Private Hospital
The new $50 million neuroscience & cancer wing
Pretty in Pink
Breast cancer awareness month
Movember Momentum
Boating
Motoring
TRAVEL
Pindara Rising
Boats of Integrity
Complimentary Pindara Magazine Issue THREE Summer 2014/15
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X-Citing arrival - BMW welcomes new addition
Changing the face of men’s health
Hong Kong High & Berlin or Bust
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Contents Regulars
From the CEO
Editor’s Desk
Pindara News
Features
Brain Tumours Who’s at risk? Men’s Health How Movember is changing the face of men’s health Pretty in Pink The colour, spirit & meaning of Cancer Awareness Month
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Freezing Time Why young women are preserving their fertility Children’s Health Kids and Sleep Awareness Week Hong Kong High Taking a cultural and culinary trip to the NYC of Asia
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X-Citing Arrival BMW welcomes an all-new addition to the family
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Health & Wellbeing
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Lymphoma How white blood cells develop cancer Alzheimer’s Uncovered What not to forget about Alzheimer’s Disease
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Diverticulosis & Diverticulitis Understanding the differences between these conditions
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Pain Today Gone Tomorrow Putting chronic pain in the past
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Breast & Ovarian Cancer Dr Stephen Withers explains how these impact women
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The Forgotten Cancer 36 The rise of testicular cancer in young men
Full Service VS Low Cost VS Bulk Billed IVF Knowing your options
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A Toothy Issue 52 Brushing away the mysteries of teething Child Safety & Injury How to prevent and deal with kids’ injuries
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Nutrition & Fitness Take On The Takeaway How to make your takeaway favourites healthy at home
Fit & Free Your no-cost exercise options on the Gold Coast
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Lifestyle
Boats of Integrity Jumping aboard Australia’s beautiful Integrity Motor Yachts Finance How safe is investing in the market for homes?
Travel
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Tartufo 107 Brisbane’s piece of delicious Italian history
Health & Beauty
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Reconstructive Breast Surgery Choosing the right technique for you
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Eye Spy Professor Howes sheds light on the latest eye surgical technology
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Gizmo Guide
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The Freshest Catch The Fish House proves to be the Coast’s finest & freshest
You Beauty This season’s best beauty buys
Escape at O’Reilly’s 74 The Gold Coast Hinterland’s eco-haven of relaxation & reconnection Berlin Or Bust Pindara’s Robbie Falconer recounts her trip to Europe’s coolest city
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Dining
Movies & Books Latest DVD Reviews Great Reads
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From the CEO Trish Hogan
CEO Pindara Private Hospital
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Welcome to the summer edition of Pindara Magazine. ince our last edition we have been thrilled to open our brand new hospital wing named after a great Gold Coast Doctor who was very well respected and admired by the whole Gold Coast health services community - Dr David Lindsay. It marked another wonderful occasion in the history books of Pindara Private Hospital. In 1971 Gwen and Allan Ramsay on the advice of Sir Bruce Small purchased eight acres of land here in Benowa for the purpose of building a private hospital. They had a belief they could build a private hospital to serve the community of the Gold Coast. Since it was first built, Pindara has had five owners – Australian Hospital Care Limited purchased it in 1986 from the Ramsay family. In 2001 it was then purchased by Mayne Health and then sold onto Affinity Health in 2003. Ramsay Healthcare purchased this facility in April 2005 and the facility has not looked back since. Pindara has a proud history of community engagement and excellence in healthcare. Facility upgrades to various sections of the hospital have occurred over its 43 year history. Operating theatres were increased from four to five in 1993; the east wing maternity and orthopaedic patient rooms were added in 1995; the building and opening of Pindara Place and the Pindara Day Procedure Center in 1998, the addition of a New Critical Care Unit in 2000, a cardiac Catheter Laboratory and a sixth operating theatre were added in 2004, the east wing was refurbished in 2007, and a Ramsay Healthcare $63m construction of a 37 bed surgical ward, 13 bed children’s ward, six operating theatres including a self-contained endoscopy unit, a 48 suite
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Medical Consulting Building and a multistorey car park accommodating 750 cars onsite was completed in 2010. Pindara has always been earmarked by the Ramsay Board for a multistage redevelopment with the site having been approved by council for 450 inpatient beds. On 16 September we celebrated the opening of another milestone in redevelopment of this very busy campus. In May 2013 Mayor Tom Tate turned the sod on the land purchased adjacent to the hospital. Now, thanks to another $50 million investment by the Ramsay Board we are able to showcase the beautiful five-storey building at the Allchurch Avenue entrance of the hospital. The building consists of 116 private ensuited rooms, a new hospital kitchen, staff dining facilities, and an additional three operating theatres. These specialist facilities house surgery, oncology, haematology, palliative care and neuro sciences. I was particularly delighted with the opening of the Gold Coast Neurosciences Unit on the third floor. This dedicated specialist unit treats patients for neurosurgery and spinal surgery and is the first private facility for interventional neuroradiology on the Gold Coast and the second private facility in Queensland. As an adjunct to the neurosciences unit and to enhance vascular surgery at this hospital, Pindara has built an absolute state-of-the-art Philips and Stryker Hybrid operating theatre. This operating theatre commanding a space of 58 sqm is fitted with $2.4 million of radiology equipment, has specialist staffing and provides for advanced techniques in interventional surgery and procedures and is the number one configuration of its type in the world. Mr Kevin Barrow – CEO Philips Health Care joined us for the opening to present a plaque which will be displayed at the hospital indicating that this suite is a Philips Number 1 in the world. Today the Pindara campus houses a total of 17 operating theatres and 335 inpatient beds, together with a comprehensive range of high-end specialist support services, making it the largest and most comprehensive private hospital on the Gold Coast. Redevelopments of this magnitude and logistical difficulty don’t just happen. All this has been made possible with the cooperation and leadership of many people, and we are indebted to their superb skills in bringing this all to fruition. It has been wonderful to see the patients enjoying such gorgeous accommodation and facilities. Many patients have now been treated in our multimillion-dollar hybrid and recovered in the purpose-built Neurosciences unit. The feedback from the patients and staff has all been very positive. Other construction is still underway as we continue to develop the campus into the best private health facility on the Gold Coast. I hope you enjoy the pictorial coverage of the new facilities in this edition.
Summer | 2014/15
Pindara Private Hospital Trish Hogan CEO Pindara Private Hospital Katriya De Vincentiis Editor Pindara Magazine Robbie Falconer Assistant Editor Pindara Magazine Business Development & Marketing Manager Pindara Private Hospital Published by Nude Publishing a division of Nude Creative Pty Ltd www.nudepublishing.com.au Art Direction, Editorial & Production Nude Creative hello@nudecreative.com.au www.nudecreative.com.au National Advertising Manager Peter Wastie peter@nudepublishing.com.au Medical Contributors Dr Frank Howes Ophthalmologist (Eye Spy) Dr Meenahski Raj Neurologist (Alzheimers Uncovered) Dr Daniel De Viana Breast Surgeon (Reconstructive Breast Surgery) Dr Stephen Withers Genetist & Paediatrician (Breast Cancer, Ovarian Cancer and Genetic Predisposition) Lifestyle Contributors Amanda James Anthony Sherratt Jason Oxenbridge Lizzie Keen
creative / digital / publishing phone 07 5514 8355
www.nudecreative.com.au 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.
Pindara Two Competition
W INNERS Congratulatio ns
WELCOME
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ello and welcome to the third issue of Pindara Private Hospital Magazine. As we move into the warmer months, a lot of us are paying closer attention to our health and wellbeing. It’s important to remember that good health comes from the inside, so it’s vital to undergo your annual health check now, if you haven’t already. In this issue we cover some serious medical conditions such as Alzheimer’s, brain tumours and breast cancer, and break them down for you in plain English. We also discuss one of the biggest health awareness events of the year – Movember. Will you be supporting the Mo Bros and Mo Sisters this year? We also take you away to one of the busiest cities on earth, Hong Kong, and show you where to eat, drink, shop and play, for a top-notch getaway.
Pindara’s Business Development Manager, Robbie Falconer, also shares her recent experience travelling to Berlin and Munich. If you haven’t visited Germany before, you will definitely want to after reading Robbie’s story. Closer to home we review two of our favourite restaurants in Southeast Queensland, Tartufo (Brisbane) and The Fish House (Burleigh). You’ll also find our usual movie and book reviews to keep you entertained during your recovery period. We hope you enjoy the read. Until next time … Katriya & Robbie
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TWO-NIGHT LUXURY HINTERLAND ESCAPE Pindara Magazine have teamed up with O’Reilly’s Rainforest Retreat for this exciting giveaway Simply enter online at www.pindaramagazine.com.au/ oreillys and you’ll be in the running to win two nights in a two-bedroom villa for up to four people at O’Reilly’s Rainforest Retreat in the Gold Coast Hinterland, valued at over $1100.
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Bruce Lynton
ONE WITH THE MACHINE. THE ALL NEW BMW M4 COUPÉ HAS ARRIVED AT BRUCE LYNTON. The wait is over. All hail the latest Ultimate Driving Machine that is built to dominate the road and track, the all new BMW M4 Coupé. Featuring a new high-revving, in-line six-cylinder engine with BMW M TwinPower Turbo technology that generates 317kW of power, 550Nm of torque and an undeniable defiance of gravity that is guaranteed to get your adrenaline pumping. The M Double Clutch Transmission with Drivelogic will ensure lightning quick gear shifts and uninterrupted acceleration. While the Active M Differential delivers maximum power to the road, the lightweight carbon fibre roof and drive shaft help lower the centre of gravity, creating unrivalled agility. It is time to be completely at one with the machine. Visit Bruce Lynton for more information.
Bruce Lynton 82-84 Nerang Street, Southport. Ph (07) 5557 7999. bmwsales@brucelynton.com www.brucelynton.com
Pindara private hospitalopenS $50million development PINDARA PRIVATE HAS OPENED A NEW 116 BED PRIVATE ROOM WING INCORPORATING A STATE-OF-THE-ART GOLD COAST NEUROSCIENCES UNIT & A NEW CANCER UNIT.
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Mrs Jan Lindsay (wife of the late Dr David Lindsay) and Jan Lloyd (ADOC&HS Pindara) Trish Hogan, Chris Rex, the Hon Peter Dutton, Dr Guy Wright-Smith
The wing was officially opened on 16 September 2014 by the Federal Minister for Health & Minister for Sport, The Hon Peter Dutton and dedicated in memory of prominent Gold Coast Thoracic Physician Dr David Lindsay. Paul Johansen (SCR), Michele Hoffman (Pindara) & Helen Planting (SCR)
Phil Lindsay (brother of the late Dr David Lindsay) & Fiona Lindsay
Chris Rex, Trish Hogan, Judy Brinsmead and The Hon Peter Dutton
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Pindara Private Hospital CEO Mrs Trish Hogan and Ramsay Health Care Managing Director Mr Chris Rex inspect a new patient room in the Dr David Lindsay Wing
Summer | 2014/15
Mrs Jan Lindsay, wife of the late Dr David Lindsay and family. Front left, Molly Eaton; Rebecca Eaton (standing behind Molly); Stella Eaton; Claire & Matthew Eaton; Mrs Jan Lindsay & Isabella Eaton
Dr Vijay Kapaedia and the Philips Health Care team
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Pindara Private Hospital CEO Mrs Trish Hogan and Ramsay Health Care Managing Director Mr Chris Rex inspect the new Dr David Lindsay Wing
Pindara Private Hospital CEO Mrs Trish Hogan and Kevin Barrow CEO Phillips Health Care
Mr Chris Rex Ramsay Health Care Managing Director & The Hon Peter Dutton Minister for Health & Minister for Sport
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General Health
{ lymphoma } Lymphomas are cancers that affect the lymphatic system. Lymphomas arise when developing lymphocytes (a type of white blood cell) undergo a malignant change and multiply in an uncontrolled way.
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ncreasing numbers of abnormal lymphocytes called lymphoma cells accumulate and form collections of cancer cells called tumours in lymph nodes (glands) and other parts of the body. Over time, lymphoma cells replace normal lymphocytes, weakening the immune system’s ability to fight infection. Lymphoma is the fifth most common cancer in Australia (sixth most common type of cancer in men and the fifth most common type of cancer in women). At least 89 percent is non-Hodgkin Lymphoma. Lymphomas are seen in all age groups but are more common in people aged 50+. The peak age for diagnosis of Hodgkin Lymphoma is between 15 and 30 years.
Causes
The incidence of lymphoma is increasing every year. While the causes generally are unknown, it is reasonable to assume there are likely to be a number of factors involved. Like all cancers, lymphomas may result from damage to (or
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mutation of) special proteins called genes that control the growth and division of cells. We know that people with a weakened immune system (either due to an immunodeficiency disease or drugs that suppress the function of the immune system) are at an increased risk of developing lymphomas. Certain types of viral infections may also play a role, especially in people with a weakened immune system.
Symptoms
Lymphomas commonly present as a firm painless swelling of a lymph node (swollen glands), usually in the neck, under the arms or in the groin. Other symptoms may include: - Recurrent fevers - Excessive sweating at night - Unintentional weight loss - Persistent lack of energy - Generalised itching Lymphoma may develop in the lymph nodes in deeper parts of the body like those found in the abdomen (causing bloating), or in the chest
Summer | 2014/15
General Health
Lymphoma is the fifth most common cancer in Australia (sixth most common type of cancer in men and the fifth most common type of cancer in women). (causing coughing, discomfort in the chest and difficulty breathing). In some cases people don’t have any troubling symptoms and the disease is picked up during a routine chest x-ray.
Treatment
Treatment will vary depending on the exact type of lymphoma a person has, and how fast it is likely to grow and cause problems in the body. It will also depend on the extent of disease at diagnosis, the person’s age and their general health. Some lymphomas grow slowly and cause few troubling symptoms, and may not need to be treated urgently. Others grow more quickly and
need to be treated as soon as they are diagnosed. The main treatments are chemotherapy and radiotherapy. This is given to destroy the leukaemic cells and allow the bone marrow to function normally again. Other types of treatment are also used. Occasionally, a stem cell transplant is given to treat disease which has relapsed (come back), or where there is a high likelihood that the disease will relapse in the future.
Side effects of treatment
All treatments can cause side effects. The type and severity of side effects vary, depending on the type of treatment used and the response to it.
In general, more intensive treatment is associated with more severe side effects. It is important that symptoms are reported immediately. Possible side effects of chemotherapy include: - feeling sick - nausea and/or vomiting - feeling tired and weak - a drop in blood counts, especially white cells (with increased susceptibility to infection) - hair loss and thinning - mouth problems such as mucositis or ulcers - diarrhoea or constipation - skin problems such as dryness, rash or sensitivity to sunlight. pm
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General Health
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General Health
Alzheimer’s
Uncovered Most of us are familiar with, or at the very least, have heard of Alzheimer’s, but how many of us truly understand the effects of this debilitating disease?
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lzheimer’s disease is the most common type of dementia, an overall term for conditions that occur when the brain no longer functions properly. The disease causes problems with memory, thinking and behaviour and it is a progressive disease, which means symptoms worsen
over time. In the early stage of Alzheimer’s, symptoms may be minimal and seem to develop slowly, but as the disease progresses, symptoms worsen and eventually become so severe they interfere with daily tasks. Symptoms vary in individuals and the rate at which the disease progresses differs for everyone. In its early stages, memory loss is mild, but with latestage Alzheimer’s, individuals lose the ability to carry on a conversation and respond to their environment. Those with Alzheimer’s live an average of eight years after their symptoms become noticeable to others, but survival can range from four to 20 years, depending on age and other health conditions. One of the most common signs of Alzheimer’s is memory loss, especially forgetting recently learned information, or important dates or events. Other signs include asking for the same information over and over, increasingly needing to rely on memory aids, or depending on family members for things they used to handle on their own. People with Alzheimer’s often find it hard to complete daily tasks. They may have trouble driving to a familiar location, managing a budget at work, or remembering the rules of a favourite game. They can lose track of dates, seasons and even the passage of time. Sometimes they may forget where they are or how they got there. Vision problems can be a sign of Alzheimer’s in some people. They may have difficulty reading, judging distance and determining colour or contrast, which may cause problems with driving. People with Alzheimer’s may have trouble following
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or joining a conversation. They may stop in the middle of a conversation and have no idea how to continue or they may repeat themselves. They may struggle with vocabulary, have problems finding the right word or call things by the wrong name (e.g. calling a ‘watch’ a ‘hand-clock’). A person with Alzheimer’s disease may put things in unusual places. They may lose things and be unable to go back over their steps to find them again. Sometimes, they may accuse others of stealing. This may occur more frequently over time. People with Alzheimer’s may experience changes in judgement or decision-making. For example, they may use poor judgement when dealing with money, giving large amounts to telemarketers. They may pay less attention to grooming or keeping themselves clean. A person with Alzheimer’s may start to remove themselves from hobbies, social activities, work projects or sports. They may have trouble keeping up with a favourite sports team or remembering how to complete a favourite hobby. They may also avoid being social because of the changes they have experienced. The mood and personalities of people with Alzheimer’s can change. They can become confused, suspicious, depressed, fearful or anxious. They may be easily upset at home, at work, with friends or in places where they are out of their comfort zone. There is no doubt Alzheimer’s is a life-changing disease, not only for the individual diagnosed, but also for their family and friends. The stages below provide a general idea of how abilities change during the course of the disease. This sevenstage framework is based on a system developed by Barry Reisberg, M.D., clinical director of the New York University School of Medicine’s Silberstein Aging and Dementia Research Center. Remember: It is difficult to place a person with Alzheimer’s in a specific stage as stages may overlap.
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About Us The Gold Coast Heart Centre now has 8 specialist cardiologists available for consultation across all 3 locations. We provide a diverse range of services in comprehensive cardiac health care with extensive diagnostic cardiac testing and specialist imaging.
Diagnostic Cardiac Testing Stress Echocardiography Blood Pressure Monitoring Event Loop Recording
Transthoracic Echocardiography Exercise Stress Testing
TILT Table Testing
Transosophageal Echocardiography Holter Monitoring ECG Reports
Cardiologist Consultations Dr Vijay Kapadia Dr Mathew Williams Interventional and Pacing Cardiologist General Cardiologist Dr Kang-Teng Lim Dr Michael Greenwood General and Electrophysiology Cardiologist Interventional Cardiologist Dr Tony Lai Dr John Bou-Samra Interventional Cardiologist General, Pacing and Heart Failure Cardiologist Professor Jonathan Chan - Multi-Modality Cardiac Imaging and General Cardiologist Welcoming Interventional Cardiologist Dr Ashok Gangasandra for consultation at our John Flynn rooms in 2014
Rooms
ALLAMANDA PRIVATE HOSPITAL
21 Spendelove Street Southport 4215
JOHN FLYNN PRIVATE HOSPITAL
Suite 6A, John Flynn Medical Centre Inland Drive, Tugun 4224
Phone: 5531 1833
PINDARA SPECIALIST SUITES
Suite 2.09, Level 2 Carrara St, Benowa 4217
www.gchc.com.au
General Health
Treatments
While there are currently no treatments to cure or to stop Alzheimer’s disease from progressing, medication can be used to treat symptoms, such as memory loss and confusion, for a limited time.
a limited time) by affecting certain chemicals involved in carrying messages among the brain’s nerve cells.
Types of drugs
Prescription medications currently approved to treat Alzheimer’s symptoms, in early to moderate stages, are all from a class of drugs called cholinesterase inhibitors. Cholinesterase inhibitors are prescribed to treat symptoms related to memory, thinking, language, judgement and other thought processes.
Two types of medications — cholinesterase inhibitors and memantine — are used to treat the cognitive symptoms (memory loss, confusion, and problems with thinking and reasoning) of Alzheimer’s disease. As Alzheimer’s progresses, brain cells die and connections among cells are lost, causing cognitive symptoms to worsen. While medications cannot stop the damage Alzheimer’s causes to brain cells, they may help lessen or stabilise symptoms (for
Medications for early to moderate stages
Cholinesterase inhibitors
Prevent the breakdown of acetylcholine (a-SEAtil-KOH-lean), a chemical messenger important for
learning and memory. This supports communication among nerve cells by keeping acetylcholine levels high. Delay worsening of symptoms for 6 - 12 months, on average, for about half the people who take them. Are generally well tolerated. If side effects occur, they commonly include nausea, vomiting, loss of appetite and increased frequency of bowel movements.
Medication for moderate to severe stages
A second type of medication, memantine is used for treatment of moderate to severe Alzheimer’s. Memantine is prescribed to improve memory, attention, reason, language and the ability to perform simple tasks. It can be used alone or with
Stage One No impairment (normal function) The person does not experience any memory problems. An interview with a medical professional does not show any evidence of symptoms of dementia.
Stage TWO Very mild cognitive decline (may be normal age-related changes or earliest signs of Alzheimer’s disease) The person may feel as if he or she is having memory lapses — forgetting familiar words or the location of everyday objects. But no symptoms of dementia can be detected during a medical examination or by friends, family or co-workers.
Stage THREE Mild cognitive decline (early-stage Alzheimer’s can be diagnosed in some, but not all, individuals with these symptoms) Friends, family or co-workers begin to notice difficulties. During a detailed medical interview, doctors may be able to detect problems in memory or concentration. Common Stage 3 difficulties include: • Noticeable problems coming up with the right word or name. • Trouble remembering names when introduced to new people. • Having noticeably greater difficulty performing tasks in social or work settings. • Forgetting material that one has just read. • Losing or misplacing a valuable object. • Increasing trouble with planning or organising.
Stage FOUR Moderate cognitive decline (mild or early-stage Alzheimer’s disease) At this point, a careful medical interview
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should be able to detect clear-cut symptoms in several areas: • Forgetfulness of recent events. • Impaired ability to perform challenging mental arithmetic - for example, counting backward from 100 by sevens. • Greater difficulty performing complex tasks, such as planning dinner for guests, paying bills or managing finances. • Forgetfulness about one’s own personal history. • Becoming moody or withdrawn, especially in socially or mentally challenging situations.
Stage FIVE Moderately severe cognitive decline (moderate or mid-stage Alzheimer’s disease) Gaps in memory and thinking are noticeable, and individuals begin to need help with day-to-day activities. At this stage, those with Alzheimer’s may: • Be unable to recall their own address or telephone number or the high school or college from which they graduated. • Become confused about where they are or what day it is. • Have trouble with less challenging mental arithmetic; such as counting backward from 40 by subtracting 4s or from 20 by 2s. • Need help choosing proper clothing for the season or the occasion. • Still remember significant details about themselves and their family. • Still require no assistance with eating or using the toilet.
Stage SIX MoSevere cognitive decline (moderately severe or mid-stage Alzheimer’s disease) Memory continues to worsen, personality changes may take place and individuals need
extensive help with daily activities. At this stage, individuals may: • Lose awareness of recent experiences as well as of their surroundings. • Remember their own name but have difficulty with their personal history. • Distinguish familiar and unfamiliar faces but have trouble remembering the name of a spouse or caregiver. • Need help dressing properly and may, without supervision, make mistakes such as putting pyjamas over daytime clothes or shoes on the wrong feet. • Experience major changes in sleep patterns - sleeping during the day and becoming restless at night. • Need help handling details of toileting (for example, flushing the toilet, wiping or disposing of tissue properly). • Have increasingly frequent trouble controlling their bladder or bowels. • Experience major personality and behavioural changes, including suspiciousness and delusions (such as believing that their caregiver is an impostor), or compulsive, repetitive behaviour like hand-wringing or tissue shredding. • Tend to wander or become lost.
Stage SEVEN Very severe cognitive decline (severe or late-stage Alzheimer’s disease) In the final stage of this disease, individuals lose the ability to respond to their environment, to carry on a conversation and, eventually, to control movement. They may still say words or phrases. At this stage, individuals need help with much of their daily personal care, including eating or using the toilet. They may also lose the ability to smile, to sit without support and to hold their heads up. Reflexes become abnormal. Muscles grow rigid. Swallowing impaired.
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General Health
Gold Coast Neurologist, Dr Meenashki Raj, advises that physical and mental exercise can delay and slow the speed of progression, especially very early stages. other Alzheimer’s disease treatments. There is some evidence that individuals with moderate to severe Alzheimer’s who are taking a cholinesterase inhibitor might benefit by also taking memantine.
the risk of Alzheimer’s. The most important risk factors – age, family history and heredity – cannot be changed, but emerging evidence suggests there may be other factors we can influence.
Memantine
Age
Regulates the activity of glutamate, a different messenger chemical involved in learning and memory. Delays worsening of symptoms for some people temporarily. Many experts consider its benefits similar to those of cholinesterase inhibitors. Can cause side effects, including headache, constipation, confusion and dizziness. Doctors sometimes prescribe both types of medications, cholinesterase inhibitors and memantine, together.
Vitamin E
Doctors sometimes prescribe vitamin E to treat cognitive Alzheimer’s symptoms. Vitamin E, also known as alpha tocopherol, is an antioxidant. Antioxidants may protect brain cells and other body tissues from certain kinds of chemical wear and tear. In 2014, results of a study published in the Journal of the American Medical Association showed that individuals with mild-tomoderate Alzheimer’s disease who received high doses of vitamin E had a 19 percent slower rate of functional decline than study volunteers who received a placebo. Functional decline includes problems with daily activities such as shopping, preparing meals, bathing, eating, planning, and travelling. Study participants were followed up for an average of a little more than two years. CAUTION: No one should take vitamin E to treat Alzheimer’s disease except under the supervision of a physician. Vitamin E — especially at the high doses — can negatively interact with other antioxidants and medications, including those prescribed to keep blood from clotting or to lower cholesterol.
Risk factors
Scientists have identified factors that increase
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The greatest known risk factor for Alzheimer’s is advancing age. Most individuals with the disease are aged 65 or older. The likelihood of developing Alzheimer’s doubles about every five years after age 65. After age 85, the risk reaches nearly 50 percent. One of the greatest mysteries of Alzheimer’s disease is why risk rises so dramatically as we grow older.
Family history
Another strong risk factor is family history. Those who have a parent, brother, sister or child with Alzheimer’s are more likely to develop the disease. The risk increases if more than one family member has the illness. When diseases tend to run in families, either heredity (genetics) or environmental factors, or both, may play a role.
Heredity (Genetics)
Scientists know genes are involved in Alzheimer’s. There are two types of genes that can play a role in affecting whether a person develops a disease— risk genes and deterministic genes. Alzheimer’s genes have been found in both categories.
Genetic testing – risk genes
1. Risk genes increase the likelihood of developing a disease, but do not guarantee it will happen. Scientists have so far identified several risk genes implicated in Alzheimer’s disease. The risk gene with the strongest influence is called apolipoprotein E-e4 (APOE-e4). Scientists estimate that APOE-e4 may be a factor in 20 to 25 percent of Alzheimer’s cases. APOE-e4 is one of three common forms of the APOE gene; the others are APOE-e2 and APOEe3. Everyone inherits a copy of some form of APOE from each parent. Those who inherit APOE-e4 from one parent have an increased risk of Alzheimer’s. Those who inherit APOE-e4
from both parents have an even higher risk, but not a certainty. Scientists are not yet certain how APOE-e4 increases risk. In addition to raising risk, APOE-e4 may tend to make Alzheimer’s symptoms appear at a younger age than usual. Genetic tests are available for both APOE-e4 and the rare genes that directly cause Alzheimer’s. However, health professionals do not currently recommend routine genetic testing for Alzheimer’s disease. Testing for APOE-e4 is sometimes included as a part of research studies 2. Deterministic genes directly cause a disease, guaranteeing that anyone who inherits them will develop the disorder. Scientists have discovered variations that directly cause Alzheimer’s disease in the genes coding three proteins: amyloid precursor protein (APP), presenilin-1 (PS-1) and presenilin-2 (PS-2). When Alzheimer’s disease is caused by these deterministic variations, it is called “autosomal dominant Alzheimer’s disease (ADAD)” or “familial Alzheimer’s disease,” and many family members in multiple generations are affected. Symptoms nearly always develop before age 60, and may appear as early as a person’s 30s or 40s. Deterministic Alzheimer’s variations have been found in only a few hundred extended families worldwide. True familial Alzheimer’s accounts for less than five percent of cases.
Factors you may be able to influence
Most experts believe that the majority of Alzheimer’s disease occurs as a result of complex interactions among genes and other risk factors. While age, family history and heredity are risk factors we cannot change, researchers are beginning to focus on risk factors we may be able to influence, through general lifestyle and wellness choices and effective management of other health conditions. Protecting the brain from head trauma: There may be a strong link between serious head injury and future risk of Alzheimer’s, especially when trauma occurs repeatedly or involves loss of consciousness. Protect your brain by buckling your seat belt, wearing your helmet when participating in sports, and “fall-proofing” your home. Heart-head connection: Growing evidence links brain health to heart health. Your brain is nourished by one of your body’s richest networks of blood vessels. Every heartbeat pumps about 20 - 25 percent of your blood to your head, where brain cells use at least 20 percent of the food and oxygen your blood carries. The risk of developing Alzheimer’s or vascular dementia appears to be increased by many conditions
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that damage the heart or blood vessels. These include high blood pressure, heart disease, stroke, diabetes and high cholesterol. Work with your doctor to monitor your heart health and treat any problems that arise.
General healthy aging:
Strategies for overall healthy aging may help keep your brain as well as your body fit. These strategies may even offer some protection against developing Alzheimer’s or related disorders. Try to keep your weight within recommended guidelines, avoid tobacco and excess alcohol, stay socially connected, and exercise both your body and mind. Gold Coast Neurologist, Dr Meenashki Raj, advises that physical and mental exercise can delay and slow the speed of progression, especially very early stages. She recommends exercise, having a day plan and continuing to do stimulating work. pm
Aluminium not a cause
During the 1960s and 1970s, aluminium emerged as a possible suspect in causing Alzheimer’s disease. This suspicion led to concerns about everyday exposure to aluminium through sources such as cooking pots, foil, beverage cans, antacids and antiperspirants. Since then, studies have failed to confirm any role for aluminium in causing Alzheimer’s. Almost all scientists today focus on other areas of research, and few experts believe that everyday sources of aluminium pose any threat.
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General Health
Brain Tumours Who’s at Risk?
Whilst it sounds like a rare occurrence, brain tumours can affect anyone at any age. As the leading cause of cancer death in young people under the age of 40 and children under 10, brain cancer is one of the most deadly cancers, yet is one of the least understood cancers. Not all brain tumours are cancerous, but what does a diagnosis mean for you?
Types of Brain Tumours
There are over 100 different types of brain tumours. They are commonly named after the type of cell they come from. Most brain tumours develop from glial cells, which grow from the supporting cells of the brain. These tumours are called ‘gliomas’. Tumours that begin in the brain are known as primary brain tumours. Some types of brain tumours are malignant (cancerous) and others are benign (non-cancerous). Benign brain tumours are often slow growing and are unlikely to spread, but they can press on and damage the surrounding brain tissue. Usually, this type of tumour can be successfully removed with surgery. Conversely, malignant brain tumours vary in how fast they grow and respond to treatment. Some are contained inside a capsule and are easy to remove, while others have thin filaments spreading through the brain that make them very difficult to take out. Brain cancer affects adults of all ages and is one of the few cancers that occur in children.
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Causes of Brain Tumours
The causes of primary brain tumours are not fully understood. Researchers know that brain and spinal cord tumours are more common in people with certain inherited or genetic conditions; or people exposed to very high doses of radiation. However, for most people, the cause of their brain tumour is unknown. Many people ask whether or not mobile phones cause cancer and more specifically, brain tumours. At the moment, the evidence is very weak that mobile phones cause cancer. Brain tumour incidence rates have also remained relatively steady, globally, but research continues in this area.
Diagnosis of Brain Tumours
If your doctor suspects you have a brain tumour, you will be referred to a neurologist or neurosurgeon for further tests, such as: • Neurological examination – checking muscle strength, reflexes, memory and the ability to tell
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General Health
Many people ask whether or not mobile phones cause cancer and more specifically, brain tumours. hot from cold on your skin (sensation tests) . • Eye test – the optic nerve, which connects the eye to the brain, tends to bulge a little if a tumour is present. • CT scan – three dimensional x-rays. A dye will be injected so that anything unusual will show more clearly. • Magnetic resonance imaging (MRI) – similar to a CT scan, but magnetism instead of x-rays is used to create a picture. This test will almost certainly show up any brain tumour. • X-rays and blood tests – to test your general health. • Angiogram – injected dye is x-rayed as it flows through the blood vessels of your brain. This is not done for all types of brain tumours. There may be other scans and tests to help diagnose a tumour. These will depend on the type of tumour and whether it has spread to other parts of the body.
Treatment for Brain Tumours
Treatment aims to remove the tumour, or at least slow its growth and relieve the symptoms. Some of the treatment options include: • Surgery – some tumours can be completely removed. In other cases, a tumour may have spread throughout the brain and may be very close to important structures in the brain. In
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this case, only pieces of it can be removed. • Radiotherapy – is used to kill cancer cells, or in the case of a benign tumour it can be used to halt the growth of the tumour. In children, low doses of radiation are used because x-rays can slow a child’s development and growth. Treatment is carefully planned to do as little harm as possible to normal body tissues. • Chemotherapy – anti-cancer drugs are used to stop the cancer cells from multiplying. Chemotherapy is rarely used for adults, but often used for children because of the possible side effects of radiotherapy. • Steroid therapy – medication is used to reduce the swelling around the tumour. This does not treat the tumour itself, but does help to relieve the swelling and pressure caused by the tumour. • Complementary and alternative therapies – can improve quality of life when used alongside conventional cancer treatment. All treatments have side effects. These will vary depending on the type of treatment. Many side effects are temporary, but some may be permanent.
tumours. The success of treatment will depend on the type of tumour.
Secondary Brain Tumours
Many malignant brain tumours are ‘secondary cancers’. This means they developed from a cancer that began elsewhere in the body. Cancers of the lung, breast, kidney, stomach, bowel (colon), and skin (melanoma) can all spread to the brain. The symptoms of secondary brain tumours are similar to those of a primary tumour, but they are treated differently.
When a Cure is Not Possible
If brain cancer has been diagnosed in its later stages, the cancer may have spread to the point where a cure is no longer possible. Treatment then focuses on improving quality of life by relieving the symptoms (this is called ‘palliative’ treatment), using medications to relieve pain, nausea and vomiting. pm
Spinal Cord Tumours
These are rarer than primary brain tumours. There are a few different types of spinal cord
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P: (07) 55 393 055 F: (07) 55 278 226 E: info@jordaansurgical.com.au A: 29 Carrara St Benowa Q 4217. Suite 2.05 Pindara Specialist Suites www. JordaanSurgical .com.au
General Health
Diverticulosis and Diverticulitis
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ore than half of all adults over the age of 70 have diverticulosis but most are unaware they have the condition as the condition is common and frequently causes no symptoms. Diverticulitis, on the other hand, may be painful and disabling and is often a medical emergency. While mild attacks can be treated at home, the condition should always be assessed promptly.
But what is diverticulosis and how does it differ from diverticulitis?
Diverticulosis occurs when small defects in the muscle of the wall of the large intestine or colon allow small pockets or pouches (diverticula) to form. Diverticulitis is inflammation or infection of abnormal pouches in the bowel wall. Together, diverticulosis and diverticulitis are called diverticular disease. Diverticular disease isn’t associated with more serious conditions, such as bowel cancer. Diverticulosis is extremely common. Old age and diet may be the most important risk factors as the condition is less common in people under 50.
Symptoms of Diverticulosis
Diverticulosis is usually asymptomatic (has no symptoms). However, when many diverticula (pouches) are present, the normal smooth working of the bowel can be affected. This may cause a range of symptoms including: • Abdominal pain and bloating. • Constipation and diarrhoea. • Flatulence. • Blood in the faeces – this is usually minor, but bleeding can sometimes be heavy if a diverticulum gets inflamed or is near a blood vessel.
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• A naemia from repeated bleeding may occur. Many of these symptoms are similar to those of bowel cancer. Diverticulosis is more common, so these symptoms may be more likely to be due to diverticulosis than cancer.
Symptoms of Diverticulitis
Diverticulitis requires immediate medical attention and, frequently, admission to hospital. Symptoms of diverticulitis include: • Sharp pain, often located at a specific point – for example, in the lower left half of the abdomen • Fever • Distension (bloating) of the abdomen. • Nausea and vomiting. Some of the complications of diverticular disease include: • Abscess – untreated, diverticulitis may lead to an abscess (a ball of pus). • Perforation – a weakened pocket of bowel wall may rupture. The contents of the bowel can then seep into the abdominal cavity. Symptoms include pain, high fever and chills. A perforated bowel is a medical emergency. • Peritonitis – perforation can lead to peritonitis (infection of the membranes that line the abdominal cavity and abdominal organs). This complication is potentially life threatening. • Haemorrhage – diverticula can be the source of haemorrhage. When bleeding occurs, it is important to exclude other causes. A person with diverticulosis can also get cancer.
Diagnosis of Diverticular Disease
Since diverticulosis often has no symptoms, it tends to be discovered during an examination for other conditions such as colorectal cancer. Diverticulitis is usually diagnosed
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Increase your daily intake of green vegetables. Introduce fibre gradually to avoid unpleasant symptoms such as flatulence. during an acute attack. Tests to confirm the diagnosis of diverticular disease include: • Medical history – including dietary habits • Physical examination – including rectal examination. • Colonoscopy – a slender flexible tube inserted into the anus so that the doctor can look at the entire length of the large intestine, • Barium enema – a special contrasting dye flushed into the bowel via the anus and x-rays are taken, • CT scan – to detect abscesses outside the bowel lining, • Blood tests – to check for signs of infection. • Stool tests – to check for the presence of blood in the faeces or the presence of infections, which may mimic the symptoms of diverticulosis and diverticulitis.
Treatment for Diverticulosis
For a person with diverticulosis, there is no proven way to prevent the formation of new diverticula. Treatment revolves around the settling
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of symptoms. • A gradual switch to a diet with increased soluble fibre (green vegetables, oat bran and fibre supplements such as psyllium) usually leads to an improvement in bowel habit and mild symptoms. • Some foods may make symptoms worse or even lead to diverticulitis. Nuts, seeds and pips are best avoided, while some individuals find avoiding legumes (peas and beans) and sweet corn also helps. • Short-term use of laxatives to treat and prevent constipation may be advised. • Rarely, elective surgery is performed to remove seriously affected bowel segments when symptoms are disabling.
Treatment for Diverticulitis
Diverticulitis requires immediate medical attention, and treatment may include: • No eating or drinking – intravenous fluids are given to rest the bowel. • A ntibiotics. • Pain-killing medications.
• Surgery – if the weakened sections of bowel wall have ruptured or become obstructed, or if the attack of infection fails to settle. • Colostomy – if it isn’t possible to rejoin the healthy sections of bowel, a colostomy bag will be fitted. This is more common if the surgery is performed as an emergency. The use of a colostomy is generally temporary and the bowel can be rejoined after six to 12 months, if health permits. • The long-term use of a mild antibiotic – this is often necessary to prevent further attacks. Self-care suggestions include: • Increase your daily intake of green vegetables. Introduce fibre gradually to avoid unpleasant symptoms such as flatulence. • Consider using a fibre supplement (such as psyllium). • Drink plenty of fluids to ensure your stools are soft, moist and easy to pass. • Exercise regularly to encourage bowel function and peristalsis.
Where to get help
• Your doctor. • Gastroenterologist or specialist surgeon.
Things to remember
• Diverticulosis is the formation of abnormal pouches in the bowel wall. • Diverticulitis is inflammation or infection of these abnormal pouches. • Together, these conditions are known as diverticular disease. • Treatment options include a change of diet, antibiotics and (rarely) surgery. pm
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General Health
Pain today gone tomorrow Pain is a very personal and subjective experience. No one can judge how much pain you are in but you.
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veryone at some point has experienced the feeling of acute pain such as when you stub your toe or slice your finger. Acute pain is the body’s way of warning you of injury and tends to resolve quickly with little to no treatment. Chronic pain is different. Chronic pain persists. Defined as pain lasting longer than six months despite adequate time to heal, it can occur in any area in the body. One in five Australian adults are reported to be living with chronic pain. For most, it develops from a disease, injury or surgical procedure that has long since healed and for others, it can just appear out of nowhere.
Why does some pain persist?
In order for a person to experience pain, special pain receptors (noiceptors) have to be activated through some type of tissue damage or inflammation. A pain signal is sent via nerves to the brain where it is interpreted as pain. In the case of chronic pain, the pain signal continues to travel to the brain despite no sign of the original injury as a result of damage or dysfunction to nerves carrying the pain signal (also called neuropathic pain). Unlike other types of pain, neuropathic pain can be quite severe, and is often described as a sharp, burning, stabbing, shooting or aching pain with some even comparing it to an electric shock. It is also more likely to be chronic and less responsive to pain medications.
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This therapy has proven particularly successful in managing pain indications involving anatomical areas... Importance of managing chronic pain
For those who live with chronic pain, it can be so unbearable that it can make even the simplest task difficult to perform. For others, the biggest challenge they face is not knowing what sort of day it will be, making it difficult to go to work or make plans with family and friends. If left unmanaged, chronic pain can lead to permanent disability and manifest other health problems, such as chronic fatigue, sleep disturbance, decreased appetite and depression.
Managing chronic pain
Because pain is such a subjective experience, the same treatment does not necessarily work for everybody. The most common method for managing chronic pain is prescription medication. Interventional therapies involving injecting local anesthetics directly into the nerve at the site of pain or the use of heat to alter the nerve or nerves that are sending pain signals to the brain are also popular. Spinal cord stimulation is another well established therapy that uses a small implantable system (called a neurostimulator) to deliver electrical signals to nerves. Patients experience a comfortable tingling sensation in the area of pain or in some circumstance the absence of pain all together. Clinical data shows that applying an electrical field to the DRG may provide improved pain relief to patients by restoring the firing threshold of the nerves that have become hypersensitized due to chronic pain. This therapy has proven particularly successful in managing pain indications involving anatomical areas including the hands, feet and groin, which have traditionally been more challenging to capture with traditional spinal cord stimulation, as well as more targeted and specific pain areas Pindara hospital now has trained doctors offering these procedures. If you would like to find out more or feel you may be appropriate for this therapy, please call The Pain Doctors on (07) 5527 8025. pm
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Patient Story:
Jason Campbell, aged 25 from Gold Coast, Queensland
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ason’s story began 5 years ago when complications during a routine surgical procedure to his patella resulted in him needing several surgeries in short succession., Jason subsequently developed chronic pain in his knee and the impact it had on every aspect of his daily life- from work performance, to family life, to social interactions was profound until management with DRG stimulation drastically improved his condition. I was in the Army leading a very physically orientated and active life. During morning training one day I dislocated my patella. It required me to have surgery to correct damage to my cartilage. A post surgical facture lead to a further 12 more surgeries in short succession. The pain in my knee was so bad I could no longer perform my duties, and I have been unemployed since. I couldn’t walk or stand for any period of time. All physical activities just came to a sudden halt and all I could do was sit around the house and watch TV and that’s when the depression set in. I was living
on medications – Morphine, Targin and antidepressants but they were not managing my pain. When I was selected for Dorsal Root Ganglion stimulation therapy I hoped and expected the pain to decrease a small amount but certainly not to the extent it has. As soon as the neurostimulator was turned on there was an immediate reduction of my pain which has progressed to a 80-90% reduction over the last few months.. The stimulation only affects the area of pain in my knee and the light sensation of tingling in the area is fading as time goes on. The device is on all the time and I have been able to stop all my regular painkillers that I was having to live on just to get by. I’ve started to become more active. I’m walking the dogs every day, and I’m walking for over an hour straight twice a day, which is something that I wouldn’t have even dreamed off doing before. I feel like a normal 24 year old again My message to others who have chronic pain who have been selected for this new therapy would be don’t be scared about it. Give it a chance. It may change your life.
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General Health
Q U E E N S L A N D U L T R A S O U N D F O R W O M E N Caring for the women on the Gold Coast & surrounding areas.
Q U E E N S L A N U L T R A S D O U N F O R D W O M E N
Men’s health
movember momentum Changing the face of men’s health
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rom only fairly hairy beginnings with 30 ‘Mo Bros’ in Melbourne in 2003 to four million Mo’s in 2013, Movember has become a truly global movement that is changing the face of men’s health. Travis Garone and Luke Slattery were having a quiet beer at a Melbourne pub just over a decade agowhen they questioned the demise of the Mo and joked about bringing it back. Inspired by a friend’s mother who was fundraising for breast cancer, they decided to make the campaign about men’s health and prostate cancer and talked a few of their mates into growing a Mo. The first 30 Mo Bros grew their moustaches with such momentum that in 2004, a decision was made to formalise the concept and get all participants growing for a cause. They designed rules and guidelines for Movember (which are still in place today) and a price of $10 per Mo was set. Adam Garone stepped up to help take Movember to the next level, registered a company and created
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a website, and Justin Coghlan came on board to run the campaign in Queensland. The guys researched men’s health issues and agreed to formally support prostate cancer as their cause. Adam approached the Prostate Cancer Foundation of Australia (PCFA) which agreed to accept $54,000 generated from 450 Mo’s in 2004 campaign, but it was not acknowledged as an official men’s health partner. That same year, Spain and the UK became the first international Mo Bros. The entire proceeds were donated to the PCFA - all costs were covered by the four co-founders through the 2005 campaign. That first Movember cheque to the PCFA was the largest single donation it had ever received. In 2005 a new campaign creative with the concept ‘Give Prostate Cancer a Kick in The Arse’ was hatched and a formal agreement was struck with the PCFA, and they became Movember’s first official men’s health partner. The campaign that year saw 9,315 Mo Bros raise $1.2 million for the PCFA. The following year, the four co-founders
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Men’s health
established an official Australian charity, the Movember Foundation. By now, the campaign was too big to manage on nights and weekends, so Adam and Luke began working for Movember full time. Together they employed Movember’s first full-time employee and the campaign was run from Prahran in Melbourne and Luke’s apartment in Queensland where he developed the official tagline – ‘changing the face of men’s health’. Further research into men’s health in Australia revealed that depression was a significant issue, and beyondblue, the national depression and anxiety initiative was brought on as Movember’s second men’s health partner. That year, the campaign launched in New Zealand in partnership with The Prostate Cancer Foundation of NZ. An amazing 56,129 Mo Bros and Mo Sistas in Australia and New Zealand raised $9.3 million while small unofficial campaigns were also run in the UK and Spain. In 2007, encouraged by the growing enthusiasm and efforts around the world, a decision was made to grow the campaign internationally. Through the power of the moustache, the mighty Movember is now in 21 countries, from the frozen research bases of Antarctica and the South Atlantic Island of St. Helena, to the steps of Machu Picchu, the beaches of Cuba and even the deserts of Dubai. With moustaches sprouting all over the world,
Something to Mo About 4,026,562 Mo Bros & Mo Sistas AUD $576 million raised 770 men’s health projects funded
Participating countries: Australia, Austria, Belgium, Canada, Czech Republic, Denmark, Finland, France, Hong Kong, Germany, Ireland, Netherlands, New Zealand, Norway, Singapore, South Africa, Spain, Sweden, Switzerland, UK and USA. Get involved at www.movember.com
the number of Mo Bros and Mo Sistas who have taken part over the years is higher than the entire population of Iceland, Jamaica, Namibia, or even Mongolia. United and committed to making a difference, they come from all walks of life – teachers, students, doctors, firemen, octogenarians, carpenters, CEOs, actors, Olympians, the armed
forces, sport stars and even astronauts. The Movember Foundation now funds programs across four areas: Prostate Cancer, Testicular Cancer, Mental Health and Men’s Health. The global reach of these programs are, for the first time, uniting researchers from around the world. The Foundation is connecting and funding the best scientific and clinical minds in the world fast tracking a time when no man will die from prostate or testicular cancer. The idea that was spilled during a few beers 11 years ago has evolved to become the largest global alliance of prostate and testicular cancer researchers and clinical specialists ever formed - working together tackling head-on the toughest cancer challenges in an initiative known as the Global Action Plan (GAP). Executive Director of Programs at the Movember Foundation Paul Villanti, explains the fundamentals behind GAP. “Our vision is to have an everlasting impact on the face of men’s health and it’s to this end that we’ve established GAP. We believe that team-based research, performed across borders with a strong collaborative mindset, avoiding duplication of work, can deliver innovation and knowledge sharing that leads to an acceleration of results that benefit me diagnosed and living with prostate cancer and testicular cancer today,” he says. pm
Behind Ever y Great Mo Bro Sta nds a Great Mo Sista Never a truer word was spoken, when it was said that behind every great man, stands a great woman. Wise words indeed which remain as meaningful today as the day they were uttered. Whilst a Mo Bro may grow a moustache, it is the Mo Sista that is often the driving force, first planting the seed of an idea and then carefully working behind the scenes of fine moustachery for the 30 days of Movember.
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A Mo Sista is essentially a woman who loves a Mo. An individual that is dedicated to supporting the Mo Bros in her life through their moustache growing journey; whether it be a friend, colleague, family member, partner or boyfriend. These inspirational women are committed to raising awareness of men’s health issues and much needed funds for men’s health along the way.
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Men’s health
The Forgotten Cancer
The rise of testicular cancer in young men.
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t’s known as the ‘forgotten cancer’ due to its comparative rareness but remains as the biggest threat to males aged between 15 and 35. Testicular cancer peaks in men during their 20s and 30s and those diagnosed with the disease often live with the effects and the treatment for more than 40 years. The survival rate for testicular cancer is 98 percent, but of concern is an increase in the number of cases, resulting in a greater need to identify patients most likely to relapse after initial therapy and to ensure continued delivery of personalised treatment strategies. According to the Cancer Council Australia, the risk of being diagnosed with testicular cancer by age 85 is 1 in 214. The rate of men diagnosed with testicular cancer has grown by more than 50 percent over the past 30 years, however the reason for this is not known. Dr Charles Charbet is a Urologist at Pindara Private Hospital. He says there are around 700 diagnosed cases of testicular cancer in Australia each year – low, compared to more than 20,000 diagnoses of prostate cancer. “The cure rate has changed radically over the last three decades thanks to a platinum-based chemotherapy develop in the 1980s,” he says. “We don’t know why the incidence of testicular cancer is increasing and research is absolutely critical as we’re yet to be able to pinpoint specific risk factors. We need to explore prevention and increase early detection.” Most testicular cancers are successfully treated. Cancer Council Australia stats show that in 2011, there were 16 deaths. Symptoms can include a pain in one of the testes and/or a lump. While treatment is highly successful, the medical consensus is
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that more must be done to improve the quality of men’s lives. An imbalance of testosterone can result from therapy and can have effects such as cardiovascular disease, osteoporosis, altered sexual function and a reduced quality of life. This year the board of global men’s health charity Movember approved expanding its Global Action Plan (GAP) to include testicular cancer with an initial investment of $2.5 million over the next two years. Head of Programs Paul Villanti identified a critical need to fill in the funding shortfalls experienced by testicular cancer researchers across the world. For now though, Movember is uniquely positioned to at least start the process of bridging this gap. “We believe that getting the best researchers from around the world to work together on key challenges will accelerate breakthroughs that will ultimately benefit men,” he says. “Further, we believe that team-based research, performed across borders with a strong collaborative mindset can deliver innovation and knowledge
sharing which leads to faster results that benefit men living with testicular and prostate cancer.” Australian cricketer and testicular cancer survivor Matt Wade is helping to raise awareness to ensure the ‘forgotten cancer’ is remembered by researchers. “I’ve been a dedicated ‘Mo Bro’ for a number of years now. Men’s health is a cause close to my heart (and) it’s great to see Movember getting behind testicular cancer to raise important awareness,” he says. Movember CEO, Adam Garone, says many of the Mo Bros (supporters) are in their 20s and 30s where testicular cancer is most common. “It’s a proud day to be able to announce such a significant commitment to an often forgotten cancer,” he says of the funding commitment. “Our approach to research will see testicular cancer researchers from across the globe come together for the first time to collaborate. The Mo Bros and Mo Sistas that join the movement each year make such progress possible. On behalf of every man and their families that have been through the testicular cancer journey – thank you”. pm
Number Crunch 700
98%
15 - 35
2.5
number of new cases each year in Australia ages of males where disease prevalent
survival rate million dollars allocated for research by Movember
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Women’s Health
Pretty in Pink:
October was Australia’s Breast Cancer Awareness Month
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Women’s Health
cancer One in nine Australia n women will be diag nosed with breast lation, before the age of 85. This is a sobering fact for the current popu and one that reminds both men and women in Australia of the (BSE). importance of regu lar screening and breast self-examination
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very year, Australia’s Breast Cancer Awareness Month in October seeks to raise national recognition of our access to prevention, treatment and support services around the country and together focus on those affected by breast cancer and their families.
The Month
The concept of Breast Cancer Awareness Month originated in the 1980s and has since become an internationally recognised campaign represented by the iconic pink ribbon, a symbol that promotes the breast cancer awareness brand and expresses moral support. The culture of Breast Cancer Awareness Month is centralised on a pro-mammogram, prohealth and prevention mentality, not embedded
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solely in the progress of finding a cure. The culture of the event seeks to unite fighters of breast cancer, their families and the local and national community in an expression of support, a celebration of femininity and optimism. This year, Monday 28 October was Australia’s Breast Cancer Day, on which people came together at organised events or individually expressed their support for breast cancer patients and the continuous development of research, treatment and support facilities. Wearing a pink ribbon on this day is a quintessential expression of support in all participating countries.
Current Statistics
• Breast cancer is the most common form of cancer among Australian women. • Up until it was recently surpassed by lung
cancer, breast cancer held the highest rate of cancer-caused deaths in Australian women. • Breast cancer accounted for 27 percent of all new cancers diagnosed in Australian women in 2009 and 16 percent of all cancer deaths among females in 2007. • 2,912 Queenslanders were diagnosed with breast cancer in 2011.
The Pink
As defined by Breast Cancer Network Australia, October is a time for support and reflection, a time to celebrate advances in diagnostics, medicine and management of the cancer, and a very important time to remember those who have lost the battle and their families. By wearing pink or the pink ribbon badge throughout the month, especially on Breast
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Cancer Day, you will have voiced your part in the movement. With our admirable Australian spirit of community and our optimistic approach to raising awareness, October is the month in which everyone looks good in pink.
Getting Involved
Hosting or joining an event to raise awareness amongst your family, friends and community is not only an opportunity for reflection and unity, but also a chance for you to get creative and create memories. A night of pink champagne, an afternoon tea of pink coloured treats or a bike ride of pink bandits; there are hundreds of great event ideas for you and your friends, workmates or neighbours to experiment with. Also, given its potential for imagination in a range of indoor and outdoor settings, hosting a fundraising event also gives ladies a chance to release a little bit of their wild side! Pink Panther dress ups and pretty-in-pink gala balls aside, participants can opt for something more subtle like a book sale, a local trivia night or pamper night at home. No matter the size or location, every event is a celebratory effort towards getting the message out there: that together as women and as a nation, we can beat this illness. For event ideas, go to www.nbcf.org.au
Who is at Risk?
Despite decades of epidemiological research on an international scale, there still is no concrete solution to reducing the prevalence of breast cancer. Due to the laudable amount of ongoing research, however, many influential factors of cancer have been identified as well as important warning signs, which continue to be disseminated around the world. This same research has also reached a point at which health professionals can detect the likelihood that someone will develop the cancer. The profile
of women at high risk of breast cancer considers the following factors: • Increasing age •A family history of the illness • Inheritance of genetic mutations (BRCA1, BRCA2 or CHEK2) • Exposure to female hormones (naturally or through use of combined hormone replacement therapy or the contraceptive pill) • Obesity (poor diet and inadequate exercise) •A lcohol consumption These factors are not defined as causes of the cancer, but rather as genetic or lifestyle elements that should be examined in their relation to risk and possibly altered in efforts to decrease one’s risk. In addition to these risk factors, the following have also been proven to affect the likelihood of developing or avoiding the cancer. • Sex: Women are 100 times more likely to develop breast cancer than men, but that doesn’t render men completely immune to it. Of the 502 people who died from breast cancer in Queensland in 2011, three of them were men. Though the illness is marked as female-oriented, it is important that both men and women check themselves regularly. • Affluence: Despite the fact that money and development generally equates to higher levels of health, breast cancer occurs more frequently in affluent and western populations, including that of Australia. This is a direct correlation with the lifestyle factors that are more prevalent in these societies such as overeating, lack of adequate nutrition, excess alcohol consumption and heightened technology use. • Childbirth: Women who have their first full-term pregnancy at a younger age have a decreased risk of developing breast cancer, as well at those mothers who continue breastfeeding for a longer period of time. Research also shows that women who have given birth to five or more children have half the chance of
developing breast cancer than women whose first full-term pregnancy occurs after the age of 30.
Early Detection
Health experts and campaign authorities say that the best way to fight breast cancer is through early detection, which can be achieved in medical clinics or in the home using simple self-analysis techniques. Get to know your breasts! Changes to look for include: • A new lump or lumpiness, especially if only in one breast • A change in the size or shape of the breast • A change to the nipple, such as crusting, ulcer, redness or inversion • A nipple discharge that occurs without squeezing • A change in the skin of the breast such as redness or dimpling • Persistent or unusual breast pain Experiencing one or a number of these symptoms does not guarantee that you have developed the cancer, but should be examined further by your doctor. How to search for changes: • View your breasts in the mirror and feel them from time to time. It should only take a few minutes and could be done while in the shower or bath, while dressing, or while lying down. • Remember to feel all the breast tissue, from the collarbone to below the bra-line, and under the armpit. • Use the flat of your fingers and the finger pads to feel near the surface and deeper in the breast.
Support
Those who have been diagnosed with breast cancer should consult seriously with their doctor the treatment options that are available and the lifestyle changes that should be made. pm
For more information on breast cancer and nationwide services and treatments, call the Cancer Council Helpline on 13 11 20 Monday to Friday from 8.00am to 6.00pm or visit any of the following websites:
www.cancerqld.org.au www.cancer.org.au www.cancerscreening.gov.au www.cancerausralia.gov.au
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Women’s Health
Breast Cancer, Ovarian Cancer and Genetic Predisposition Dr Stephen Withers, Clinical Geneticist, shares his insight into this pressing issue.
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he move by Angelina Jolie to go public with her decision regarding risk reduction breast surgery has promoted wider interest in the genetics of breast cancer. The risk for women in Australia to develop breast cancer is approximately 1 in 11 (nine percent). Of these women who do develop breast cancer only five percent carry an inheritable predisposition. Whilst the key genes which predispose to a risk for breast cancer and ovarian are the BRCA genes, it must be remembered there are other genes linking breast cancer with other forms of cancer, for example breast cancer and osteosarcoma (Li-Fraumeni syndrome). Whilst the BRCA genes confer a lifetime risk for
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breast and ovarian cancer, they are also linked to an increased for other forms of cancer including pancreatic cancer, melanoma and prostate cancer. For many women and their families it can be difficult to determine where their own risk is positioned. Are they at genetic risk, community risk or somewhere in between? The BRCA genes are inherited in what is known as a dominant fashion. This means that if a parent carries the gene then their children are at a 1 in 2 (50%) risk of having inherited the gene. For a woman who has inherited a BRCA gene her lifetime risk for breast cancer increases to 40 – 80 percent and lifetime risk for ovarian cancer increases from a community risk approximately one percent up to20 – 40 percent. Whilst the numbers may vary in the literature the key point is that it does represent a lifetime risk well above the community risk. Assessing the family history is a critical
feature of a genetics consultation. It must be remembered genes can be passed through both the maternal and paternal line. This means that a gene can be passed through multiple generations of males. A genetic history ideally carries over three generations paying special attention to all forms of cancer affecting both males and females. Of significance may be the important issue of the age of onset. A family history of breast cancer at less than 40 years of age is far more significant than onset of breast cancer in the mid-seventies. Another important flag for risk may be an unusual form of unexpected cancer. A good example of this would be male breast cancer. Whilst very rare, it is considered a strong indicator of the presence of a BRCA gene. The other rare form of cancer is primary peritoneal carcinoma again which has a link to the BRCA genes. It must be remembered a family member may carry the BRCA but not develop cancer
Many women now in treatment for breast cancer are seeking genetic testing as a means of giving guidance to their treatment.
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during the course of their lifetime. For an individual, the key issue is trying to determine what the best strategy is for that person at that time. We are all influenced by our past experiences. A woman who has lost her mother to breast cancer as a teenager is far more likely to take a proactive step towards surveillance and genetic testing than a woman who only knows of family history and has not personally had any experience with breast or ovarian cancer. Both women may be at an identical risk. For women who perceive a risk, it is important to address the risk and guide them with respect to all options available. This may be simply implementing a sound surveillance plan through to genetic testing with the possibility of risk reduction surgery. Genetic testing needs to be well considered. Is it the right test at the right time and have all of the implications for genetic testing been weighed up? Often after consultation a cooling off period may be appropriate to allow time for consideration with respect to proceeding with genetic testing. Similarly risk reduction surgery needs careful consideration with the need for informed consent and discussion of available options with the specialists who may be involved. Many women now in treatment for breast cancer are seeking genetic testing as a means of giving guidance to their treatment. This may include an elective mastectomy on the unaffected side to decrease their future risk for breast cancer. Another strategy is the idea of having an oophorectomy (removal of the ovaries) to decrease the lifetime risk for ovarian cancer. For some women their decision making is based directly on the results of BRCA testing. BRCA testing is an expensive test but may confer significant benefit to the recipient of the result. Once a family is identified as BRCA positive it is possible then to offer other family members testing for a cost of around 20 percent of the full cost of the BRCA testing. Genetic counselling is an integral part of any genetic testing. The implications of either a positive and negative result can be significant. Issues including life and disability insurance may need to be considered. Laboratories which offer BRCA testing all require any patients requesting genetic testing to have genetic counselling. For any family concerned regarding a possible increased familial risk for breast, ovarian or any other form of cancer should discuss this with their family general practitioner who may then refer them on to a genetics service. pm
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Women’s Health
Freezing Time Why healthy young women are going to great lengths to preserve their fertility. What is Egg Freezing?
Egg freezing, or Oocyte Cyropreservation, is the process of extracting, freezing and storing a woman’s eggs in order to postpone pregnancy for later in life, due to personal choices surrounding health, social circumstances and fertility insurance. Like a biological bank, a woman’s eggs can be stored for a number of years until she is ready for their fertilisation with a partner. While egg freezing, like all alternate fertility procedures, does not guarantee a successful pregnancy, it is analogous to securing a greater possibility of having children in the future. Egg freezing is a relatively new process, following similar motives behind embryo and sperm freezing, two processes which have long been practiced and continue to demonstrate a high success rate around the world. There are a number of procedural and ethical differences between these processes and egg freezing, and with global research in this area exhibiting consistently promising results, egg freezing is anticipated to become a more accessible and popular means to embark on the parenthood journey.
The Method
The egg freezing process is like that of in vitro fertilization (IVF) and begins with several weeks of hormone injections, which stimulate the ovaries to ripen multiple eggs. When the eggs
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are mature, the woman is given a medication that prompts ovulation, and the eggs are extracted from the body using an ultrasound needle inserted through the vagina. While IVF patients’ eggs are fertilised straight after, those intended for the egg freezing process are frozen and stored for future use. Eggs are the biggest cell in the body and contain a large quantity of water, which can lead to two types of potential cell damage. These are defined as ‘mechanical damage’, by which the cell’s shape is distorted by ice crystals, and ‘solution effects damage’, which is caused by the chemical effects of concentrated water in the residual unfrozen water between ice crystals. Evidently, it is a very delicate process. To avoid cell damage, the eggs need to be dehydrated prior to freezing, which is where cryoprotectants step in. These are ‘anti-freeze’ chemicals that protect the biological tissue in the cells from above mentioned freezing damage.
There are two main methods for egg freezing Slow Freezing
This technique slowly freezes the eggs by replacing the water content with small, gradually added quantities of cryoprotectant. The freezing and thawing of the eggs is conducted at a slow
and controlled rate to allow sufficient amounts of water to leave the egg, After approximately three hours, they are plunged into liquid nitrogen and are solidified.
Fast Freezing
This process is also known as vitrification, which freezes the cell rapidly to create a glasslike cell without ice crystals. This option requires a larger quantity of cryprotectants; at 0 degrees Celsius, slow frozen eggs contain 15%, whilst those vitrified contain 60%. Fast freezing has yielded a higher success rate and better cell development than slow freezing. There is, however, a greater risk of cryoprotectant toxicity. Nowadays, more clinics tend to adopt this method. When the woman and her partner are ready for pregnancy, the eggs are thawed from slow freezing or warmed from fast freezing and fertilized by an embryologist who injects the sperm into the cell using a technique called ICSI (Intracytoplasmic Sperm Injection).
Number of Eggs
Simply put, the more eggs harvested, the higher the chance of conception. Additionally to the quantity, the quality of eggs is also important. All females are born with around 1 million eggs, two thirds of which are gone by puberty, leaving between 20 and 30 years to utilise the remaining
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quantity. Youth is the key to better quantity and quality of eggs, which is why fertility experts encourage early egg extraction.
Success Rates
According to the USC Fertility Organisation of the United States, there have been approximately 2,000 babies born from frozen eggs, and so far no results that associate an increased risk of birth defects when compared to natural conception. Although this figure is significantly lower when compared to 300,000 babies born worldwide from the frozen embryo procedure, egg freezing is relatively new and was only recognised as an official fertility technique by the ASRM (American Society of Reproductive Medicine) in 2012. It is anticipated that egg freezing will continue to constitute a viable alternative to embryo and sperm freezing. As mentioned, age is an extremely important factor of pregnancy success rates. It is recommended that women who are considering egg freezing undertake the procedure before 38 years of age. There have been a number of successful pregnancies among women aged 40 and over that fertilised their eggs prior to turning 38 years old. Based on international primary data, there is a 75% success rate between both the egg thawing and fertilisation stages. In other words, if ten eggs are frozen, seven are expected to withstand thawing, and generally five to six will be fertilised and become embryos. It is recommended that women store at least ten eggs for each pregnancy attempt. Most women under 38 years of age will harvest between ten and twenty eggs per cycle.
Why?
themselves in finding the one. Egg freezing empowers the woman to take control of her own fertility in her own time.
Ethical or religious reasons that deter from embryo freezing
Egg freezing offers a chance to women diagnosed with cancer to preserve eggs prior to chemotherapy, surgery or radiation, which all destroy eggs and result in infertility. Although some eggs may be present following cancer treatment, their quality and quantity are not promising.
During the embryo freezing process, many individuals or couples are left with excess embryos, which often entails the prospect having to destroy them via selective termination. This harbours complex religious and ethical consequences for some individuals or couples, whilst egg freezing allows for fertilisation of only the eggs that will be used in the IVF process.
Women who want to postpone pregnancy for Social reasons
Women with a family history of early menopause
Women diagnosed with cancer
Nowadays, women are having children much later than they used to, which is primarily due to a higher and now customary level of female independence in career, educational and family life ambitions. While the eggs are affected with age, the uterus maintains the adequate health for pregnancy into the 40s and 50s. Women may also want to preserve their eggs in waiting for a life-long partner. Women who have undertaken the procedure commonly acknowledge a sense of relief in knowing they do not have to rush
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Some forms of premature ovarian failure, or early menopause, are genetic. Women with a family history of this condition have a chance to preserve eggs before they are depleted.
Cost
The combined costs for the entire procedure will vary between clinics, but generally range between $6,000 and $10,000 including testing, monitoring, medications and the egg freezing. Egg storage costs will also vary, and may increase
at certain intervals. Generally clinics will charge another cost for the egg thawing (or warming), fertilisation and embryo transfer procedures, which should all be reviewed, evaluated and discussed with your partner and fertility specialist prior to selecting the clinic. The costs may seem daunting, but individuals, families and specialists consider this as an investment and an invaluable step towards future parenthood. Payment plans and insurance concerns can be discussed with the clinic’s billing manager.
Making the Decision
Egg freezing has been upheld as an empowering and gratifying experience by thousands of women around the world, and with the wealth of information and resources that we have access to today, the procedure is quickly growing in prominence on the IVF scene. Educating yourself about egg freezing is the first, and arguably most important, step and all women considering this path should dedicate a sufficient period of time to researching the associated pros, cons, risks and rewards before committing. Egg freezing is a proactive step towards a future family, and may be the right option for you to put a pause on that biological clock. pm
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Full Service VS
Low Cost or Bulk Billed IVF
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ith recent media announcements of Bulk Billing IVF clinics emerging, it is certainly time to consider the subject in some detail. First and foremost IVF is an expensive service to provide at the highest quality level and as in most aspects of life “you get what you pay for”. As a founding director of QFG Gold Coast at Pindara Hospital, I have first hand knowledge of the expenses involved in setting up an IVF clinic capable of providing
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the full range of Assisted Reproductive services. The cost to set up a modest volume IVF unit including the microscopes, the incubators, the specialised ICSI equipment, the IT system, The Cryopreservation tanks, the Quality assurance systems and compliance requirements runs into many hundreds of thousands of dollars. To recruit and retain the highest quality Scientific, Nursing, Counselling and Administration staff is both vital and a considerable expense both initially
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and ongoing. To build or lease a facility that can accommodate a laboratory with it’s own isolated and highly purified air supply is paramount to ensuring success rates are industry best. Knowing the costs involved in establishing and running a unit certainly raises some questions about what compromises may be need to be made to run a financially viable unit on Medicare rebates alone. Does one “cherry-pick” the simplest cases which require the least technology and time and exclude the complex cases requiring high level technology who may benefit most from this area of medicine? Does one compromise on staffing levels, or rates of pay, or perhaps accept those lesser qualified who accept lower rates of pay? Does one limit the length of medical consultations or employ doctors who are less experienced, less qualified or work to an algorithm rather than those with the education level and experience to think broadly and laterally to tackle the challenging clinical scenarios which frequently present? The future of Medicare funding creates more unknowns for the future of the industry generally with a greater degree of vulnerability placed on a Bulk Billing model of care. We all know that the only reason there is a “gap” between
Medicare rebates and standard AMA medical fees is that successive governments have failed to apply CPI increases to medical services. An increasing shortfall will place more economic stress on a cut-price model and put more pressure to compromise. The concern also is the ultra-low cost models have not been subject to scrutiny and will likely need to be in existence and funded by tax payers through Medicare for a significant length of time before anyone gets to analyse the success rates and critically assess the operational issues. As a senior clinician and founding partner at QFG Gold Coast, I personally believe the commitment to an IVF unit of the highest quality, capable of dealing with the full range of fertility disorders and producing industry best success rates justifies the term “full service”. With a cost structure reflective of the level of service, expertise and success which every couple dealing with fertility difficulties deserves will remain our primary focus. pm Dr Gary Swift MBBS FRANZCOG MReprodMed Senior Specialist QFG Gold Coast
Leading Specialist in Reproductive Medicine Fertility IVF Laparoscopic Surgery Gynaecology Obstetrics
Dr Gary Swift
www.drgaryswift.com.au
MBBS (QLD) FRANZCOG, MReprodMed (UNSW)
Suite 4, Level 1 Pindara Place
Leading Specialist in Reproductive
13 Carrara Street, Benowa, 4217
Medicine and Surgery
Ph: (07) 5564 6017 Fax: (07) 5564 7940
Children’s Health
Sleep Awareness Week
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e all love a bit of sleep, don’t we? Sunday mornings always start brighter at 10.00am, continued with a lazy coffee and a favourite book in bed. And who can resist the temptation of an afternoon nap on a balmy summer weekend? Sleep not only is something we must do, but something most of us love to do. But let’s put the enjoyable factors of sleep to rest for a moment. We often forget in our fast-paced lifestyles, dictated by smart phone technology and encumbered by to-do lists, that sleep is a fundamental pillar of our physical and mental health. Unfortunately for some, sleeping entails a lot more stress than it should. Snoring, sleep apnoea, nightmares and insomnia are just a couple of serious sleep-related health issues that many Australians have to tackle before earning a good night’s rest. Though most sleep issues are often linked with the daily work and university life, there is also a large amount of sleeping disorders experienced by young and school aged children that affects their lives just
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as seriously as they do adults. Luckily, there is a wealth of information, services and treatments for kids who struggle with sleeping, and their families. Along with national events like Sleep Awareness Week, which endeavours to raise awareness about the importance of sleep, we can work towards treating our kids’ sleeping issues so that they never disturb their slumber again.
Sleep Awareness Week
This year, the annual event ran from Monday September 29 to Sunday October 5 of 2014, ending simultaneously with the beginning of daylight savings (New South Wales, Victoria, South Australia, Tasmania and the ACT all push their clocks forward by one hour at 2.00am on October 5). Sleep Awareness Week was created and is managed by the Australian Sleep Health Foundation, a non-forprofit company governed by a board appointed by the Australasian Sleep Association and independently by members whose aim it is to improve people’s lives through better sleep. The Australian Sleep Foundation acts as the leading
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national advocate for sleep health, maintaining an authoritative and informative presence Australiawide through multiple media outlets, cooperation with community leaders, interaction with health bodies and continuous dissemination of educational information to the public. The Foundation works to: • Advocate healthy sleep among Australian communities and their leaders • Raise awareness of sleep problems via print and broadcast media • Educate the community about sleep health through online and print information resources • Build partnerships with other organisations to promote sleep health • Encourage and endorse best practice standards among suppliers of sleep therapies • Support constant research and development through researching funding programs
themselves on a few of the common sleep issues that children experience at different ages. From the toddler years all the way through to the primary school ages, sleep is essential for children’s brain development and function, moods and their general enjoyment of life!
Sleep Issues Among Kids
A number of sleep deprivation disorders among children are associated with melatonin. What is melatonin? It is the hormone produced by the pineal
It is a good idea for parents, teachers, childcare workers and child health experts to further familiarise
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Important Facts
• More than one third of school aged kids experience sleep problems. • Disturbed sleep impedes daytime function, especially in relation to learning and social behaviour. • Sleeping disorders might not be noticed at first. Keeping yourself informed of the influences and symptoms of child sleeping disorders will help with early detection. • Most sleeping disorders and problems are treatable and manageable through habit and lifestyle changes and a range of natural and traditional medications.
Some Background on Melatonin
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gland in the brain that varies in 24-hour cycles and is controlled by our personal body clock. Often referred to as the “hormone of darkness”, its function is to help us get to sleep at the hours closer to nighttime. Melatonin is also used to treat children’s difficulties with falling asleep or remaining asleep. It has shown to benefit children with normal development as well as children with ADHD, autism and other developmental disabilities. The root cause of a child’s sleep disorder, however, should be investigated and diagnosed properly before melatonin dosage is considered. For example, a child’s inability to achieve a whole night’s sleep may be due to disruption by apnoea or anxiety, not to behavioural disorders. Parents and carers must take into account the range of sleeping disorders for children in relation to their daily activity, diet, moods and general health.
ADHD in Children and Sleep
Up to 70% of children with ADHD experience difficulty with sleep, which may be either behaviourally or medically based. Generally children with ADHD are unwilling to go to bed or fall asleep, experience anxiousness prior to bedtime, have Delayed Sleep Phrase Syndrome whereby they fall asleep and wake up later, or have insomnia. The presence of someone else, like a sibling, adult or a favourite movie, may be required to ease the child into sleep. Sleeping difficulty may be a side effect of ADHD medication or due to depression, anxiety or behavioural issues.
Behavioural Sleep Issues in School Aged Children
These include the common bedtime struggles that parents and carers experience when that particular hour arrives, including refusal to get into and stay in bed, not settling into sleep, not staying in their own bed, waking up during the night and getting up early. All of these generally equate to the child not experiencing enough nightly sleep.
Childhood Snoring and Apnoea
Sleep apnoea is a condition that causes breathing to stop for a few moments while sleeping. Generally children who experience sleep apnoea will snore, but not all little snorers have the condition. Children with apnoea may struggle to breathe and have restless sleep, often awaking suddenly and frequently with gasping or loud choking noises. As a result, children may sleep in odd, uncomfortable positions, sweat a lot during sleep or wake up with confusion and/ or a headache.
Nightmares
Nightmares are more commonly experienced among children and stop between the ages of
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nine to ten. They occur during the sleep stage or REM (Rapid Eye Movement) sleep, in which dreams and nightmares often reflect information attained that day. REM is often more intense among children, meaning their nightmares are more vivid, which can lead to higher levels of fear, discomfort and disturbance of sleep. 10% to 15% of children have nightmares.
Narcolepsy
This is a neurological sleep problem that disables the brain’s control over a person’s desire to sleep. Its main symptoms are feeling very drowsy throughout the day and random attacks of sleep.
More than one third of school aged kids experience sleep problems.
Periodic Limb Movements (PLMS)
These are the movements of a child’s limbs during sleep and often are disruptive to sleeping patterns. The limb often jerks continuously, stopping periodically, and then continues moving again until the child awakens. It is often sleep depriving and affects the child’s behaviour and learning ability during the day.
Good Sleeping Habits Toddlers
• Determine and maintain a daily sleep schedule and bedtime routine • Maintain the sleep environment consistent every night, throughout the night (lighting, bedding, etc.) • Establish limits for bedtime and enforce through explanation and negotiation • Provide a security object such as a blanket or toy
Preschoolers
• Maintain a regular and consistent sleep schedule • End the bedtime routine with the child in bed. The use of bedtime stories is a successful technique in this context • Avoid using the television as a means to put the child to sleep
School Aged Children
• Teach school aged children about the health benefits of sleep • Reward good sleeping behaviour • Separate the area of television watching from the bedroom • Avoid caffeine
Child Sleep Units
Around the country, there is a number of Children’s Sleep Units that specialise in children’s sleep and assess and diagnose behavioural and medical sleep disorders. Experts in children’s sleeping behaviours will undertake overnight sleep study and daytime nap studies to determine a child’s disorder and treatment necessary, including sleep training and management, and/or medication. pm
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Children’s Health
For More Information For a range of helpful information, tips and resources, visit www.sleephealthfoundation.org.au/childrens.html
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A Toothy Issue Watching a baby grow with strong bones and a healthy spirit is a great experience for every parent.
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heir soft head of fuzz grows into bouncy curls, their quiet shuffling around the house suddenly becomes the playful pitter-patter of exploration, and within only a few months they begin to take on Mum’s eyes or Dad’s dimpled cheeks. Child development is generally a peaceful and pleasant period to watch. Until teething begins, which, often accompanied with weeks or months of howling cries and sleepless nights, becomes everyone’s business. Teething can be extremely painful for some children whilst barely noticeable among others. The term refers to the process in which the infant’s first teeth begin to show through the gums, which typically occurs between six and ten months of age, however can occur as early as three or as late as twelve months.
Did you know?
• During teething, or when any tooth erupts during our life, the gum does not actually tear open to give way to the tooth. In fact, the body generates a special chemical that destroys and separates the gum. • The initial development of baby teeth begins in the womb! At approximately five weeks, the primary buds of teeth begin growing in the baby’s bottom jaw. At birth, the baby already has a set of 20 teeth all hidden in those soft, gooey gums. • Baby teeth are also known as “milk teeth” or “deciduous teeth”. • Despite being a common belief among new parents, there is no proven link between teething and fever or diarrhea.
The Teething Process
Teething timing will vary between children, but the sequence of tooth eruption is the same for all kids. • The two front teeth (central incisors) in the bottom jaw generally appear first between the ages of six and ten months. • The two front teeth in the top jaw (central incisors) in the upper jaw appear later between the ages of eight and 13 months. • The two teeth on each side of the central incisors (lateral incisors) appear in both the top and bottom jaw between the ages of eight and 16 months, more closely around ten months. • The first set of four top and bottom molars erupt between 13 and 19 months. • The canine teeth (also known as eye teeth) erupt in the top and bottom jaws around 16 and 23 months. • The second set of top and bottom molars appear between the ages of 25 and 33 months. Children will likely have their whole set of 20 teeth by the age of three. It is common for girls to teethe earlier than boys, and the patterns and timing of teething have shown to be hereditary. The timing of teething has is not reflective of the health of the child.
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Teething can be extremely painful for some children whilst barely noticeable among others.
child to the teeth-cleaning routine, which can be a nightmare for some parents in the later years! Be careful in the first lessons of teeth cleaning, as the gums around the erupting teeth are quite tender. For this reason it is important to select the correct toothbrush for your child’s age (check on the packaging) with soft bristles and a small head.
Losing Teeth
Having wobbly teeth is an exciting but often disconcerting experience for kids, occurring around six years of age, generally earlier in girls than boys, and is something that should be handled with sensitivity and optimism by parents. • Assure your child that losing baby teeth is a natural occurrence, explaining that the old teeth will be replaced by bigger, stronger ones. • Apply cold compresses to the area to relive loose tooth pain, or refer to your GP or dentist for the appropriate medication for pain relief. • Have fun with the tooth fairy! As a longstanding tradition, the tooth fairy mythology has remedied a lot of children’s fears with a gold coin hidden under the pillow.
Adult Teeth Concerns How to Deal with Infant Teething
Teething often causes mild pain, drooling and different mouthing behaviours, and often fussiness and sleep disturbance. The soreness that babies experience is a result of gum swelling, which usually occurs within three to five days prior to the tooth erupting. During the process, crying, sleeplessness and restlessness are also common, and sometimes, albeit rarely, the area around the erupting tooth can fill with fluid and cause extreme gum sensitivity. It is usually quite evident when a child is experiencing teething. Often a child will begin chewing on fingers (or the fingers of others), toys or different objects to relieve the pressure building around the erupting teeth. Children may also refuse food and drink, or certain foods that exacerbate the pain, which is then deemed as fussiness. Pulling on the ears can also signify teething pain as an attempt to elevate head pain, or irritation around mouth due to excessive drooling. It is important to remember that teething is a transient period and that pain and discomfort are normal, and don’t usually warrant medical or special treatment. There are a number of low-cost, highly effective methods to soothe the process that parents can adopt to help their child’s toothy troubles.
Remedies
• Gentle massages on sore gums with clean fingers or a wet, soft cloth to relieve the pressure around erupting teeth. If you are going to use a bib or baby blanket, it is important to ensure
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the cleanliness of these objects if they are going to be carried and left around the house. • Chilled teething rings or toys to reduce inflammation and discomfort. Only purchase products that are BPA-free and avoid all products that have disononyl phthalate, a chemical that can cause systemic (liver and kidney) toxicity in young children. • Unsweetened teething rusks or sugar-free teething biscuits. • Cleaning to drool around the mouth to avoid skin irritation. Applying Vaseline in the area can protect against this irritation.
Beginning To Brush
They’re only small, but keeping baby teeth clean and healthy is as important as doing so for our adult teeth. Healthy, strong baby teeth are essential for chewing food, speech development and reserving places in the gums for adult teeth. Although is seems early, it is wise to visit a dentist when the first teeth begin showing, as this is a good opportunity to discuss teething expectations, children’s oral hygiene and fluoride queries, as well as potentially catch any early dental problems such as cavity. It is a good suggestion to visit the dentist within the first and second birthday. Start by cleaning your child’s teeth at least once or twice a day as soon as they begin to appear. It might be easier initially to use a wet, slightly rough piece of material wrapped around your finger. As the child grows, the more capable they become in brushing on their own teeth. In starting brushing early, you are also accustoming your
The first adult teeth will begin to emerge around six years of age, and the process usually ends with 32 adult teeth around the age of 25. In the younger years, the dental enamel of new permanent teeth is not yet fully mineralised, making them highly susceptible to acid and bacteria. This makes good oral hygiene and sufficient levels of calcium and fluoride pivotal to a lifetime of healthy teeth, starting at brushing them twice a day with regular flossing. Some adult teeth concerns among children include thumb sucking and grinding, which you should discuss with your GP or dentist, and tooth injury. Tooth injury is especially problematic in young children with developing teeth and jaws. Make sure your child who plays contact sports wear a professionally-fitted mouth guard.
Does Your Child Need Braces?
Crooked, overlapping, overcrowded teeth, and over or under-bites are all common reasons for braces. Not only are teeth often central to adult confidence and speech, but also their correct positioning will avoid associated dental problems such as tooth decay and jaw problems. It is recommended that you take your child to an orthodontic visit as early as the age of seven, as this is a good time to evaluate the growth trajectory of young teeth and discern whether any treatment will be needed. The earlier this knowledge is, the better in most cases, as braces can constitute a significant cost for families, especially if sprung upon them unexpectedly! Visiting the orthodontist early will also help address teeth issues such as crowded or gappy teeth, which may require other orthodontic treatments. pm
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y t e f a S d Ch i l y r u j n I d n a As a parent, it’s natural to fear for the wellbeing our young ones every day - what challenges or potentials risks could they encounter beyond the familiar boundaries of the backyard fence?
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hether it’s the local playground, swapping lunches with class mates or the snarling dog down the street, parents are concerned about the safety
of our kids. But our own homes and peaceful neighbourhood streets can harbour a multitude of dangers that escape a watchful eye, even though we consider these ‘safe zones’. Without diligent inspection, management and prevention of home and neighbourhood risks, our children are still at an equally high risk of serious injury. According to Kids Safe Australia (2011), 67 percent of child injuries occur in the home, eight percent
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occur in somebody else’s home (relative, friend) and seven percent on roads and footpaths. That’s a lot of our comfort area to re-evaluate, but with the right information, assistance and attitude to improving the safety and security of our kids, the necessary adaptations to the home and daily rules will be as easy as one, two, three.
Prevention is the key
Like workplace health and safety risks that adults manage and avoid day-to-day, risks in the home are caused by hazards, which fortunately we can control. Every danger begins with a hazard, and the quicker we discover them, the quicker we can assure the safety of the kids, and avoid having to follow them into every room on their daily adventures. Make
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the home as danger-free as possible with these easy steps.
1. Locate the hazards
Dedicate the morning or afternoon, or even the whole day (you might need to!) to searching around the house for any hidden risks. Remember that you are a couple of feet higher than the little ones, so try and view the room from their perspective. Start at one end of the house and act like a fine-tooth comb sweeping all areas of danger.
2. Deal with it
Great, we’ve found all the risks, now it is time to act! Some risks are easily removable, like badly placed shelving or sewing kits, or fixable, like cupboard doors under the sink or toilet seats. General high-risk zones, such as the kitchen, have to be dealt with carefully and occasionally inviting the cooperation of the kids can pay dividends. Educating them about not running, touching or playing in the kitchen, say, is pivotal in developing their self-awareness from a young age. Reward good behaviour during the learning period, and faults in safe behaviour should be highlighted immediately. One suggestion is creating time constructs for different rooms of the house. For example, between 5.00pm and 6.00pm, the little ones are not to enter the kitchen when Mum or Dad are cooking, and are to spend that hour in the playroom or garden with the careful supervision of a parent or guardian.
3. Be fast
There is no point to all the identification and education if rules, boundaries and lessons are not established immediately. The quicker each hazard is isolated or removed, the quicker Mum and Dad can be assured that play time won’t end in injury.
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Some common hazards and their prevention Kitchen
• All kitchen appliances must be out of reach of children. • Hot liquids and foods should be put out of reach and cooled long prior to the children consuming them. • If you are making a coffee or tea (wellearned!), don’t leave the total amount of hot liquid sitting. Just boil enough water that is necessary for one or two cups. • Install fire extinguisher and blankets, and educate children about fire safety. • Use the back heat elements on the stove when possible.
Facts:
In Australia each year, 280 children die as a result of injury, and many thousands more suffer serious injury (Kids Safe, 2011)
For every one child who dies, 160 are admitted to hospital and 5,000 need medical attention all as the result of injury (Kids Safe, 2011)
Half the children who are injured are under the age of five (Kids Safe, 2011)
A child is treated in emergency every four seconds in Australia (AIFS, 2012)
Bathroom
• Lay towels and sticky mats down on tiles. • Install the water temperature at maximum 50 degrees Celsius. • Always supervise children during bath time. • Check the ingredients on soaps and bubble baths for children with sensitive skin or allergies. • Warn kids about running when they’re wet - dry them all over first.
Bedroom
• D ress the kids in materials with low flammability and as tight fitting as possible - dangly details and loose sleeves are at greater risk of catching onto flame or on other objects. • Ensure all lamps and light sources are certified and in good condition. • Install bedding away from windows where possible during the adventurous ages.
Garden and Pool
• Fence the pools at a height of around four feet minimum. • Educate children on water safety, and sign them up for swimming classes early. • Supervise at all times, and ensure those watching are fit to do so (in terms of age and swimming ability). • Fence all garden and patio areas, and if the driveway or public pathways lead into the garden, fix a child-proof gate at the entrance. • Try to keep the surface areas clean of moss and debris to avoid trips and falls. • Fence off steps and steep slopes. • Remove any pet faeces and waste as soon as possible, as these can contain parasites that are seriously dangerous to young immune systems. Additionally, toxoplasmosis, a toxic parasite carried through cat faeces,
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team of thoroughly trained and knowledgeable poisons experts ready to advise both medical experts and the general public about the poisons that can be found in the home.
Always be prepared
A safe home is a fun home, and a perfect place to prepare our kids for that big, wide world. has been known to cause birth defects in unborn children, so these droppings should be removed as soon and carefully as possible. • Keep all weed killers, fertilisers and garden products securely locked away. • Supervise trampoline and large toy use.
What to do right away Head injury
Little climbers and runners may likely come into heavy contact with the floor or furniture during playtime, so it is imperative to be familiar with the signs of moderate and serious head injuries and how to act accordingly. A head injury may be indicated by bruising, lumps or cuts to the head. Seek medical help if: • You child has fallen unconscious. • Your child has suffered a heavy fall, like from the high chair or car seat, or has been hit by another object, such as a fallen object from shelving or a bat. • Your child begins to vomit, experience confusion, a head or dizziness or seems unwell shortly after. • To treat minor head injuries • Apply ice to the area of injury to minimise swelling. • Clean all cuts adequately and bandage them, pressing hard on the area for around five minutes. • Monitor behaviour following the injury, watching for signs of drowsiness, irritability or mood swings.
Swallowed poisons
Not only the obvious cleaning products are dangerous to children. Chemicals, medicines and
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certain plants can be dangerous to our children’s health, and all households should keep such products out of reach and be prepared in the case of minor or major poisoning. Make sure you: • Dispose of all old or out-dated medications. • Always check the label of all medications for children. • Watch out for residue poisons around the house like the oven, water heaters, gas dryers, furnaces etc. Carbon monoxide is an odourless colourless gas that is produced from such appliances and is lethal for both adults and children. Signs of poisoning; • Difficulty breathing • Severe throat pain • Burns on lips or mouth • Convulsions • Dizziness • Vomiting • Unconsciousness • Extreme sleepiness What to do: • Stay calm! • Do not try to make your child vomit - this can often cause extreme burning or choking. • Call 000 if your child is unconscious or if certain the child has consumed something highly dangerous. • Remove and isolate the poison safely and immediately. In the cases of uncertainty, for example if the child has swallowed make-up or stale medication, call immediately the Poisons Information Centre 24 hour Advice Line on 13 11 26. Between four national offices located in Queensland, NSW, Western Australian and Victoria, there is a large
It’s always better to be over prepared. Taking precautions such as programming all emergency and necessary support services into our home telephones and mobiles can make an enormous difference in the wake of an emergency. Keeping you and your partner and all members of the household informed about child safety, the potential risk at home, prevention, remedies and emergency procedures is extremely important in maintaining your home a ‘safe zone’. Reading current government and health organisation publications, attending child safety work shops and lectures, completing your First Aid Certificate and speaking with child health and safety professionals (local GP, local poisons centre, child safety product providers) are simple ways to be sure that your child is at lesser risk during play time, bath time and sleep time. It is also a good idea to make sure your babysitter and elected guardians are informed and equipped in the case of an emergency, and unsure they know where all the first aid resources, hotlines and emergency numbers are located, as well as having your own number and those of the neighbours. A safe home is a fun home, and a perfect place to prepare our kids for that big, wide world. pm
Summer | 2014/15
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HEALTH & BEAUTY
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A multi-tasking cleanser for men with an active lifestyle. This sports wash works as a shampoo, face wash, shaving gel or body wash. Infused with citrus notes including Cassia bark for refreshing properties it leaves skin and hair clean, smooth and invigorated Molton Brown David Jones, Robina Town Centre Shop 4013, Robina Town Centre Drive, Robina (07) 5585 2999
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Summer | 2014/15
HEALTH & BEAUTY
Mecca Cosmetica SPF 30 Hand Cream
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Packed with coffee, sweet almond oil, brown sugar and sea salt, Frank Body Coffee Scrub will target cellulite, stretch marks, psoriasis, varicose veins, eczema and acne all in one hit. Smoothing lumps and bumps while moisturising and toning the skin, Frank Body Scrub uses essential vitamins and minerals to work wonders from the outside in, and will leave you feeling fresh and new.
To Save Hands SPF 30 Hand Cream keeps your hands smooth, soft and beautifully cared for. Providing environmental SPF protection, this is an essential in your anti-aging arsenal. The non-greasy, cashmere-feel cream formula with our non-sunscreen fragrance blend is the perfect combination of high performance and indulgence for luxury SPF protection on the go. MECCA Maxima Robina Shop 4007 Robina Town Centre Drive, Robina (07) 5593 3780
The Memory Lane Fragrance Lamp is the ultimate product to refresh the home! These fragrance lamps represent quality, luxury and above all, style. The stunning ornamental fragrance lamps utilse a century-old catalytic combustion technique that filters airborne odour-causing molecules. In addition the fragrance contained within the fragrance lamp is emitted to provide a gentle fragrance to the room. The fragrance lamp compares favourably to other room fragrance products and is a most efficient diffuser of fragrance, spreading it evenly and quickly around a room
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HEALTH & BEAUTY
Reconstructive Breast Surgery Approximately 800 women under the age of 40 will be diagnosed with breast cancer this year. Due to the prevalence of larger, high-grade tumours and frequency of oestrogen receptor (ER) negative cancers, this group of women experiences a lower rate of disease-free survival.
D
espite the high rate of diagnosis, this group is also often dismissed as having a benign health problem without further examination. This isn’t enough according to leading Gold Coast Breast Surgeon Dr Daniel De Viana, who advises that any woman who experiences unexplained symptoms deserves an ultrasound of the breast. Ultrasound is the best procedure in determining the benign versus malignant status of a lump. Whilst mammography can be utilised, the denser tissue in this age group limits the sensitivity resulting in a higher false positivity rate in the interpretation of any change. Further examination and management depends on suspicion. Any unexplained symptom should be investigated with a short-term clinical review, followed by an MRI as the gold standard investigation if the patient harbours further concern. The MRI should be timed with the patient’s cycle, ideally coinciding with day 7-10 to reduce the background
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noise of hormone changes. Unfortunately there is no rebate for MRI of the breast, unless the patient’s family history (three relatives with breast cancer under the age of 50) indicates a strong likelihood. This procedure should be used selectively, as there is a high rate of false positivity particularly in the premenopausal breast, despite its sensitivity. Surgical options for women under 40 are the same as those available to other age groups. Many choose lumpectomy, as this combined with radiation provides the same survival rates as mastectomy. As larger tumours are more common this age group, however, lumpectomy is often not feasible at the initial presentation. There is a growing trend to offer these women neoadjuvant chemotherapy prior to surgery to try to shrink the tumours and allow breast conservation. This approach has proven to be safe with no significant difference in survival compared with surgery up front. In fact, complete pathological remission with no tumour seen in the excision specimen can be
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Depending on the agent used and the woman’s age, the risk of infertility following chemotherapy can be affected.
achieved in 10-20% of cases, as well as significant reduction in tumour bulk in most cases. Rates of over 40% in complete pathological response have been seen in some HER-2 positive breast cancers that are more aggressive and historically have had a poorer prognosis (refer Image 1). Larger numbers of women are choosing mastectomy over lumpectomy and also electing to have a contralateral prophylactic mastectomy with combined immediate reconstruction. This trend as a personal choice has increased over the last decade and has the advantage of reducing
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the long tail of surveillance required for younger women with breast cancer. There has also been an increase in the rate of nipple preservation with subcutaneous mastectomy, which allows for a superior cosmetic result and optimises the psychological wellbeing of patients. In the case of the more aggressive and less hormone-sensitive disease, patients will often be offered chemotherapy to improve the chance of survival. This results in a number of issues for consideration, including the patient’s management of fertility, early menopause and its associated symptoms, and dealing with major body
image changes. This approach necessitates the engagement and cooperation of breast surgeons, oncologists, gynaecologists, psychologists and other health care professionals in the perioperative management of these patients. Depending on the agent used and the woman’s age, the risk of infertility following chemotherapy can be affected. Pregnancy after breast cancer has not shown to increase the risk of recurrence as a whole. The data, however, is limited and caution should be taken especially for high risk and ER positive patients. Treating high-risk patients with a family history requires referral to specialist clinics that provide screening services, genetic counselling and options for surgical prophylaxis for these patients. It is essential that the management of these be individualised to minimise risk and ensure the psychological wellness and comfort of each patient. Along with lumpectomy and mastectomy, oncoplastic surgery is also a management option for breast cancer, and offers breast-conserving surgery to women who were previously destined to have a mastectomy. With the latest techniques and the best principles of plastic surgery, surgical oncology achieves tumour-free margins and optimal cosmetic outcomes. As it allows wide margins, this option can result in a decreased recurrence and improved survival rate, as well as maintaining or improving the shape of the existing breast. There are numerous oncoplastic techniques that can be used, depending on the position of the tumour and its size relative to the breast. Level 1 oncoplastic volume displacement techniques are useful if < 20% of the breast is to be resected. Simple volume displacement techniques are used to move healthy breast tissue into the area where the tumour has been excised, thus filling the space left by the tumour and distributing the volume loss to the whole breast. Level 2 oncoplastic mammaplasty volume displacement techniques are used when 20-50% of breast volume is to be resected. Mammaplasty volume displacement techniques are used for larger tumours or when the tumour’s location renders simple methods unsuitable. The remaining breast tissue is refashioned and the nipple-areola is relocated into a better position, resulting in smaller but normally shaped breasts. When significant breast ptosis or excess breast volume is corrected during these procedures, surgery to opposite healthy breast can provide good symmetry and cosmetic results. Oncoplastic volume replacement techniques are used when removal of a large tumour does not allow a satisfactory cosmetic result. If inadequate breast tissue is present, local tissue flaps can be used for partial breast reconstruction. When mastectomy is required, it may be possible to preserve the breast skin, and in some cases the nipple as part of a breast reconstruction. pm
Summer | 2014/15
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HEALTH & BEAUTY
Eye Spy Professor Frank W Howes outlines the latest technologies saving and improving sight.
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HEALTH & BEAUTY
T
here a few things that are certain in life, but as we all know, what we can count on are aging and taxes! The implication of this is that time moves on – the movement of time in ophthalmology has produced some great developments for us all in technology specifically directed towards the improvement and restoration of the wonderful gift of sight. We are all living longer thanks to the many other wonders of modern medicine (in Australia the average lifespan has increased to 87 years for women and 84 years for men,) meaning that the eye diseases of aging are being seen more frequently. Not that the advances are restricted to aging eyes, some wonderful advances are now available for eye diseases that affect young people as well. Sight is one of the gifts that dramatically improves the quality of life even when other afflictions are present. The first collection of advances that come to mind in a discussion like this are the devices that we use to improve sight (about which I will write shortly) but there are many eye diseases that are incurable and the exciting thing in this realm are the advances in technology that have provided us with the ability to diagnose the incurable diseases at an earlier stage and introduce treatments that would otherwise have been delayed, in some instances, to a much later time in the course of disease when return of function or at least stabilisation is too late.
Lasers
We glibly use the term LASER (an acronym meaning - Light Amplification by Stimulated Emission of Radiation), and while LASERS have been around for a while, the refinement has been dramatic - so much so that we now have at least 10 forms of laser with refinements in many of them.
EXCIMER Laser
This is one of the more well known lasers also named by acronym (EXCited dIMER), that we have used for many years as a corneal treatment for refractive surgery for the removal of spectacles, but in the last five years, the accuracy and speed of the Excimer Laser has improved so much that any inaccuracies nowadays relate more to variance in personal healing properties than laser variance. Much of this is contributed to by
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the speed and regulation of the laser delivery (the speed of delivery has increased from 10 pulses per second to 600 pulses per second) making the laser treatment much easier for the patient.
FEMTOSECOND Laser
This laser energy is capable of making preprogrammed cuts in the cornea of the eye at virtually any angle depth length or breadth. Such is the accuracy of this laser that lenticules of tissue can be removed through small incisions from the less important deeper tissues of the cornea to provide refractive correction as accurate as the Excimer but making a much safer refractive procedure. This process also permits treatments on thinner and irregular corneas such as in certain milder forms of keratoconus, never before possible. In respect of keratoconus (an eye disease progressive in childhood and young adulthood), this laser can be used to assist with the rectification of the corneal distortions of keratoconus by cutting tracks for another new technological advance – Intra-Corneal Stromal Ring Segments (ICSRS – Kerarings / Intacs / Ferrara Rings) that are strategically implanted into the cornea to correct the distortions permitting significant improvement in quality of vision (invariably, particularly in the young progressive keratoconus, after strengthening the cornea with Collagen Crossslinking – CXL, the state of the art being “Pulsed Accelerated Transepithelial CXL”). Similarly the Femtosecond laser can be used to accurately - correct astigmatism, perform corneal grafts and cut the flaps required for Lasik as well as prepare cataracts for surgery.
Nd:YAG & DIODE Lasers
The Nd:YAG (or YAG laser as it commonly shortened to) permits cutting inside the eye without the need to enter the eye with surgical instruments and used often to cut a Peripheral Iridectomy, a pressure release valve for angle closure glaucoma (qv) or to cut a thickened posterior capsule, the membrane supporting an intra-ocular lens after cataract surgery. This laser too has been refined in recent times to add further functions to it’s cutting ability such as permitting lysis and photodisruption (“evaporation”) of floaters in back of the eye, a very common and frustrating problem for many people). This is called Laser Vitreo-Lysis. Additionally by scientifically doubling the frequency of Nd:YAG laser which means cutting
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older laser systems. This permits the treatment of fluid in the macula secondary to diabetes and other conditions such as venous occlusive disease, which occurs secondary to high blood pressure and high blood fats as well as Glaucoma
Intraocular Lenses
Nd:YAG & DIODE Laser
...in some patients, the correct lens selection can provide freedom from reading spectacles as well.
the wavelength in half (1064nm to 532nm) we can cut the machine size 10 fold and produce Green laser which has been used for many years but still Q-switch the exposure time (2x10-9 sec) which permits almost totally side effect free and highly effective treatment for Glaucoma (called SLT or Selective Laser Trabeculoplasty, a great improvement over the older ALT or Argon Laser Trabeculoplasty) This form of Solid State Laser can be produced by Diodes nowadays in continuous wave mode (measured in milliseconds as opposed to the ultrashort exposures discussed above) which permits the substantial downsizing of the equipment (the size of a small suitcase instead of occupying half a room and using 100 litres of water per minute for cooling!) but retaining the power of all the older and useful treatments that we still use (the green and red continuous wave lasers which are used to treat the retinas of people with diabetes retinal detachment and advanced glaucoma â&#x20AC;&#x201C; Cyclodiode / Endolaser / Indirect Laser / Direct laser and so on).
Micropulse Laser
This type of laser is an off shoot of the Argon (green) Laser which, with the advent of the Diode lasers which can produce Red Green and Yellow wavelength lasers, have also very short pulse duration (duration of laser delivery) as described above but also have very short pulse interval (duration of interval between pulses) permitting the direction of laser energy towards vital structures such as the macula without fear of laser induced damage as per many of the other
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Intraocular lenses are mainly used to replace the natural lens of the eye when cataracts develop, but also when the natural lens enlarges with age to become too big for the eye, causing glaucoma. Occasionally we use a supplementary lens or piggy back lenses over another lens to supplement correction, or as a lens over the natural lens of the eye to make large corrections of refractive error. This type of lens is called the ICL or Implantable Collamer Lens. The wonderful lenses help those with thick glasses to achieve quality normal vision without spectacles. newer intraocular lenses used in cataract surgery are built to provide an approach of customisation for each individual, not only correcting long sightedness, short sightedness and astigmatism but also some higher order aberrations. By optimising all the above parameters in the preoperative assessment and choosing the correct lens, excellent visual outcomes and spectacle freedom are enhanced. Additionally, in some patients, the correct lens selection can provide freedom from reading spectacles as well. This is created by using one of the eyes to read and the other for distance correction (called monovision) or with intraocular lenses that provide both near and distance correction in both eyes. These multifocal lenses have been refined significantly in the last two years, producing good near intermediate and distance vision with little (although some) night time optical glare phenomena.
Glaucoma
Glaucoma is a disease that takes our sight without us really noticing until it is too late. Both peripheral and central vision is lost with central vision often the last to go in glaucoma. The mainstay of treatments in glaucoma are those to lower intraocular pressure and facilitate fluid flow in the eye. Eye drops that do this have been used for many years in the past and require use into many years in the future. Recently we have acquired drops from the research fields that minimise ocular surface irritation (no preservatives, more gentle preservatives) that provide for future years of trouble free use. Nevertheless, some people react not only to preservatives in the drugs but to the active drug in the medication. The answer for this is SLT or Selective Laser Trabeculoplasty. SLT is not only
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highly efficacious but also an extremely safe treatment, with no other drug interactions, absolutely minimal side effect and easy/painless to receive. The drugs spoken of above lower eye pressure by reducing the production of fluid within the eye but in some instances anatomical blockages within the eye cause the pressure problems. This is the cause of glaucoma in the so-called narrow angle glaucomas – the solution in these circumstances is to cut a pressure release valve in the peripheral iris. This is called a Peripheral Iridotomy and is cut with the YAG laser written about above (occasionally the natural lens requires removal if an iridotomy is insufficient or if a cataract is present). Anatomical obstructions in microscopic form can be present in the eye fluid back pressure control mechanisms in the eye. These type of obstructions occur in the anatomical structure called the Trabecular Meshwork in the so-called open angle glaucomas. The newest treatment in this respect is called the iStent (made by Glaukos). Much like a stent in the heart vasculature can re-establish blood flow to the heart muscle, so can the iStent re-establish flow through a blocked Trabecular Meshwork. This device is inserted through the Trabecular Meshwork into Schlemms canal at the time of cataract surgery to bypass the blocked Trabecular Meshwork. The procedure is simple and quick adding minimal time and cost to the cataract surgery.
Advertise in Pindara Magazine Advertise in Australia’s only private hosiptal magazine and the Gold Coast’s most exciting publication enjoyed by over 250,000* readers annually. Call Peter Wastie today Mobile: 0411 453 444 peter@nudepublishing.com.au
Retinal Drugs
One of the leading causes of blindness is Age Related Macular Degeneration or ARMD or purely AMD. This is, as the name suggests, an age related eye affliction. The disorder is restricted to the macular, not affecting the peripheral retina and comes in two forms, wet and dry. The dry type progresses very slowly with very little available to manage the condition except for the possible slowing of progression by appropriate dietary means (the coloured and leafy vegetables and supplements such as Macuvision) but when the dry variety converts to the wet form of AMD by the development of aberrant blood vessels with bleeding and serum leakage, vision can become significantly distorted and decline. One of the more significant advances in eye treatments has emerged from the research units in the treatment of these aberrant macula blood vessels and that is the development of the AVEGF’s (Anti Vascular Endothelia Growth Factor), originally used in the treatment of certain cancers. The action of closing down blood vessels and hence causing cessation of the leakage of serum has ideal application to the treatment of these aberrant blood vessels (SRNVM – Sub Retinal Neovascular Membrane) in AMD. Avastin (Bevacizumab) was the first with more specific eye suitable agents to have followed – Lucentis (Ranibizumab) and Eylea (Aflibercept). These agents are injected in very small quantities through an area of the eye that has no important structures called the Pars Plana, in the vitreous cavity. The presence of these AVEGF agents in the eye closes the offending blood vessels allowing the macula to return to normal or close to normal depending on the rapidity of diagnosis and treatment. pm
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My Birthday Present Five years ago my wife and myself were on our annual summer holiday. At breakfast one morning my wife was reading the local newspaper and she announced to me that she was going to give me a surprise birthday present. I pestered her to tell me what the present was and eventually she told me that she was going to buy me a ‘Bidet’. I told her that I knew where The BIDET SHOP ® was as I had passed it once before.We both went to The BIDET SHOP® that day where we met with one of the state sales representatives. He was most helpful and demonstrated all the different models that were on display. We eventually decided on the ‘Coway’ as this model appealed to us as being very stylish and ‘user friendly’. The Bidet was delivered to our home, arriving a couple of days after our return from our holiday. With the easy to follow instructions it took me only about 20-30 minutes to install.After five years of using the Bidet we have not experienced any problems whatsoever and I wonder how we ever did without it for so long. I have kept in touch with The BIDET SHOP® and the man who sold me my Bidet has become a good friend, so much so I have become an ‘honorary’ consultant for the BIDET SHOP®.
I have given many demonstrations of the unit in our home to prospective buyers. On one occasion recently I paid a visit to a gentleman who had just had a new Bidet installed and he needed some advice on the unit as he had recently undergone radiotherapy, which meant that he did not have a sense of feeling in the area where it was needed. I thought that the best way for me to carry out the test was to lock the door and carry out the ultimate test by dropping my ‘dacks’ to test the pressure. I’m pleased to say that all was fine and I left a satisfied customer. I highly recommend The BIDET SHOP ® as the place to purchase your Bidet. Signed, Des Parr. **Call The BIDET SHOP® 07 5591 7744
PM8
Nutrition & Fitness
takeaway take on the
From fish and chips to pizza, and Indian to Japanese, Australians love a good takeaway meal. Whether itâ&#x20AC;&#x2122;s a Sunday night treat or a midweek respite from the kitchen, we all like to indulge in our favourite takeaway foods. The problem is though, that more often than not, our favourite meals are not always the healthiest. With that in mind, weâ&#x20AC;&#x2122;ve come up with some healthier homemade versions of your favourite comfort foods that will surely satisfy your next craving!
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Philips Airfyer The Philips Airfryer allows you to enjoy foods like french fries or fish and chips with up to 80% less fat than traditional versions. The benchtop appliance uses unique patented Rapid Air technology to ‘fry’ food using heat and air, minimising the need for oil. We used it to cook chips, sweet potato fries, crumbed fish, chicken schnitzel and more with excellent results. For more information visit www.philips.com.au
Japanese Chicken Katsu -4 chicken breast fillets (preferably organic), halved and pounded to about 1 inch thickness -2 eggs, lightly beaten -¼ cup potato flour -S alt & pepper to taste -1 cup Japanese panko breadcrumbs -½ tablespoon peanut oil Heat the air fryer to 200 degrees Celsius. Meanwhile, season the flour with salt and pepper and then coat each piece of chicken with the seasoned flour, shaking off any excess. Dip the chicken in the egg and then coat with the breadcrumbs. Add the oil to the air fryer, as per manufacturer’s instructions and then cook the chicken for 15 minutes or until golden brown and cooked through. Serve with brown rice, Japanese katsu sauce, miso soup and side salad for an authentic but healthy Japanese style meal.
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Crumbed Salmon & Chips (serves two) -2 x skinless salmon fillets -½ cup wholemeal flour -½ teaspoon sea salt flakes -¼ teaspoon ground black pepper -1 egg, beaten -1 cup gluten-free breadcrumbs -2 tablespoons finely grated parmesan cheese -½ teaspoon dried Italian herb blend -2 large potatoes, peeled and cut into chips, and soaked in cold water for 30 minutes and then thoroughly dried -1 tablespoon olive oil -S alt & pepper, to season Preheat oven to 200 degrees Celsius. Line a baking tray with baking paper. Combine flour, salt and pepper in large shallow dish and mix well. In a separate dish, combine the breadcrumbs, parmesan and herbs. Press the salmon fillets into the seasoned flour, dip into the beaten egg and then coat with the breadcrumb mixture. Place on prepared baking tray and bake for 20 minutes, or until crust is golden brown. While salmon is baking, take the prepared potato chips and toss them with the olive oil in a large bowl. Transfer to the air fryer and cook at 160 degrees Celsius for 5 minutes. Remove from air fryer and allow to cool, before returning to air fryer and cooking at 200 degrees for a further 10 – 15 minutes or until crisp and golden brown.
Slow Cooker Chicken Tikka Masala -1 kg skinless chicken thighs, diced - 1 package frozen chopped spinach -1 large onion, diced - 1 tablespoon minced garlic - 2 tablespoons minced ginger - 1 can of tomato puree - 2 tablespoons tomato paste - 1½ cups plain Greek yogurt - 2 tablespoons olive oil - 2 tablespoons garam masala - 1 tablespoon cumin - ½ tablespoon paprika - 2 teaspoons salt - 1 tablespoon brown sugar -¾ teaspoon cinnamon - ¾ teaspoon fresh ground black pepper - Cayenne pepper, to taste - 2 bay leaves - 1 cup evaporated milk - 3 tablespoons cornflour - 2 cups mashed sweet potato (optional) Combine onion, garlic, ginger, tomato puree, tomato paste, yoghurt, olive oil, sugar, all spices and bay leaves in slow cooker. Stir until thoroughly combined. Add the diced chicken and spinach to slow cooker and stir through the sauce so that everything is coated in the sauce. (You can prepare recipe up to this stage the night before and refrigerate.) Cook on low for 8 hours or on high for 4 hours. Whisk the cornflour into the evaporated milk and then add to the slow cooker and simmer for another 20 mins. If you like your curry nice and thick, add the mashed sweet potato when you add the evaporated milk.
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Fit Free and
Your no-cost exercise options on the Gold Coast
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G
old Coast locals have many things to boast about. Seventy kilometres of shimmering coastline hedged by lush native vegetation that spreads over a huge area of reserves, bushland, parks and hinterland. The dynamic conditions of SouthEast Queensland make the city’s environment exciting all year-round, something that strategic city development has celebrated through endless lengths of footpaths, spacious parks and stunning scenic lookouts. The Gold Coast can also boast about its higher than average health status when compared to the rest of the state. In 2013, according to the Gold Coast Medicare Local (GCML) self-review resident survey, 85 percent of Gold Coasters rated their health between good and excellent and 92 percent rated their quality of life good
to very good (compared with 83 percent and 90 percent respectively for Queensland as a whole). Despite the region’s higher rate of physical activity and lower rate of obesity compared with the entire state, however, the rate of overweight or obese people has increased to over 50 percent in the last few years, with over 250,000 residents within this health bracket. Exercise can often be expensive; not everyone has the time or money to hit the gym five times a week. But with the Gold Coast’s safe, social and stunning environment, and its huge range of free outdoor and community-run exercise activities, everyone has the opportunity to improve their health, get fit and make new friendships. Here are some of the city’s best free exercise options that are fun for all ages and adaptable to all levels of health. pm
Bushwalking
Surfing
As well as its beach-life personality, the Gold Coast also has a greener side, with 49 percent of its land being native vegetation - part of that being the Heritage-listed Gondwana rainforest and the Ramsar Convention-listed coastal wetlands of southern Moreton Bay. Pack a light lunch and your walking shoes for a day of hiking one of the region’s magnificent national parks, such as the Gold Coast Hinterland Great Walk or Binna Burra in Lamington National Park. The Bushwalkers of Southern Queensland Inc (BOSQ) is one of the state’s major bushwalking clubs and organises a number of bushwalking activities throughout the year between Fraser Island and northern New South Wales. Trips vary on levels of fitness, distance and terrain and membership is for all ages. Visit www.bosq. bwq.org.au for more information.
Know someone with a surfboard? Maybe a neighbor with a paddleboard? Or if you just like to paddle around on a boogie-board, getting among the waves is a fantastic way to exercise at no cost! The Gold Coast is a surfing mecca and attracts learners and pros alike from all over the world, so go with the flow and hit the ocean! Even without standing up, all the swimming, maneuvering and paddling is a great cardio and muscular workout and a fun time spent with family and friends. Beginners should try to use a bigger board for balance, and always go with someone experienced in surfing or swimming for guidance and safety, in patrolled conditions.
Walking & Cycling on the Oceanway As the saying goes, every step counts towards better health. Count those footsteps along the Gold Coast’s magnificent oceanway and enjoy a relaxed outdoor journey that fringes the city’s iconic white-sand beaches. The 36-kilometre oceanway path is broken into nine distinct zones and includes a number of stunning ocean viewpoints, parks and barbeque areas. On foot or by bicycle, the oceanway is a great way to begin a new fitness regime or do some intense training, individually or in groups. Setting distance goals and measuring progress is easy with the frequent landmark posts. In connection with the Heart Foundation and the 10,000 Steps Australia Campaign, the Gold Coast City Council facilitates social walking groups and encourages daily exercise through community gatherings and online support services. Walking and cycling are also great ways to get to work for free! Map your walk or ride with www.mapmyride.com and track your progress.
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Public Exercise Equipment To break up a run, or mix up the workout, exercisers have access to a range of stimulating and challenging fitness circuits that are located in eleven different parks along the coast. Create your own routines or visit www.gcparks.com. au for explanations of use and suggestions, keeping in mind that equipment varies between each park. Across the locations, equipment includes ab-hip swingers, steppers, cross trainers, rowing machines, cycle seats and push up and sit-up boards among others.
Yoga and Pilates Bend and stretch your way to better fitness with the following free yoga and pilates classes on the Coast. Surfers Paradise Pilates Tuesdays 5.15pm November-March On the foreshore at the end of Cavill Ave Essence of Living (07) 5526 6600 Southport Pilates Thursdays 5.15pm Southport Broadwater, Parklands Essence of Living (07) 5526 6600 Yoga Thursdays 9.15am Southport Community Centre, 6 Lawson Street Australian School of Meditation and Yoga (07) 5554 5440 Nerang Yoga Wednesdays 6.00pm Country Paradise Parklands, 74 Billabirra Crescent Australian School of Meditation and Yoga (07) 5554 5440 Currumbin Yoga Tuesdays 6.00am Let Wot Park, Teemangum Street Essence of Living (07) 5526 6600 Burleigh Yoga Saturdays 8.00am Justinâ&#x20AC;&#x2122;s Park, The Esplanade Australian School of Meditation and Yoga (07) 5554 5440 Yoga Sundays 11.00am Fradgely Hall, Park Avenue (above library) Essence of Living (07) 5526 6600 Jacobâ&#x20AC;&#x2122;s Well Yoga Saturdays 9.30am Harrigans, Calypso Bay Marine Village Harrigans Lane Enhance Your Life PT 04315 753 930 Robina Easy Yoga Tuesdays 9.00am Robina Community Centre, Robina Town Centre Drive Australian School of Meditation and Yoga (07) 5554 5440
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As well as its beach-life personality, the Gold Coast also has a greener side, with 49 percent of its land being native vegetation...
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Escape O’Reilly’s at
Located in the World Heritage listed Lamington National Park, tucked away in the Gold Coast Hinterland, O’Reilly’s Rainforest Retreat, Villas and Lost World Spa truly is the ideal getaway to relax, revive and rejuvenate.
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he scenery of this luxurious resort is reminiscent of a real-life Fern Gulley fairy tale, encircled by an ancient rainforest dripping in fresh water and shards of sunlight, and echoing nature’s call in the crisp mountain air. By evening, as the darkening mountains emboss against the sky’s luminescent red fabric like coal on a fire, the forest begins to sleep under a sky of ink and twilight. O’Reilly’s location is telling of its owners’ passion for ecotourism. Outlined by 160kms of walking trails and over 500 crystal waterfalls, the retreat, which is owned and run by the ecotourism pioneering O’Reilly family, shares its home with over 250 species of Australian wildlife. O’Reilly’s has become renowned for its fantastic
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and uniquely Australian hospitality for over 85 years, rendering itself an international benchmark for ecotourism and relaxation retreats. The retreat harmonises the traditional warmth and charm of a small guesthouse with the vanguard design of a modernistic tree house, making it both visually captivating and addictively cosy. The retreat focuses wholeheartedly on nature, and packages include early morning bird walks, afternoon rainforest walks and evening audio-visual presentations. To punctuate each activity with a note of relaxation, each day includes country style morning and afternoon tea. Located just 500 metres from the Retreat, O’Reilly’s Villas are luxurious self-contained two and three bedroom villas with rainforest or valley views. Each villa features a full kitchen, lounge and dining area plus large balcony
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with spa, and every bedroom has its own ensuite. This allows for privacy and space among families and couples travelling together. While the surrounds quench your soul’s thirst for a reconnection with the earth, O’Reilly’s Lost World Spa awaits to sooth your body via therapeutic rejuvenation and relaxation. Lost World employs the internationally adored chemical-free Sodashi skin care range, which originates from Freemantle, WA, as well as unique vinotherapy treatments with O’Reilly’s vineyard grapes. The Spa’s highly skilled, sensitive therapists embrace the visitor in a world of leisurely detachment, and have them leaving in a state of total untwine. Back on the search for action, one can undertake O’Reilly’s ‘Discovery Program’, operating daily, which includes guided rainforest walks, 4WD bus excursion,
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adventure activities, spotlighting and glow worm tours. Though this luscious valley getaway seems worlds away, O’Reilly’s is just a small two-hour drive from Brisbane and one and a half hours from the Gold Coast. There are also transfer services available on request. O’Reilly’s Canungra Valley Vineyards, located at the base of the mountain, is a boutique vineyard dedicated to the enjoyment of food and wine. Enjoy the ambience of the historic Queenslander homestead, indulge in gourmet picnic baskets by the creek or sample internationally award-winning wines at the Cellar Door. This retreat is heaven on our South East Queensland doorstep. From its luxury interiors to the finer details in its breathtaking natural setting, O’Reilly’s was built seamlessly into its landscape for a holiday marked by escape, experience and connection. pm
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HONG Kong
HIGH Story Amanda James
Owing to its historically diverse past, and arguable position as â&#x20AC;&#x2DC;the New York of Asiaâ&#x20AC;&#x2122;, Hong Kong makes for a rich and combustible melting pot.
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t’s fast and fascinating. A city with the world’s third highest population density, one comprised of cultures, both domestic and international. It’s Eastern and western, new and old, and together a space, that over time has evolved into one rich with offerings. They’re offerings found in many of the city’s sectors, and combine to create a layered effect. It’s one that makes the city a favoured destination for all for the opportunities afforded to the visitor. Whether seeking modern or traditional, active or leisurely, chic or crazed, Hong Kong provides it all.
SHOPPING
Pack an empty suitcase, for the opportunities to spend regardless of budget limits/limitations are endless. Those looking for serious retail respite should make for the IFC Mall. It’s a mecca for every covetable high street and luxury brand, with the pinnacle, Lane Crawford on the top floor. The department store’s beginnings date back to 1850 and today it serves as one of the finest examples of ‘retail detail’ with every section an edit of all that’s globally cool. Brands are crossmerchandised which only heightens their appeal, with the contemporary sitting alongside the classic, and the bold with the elegant. Appealing too, is the famed Shanghai Tang. Owned by Sir David Tang, it’s an institution and the birthplace of the coined term, ‘Chinese chic’. It’s a style applicable to both the home and self, and one Tang’s also applied to his latest venture Tang Tang Tang Tang, a renovated colonial style building on Johnston Road, that was designed to make the shopper envision they’re walking
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through their own home. It is (or will be soon) one appointed with silver, silks and china aesthetically and historically sourced. For the cool and eclectic, head to Star Street Precinct and browse the small lanes that entwine and boast hip offerings like the very cool Monocle and Russel Street – stocked with labels like Victoria Beckham, it’s for the true fashion fiend. No trip to Hong Kong would be complete without a day of market bartering, and it’s best to seek yours across the border in Shenzen. You can pick up a visa for the day when you arrive. Renowned for its abundance of counterfeit goods, the surrounding area is a manufacturing hot spot, meaning almost anything you desire, from electronics to tailor made leather goods are available here. But if you are after authenticity and fine antiques, head for Hollywood Road where the transactions take time and wares will be shipped carefully to your home under the direction of long-time owners.
DRINK
Hong Kong holds no shortage of bars but for the more discerning drink surrounded by an equally discerning crowd, head for Duddell’s. From the interiors to the service, it’s all so slick. However, if you desire an impressive view of that famous skyline and harbour as part of your pre or post-dinner drink, Sevva Bar or Woolamaloo will exceed expectations. And, as you’d forecast with spanning vistas, so too the prices. Those looking to drink without fuss and budgetry implications should begin their night at the intersection of Peel and Staunton streets. From there it’s an easy stroll through this gentrified neighbourhood, choosing bars that beckon at will. They’re all different, but bound by a somewhat
nonchalant and carefree nature. Or for a more boisterous experience, and one you’ll possibly find a little hazy to recall, the lane of Lan Kwai Fong, answers.
ACTIVITY
Since 1928, The Peninsula Hotel has served as the city’s finest beacon of hospitality. It’s a reputation derived both for its rich history (the British surrounded to the Japaense on the third floor in 1941), opulent surrounds and sky-high tariffs. It’s a must visit, however fortuitously you need not be a guest to experience the grandeur. High tea served from 2pm each day offers the perfect, and more pleasantly priced excuse to experience this opulent oriental gem. It’s a nod to the days of old. The tea selection is exquisite and spending an afternoon working through a tower of finger sandwiches, scones and other tiny treats, really equates to a true vacation experience. Hiking sits at the other end of the spectrum. And with 40 percent classified as parks or reserves, the opportunities to pound the surrounding peaks (and perhaps work off a little indulgence) are numerous. Twin Peaks makes for a steep venture, but the descent into Stanley Fort, a former British administrative post, truly delivers on the energy expended. It’s a rewarding experience and so too the lure of a seafood centric lunch on the water. While the city affords many opportunities, gambling isn’t one of them. Ergo, on a Wednesday evening, the Hong Kong Jockey Club becomes crammed with those looking to take their chances, and take home some hefty winnings. Interestingly and to attach some scale to the size of the operation - the monies streaming through the club on just one Wednesday night, far exceed those taken during
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A city with the world’s third highest population density, one comprised of cultures, both domestic and international.
Flemmington’s entire Melbourne Cup Carnival.
CULTURE
For an educational experience, work your way from the ground to the top of the Hong Kong Museum of History. It’s chronologically ordered, and guides patrons up and through the area’s diverse past, via interactive and aptly curated spaces. Linger in The Opium Wars and cessions of the City exhibitions – they’re rich with photographs, artefacts and film. For a unique, and slightly off kilter experience, make for the Medical Musuem. Housed in an Edwardian style house, it’s a unique institution that charts the historical development of medical sciences in Hong Kong, and documents the interface between Chinese and Western medicine. Glass jars, instruments and a medicinal herb garden abound. It’s a cash heavy scene on the art front, and there are endless opportunities both to purchase and peruse works from the industry’s hottest talents. However, in mid May, the scene elevates when Hong Kong plays host to the internationally regarded Art Fair. It brings together a serious edit of the world’s leading galleries, and with them, the covetable works of their represented artists. The public programs add just another element to the fair, as well as the opportunity to fill your evenings with performances and parties – most of which are open to the public. The Hong Kong Museum of Art have made it their mission to preserve the cultural heritage of China, and have more than adequately delivered, with in excess of 16,000 art objects on display. Notable Chinese paintings, calligraphy works and antiques populate this harbour side building, and
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it’s easy to while away hours walking through the collections that boast great historical significance.
EAT QUICK
Opportunities to eat well and cheaply are in surplus, and none more so than on Wellington Street. On the noodle front, make for Mak’s Noodles. The line moves quickly as patrons are ushered in and out for bowls of egg noodles, blanched in clear broth and covered with various toppings. The beef brisket is excellent. Across the street sits Tsim Chai Kee, and while younger than Mak’s, they’re fast amassing a reputation for their similar fare – the bowls might seem small, but are ladled thick, and at roughly $3AUD per person, great value. Nha Trang, is another eatery graced by lines and deservedly so, for their traditional Vietnamese fare is clean and crisp, and the fresh coconuts cold – a welcome option in the humid months. Further along the street and up the stairs lies Ling Heung Tea House. A favourite of locals and clued-in expats, and the bowls of Cantonese fare are arguably some of the best in the city. The minced pork and braised eggplant hot pot is delicious. And crave inducing. Like all great food cities, pop-up eateries abound, and it’s wise to follow the location of Mina Park’ Sook. Her Korean style tacos, filled thick with gorgeously marinated meat and topped with Kimchi are a revelation, so too the service and home made vibes. Cha Cha Wan (under the direction of restaurant entrepreneur Yenn Wong) is frequently visited by the cool and clued in, who line up to nab a table for plates of Issan style, Eastern Thai cuisine. Forget heavy curries, the dishes are refreshing, light and
really pack a kick, as do the cocktails a punch. It’s the cheapest Michelin meal you’ll ever have. For years Tim Ho Wan have been long billed as the “dumpling specialists”, and since inception have expanded into several locations and countries. However, you can’t beat an original, and for an eye-opening and bustling experience, grab a taxi and make for their Mong Kok eatery. It’s packed with locals, and visitors are a rarity, albeit a welcome one, with frequent customers advising their new neighbours what to tick on their order form. A true dim sum experience, with servers bringing out new dishes every few minutes. The pork buns can only be described as heavenly, and to not have one, would equal absolute sacrilege.
LONG & LEISURELY
The city is heavy with restaurants sporting Michelin stars. However, for an experience that’s more traditionally tailored, and dishes you won’t experience anywhere else, book into Bo Innovation. Headed by ‘demon chef’ Alvin Leung, it operates according to the uniquely coined philosophy of “X-treme Chinese cuisine”. Chinese ingredients and recipes centuries old are transformed by Alvin and his team to yield dishes that acknowledge the ingrained, but welcome in the organic and new. Or for the finest feast of roasted duck and hand made noodles, head to The China Club. There’s a strong sense of tradition, with the service sleek and the interiors transportative to the glamour days of 1930s and 40s Hong Kong. It’s members only, and a word to the wise, you’ll need a reservation made by a clued in and connected concierge. Alternatively, call the club and plead your case. They’ve been known to waiver. pm
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Berlin or Bust Pindara Private Hospital’s Business Development and Marketing Manager, Robbie Falconer, shares her recent travel experience to Berlin with us.
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e Australians tend to have a certain version of Europe. As our excited pre-holiday fingers trace over the European map, we envision the ideal experience typified by Lonely Planet travel guides and National Geographic programs. And our expectations of following a similar script run high. On my recent Deutschland adventure, I explored two of Germany’s major cities, Berlin and Munich, and I found expectations can potentially distract us from fully enjoying the real experience of a place. So I have come to the conclusion, sometimes it is best to put our expectations on hold, simply follow the map and let the country, or in this case, the cities do the talking. I was really excited to be visiting Berlin. Everything I had heard and read about this famous city was articulated by words like “cool”, “hip” and “high art,” so my expectations were high. My expectations of Munich, on the other hand, were different. I had visited Germany’s third largest city years ago, but could not recall anything about Munich other than the substantial hangover I had back then. My real plan was to spend my few days in this part of Germany travelling the Alpine area, as the city is around 50 kilometres north of the cragging borders of the Alps, before then travelling onto Berlin. Perhaps the overindulgence in German beer all those years ago was to blame - or perhaps my age and life experience have refined my interpretative lens - whichever the case, these days Munich is a much more memorable city than I had credited. While not the most bustling, electric city I have visited, it certainly has a lot of personality and charm. As the capital city of the state of Bavaria, Munich showcases the best of Bavaria. The city was named in reference to the region’s Benedictine monastry, and has a long and significant history. Sightseeing includes interesting (old and more recent) historical sites and buildings, beautiful gardens and of course the delightful Isar River that cuts through the middle of the city. City streets are picture postcard pretty, with many
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punctuated by beautiful trees, flower beds and window boxes of floral colour. For foodies, there is plenty to indulge. The variety and choice of culinary delights and dining experiences are excellent. Whether your preference is for the traditional beer halls that swill with rosy-cheeked cheer and chatter as regulars and tourists enjoy the local beer, roasted meats and piquant ginger-bread, or the contemporary upmarket version of this Bavarian dining experience or simply a small family operated restaurant with inexpensive home style fare – Munich has it all. The city also caters well for those in need of a heavy dose of retail therapy. Munich has shopping for every taste from high end luxury to tourist souvenier. Its refinement is completed by a super-efficient and clean public transport system, which makes it very easy to get around. If satisfaction is the gap between expectation and result, then Munich completely filled that gap and to my surprise I was blown away by its harmonious environment and traditional vibe. Next stop, Berlin. Touching down on the tarmac at West Berlin airport, I readied myself for a clean and quick terminal-to-tourism transition, similar to my
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Munich airport experience. Instead West Berlin airport welcomed us with a shock of bodies, colour and noise. Leaving the airport we were confronted with a myriad of faces and a blurred palette of fastmoving colour. The indifference of our taxi driver, whose lead-footed driving sent us sliding over the seats, and seeking an introduction to the city out the the window. The passing scenery morphed from derelict buildings splashed with graffiti to glamorous contemporary structures, sharply intercepted by flashes of steely blue water and soft emerald green patches of forest. Finally we entered Marienstrausse, a quiet cobblestoned street in the Mitte area. This area is known as a historial melting pot of the former West and East Berlin districts. It harbours immense historical and touristic value, including the Museum Island, Brandenburg Gate and Potsdamer Platz. Our friendly host handed over the keys to our lovely two-bedroom apartment, and we were delighted to find it was equipped with every modern convenience. Sightseeing was a breeze from our central location. A five-minute walk across the River Spree was the famous Unter den Linden with
the Brandenburg Gate, Reichstag and various Parliamentary and Embassy buildings at one end, and the Humboldt University, among other significant sites, at the other. A fifteen minute walk along Friedrichstrasse, once the main shopping strip in East Berlin, past modern retail icons such as Galleries Lafayette and Quartier 206, was Checkpoint Charlie and the remnants of the Berlin wall; a stark reminder that the unified Berlin is only 26 years old. Following the line of cobblestones that indicate where the famous Berlin Wall once stood, we encountered fading old and stunning new buildings standing side-by-side, surprisingly interspersed with an occasional overgrown vacant lot. The stark vacant lots reflect the reality of Berlin’s (modern) history. More bombs were dropped on the city in the last weeks of WWII than during the entire war. It seems live artillery shells and bombs are still found regularly in areas of Berlin, especially on these vacant lots, and the city employs a bomb demolition team which reportedly defuses a bomb per day. For lovers of architecture, there is plenty to admire, especially the differentiation between modern refurbishment and the historic landmark. The Reichstag is a perfect example. Badly damaged at the end of WWII, the Reichstag was remodeled in 1990 by English Architect Norman Foster and the results are stunning. The other newly built contemporary buildings closeby are equally as striking and new infrastructure projects such as a subway (currently under construction) beneath the Unter Den Linden give a glimpse of the spectacular that will be Berlin in the not-sodistant future. On the surface, the shopping seems glamorous. Most of the big names in retail have a presence in either the Kurfürstendamm, Berlin’s most popular shopping street, or around Friedrichstrasse and Hackescher Markt, the East’s up-and-coming shopping areas. But maybe it was the time of year, or the recent end-of-season sales, but the range
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The passing scenery morphed from derelict buildings splashed with graffiti to glamorous contemporary structures...
of goods available in the shops seemed limited. Berlin’s topography is flat. As Germany’s largest city it spreads out over nearly 900 square kilometres of which one third is covered by forests, parks, gardens, rivers and lakes. Geographically, the city sprawls across low-lying marshy woodlands. To prevent its buildings sinking into the marsh, large metal drain pipes, painted in bright colours, meander through the city to drain underground water away into the River Spree. The river Spree forms a major navigation network through Berlin, and a rivercruise is arguably the smartest way to absorb it. A short cruise will take you past Berlin Cathedral (Berliner Dom), the Reichstag, the Schloss Charlottenburg and the renowned Museum Island (Museumsinsel), with its collection of five major museums. A longer cruise will take you past make-shift beaches and abandoned buildings converted into night clubs by Berlin’s cutting-edge entrepreneurs, and the Badeschiff, a floating swimming pool moored in the Spree. Looping though residential areas, the boat enters a living postcard framed by lush tree lined river banks, shimmering water, low bridges and languid sunbathers. Through the city’s conservation of old infrastucture and its continuous evolution of head-turning architecture, Berlin’s history is woven seamlessly into the present, cloaking the visitor in two eras. A tour of the underground bunkers provides thorough insight into the life of pre-WWII Berlin as well as the period during the war. The tour especially outlines the final weeks leading up to Berlin’s bombing, a chilling reminder of the event’s proximity on the modern history timeline. Despite the swarms of cameraarmed tourists, visiting the Berlin Wall is still a sobering experience and enough to cast a reflective shadow over the rest of the afternoon. At this point in its history, it seems Berlin is still a city of contrasts. It’s almost like a city just out of a turbulent adolescence, and its acne scars and attitude give an arresting rawness and
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roughness. Whilst Berlin is cracking its knuckles and turning up the volume Munich, on the other hand, offers a comfortable, slower-paced German experience. Like a pair of siblings in a diverse extended family, Berlin and Munich are equally and unexpectedly loveable in their own ways. Reflecting back, I realise our expectations might define our attitude on meeting a place, but our actual experience cannot withstand the allure of an intriguing history, hospitable culture and generous language, nor can it resist the seductive power of breathtaking beauty, architectural landmarks and a frosted stein of German beer. “Proust” to Germany, I will be back, but next time I will leave my expectations at home. pm
Brandenburg Gate
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MOTORING
X-CITING ARRIVAL BMW welcomes all-new addition to the family.
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Spring - Summer | 2014
MOTORING
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ts signature BMW X features, unmistakable coupe character, distinctive design and excellent dynamic ability make the new BMW X4 set to build on the success of the X6, as well as offer a unique vehicle to this segment. The BMW X4 creates a whole new proposition for sports-minded customers seeking action as well as high versatility. “The new BMW X4 is based on the technical blueprint of the BMW X3, but exhibits a sporty character with a generous level of standard specifications. It’s very much its own,” Bruce Lynton Group’s Dealer Principal Beric Lynton said. Style is a high point of the all-new BMW X4. The distinctive front face of the new model guarantees its immediate recognition as a member of the BMW X family. Light bands around the outer edges of the headlights are slightly flattened at the top and back, creating a broad appearance. The distinctive radiator grille surround in chrome and the large front air inlets underline the X4’s sporting potential. In profile, the low coupé-style roofline extending into the rear is a distinctive feature, which places the BMW X4 in a class of its own. The generously sized interior of the BMW X4 combines sportiness and exclusivity with high-level functionality. Every BMW X4 comes equipped with 40:20:40 split fold rear seats that allow for a flexible luggage compartment
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capacity of between 500 and 1,400 litres. A storage compartment package with a range of handy storage and luggage carrying features is also standard. Every control element optimises driver ergonomics. The xDrive status display identifies the BMW X4 as a member of the BMW X family. Occupants in the BMW X4 enjoy a slightly elevated seating position compared to the BMW X3, with increases of 20 and 28mm in the front and rear seats. This conveys a sportier seating experience and comfortable headroom in the rear despite the roofline being 36 mm lower. The rear seat bench has two elegant coupé-style individual seats but still provides enough room for up to three passengers. The BMW X4 will launch with four powerful engines – two petrol and two diesel units – all with BMW TwinPower Turbo technology. All of these engines excel with their tremendous revving ability, spontaneous power development and convincing refinement. All BMW X4 models are fitted with an eightspeed automatic transmission - sports automatic transmission in the case of the X4 xDrive30d and X4 xDrive35i- and include gear shift paddles on the steering wheel. Pricing on the new BMW X4 clearly demonstrates the German manufacturer’s commitment to offering high vehicle content at increasingly attractive price points. The new BMW X4 builds on the
recent value improvement of the BMW X3. The entry level X4 xDrive20i and X4 xDrive20d are priced at $69,900 and $73,400, and offer exceptional levels of standard equipment, including a host of extra features (valued at more than $9,000) over their equivalent X3 models. Standard features that highlight the dynamic credentials of the BMW X4 include Performance Control and variable sports steering, both of which combine to enable a higher level of dynamic cornering and handling with maximum grip, excellent directional stability and a very high degree of steering precision as well as comfort when parking. Other standard features include 19-inch Y-spoke alloy wheels, xLine exterior and interior design
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MOTORING
scheme, two zone air-conditioning including rear air vents, leather upholstered sports seats with lumbar support and electric adjustment for the front seats, memory function for the driver and sport leather steering wheel with gear shift paddles. It also includes Bi-Xenon headlights with LED daytime lights, LED fog lights, lights package including exterior door handle lighting, USB, Bluetooth with audio streaming, Voice Control and pairing of multiple phones, Navigation Professional with large 8.8-inch screen and 20GB hard drive for audio files, as well as Intelligent Emergency Call and Teleservices. Cruise Control with braking function is also in the new vehicle, with front and rear parking
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sensors, rear view camera and automatic tailgate. The value story is similar with other variants in the X4 range. The X4 xDrive30d, at $83,900 also adds Surround View with 360 degree visibility with help from cameras in the exterior mirrors, a wide-angle camera in front and the Rear View camera, exterior rear view mirrors with anti-dazzle and fold-in function, dual round exhaust pipes, nine-speaker seven-channel HiFi loudspeaker system and Dynamic Damper Control, which can adjust the damper characteristics to suit the driving conditions, road quality and customer preferred settings. Claiming its position at the top of the range at $87,900 is the X4 xDrive35i. As one may expect
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AT A GLANCE BMW X4 xDrive20i 2.0-litre four-cylinder petrol engine 135 kW, 270 Nm 0–100 km/h in 8.1 sec 7.2 l/100 km CO2: 168 g/km from the premier model of a Sports Activity Coupe, it comes resplendent with features befitting its position and dynamic nature. Enhancing the sporty character of this top model is the standard M Sport package. This includes 20-inch M double spoke alloy wheels standard, sport suspension settings for the standard Dynamic damper control, M aerodynamics package, anthracite roofliner, M designated door entry sills and leather M steering wheel, as well as highgloss shadowline exterior trims and aluminium interior trim. Further boosting the value of the X4 xDrive35i over the xDrive30d are features like the top-end 16 speaker harman/kardon sound system and comfort access, which enables keyless entry to the vehicle including tailgate. The new BMW X4 models’ maintenance requirements are controlled by BMW’s Condition Based Service (CBS) program, which identifies the condition of a vehicle based on actual use, realising the full potential of a vehicle and minimising costs. Under the CBS system, sensors and advanced algorithms monitor and calculate the conditions in
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which the vehicle is used including mileage, time elapsed since the last service, fuel consumption and how the vehicle is driven. The information captured is used to determine the vehicle’s maintenance requirements, indentifying that either an annual vehicle inspection or an oil service is due. In addition, BMW service and selected maintenance costs can now be covered by a single, one-off advance payment with BMW Service Inclusive (BSI). BSI offers two packages; BMW Service Inclusive Basic provides scheduled servicing cover, while BMW Service Inclusive Plus combines scheduled servicing and selected maintenance items. Based on individual lifestyle needs, a year range and kilometre option is selected, starting from three years/60,000kms. The BSI plan provides a long-term solution enabling cover to be extended and transferred to future vehicles owners before expiry. The all-new BMW X4 is available to test drive at Bruce Lynton today. pm
BMW X4 xDrive20d 2.0-litre four-cylinder diesel engine 140 kW, 400 Nm 0–100 km/h in 8.0 sec 5.2 l/100 km CO2: 138 g/km BMW X4 xDrive30d 3.0-litre six-cylinder in-line diesel engine 190 kW, 560 Nm 0–100 km/h in 5.8 sec 5.9 l/100 km CO2: 156 g/km BMW X4 xDrive35i 3.0-litre six-cylinder in-line petrol engine 225 kW,400 Nm 0–100 km/h in 5.5 sec 8.3 l/100 km CO2: 193 g/km For more information visit: www.brucelynton.com
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Boating
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boating
Boats of
Integrity Story Warren Steptoe
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Boating
T
he recent sale of their 50th boat is a clear indication of how well established Integrity Motor Yachts are as THE leading displacement hulled cruising motor yacht in Australia. Although they’ve only been available in this country for a relatively short time, Integrity’s relaxed and comfortable, yet entirely practical style of boating is so suited to Australian waters. The marque was an overnight sensation at the prestigious Sanctuary Cove International Boat Show just three years ago, and has gone forward from there! Southern Moreton Bay and the Gold Coast are the perfect cruising grounds for the entire Integrity range, all of which feature a sturdy full-length keel which very effectively shelters the propeller and rudder from the sand banks
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so ever present here. These are displacement hulls which cruise at 8-10 knots on the smell of an oily rag, much admired for their understated superstructure and a bottom shaped to blend the type of seakindly manners essential for comfort during long coastal passages, with the rock solid stability underfoot that endears them to the social set and nervous crew alike. Quite a few Integrity motor yachts belong to boating couples who find they happily handle their boat without assistance while setting ground tackle and docking. Wide side decks secured by high sides and a stout rail make the boat’s entire periphery instantly accessible. Beside the helm a large sliding door means it’s two short steps to a dock once alongside, and powerful thrusters make it simple to get alongside in the first place. Experienced boaties delight in their
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user friendliness; people just getting into boating find Integrity yachts a very easy boat to learn to handle. Gaining confidence is facilitated by Integrity’s Australian distributor who runs tours escorted by an experienced skipper to places like Great Sandy Straits and northern Moreton Bay. Two recent trips to wonderful destinations were a great success, with the Great Sandy Straits tour lasting a full 10 days. Boating aspects entirely aside though, it’s probably two things that sell most Integrity yachts: a full-length hardtop that extends all the way to the transom and out to the sides of the boat, and a very cleverly designed aft cabin bulkhead. The two blend to offer unmatched versatility in indoor and outdoor living, and combinations thereof. Aft of the cabin and salon, the stern
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area features a spacious cockpit lounge with contemporary upholstered seating and a drop down table. Not to mention an open swim deck on the outside of the transom, kept safe for kids playing in the lounge by a childproof transom door. This lounge can be maintained as an outside living space separated from the salon’s airconditioned interior. Or alternately, with a set of ingenious multi fold doors comprising the aft cabin bulkhead opened and secured, the cockpit lounge and salon become one big open-plan single-floor entertaining space, while the galley benchtop becomes a handy servery. Versatility can be extended even further by fitting camper covers to the underside of the hardtop. Integrity’s camper covers have large zipped windows and curtains for the side decks, which close up tight to weather proof the cockpit
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Youâ&#x20AC;&#x2122;re in safe hands at Short Street Day Surgery Ophthalmologists Dr Robert Bourke Dr Frank Howes Dr Darryl Gregor Dr Jon Farrah Dr Alan Hilton Dr Matthew Russell
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boating
lounge and allow the interior’s air conditioning to control the climate throughout the boat. Unzipped, the windows reveal insect screens for times when air movement is preferable, but isn’t perhaps such a great idea due to the presence of annoying insects - a not-so-unusual occurrence in boating. Forward and downstairs, various Integrity models offer several variations in sleeping accommodation. Basically they all have a master stateroom with a double bed, while the guest bedroom can be set up with a double bed, or a bunk style layout. Integrity pride themselves on a certain flexibility here, recognising that different people have differing ideas about how their boat should be. In every case, the dinette lounges in the salon
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and cockpit can be converted to bedding to sleep extras aboard when necessary. At present, Integrity Motor Yachts come in two types: sedan style cruisers, and flybridge boats. Their salon level and sleeping deck floorplans are identical, but flybridge models have an upper helm station and surround the hardtop with a waist high stainless steel rail to add an open air ‘upstairs’ living space to their entertainment options. People who have no need for all that additional living space, and those who must negotiate low bridges on their way to favoured cruising destinations, happily opt for sedan models. Sedan model Integrity motor yachts are currently available in 340, 380 (the first two numbers are
the boat’s approximate length in the old fashioned feet still favoured by the marine industry, so a ‘340’ is a nominal “34 footer,”) and 440 sizes. In flybridge models there’s a single ‘380’ size available at present, with a ‘450’ Flybridge and a flagship ‘490’ Sedan soon to be released. An all new ‘320’ Sedan is scheduled for release in November this year. The new 320 is an entry level model expected to sell for as little as $299,000AUD while maintaining features like the full length keel and multi fold salon doors now synonymous with Integrity. Integrity boats come with a full factory backed warranty serviced in Australia by a nationwide dealer network. pm
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Gizmo guide
Fujifilm Instax Neo Classic Instant Camera
RRP $219.00 This fun sized instant camera allows you to take expressive and unique Polaroid photos, printed right before your eyes! Including a high performance flash enabling you to capture background and subject in low light conditions, kids mode, double exposure mode and the newly equipped macro mode to enjoy stunning close up photography. SurfStitch www.surfstitch.com
Yonanas DesSert Maker
RRP $79.00 With Yonanas Fruit Dessert Maker it takes just minutes to make and clean up a healthy and delicious creamy low-cost frozen treat. With several possible combinations your fruit will be made into a beautiful dessert in no time! Target Pacific Fair Shopping Centre Hooker Boulevard, Broadbeach (07) 5553 2600
gizmo guide
Wearables - Samsung Gear 2
RRP $369.00 When you canâ&#x20AC;&#x2122;t use your phone, the Samsung Gear 2 is right there for you. It makes communication smooth and effortless by allowing you to make and receive calls, check messages, and view notifications directly on the large Super AMOLED screen. As well as this, the Samsung Gear 2 allows you to track your fitness status in real time with its built in heart rate sensor and pedometer, control your devices such as your TV or set-top box and even capture precious moments with itâ&#x20AC;&#x2122;s built in FHD still shot and 720p video recording, plus much more. Telstra Shop 2015 Robina Town Centre, Robina Parkway, Robina (07) 5578 8155
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Gizmo guide
LG Pocket Photo Smart
RRP $179.00 LG’s Pocket Photo is the perfect way to turn your photos into a keepsake. Now your beautiful moments don’t need to stay hidden in your smartphone. Print it out and bring it to life. Enjoy editing and sharing photos whenever and wherever with the smart mobile printer, the LG Pocket photo! JB HI-FI 53 - 57 Upton St, Bundall (07) 5561 0703
Beats by Dr. Dre Solo2 On-Ear Headphones
RRP $259.95 Apple - Livescribe Echo Smartpen
RRP $169.95 The Echo smartpen records everything you hear and write, so you can find what you need with a simple tap. Ideal for meetings, conferences, or classes, this compact tool is as easy to carry as traditional pen-and-paper, but smarter. Replay your recorded audio anytime, anywhere, with a quick tap on your notes.
A complete update of Beats’ most popular model, the Beats by Dr. Dre Solo2 headphones offer improved acoustics, a wider range of sound and enhanced clarity for all the music on your iPhone, iPad or iPod. They also deliver even greater comfort thanks to a streamlined, lightweight and durable design. Apple Store Robina Robina Town Centre, Robina (07) 5667 0400
Apple Store Robina Robina Town Centre, Robina (07) 5667 0400
Leap Motion Controller
RRP $129.98 In Airspace, the Leap Motion App store, you’ll find a wide variety of specially designed free and paid apps for gaming, music, art creation, science, productivity and much more. Apps from the Airspace app store let you interact with your computer just by moving your hands through the air. To get you started, the Leap Motion Controller comes with a free set of apps. Dick Smith Shop G100 Australia Fair 42 Marine Parade, Southport (07) 5528 0242
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MOVIES
out now
Edge Of Tomorrow
Godzilla
Blended
What’s it about?
What’s it about?
What’s it about?
What did we think?
What did we think?
A non-combat officer finds himself caught in a time loop during a war with an alien race. He combines with a special forces officer but will it be enough to save the world? It’s Groundhog Day mashed with Independence Day and yes it works. With more laughs than I would have expected, the latest Tom Cruise sci-fi offering has a great balance of action, good characterisation and interesting plot. Emily Blunt is amazing and it has to be said Cruise plays the unlikeable Major/Private Cage really well. The story is really well told so the repetition doesn’t (quite) grate and you’re not actually quite sure how it’s going to end, which is a nice change. Good action and effects round off a highly polished piece of entertainment, And even anti-Tom Cruise fans should enjoy it as they at least get to watch him die a hundred or so times.
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Journalist and movie critic, Anthony Sherratt, shares his (very) honest reviews of the latest movies on DVD.
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A natural disaster that isn’t actually natural sparks off a chain of events, which leads to a giant monster that could spell the end of the world for humanity. The new Godzilla is like a one-night stand. It’s fun and exciting while it lasts, but the next morning you have questions and thoughts that are generally unsatisfying. Great effects and the best finishing move of all time (OF ALL TIME) mask some deficiencies in characterisation and story. The main ‘hero’ follows a journey of interconnected events that is beyond the belief of even someone who’s happy to believe in giant monsters. But for those who do, it isn’t about the frailties of the script, it’s about the giant lizard. And although we don’t see enough of the big guy, what we do see is simply good fun. There are some good twists (avoid spoilers beforehand if you can) and some genuine respect and love for the character and its history but just don’t think about it too much.
A series of highly implausible coincidences sees a widower (Adam Sandler) and his three daughters forced to share South African holiday accommodation with a divorcee (Drew Barrymore) who he went on a terrible blind date with and her two sons. Predictable hijinks and the titular “blending” of the families ensue.
What did we think?
I want to use the phrase ‘poor person’s Brady Bunch’ but that would be doing a disservice to a successful television show. There is nothing successful about Blended. It is a painful 117 minutes of generalised jokes about gender, and race stereotypes. Oh and the obligatory gross-out comedy moments of course. Trying to recreate the previous chemistry Barrymore and Sandler shared on-screen seems logical. Using this script is anything but. Blended was an early contender for worst film of the year before the new Transformers movie stole three hours of my life without providing a plot in return.
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MOVIES
Maleficent
The Monuments Men
What’s it about?
What’s it about?
Disney steal the concept of Wicked by telling the story of Sleeping Beauty from the perspective of the villain Maleficent.
What did we think?
Definitely not for kids and with a story not strong enough for most adults, it’s unclear who the target audience for Maleficent really is. Die-hard Disney and Angelina Jolie fans will certainly flock to it but the many faults balance out the majesty of the effects and performances. The failure to commit to making Maleficent actually evil really robs the movie of any gravitas, as does the bizarre decision to make the three ‘good fairies’ bumbling idiots. An adversarial relationship there alone would have strengthened a film sadly lacking real backbone. Long story short, it’s not actually a bad movie (I did enjoy it) but those who haven’t seen the original Sleeping Beauty would love it much more.
George Clooney, Matt Damon, Bill Murray, John Goodman etc and company go undercover to save art from Hitler. Based on a true story.
What did we think?
It’s bizarre that such a star-studded film manages to actually NOT grab you. Despite the charm of Clooney, most people will struggle to really find anything in Monuments Men worth watching. Even the supposedly impassioned speech justifying risking lives for art came across as juvenile rather than inspiring. What we’re left with is a group of beloved actors romping through an unfunny homage to classic WW2 movies. Watching The Monuments Men feels like watching your dad and his mates acting out their tired stories. You’ll nod, you’ll smile — you might even chuckle once or twice — but you’ll be relieved when it’s over.
Grand Budapest Hotel What’s it about?
Zero Moustafa (Tony Revolori) a young lobby boy and Gustave H. (Ralph Fiennes) the legendary concierge of The Grand Budapest Hotel go on a series of adventures, as told by the Mr Moustafa (F. Murray Abraham).
What did we think?
Fans of director Wes Anderson will simply fall in love with his latest quirky film. All the normal elements of his movie making are present – colour, whimsy and a mindboggingly awesome cast backing up an engaging clever storyline. A chaotic collection of characters have you alternating between serious and surreal in a way that - if you like wacky - will leave a smile on your face for hours to come. Eloquent, off-beat and boasting the highest of production values, what’s not to love?
About Anthony
Anthony Sherratt lectures at university in Journalism, reviews movies and writes for various travel publications, all while caring for twins. He’s finally thankful for his insomnia.
Read more of Anthony’s reviews at superquickreviews.com
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FOREWORD
read...it
Favourites
Gary Mehigan
Support and Defend Tom Clancy
For another novel’s length, Mark Greaney has readers balancing on the edge of their seats through a whirlwind of action, espionage and narrative realism that whips the reader through Dominic Caruso’s deadliest challenge yet. As the series’ co-author alongside Tom Clancy, Greaney illustrates the peak of human desperation and danger. The plot follows a fugitive’s evasion of the CIA and Russian terrorist groups as he flees wtih a Microdrive with enough information to expose all of America’s intelligence efforts around the world. What will Caruso do to stop them without the aid of his Campus colleagues?
When it comes to mastering the kitchen favourites, sometimes it’s a good idea just to grab the wooden spoon and to leave the thinking to the experts! Australia’s Masterchef host and the legend behind Melbourne’s The Boathouse restaurant Gary Mehigan brings thirty years of industry knowledge to our tables. Enlivened with his fiery foodie passion and eye for quality, Gary offers tastes from his British childhood, his early cooking career in London and his exciting Australian timeline. Alongside classics like sticky-braised pork ribs and his wife and daughter’s home favourites, this kitchen go-to guide also has a series of mini-masterclasses covering areas like bread, chilies and tomatoes.
Will To Live
Matthew and Diane Ames Sometimes a lousy day at the office isn’t so bad when you can return home with a fully functioning body, something that Matthew Ames no longer has the privilege of. Matthew astounds and inspires as he recounts his contraction of severe toxic shock syndrome and the amputation of his four limbs. After being placed into an induced coma, Matthew’s wife Diane was faced with a decision of immense magnitude, but despite her husband’s one per cent chance of survival, she gave the radical operation the green flag. Matthew’s quick and resilient adaptation to his new life has amazed doctors and motivated thousands, as he radiates the message that when life gives you a challenge, you’ve got to step up to the plate.
Same hotel. DIFFeReNt PRIceS. 100
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FOREWORD
Hasel And Rose Caroline Magerl
After moving to a new town, Rose wishes and searches for something that she is missing, though she isn’t quite sure what that is. Then as Rose and Hasel begin a new journey together, they discover that courage is the key to starting over again finding yourself. A magical children’s story of hope and discovery woven among the delicate and detailed illustrations of Caroline Magerl, this book is a small celebration of imagination and resilience, and of overcoming life’s challenges with the help of a friend.
Here Come The Dogs Omar Musa
Marked by novelists Irvine Walsh and Christos Tsiolkas as one of the most exuberant and raw novels of the year, Here Come The Dogs obliges the reader to examine their idea of Australia’s ethnic youth culture within a rough suburban setting. Three young men, Solomon, Jimmy and Alekes, bound by loyalty and their common side-line position on mainstream culture, wait for the right moment to express themselves in the oppressive Australian summer heat. As their surrounds roar with flames, a change ignites, but not one that the three had been waiting for.
If I Should Die Matthew Frank
Vicious, apparently motiveless attacks target defenseless down-and-outs in South London. But when one of the victims dies from his injuries, it’s murder…For Joseph Stark, the Met investigation team’s newest detective and recently returned solider from Afghanistan, death is already all too familiar. Whilst coping with his own tormenting nightmares, Stark must also try to solve a murder investigation that has him perplexed at every unfolding detail. As the mystery deepens, he soon begins to understand what lies at the rotten heart of the killings and realises just what is at stake. But with his strength fading, this ex-soldier’s determination to see justice done may not be enough to carry him through. A gripping and chilling novel enriched by a deftly ominous writing hand and a skillfully twisted plot.
Finding the right Hotel just got a whole lot easier. Compare and Book 100’s of travel sites at once.
www.CompareandBook.com.au
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DINING
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dining
the
freshest
catch Story Lizzy Keen
T
hink the Gold Coast and food and you’ll likely think fish and chips. Fair enough. It’s true that being perched post-surf on Burleigh Headland, unwrapping that paper bundle of salt and batter is nothing short of Australian quintessence. But sometimes we want a little silver to our service and a finer viewpoint to toast the surfers down the line. And for a city that was born from an ardent fishing industry, our great seafood options are scarce. Cue The Fish House at Burleigh Heads, and a restaurateur that brings together the best of both worlds. Simon Gloftis took a risk by shifting the focus of this restaurant from the touristic come-and-go to the longstanding locals, especially on the Gold Coast, whose population is as transient as its tides. But with a steadfast philosophy that values coastal clientele, one that he’s carried across previous cafés, as well as Nobby Beach’s esteemed Hellenika, he was able to keep The Fish House busy from the get-go. “We don’t get as many tourists as we think we do,” he explains. “Sydney gets 100 times more. So you need to focus on the locals and make sure they come back regularly. And with them, they’ll bring the tourist anyway.” With its fishing shack-meets-studio design, crisp timber and tile fit-out and professionally conversant staff, The Fish House attracts a clientele that is as likely to be as spruced up as they are salty haired. Surf sophistication with an eye for detail. “I’d be kidding if I didn’t say the location definitely helps with business,” he gestures to the sand-to-Surfers panorama. “Here you see the people as well as the ocean, and then the city. The whole picture of the Gold Coast.” So, enter. From the first step in the door, welcomed by the attentive staff, it’s clear that Simon knows how to make seafood sightly. Split between olivegreen paint and pearly-white tiles overhead, the four walls run around a both spacious and cosy dining area, punctuated by exposed brick pillars and opened by north-facing sliding windows. The dark timber settings contrast splendidly with the stark-white crockery and warm hue of the tabletop candles, sending a twinkle of polished glass around the room like an indoor milky way. Second to welcome diners are the outsized portraits of a King George whiting (Simon’s favourite fish) and a red lobster, keeping the theme comically consistent. Third, perhaps, is the sinuous
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offshore breeze and subtle aromas of lemon and salt. So, cast a line and relax. Unlike a number of overtly casual restaurants in the vicinity, there are no checks with the kitchen, no menu ambiguity. Simply knowledge. Waiter Brody delivers a fluent recital of the evening’s produce that sparks the appetite without leaving us floundering in options and fishing terminology. Details and ingredients are explained and recommended with an attitude as professional as the uniform. The service is both proficient and friendly and sees waiters setting down the correct dish to diner whilst informally talking fish with the locals. Wine and water topped, fish filleted on the table, more olive oil madam? (Or mate, depending). The team moves effortlessly around the room like a freshwater current and is a focal ingredient
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to this venerable dining experience. The Fish Board is subject to change, which is a good thing. A great thing in fact, when the produce is caught off the South Australian coast before dawn, bought, filleted, cleaned and packeted in Melbourne, flown to Coolangatta by 10.30am and sprawled on the menu just in time for lunch. “A heavy process,” as Simon calls it. But one you won’t find anywhere else in Gold Coast, or even Queensland. The menu speaks Australian with a Mediterranean accent, wholesome Greek-inspired home recipes with outstanding national produce. The menu endeavours to simply satisfy rather than overwhelm diners with plated theatrics. And in true healthconscious Gold Coast fashion, the kitchen prefers olive oils and lemon juice to cream and butter. Well in that case, we’ll have both.
The Simple Lemony Fish Soup, and this wouldn’t be the first you’ve heard of it, has gathered a cult following and enough social media stardom to give acai bowls a run for their money. From the first spoon-dip erupts an intoxicating aroma of fresh lemon, dill and olive oil, which only improves on the palette with its velvety texture and fleshy chunks of Snapper. The Daily Fried Selection, which depends on the day’s catch, of cuttlefish, school prawn and whiting was treated light and fried fast, each mouthful crisp, salty and moreish like Pacific Ocean popcorn, electrified with a squirt of fresh lemon juice. The Pan-Seared Scallops arrived cuddled together in a deep white dish, glistening like an oversized pearl bracelet in citrusy golden butter. Their toasted skin bursts to flesh as sweet and
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dining
silky as summer lychee, with a subtle bite of shallot and lemon. There is something so enjoyably quirky about meeting your fish at the table. The waiter delivers the raw, chilled whole fish on a silver platter straight to the table for customers to inspect its size, appearance and give the green flag before it’s returned to the kitchen. They’ll even bring two fish for the indecisive. A little surprising for those unacquainted with their food origins, but perfect for demonstrating their fresh-is-best attitude. The Rainbow Trout of 350 grams is an ideal share size for two, and filleted before your eyes, leaving the parcels of steaming pink flesh swimming in a puddle of olive and lemon juice. Particularly special occasions call for the one-kilogram Snapper baked in white wine and oregano, a whopper of
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a fish that truly melts in your mouth - ideal for two or more people. NB: Excellence doesn’t come at corner shop prices, so be prepared to splash out a little more for the cause of quality. All the Whole Fish options are accompanied with a neat little slab of potato gratin, seasonal greens and a cos lettuce salad dressed in vinaigrette and fine slivers of spring onion. The whole dish arguably rests on the house-made tartare sauce, which is all but medicinal; creamy, tangy and nary a bottle in sight. They say Sunday nights are quiet nights. Not quite. By 6.30pm the contemporary jazz mood music begins to soften against the jovial rumor of local conversation and tomorrow’s surf forecast. The whir of waiters continues to keep glasses glistening with the principally European wine list. This being a mindful and award-winning
selection of Old Worlds by the bottle, and both fresh aromatic whites and light to mediumbodied reds by the glass, half and full bottle, all which compliment the Mediterranean character of the food. Before you know it, the sun slips away beneath a veil of winter violet and steel blue, embossing the stately elevation of Surfers Paradise in the distance, and leaves you in the hands of a pleasant evening and the whispering roll of the waves. And as you start to forget the hefty batter and the ring-ring of pokie machines that signify the iconic surf club experience, you know The Fish House has you caught - hook, line and sinker. pm
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dining
tartufo
In the middle of an urban hot spot in Brisbane, an Italian cuisine legend artfully brings to life decades of family culinary history in a setting that is reminiscent of 1950s downtown Chicago.
Story Lizzy Keen
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here’s something very romantic about this place. The sultry red hue of the bar embosoming the bourbon bottles like naked flames, the vintage mirrored black and white pillars framing the settings of stark white crockery under the petroleum black ceiling. There’s plenty of scarlet red leather, soft lighting and dark timber; the only thing missing is a plume of cigar smoke to cloud the evening chatter. The setting of The Valley’s Tartufo, and Tony Percuoco’s longstanding pledge to intelligent Italian cuisine, is sophisticated and intriguing, and a good enough reason to change the tricolori to red, white and black. While there’s no cigar smoke or accents to contemplate, Tartufo has a lot of international character to its name, and lots of virtuosic Italian personality to its dishes. Being son to Sydney Italian cuisine legend, the late Mario Percuoco of Kings Cross’ reverenced Pulcinella, probably makes Tony’s ability a given, if not a right. Tartufo is a gastronomic gallery of Italian–Australian history through simply stylish cooking that anyone would cross town for. Tony’s desire to show Brisbane a piece of his history, his Italy, is reflected by the enormous black and white photos on the walls, depicting 1920s Naples. The people in the pictures are frozen in time, in an era gone by. Tony doesn’t need to be prompted to tell you about these images – he will happily tell you they are of his own family. “They look down on me. I think of them as my
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angels,” he says. Tartufo’s menu speaks a language that anyone with an idea of decent Italian food can understand. The gli stuzzichini (appetizer) menu measures out a tempting expanse of Italian classics like arancini balls swelling with green peas and ricotta, calamari fritto with wild rocket, and polette al sugo (traditional meatballs). The primi menu (entrees) follows in a similar light-flavoured suit, with a selection of raw fish and meats or hot wood-smoked salmon filet with chives and wicked mascarpone. All’s well that starts well, but this is a time to let the mixed desgustazione do the talking. True amore begins with the bread; warm, chewy slices of ciabatta dripping in organic extra virgin olive oil that disappears through the dough between the table and mouth. It’s an indulgent and comforting confirmation that bread is the staff of life. The crudo di pesce, a fan of raw kingfish and silky scallop peppered with capers, chives and diced tomato and layered in lemon juice and golden olive oil softens the palette with mellow salty sweetness. The sensations are roused suddenly by the piquancy of braised veal and anchovy of the vitello tonnato, the latter mixed with tuna, capers and mayonnaise to coat the slices of pungent cornichons. Both dishes echo a famous Italian adage; an appetiser is a dish best served cold. Mafia movies aside, the origine of the Percuocos’ culinary craftsmanship is in fact linked somewhat to the mafia escalation in Naples during the early 1970s. Mario’s decision to getaway from the then
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DINING
expanding corruption and violence by the Camorra Mafia stirred a curiosity for Australia. Despite Italy’s returning economic buoyancy that saw much of Australia’s Italian population returning to their homeland vita y vino, Mario made the move, and fell in love. The Percuoco family was here to stay. On tasting the Rollata di Salmone, we can appreciate the intelligence of that decision. The wood-smoked Atlantic salmon is rich in oil and toasty undertones, and indulged with creamy mascarpone, a spoonful of avocado and lemon mouse and enlivened with bites of chive. Following this richness road, the
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Risotto alle Capesante too is a generous serving of aborio, corn and peas buttered in mascarpone and fresh herbs, crowned by two lightly torched scallops. Reach for a glass of 2012 Kris Pinot Grigio from Northeast Italy for a playful, greencitrus slice through the creamy elements, or a simply ripe and fruitful Borgo Chardonnay to ballast the weight. The Barramundi é Salsa Verde of grilled Cone Bay Barramundi and served over puy lentils, shaved fennel and zesty salsa verde is also a great option for those seeking freshness without the bulk of pasta or rice. Otherwise, on
the other end of the spectrum is the Linguine ai Funghi Tartufati, a house-made linguine with wild and cultivated mushrooms swelling in burnt butter, mascarpone, sage and truffle paste, and speckled with hot cracked pepper and shaved Parmesan. It’s a divine moment finally tasting the ingredient behind the restaurant’s very name (tartufo: truffle), and a special one given the scarcity of this wickedly delicious product. Tony is an authentic mix of Italian and Australian. Like many second or third generation Italians, it’s clear to see his heart is divided between both countries. While his Italian
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dining
roots hold him firm, Australia is his home. He began his own restaurant in the mid 1980s in Sydney’s Surry Hills, Senso Ultimo, which was the inner-city echo of his father’s vanguard La Zagara Ristorante in Leichardt, which boomed in the mid 1970s. He ran Senso for nine years before moving to the Gold Coast and finally to Brisbane, whose riverside dynamism and easygoing community reminded him of a 1970s Sydney. He incorporates this love affair with every dish, sourcing all products within a 200-kilometre radius of Brisbane, and reflecting them in seasonal variation.
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Finally, the night melts into saccharine satisfaction with the Panna Cotta al Miele & Vaniglia, whose balance of honey and vanilla bean with the toasted crunch of honeycomb shards is the evocation of a summer night’s dream. Similarly said for the presentation: a crumbling frame of honeycomb and fruit jellies surrounds the silky vanilla dessert as though Tony has thrown them to see how they fall. Though Sydney might have made Tony the masterful mediator between Italian and Australian cuisine that he is today, Brisbane is where he took that flame and made a fire that
burns ardently in the city’s budding dining scene. With Italy in one palm and Australia in the other, Tony deftly applauds the past and present with the traditional flavours and ingredients of two eras. Stepping back onto bustling Anne Street is like greeting reality well satisfied after a night of European reverie, and as the red glow and jet-black interior fades into evening like embers in an old fire, it becomes apparent. Tartufo is the best of both worlds, which earns Tony a thank you, and two kisses, for a little taste of history. pm
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Finance
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Finance
Investing in bricks & mortar Safe as houses? Make informed decisions and watch your nest egg grow.
R
esidential property has historically delivered strong returns over the long-term and whether you’re an astute investor or owner-occupier looking to dip a toe in the market to take advantage of low interest rates, a simple check list could result in significant savings.
Plan for the future
Have a clear understanding of what you intend to do with the property. Does it require renovations? Is it high maintenance? Is it a future investment or will you owner-occupy? The upside of residential property investment is that there are no daily price fluctuations, making it easier to stick to your investment plan. One of the ways that investors can make a difference when it comes to residential property investment is with their personal involvement and local knowledge.
Locality risk
Buying in the wrong location is a real risk for residential property. While other areas are steadily increasing, a wrong location can be stagnant and affect return over the long-term. Do your homework before committing.
Who should be on the title?
Think about who will be on the title and why.Consider your long-term goal and whether you later plan to rent the property. It might be 99 per cent income to the highest and most stable income earner and 1 per cent to the other. Will it be in a company name or a trust? Know the reason and make sure it’s not going to cost you in tax deductibility down the track.
Stamp duty
Consider the purchase price offered by referring to the stamp duty guide before signing a contract as there could be savings. The costs to buy and sell are quite high for residential property. Stamp duty and mortgage registration
costs need to be taken into account. Make sure of savings to be had on stamp duty.
Contract timeframe
Consider the time frame for the contract, particularly if you are self-employed. It is best to request 14 working days for finance due to bank requirements these days with valuers so there could be timing issues. If you extend settlement to 60 days, remember stamp duty is still payable in 30 days. If purchasing an investment property with contents, request that the contract is split to include two figures - the purchase price and contents for tax purposes with a list of the contents attached. This could save hassles with the taxation office, but also assist with minimising stamp duty costs.
Building and pest inspection
Buying a home or investment property is likely to be one of the biggest decisions most of us will ever make. And yet some people are willing to let it all come crumbling down because of a tiny invader. The average repair cost for termite damage to a house is $7000 but we’ve all heard horror stories where homeowners have had to pay out tens of thousands of dollars to rectify a termite problem. Make sure it is the seller’s problem and not yours.
Get the right product
Talk to your financial adviser and work out if the loan should be considered with a 100 per cent offset account. If long-term for investment, try to keep the debt high so you can make use of the tax deductibility when you rent the property at a future date.
Insurance
Insure within three business days of signing purchase contract to cover property as you are responsible. If the property is not insured during this timeframe, you are responsible not the seller.
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Finance
Choose someone you absolutely trust and who is capable of looking after your affairs. Finance
Consider lenders mortgage insurance premium costs at other banks before deciding on a financier. All banks have different premiums.
Will
A Will is an in important legal document which will ensure your assets are passed on according to your wishes. In the absence of a valid Will, your assets will be passed according to the rigid laws of Intestacy â&#x20AC;&#x201C; you will have no say in the matter and the distribution of your estate may not accord with your wishes. Donâ&#x20AC;&#x2122;t take any chances; a Will can be drawn up quickly.
Enduring Power of Attorney
An EPA authorises another person to act on your behalf in your financial and health affairs if you are unable to act for yourself. The benefit is that you get to choose who you want as attorney, rather than leaving matters to chance. Choose someone you absolutely trust and who is capable of looking after your affairs.
Advance Health Directive
An Advance Health Directive is a document which allows you to instruct decisions on your future health care should you be unable to at the time. The document is valid during a period of lost capacity.
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Surveying
Consider a re-peg of the property by a surveyor. Boundary pegs are often moved and you want to avoid expensive legal stoushes with neighbours. Always in older areas have it re-pegged. In newer estates people move the pegs too. As a general rule, engage the original surveyor, it could be the best money you spend. If you are investing, consider using a quantity surveyor for a report. In apartments or units, TV aerials etc are tax deductable to each owner and there a general common areas where responsibility is shared.
Body corporate
Consider sighting body corporate meeting minutes to get a handle on various administration funds to cover costs such as roof repairs, landscaping, concrete cancer and any other maintenance surprises that may arise. Itâ&#x20AC;&#x2122;s also a good way to get some background on the owners.
Rent increases
Liquidity
Remember that if funds are needed in the shortterm, property is not an asset that you can quickly liquidate or just sell a small portion.
Interest rates
Interest rates play a significant part of the costs of owning a property. When interest rates rise, investors need to be able to bear the brunt of the increased payments. Consider advice around fixing a part of the loan and understand the risks associated with doing so.
Negative gearing
If a rental property is negatively geared then the investor needs to find the difference each month between the income and the expenses. Many brochures show the annual result - not the monthly cashflow required. pm *Advice provided by financial adviser Peter Cooper from Cooper Financial Connections.
Legislation protecting both the landlord and tenants means that rent increases can be negotiated and need to be reasonable. The Australian Government social welfare policies means that residential property investors can still increase rents where they rent to low income earners because rental assistance through Centrelink is based on market rates.
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