nets along the Ballina coastline in a controversial attempt to control the risk to sea goers. Sharks tend to cause trouble by accidentally knicking major arteries, resulting in blood loss. First aid attempts are therefore focused on attempting to control blood loss. Direct pressure to the wounds is the only available option in most cases. That said, there have been 250 or so recorded deaths due to shark attacks on record which seems relatively insignificant compared to the 280 drowning deaths documented last year in the Royal Life Saving National Drowning Report.
Spiders Although Australia is famous for scary spiders, in actual fact there are only really two of medical interest. Redback spiders cause an annoying, painful condition – lactrodectism - which is rarely fatal and can be treated with anti-venom. However, Funnel Web Spiders can be very nasty! Envenomation occurs rapidly, almost always within a two-hour period and causes a florid multi-organ syndrome with skin changes, sweating, high blood pressure, agitation, muscle spasms and cardiovascular collapse. A pressure immobilisation bandage can be employed prior to getting to a hospital with the anti-venom. There have been 27 recorded deaths in the last 100 years.
Octopus Number 8 on the list is a slightly unsuspecting and very attractive looking octopus. The Blue Ringed Octopus apparently carries enough of the tremendously potent tetradotoxin to kill 26 humans within minutes! This toxin causes rapid onset paralysis and causes people’s respiratory muscles to stop working. There is no anti-venom but this effect wears off if we can take over the victim’s breathing for them in time.
2016
Snakes We are famous for poisonous snakes and three of our best made it into the top 10: the Eastern Brown Snake, the Taipan and the Death Adder. The venomous Australian snakes all have a multitude of toxins that travel within the lymphatic system of their victim. This means that a properly applied Pressure Immobilisation Bandage (PIB) is the key to the first aid. Anecdotally, the common teaching is that no one has ever died where a properly applied PIB has been used in a timely fashion. This technique is well described and demonstrated on various websites but involves wrapping a bandage firmly (but not too tightly) around the entire affected limb staring from the furthest point (fingers or toes) and then splinting the limb and not using it. Once at hospital, a series of examinations, blood tests, swabs and other tests can be used to determine firstly whether envenomation has taken place, and if so, which anti-venom will be most helpful. Whilst there have been approximately 50 deaths in the last 35 years, the overwhelming majority of these have been males with alcohol in their system. So if you are not male and not drunk then you have a fairly good chance of survival!
Honey Bees The final ‘deadly beast’, taking out the number two spot on the Australian Museum’s list is the humble honey bee! Whilst responsible for the production of my favourite natural sweet treat, and pollinating much of the world's crops and flowers, a significant proportion of the world’s population are actually severely allergic to the sting of a bee. Anaphylaxis to this poor little insect kills two to three people every year. Intramuscular injection of adrenalin is the treatment of choice for this condition. With commercial ‘Epipens’ now readily available, often susceptible individuals will be carrying the treatment with them.
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It sounds terrifying doesn't it? And all of these creatures live around Australians and could strike at any time. But considering that 22 people died falling off ladders in 2005 (according to a report published by the Australian Government), and ladder related injuries accounted for 16,800 hospital stays that year, this holiday period worry a little less about the dangerous creatures and a little more about falling off the ladder whilst hanging Christmas decorations. Be careful putting up those lights!
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2016
Guide TO SURVIVING SILLY SEASON
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Contrary to the rumours, there is no secret miracle hangover cure, known only to doctors. There are, however, ways to minimise the pain the morning after the night before! Six of Pindara’s top doctors share their tips for making it through the festive period (relatively) unscathed.
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DR GARY SWIFT
DR CHRIS MIRAKIAN
DR ALISON SPRAGUE Eat, drink and be merry - that is what the season is for. And then January is when the new resolutions start. The kids are on school holidays, so they should get more household duties. Put the older kids to work in the kitchen, and tell them to have dinner ready by the time Mum and Dad get home, or get them to help out with the laundry. In my experience, a burger definitely works for a hangover. I also agree with the theory of having a glass of water between each alcoholic drink, but unfortunately I never actually remember to do this myself. Haha!
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In regards to keeping the weight gain at bay, I try to eat a minimal amount during the day so that I can eat what I like in the evening. Calorie control works! I haven’t had a hangover for a long time but a big greasy meal usually works for me. We know it’s bad for you, but it does make you feel good! A Berocca multi-vitamin also helps me. In terms of preventing the hangover, it’s good to eat while you drink - having a meal with your alcohol can reduce blood alcohol levels by up to 50%. Part of my job is to perform forensic blood alcohol tests, so I know! Generally the thought is that you metabolise one drink per hour, but that is variable from person to person (depending on size, stature etc) so you can’t count on that as a hard and fast rule.
Make sure to have a glass of water with every glass of booze, especially in the hot sun, to avoid dehydration. Alcohol is a diuretic, so it makes you very dry. Keep some Berocca multi-vitamins handy for the morning after to help get your B group vitamins back. Down a big glass of water before you go to bed, and whatever you do, don’t drink and drive! Excess alcohol (and food) consumption is definitely not good for you, so just remember to have everything in moderation. Try and have at least two alcohol-free days per week during the festive season to let your body recover. I stick by that, keeping Monday and Wednesday as my alcohol-free days. Red wine has more potential health benefits than other alcohol, so that would be my recommended drop. Some are better than others. Generally, the better quality (and probably more expensive) it is, the less pain you’ll feel the next day! Cheaper wines usually contain a lot of chemicals and preservatives to help speed up the maturation process and extend shelf life. A good wine will tend to be much lower in chemicals and preservatives.
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DR DREW MOFFREY In regards to seasonal weight gain, try to eat more protein, and less carbs – try and cut off your carb consumption at 2pm. Having said that, a greasy carb-laden meal is always good for a hangover – I personally can’t go past KFC. Try and minimise the hangover by drinking lots of water before bed so you don’t wake up with the ‘dry horrors’! Try and avoid sugary alcoholic drinks, and stick to low-calorie options like vodka and soda with fresh lime.
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DR SHANNON WEBBER I find that sparkling water goes down easier. Get up in the morning and then drink more sparkling water again! Drinking a glass of water between alcoholic drinks is the best advice – but this never happens! Non-carbonated alcoholic drinks and red wine are least likely to give you a hangover It’s always best to have a bit of food in your stomach prior to a big night of drinking, and sparkling water and a nice fresh juice the next morning will help to flush the kidneys out.
DR BENJAMIN WALTERS My stance on hangovers is to either consider not drinking too much, or not whinging too much about it! Keep fluids up while drinking alcohol and try and choose something like a long gin and tonic, which is low in calories and not as dehydrating as a sugary alcoholic drink. In regards to travel during this holiday season, hydration and mobilisation are the best things to do on a plane. Compression stockings and regular movement or exercises are worthwhile looking into.
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DO YOU HAVE YOUR ESTATE PLANNING BASES COVERED?
We’ve all been there, a visit to hospital to see a loved one or a health scare of our own, prompts us to start thinking of our own mortality and can highlight the need to make sure your personal legacy to your family is not one of debt, chaos and frustration.
DO YOU KNOW IF YOUR SUITE OF ESTATE PLANNING DOCUMENTS ARE IN PLACE AND UP TO DATE? It is common for clients to prepare Wills early in their careers or early in a relationship, and consider that they are a ‘set and forget’ document, not realising your estate planning needs can change as your life, family and career circumstances change. Besides this misconception, many people are also not aware that their estate planning documents may be incomplete, due to a number of potential reasons, such as: • • • •
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Marriage or divorce may partially or wholly revoked your existing documents; You hold assets via different structures, meaning a Will may not be sufficient to give effect to your wishes on your death; Superannuation binding death benefit nominations may have lapsed or may be ineffective; or Being in a new ‘blended’ family may mean your estate plan is subject to different risks from challenges to your Estate.
DID YOU KNOW? If you hold assets other than in your personal name, they are not estate assets and cannot be gifted via your Will. This includes assets held in joint names as joint tenants, which on your death simply revert to the survivor. Many spouses hold their homes and bank accounts as joint tenants. For blended families in particular this may result in assets being transferred other than in accordance with your wishes. Assets held via family discretionary trusts or unit trusts are not governed by your Will, and are instead governed by the Trust Deed. It is important that the relevant Trust Deed is reviewed to see who will have control of this structure on your death and what can be done to complement your estate plan. Superannuation is an area where Australians hold an increasing amount of their wealth. The only circumstance in which your superannuation death benefits will be paid in accordance with the terms of your Will is where the funds are paid to your Estate. This is only one of a number of potential scenarios. Your superannuation death benefits can be paid to:
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ADVERTORIAL
• • • •
Your spouse (whether married or de facto); Your child (whether a minor or adult child); Someone who is your interdependent, a term defined in tax and superannuation legislation; or Your Estate or Legal Personal Representative.
You can bind the Trustee of the superannuation fund as to how your superannuation death benefits are paid by preparing a valid binding death benefit nomination (BDBN). If you do not have a self-managed superannuation fund (SMSF) then a BDBN lapses every three years. Your superannuation provider may not advise you when your BDBN lapses, so it is important to keep tabs on whether this is up to date. If you are a member of an SMSF, then currently any valid BDBN will not lapse, and the trust deed of the SMSF may allow you to include your specific wishes as a rule of the fund itself. It is still important to continue to review your SMSF requirements as superannuation law changes frequently. When considering your estate planning it is vitally important to also ensure you have a valid Enduring Power of Attorney in place. In Queensland, an Enduring Power of Attorney (or EPOA) provides an Attorney with the ability to manage your financial affairs and personal/ health affairs in the event of your incapacity. An
Enduring Power of Attorney will be required in order for your assets to be managed on your behalf, whether that is: • •
Ensuring you have cash flow to continue to pay bills; or Arranging the sale of larger assets to fund the transition to a retirement home or assisted care.
The personal/health side of the EPOA allows your Attorney to manage your care and living arrangements when you lose the capacity to make these decisions for yourself. Importantly, many aged care facilities will require a valid EPOA for a resident before they allow them to move in. In the absence of a valid EPOA, family members or interested parties must then apply to the Queensland Civil and Administrative Tribunal (QCAT) for Administration or Guardianship Orders. Whilst the Tribunal is designed to be user friendly (you are not required to engage a lawyer to appear at QCAT), urgent applications can still take time and be a stressful process. To ensure a smooth transition in the management of your affairs and have the Attorneys of your choice in place, it is best practice to have a Enduring Power of Attorney prepared when you still have capacity. If there are potential concerns as to your capacity when
signing an EPOA, you may wish to consult your General Practitioner or consider obtaining a referral to a relevant specialist who can provide a report to your solicitor as to your capacity to understand and make an EPOA (and a Will, if relevant). It is also important to recall that if you reside outside of Queensland or hold assets outside of Queensland (for example, New South Wales), then you will need to prepare the relevant documents for that State. In New South Wales Enduring Powers of Attorney govern your financial matters and Enduring Powers of Guardianship govern personal and health matters.
Penelope Wells Senior Associate Small Myers Hughes pwells@smh.net.au
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Under Pressure The link between high blood pressure and dementia
Words by Dr Mohamed Khafaji, Nephrologist
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OPTIMAL BLOOD PRESSURE
BELOW
120/80
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Blood pressure, in basic terms, “is simply the pressure of blood on the blood vessel walls as it is pumped around your body” (National Heart Foundation, NHF). Optimal blood pressure is generally below 120/80 with the pre-hypertension range up to 139/89. Astoundingly, one third of all Australians over the age of 18 suffer from high blood pressure. Many research studies, including an NHF study, have shown that long-standing high blood pressure can damage the small blood vessels in the brain that allow us to think and provide our memory. When it comes to dementia, age is the strongest risk factor, with the incidence increasing with each decade of life. Genetics also plays a role in both early and late onset dementia while lifestyle factors including social, mental and physical activity, obesity, smoking, and high alcohol intake have also shown links with cognitive decline and dementia in many observational studies. There is also some evidence that other factors such as head trauma, toxin exposure and depression may also increase the risk. Vascular conditions such as hypertension have been found to have strong links in many research studies to cognitive decline and are now also considered a risk factor for dementia. Of the many risk factors, the increasingly strengthened links of hypertension with dementia is quite alarming. However, this is one risk factor that can be controlled.
DEMENTIA
3IN10 OVER 85
AFFECTS
Dementia is the second leading cause of death in Australia and there is no cure. This progressive decline in a person’s functions affects one in 10 Australians over the age of 65 and this number rises to three in 10 for Australians aged over 85. Alzheimer's Australia describes dementia as “a collection of symptoms that are caused by disorders of the brain … that affects thinking, behaviour and the ability to perform everyday tasks”. This debilitating diagnosis not only affects the quality of life for the person with dementia but also puts an enormous emotional pressure on family members and carers with an estimated 1.2 million people involved in caring for a person with dementia in Australia. Increasing numbers of people suffering from dementia also puts a financial burden on the health care system, with the spending on dementia set to outstrip that of any other health condition by 2060. However, recent studies have shown that there may be some hope when it comes to the prevention of dementia. A statement issued by the American Heart Association (AHA) in October this year, supports the increasing evidence of the strong link between long-standing high blood pressure (hypertension) and declining cognition that leads to dementia. The AHA authors wrote that "the treatment of hypertension may prove to be one of the best ways to prevent or delay dementia".
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High blood pressure as a condition carries many key influences that contribute to its cause. Family history, diet, alcohol, weight and physical activity are many factors that can lead to high blood pressure and which can be immediately addressed through a lifestyle change. Treating high blood pressure has been important for a long time in reducing cardiovascular events. Now, increasing evidence for early management of blood pressure helping to also prevent or delay dementia is becoming more apparent with evidence for blood pressure control being reinforced by a report published by John Hopkins in the journal 'Neurology.' This report showed the use of simple blood pressure medication significantly reduced the risk of dementia by up to 75%. While this is good news, one size does not fit all. Since the importance for early intervention and 'precision' medicine with blood pressure control has been established, the need for a focus on individualised blood pressure management has become more evident. A study published in the JAMA Journal 2013 demonstrated the significance of monitoring of an individual’s blood pressure showing a vast difference in varying blood pressure end targets depending on other factors such as a person’s age. Some individuals had shown poorer outcomes if blood pressure was reduced too low and older groups had better outcomes with higher blood pressure targets. Timely initiation of treatment also plays an important role. In the absence of contraindications, it has been suggested that starting blood pressure treatment even in the pre-hypertension range may be beneficial. There is also evidence that there is an association for increased dementia risk even in this suboptimal range. There are many obvious challenges clinicians face in treating high blood pressure, which is why it is essential to have specialist, individualised management. The link between high blood pressure and dementia has been known for many years. With further research, new discoveries into cellular and molecular pathology and the continued advancement towards new technologies, the complex relationship between blood pressure and cognition will become increasingly defined to support the best possible outcomes for individuals. Meanwhile, regular health checks with your GP and healthy lifestyle changes starting today are vital to help prevent and reduce known risk factors for a decline in cognition and dementia.
FOR MORE INFORMATION, YOU CAN PHONE: National Heart Foundation 1300 362 787 National Dementia Helpline 1800 100 500
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PHONE 07 5564 6501 Suite 2, Pindara Professional Centre 8 - 10 Carrara Street, Benowa QLD info@surgerygoldcoast.com.au www.surgerygoldcoast.com.au
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Immunotherapy TREATMENT FOR CANCER
Dr Marco Matos, Medical Oncologist
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Cancer is the result of the accumulation of changes in the genetic material (mutations) that allow the cancer cell to survive, proliferate and invade other healthy organs. Environmental factors (smoking, sun exposure, radiation etc), chronic inflammatory processes (viral infections, etc) and host-related factors (obesity, hereditary conditions, etc) are important in the carcinogenesis process (formation of cancers). The human body has more than one hundred trillion cells, dividing every day from the very first day we are born, except for brain and nerve cells. Every second of our lives, one million cells die (apoptosis) due to aging, and new cells replace them with the exact same DNA material. During this process, things can go awry and the body (including immune system) attempts to rectify the mistakes or destroy those wrongdoings. Cancer occurs when an altered DNA sequence (mutation) remains occult or disguises itself to allow that cell to survive. The newly formed mutated cell then will have to learn many other abilities (further mutations) before it becomes malignant and proliferates and invade other organs. The immune system plays an important role in protecting our organisms from external invaders (bacteria, viruses, fungus, etc) and also maintaining the balance among other cells, destroying unwanted extras. The immune system has the ability to recognise every molecule in the universe (diversity), to react to a specific event (specificity) and to memorise that event (memory) so it can mount a big defence if confronted again.
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Immunotherapy is an anti-cancer approach that complements traditional ways of fighting cancer such as chemotherapy and radiotherapy.
Immunotherapy is an anti-cancer approach that complements traditional ways of fighting cancer such as chemotherapy and radiotherapy. Over 120 years ago, Dr William B. Coley - considered the father of cancer immunotherapy - injected a mixture of dead bacteria into patients with cancer after observing that some cancers regressed in the presence of streptococcal infections. Since then we have learned a lot that allows us to manipulate the immune system with more specificity to a variety of antigens, including cancer antigens (proteins sitting in the surface of cancer cells), activating or inactivating mechanisms that allow the immune system to recognise cancer cells as wrong cells, developing antibodies that slow down pathways that are overactive and creating vaccines that induce the formation of a robust army against cancer cells. The main types of immunotherapy can be divided into non-specific immunotherapies, antigen specific antibodies and cancer vaccines.
Non-specific Immunotherapy Antigen therapy, such as BCG therapy, uses a weakened strain of mycobacteria originally designed to produce immunity against tuberculosis, which also produces an immune response when injected into early bladder cancers. Cytokines such as interferon alpha IFN, tumour necrosis factor TNF and interleukins IL 4 and 6 have a direct anti-tumour effect as well as an indirect effect, enhancing the immune response. Used to treat kidney cancers and melanomas. Cell therapy, such as dendritic cell therapy, cultivates and multiplies cells that recognise cancer cells, and are then infused back into the patient.
Dr William B. Coley considered the father of cancer immunotherapy injected a mixture of dead bacteria into patients with cancer
Transfer of T-cells (the killer cells of the immune system) isolated from a patient with cancer then cultivated to large numbers and reinfused back to the patient.
Cancer occurs when an altered DNA sequence (mutation) remains occult or disguises itself to allow that cell to survive.
Antigen Specific Immunotherapies Antibody therapy uses different immune proteins that attack specific molecular targets such as Herceptin, which targets a type of breast cancer that overexpresses a growth factor receptor (Her2) or panitumumab - an antibody that targets the gene RAS, present in half of colorectal cancers. Transfer of T-cells (the killer cells of the immune system) isolated from a patient with cancer then cultivated to large numbers and reinfused back to the patient. The results are good but short-lived. Enormous efforts are put into expanding and maintaining the killer effect of the T cells.
Specific Immunotherapy Vaccination of tumour-based vaccines, virusbased vaccines or protein and peptide-based vaccines. Check-point inhibitors act by releasing the brakes that stop the immune system unleashing the immune system to attack cancer cells. Cancer cells use check points to escape the detection of the immune system. CTLA4 and PD-1 are the most studied and drugs and include Pembrolizumab (Keytruda), Nivolumab (Opdivo) and Ipilimumab (Yervoy), which are currently routinely used to treat melanomas. As evidence emerges that other cancers (lung cancer, head and neck carcinomas, bladder cancer, kidney cancer, some types of breast cancer and prostate cancer) can also respond to check point inhibitors, the management of cancers have changed dramatically. Patients that respond to these drugs have less side effects, and respond for longer periods of time, providing new hope for cancer sufferers around the world.
Me n ta l He a lt h Matters Dr Andrew Teodorczuk, FRCPsych (Associate Professor in Medical Education, Griffith University, Australia)
Globally, the World Health Organization (WHO) estimates that in 2030, depression will represent the single greatest cause of health burden. This is from both an economical and sociological perspective. Currently sitting at number three, behind cardiovascular disease and cancers, depression is set to rise to number one within the next 15 years. Arguably, this epidemiological transition is attributable to greater medical advances in the treatment of physical illnesses and, importantly, healthier lifestyle changes such as a reduction in smoking at a time when modern day life is becoming more stressful and demanding. In financial terms, depression costs the Australian economy approximately $12.6 billion a year, accounting for six million working days of lost productivity. This is because depression and anxiety affects one in three Australians, often during their working lifetime. However, aside from economic reasons, the burden of depression is worrying due to the considerable human toll. Unlike deaths from heart disease, cancer and motor vehicle accidents, deaths from depression are on the rise. In Australia, recent suicide figures from the Bureau of Statistics suggest the national suicide rate has increased to 12 deaths per 100,000. Middle-aged men are especially
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vulnerable and suicide accounts for a shocking 18.3% of male deaths in the 40 to 44 age bracket. Urgent attention from healthcare services and providers is essential. The problem is that depression tends to be under-diagnosed with less than half of patients presenting to their GP receiving a diagnosis. Furthermore it may be masked, especially in older patients where depression may not always present with low mood but rather with physical symptoms. In fact it has been estimated that nearly 38% of patients attending medical outpatient services have depression and no discernable physical illness. Other challenges relate to stigma that blocks self-referral. Mood difficulties without physical signs may be perceived as a sign of weakness when the reality is that depressive symptoms such as low mood and lethargy represent an underlying medical illness in a similar manner to which chest pain and shortness of breath are symptomatic of heart disease. Worryingly, stigma and social embarrassment can lead to isolation and further internalisation of negative attitudes, as a patient does not seek the help that ultimately they need. With this in mind, raising awareness of depression, reducing stigma and discrimination and encouraging help seeking behaviour are core priorities for national charities such as Beyond
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S UICIDE ACCOUNTS FOR
18.3%
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MALE DEATHS IN THE 40-44 AGE BR ACKET
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Ramsay Healthcare is investing in a new state-of-the-art private hospital in Southport dedicated to mental health matters Blue (https://www.beyondblue.org.au). This is even more pertinent at this festive time of the year when expectations are high, and the reality for many is that the holiday season can be a lonely experience. Further, Christmas by its very nature is stressful and loss events or anniversaries at this time can precipitate depressive symptoms and syndromes in those who may be at risk. So how can depression be spotted? More specifically how can we differentiate a depression syndrome requiring treatment from normal sadness that we all encounter in everyday life? Essentially, depression lies at one end of a mood spectrum and whether someone is in need of treatment is dependent on the symptom profile and degree of associated functional impairment (disability). Broadly speaking, depressive symptoms fall into five categories. These are biological (so called “neurovegatative� symptoms) such as poor appetite and sleep difficulties including early morning wakening; emotional symptoms such as low mood and inability to experience pleasure; behavioural symptoms such as withdrawal and selfneglect; cognitive symptoms such as feelings of worthlessness, suicidal thoughts and poor concentration (especially prevalent in older patients) and lastly, in the severely depressed, psychotic symptoms including delusions of guilt and hallucinations with a negative theme. The exact profile of symptoms present will depend on multiple biological, psychological and social factors that vary from patient to patient. No two patients will have the same clinical presentation and understanding the patient’s experience of depression is key to successful management. In mild to moderate 36
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depression, low grade psychological therapies and exercise may be necessary, whereas in moderate to severe depression, if risk is present, inpatient management with more complex psychopharmacological management may be indicated. The paradox is that despite the fact that effective treatments exist in the form of novel anti-depressants, ECT and psychological therapy and despite the rising cost of depression, health services invest significantly less in depression than other illnesses. For this reason it is known as the silent epidemic, and mental health is referred to as the Cinderella specialty. In addition, depression rarely exists as an illness in isolation. Often there may be co-existing physical illnesses and treatment of the depression will improve physical outcomes. Recently, however there have been some local developments that offer some hope for the future. Firstly, Ramsay Healthcare is investing in a new state-of-the-art private hospital in Southport dedicated to mental health matters. A team of experts across the healthcare spectrum are being recruited. Importantly, the team will include psychologists able to offer cognitive behaviour therapy and skilled psychiatric nurses to help provide essential care. Initially, the focus of the new hospital will be on depression, pain management and rehabilitation. However with time the service is set to expand to manage psychogeriatric disorders as part of an elderly assessment program. With population ageing and advances in our understanding of late life depression, this is especially timely. Secondly, recognising that physical and mental difficulties are intertwined, internationally Liaison
Mental Health services are being developed within healthcare systems. The value of these services is not only in terms of treating patients with complex mental health difficulties such as delirium in the general hospital but rather in their education capacity. By successfully training medical and surgical staff at both team and organisational levels, more holistic care and better outcomes can be achieved. Within the UK the new RAID liaison consultation model has been demonstrated to have proven economic benefits purportedly leading to four pounds sterling saved for every pound spent. It is hoped that with time Ramsay will be able to offer a degree of liaison input into the general hospitals too. Lastly, greater awareness amongst the public of depression as an illness affecting people from all walks of life is being developed. Championed by inspirational role models such as Ben Roberts Smith VC (who recently spoke at the first Ramsay Legacy event), slowly stigma is being tackled and public attitudes are changing. Consequently, patients with depression are more open about their symptoms and may seek the help they need. Never has it been clearer that mental health is important, and with a rising global burden it is imperative that healthcare providers focus on tackling depression as a priority area. However, despite WHO predictions of a gloomy future, by focusing on raising awareness, fighting stigma and developing appropriate services to implement evidenced based treatments it is hoped that, as with cancers and cardiovascular diseases, depression may even one day become an illness on the decline. 2016
New Year New You
Re-setting the clock for 2017 with this life-changing gynaecological treatment
Dr Suhad Hassan, Obstetrician & Gynaecologist
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In 2014, Obstetrician Gynaecologist Dr Suhad Hassan was the first doctor to introduce the revolutionary MonaLisa Touch treatment to the Gold Coast identifying the need for a convenient, non-hormonal treatment to help and support Gold Coast women suffering from vaginal atrophy. Over 2,000 treatments have been performed in Australia and their immediate and remarkable results are supported by mass clinical data presented world-wide. Dr Hassan has seen first-hand the life-changing effects of MonaLisa Touch and says women hold the key to helping other women through a common health issue. “We’ve seen a dramatic increase in the number of women coming in for treatment as a direct result of word-of-mouth communication. With patients talking openly to friends, family and colleagues about their own overwhelming results, we’ve been able to help so many more woman who assumed nothing could be done,” Dr Hassan said. Vaginal atrophy, or atrophic vaginitis, is thinning, drying and inflammation of the vaginal walls due to a reduction in oestrogen levels. It affects around 50% of all menopausal and postmenopausal women and younger women who have used the contraceptive pill for prolonged periods, breastfeeding mothers and women who have experienced traumatic labour and delivery or severe perineal repair and scarring. Despite its prevalence, only 25% of women suffering from this issue seek medical advice. As Dr Hassan says, we need to get better at talking about atrophy. “Unfortunately, many women ignore symptoms relating to the vagina and urinary system and put up with them as a natural part of aging, menopause or childbirth, unaware that we can significantly improve their quality of life,” Dr Hassan said.
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The treatment is also ideal for those looking for a less invasive procedure compared to traditional surgical or pharmaceutical treatments and for women who just prefer not to take oestrogen-based medications
Over the last 30 months, Dr Hassan has treated women of all ages including post-menopausal woman and breast cancer patients and says the main symptoms woman present with include painful intercourse, itchiness and burning, dryness, laxity, loss of lubrication, incontinence and urinary urgency. “The exciting news is that women who have endured years of painful and uncomfortable symptoms are experiencing significant improvement after the first five-minute treatment, and the results are long-lasting. “What we want to encourage women to do is come in for a consultation, where we can very quickly determine whether MonaLisa Touch is right for them. The treatment will only be performed when we know we can achieve significant benefits for the patient,” Dr Hassan explains. The breakthrough non-surgical laser treatment successfully treats a string of painful, uncomfortable and often embarrassing symptoms by addressing the issues that cause them. “Suitable for almost all women, the treatment is non-invasive, needle-free, extremely low risk and requires no recovery time,” Dr Hassan said. While Dr Hassan says patients report dramatic improvements after just one treatment, the greatest outcomes and full benefits are achieved with three treatments and a follow-up treatment 12 - 18 months later. So how does it work? MonaLisa Touch uses anti-aging technology with hundreds of pillars of laser energy to stimulate the natural regeneration of tissue, and is quick, simple and safe. “The procedure works by stimulating the body’s own regenerative processes, creating more hydrated and healthy cells and improves the circulation and nutrient supply to the area. Basically, we’re restoring the body’s natural balance and function,” Dr Hassan said. With over a decade of experience in women’s health and seven years in private practice on the Gold Coast, Dr Hassan is excited by the treatment’s ability to change lives.
“This is about using new technology to develop individual treatment plans tailored to individual symptoms to provide the highest level of care and the very best outcomes for patients,” Dr Hassan said. In the past, the most common treatment for vaginal atrophy has typically consisted of hormone therapies that counteract symptoms by increasing oestrogen levels. For many women, Hormone Replacement Therapy (HRT) is not an option. Around 60% of breast cancer patients experience vaginal atrophy with no effective treatment for their symptoms - until now! “MonaLisa Touch is perfect for women who have induced menopause as a result of cancer treatments, including breast cancer patients who can not safely be prescribed oestrogen,” Dr Hassan enthuses. “The treatment is also ideal for those looking for a less invasive procedure compared to traditional surgical or pharmaceutical treatments and for women who just prefer not to take oestrogen-based medications.” Dr Hassan said they were also achieving significant outcomes for women of all ages who experienced vaginal laxity following childbirth or severe atrophic vaginitis as a result of breastfeeding. It has also successfully treated patients with urinary incontinence, mild prolapse, recurrent thrush and urinary tract infections. While most patients experience no pain at all during the procedure, some report a slight burning sensation towards the end of the treatment, but say the benefits far outweigh the temporary and mild discomfort. By addressing and successfully treating the physical symptoms of atrophy, patients experience enhanced libido, femininity and self-confidence as a flow-on effect allowing them to reclaim control of their lives, re-engage in physical activities and enjoy their intimate relationships. Many women may feel embarrassed to speak openly about such personal health issues, about
but seeking support from a female specialist allows women to feel at ease about discussing their symptoms and the changes they are experiencing. “Women need to find a specialist they can relate to, who can provide them with personal, discreet and individual care; one who will take the time to really listen and deliver this care with compassion and understanding. We believe this is such an important part of the treatment,” Dr Hassan says. Women who have previously been too frustrated or embarrassed to talk about these issues are putting their hands up to openly sing the praises of this new treatment in the hope of helping other women. It’s an incredible vote of confidence and a wonderful message of hope,” Dr. Hassan said. Based in the Pindara Specialist Suites, Dr Hassan is a highly trained Australian Board Certified Obstetrician/Gynaecologist who provides a compassionate, understanding, nonjudgmental and safe environment for Gold Coast women to take charge of their health. “It’s important for women to know there is an effective, alternative solution now available and that they feel safe in taking pro-active steps towards a better quality of life for 2017,” Dr. Hassan said.
For more information, you can contact Dr. Suhad Hassan at info@drhassan.com.au or call (07) 5597 6887.
Endometriosis AND ITS EFFECTS ON FERTILITY
As we head into 2017, it may be time to look at endometriosis again. With approximately one in ten Australian women at some point of their lives affected by this condition, the month of March is dedicated to drawing worldwide attention to this condition. In 2017, the ‘March into Yellow’ movement falls on the 10th of March.
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But what is endometriosis exactly?
Dr Erlich Sem, Obstetrician & Gynaecologist
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Endometriosis is a condition where the tissue that normally grows inside the womb, also grows outside the womb. The most common places where endometriosis occurs are the ovaries, the Fallopian tubes, the bladder, the bowel, and the areas in front, in back, and to the sides of the uterus. It has also been found in liver tissue, the diaphragm, lungs, and even the brain! We don’t know exactly why it happens, but there are a few theories. One of the theories is retrograde (backwards) menstruation. When a woman has her monthly period, the menstrual fluid (which contains endometrial cells) flows not only through the vagina, but also Fallopian tubes. The endometrial cells then start to grow in those different locations. Another theory suggests that normal inner abdominal lining, for whatever reason, undergoes a conversion into endometriosis. This condition may be associated with cyclical and long-term pelvic pain, abnormal vaginal and rectal bleeding, and can also result in reduced fertility, which will be the focus of this article. Reduction of fertility can occur through damage to the normal anatomy, but also increased production of inflammatory chemicals released by endometriosis cells. Some of the damages to the normal structures of reproductive organs include blocked Fallopian tubes, scar tissue formation, as well as development of endometriosis cysts in the ovary - so called “chocolate cysts” or endometrioma. The thick fluid filling the cyst is basically old blood produced by endometriosis cells, and resembles chocolate, hence the name. Unfortunately, this is not the only way that endometriosis can affect a woman’s fertility. Endometriosis cells also release chemicals that adversely reduce the quality of the eggs, creating a hostile environment for a growing embryo. Pain associated with endometriosis can also indirectly reduces fertility, with the reduction of libido and frequency of sexual intercourse.
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Detailed history and careful physical examination will often give clues to the presence of endometriosis. Non-invasive imaging, such as ultrasound scan can pick up endometriosis ovarian cysts (endometriomas). However, the gold standard to diagnose this condition is still through laparoscopy (key hole) surgery, by means of direct visualisation and biopsy of typical endometriosis lesions. Once the diagnosis is established, it is important to look at the goal of the treatment. Where fertility is desired, medical treatment will not be suitable, as treatment using hormonal medications such as progesterone-like substances and birth control pills, all inhibit ovulation. There is a good body of evidence showing increased pregnancy rate and successful pregnancy after surgical treatment of mild to moderate endometriosis. For women with severe endometriosis, the evidence in terms of effectiveness of surgical treatment is not as clear. However, with restoration of a normal anatomy, it may assist women who require IVF treatment. There is also good evidence that favours removal or excision of endometriosis lesions rather than just “burning� (diathermy) them. Depending on the severity of the endometriosis, sometimes surgical treatment can be performed together with diagnostic procedure. When it is too severe, the gynaecologic surgeon may decide to do this in a separate procedure, after appropriate counselling and pre-operative preparation. Abnormal peritoneal lining of the abdomen is excised to achieve complete removal of endometriosis at the end of the procedure. To treat endometrioma, a cystectomy is performed, while preserving as much healthy ovarian tissue as possible. All scar tissue is divided, and to prevent formation of new scar tissue, special anti-adhesion barrier is applied. In the majority of these types of surgeries, they can be completed with laparoscopy (key hole). There are a lot of online resources and support available readily to assist women in understanding this condition, including:
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Detailed history and careful physical examination will often give clues to the presence of endometriosis.
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www.endometriosisaustralia.org www.jeanhailes.org.au www.betterhealth.vic.gov.au You may also like to speak with your GP or gynaecologist for further information. Early diagnosis and treatment are important aspects in managing endometriosis, so in March 2017 let us wear yellow to raise awareness for this condition!
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Protect Your Kids from the Sun this Summer
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Leading Gold Coast surgeon Dr Dilip Gahankari reminds parents about sun safety
Summer is upon us and almost all parents are encouraging their kids to get off their iPads and head outside. However, parents in Queensland should be aware that the Sunshine State is also the skin cancer capital of the world. The figures are staggering. Overall, Australia has 48 cases of melanoma per 100,000 people, whilst New Zealand has 50 cases per 100,000. Queensland tips the scales at 71 cases per 100,000. Cancer Council Queensland CEO, Professor Jeff Dunn AO, said the rates in Queensland vastly exceed rates in all other jurisdictions nationally and internationally. “Our climate and demographics make us uniquely vulnerable to skin cancer, necessitating ongoing vigilance in sun protection,” Prof Dunn said. They are figures that leading Gold Coast surgeon and skin cancer specialist Dr Dilip Gahankari says are simply unacceptable. He is urging parents to be sun safe with their kids this summer, or risk lifelong damage. “I think people see the campaigns and know we are addressing the issue so they think it is somewhat under control, but that just isn’t the case,” Dr Gahankari says. “While we are certainly making headway and there is a greater level of awareness, there is still so much complacency around sun protection, particularly here on the Gold Coast. There are around 2,000 deaths from skin cancer in Australia each year. That figure is just too high. Dr Gahankari says that what is most disturbing about the rising rates of skin cancer in Queensland is that so much of it is preventable. “There are really simple steps to follow, such as covering up with protective clothing, wearing a hat and sunscreen, and avoiding prolonged periods of sun exposure,” Dr Gahankari says. “The Cancer Council guidelines say that sun protection is required when the UV Index is three and above. In Queensland, the UV Index is three and above all year round, so we have to be diligent with sun protection every single day, no matter what the season.” Protecting children from the sun is vitally important. Their young skin is particularly susceptible to burning.
SUN PROTECTION AND BABIES The Cancer Council suggests the following guidelines for babies and young children: Evidence suggests that childhood sun exposure contributes significantly to your lifetime risk of skin cancer. Cancer Council Australia recommends keeping babies out of the sun as much as possible for the first 12 months. Where this is not possible, parents and carers should minimise exposure by: • Planning the day’s activities outside the middle of the day when UV levels are most intense. • Covering as much skin as possible with loose fitting clothes and wraps made from closely woven fabrics. • Choosing a hat that protects the baby’s face, neck and ears. • Making use of available shade or create shade for the pram, stroller or play area. The material should cast a dark shadow. The baby will still need to be protected from scattered and reflected UV radiation. • Keeping an eye on the baby’s clothing, hat and shade to ensure they continue to be wellprotected. • Applying a broad spectrum, water resistant sunscreen to small areas of the skin that cannot be protected by clothing, such as the face, ears, neck and hands, remembering to reapply the sunscreen every two hours or more often it is wiped or washed off.
There is no evidence that using sunscreen on babies is harmful, although some babies may develop minor skin irritation. Try sunscreen milks or creams for sensitive skin which are less likely to irritate the skin. As with all products, use of any sunscreen should cease if any unusual reaction occurs.
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Safe Sports FOR KIDS
Australia’s hidden but preventable sports injury health epidemic
Dr Chris Vertullo, Orthopeadic Surgeon
Australian sport is great. Australian sport for Australian kids is really great. Not only is it fun, but it teaches important life skills and experiences. In addition, sports and exercise participation is vital in preventing obesity and other associated diseases by keeping people fit and active. The downside of all team sports played in Australia is the high rate of knee injury and lower limb injury. In fact, sports injuries causing admission to hospital are growing at 6% per year in Australia, while injury from other causes like car accidents are dropping by 6% per year. This is causing an injury epidemic that is plaguing the nation’s youth to the tune of a $220 million health bill, with sports injuries (particularly joint injuries) accounting for almost half of all hospitalisations for young people. Of the 19,741 hospitalisations last year, almost half (9,820) were the result of team ball sports. This means, over half-a-million Australians have a longterm health issue resulting from a sporting injury from their youth, with the most common sports injury in Australia being rupture of the anterior cruciate ligament (the ACL). Australians are almost twice as likely to rupture their ACL compared to any other country, with ACL reconstruction having an incidence of over 250 per 100,000 persons annually in males aged between 15 and 25 years. Over the last 14 years, there were over 140,000 ACL reconstructions in Australia. ACL injury has major implications for an injured person’s quality of life, their risk of osteoarthritis and longterm injury. In addition, sports injury to the knee can also cause other damage such as meniscal tears. pindaramagazine.com.au
The great news is that most of these knee and lower limb injuries from sport are actually preventable. The big problem is that no one ever finds this out until they are in an orthopeadic surgeon’s office with a knee injury. Knee reconstructions are big operations, and while they usually work out pretty well for most injured young athletes, osteoarthritis is inevitable in the future, particularly if the menisci are damaged.
IMAGINE HOW MUCH BETTER IT WOULD BE IF YOU NEVER HAD THE INJURY IN THE FIRST PLACE? Simple neuromuscular training programs can prevent these severe lower limb injuries in young athletes. Multiple studies from around the world show a 50 - 80% reduction in lower limb and cruciate injuries with these programs. The programs are inexpensive and replace a traditional warm-up program with special neuromuscular exercises delivered via smart phone apps. These Sports Injury Prevention Programs are based on internationally accepted training techniques to encompass a modified warm-up to improve balance and agility in young athletes. These training techniques have widespread support from eminent international organisations such as the International Olympic Committee and FIFA. The big problem is a lack of awareness that most lower limb sports injuries are not just bad luck, but actually bad preparation. Surprisingly, at the moment, there is no nationally coordinated sports safety policy, program or action plan to address this epidemic. Pindara Magazine
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WHAT CAN WE DO ABOUT IT? Firstly, sports clubs, coaches and schools should be approached to ask what they are doing about implementing sports injury prevention programs for your children and grandchildren. Secondly, you can ask your local MP what the Federal and State Governments are doing about this epidemic. The Australian Orthopaedic Association (AOA) believes that his problem is so dire, that an effective and universal Federal Government level response to youth sports injury prevention is needed now in order to make sport safe for all participants, increase participation to prevent obesity and reduce the later burden of osteoarthritis. The AOA has proposed a National Youth Sports Injury Prevention Program implemented by the Australian Sports Commission. A federally-funded National Youth Sports Injury Prevention Program would have a very modest cost compared to the reduction in direct and indirect medical costs of highly these preventable injuries. Associate Professor Christopher Vertullo is a Specialist Orthopaedic Knee Surgeon and Director of the Orthopaedic Surgery and Sports Medicine Centre, Gold Coast, an Adjunct at Griffith and Bond Universities, Chair of the AOA Youth Sports Injury Prevention Working Group, Founder of Knee Research Australia and Secretary of the Australian Knee Society.
19,741 HALF HOSPITALISATIONS
L AST YEAR
WERE THE RESULT OF TEAM BALL SPORTS
For more information visit www.safesport.org.au
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MEDICINE IN
The Amazon
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Words: Dr Chris Mirakian
When my niece told me she had just been to the remote Amazon jungle and set up a pilot program screening women for cervical cancer, the first thing I said was “when can I do that too?” Twelve months later my family set off with our newfound grasp of the Spanish language, and donations from Pindara and St Hilda’s School families and headed to the Napo region of the Amazon jungle in Peru on one of the most exciting and rewarding trips we’ve had to date. The project came to exist as my niece, Dr Geordan Shannon, is the medical director of DBPeru - a nonprofit agency founded in the USA, which has provided outreach healthcare to remote communities in the Lower Napo region of the Amazon basin for the past 14 years. Unfortunately, Peru has some of the highest incidence and mortality rates of cervical cancer in the world. The Cervical Cancer ‘screen and treat’ Program was established to create a replicable model of co-operation between local government, national government and NGOs to serve isolated women who are suffering from, or at risk of, cervical cancer. The aim is to reduce the number of deaths from cervical cancer through education, screening and treatment. In August we joined 20 other volunteers to implement the second phase of the ‘screen and treat’ model, incorporating the following: 1. Screening for Human Papilloma Virus (HPV) in women between 25 and 70 using self- sampling kits 2. A physical examination for signs of pre-cancerous cervical changes using “visual inspection with acetic acid” (VIA) 3. Treatment, if necessary, using cryotherapy - a technique that will freeze and destroy any pre-cancerous cells on the cervix. This model of program is promoted by the World Health Organisation (WHO) and the International Agency for Cancer Research (IARC), and has been successfully employed in multiple low-resource settings worldwide. Through this type of program, both screening and treatment can be successfully and safely delivered in remote communities such as those in the Lower Napo River. DBPeru does outreach to 25 remote villages on a rotating basis so that each village is visited once a year. pindaramagazine.com.au
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The other volunteers on our trip were a mix of nurses (local and American), a local ‘obstetrize’ (cross between a midwife and an obstetrician), Spanish speaking non-medical interpreters and all of my husband’s family! The only doctors were my niece, my husband (Ian Dickinson) and myself. Due to the ‘luxury’ of having three doctors along on a trip, we arranged to run a concurrent general medical clinic in each of the five villages we visited. Ian and his trusty interpreter Silvia worked hard in the makeshift ‘clinic’ that was set up in the schoolroom of each village. The population ranged from 70 - 280 in the five villages. Ian managed to see 190 patients during the five days, whilst the local obstetrize and I saw 77. Whilst we had more women who were eligible to be seen, there is still fear and uncertainty among the women and some of them were not ready to undergo an examination. Meanwhile, we had the nurses providing vaccinations (both childhood and adult) to the villagers including HPV vaccinations, which were fortunately provided by the Peruvian government. We also donated school supplies to each of the villages, which were kindly provided by the families of St Hilda’s School. In the middle of the week DBPeru also ran a Health Fair at one of the larger villages and people from many surrounding communities attended. It was a relaxed and fun day where we had different health stations including an eye station where people had their sight (crudely) tested and 450 pairs of donated glasses were distributed. The children were all educated on dental hygiene and given toothbrushes. The women underwent a breast examination and then given one of the 800 donated bras we had with us – which we spent hours sorting into sizes! There was a vaccination station for any adult or child who required immunisation and there was a neonatal resuscitation session, where the local midwives were all updated in their skills. The biggest draw card however was the annual soccer competition to win the coveted DBPeru Cup! The volunteers even have a team and we played one of the women’s teams … no need to inform you who won. One of the most difficult jobs on these outreach trips is looking after the children of the women whilst they are being educated about cervical cancer and then examined. My daughters, aged 10 and 11 at the time, did a marvellous job entertaining up to 30 children with no grasp of the Spanish language at all. Fortunately, the kind donations of toys, stickers, temporary tattoos, drawing implements and Lego from all the volunteers crossed the language barrier and they managed well (with a little help from the adults). Of course, one of the big incentives to go on this trip was the amazing location. To reach the Napo basin requires a one-hour flight from Lima (on a
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One of the most difficult jobs on these outreach trips is looking after the children of the women whilst they are being educated about cervical cancer and then examined.
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big plane!), then a six-hour boat ride to the most remote of the four lodges operated by Explorama. I use the term ‘lodge’ loosely. The ExplorNapo accomodation consisted of ‘rooms’ containing two single beds, each cocooned in a mosquito net. Each ‘room’ is separated by a partial wall, and the back wall is only chest height so it is essentially open to the elements (and creatures), except for a small curtain. There is no electricity, flushing toilets, or hot water. There is no pool, although there is the river full of Piranhas. The weather is a mere 34 degrees with about 90% humidity. And of course there is the wildlife. I soon realised that the planet’s insects, 25% of which live in the Amazon, were actually all living at the ExplorNapo Lodge we were staying at – and they were all giant size (even the butterflies). Ironically, the lodge did have wi-fi in the main communal dining room so my children fortunately could survive the six nights there. The food was also amazing, which was remarkable in such a remote part of the world. There was no one else at the lodge whilst we were there and we had our own guide so after a day of ‘work’ we returned to some piranha fishing, a jungle cruise, a canopy walk, or for enthusiasts, a very early morning bird watching safari. Each day was an adventure. At the end of our volunteering we transferred to the ‘luxury’ Explorama lodge, four hours closer to civilization, where we spent another three nights being tourists with air conditioning and a swimming pool. Overall, it was an amazing experience and educational in so many ways, both for the Amazonians and for us. These people are so grateful for any help they receive and the basic healthcare we sometimes take for granted is so appreciated there. DBPeru is continuing their work and plan to do the next ‘screen and treat’ program in February 2017. They do outreach trips to the region every one to two months. It would be wonderful to set up a cataract clinic and offer treatment, similar to the work of the Fred Hollows Foundation (who unfortunately don’t travel as far as South America). It was very apparent in the general medical clinics that eyesight was a big problem for these communities. For anyone who is interested in volunteering, all the information can be found on the DBPeru website www.dbperuong.com. Finally, a huge thank you to Pindara Hospital who last year donated hundreds of “blueys” that I sent over with my niece, and this year 700 sanitary napkins, which were provided to the women after having cryotherapy treatment. A big thank you also to the families of St Hilda’s School who donated sanitary napkins and school supplies, which were gratefully received. Finally, a big thanks to Dr Andrew Jones for his continual support and the most amazing infectious disease knowledge, which came in most handy with the fortunate technology of iPhone picture texts! Pindara Magazine
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Taking a trip these holidays?
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Summer in Australia is a time for the outdoors, relaxation and spending time with friends and family. Add some wannabe sports heroes, a few holiday beverages and a whole lot of rooftop twinkly lights to this mix and your enjoyable afternoon barbecue could turn into a disaster waiting to happen. During the holiday season, emergency rooms across Australia experience an increase in patients by up to 40 percent. Here are eight common holiday injuries and illnesses which may result in a trip to Accident and Emergency this festive season.
DON’T MAKE IT TO THE EMERGENCY ROOM!
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FOOD POISONING The weather is hot, the fridge is overloaded and we are making recipes we drag out once a year, for more people than we usually cook for. All this creates the perfect conditions for an increased risk of food poisoning. This holiday-dampening illness is usually caused by eating contaminated food and can lead to symptoms of vomiting, diarrhoea and fever. There are many tips and tricks to help avoid this unpleasantness, such as using a kitchen thermometer when cooking meat, only eating fresh seafood and keeping enough ice on hand at the barbecue to keep food cool. Children, older people, pregnant women and those with a weakened immune system are particularly vulnerable to this illness and should seek treatment sooner rather than later.
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COOKING Not all food related injuries happen whilst eating. Open flames, boiling water, sharp knives and slippery surfaces make the kitchen a very dangerous obstacle course to navigate. Add a few ‘helpful’ aunties into the mix and chaos is sure to ensue. Cuts from rushed dinners and turkey-carving happen a great deal around the holiday time. Burns are also common place and can happen in the blink of an eye, especially at barbecues and bonfires. It is always best to avoid drinking too much festive cheer before cooking and to keep children out of the kitchen while food is being prepared.
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FALLS AND SHOCKS WHILE DECORATING Beware of your Christmas tree! Fake or real, these sentimental additions to the household are not as innocent as they look. Many people are hurt each year while decorating trees. This usually occurs while placing the high-up ornaments, putting up lights or rooting around in the roof trying to find where it was stowed after last year for safe keeping. Falls while decorating, children swallowing small bulbs and people getting electrocuted or burnt while hanging fairy lights are just some of the more common decorating antidotes heard in the emergency room. Using a step ladder rather than furniture when reaching any high places, keeping anything small or fragile out of reach of toddlers or pets and not overloading electrical sockets are just a few of the small ways to keep a household risk free during the festive season.
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GIFTS THAT GIVE (INJURIES) Gifts are the highlight of Christmas for many, especially the kids. Mum and Dad staying up late to help Santa assemble complicated toys with 3.2 million pieces or screw together the parts of a bike with scissors because they can’t find the screwdriver is pretty much a rite of passage as a parent. However, this often leads to cuts, bruises and the jaw-clenching pain of stepping on the same piece of Lego for the tenth time. On Christmas Morning, people cutting themselves with knives when opening presents too quickly, tripping over toys and electric cables while rushing to try out their new electronic devices, or slipping on wrapping paper usually result in only minor injuries but can ruin the fun if something serious happens. Try to have the correct tools on hand for any opening or assembly and clean up as you go. Besides, there are easier ways to get rid of the ugly vase your mother-in-law gave you then landing on it.
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LIFTING LUGGAGE If we are not driving, we are flying. Whether you’re packing an overnight bag or you’re checking in bags the size of a small apartment, it is always best to keep in mind who will be handling the luggage. Neck, back and shoulder strain can happen in an instant and wreck an otherwise perfect holiday. Luckily, summer in Australia is very hot, so you can pack light. Throw in a swimming costume and some sandals and you are good to go. But if that is not going to cut it, then remember wheels are your friend. Invest the time in getting a trolley to transport luggage and check heavy bags onto the plane rather than lifting into overhead lockers. Knowing how to lift heavy objects correctly can also save avoidable stress and strain on joints. And keep in mind it may not only be luggage. Remember, there are no prizes for dislocating your elbow carrying all the groceries into the house from the car in one go.
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SPORT INJURIES ‘I did it all the time when I was younger’ is a common catch phrase of those in the emergency room with sports injuries. It doesn’t take that much common sense to know if you haven’t done something for at least a year, it is probably best to start slow or at least warm up well. Although, we all know common sense goes out the window in a competitive family when a game of footy is at stake. Broken bones, concussion, sprains, cuts and bruises can all result when a friendly game gets out of hand. Just like batteries, safety equipment is often not included in presents for kids. Ambulance calls increase significantly in the afternoon on Christmas Day when there are many children trying new bikes, skateboards, basketball hoops and water slides for the first time. It is always best to give knee pads and helmets along with the present to avoid anyone losing too much skin.
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SUNBURN AND HEAT STROKE Sunburn is synonymous with summer and conjures images of days spent in the backyard or in the pool. However, it can be a very serious condition. As well as significantly increasing the risk of melanoma, sunburn if severe enough - can cause severe burns, especially in children. This can result in serious blisters and the risk of infection. Heat exhaustion is another condition that can happen easily, especially when performing activity in the heat. People suffering from heat exhaustion can experience headaches, muscle cramps, dizziness, profuse sweating and nausea. If left untreated, there is a risk this can develop into heat stroke where the body is no longer able to cool itself and a person’s body temperature becomes dangerous high. Moving to a cool place, stopping activity and re-hydrating are the best things to do for heat exhaustion. If a person has seizures, loses consciousness or is not responding after cooling off for 30 minutes, it is best to seek medical advice.
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MENTAL ILLNESS Christmas can be one of the most stressful times of the year. The combination of Christmas shopping, relatives, lack of sleep and logistics can add a level of anxiety and exhaustion to an already busy time of year that can become too much for some people. It is important to be aware of your mental health and the mental health of those around you during this time. Existing mental illness can be a serious matter and the pressure of this season can exasperate existing feelings around financial concerns, loneliness, depression and substance abuse. It is important that we all take the time to rejuvenate the mind along with the body and check in on loved ones who may be feeling isolated. If disaster does strike, Pindara Private Hospital’s specialised Emergency Team are there to help 24 hours a day, seven days a week.
Hanging up His Stethoscope Dr Julien de Jager set for retirement
In an industry that is constantly changing, adapting, introducing new techniques and trialling new pharmaceuticals, 42 years is a long time. However, after talking to Dr Julien de Jager for a short time, it is easy to get the impression that it is not quite long enough for the rheumatologist. Set to retire at the end of 2016, before, as his wife says, “he gets stupid and starts making mistakes”, he describes the last six months on the job as the worst of his life. “I have to stop people from crying,” he says with a sensitive smile. “One woman spent 15 minutes of a half-hour appointment crying last week. It’s terrible. “I would almost stop the retirement and go back to it now except that you have to make a decision and turning 70 is a watershed because otherwise you stick around forever. There are lots of doctors who wait too long.” It seems that this cheeky, no-nonsense charm may be part of the reason de Jager’s patients have such a fondness for him. After all, it is the patients that have continued to drive the Mudgeeraba local. “I did get offered a position to work in the USA but it meant not working with patients for two years and to get a PHD, but what for? It was not what I wanted to do. I want to work with people. That is what I enjoy most and have the most feedback from. The patients have been fantastic. I have got more out of it then I’ve had to give.” Being a doctor is always something that de Jager wanted to do. As a boy, he grew up on a block of land opposite his aunt’s farm in rural South Africa where he spent his time dissecting frogs, playing with Boar War relics, blowing stuff up and riding his bike five miles to and from school each day. He admired his family doctor who made house calls and who once gave him the day off school for an ear infection. Although de Jager describes medicine as ‘a calling’, it wasn’t until after he had completed 60
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military service and was nearing the end of university that he found his niche. “I was going to do orthopaedics and my orthopaedic professor said no. We don’t have any rheumatologists in South Africa. You should do that. He arranged for me to work with Barbara Ansell. It changed my life. It was fantastic.” Barbara Answell was renowned as the founder of paediatric rheumatology and for someone who followed in her footsteps to become a distinguished and much admired expert in his field, it is hard to imagine that this life path may never have come to pass for de Jager. “We had three chances at the fellowship exam in those days. The first time I went in half-baked and failed the written exam, the second time I was much more prepared and passed the written exam but failed the physical exam.” He describes this training at the University of the Witwatersrand in Johannesburg as tough and practical and also as the place where he met his future wife, Moyra. “We met over the dissecting table. She was studying to be a physiotherapist and we shared a lab. I am very lucky to have her. She is a wonderful woman.” After getting married and spending some time in England, they moved to Australia in 1975 to escape the political situation in South Africa. “They had good training at that stage in Australia. The plan was to live in Australia for a year and then move to the USA, but after six months, we realised we would be crazy to live anywhere else.” De Jager eventually became a Rheumatology Registrar at the Prince of Wales and Prince Henry Hospital Group before moving to St Vincent’s Hospital where he became Chief Medical Register before going into practice with Frank Johnston in 1985. Dr Johnson was a rheumatologist on the Gold Coast seeking someone to look after the hospital 2016
“We met over the dissecting table. She was studying to be a physiotherapist and we shared a lab. I am very lucky to have her. She is a wonderful woman.�
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side of the practice while he looked after the rehabilitation. “He showed me a good time. We ate mud crab and he showed me what the hinterland was about and that is what really sold me. I could see myself coming back here, a place like my childhood and giving our kids the same sort of thing.” It was also around this time that de Jager started expanding into the research side of rheumatology. He had started research while working closely with clinical pharmacology into the therapeutics for rheumatoid arthritis during his time at St Vincent’s Hospital. When he moved to the Gold Coast, de Jager’s practice was picked from a number of sites for another study where he ended up in the writer’s group, which resulted in a paper that has now been cited 1780 times. It was the beginning of a research career that would see de Jager listed as the author on more publications than the number of years he had been practicing. It was also the start of a career that would see the consultant rheumatologist have a voice in the profession. “That study was the main reason the government approved anti-TNF therapy. We ended up going down the Canberra to lobby the Health Minister. This would cost $100 million so we met with the head of the finance committee, who happened to be a doctor, and he listened to our presentation and he bought it.” In 1995, de Jager became a Senior Visiting Rheumatologist which was a position applied to and granted by the Health Minister. By then, he was Chair of the Royal Australian College of Physicians in Queensland, had been President of the Australian Medical Association on the Gold Coast and was Chair of the Committee of Queensland Medical Colleges. During his career, de Jager has held many distinguished roles in associations and learned societies but says his biggest achievement was being elected president of the Australian Rheumatology Association in 2001. “We managed to get arthritis recognised as the sixth national health priority and I chaired the rheumatoid arthritis section of that. We managed to get agreement through the whole country on the treatment of early rheumatoid arthritis. To get anything through on the national health priority list is unbelievable; it took five years.” De Jager would go on to be president a second time in 2013. His contribution to the association was officially recognised in 2007 when he was awarded the Distinguished Service Gold Medal of the Australian Rheumatology Association. It was not only on a national scale that de Jager was making waves. Closer to home, the doctor who has been described as a “loud” advocate for the profession by colleges, along with his good friend Dr David Lindsay, played an integral part in the threat of doctors to resign en masse in the late 1980s. This was during a time of health crisis and the aim was to encourage the Health Minister, Leisha Harvey, to make some dramatic changes in public health care facilities on the Gold Coast. However, this professional achievement did come at a cost. “My work has impacted my personal life a lot especially during the years of the political scenes. I would often have
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"We managed to get arthritis recognised as the sixth national health priority and I chaired the rheumatoid arthritis section of that."
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meetings three or four nights a week. That clearly had an impact on the family. I have tried to have as good a work-life balance as I can but I acknowledge there were many years when I just had to fulfill the obligations and get things done. I was away a lot and spent an awful lot of time in meetings or elsewhere.” However, he says that his grandchildren are the shining light in his life now. de Jager has five grandchildren under the age of eight, who he and Moyra happily help to look after part-time. When the subject of his grandchildren comes up, the amateur photographer immediately takes out photos of them and talks about his two daughters and their families with obvious pride. His family is also not the only place the soon-to-be retiree has regained some balance. The energetic 70-yearold has an evident enthusiasm for his hobbies including paddle boarding, hiking trips in Tasmania, fun runs, Monday-night tennis and vegetable gardening. He also mentions the librarian course he completed during his early years and that he was an early adopter of computers and the internet. “I have always been interested in computers. I actually did a part-time course at NSW University in electronics and built my computer in 1976. “I got my first laptop in 1986. If you put it on your lap it would break your femurs but it was a portable desktop. I still have the thing. It allowed me to connect to Bethesda, Maryland for medical information. People would come to me to do their medical searches.” This varied range of interests is a quality which has allowed de Jager to connect to his patients and a skill that has often found that the “next thing you know, you are running 20 minutes late.” And it seems that de Jager will not be able to step away completely just yet. He will be spending some time in his clinic until a replacement can be found as well as continuing to contribute to ongoing research. “I am still a Director on Opal which is a rheumatology database. We set clinical questions to get answered and there are enough companies that want things answered to have sufficient support. I’ll keep working on that and there are several papers we have got to get out in the next year.” Described as one of the last ‘old-school’ doctors, the mild-mannered and good-humoured grandfather will continue to fulfill his love of people with continued teaching commitments. “I have always taught at Griffith and Bond Universities and I was made a Professor of Medicine at Griffith, about eight years ago now. That‘ll end in 2018. It is open for renewal if I wish to keep going, which I probably will because it is not onerous and I really enjoy the interactions with students.” And his advice for the next generation coming through? “The advice I would give my grandchildren looking into medicine is to first ask them to examine why they want to do it and really realise why. You have to devote your life to it; there is a fair bit of sacrifice for yourself and everybody around you but it is unequivocally the most worthwhile thing you can do.”
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Humans of pindAra THIS ISSUE WE GET TO KNOW NEUROSURGEON, DR CHRISTIAN SCHWINDACK
WHY NEUROSURGERY?
There is still so much we do not understand about the brain – it is a marvel; we learn new things every day but it still holds many mysteries. It is a privilege to be allowed to operate on this most delicate of organs, the seat of our personality, memory, skills and consciousness. Operations are often complex, carry inherent risk and require meticulous planning, attention to detail, patience and dedication. Many cases in neurosurgery are matters of life or death – the responsibility is enormous. There is no room for error and the threat of possible disaster juxtaposed with the exhilaration of a successful operation creates a constant tension that drives us and keeps us humble.
WHAT DOES A NEUROSURGEON DO?
I think Wikipedia describes it well when they write, “Neurosurgery, or neurological surgery, is the medical specialty concerned with the prevention, diagnosis, surgical treatment, and rehabilitation of disorders which affect any portion of the nervous system including the brain, spinal cord, peripheral nerves, and extra-cranial cerebrovascular system.” A lot of a neurosurgeons’ work actually doesn’t involve surgery. One thing that I think about often is that the true art of surgery is not knowing how to operate, but when to operate.
WHEN DID YOU KNOW YOU WANTED TO BE A NEUROSURGEON?
Both my parents are doctors - It's in my DNA. At medical school, I always thought the neurosurgeons were the coolest characters around. Together with my fascination with the brain, the choice was easily made – within minutes of doing my first neurosurgical attachment I was sold.
HOW LONG HAVE YOU BEEN DOING THIS?
I started medical school in South Africa in 1992 – it was a six year course. I then did my
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residency in Namibia and a year of general practitioner work in rural South Africa. My basic surgical training in Edinburgh, Scotland took two years. The specialist training in Cambridge took six years, completed by a fellowship in Perth. It took 17 years from starting medical school to finally becoming a specialist neurosurgeon!
WHAT ADVICE WOULD YOU GIVE TO ANYONE WANTING TO START OUT IN THIS FIELD?
• Perseverance, perseverance, perseverance • Curiosity • Respect for and a genuine desire to help others
DO YOU DO ANY TEACHING OR RESEARCH?
I am very much involved in giving lectures to students, nurses, GPs, and general and specialist trainees. I convene a course at the Royal Australasian College of Surgeons teaching young fellows on setting up a practice. I am also a mentor to surgical students at Griffith and Bond Universities and I am keenly involved in that. In regards to further development for myself, I regularly attend course locally and abroad to find the safest, least invasive techniques to perform surgery.
WHAT BROUGHT YOU TO, OR MADE YOU STAY ON THE GOLD COAST?
Surfing at dawn, world-class professional facilities during the day, dinner on the deck at night in the hinterland – what else could one ask for? Life is relaxed and there is just no excuse to not get outside and enjoy the outdoors.
WHAT DO YOU LIKE TO DO IN YOUR SPARE TIME?
Spend as much time with my family as possible. My girls have completely embraced the Gold Coast lifestyle, my wife has become a triathlon enthusiast. The Gold Coast has so many options for young families: beach, hinterland, parks, festivals – never a dull moment! Brisbane and Northern NSW can be reached in under an hour and I can be on a plane to somewhere beautiful and exciting within one hour from my house!
HOW DO YOU RELAX?
I go for a run in the evenings after work – it’s good for the mind, soul and waistline (and a sore back). I love to have dinner with friends on the deck or go out to eat somewhere with a view of the ocean. Any restaurant with nice seafood that has a view of the waves gets my tick of approval!
IF YOU WEREN'T A NEUROSURGEON, WHAT WOULD YOU BE?
A sound engineer: I love music, acoustics and computers. Although the math might be a problem!
WHAT DO YOU LIKE BEST ABOUT WORKING AT PINDARA PRIVATE HOSPITAL?
The people! I have been made to feel very welcome at Pindara. The staff are always willing to help and go the proverbial ‘extra mile’; every problem has a solution! The culture of a ‘can-do’ attitude is very positive. It’s good to know that there are people who have your back.
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AN INSIDER’S GUIDE TO
HERITAGE HEART
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Singapore is renowned for its cosmopolitan edge, exuding modern-day style and sophistication. But if you dig a little deeper, you will find a mix of cultures as well as a medley of architecture, heritage and history that tells fascinating stories of this unique city-state.
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There is no better place to discover this cultural side of Singapore than the Balestier region, which takes you on a 180-year journey from British colonial times to present day. Balestier is less than five kilometres from the city centre and allows you to venture away from the towering skyscrapers and the bustle of the city, and into the heritage heart of Singapore. Position yourself in the centre of it all at Ramada Singapore At Zhongshan Park or Days Hotel Singapore At Zhongshan Park, put your walking shoes on and get ready to discover the colourful and historical charms along the Balestier heritage trail.
ZHONGSHAN PARK
Start off in the picturesque Zhongshan Park nestled between the two hotels, offering a tranquil setting amongst lush greenery. Zhongshan is one of more than 300 parks located across Singapore to provide residents and visitors with a touch of nature in an urban setting. The park is a popular meeting spot for families of an afternoon and is lined with restaurants, bars and cafĂŠs for a coffee break or casual meal.
PLACES OF WORSHIP
Singapore is one of the most diverse countries in Asia, with a mix of Chinese, Malay and Indian residents, four official languages including English, Malay, Mandarin and Tamil, and varying religious beliefs. In the Balestier region, the heritage trail tour will take you to Novena Church, one of the first churches built in Singapore following World War 2, the Goh Chor Tua Pek Kong Temple, built by early Chinese immigrants in 1847, the Phang Pheng Mei Buddhist Temple and the Masjid Hajjah Rahimabi Kebun Limau mosque. One of the most prominent temples in this region is the Maha Sasana Ramsi Burmese Buddhist Temple, which was originally founded in 1878 and relocated to its current location today in 1991. The design of the new temple reflects the history of Burma (now known as Myanmar), with a tiered roof adorned by woodcarvings and a golden pagoda on the roof. A number of Burmese cultural and religious artefacts are displayed on the third floor and there is a mural depicting the history of the temple.
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ARCHITECTURE
The beautifully persevered pre-war terrace houses and traditional shophouses are scattered throughout the area and showcase a European, neo-classic style in an array of pastel colours. The traditional shophouses were first developed in the 1920s by architect Kwan Yow Luen in a style that fuses east and west. The walls have moulded designs including Chinese dragons and bats, as well as carvings of Sikh men, who were often employed as guards during colonial times. You will find many beautiful photo opportunities along your walk of the heritage trail.
HAWKER MARKETS
It is time for lunch and the Whampoa Market is one of many hawker markets across Singapore that serve up every kind of delicious Singaporean delicacy imaginable at an affordable price. Some honourable mentions include the Rojak (a fruit and vegetable salad), Nasi Padang and savoury fried carrot cake which are much-loved favourites to locals and tourists. But you can’t go past the chicken rice, a national dish of steamed or roasted chicken with flavoursome rice cooked in chicken stock. The Balestier area is famous for having some of the best chicken rice in the city.
SWEET TREATS
Take a turn off Balestier Road and onto Kim Keat Road and follow the irresistible aroma of freshly baked bread for some delicious eats at Sweetlands Confectionary. Bread has been produced here for more than 50 years for local coffees shops and there is a counter filled with warm, fresh French loaves and buns with a variety of fillings from coconut to cheese and Kaya (a local jam made from coconut and egg). There are plenty of other notable eateries to stop off at along the way for a quick snack including places that serve up rice dumplings and Tau Sar Piah, bean paste biscuits which come in sweet or savoury varieties. Pindara Magazine
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DINNER TIME
End your day with a hearty meal at Ramada Singapore’s Flavours At Zhongshan Park or Days Hotel Singapore’s, 21 on Rajah. Flavours is a modern Asian restaurant, which offers a “Hawkerlicious” buffet showcasing fresh seafood with a selection of flavours including black pepper sauce and salted egg yolk. Head chef Kristopher Cheng and his team have brought Singapore street food into the restaurant inspired by the open air hawkers markets. 21 on Rajah is located at Days Hotel Singapore at Zhongshan Park is one of the area’s only Halal certified restaurants and does not serve pork, lard or alcoholic beverages.
WHERE TO STAY
The award-winning Ramada and Days Hotels Singapore at Zhongshan Park sit on either side of Zhongshan Park and are connected to an underground carpark with ample parking lots, bringing greater convenience to guests choosing to drive to the hotels. Both hotels offer complimentary single-entry parking for in-house guests, as well as shuttle bus services to Novena MRT and Orchard Road. The hotels have access to an outdoor swimming pool, gyms, meeting and event facilities, free Wi-Fi and several dining options. The hotels have recently launched The Balestier Insider Guide, adding another perspective and enhancing the traveller’s stay experience at the hotels and an easy way to discover the area on foot. Prices start from SGD$170 at Ramada Singapore at Zhongshan Park and SGD$130at Days Hotel Singapore at Zhongshan Park. Visit ramada-dayshotelssingapore.com
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GETTING THERE:
Scoot Airlines flies direct to Singapore from Sydney, Melbourne, Gold Coast and Perth airports. The low cost airline features super comfortable seats, plenty of leg room, Wi-Fi on board and the option of Scoot in Silence for a quieter journey. Scoot was recently awarded best low cost airline Asia Pacific by airlineratings.com for the third year in a row. Visit flyscoot.com
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S FEEL THE HEAT:
UMMER
ST
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Her CHRISTENSEN COPENHAGEN Alice & Olivia Dress $625, Alice & Olivia Cardigan with Detachable Fur $1195 NINE WEST Tatiana Silver Heel $149.95 SUNBURN Seafolly Montrey Sunglasses $89.95 ARDEN COLLECTION White Overnight Bag $199 CALLEIJA Platinum Glacier Diamond Ring POA, Platinum Half Circle Diamond Wedding Ring $7,850, Platinum Stud Earrings POA, 18ct White Gold Glacier Bracelet POA Him GAZMAN White Linen Shirt $109 TOMMY HILFIGER White Denton Chino $225 TOMMY BAHAMA Maui Jim Sunglasses $369 GANT Time Park Hill Silver Watch $280 JOHN FORSYTH Penny Loafer Brown $199 MARIORA Black Opal Ring $11,000
07 5555 6400 74 SEAWORLD DRIVE, MAIN BEACH 4217 MARINAMIRAGE.COM.AU @MARINAMIRAGE
JANINE EDWARDS Equipment Short Sleeve Signature Shirt $411 CARLA ZAMPATTI White Crepe Fluid Pant $499 DOMANI Azuree Nani Shoe $479.90 SONIA STRADIOTTO COUTURE Hexagon Sunglass $99 BON GENRE Covet Handmade Halo Bangle $159.90 CALLEIJA Yellow Diamond Stud Earrings with Pink Diamond Halo $42,800, Symphony Marquise Diamond Ring $21,900
CARLA ZAMPATTI White Crepe Alisha Lace Jumpsuit $1149 NINE WEST Tatiana Silver Heel $149.95 CALLEIJA Pave 18ct White Gold and Diamond Bangle $34,500, Platinum 6.05ct White, Pink and Blue Diamond Ring POA Marquise Diamond Earrings $26,890
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hello
little
one
LEFT TO RIGHT; THE MISSES BONNEY Playsuit Cross Waves $179 THE MISSES BONNEY Hand Painted Hair Brush $85 THE MISSES BONNEY Floppy Rag Doll Pastel Roses $59 THE MISSES BONNEY French Smocked Dress $295 THE MISSES BONNEY Cross Waves Blanket $229 CATALINA HOMEWARES Donsje Sibi Baby Shoe $79 CATALINA HOMEWARES Donsje Handmade Leather Baby Sandals $69 THE MISSES BONNEY Pink Bows $30 Each THE MISSES BONNEY Flatout Bear Baby $45 BON GENRE Voluspa Casa Pacfica Candle $61.90 THE MISSES BONNEY Rattle Mini Pink Check Horse $39 THE MISSES BONNEY Pink Jumpsuit $169 THE MISSES BONNEY Going to Grandmas Suitcase $120 THE MISSES BONNEY Blue Bow $30 BON GENRE Voluspa Prosecco Rose Candle $61.90 BON GENRE Pocket Mirrors $15.95 each, Round Magnet $11.95 BLUE ILLUSION Silver Lining Book $19.99 BON GENRE Mr Grumpy Travel Mug 300ml $19.90 BON GENRE Sunnylife Flamingo Watering Can $29.90, SUNBURN Seafolly Ocean Rose Bandeau Bustier $99.95, Frill Bottom $79.95 BON GENRE See Junior Sunglass $49.90 BON GENRE Sunnylife Ice Cream Scoop $19.90 BON GENRE Hammamas Towels in Splice Dolce $49.90, Aztec Blue $49.90, Water Melon $44.90 SUNBURN Mink Pink Kubrick Love Heart Sunglasses $49.95 BON GENRE Slim Aarons Great Escapes Journal $29.95
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The MissesBonney EST 1906
Established in 1906, The Misses Bonney is internationally renowned for the most exquisite collection of babywear, christening wear, luxury toys and exclusive gifts. The treasures at The Misses Bonney attract followers from all over the world; from their original home in Sydney right across the globe to the UK, and now a beautiful new boutique has opened at Marina Mirage on the Gold Coast, just in time for summer. The Misses Bonney is steeped in history and tradition, and caters for newborns, babies, toddlers and small children, each with their own range of Australian and international items. Famous for their collection of precious handmade shawls and blankets for newborns, they are also renowned for their christening gowns & bonnets which are still made to the original patterns. This highly sought-after boutique has had many famous visitors over the years, not to mention plenty of royal interest! A real delight that will please every visitor with gifts and treats to last a lifetime, The Misses Bonney continues to be a firm favourite and should not be missed! themissesbonney.com.au (07) 5528 0323 Shop 134, Level 1, Marina Mirage. Follow us: @themissesbonney (Source: J. Barletta, & J. Bond, (Eds.). The Home Therapist: A practical, self-help guide for everyday psychological problems. Brisbane, Australia: Australian Academic Press. Š)
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Get ready for the ride of your life in the stunning new Aston Martin DB11.
Aston Martin Queensland is proud to announce the arrival of its DB11 demonstrator, heralding the delivery of the first customer DB11s in December. The first product launched under the company’s ‘Second Century’ plan, DB11 is the bold new figurehead of the illustrious ‘DB’ bloodline and an authentic, dynamic sporting GT in the finest Aston Martin tradition. Patrik Nilsson, President of Aston Martin in Asia Pacific, said, “Aston Martin has a proud, 103-year heritage in the luxury automotive market, and the DB11 embodies every aspect of the brand with absolute elegance and indulgence, combining the very latest technology and finest quality hand craftsmanship.” Earlier in the year, Aston Martin engineers toured a DB11 prototype around Central Australia and North Queensland as part of the new model’s hot weather testing. Australia was one of several countries involved in the new vehicle’s extensive engineering sign-off process. The DB11 showcases a fresh and distinctive design language, pioneering aerodynamics and is powered by a potent new in-house designed 5.2-litre twin-turbocharged V12 engine. Built upon a new lighter, stronger, and more space efficient bonded aluminium structure, DB11 is the most powerful, most efficient and most dynamically gifted DB model in Aston Martin’s history. As such, it is the most significant new Aston Martin since the introduction of the DB9 in 2003. Pindara Magazine
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Heralding a new design era for Aston Martin, DB11 is the latest landmark in a remarkable aesthetic journey; one that gave us icons such as the DB2/4, DB5 and, most recently, the DB10 developed specifically for James Bond. DB11 re-imagines the relationship between form and function with a series of fresh design signatures. Innovative aerodynamics play their part in this aesthetic revolution with clever management of airflow both over and through the bodywork aiding stability while preserving the DB11’s uncluttered surfaces. Like every Aston Martin, the heart of the DB11 is found beneath the bonnet, though unlike any Aston Martin before it, the DB11’s heart is a 5.2-litre twin-turbocharged V12. Designed in-house this new engine develops 608PS and 700Nm of torque, making DB11 the most powerful production DB model ever. Naturally, it’s the most dynamic and most accelerative too, with a top speed of 322km/h and a 0-100km/h time of just 3.9sec.
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DB11 Recommended Retail Pricing starts from AUD$395,000 excluding on-road costs. For enquiries regarding the DB11, please contact: Aston Martin Queensland Paul Hewitt – General Manager 179 Nerang Road, Southport QLD 4215 Tel: +61 (0)7 5582 7888 M: +61 425 001964 Email: paul.hewitt@sunshineastonmartin.com.au
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ASTON MARTIN QUEENSLAND
Aston Martin Queensland, 179 Nerang Road, Southport QLD 4215 | General Manager Paul Hewitt M: +61 425 001 964 | Tel:+61 7 5582 7888 W: queensland.astonmartindealers.com combined 11.4 (24.8). CO2 depending on factors including road conditions, weather, vehicle load and driving style.
GIZMO GUIDE
2016
COOL THINGS FOR A
Giant Red Gummy Bear Pool Float $49.95 Bring your chilling experience to a whole new level of awesomeness with this sweet and juicy looking Gummy Bear Pool Float! It inflates into a gigantic, bright red Gummy Bear with a super-comfy circular cutout so you can laze about snacking on lollies all day!
Inflatable Watermelon $79.95 Nothing says "summer" like a cool slice of watermelon, so lay back and soak up some rays in the pool, at the bay or at your local swimming hole with this over-sized slice of vibrantly coloured fruit! Why snack by the pool when you can be snacking on a watermelon while, well, floating in a watermelon? It's the perfect addition to your next pool party or family cool down session!
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Donut Inflatable Drink Holders $16.95 This pair of donut-shaped beverage boats make a yummy addition to your home pool. Keep your drinks safely above water and within easy reach to make lounging in the pool that much more convenient. Each drink holder is shaped like a delicious donut that someone took a bite out of, then tossed in the pool!
Watermelon Ping Pong Play On $54.95 Turns any table into a cool Table Tennis play area. Keep your family and friends entertained at picnics, barbecue, the beach and more with your Watermelon Ping Pong Play on Set! Simply fasten the portable and fully adjustable Ping Pong net to your table for instant ping pong fun!
Unpredictaball $14.95 The inflatable Unpredictaball features a unique weight, which causes it to move in wacky ways, by veering unexpectedly or looping back if rolled, or zooming in zany directions if thrown! If you can catch it, you can catch anything!
All items pictured are available now at www.coolthings.com.au
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TOP READS
2016
HOLIDAY reads
Blueberry GLENNA THOMSON
Friday Barnes 6: Danger Ahead
The Barbershop Girl GEORGINA PENNEY
R.A SPRATT Greer O’Reilly needs to start over. Her professional success belies private sadness and domestic overload. She’s torn between her career and motherhood. Her partner of twelve years has left her. And up ahead is her new home - a beautiful though neglected blueberry orchard in the hills of north-east Victoria. But when she and her six-year-old daughter Sophie arrive at the property to take possession, there’s an unforeseen complication - the former owner, 81-year-old artist and jazz lover Charlie Chandler, refuses to move out. Charlie is dying and desperate to spend his last days in his old home. With Greer at the beginning of her new life, and Charlie at the end of his, the unlikely pair soon form a close bond. One that will offer the strength and inspiration Greer needs – because the next twelve months will either make or break her.
Friday Barnes is forced to face her biggest fear – her own emotions! She must wave goodbye to Ian as he takes off to join his father in the Cayman Islands. But when your dad is a whitecollar criminal, family reunions never go to plan. Ian is kidnapped en route and it’s up to Friday to rescue him. On her return to school, the Headmaster has a treat in store – a four-week camp for students to learn wilderness survival skills! ‘Camp Courage’ is even worse than Friday imagined. And all her book smarts aren't much help when she's got wood to chop, potatoes to peel and latrines to dig. Can Friday survive the great outdoors, debunk the legend of a camp ghost and make it back to Highcrest Academy alive? Only time (and a compass) will tell!
You don't become a notorious British celebrity without rubbing a few people the wrong way, which is why writer and comedian Ben Martindale has decamped to Australia until the latest media frenzy dies down. When he meets Amy Blaine, a perky blonde who dresses like a 1950s pin-up girl, he knows he's hit the satirical jackpot. He begins to fill his weekly London column with snarky observations about her life, clothes, and even their most intimate moments. It doesn't occur to him that Amy, who is letting her guard down for the first time in her adult life, might be upset - after all, it's hilarious, and his readers love her! It isn't until Amy discovers the extent of his betrayal that Ben begins to realise just how badly he's cocked up the best thing that ever happened to him. But is it too late?
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TOP READS
Long lazy days at the beach or by the pool mean plenty of time to catch up on your reading. We’ve selected the best new releases for you these holidays.
Isadora
Private Delhi
Good Me Bad Me
MCCONAGHY
JAMES PATTERSON & ASHWIN SANGHI
ALI LAND
You don't become a notorious British celebrity without rubbing a few people the wrong way, which is why writer and comedian Ben Martindale has decamped to Australia until the latest media frenzy dies down.
Santosh Wagh quit his job as head of Private India after harrowing events in Mumbai almost got him killed. But Jack Morgan, global head of the world’s finest investigation agency, needs him back. Jack is setting up a new office in Delhi, and Santosh is the only person he can trust.
'New Name. New Family. Shiny. New. Me.'
When he meets Amy Blaine, a perky blonde who dresses like a 1950s pin-up girl, he knows he's hit the satirical jackpot. He begins to fill his weekly London column with snarky observations about her life, clothes, and even their most intimate moments. It doesn't occur to him that Amy, who is letting her guard down for the first time in her adult life, might be upset - after all, it's hilarious, and his readers love her! It isn't until Amy discovers the extent of his betrayal that Ben begins to realise just how badly he's cocked up the best thing that ever happened to him. But is it too late?
Still battling his demons, Santosh accepts, and it’s not long before the agency takes on a case that could make or break them. Plastic barrels containing dissolved human remains have been found in the basement of a house in an upmarket area of South Delhi. But this isn’t just any house, this property belongs to the state government.
Annie's mother is a serial killer. The only way she can make it stop is to hand her in to the police. But out of sight is not out of mind. The secrets of her past won't let her sleep, even with a new family and name - Milly. A fresh start. Now, surely, she can be whoever she wants to be. But Milly's mother is a serial killer. And blood is thicker than water … She is, after all, her mother's daughter.
With the crime scene in lockdown and information suppressed by the authorities, delving too deep could make Santosh a target to be eliminated.
Finding the right Hotel just got a whole lot easier. Compare and Book 100’s of travel sites at once.
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At the movies AT THE MOVIES
2016
Our pick of summer’s hottest cinematic releases.
La La Land
Red Dog: True Blue
Sing
Starring Ryan Gosling, Emma Stone, Amiée Conn A huge hit with audiences and critics, La La Land is an exhilarating, music-filled romance starring Ryan Gosling and Emma Stone. In modern day Los Angeles, two ambitious artists who fall in love – one a dedicated musician, the other an aspiring actress – chase their dreams and discover the joy and heartbreak of risking it all for your passion. Daring, enchanting and moving, La La Land re-invents the Hollywood classic for a new age, creating the kind of movie magic that sends you out of the cinema on a high.
Starring Levi Miller, Bryan Brown, Jason Isaacs When eleven year old Mick (Levi Miller) is shipped off to his grandfather's (Bryan Brown) cattle station in the remote Pilbara region of Western Australia, he prepares himself for a life of dull hardship, but instead finds myth, adventure and a friendship with a scrappy, oneof-a-kind dog that will change his life forever.
Starring Scarlett Johansson, Matthew McConaughey, Reese Witherspoon Set in a world like ours but entirely inhabited by animals, Sing stars Buster Moon (Academy Award® winner Matthew McConaughey), a dapper Koala who presides over a once-grand theater that has fallen on hard times. Buster is an eternal optimist—okay, maybe a bit of a scoundrel—who loves his theater above all and will do anything to preserve it. Now facing the crumbling of his life’s ambition, he has one final chance to restore his fading jewel to its former glory by producing the world’s greatest singing competition. Five lead contestants emerge: A mouse (Seth MacFarlane) who croons as smoothly as he cons, a timid teenage elephant (Tori Kelly) with an enormous case of stage fright, an overtaxed mother (Academy Award® winner Reese Witherspoon) run ragged tending a litter of 25 piglets, a young gangster gorilla (Taron Egerton) looking to break free of his family’s felonies, and a punk-rock porcupine (Scarlett Johansson) struggling to shed her arrogant boyfriend and go solo. Each animal arrives under Buster’s marquee believing that this is their shot to change the course of their life.
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AT THE MOVIES
2016
Assassin’s Creed
Fifty Shades Darker
Moana
Starring Michael Fassbender, Marion Cotillard, Michael Kenneth Williams Through a revolutionary technology that unlocks his genetic memories, Callum Lynch (Michael Fassbender) experiences the adventures of his ancestor, Aguilar, in 15th Century Spain. Callum discovers he is descended from a mysterious secret society, the Assassins, and amasses incredible knowledge and skills to take on the oppressive and powerful Templar organization in the present day.
Starring Jamie Dornan, Tyler Hoechlin, Dakota Johnson Jamie Dornan and Dakota Johnson return as Christian Grey and Anastasia Steele in Fifty Shades Darker, the second chapter based on the worldwide bestselling “Fifty Shades” phenomenon. Expanding upon the events set in motion in Fifty Shades of Grey, which has grossed more than $560 million globally, the film will again become the motion-picture event for Valentine’s Day 2017. Michael De Luca and Dana Brunetti, alongside E L James, the creator of the series, also return to produce.
Starring Auli'i Cravalho, Dwayne Johnson, Jemaine Clement For centuries, the greatest sailors in the world masterfully navigated the vast Pacific, discovering the many islands of Oceania. But then, 3,000 years ago, their voyages stopped for a millennium – and no one knows exactly why. From Walt Disney Animation Studios comes “Moana,” a sweeping, CG-animated feature film about an adventurous teenager who is inspired to leave the safety and security of her island on a daring journey to save her people. Inexplicably drawn to the ocean, Moana (voice of Auli'i Cravalho) convinces the mighty demigod Maui (voice of Dwayne Johnson) to join her mission, and he reluctantly helps her become a wayfinder like her ancestors who sailed before her. Together, they voyage across the open ocean on an action-packed adventure, encountering enormous monsters and impossible odds, and along the way, Moana fulfills her quest and discovers the one thing she’s always sought: her own identity.
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Summer Recipes Light on calories but heavy in flavour, these delicious recipes are sure to impress family and friends!
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Oysters
with Grap
Entree
efruit & M
int Salsa
• 12 fresh o ysters, shu • cked, on th 1 ruby red e half shel grapefruit l • , segmente 1 small re d and diced d o n ion, very fi • Juice of o nely diced ne lime • 1 teaspoon honey • 2 tablespo ons finely • chopped m Salt & pep int leaves per to tast • e 12 whole mint leaves , to garnis h 1. Com bine the li me juice an small bow d honey in l and whis a disso k until the lved. honey has 2. Add the diced grapefruit , onion an mint and st d chopped ir to comb ine. Seaso and pepper n with salt . 3. Top each oyster with one te salsa and aspoon of garnish w the ith a mint leaf.
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es Serlvve twe
REAKFAST SAVOURY B
MUFFINS
-raising flour 1 ½ cups self • meal flour 1 cup whole • eal/polenta m ¾ cup corn • ilk 1 cup butterm • butter d te el m p ½ cu • ly beaten 2 eggs, light • zucchini ed 1 cup grat • diced bacon ed ok co ½ cup es • chopped chiv ¼ cup finely se • ee cheddar ch ½ cup grated • e to tast Salt & pepper • Celsius 210 degrees to en ov t ea s. 1. Preh e muffin tray se two 12-hol ea rge gr la d a an eal into ur and cornm flo e th . re ft nt Si ce e 2. e a well in th the er bowl and mak th ge to bowl, whisk te ra pa se r. a 3. In melted butte ttermilk and bu , gs e. st eg to ta salt & pepper Season with nts and stir ie ed gr in ng ni ai m re e th 4. Add to combine. to the well in wet mixture e th ir dd st A d 5. edients an l of dry ingr w e bo ak e M th d. ne re is combi tu ix m til un just ixture. erwork the m sure not to ov prepared e th to e mixture in th n oo Sp 6. ke for 20 – 25 trays and ba fin uf m n ow til golden br minutes or un rough. th and cooked
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Salad
PANZANE
LLA SALA
D
• 1 loaf day-old ci abatta, cru • 500 g st removed rams roma and torn in tomatoes, • 100 g to chunks cut into bit rams cher e-size chu ry tomato • 100 g nks es, halved rams baby plum tom • 1 sm atoes, halv all red onio ed n, thinly sl • 1 sm iced all cucum ber, diced • 1 han dful fresh basil leaves • ¼ cu p extra-vir g in olive oil • 2 tab lespoons ag ed balsam • 1 tab ic vinegar lespoon re d wine vin • Salt & egar pepper to taste 1. Lay th e bread ch unks on a preheated baking sh oven at 10 eet and bak 0 degrees e in a Allow to co Celsius fo o l. r 30 minu 2. Toss tes. the bread and all rem a large bo ai n in g ingredie wl and serv nts togeth e immedia er in tely.
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tail
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MPAGNE ERRY CHA
RASPB
COCKTAIL
berries frozen rasp cup fresh or ¼ • s lime juice 2 tablespoon r • s caster suga 2 tablespoon • mpagne • Cha queur Raspberry li • s to garnish sh raspberrie re F a • er sugar in ice and cast ju e m li s, ie spberr Puree the ra 1. e l smooth. ti un r espoon of th de blen add one tabl s liqeuer. as y gl rr e be gn on of rasp po In a champa as te e on 2. esh ree and ish with a fr raspberry pu gne and garn pa am ch h it Top w 3. spberry. ra
CRANB
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• • • • • •
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MART
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¼ cup gin ¼ cup cranbe rry juic 2 table e spoons vermo 3 ice c uth ubes Frozen or Sprig o dried cranbe rries to f mint to garn garnish ish
1. Combin e all in gredien in a cocktail ts exce shaker pt garn second and sh s. 2. ake for ish S tr 10 ain into a ch garnish with illed martini glass a the cra sprig. nd nberrie s and m int
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Cocktail Hour Poli Southside 20ml lemon juice 20ml thyme syrup 60ml Marconi Poli Italian Gin
Salvadego 30ml Ketel One Vodka 30ml Cinzano Bianco 4 cube of fresh Pineapple 4 sage leafs 20ml lemon juice 15 ml agave syrup
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The Canary 2 slices fresh turmeric 20ml lemon juice 20ml chilli and thyme syrup 40ml Tanqueray 10 20ml Cinzano Bianco
La Nanas 20ml fresh Pineapple juice 20ml lime Juice 40ml Pampero Blanco 10ml Amaro Montenegro 10ml Fair Kumquat Liqueur 10ml honey syrup
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Esprit d'ete 20ml Blueberries and rosemary syrup 20ml lemon juice 20ml Esprit de Figue 40ml Ketel One Vodka
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SUPERANNUATION THE WINDS OF CHANGE ARE BLOWING
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Significant changes to superannuation are soon to commence. This article explores these changes, and some strategies you may wish to consider before the 1 July 2017 start date.
Overview On 23 November, the Australian government passed a range of significant superannuation measures into law including: • • • pindaramagazine.com.au
From 1 July 2017 only individuals with a superannuation account balance below $1.6 million (the vast majority of the population) are permitted to make non-concessional (after- tax) contributions to their fund For those that remain eligible, the contribution cap for this type of contribution will be reduced to $100,000 per year or $300,000 over three years from 1 July 2017 (down from $180,000 or $540,000 respectively) Concessional contributions (e.g. Superannuation Guarantee, salary sacrifice, and contributions for which you can claim a deduction) will be capped at $25,000 per year from 1 July 2017 (down from $30,000 or $35,000 for those aged 50 or over)
• • • •
Allowing all individuals eligible to contribute to superannuation a deduction for their personal, after-tax contributions up to the $25,000 concessional contribution limit from 1 July 2017 Taxing the earnings in respect of Transition to Retirement Income Streams (TRIS) at 15% (up from 0%) from 1 July 2017. This will apply to all TRIS pensions irrespective of their commencement date Reducing the income threshold at which taxpayers are charged an extra 15% tax on their concessional contributions from $300,000 to $250,000 from 1 July 2017 Allowing individuals with superannuation balances below $500,000 to make ‘catch up’ concessional contributions. This will assist an estimated 230,000 individuals with broken works patterns (the overwhelming majority of whom are women) better provide for their retirement.
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Impact Although there has been much publicity surrounding these changes, the Government estimates that 96% of individuals with superannuation will either not be affected by these changes or will be better off. The majority of the 4% of individuals that are adversely affected by these changes are unlikely in any case to rely on the Age Pension in retirement.
Strategies With these changes not due to come into effect until 1 July 2017, there are a number of strategies individuals may wish to consider over the coming months to optimize their position including:
Ensure Your Contributions Are Deductible If you are contemplating making an after-tax contribution to superannuation and like many employees and contractors who draw income from salary and wages you are not eligible to claim a deduction under current law, then you may wish to hold off on making your contribution. If you delay the contribution until after 30 June 2017, then you will generally be able to claim a deduction for that contribution. Under the current law, you cannot.
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Beat the Non-Concessional Cap Reduction Over the coming months leading up to 1 July, taxpayers who are contemplating making large non-concessional, after-tax contributions (e.g. you may have received an inheritance, or sold a property and wish to contribute the proceeds) may wish to consider bringing forward those contributions to before 1 July. If making a large contribution, bringing it forward will enable you to take advantage of the currently larger caps and thus deposit more money into the concessionally taxed superannuation environment sooner, and enjoy the tax concessions from an earlier date.
GOVERMENT ESTIMATES
96%
WILL NOT BE AFFECTED BY THESE CHANGES
Review Your Salary Sacrifice Arrangements From 1 July 2017, employees who salary sacrifice may need to review their arrangements to ensure that you are not in breach of the reduced $25,000 concessional cap.
Further Advice The information contained in this article is general in nature. Your specific circumstances, objectives and financial needs have not been taken into consideration.
If you would like specific advice on how they impact you, please contact Kellie Powell at PT Partners on (07) 3808 4499. You can make an appointment with Kellie at bookings.ptpartners.net.au/ KelliePowell
2016
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