you are what you eat by gdf57j


promoting a healthy canterbury

you are
you eat
 how what you
 eat and drink
   can affect
  your health

    Foods to avoid
     to lower your
    risk of cancer

ISSN 1176-0435 (Print) ISSN 1178-1734 (Online)
 PROmOtING A HEAltHY CANtERBuRY                                       Food for thought
                                                                      You are what you eat. It’s an old saying – but there’s more than a hint
Inside this issue                                                     of truth in it.
                                                                         While many people may think that good nutrition is all about
Since being diagnosed with coeliac
                                                                      maintaining a healthy body weight, the impact of healthy eating goes
disease in 1984, Natalie Johnston has
                                                                      much further than that. Eating unhealthy foods and being overweight
had to eat a strictly gluten-free diet to
                                                                      or obese puts people at increased risk of many chronic (long-term)
avoid becoming ill. Pizza has been off
                                                                      diseases, such as type 2 diabetes, heart disease and cancer. With
the menu unless it was homemade –
                                                                      more than half of all adult New Zealanders now overweight and one
until recently when gluten-free options
have become available. Now Natalie
                                                                      in five obese, Canterbury General Practices and hospitals see the
says she is gaining a new appreciation                                results every day of the increasing number of people with chronic
of food and becoming good at baking                                   conditions.
– two positive spin-offs of living with                                  Aside from the impact nutrition has on our body weight, evidence
coeliac disease.                                                      also suggests that eating certain foods can increase our risk of cer-
                                                                      tain chronic diseases, such as cancer, even if we are not overweight.

                                                6                     One example is bowel cancer, which is the second leading cause of
                                                                      death in New Zealand and is the most common type of cancer in
                                                                      our country. Research shows that, while being overweight or obese
                        Babies who are breastfed are less likely
                        to become ill as children and later in life
                                                                      is a major risk factor for bowel cancer, eating a diet that is high in
                        – and breastfeeding has long-term health      processed meat and fat and lacking in fruit and vegetables is also a
                        benefits for mums too. silver fern Adine      contributor.
                        Wilson (with baby Harper) was one of the         In this issue of Healthfirst, we focus on a raft of diseases that are
                        young mums taking part in the Big latch       linked to diet. We examine how some conditions, gout and coeliac

11                      On event, part of World Breastfeeding
                        Week at the start of August.
                                                                      disease, can be managed through careful management of diet and
                                                                      we look at how making lifestyle changes can help to delay the onset
                                                                      of other conditions, such as diabetes or heart disease – or even pre-
People with pre-diabetes                                              vent them altogether.
are able to be referred to a                                             Kaiapoi man Dennis Brown (see page 13) is just one example of
pre-diabetes programme, run                                           how people can reap the benefits of making just small changes to
by Dietitian Nicky mcCarthy,                                          what they eat. After being diagnosed with pre-diabetes earlier this

under an initiative funded by the                                     year, he was referred by his General Practice to a programme that
Partnership Health Canterbury
                                                                      has helped him to make lifestyle changes, which he hopes will keep
Primary Health Organisation.
                                                                      him diabetes-free.
since completing the pre-diabetes programme, Dennis Brown
                                                                         In this edition, we also give you tips on how to
(pictured above) exercises at least three times a week and
                                                                      get a good night’s sleep, profile an initiative that is
reads food labels when he goes supermarket shopping –
                                                                      helping Canterbury kids to dance like the stars and
which helps him to choose healthy foods.
                                                                      look at a new vaccination for young women that will
                                                                      help to protect them against cervical cancer.
 Healthfirst is produced by the Canterbury District                      We hope you enjoy this edition of Healthfirst and
         Health Board Communications Team:                            that it provides plenty of food for thought on what
            Communications manager: Michele Hider                     you and your family can do to stay healthy.
             Communications officer: Rachel Solotti                                                                                   Best wishes
              For story ideas, contact Rachel Solotti on                                                                             Gordon Davies
              03 364 4122 or                                                                    Chief Executive Officer
       Phone (03) 364 4103 Fax (03) 364 4101                                                                       Canterbury District Health Board
            Or visit
                 Design & layout: James Mackenzie                     Win rugby tickets
            Photography: John McCombe & Pam Johnson
                                                                      thank you to everyone who entered our healthy eating competition in the
                      Cover art: Steven Dunn                          June edition of Healthfirst. We received more than 400 entries to the com-
                     Printed by: APN Print Ltd                        petition! Our lucky winners were Bernadette Ellicott and sylvia somerville.
                                                                        In this month’s Healthfirst, be in to win a double pass to the

                                                                      Canterbury versus Hawke’s Bay Air New Zealand Cup match at AmI
                                                                      stadium on 27 september.
                                                                        Please answer this question: What stories/health information would
                                                                      you like to see in Healthfirst?
             District Health Board                                      send your entries to Healthfirst competition, Communications team,
                                                                      Corporate office, the Princess margaret Hospital, PO Box 1600,
             Te Poari Hauora o Waitaha                                Christchurch. the winner will be drawn on friday, 19 september.

 02 / HealtH fIRst september 2008
Food allergies

  raewyn Mitchell with five-
year-old Jack, who has a
severe allergic reaction to
some foods. raewyn says
Jack has learnt to be respon-
sible and understands the
importance of not eating the
foods to which he is allergic.
  full story – p4-5              HealtH first / 03
Food allergies

severe reaction to foods won’t

                  t five years old, Jack Mitchell already                                              increasing. Across the gen-
                  knows how to swing a golf club and                                                   eral population, about 3.5%
                  dreams of being an All Black one day.                                                of people have food aller-
                     His mother, raewyn, says people are                                               gies, with the most com-
                  often surprised to learn that Jack has                                               mon being to fish, peanuts
                  several serious food allergies, including                                            and kiwifruit.
peanut and egg – two of the most common childhood                                                         Canterbury District Health
allergies.                                                                                             Board Clinical immunologist
   “He’s just a normal five-year-old. People look at you                                               Dr John O’Donnell says
and say: ‘but he looks so healthy’ because he’s extremely                                              that although food allergy
active. i’m sure he’s going to be an All Black one day!”                                               is relatively common, par-
   However, despite his healthy appearance, eating these                                               ticularly among children,
foods which most people take for granted could cause                                                   it is quite rare for those
Jack to have a severe, life-threatening reaction, known as                                             affected to suffer from a life-
anaphylaxis. His parents carry a device that administers                                               threatening reaction. Even
adrenaline as an “insurance policy” in case this occurs.                                               if they do, people rarely
   if Jack was to accidentally swallow any of the food                                                 die from anaphylaxis. Even
                                                                              Raewyn and Jack Mitchell
products he is allergic to, the adrenaline would help him                                              though the reaction may
by constricting his blood vessels, stimulating his heartbeat,         seem very severe, people have less than a 10% chance
relaxing his lung muscles to improve breathing and stop-              of dying from it.”
ping swelling around his face and lips.                                 to diagnose a food allergy, John says health profession-
   A food allergy occurs when the body’s immune system                als will look at a patient’s food intake and what they have
reacts to a food protein (allergen) and produces antibodies           eaten just before the reaction occurred. A blood test or a
(called immunoglobin E antibodies). People usually develop            skin prick test is also usually necessary to determine the

a reaction to foods they                                                                                    allergens to which they
are allergic to within 30                   Children frequently grow out of cow’s milk and react.
minutes of eating them.                     egg allergy by the time they start school.                         A skin prick test
symptoms can include                                                                                        works by placing drops
                                                                                 Dr Clare Doocey
hives, itching, facial swell-                                                                               of a variety of allergen
                                                                                 CDHB Paediatrician
ing, vomiting, diarrhoea                                                                                    extracts on the person’s
and nausea. Anaphylaxis                                                                                     forearm and scratching
is a more severe reaction and can cause breathing difficul-           the surface of the skin underneath. if there is a reaction
ties, and/or a drop in blood pressure.                                where the skin has been scratched, then it is possible the
   food allergies are relatively common among young chil-             person has an allergy.
dren, affecting about 6% of those under three years old.                Canterbury District Health Board Paediatrician Dr Clare
the most common allergies among children are to cow’s                 Doocey says most people who have nut or shellfish aller-
milk and eggs, followed by soy, peanuts, tree nuts (includ-           gies when they are young continue to have them into
ing cashews, pistachios, walnuts and almonds), wheat                  adulthood, for example studies show that only 20% of
and shellfish. Allergies to sesame and kiwifruit are also             children grow out of peanut allergy. “However, the news

 Patient             Oncology department, Christchurch Hospital: The staff were cheerful but professional. They were interested in you as
BOUQUEts             a person and able to talk a little about every day matters. This helped to normalise the experience, to help promote the trust of
                     being cared for well, which helped me to relax and to stay as still as possible. – BJ, Papanui

04 / HealtH first
Food allergies

slow Jack down                                                                     Health on the web
                                                                                   A new website is designed to be a
                                                                                   first port of call for health service infor-
                                                                                   mation in Canterbury.
                                                                                      the website
is better with other common food allergies; children frequently grow               provides another avenue of access to
out of cow’s milk and egg allergy by the time they start school,” she              health and social services and relevant
says.                                                                              information. the site is sponsored by
   she recommends parents of children who have been diagnosed                      the Canterbury District Health Board.
with food allergies should work with their GP or paediatrician to draw                Webhealth District Co-ordinator
up an “action plan” that sets out what should be done if their child is            Canterbury tara thomas says she
accidentally exposed to a food to which they are allergic. teachers                regularly maintains the site and keeps in
at the child’s preschool or school should also know what to do in an               touch with local community providers of
emergency and have a copy of the action plan.
                                                                                   health services.
   she says parents should also ensure their children are re-tested
                                                                                      “sometimes websites can be seen to
for allergies as they get older because children can outgrow them,
                                                                                   lack the personal touch. But you can
even into their teenage years.
                                                                                   feel assured is totally
   starting school has held a new set of challenges for Jack. raewyn
                                                                                   focussed on connecting local people
has given Jack’s teacher information about what to do during an
                                                                                   with local services. We aim to provide
emergency and they will keep adrenaline for him. His fellow pupils
                                                                                   the most up to date information and to
have also been taught about food allergies.
                                                                                   help keep the Canterbury community
   she says Jack is very responsible and understands the impor-
tance of not eating the foods to which he is allergic.
                                                                                      “the Webhealth website helps people
   “Because he has grown up with it, he’s very good . . . he knows
the food is going to hurt him so he knows not to go near it,” raewyn               find their own solutions to issues in their
says.                                                                              lives with the best possible information
                                                                                   and resources. it’s a resource for health
                                                                                   professionals and the general public of
What should I do if my child has a bad reaction to something they                  Canterbury,” she says.
have eaten? if your child has an immediate reaction and has problem
breathing or appears pale, floppy or drowsy, call an ambulance on                    On the Webhealth website you will be
111. if your child develops hives, they should go to their General                 able to:
Practice or an after hours service.                                                • find a health or social service.
                                                                                   • find health and wellbeing information.
fOr mOre iNfOrmatiON about food allergies see www.allergy.                         • Check out the community notice or contact allergy New Zealand at or                board.
phone 0800 34 0800.                                                                • Get a website for your service.

DO yOU sUffer frOm CHrONiC lOW-BaCk PaiN?
the Centre for Postgraduate Nursing studies at the                        your expectations of recovery. the research involves a
University of Otago Christchurch, is currently running                    questionnaire followed by an interview.
a research study looking at chronic low back pain and                       if you suffer from chronic low back pain and depres-
depression. the researchers are interested in your                        sion, then we would like to hear from you.
experiences of living with low back pain and depres-                        Please call avin Panckhurst 03 364 3869 or email
sion, things you do to manage your condition, and               

                                                                                                                   HealtH first / 05
                                                                                                                                Johnston says
Coeliac disease                                                                                                                 persisting
                                                                                                                                and becoming
                                                                                                                                good at bak-
                                                                                                                                ing, as well as
                                                                                                                                gaining a new

                                                                                                                                of food are
                                                                                                                                some of the
                                                                                                                                positive spin-

gluten allows
                                                                                                                                offs of living
                                                                                                                                with coeliac

for normal life

                  bout two years ago, Natalie Johnston ate bought
                  pizza for the first time since she was diagnosed
                  with coeliac disease more than two decades
                  ago. since being diagnosed with the disease in
                  1984, Natalie has had to eat a strictly gluten-free
                  diet to avoid becoming ill. Although she only
eats it occasionally, it ensured pizza was off the menu unless it
was homemade – until recently when gluten-free options have
become available.
   Coeliac disease is an inflammatory condition caused by an            food as everyone else . . . i started experimenting with baking but
intolerance to gluten, which is found in wheat, barley and rye.         it took me a long time to get it right. At first, i was throwing all my
Many people also react to oats. Gluten causes the body’s                expensive ingredients out but even the birds wouldn’t eat it!”
immune system to be activated inappropriately, which leads to               But Natalie says persisting and becoming good at baking,
the lining of the bowel or intestine becoming inflamed and dam-         as well as gaining a new appreciation of food are some of the
aged. Common symptoms of the disease include tiredness,                 positive spin-offs of living with coeliac disease. “You learn to
weight loss or gain, abdominal pain, bloating, vomiting, diarrhoea      bake again. it’s made me look at what i eat; i choose quality over
and skin rashes. People with the disease may also develop anae-         quantity and i’m not afraid to experiment with new foods. You’re
mia or have folate or vitamin B12 deficiencies.                         only limited by yourself.”
   Natalie was diagnosed with coeliac disease after blood tests             Canterbury District Health Board Gastroenterologist Dr richard
and undergoing a gastroscopy, which enables the small bowel             Gearry, who is also a senior Lecturer at the University of Otago,
to be examined, and a biopsy taken. Although, she was already           Christchurch, says one in every 100 people have coeliac disease.
being treated for anaemia she was extremely tired, had sores on         However, about four out of five people do not realise they have it.
her face, chest and arms and was experiencing severe abdomi-            it is thought that coeliac disease is genetic and is more common
nal pain. “As soon as i was diagnosed, i read everything i could        among people of Celtic origin.
and eliminated gluten. i could face the world again and my energy           “it’s a tip of the iceberg disease in that an enormous number
returned.”                                                              of people are not diagnosed with it. some people are asympto-
   Although the range of gluten-free products available has             matic or have symptoms but tolerate them.”
increased since Natalie was diagnosed, she makes her own                    He says people with coeliac disease who follow a gluten-free
gluten-free bread and has adapted many other recipes to ensure          diet can expect to lead a normal life. “the outcome for people
they do not contain gluten.                                             with treated coeliac disease is exactly the same as for someone
   she often cooks gluten-free meals for family and friends but         without the disease.”
will also opt for gluten-free versions of particular foods at social
functions, such as BBQs.                                                tHe COeLiAC sOCietY Of New ZeALAND offers support
   “You go through a grieving process when you are diagnosed            groups for people with coeliac disease. for more information
because you realise you are not going to be able to eat the same        about coeliac disease and the society, see

 Patient              Ward 28 (neurology and neurosurgery), Christchurch Hospital: My daughter was admitted to Ward 28 and
BOUQUets              I wanted to say a sincere thanks to the team there for the outstanding way in which she was looked after and treated,
                      with someone also sitting with her whenever needed. My daughter has cerebral palsy and high physical disability-related
                      needs so the quality of care was much appreciated. – MO, Avonhead
06 / HealtH first
Living with gout

Diet key factor
in controlling joint-pain

A year after              being diagnosed with gout, Maureen                            You don’t realise that your diet
Annison knows to steer clear of shellfish and meats such as                             is so important until something
corn beef, bacon and salami. She also avoids many fruit and                             like this happens.
vegetables, such as asparagus, strawberries, citrus fruits,                                                Maureen Annison
rhubarb and pickles.
   That’s because eating any of these foods could trigger a
painful gout attack.                                                      mon among women after menopause. She says treatment
   Gout is a form of arthritis, which can occur in any joint but          focuses on trying to keep uric levels in the blood at a certain
commonly starts in the big toe. Symptoms of the condition                 level to prevent the uric acid crystals, which cause gout,
include painful, tight and swollen joints, with the skin over the         from forming. This includes eating a healthy diet and reduc-
joint often appearing red and shiny.                                      ing intake of foods that can trigger gout attacks, such as red
   The pain in the joints                                                                                    meat and seafood.
occurs when the body                                                                                            People with gout should
makes too much uric acid,                                                                                    try to avoid alcohol, particu-
which is in everyone’s                                                                                       larly beer and red wine. They
bloodstream. Usually most                                                                                    should also aim to take part
uric acid passes from the                                                                                    in regular physical activity
body in urine but if it builds                                                                               to ensure they maintain a
up in the body, tiny crys-                                                                                   healthy body weight.
tals form in and around                                                                                         Lisa says people who
the joints. If the crystals                                                                                  have experienced more than
are not destroyed and                                                                                        one attack of gout are usu-
not prevented from grow-                                                                                     ally also given a medica-
ing again, they can cause                                                                                    tion called allopurinol, which
arthritis which may eventu-                                                                                  helps to lower uric acid lev-
ally permanently damage                                                                                      els in the bloodstream. “The
the joints.                                                                                                  problem we have with gout
   Rheumatologist Dr Lisa                                                                                    is that it’s episodic. People
Stamp says one of the
                                    Painful, tight and swollen joints are a feature of gout.                 with it might sometimes go
biggest myths about gout                                                                                     months or years without an
is that it is triggered solely by rich food and red wine.                 attack. The big thing is that people on allopurinol have to
   “In the old days it was thought that gout was a rich per-              keep taking it, even if they are feeling well, otherwise the gout
son’s disease because they drank lots of red wine and ate                 will keep coming back.”
rich foods. But, while diet is a factor, there is also a genetic             Maureen says she has cut out all the foods that she has
link. Maori and Pacific people are three times more likely to             identified as likely to trigger an attack of gout and is now
get gout. Although no one really knows why this is there are              careful to do regular physical activity.
indications that there is at least some genetic component.                   “I’ve started exercising more; I usually go for a walk for
Some medications used for treating heart failure can also                 about 25 minutes each day. It really helps because it has
stop uric acid from getting passed through the kidneys, mak-              made my feet much more pliable. The attacks just come on
ing gout more likely.”                                                    so quickly and the pain just grips you so severely. You don’t
   Lisa says while men are more likely to develop the dis-                realise that your diet is so important until something like this
ease at a younger age, the disease becomes more com-                      happens.”

                                                                                                                        HeAltH fIRST / 07
Cancer prevention

                    Healthy eating can
                ating healthily is good for the waistline – but it   ity and therefore some cancers. try to eat lower energy-dense
                can also help to protect us against cancer.          foods such as vegetables, fruits and wholegrains instead.
                  sue Clark, Health Promoter for the Cancer          Drink water or unsweetened tea or coffee instead of sugary
                society, says research shows that eating a           drinks.
                wide variety of foods in moderation, with an
                emphasis on fruit, vegetables, whole grains             Plenty of fruit and vegetables
and pulses, can help to prevent cancer.                                 Eat more of a variety of vegetables, fruits, wholegrains
    “there is no one factor that can explain why some people         and pulses, such as beans. the dietary fibre in these foods
develop cancer and certainly no one food that causes cancer.         may protect against a range of cancers, especially colorectal
Our risk of developing cancer results from our genes, our            (bowel) and oesophageal (gullet). these foods help to protect
environment and the choices we might make through life,”             against weight gain and obesity. try to include wholegrains
she says.                                                            and/or pulses with every meal.
   sue says a report* released in November last year makes              Plant foods are important sources of water-soluble vitamins,
a series of recommendations around how a healthy diet and            antioxidants and minerals important for good health and
regular physical activity can help to reduce the risk of cancer.     evidence shows that eating more of them reduces the risk
for people who have already had cancer, eating healthily and         of lung, prostate, and a number of digestive tract cancers.
regular physical activity can also lower the risk of it recurring.   Eating more than five servings – at least three vegetable and
   “Although it focuses on cancer, many of the recommenda-           two fruit – a day is recommended.
tions may also be relevant to other chronic diseases such as            Eat a wide variety of vegetables and fruits and choose
diabetes and heart disease,” sue says.                               from the five colour groups; red (for example, tomatoes,
                                                                     strawberries), white/brown (potatoes, bananas) green (broc-
  Recommendations include:                                           coli, kiwifruit) yellow/orange (carrots, oranges) and blue/purple
  Avoid becoming overweight. Weight gain as an adult and             (beetroot, prunes). A serving is about a handful.
obesity increases the risk of a number of cancers, including            Pulses such as lentils can be added to soups and stews
colorectal (also known as colon or bowel cancer), post-men-          and chickpeas or kidney beans to salads and mince dishes.
opausal breast, pancreatic, kidney and oesophageal (gullet)          Watch out for interesting vegetarian recipes.
cancer. Maintaining a healthy weight through a balanced diet
and regular physical activity throughout life may be one of the         limit your meat intake
most important ways to protect against cancer.                          Limit consumption of red meats (such as beef, pork and
                                                                     lamb) and avoid processed meats. Aim to limit red meat
  Be physically active                                               intake to less than 500g of cooked weight (about 700-750g
  Physical activity for at least 30 minutes every day protects       raw weight) a week. this means four or five servings; a serv-
against some cancers, particularly colorectal (bowel) and            ing equates to two slices of cooked meat or three quarters of
post-menopausal breast and endometrial cancer (cancer of             a cup of mince or casserole.
the lining of the womb/uterus), because it helps to maintain a          Choose lean meat or remove visible fat before cooking.
healthy body weight. it is also the key to maintaining a healthy     try to avoid processed meats such as bacon, ham, salami,
weight. Any type of activity, for example dancing, gardening         corned beef and some sausages.
and walking, counts and the more you do the better.                     Eating a lot of red meat is linked to an increased risk of
                                                                     colorectal (bowel) cancer and there is a suggested link to
  limit energy-dense foods                                           oesophageal (gullet), lung, pancreatic and endometrial (lin-
  Avoid sugary drinks and limit the consumption of energy-           ing of the womb/uterus) cancers. Processed meats may
dense foods (particularly processed foods that are high in           also increase the risk of colorectal cancer and there is some
added sugar, low in fibre, or high in fat). Energy-dense foods       evidence suggesting a link to oesphogeal, lung, stomach and
can be low in nutrients. these foods increase the risk of obes-      prostate cancers.

08 / HealtH first
Cancer prevention

lower cancer risks
      A diet including
 plenty of fresh fruit
      and veg, whole
  grains and pulses
 will help lower your
       risk of cancer.

   limit alcohol intake
   if consumed at all, limit alcohol-
ic drinks to two for men and one
for women a day. Any alcohol
consumption can increase your
risk of a number of cancers with
convincing evidence that it is a
factor in mouth, pharynx (throat),
larynx (voice box), oesophageal,
colorectal (for men), and breast                                       However, for some groups of people supplements may be
cancers, both pre and post-menopausal. the more alcohol                beneficial.
someone drinks, the greater the risk, and if they also smoke,
their risk increases further. there is some evidence to suggest          Breastfeeding recommended
that small amounts of alcohol can help to protect against                it’s best for mothers to breastfeed exclusively for up to six
heart disease in some people but it should be consumed as              months and then add other liquids and foods. Breastfeeding
part of a meal.                                                        protects mothers against breast cancer and babies from
                                                                       excess weight gain. for more information see page 11.
  Not too much salty food
  Limit consumption of salty foods and foods processed                  after treatment, cancer survivors should follow the rec-
with salt (sodium) and avoid mouldy cereals or pulses. try             ommendations for cancer prevention.
to use herbs and spices to flavour food and remember that
processed foods, including bread and breakfast cereals, can              RememBeR: smoking or using tobacco in any form
contain large amounts of salt.                                         increases the risk of cancer and other serious diseases.

  Beware of supplements
  Don’t use supplements to protect against cancer. High-                  * World Cancer research fund and the American institute for
dose nutrient supplements can increase our risk of cancer              Cancer research, food, Nutrition, Physical Activity and the preven-
– so it is best to opt for a balanced diet without supplements.        tion of cancer: a global perspective.

                       to fiNd out how to incorporate these recommendations into your everyday life visit
              to get practical tips sent directly to your email inbox, see

                                                                                                                      HealtH first / 09
Cardiovascular disease

It’s our biggest killer – but
                                                                                     Look after
you can improve your odds                                                            your bones
              ardiovascular disease is still the leading cause                       Young people are encouraged to eat calcium-rich
              of death in New Zealand, accounting for 40% of                         foods and enjoy regular exercise to protect themselves
              deaths annually.                                                       against osteoporosis – a bone disease that can increase the
                 that adds up to almost 11,500 people and it                         risk of fractures.
 means that one New Zealander dies of cardiovascular dis-                               Women should also increase their calcium intake after the
 ease (heart and blood vessel disease) every hour, according                         age of 50 because levels of the female hormone oestro-
 to the Heart foundation – the charity leading the fight for                         gen, which helps to maintain bone strength, decrease after
 heart health.                                                                       menopause.
    However, many of these deaths are premature and pre-                                Canterbury District Health Board specialist Physician
 ventable, and now that half of the New Zealand population                           Dr Nigel Gilchrist says young people who are still growing
 is overweight or obese, it is even more critical that we take                       should aim to have 800-1000 milligrams of calcium a day –
 stock of our dietary and exercise habits.                                           which is equivalent to a glass of milk, a pottle of yoghurt and
    Healthy eating and leading a healthy lifestyle help lower                        a “decent wedge” of cheese.
 individual risk of cardiovascular disease.                                             for women over 50, the recommended amount is about
    this can be achieved through simple lifestyle changes                            1500mg a day, which is equivalent to about two glasses
 – such as having three meals a day and eating fruit and                             of milk, a pottle of yoghurt and a few wedges of cheese.
 vegetables regularly, choosing high-fibre breakfast cereals,                        People who are unable to eat dairy products should aim to
 grains and whole grain breads, and including fish, lean meat                        substitute them with non-dairy products, such as soy milk.
 and poultry in one or two of your meals each day.                                      “We shouldn’t think of bones as lumps of cement that
    it is also sensible to choose low-fat milk or soy, use                           don’t change; they are always being remodelled and
 small amounts of oil, margarine, nuts and seeds and drink                           replaced so we need a good calcium intake to maintain
 plenty of fluid each day, especially water, while limiting sugar-                   that,” Nigel says.
 sweetened drinks and alcohol. Use small amounts of butter,                             Osteoporosis is more common among women, with one
 sugar and salt in meals.                                                            in two developing a fracture after the age of 60, as their
    Buying tick-approved products is a good option because                           oestrogen levels drop. Men generally also have larger and
 tick products meet criteria for reduced levels of saturated                         stronger bones than women, which protects them against
 fats and trans fats. trans fat is more harmful to health than                       osteoporosis. People with conditions such as anorexia or
 saturated fat and can increase bad cholesterol.                                     coeliac disease, who may be lacking in nutrients, are also at
    Many tick products have fewer kilojoules (energy) and                            increased risk of the disease.
 increased levels of dietary fibre, which slow the release of                           Nigel says getting adequate amounts of vitamin D, which
 glucose into the bloodstream, giving us more sustained                              is produced in the body after exposure to the sun, is also
 energy. fibre adds volume to meals, creating a feeling of                           important for calcium absorption and bone formation.
 fullness, which is especially important in healthy weight                           regular exercise throughout life can also help to increase
 management.                                                                         bone density.
    However, the Heart foundation strongly recommends                                   He says provided people have enough calcium in their
 that people with health conditions or special dietary needs                         diets, most people will generally not need a bone density
 should consult a health professional before using the tick as                       test to determine if they are at risk of osteoporosis. “tests
 a guide to healthier eating. More than 1000 tick-approved                           will mainly benefit older women who have had fractures or
 healthier choice products are now on supermarket shelves.                           people who are considered to be at risk of developing a frac-
    Visit for recipes, information and                        ture, for example someone who is very underweight or has
 competitions or                                         an underlying disease that could lead to osteoporosis.”
 fOr HEart HEaLtH iNfOrMatiON contact Kirsty                                         fOr MOrE iNfOrMatiON about
 Donaldson at the Heart foundation, on 03 366 2112.                                  osteoporosis, see

 Patient                 Ward K2 (Psychogeriatric), the Princess Margaret Hospital: From my [mother’s] initial assessment to the follow-ups
BOUQUEts                 still in progress, her treatment has been carried out with care and compassion. I liked so much your approach to my mother’s
                         care. She was a real person to you, not a number on a file. I liked the way you took our wishes into account when deciding the
                         action required. I did get the feeling that patients’ needs came first. – WC, Cashmere
10 / HealtH first
Infant feeding

is best
for babies
and mums

Babies who are breastfed are less likely
to become ill as children and later in life – and breast-
feeding has long-term health benefits for mums too.
   That’s the message from Carol Bartle, breastfeed-
ing advocate for the Te Puawaitanga Ki Otautahi
                                                                                    Silver Fern Adine Wilson with baby Harper
Trust’s new Canterbury Breastfeeding Advocacy                                       at the Big Latch On event, part of World
Service. Carol says research shows antibodies are                                   Breastfeeding Week at the start of August.
passed from mother to baby through breast milk
which ensures children are less likely to have stom-         feeding exclusively and have not introduced infant                • An advertis-
ach upsets, respiratory (breathing) and ear infections.      formula. Only 25% of babies are still being breastfed             ing campaign
Babies who are breastfed are also at less risk of            at six months. Breastfeeding rates are also usually               which began
becoming obese and having diabetes and cardio-               lower among Maori and Pacific women.                              in July aims to
vascular disease later in life.                                Carol says the aim of her new role is to identify the           increase breast-
   Carol says mothers who breastfeed their babies            barriers to breastfeeding, for example in workplaces              feeding rates by
also gain health benefits because they are at less risk      and in public places and to protect, promote and                  emphasising how
of developing breast and ovarian cancer and oste-            support breastfeeding. A key focus will be looking at             important it is for
oporosis. Breastfeeding can also help mothers to             how Maori and Pacific women can be supported to                   family/whanau
return to their pre-pregnancy weight more quickly.           breastfeed for longer.                                            and friends to
   “Breast milk is also readily available, can be digest-      The breastfeeding advocacy service has been                     encourage and
ed by babies easily and provides the best nutrition for      established by the Ministry of Health through the                 support mothers
them,” she says.                                             Healthy Eating, Healthy Action (HEHA) initiative,                 to breastfeed.
   The Ministry of Health currently recommends               which aims to improve nutrition, increase physical
that infants are exclusively breastfed from birth to         activity and achieve a healthy weight for all New
six months of age and preferably until at least 12           Zealanders.
months with appropriate complimentary food being
introduced at around six months.                             How family/whanau and friends can support mums to breastfeed:
   Carol says while around 90% of all women in               8Offer to help with other children – read them a story or play with them.
New Zealand begin breastfeeding their babies, rates          8Help around the house – do the dishes, or the grocery shopping.
decline significantly with time. After six weeks, 66% of     8if mum is finding breastfeeding hard going, encourage her to keep it up.
women continue to breastfeed their infants. However,         8Other family members can enjoy bonding too. Cuddling and soothing
only about 46% of these mothers are actually breast-         baby will give mum the rest she needs before breastfeeding.

For more information about breastfeeding, see or contact the Canterbury Breastfeeding Advocacy Service on 03 351 3559.
                                                                                                                             HealtH firST / 11
 Primary Health Organisations

                                                          Pre-diabetes diagnosis?
                                                          Time to change your lifestyle
Free health checks                                        Canterbury people who have been diagnosed with pre-diabetes are

           ural people from 45-65 years old are ben-      being given a helping hand to make lifestyle changes that could delay or pre-
           efiting from a new service that enables        vent them from developing Type 2 Diabetes.
           them to have a free overall health check          People with pre-diabetes are able to be referred to a pre-diabetes pro-
           if they have not had one in the past two       gramme, run by Dietitian Nicky McCarthy, under an initiative funded by the
years.                                                    Partnership Health Canterbury Primary Health Organisation.
   The rural Canterbury Primary Health Organisation’s        The programme aims to help people to make lifestyle changes, specifi-
new service provides adults in the Ashburton,             cally around diet and physical activity. Classes are held every second month
Waimakariri and Banks Peninsula districts with a free     at the Canterbury District Health Board’s Diabetes Centre in Hagley Ave,
men’s or women’s “wellness check” at their General        Christchurch.
Practice. The aim is to ensure the first signs of long-      Pre-diabetes occurs when someone’s blood glucose (sugar) levels are
term conditions, such as diabetes and heart disease,      higher than normal but not high enough to be called diabetes. It is diagnosed
are detected early and that steps can be taken to         by a blood test. People with pre-diabetes (also known as Impaired Fasting
treat and possibly delay or prevent the onset of          Glucose or Impaired Glucose Tolerance) are at high risk of developing Type 2
complications. General Practices are subsequently         diabetes. However, leading a healthy lifestyle can delay, or even prevent, this
able to refer patients to other services that can help    from occurring.
them to make lifestyle changes, particularly around          Nicky says people with pre-diabetes are invited to take part in two group
diet and physical activity.                               sessions, lasting about two hours each, which look at what is meant by pre-
   rural Canterbury PHO Project Officer Jill robinson     diabetes and how they can start making changes to their diet and levels of
says it was decided to target the 45 to 65-year-olds      physical activity. They are also able to bring along a “support person”, such as
because the first signs of chronic disease often          their partner, a friend or neighbour.
start to show among this age group. Patients are             “We discuss the importance of regular physical activity to help reduce blood
asked about their diet, levels of physical activity and   glucose levels and how to lose weight safely, if this is necessary. We look at
whether they smoke. Their blood pressure, weight,         the importance of following a healthy diet, which includes reducing saturated
cholesterol and blood sugar levels are also checked.      fat (in particular, animal, palm and coconut fats), eating plenty of colourful veg-
“If we can detect the signs of chronic disease early      etables and fruit, choosing wholegrain products and reducing sugar intake.
on, it may just be a matter of someone losing weight,        “We’re trying to show that it’s not about following a special or drastic diet
doing more exercise or making changes to their            or leading a restricted lifestyle. It’s about making healthy choices for the rest
diet – all of which can help to slow or even halt the     of your life. The best thing about these classes is that people say they don’t
progression of serious disease,” Jill says.               feel hungry or deprived, that their energy levels are better and that they have
   Since the men’s wellness checks began running in       better health overall.
January last year, a total of 804 men have taken up          “With pre-diabetes, it is possible to prevent Type 2 diabetes from occurring.
the offer of a check. Of these, 651 were found to be      Even if it does develop, the longer people can delay it, the less likely they are
overweight; 166 had pre-diabetes and 649 had high         to have complications down the track. If they’ve put in place lifestyle changes
blood pressure.                                           and diabetes develops as a consequence of other factors such as genetics
   referrals to other services are made to different      or age, people can still lead a healthy and fulfilled life.”
services according to the area where the patient             Nicky also takes the groups on supermarket tours, which allows her to
is living. For example, in the Waimakariri district,      show them how to read food labels and how to make healthy food choices. If
patients can be referred to the eatfit programme for      the person who has been diagnosed with pre-diabetes does not do most of
nutrition, exercise and motivation advice. Patients in    the supermarket shopping and cooking, their partner can attend the super-
Akaroa or Diamond Harbour are offered nutrition and       market sessions instead.
physical activity advice through a pilot face-to-face        Nicky has this year also begun running follow-up sessions for people who
Green Prescription (Grx) scheme and/or to dietitian       have already completed the pre-diabetes programme. The aim of the pro-
services. In rakaia, patients can be referred to a        gramme is to offer ongoing motivation and information and allow participants
healthy lifestyle clinic.                                 to share their successes.
FOr MOrE INFOrMATION contact Jill robinson on             FOr MOrE INFOrMATION about the programme
03 357 4970.                                              contact your General Practice.

 12 / HealtH FIrST
Primary Health Organisations

Lifestyle changes paying off
S                                                                      “
          ince completing the pre-diabetes programme, Dennis                    the best thing about this is that i know
          Brown (pictured above) exercises at least three times                 that i can do something to prevent dia-
          a week and reads food labels when he goes super-
                                                                                betes occurring. Often when you find out
          market shopping – which helps him to choose healthy
foods.                                                                          that you’ve got a condition, it’s too late.
    the Kaiapoi man, who was diagnosed with pre-diabetes ear-                                                            Dennis Brown
lier this year, says while he was aware that he should be exercis-
ing and eating healthily, attending the pre-diabetes classes was
helpful because it confirmed the importance of making small            tried to exercise but i was jogging so, during winter, it didn’t
lifestyle changes. “the best thing about this is that i know that      happen and when we got busy, it didn’t happen.
i can do something to prevent diabetes occurring. Often when               “After attending the classes, we got an elliptical trainer (a cross
you find out that you’ve got a condition, it’s too late,” he says.     trainer machine which allows the person to simulate running
    since attending the pre-diabetes classes earlier this year,        and walking), which we do for half an hour at least three times a
Dennis has reduced his alcohol intake and portion sizes. He has        week. the programme was good because it looked at different
made other small changes such as swapping margarine or but-            ways to exercise.”
ter for other spreads such as hummus or cottage cheese, and                Dennis says regular exercise and changes to his diet have
reads food labels to ensure he and his wife are buying foods that      also helped him to lose weight and, along with medication, have
are low in saturated fat and sugar. He also eats plenty of fruit and   helped to lower his blood pressure. “i wasn’t overweight before
vegetables. “i wouldn’t say i’m an expert; i’d just say i’m more       but i’ve lost 2kg and i’m about 1kg off my goal weight of 87kg.
conscious of what i’m eating. for example, when you’re buying          the exercise is also firming me up so i’m able to wear tighter
crackers you really need to look at the label as they range so         clothes and, because i’m fitter, i’m not as tired.”
much in salt and fat content.”                                             Dennis says he would recommend the course to others who
    Along with changes to his diet, Dennis is also enjoying regular    have been diagnosed with pre-diabetes. “it was a very beneficial
physical activity.                                                     course. i would recommend it, even if you think you know it all.
    “One of the biggest things for me was that we have always          it’s all about everything in moderation.”

                                                                                                                          HealtH first / 13
Dietary support

slimming for surgery
Bill Broughton lost 20kg before having a hip replace-                 a BMi of 35-40 are offered surgery at the discretion of the
ment at Burwood Hospital, thanks to an initiative that offers         operating surgeon or anaesthetist. those with a BMi of over
dietary support to obese people needing hip or knee replace-          40 also remain under shelley’s supervision but are returned to
ments.                                                                General Practice care and are reviewed again once their BMi
   Bill weighed 140kg when he was referred to Dietitian shelley       is below 40.
Hargadon in November last year under the Canterbury District             richard says although most people believe they will lose
Health Board (CDHB) initiative. With shelley’s help, he made          weight after surgery with improved mobility, studies show
changes to his diet that helped him lose enough weight to             most do not do so. “We recognise that the need for surgery is
undergo hip replacement surgery last month. “from the bot-            unlikely to disappear. However, weight loss can improve mobil-
tom of my toes to the tip of my head i feel healthier,” he says.      ity, general wellbeing and pain and this then offers an effective,
   figures from Burwood Hospital show that 75-87% of                  if temporary alternative to surgery whilst the target weight is
patients referred for hip and knee replacement surgery are            achieved. We’d like to think that the extra time waiting for
overweight. some are very overweight (morbidly obese).                surgery will be rewarded by a better quality of life afterwards –
   CDHB Anaesthetist Dr richard seigne says obesity tends             and perhaps a longer one as well.”
to make arthritis and the                                                                                            At a weight of

pain from it worse. Pain                      People who are very obese are at greater risk of                    140kg and height of
and obesity can also                                                                                              1.8m, Bill’s BMi was
                                              complications around the time of their surgery
reduce people’s ability                                                                                           45 when he was ini-
to exercise.
                                              and are likely to find it more difficult to get back                tially referred for sur-
    “People who are very                      on their feet afterwards.                                           gery. But 20kg lighter,
obese are at greater risk                                    CDHB anaesthetist Dr Richard Seigne                  and with a BMi of 38,
of complications around                                                                                           Bill was able to under-
the time of their surgery                                                                                         go surgery.
and are likely to find it more difficult to get back on their feet       for the first three months after he was first referred to shelley,
afterwards. Most people will know that obesity is a risk factor       Bill had an appointment every week, which was reduced to
for a multitude of medical problems in the long term.”                once a fortnight once the weight started to drop off.
   Under the initiative, patients who are referred by their GP for       He says the biggest advantage of the initiative was having
possible elective hip and knee replacement surgery are seen           one-on-one support. “Before my visit with shelley i had strug-
initially by a physiotherapist at Burwood Hospital. the physi-        gled to lose 8kg over a 12-month period.
otherapist assesses and scores their mobility and disability;            Once we had our initial interview, it all clicked and, with her
the score helps the surgeon to determine if they are likely to        support and encouragement, the journey became easier for
benefit from surgery. the assessment includes their height            me.
and weight, which is used to calculate their Body Mass index             “i had 66 years of eating the same things . . . i was in the
(BMi).*                                                               army and the old adage is that the army marches on its stom-
   According to new CDHB guidelines for hip and knee                  ach. i had been to a dietitian before shelley but no one had
replacement surgery, anyone with a BMi of over 35 at the              ever told me what i needed to lose to get surgery.
physiotherapist assessment is now referred to shelley. she               “the feather in shelley’s cap was that one of the first things
invites them for a consultation and can work with them to             she said to me was: ‘this is how much you need to lose to get
help them achieve their goal weight for surgery. People with          an operation.’ i’d never had a goal in mind before. the other

 Patient               Surgical assessment Review area, Christchurch Hospital: As a recent patient of the SARA unit I write to compli-
BOUQUEts               ment the DHB for the establishment of this unit which I believe is a fairly recent initiative. The care I received at the weekend
                       was exceptional and I am extremely grateful to the doctors, nurses and support staff who looked after me during my brief
                       stay. – LI, Burwood
14 / HealtH first
New lease of life: Dietitian Shelley Hargadon discusses healthy eating options with hip replacement patient Bill Broughton.

good thing was that as i was saying: ‘but i love my bread, my         have lost 5kg-9.99kg and 13 people 10kg-14.99kg. One
meat and my potatoes’, she was saying: ‘you do not neces-             person has lost more than 30kg. some 52% of patients
sarily have to give up all of those things, you just have to look     have so far reached their goal weight for surgery or are
at your portion size and look at alternatives to some things.”        close to reaching their goal weight. About 22 people have
   since then, Bill has “gone crazy on veggies”, swapped blue         so far had surgery.
milk for powdered milk, which ensures he can monitor how                 shelley says the aim is to work alongside people to
much he drinks, cut out sugary foods and swapped mutton               encourage them to make lifestyle changes, which they can
and processed meats for chicken. He also drinks very little           maintain. she also holds group sessions with five to 10
alcohol.                                                              people, so people are able to share lifestyle tips.
   Bill says since he has lost weight, he is able to complete 18         “A lot of it is around portion sizes, making the right food
holes of golf without needing painkillers just to get round the       choices and finding the link between the amount of activ-
course, as he previously did. He is also walking for 40 to 45         ity and food intake, and adjusting it accordingly. it’s about
minutes a day during the week.                                        guiding them and helping them to come up with their own
   Bill plans to continue eating healthily and exercising regu-       goals because, ultimately, it’s up to them.”
larly in a bid to reach his own goal weight of 110-115kg.                richard says: “i believe health is a joint responsibility of
   shelley says most patients invited to access the dietitian         the individual and the DHB. this initiative shows what can
service are keen to take up the offer. Of the 128 patients she        be achieved when both work together to achieve a desired
is currently seeing, a total of 83 people have lost up to 5kg, 27     outcome.”

tHe impAct Of lOsing weigHt – feeDBAck frOm pAtients
“it used to take me two goes to make my bed as i got too breathless – now i can do it in one.”
“i can now do my seat belt up, which i haven’t been able to do for four years.”
“i went to the garage to get my car fixed and sat on one of their chairs in the waiting area. i have been going to
the same garage for 19 years and have never been able to fit in the seat. Huge motivator!”

                            *Body mass index = weight (kg) divided by (height (m) x height (m))
                            for example Bmi =           85 kg / 1.65m x 1.65m = 31.2
                            A healthy Bmi is between 18.5 and 25.
                                                                                                                  HealtH first / 15
Sleep issues

The secrets
of peaceful slumber

                 our alarm clock goes off on Monday morn-            are unable to sleep. those who are unable to sleep 20 to
                 ing and you feel so tired that you’re unsure if     30 minutes after going to bed or unable to get back to sleep
                 you’ll be able to drag yourself out of bed – let    within 10 minutes after waking during the night should get
                 alone make it to work.                              out of bed and go into another room.
                    some people have coined the term                    “Do something boring; read a technical manual or do a jig-
                 Mondayitis to describe this feeling – but what      saw in low lighting. Go back to bed when you are tired. this
many of us don’t realise is that this tiredness is often directly    helps the mind associate bed with sleeping,” he says.
linked to our sleeping patterns during the weekend.                     Michael says people should also ensure they are comfort-
   Dr Michael Hlavac, a respiratory specialist at Christchurch       able and relaxed and have no distractions in their bedroom,
Hospital’s sleep Centre, says one of the keys to a good              such as an alarm clock next to their bed. A good tip is for
night’s sleep is to maintain a consistent sleeping pattern           people to use the alarm on their mobile telephones instead.
throughout the week.                                                    Michael says people who want to sleep well at night
   “Even if you stay up late friday night and sleep in saturday      should also ensure they spend some time outdoors or in
and sunday, it will generally be more difficult to go to sleep       natural light during the day as the body relies on light to con-
on sunday night and more difficult to get up on Monday               trol secretion of melatonin – the hormone which regulates
morning because your                                                                                         our body clock.

body clock will have                        sleep that knits up the ravelled sleeve of care,                    Getting some sun-
shifted half an hour to                                                                                      light early in the day
                                            the death of each day's life, sore labour's bath,                is particularly help-
an hour which means
it will now not be at its
                                            Balm of hurt minds . . .                                         ful for resetting peo-
peak waking up time.                                                   Shakespeare’s Macbeth                 ple’s circadian clock
   “Our bodies can                                                                                           (body clock), which
generally cope with                                                                                          will ensure their bodies
this a lot better when we are younger, but as people get             know when to sleep and wake up.
older, they need to be more careful about maintaining a rou-            Exercising each day is also helpful for a peaceful slumber,
tine. However, this doesn’t mean you should get obsessive            although people should aim to do so in the morning or
about it; an occasional night out or sleep-in is not going to        before dinner time as physical activity before bedtime can
hurt,” he says.                                                      stimulate the body and make it difficult to sleep.
   Michael says anyone who wants to get a restful night’s               Michael encourages people who want to take a nap dur-
sleep will benefit from the “sleep hygiene” advice he gives to       ing the day to do so, provided it is not affecting their sleeping
patients with serious sleeping problems, such as obstruc-            patterns at night.
tive sleep apnoea (OsA) or chronic insomnia. Most people                “if people need to sleep during the day, they should limit
generally need about eight hours sleep each day, although            this to a 20-minute power nap so it does not affect their
this can differ slightly from person to person.                      sleeping at night. the reason many people feel tired at about
   Useful tips include avoiding alcohol and caffeinated drinks,      2-3pm is because their circadian rhythm (body clock) pro-
such as tea and coffee, after 6pm and stimulating activities         duces a natural increase in sleepiness during the afternoon.
such as playing on the computer or watching television in            that’s why they have siestas in the Mediterranean – they
the bedroom.                                                         take advantage of the natural increase in tiredness at this
   Michael recommends people should get out of bed if they           time!”

16 / HealtH first
Stress can cause insomnia

        nsomnia is the most common sleeping disorder, with about a quarter of all people experiencing
        it at some point in their lives. it occurs when someone has problems getting to sleep or getting a
        sustained deep sleep for more than three months.
           Dr Michael Hlavac says often the period of sleeplessness will be triggered by a stressful event.
           “Often people may have a difficult time in their lives, such as a bereavement or a stressful period
        at work and go through a period where they can’t get to sleep or have problems getting a sustained
deep sleep.”
  People with insomnia will usually see their GP for advice and usually do not need hospital treatment.
  Michael says it is unclear why people get insom-

nia but sometimes there is a family history of the
condition. Certain medical disorders, such as an
                                                                        it’s reassuring for people to know that most peo-
overactive thyroid or some psychiatric disorders,                       ple with insomnia will still get enough sleep to stop
anti-depressants or other medications, can also                         themselves from getting sick.
prevent people from sleeping properly.                                                                         Dr Michael Hlavac
  He says his preferred method of treating peo-
ple with insomnia is working with them to make
behavioural changes, rather than giving them medication, to help them sleep.
  He talks to them about good “sleep hygiene” practices to adopt (see previous page) and tries to encour-
age them to stop worrying about not sleeping properly.
  “sleeping is a passive experience so if you try to fall asleep, and if you’re anxious in bed, the less you
will sleep. it’s reassuring for people to know that most people with insomnia will still get enough sleep to
stop themselves from getting sick.”

                                                                                                                 HealtH first / 17
Sleep issues

Halt in breathing can
cause frequent waking
Obstructive sleep apnoea is another sleeping disor-
der that can have a serious impact on people’s lives if left untreated. Dr Michael Hlavac
says often people will not realise they have sleep apnoea, which occurs when people
stop breathing while asleep. it is twice as common among men.
   People with the condition can often stop breathing and start again several hundred
times a night. they often do not experience a phase of sleep
called rapid Eye Movement (rEM), which is when dreams
    “some of the very severe patients may be aware they are
waking during the night or they may feel like they’ve stopped
breathing during the night. But a lot of people will not realise
this is happening and will say ‘it feels like i’ve slept for eight
hours but i feel terrible’. Often it’s their partner who will notice
they stop breathing.”
   Michael says severe sleep apnoea, if left untreated, can lead
to heart or respiratory failure and can be life-threatening. Other
effects of sleep deprivation include problems with short-term
memory and co-ordination, and, in the longer term, it can lead
to significant mood swings and a decline in brain function.
   A major risk factor for sleep apnoea is being overweight so
treatment usually includes encouraging patients to lose weight
where necessary, getting regular exercise and looking at ways
in which they can help themselves to get a good night’s sleep.
this could include changing their sleeping position, as often
breathing is worse when people lie on their backs, or avoiding
practices that can hinder a good night’s sleep, such as drinking
alcohol before bed.
   for someone with severe sleep apnoea, the usual treat-
ment is a method called Continuous Positive Airway Pressure
(CPAP). A machine releases air into a mask over the patient’s
face, which helps to keep their throat open while they are                                                      A Continuous Positive Airway
asleep. About 1200 people being treated by Christchurch Hospital’s sleep service are                         Pressure device used by people
currently using CPAP.                                                                                              with severe sleep apnoea.
   Other less common options include wearing a dental splint, which holds the jaw and
throat open or having surgery to open up the throat.

 Patient              Wards 25 and 27 (Respiratory and Oncology), Christchurch Hospital: I was lucky enough when admitted to hospital
BOUQUEts              to be placed in Wards 25 and later 27… the nurses on duty at the time were quick to re-establish my personal sense of worth.
                      This, I believe is the direct result of having the highest quality of staff and the training given to support them. I also want to
                      thank the cleaners, the cooks and orderlies and the doctors and specialists … these people are the face of our health system
                      … it helps heal us. – PS, Burwood
18 / HealtH first
                                                                                                 Dance takes off

             Getting into the groove with Peer Led Hip Hop.

 Dancing Like
  The Stars
Children in ChristChurCh are getting active
through dance, thanks to two innovative pilot programmes
organised by the Dance and Physical Theatre Trust in local
  The Riccarton/Wigram and Fendalton/Waimairi community
boards are funding a Dancing like the Stars project in 10 primary
and intermediate schools, whilst Partnership Health Canterbury
and the Canterbury District Health Board (CDHB) are funding a
peer led dance pilot in two high schools.                           Aaron Gilmore, with partner Tina Cross, on this year’s
                                                                    Dancing With The Stars programme. image copyright tVNZ
Peer led danCe Pilot
The Peer Led Dance Pilot began in term two of the 2008 school
calendar year at Avonside Girls’ and Mairehau high schools. The     with two hugely successful performance nights hosted by Aaron
programme will run in four more schools next year. The aim of       Gilmore from TV1’s Dancing With The Stars programme.
the project is to ensure a group of students at each school are       Aaron says he was pleased at how children responded to the
capable of teaching dance. Under the programme, students            programme.
are taught by two experienced teachers over eight weeks. The           “I think for me the big thing is how this event affects the chil-
teachers also follow up with the schools and students after they    dren’s self-esteem. You have these kids that walk on to the stage
have completed the programme.                                       heads down and humble and when they walk off those same
                                                                    heads are held high with a huge smile.
danCing like the stars                                                “To see what these children can do in just eight weeks is amaz-
The aim of the Dancing Like The Stars programme is to encour-       ing and watching them perform is even better. All the parents,
age students to lead healthy, active lifestyles by providing        teachers and helpers involved are so proud but, most of all, they
dance classes in low decile primary and intermediate schools        are proud of themselves.”
in Christchurch. After a successful pilot in four Hornby primary
schools last year, the programme has now been rolled out to         FoR MoRe InFoRMATIon on either project, contact Adam
include 10 schools. During term two, students learned a particu-    Hayward at the Dance and Physical Theatre Trust on 03 366
lar style of Latin dance over eight weeks. The programme ended      7709 or

                                                                                                                     HealtH FIRST / 19
Neonatal care

                                                                                                                                  and Nick
                                                                                                                                  enjoy pre-
                                                                                                                                  cious time
                                                                                                                                  for cuddles
                                                                                                                                  with baby

             DiM tHE LiGHts
             it’s Quiet time for new babies

              very afternoon while their daughter Charli was in               Caroline says the quiet time gave her the chance to have
              neonatal care, Caroline and Nick Collins enjoyed             some “nice bonding time” with Charli while she was in the
              precious, uninterrupted “cuddle time” with her.              NiCU. “i have found it really good because i like being able to
              Charli, who was born on 20 June and had bowel                sit here with Charli when it’s a bit dimmer and when it’s more
              surgery just one day later, is among the first babies        intimate and one-on-one. We are able to cuddle from 1-3pm
to benefit from a new visiting policy introduced by Christchurch           and it’s often the only chance during the day that i’ve got where
Women’s Hospital’s Neonatal intensive Care Unit (NiCU).                    i can sit and rest and look at her.”
  the aim of the initiative is to ensure parents of premature                 NiCU Associate Clinical Nurse Manager Jenny Liley says the
and sick babies in the unit have a two-hour “quiet time”, from             change to visiting hours followed consultation with both staff
1-3pm, which research shows can help babies to grow and                    and parents and a two-month trial earlier this year.
recover.                                                                      she says research shows that babies who are premature or
  Visitors are asked to stay away, lights are dimmed, blinds are           recovering from surgery benefit from being in an unstimulating
pulled and staff try to make as little noise as possible. During           environment as much as possible.
this time, parents are encouraged to give their babies a “kan-                “the more babies are able to sleep, the more calories they
garoo cuddle” – a special cuddle where the baby’s parents hold             are able to conserve for growth. Babies recovering from surgery
the infant on their chest to keep them warm.                               are also conserving energy for recovery.”

 Patient              emergency Department, acute Medical assessment Unit and Ward 26 (Cardiology), Christchurch
BOUQUEts              Hospital: From the time I was brought into ED . . . I received exemplary professional treatment. My personal fear and
                      stress at my situation was gently addressed by many staff so that by the time I was admitted to Ward 26 I felt safe.
                      The degree of personal communication from all your staff is a credit to their training, their personal attitudes and an all
                      pervading “openness” that Christchurch Hospital exhibits. – JB, Spreydon
20 / HealtH first
Cervical cancer protection

available to young women
A new free vaccination to help pro-
tect girls and young women against
cervical cancer will be available to all
17 and 18-year-olds in Canterbury from
this month, as part of a national immu-
nisation programme.
   The Human Papillomavirus (HPV) vac-
cination will be available from all General
Practices in Canterbury.
   It will protect against the two strains
of human papillomavirus that cause
70% of all cervical cancer cases and
90% of all genital wart cases, provided
the girl or young woman has not already
been infected with those strains of the
   From next year, the programme will
be extended to include all girls and
young women aged 12-18.
   Girls and young women will have
three doses of the vaccination over a
                                              emma Thomas is one of many young new Zealand women who are eligible
period of six months, which they will be      for the new vaccination.
able to get from any General Practice. It
is unclear how much protection young
women will get from only one or two           their lives, although the infection usually   to HPV. However, a young woman who
doses of the vaccine so it is recom-          clears without treatment.                     has already had sexual contact may
mended they should receive all three             CDHB Project Manager Alison Young          still benefit from having the vaccination
doses to be fully protected.                  says the HPV programme will aim to            because it is unlikely she will have been
   It is also unclear how long young          reduce the number of cervical cancer          exposed to both of the two HPV types
women will be protected against HPV           cases in new Zealand by protecting            the vaccination will protect against.
after they have received the vaccina-         girls and young women against HPV             evidence also suggests that the vac-
tion. However, trials show that after five    infection.                                    cine is more effective when given at a
years, young women still have immu-              About 160 new Zealand women are            younger age,” Alison says.
nity to the two strains of the Human          currently diagnosed with cervical can-           Trials have shown the vaccination has
Papillomavirus which the vaccination          cer each year and 60 women die from           no serious side effects, although some
protects against.                             the disease. HPV immunisation pro-            people may experience a mild fever,
   HPV is a common virus spread               grammes are already running in other          redness or swelling at the injection site.
through skin to skin contact and some         countries such as Australia, the United          As the vaccine will not protect against
strains can cause cell changes that may       Kingdom and the United states.                all types of HPV that cause cervical can-
lead eventually to cervical cancer.              “The aim is to immunise young              cer, sexually active women will still need
   About four out of five people will be      women before they become sexually             to have regular cervical smears from the
infected with HPV at some stage of            active, and can therefore be exposed          age of 20.

                                                                                                                   HeAltH FIrsT / 21
Pneumococcal disease

The free vaccination
could protect children
like Jack Wells.
a free vaccination is now available                                             years old are admitted to hospital with serious pneumococ-
to protect babies and young children from pneumonia,                            cal disease.
meningitis and ear and sinus infections caused by pneumo-                          “Pneumococcal disease is more prevalent among infants
coccal bacteria.                                                                from four to nine months, illustrating the importance of
   All children born on or after 1 January this year are eligi-                 receiving the first three vaccines on time at six weeks, three
ble for the pneumococcal vaccine, called Prevenar. Babies                       months and five months to offer the best possible protec-
will receive this at six weeks, three months, five months                       tion.”
and 15 months, as part of the New Zealand immunisation                             Along with the introduction of Prevenar vaccine, a six-in-
schedule. it is also available to children under five years old                 one vaccine called infanrix-hexa has also been introduced.
with certain medical conditions that put them at greater risk                   this protects children against diphtheria, tetanus, whoop-
of pneumococcal disease, such as cardiac disease, chronic                       ing cough (pertussis), polio, hepatitis B and haemophilus
lung conditions and insulin-dependent diabetes.                                 influenzae type B (hib). Children were previously immunised
   Pneumococcal disease is caused by pneumococcal                               against these six diseases with two separate injections.
bacteria and is spread through the air by coughing and                             the MeNZB (meningococcal B disease) vaccination pro-
sneezing.                                                                       gramme – which began in 2004 to control the epidemic and
   Pneumococcal bacteria can cause meningitis and sep-                          ran alongside the childhood immunisation schedule – ended
ticaemia (blood poisoning), both of which can be fatal, or                      on 31 May this year. this is because the rates of disease
infections of the joints, bones and around the heart. it is                     have decreased so the vaccine is no longer needed to con-
also a common cause of pneumonia, ear and sinus infec-                          trol an epidemic. However, parents of babies and children
tions and can be a complication of a viral infection, such as                   who started their MeNZB doses before 1 June this year
influenza.                                                                      should complete the course.
   immunisation Co-ordinator Jayne thomas says it was
decided to offer the pneumococcal vaccination because                           For further information about childhood vaccinations,
New Zealand has relatively high rates of the disease.                           contact your General Practice, 0800 iMMUNE (0800 466
   Each year more than 150 New Zealand children under five                      863) or see

 Patient                 General Surgery Department, Christchurch Hospital: Every time I come in I receive the best of care, I am greeted
BOUQUEts                 warmly and the staff have all been just super ... At every stage I am well informed and know just what is happening, what
                         to expect and my questions are always answered. For me, Christchurch Hospital has been an efficient service, with caring,
                         compassionate staff. – SW, Linwood
22 / HealtH first
Falls prevention

Programme changing lives

                       hen Mary Jenkinson fractured her pelvis and       mobility. Many attribute the SOYF programme to changing their
                       some vertebrae in a bad fall, Stay On Your        lives. “One of my clients now walks every day. Before she was on
                       Feet (SOYF) – a Falls Prevention Programme        the programme she never went out, so it’s made a big difference
                       available in Canterbury – helped her to regain    to her life.”
                       strength and confidence.
   The New Brighton woman found the programme so helpful                 If you think you are at risk of a fall, ask your GP or allied
she even showed some of the exercises to her relatives – one of          health professional if one of the Falls Prevention Programmes
whom was waiting for a hip replacement.                                  in Canterbury could be right for you. Visit
   “The programme definitely helped me to get my balance back            About-Us/Elderly-Falls-Prevention.asp or
because I was really worried about walking again. It gave me             prevention/home-safety/older-adults/index.htm. for information
more confidence,” Mary says.                                             on Tai Chi and the Otago Exercise Programme.
   The six-month SOYF programme is run by Community & Public
Health; a division of the Canterbury District Health Board (CDHB).
It is part of the Falls Prevention Programmes in Canterbury – a
CDHB and Accident Compensation Corporation (ACC) collabo-
   SOYF is for people 65 years and over (or 55 years for Maori
and Pacific people) who are at risk of falling or have fallen. Trained
volunteers visit a client in their own home, five times over a six-
month period, to teach exercises designed to improve muscle
strength and balance. Follow-up telephone support is also
provided by the volunteer between visits, to help motivate the
   Dorothy Kitchingman, who helped Mary through the pro-
gramme and is one of its longest-serving volunteers, says when
she first meets a client it is important to talk to them about what
they want out of the programme and to assess their mobility.
   “Initially, I need to know what that person can do, what their
expectations are and what their fears are. The relationship I have                                                             Volunteer
with the client is more like a friendship. Most people are very keen                                                           Kitchingman
to take part in the programme because they want to stay in their                                                               and Mary
own homes for as long as possible and to remain independent,”                                                                  Jenkinson
                                                                                                                               show their
she says.                                                                                                                      balancing
   Dorothy says she has noticed a huge difference in clients’                                                                  skills.

   Meeting older persons’ needs                                          teams of health professionals, working together to assess, treat
                                                                         and rehabilitate referred patients.
   Improvements to the Canterbury District Health Board’s Older             Older Persons Health Operations Manager Diana Warren says
   Persons Health Service (OPHS) mean it will be able to better meet     the new model streamlines the way community services are
   the on-going needs of older people in Canterbury.                     accessed and delivered to patients. “General Practitioners will
      Previously the service had a number of teams within com-           also be able to refer a patient to the service much more quickly
   munity services, which were all accessed differently. This made       and easily, through a single-point-of entry referral process. Each
   obtaining services and the co-ordination of care for people           patient will have their own case manager, who has accountability
   more complicated. To simplify and speed up access to commu-           for their care within the team approach, while maintaining strong
   nity services, OPHS has been re-organised into inter-disciplinary     links with General Practice,” she says.

                                                                                                                           HealtH FIrST / 23

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