Monthly Archives: August 2015

The tale of a mermaid


I am not a baker or beautifier of cakes, it just never has been my strong suite and I have a great propensity for flopping baking. I do have a handicap in terms of an oven. So when my soon to be 4 year old was “needing” a mermaid cake and both the bakers I usually rely on – my mother in law and my sister – both super competent at an international level, were not available I had to muster all the courage I had and proceed.

I found a foolproof sponge recipe – Delia Smith says you can not flop this. Well Delia has not met me or my oven. It looked lobsided and burnt on the edges and I thought well here we go again. Almost sobbed on my 4 year old’s behalf.

I work so into the freezer the cake went looking fairly forlorn. We travelled to the beach for the weekend so frozen it stayed and into the beach freezer.

Sunday morning dawned and I put on my big girl pants, woke up early and took the flat lopsided “clay” to be moulded out.

Mixing coloured icing was something that I thought would be easy, but the stuff kept curdling. Beat beat, mix mix, curdle curdle. Cutting the shapes using my trustworthy iPhone photo on pinterest went easily – I so should have been a surgeon. Next I started icing the lady mermaid and making her look as if she was happily playing in the waves. I managed to surprise myself and all the children. Delight!

Tale of a mermaid

Tale of a mermaid

Inspiration for a monday


I watched the movie “Jobs” last night and what a lovely surprise. First of all that Ashton Kutcher is actually able to act and secondly that I did not know the story of this remarkable man who did indeed change the world for the better on a very large scale.

The persecution he endured??

Wow.

The arrogance of the corporate world at large is flabbergasting and to a degree greatly deeply disturbing in terms of our progress as humanity in all fields.

Despite multiple set backs and criticism though Steve Jobs did manage to change the world. I am possibly one of the world’s biggest mac fans so I think I am biased, BUT, look at how once again the other companies have copied a lot of what he was trying to say – and he was saying it in 1984!!! A long time ago.

The other thing that struck me was the long time frame that it did take to go from idea to a concrete product as we know it.

As for the shares – they speak for themselves. Fickle a concept as that is though. Yet so targeted and narrow-mindedly from a corporate point.

It was a great movie to watch and comprehend.

Life simply is not simple. Our greatest minds it seems are only truly appreciated once no longer with us.

The lesson for me is this : believe in your own ideas and do not let other people crush them. The will criticise them and so be it – do NOT let this stop you. It seems that the vast majority of people are not visionaries and like to stick to the narrow confines of parameters that they hold on to despite a visionary  idea. Your break will come, albeit many years that may pass in-between. Don’t ever give up on yourself of your ideas.

A journey full of criticism and hard knocks,yet he changed the world

A journey full of criticism and hard knocks,yet he changed the world

stevejobs1

Breastfeeding – don’t let it let you down


Due to my age at having my first child -not uncommon these days though I do believe that my own battle was harder than it necessarily would have been had I been in my twenties or early 30s. I was a “burn your bra” kind of adamant pregnant lady who fought very hard for a natural birth on 2 occasions and fought myself on the breastfeeding issue.

Yes we are women, yes this should indeed come naturally and I believe for some it does. However in my case both pregnancy and breastfeeding did not come naturally. I battled “illness” daily for 2 long pregnancies (both went over by about 2 weeks – 84 weeks in total).

My first child came into this world after a long distance labour and latched beautifully. I then proceeded to have some complications 3 days later and even continued breastfeeding through all of that, the casualty staff were a combination of impressed and concerned. But despite the will it was really quite tricky. I think the main problem was that she was a hungry baby and at times I don’t think I had enough. After one month I was needing to top up with formula. In retrospect I think I could have managed this differently by alternating feeds, one breast, one bottle and it would have made life a little easier. I used all manner of remedies to increase production. At the end of the day I really think my own anxiety around the issue was hampering production. I managed for 4 months.

Round 2 was a little easier but by no means easy. I certainly had less anxiety. My second born is also more laid back. She weighed less and has always been a “smallie” – so required less. She also “fussed” less and I was generally better at reading the difference between hungry, tired and just plain crabby.

Do I think breast is the only way. No not at all, for some women it is just one thing too many to deal with and for all parties concerned better off not battling it. Do I think it comes naturally and is easy? In my case certainly not. It was hard, I am not even going to go into the pain involved and nipple harrassement.

I was, as my husband put it, a poor cow. Despite that I managed to 8 months with my second born.

It certainly is not the beginning or the end of nutrition, bonding or feeding. Most of all I want to allow women to feel ok about whatever they decide as a mom there is a lot on your shoulders and you need to be at peace more than anything else. There are many issues that you are going to face and really this is not one to feel good or bad about. It is an option and if it works for you and baby then great, if not don’t beat yourself up. By the same token if you are willing to push through and have the WILL to do this and accept the battle get help and figure out where you can improve things.

Of far more importance is your own countenance and peace. Make sure that is priority no 1.

beatiful bump -no this is not me

beatiful bump -no this is not me

Breastfeeding

Breastfeeding

Banting’s best with common sense


The pearls I have gleaned from the current Banting wave are the lesser intake of simple sugars and simple carbs. One does not have to forgo all carbs, neither does one have to eat piles of fat.

This very simple message, contrary to what we have been fed both by the media and the medical profession over the last about 50 years is the low fat lie.

Certainly low fat is not the answer as seen by the past 50 years increase in both diabetes and obesity – diabesity. The lie was that carbs are ok. Yes they are in moderation and if you are eating quality carbs.

If you are eating piles of junk in the simple form of it – that is what has precipitated a tsunami of unwellness.

Glean the best of banting, lose weight slowly, have more energy and prevent diabesity.

The hamburger tsunami causing diabesity

The hamburger tsunami causing diabesity

tsunami

A Conference that exceeded expectations


I was priveledged to attend a recent conference for diabetes care professionals in the broad – namely the entire team : biokineticists, dieticians, diabetic educators, podiatrists, ophthalmologists and doctors. Hope I didn’t leave anyone out. Unique in a sense and totally committed to the best care for diabetics at large in south africa.

I commend every speaker who was both entertaining and captivating and highly educative with messages that I am sure will stick in our minds with the sole purpose of improved and great medical care to our diabetics.

I guess the topic that most excites me is the prospect of closed loop technology in our time. Something that was very nicely detailed was the lack of any current insulin to “match” physiology and the much needed pattern of glucose uptake in order to enable euglycemia. Contrasted brilliantly (the best talk I have ever heard) by the journey towards efficacious/accurate closed loop techonology in our time.

Yes new insulins that better “match” glucose uptake will help, yes new drugs for type 2 diabetes are wonderful. However a “cure” for type 1 is yet another super super exciting prospect for type 1’s. The cost of this is definitely a limiting factor but the mind blowing research going into making this a concrete reality is exciting and something that any type 1 parent prays for.

The balance, with holisitic medicine not being ignored, covering science behind the benefits of coffee and cessation of smoking done masterfully.

There are many people in this country who work beyond the best of their ability. Many health professionals who attempt to steer the ship in the direction of safe, affordable yet excellent care and I commend these professionals who despite the tide that comes against them and the punches that are thrown never waiver in the task and as someone pointed out throw a tremendous counter punch ;).

Islet cell transplantation in our time

Islet cell transplantation in our time

islet 2

Are all carbs equal ?


Are all carbs equal. No, I don’t think so. For example a plate of deep fried chips vs a quinoa salad is a totally different kettle of “carbs”. The notion that quality of carbs plays a role is something to think about. Simba chips vs roasted corn. White or brown bread vs a half a cup of brown rice. Putu “pap” vs roasted butternut.

Quality certainly is a concept that should not be thrown out with the baby and the bath water.

Should one consume heaps of protein? No I don’t think so either a healthy portion remains a portion the size of one’s palm. Protein snacks instead of simple carb snacks are a good idea as they do definitely help to keep the blood sugar stable. An overload of protein in any form and bear in mind there are also quality proteins vs less high quality proteins, is dangerous for the body especially the kidneys.

quinoa

Banting and inflammation – sugar molecules are sticky indeed!


I was asked to write a blurb about carbs and inflammation. Do I think that carbs cause inflammation?

Yes I do. The problem is that we very easily overeat carbs. It is quite possible for a human to eat a packet or two (big one) of chips and then a slab of chocolate. Right? I can confess that even I (who should know better) have done this. Would you be able to eat the same quantity of fat? I really doubt, you would start to feel bilious and have to stop.

An overload of carbs = an overload of glucose molecules. Have you ever spilt coke on the floor? It is sticky. So an overload of glucose molecules are STICKY indeed. What does sticky do? Sticky causes things to stick together = inflammation. The body obviously objects to things sticking together and so tries to get them unstuck – a mop up operation – inflammatory cascade delux.

There are studies that link high carb consumption to cancer and it is for this reason – you are forcing your body to mop up more than it should besides the stick icky sugar molecules being fuel for bad cells to grow.

Is sugar bad? Look around you. One hundred years ago people ate less rubbish (i.e. sugar) and they were generally skinnier and healthier. Look at America these days – many many overweight people all stuffing large loads of carbs down their gullets. Not fat? Carbs.

Carbs, Coke and the like are the devil.

Is fat better for you then? Well no but you are not going to eat the quantity of fat in terms of the equal quantity of carbs. Carbs are nice, they are pleasant, we like eating them. To eat a lot of fat is not as nice and one starts to feel yucky earlier on. Does fat cause inflammation ? YEs indeed. What actually happens is that all those carbs that exceed what you need are turned to fat, you heard me – turned to fat. And that is why they cause weight gain. The extra carbs are “stored” as fat for times of trouble and famine. Only in 2017 in the west there is no famine.

So should you be banting then? My personal view is that less carbs is good, more fat is not necessarily good. It is important to understand the different “fats” good vs bad and yes eat more good fat. If you decide to “Bant” – do so with a dietician. Most folk who “Bant” off the bat get it horrible wrong and do more harm.

 

pile of carbs

pile of carbs

Diabetes ketoacidosis ABC


Diabetes ketoacidosis ABC.

Diabetes ketoacidosis ABC


I have blogged about DKA before. 

DKA – diabetes keto acidosis. Starving in the sea of plenty. Too much sugar – way too much in the blood stream and not enough insulin to get it – the glucose into the cell. Did you ever do those experiments at school about osmosis, where water moves through a membrane to where it is being drawn? In this case the cells, so to speak, dehydrate and start to die and the vascular system is “loaded” with glucose. The cells are dry dry dry and have no way of doing what they need to do – metabolism – without which the human whose cells they are die.

A process begins and catapults quickly and rapidly into a serious life threatening environment which is hostile in the nth degree. Acidosis – pH below 7.4 is very unkind and unfriendly to human life.

The by-products of this deranged metabolism – which is by the way the bodies way of desperately trying to stay alive – are called ketones – these one can measure. 

NOW, a 100 years ago we did not know about ketones, about 50 years ago we discovered a way to measure them in the URINE – major breakthrough. About 20!! years ago we learnt how to measure them in the BLOOD – this is FAR more accurate – far far more accurate, in terms of being related to the timing of what is actually happening in the body as well as giving an accurate quantitative measure of the ketones. In other words one can more accurately monitor and wash them out if you are checking the blood ketones.

Generally speaking if a doctor uses urine ketones to monitor and treat you it will take up to 10 days to get rid of the ketones. IF the doctor uses blood ketones you can see that they disappear (if of course you are doing the fluids correctly and the insulin infusion) within 12-24 hours at the most 48. Not you tell me, patient, medical aid and family which would YOU prefer? Ahospital stay of 2 days or 10 days, one in ICU or one in a well run ward?

Is there a good reason to use urine ketones over blood ketones? No I really don’t think so, it is like using a horse drawn cart to drive to work.

Sorry but I just can not take it any more. Surely it is indelibly printed on your inside if you are a doctor that you wish to do NO harm and wish to HELP your patient to the best of your ability? The best of our ability at this point in time when it comes to DKA is using blood ketones (not urine ketones and yes the occasional blood gas does help but it is a painful investigation and one can very easily and safely manage with new techology).

blood ketones vs urine ketones

blood ketones vs urine ketones

The ethics of refusal of treatment in an emergency


I have not yet become calm inside myself yet. Perhaps I should not be writing a blog still in the state of turmoil of emotions. How on earth do you study a degree in the health profession and when presented with an acute LIFE threatening emergency in a CHILD whose vitals are not great on the not great scale the to point of extremely close to decompensation and not a great outcome i.e. fatality, you send them back to the place they came from – an hour away?

I would like to know in this scenario – IF a fatality had occurred – who would be responsible?

I am deeply horrified and traumatized, not to mention the patient and the family.

Basic human rights, dating back to the day of the story of the good samaritan mean that as a human beings you would do this – help – even if you were not trained?

How does one blandly cop out with excuses like “she is over the age of 12”, the unit here will only see “known” patients – IN AN EMERGENCY??

Yes I acknowledge that we should not have gone the route we did – seeking out the best care for this patient who is on an insulin pump and has previously been traumatised and treated very very badly in the local state institution. We should have just argued as I did with the local institution until we got her into a unit that could take care of this emergency. It was partly trying to respect the patients rights and dignity and wishes. Next time the only thing I will consider is her LIFE and getting the emergency treatment (albeit having to argue for more than an hour and a half on my own cell phone) to get it.

There is something VERY very wrong with the way things work when a child’s life hangs in the balance and bureaucratic CRAP stands in the way of rescuing that life.cathair

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