Do Ctor's Orders

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May 30, 2011 ... yet the HCG programme is not simply a diet because, apart from helping people ..... clinics, which offer glaucoma assess- ment, check-up for ...
Doctor’s Orders Issue 01 • Published by the Saint James Hospital Group • www.stjameshospital.com • May 2011

InsIDe thIs Issue Weight • Healthy Recipes • Weight Loss Management • Gastric Balloon • eye Clinic • Correcting your Eyesight •  Excimer Eye Laser Testimonials • health • The Benefits of Omega-3 • Cosmetic surgery • Tummy Tuck Procedures  • Skin Rejuvenation • Doctor’s Corner • Giving you back your Health, Energy and Ideal Weight – introducing the HCG Weight Loss Programme to Malta

Welcome • Page 03 • Doctor’s Orders

Doctor’s Corner

In good

THe FiRST PHaSe FoR THe ReST oF youR LiFe

health

The HCG programme gives you back your health, energy and ideal weight.

The Group made its greatest investment in Malta to date when in 2002 it took over Capua Hospital in Sliema. Recent years have also seen the Group branching out overseas with the successful opening of an eye Clinic in Budapest, Hungary, and a hospital in Tripoli, Libya. unfortunately, the latter is currently at a standstill due to the turmoil in the country. Because of such growth, i am always surprised to hear the Group occasionally referred to as Saint James Clinic. Referring to the Group as a clinic means overlooking DR LauRina HiLDeRinG and DR DiRK Van LiTH have helped thousands to lose the size of the enterprise and the vast range weight thanks to their HCG programme. of services, treatments and surgeries that Dr Hildering, who is a medical and clinical psychologist and psychotherapist, and we perform every day. Dr van Lith, a consultant specialising in nutritional counselling, lifestyle management This publication, which is being distriband anti-ageing, have developed the HCG programme over the past two decades. uted with The Sunday Times of Malta four The HCG programme takes a non-fat, low-starch, sugar-free approach and combines times a year, is intended to give you more inthe latest insights in lifestyle management with the most effective principles of success formation about the services and treatments psychology. The programme also involves the daily self-application of an extremely that the Saint James Hospital Group offers. low dose of Human Chorion Gonadotrophine drops. HCG is a completely harmless Healthcare is a dynamic sector – this, in substance circulating in maternal blood and encourages the transformation of stored turn, makes the Saint James Hospital Group fats in selective areas, such as the hips, thighs and abdomen, into energy. dynamic as it embraces its position at the “HCG is as old as mankind and is completely safe,” says Dr Hildering. “our theory is forefront of Maltese private healthcare. ealthcare is in continuous that humankind suffered a lot of famines in the past, and therefore we develFrom outpatient consultations, radiological evolution. Medical research is oped a safety mechanism whereby young, fertile women store a little bit investigations and medical treatments ongoing, new treatments are of fat in their body. Therefore, when the women were pregnant during to surgical interventions, laboratory constantly being developed a famine, the stored fat would be used to give protein to the baby.” tests and specialised clinics, we strive and existing ones refined, while diagnostic Malta’s When combined with a non-fat, low-starch, sugar-free approach, to provide accurate diagnosis, proinvestigations are becoming increasingly HCG reduces feelings of hunger and results in weight reduction obesity rates fessional care and effective treatmore accurate. Patient care is also being of up to almost half a kilo a day. are shocking. ment. To achieve this, the Saint steadily improved, since it is only the highyet the HCG programme is not simply a diet because, apart James wheel can never stop turning. est quality care that can lead to the highest Dr Laurina from helping people reach their ideal weight, it also increases Through Doctor’s Orders we hope possible rates of successful results. Hildering fulfilment and improves overall health. it reduces blood pressure, to give you a new view on healthcare The Saint James Hospital Group started lowers cholesterol and blood sugar levels, and encourages a more and on the professionals who work to as a small family clinic in Zabbar where it balanced thyroid gland. keep you in good health. The publication gradually grew into a natural childbirth will also include interesting information and centre, then into a clinic where surgical day first hand experiences by clients and staff. cases were carried out. eventually, the clinic in this issue, we focus on weight loss and on achieved hospital status – here, major surgerDr Laurina Hildering, PhD, medical and clinical psychologist, various eye treatments. We are also offering ies could be performed and medical cases success coach. fantastic discounts on cataract surgery. necessitating night stays started being treati wish you a pleasant read. ed. The Saint James Hospital Group also set The most important aspect of coaching is accepting responsibility. This is also a key elup an outpatient clinic in Mosta and a beauty ement in the HCG programme – patients have to accept responsibility for their weight. Lucienne Cassar • Editor and cosmetic clinic, Transforma, in attard. When asked what was the secret to her beauty, Grace Kelly answered “Discipline”. i completely agree. However, this kind of responsibility is not related to guilt – rather, it is positive and hopeful. you have to accept that your response to anything is your own. you cannot control the weather, for instance, but you can control your response to it. The HCG programme guarantees healthy food for every phase of the programme – patients eat fresh vegetables and fish for proteins and avoid overfeeding on carbs. yet the HCG is not a diet – it is a programme, the first phase for the rest of your life. We are offering one lucky reader a relaxing Malta’s obesity rates are shocking. it is a dangerous situation and, in the case of serenity treatment with hot stones from Le Spa children, it deprives them of a normal childhood. Parents must realise that fat is not by Transforma in Mellieha. The treatment includes just aesthetic – there are serious illnesses and conditions like diabetes and cardioa facial with deep release and a hot stone back vascular diseases that are associated with being overweight and obese. Parents must massage. Simply answer the following question assume responsibility for this because they are accountable for the food that their and e-mail it to [email protected] children eat. Parents must encourage their children to exercise and they must get in – the first correct answer that we receive wins. the habit of cooking for their children. What does BMI stand for and what does Home cooking is the best approach in the fight against obesity, because outside of it mean? home, it is very difficult to find the right food. When eating something, ask yourself whether your grandmother would recognise it as food. if she wouldn’t, then don’t eat it. All entries are to be received by not later than Monday, May 30, 2011. Terms and conditions apply.

H

Taking control

Win & Relax

Continues on page 14 »

Doctor’s Orders Issue 01 • May 2011 Executive Editor Lucienne Cassar Editorial Consultant Stanley Borg Photography Keith Borg at www.luxmoments.com Design MediaMaker Ltd – Valletta Printing Progress Press Ltd – Mriehel Publisher Saint James Hospital Group – www.stjameshospital.com For advertising in this publication, call Reuben Busuttil at MediaMaker Ltd on 2559 4708 or e-mail [email protected] © 2011. All rights reserved. Reproduction in whole, or in part, without written permission of the publishers, is prohibited.

Saint James Hospital, Sliema George Borg olivier Street, Sliema SLM 1807, Malta. Tel: 00356 2329 1000 Fax: 00356 2133 0226 [email protected]

Saint James Hospital, Zabbar St James Square, Zabbar ZBR 3103, Malta. Tel: 00356 2329 1000 Fax: 00356 2169 2030 [email protected]

Saint James Hospital, Tripoli Wesayet el Bderi noufleen, Tripoli, Libya. Tel: 00218 21 711 3092 [email protected]

Transforma The Cosmetic Clinic, Triq il-Hafur, attard aTD 3014, Malta. Tel: 00356 2142 3838 Fax: 00356 2142 3839 [email protected]

Saint James Outpatient Clinic Tat-Targa Pharmacy, 2, Constitution Street, Mosta MST 9051, Malta. Tel: 00356 2143 3146 Fax: 00356 2143 3146 [email protected]

Saint James Eye Clinic, Hungary Szilagyi erzsebet Fasar, Budapset, Hungary. Tel: 0036 1788 2927 [email protected]

Doctor’s Orders • Page 04 • Eye Clinic

Seeing eye toeye

anya Costa did not start out to become a refractive surgery nurse. Yet she always wanted to be in a profession where she could help people. “At Sixth Form, I was studying pure maths and applied physics. I was always into technology and gadgets and my aim was to read for a degree in electrical engineering,” Tanya says. “At the time, one of my closest friends was following a nursing course – in between lectures, we would meet up and she would be so enthusiastic to tell me all about the nursing course and what she had learned on the day. I was so fascinated that I changed course and started nursing. “The nursing course entailed a lot of sacrifices. I had to do night “Saint James shifts and give up my weekends Eye Clinic invests – yet it was all worth the effort. heavily in the latest I passed my nursing exams with technology, which flying colours and finished my enables us to offer course. “I placed very high in my more services and final exams and could choose achieve excellent my placement. We had to choose results.” between theatre, medicine or ophTanya Costa thalmic, either male or female wards, as at the time, wards were still separate. I chose ophthalmic and, at 23, I started my duties at the Ophthalmic Department at St Luke’s Hospital. “I soon settled in my new job, thanks to my inquisitive nature and to my nursing officer, who was like my mentor,” Tanya says. “I was constantly asking questions to the doctors and consultants, and they were always very helpful.

T

When I was on night shift, I never took my rest but would go to the Emergency Department and assist with ophthalmic patients. “Eventually, I was given the post of acting nursing officer, yet was never promoted to the actual post. At the time, Brian Bondin, who worked at Saint James Eye Clinic, and who is nowadays the General Manager of Saint James Hospital, invited me to join him at the clinic. Three months later, I did. “I immediately realised that working at Saint James Eye Clinic was different,” says Tanya. “There is constant contact with patients and the care offered is a holistic one. Service is more personal – I form a strong bond with patients and this, in turn, gives me a lot of job satisfaction. “Another challenge was to work at the Excimer Laser clinic. At the time, I had a lot of misinformation from my previous job on laser, and I wasn’t very keen on it. But I did my research and, thanks to the surgeons and trainers which Saint James Hospital brought over, I learned a lot. I was also seeing very satisfied patients and, eventually, I even underwent Excimer Laser surgery myself. From that moment, Excimer Laser became my ‘baby’,” says Tanya. “Apart from Excimer Laser, I also work on Corneal Collagen Crosslinking. This is a treatment for keratoconus, which is a disease that weakens the cornea and produces blurriness of vision. “In recent years, there has been an incredible advancement in technology. Saint James Eye Clinic invests heavily in the latest technology, which enables us to offer more services and achieve excellent results. Saint James Hospital also invests a lot in training which, together with the dedication that all my colleagues have for their calling, helps give our patients better vision.”

Refractive surgery nurse Tanya Costa explains the benefits of Excimer Laser.

Eye Clinic • Page 05 • Doctor’s Orders

Second sight For Liz Barbaro Sant and Mark Sant, getting rid of their spectacles has been a liberating experience. Liz Barbaro Sant, director at Alberta Fire & Security Limited, 39, underwent Excimer Laser surgery just weeks ago, and it completely changed her life for the better. “The surgery is really straightforward,” says Ms Barbaro Sant. “For two weeks before the operation, I just had to wear spectacles and then on the day of the surgery, I had to remove all make-up.

“The day after the surgery, I woke up, took off the eye shields, and looked around to test my vision. I could already see more clearly than before.” “Once the anaesthetised drops were placed in my eyes, eye clamps were put on to keep them open – the anesthetic is local so I was awake during the procedure,” she adds. The procedure lasted minutes. “As soon as I was ready, I hopped out of my chair to face the world again. Immediately I knew my vision had been corrected because I could make out distinct objects, although it initially felt like I was peering through a sheet of gauze because of the eye shields taped around my eyes. There is usually little or no pain involved other than temporary dryness or mild soreness in the eyes after the procedure. “I was given painkillers and antibiotic drops for my eyes and I went home and slept for about five hours – I highly recommend this. When the anaesthetic wore off, the painkillers took care of the anticipated discomfort. “The day after the surgery, I woke up, took off the eye shields, and looked around to test my vision. I could already see more clearly than before,” she adds. Commenting about how she feels after her Excimer Laser surgery , Ms Barbaro Sant says that, “Sometimes, I wake up and think that I’m still wearing my lenses. Then I remember that I don’t need them ever again. Getting the Excimer Laser surgery was one of the best things I’ve ever done – it’s certainly money well spent.” Ms Barbaro Sant highly recommends the procedure. “I recommend it wholeheartedly. Particularly for those people like me who have been dependent on lenses, Excimer Laser surgery will truly transform your life in an almost miraculous way. Freedom from spectacles and contact lenses is such an amazing liberating experience.”

Excimer Laser surgery at Saint James Eye Clinic Excimer Laser is one of the safest procedures to get rid of your contact lenses or spectacles. Saint James Eye Clinic offers the latest technology in Excimer Laser systems. This technology enables custom ablation and Saint James wavefront correction using laser that is tailor-made for every eye. Eye Clinic offers: Excimer Laser is performed by quaLasek • Cataract surgery • Squint lified consultant surgeons at Saint surgery • Glaucoma surgery • Retinal James Eye Clinic. During the prodetachment surgery • Minor ophthalmic cedure, the eye is anaesthetised by surgery • Yag/Argon lasers • IVFA • C3 Riboflavine for keratoconous • Phackic means of eye drops. It is completely implants • Oculoplastics • Outpatient pain free. The procedure takes apclinics, which offer glaucoma assessMark Sant, proximately 10 minutes for both eyes. ment, check-up for spectacles, gynaecologist, 42, The clinic recommends that you attend corneal topography and decided to undergo Excimer an informative seminar at the clinic, specular microscopy. Laser surgery three years ago. during which a qualified refractive surgery “I used to wear lenses daily for nurse will explain the procedure and answer up to 18 hours a day. My eyes used to all your questions. This seminar is offered free get tired, dry and very uncomfortable of charge. Procedures are also available to late in the day,” says Dr Sant. correct myopia from -1.0D up to -10.0D and “I remember once, I forgot to remove my also some degree of hyperopia, from +0.75D up lenses as I was very tired. When I woke up to +2.5D. Most astigmatism is corrected as well. the next morning, I was seeing halos and The clinic boasts excellent results with a very circles around things. I was very worhigh patient satisfaction rate. Treatments are ried because that day I had to operate individually tailored – this means that the best and I never managed to tolerate possible visual acuity is achieved. The clinic wearing spectacles during surgery. adopts a set of protocols in accordance with That is when I decided to go for ExEuropean Standards and only professionals who cimer Laser surgery,” adds Dr Sant. adhere to these standards are allowed to prac“Being a surgeon myself, I was tise. Saint James Eye Clinic can therefore offer worried that something might go a safe, reliable service and excellent results. wrong. However, I weighed the risks For more details on Excimer Laser surgery, and benefits of doing the procedure, contact Saint James Eye Clinic on 2329 1229 and these were strongly in favour of or e-mail [email protected] • doing the procedure, which was not uncomfortable at all. My only problem was that following the procedure, I was at home on my own and therefore did not have anyone to help me put drops in my eyes. My advice is to have someone at home to pamper you post-op,” says Dr Sant. After five days, Dr Sant was back at work, doing three caesarean sections.

“Once, I forgot to remove my lenses as I was very tired. When I woke up the next morning, I was seeing halos and circles around things. I was very worried because that day I had to operate. That is when I decided to go for Excimer Laser surgery.” “After the Excimer Laser surgery, it was such a lovely feeling to wake up, open my eyes and see clearly straight away. Also, I feel great going to the beach and not having any problems to swim and dive with my eyes open. Moreover, I have the peace of mind that I am not risking my eyesight through some eye infection from contact lens use. My only regret is not having done Excimer Laser surgery sooner.” •

For popular TV presenter Joseph Chetcuti “Seeing is Believing!”

E Enjoy njoy a c clear lear p picture! icture! N Never ever has has Cataract Cataract Surgery Surgerry y been been so so a affordable ffordable iin np private! rivate! During the month of May Saint James Hospital Eye Clinic is offering a € €300 300 d discount* iscount*WRWKHÀUVW clients who book their Eye Cataract Interventions.

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Doctor’s Orders • Page 06 • Cosmetic Surgery

On a

flat stomach Consultant Plastic and Reconstructive Surgeon Mr Joseph E. Briffa explains the tummy tuck procedure. Doctor’s Orders: Are there different abdominoplasty procedures, and how do they differ? Joseph Briffa: Abdominoplasty or ‘tummy tuck’ is a surgical procedure which is performed to make the abdomen flatter and firmer. There are numerous operations to achieve this – they differ mainly in the position of the scar and the direction of skin tightening. Excess skin and fat can be removed from the lower abdomen, leaving a scar very low down on the abdomen. This is the commonest form of abdominoplasty. However, lax skin can also be excised from the middle of the abdomen, leaving a vertical midline scar or from the upper abdomen leaving a scar across the top of the abdomen. The different procedures can sometimes be combined to tighten the abdomen in both a vertical as well as a horizontal direction. A mini abdominoplasty usually involves removing skin and fat from the lower abdomen without freeing the upper abdominal skin from the underlying tissues. It is aimed at correcting skin laxity which is limited to the lower abdomen. During an abdominoplasty, an incision is made all the way across the lower abdomen. The skin and fat are freed from the underlying muscle right up to the ribs. The umbilicus is freed from the surrounding skin but it is left in its normal position as it is fixed at that site. The central muscles are sometimes tightened by means of sutures, particularly when they have split apart due to previous pregnancies. Skin and fat are excised from the lower abdomen and the wound is closed. The umbilicus is brought to the surface by making a new hole in the skin to accommodate it. DO: Are there cases where an abdomen can be firmed up by exercise or diet alone? And when does this become impossible and an abdominoplasty is therefore necessary? JB: Dieting helps to lose excess fat while exercise tones muscles. Therefore it is possible to firm the abdomen by diet and exercise provided that the overlying skin has not been stretched excessively. Lax skin usually results from pregnancy or from significant weight loss. In these cases, the skin is like a spring which has been stretched too far – it does not return to its normal size. Persons with this problem require abdominoplasty as diet and exercise will not correct sagging skin.

Smooth operator Microneedling is a revolutionary approach to skin rejuvenation that is less invasive and has a lower risk of complications, says Dr Tania van Avendonk. icroneedling is an exciting new treatment used in skin rejuvenation. Skin needling, as it is also known, has been shown to smooth wrinkles, fill deep lines, help open pores, and improve depressed acne areas, stretch marks, and skin texture. Skin needling is easily performed using a skin roller. This roller is a handheld tool embedded with tiny metal pins, which is rolled over the skin of the face or any other part of the body. This skin roller causes multiple tiny pinpoint puncture wounds into the skin layers.

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DO: Locally, are most cases of abdominoplasty performed on patients who have achieved major weight loss or those with post-pregnancy sagging? JB: I think that locally most abdominoplasties are carried out on patients with sagging due to pregnancy. However, the number of patients seeking abdominoplasty after extreme weight loss is on the increase. People are more aware of the health benefits of weight control and are therefore putting in more effort to lose weight though diet and exercise. However, extreme weight loss always leads to sagging of skin all over the body. This can only be corrected surgically. DO: Is a tummy tuck performed solely for aesthetic reasons? Are there health risks related to excess skin? JB: Abdominoplasty is primarily performed for aesthetic reasons. Strictly speaking, there are no health risks related to excess skin. However, if there is a lower abdominal overhang, patients end up with two skin surfaces rubbing together. This can be sore, especially due to sweating in hot weather. Furthermore, fungal infections are more likely to occur where the two skin surfaces are in contact with one another. DO: Does abdominoplasty require just one procedure or are there any cases which require multiple procedures? JB: Abdominoplasty is usually a single surgical intervention. During the course of the operation, it is possible to carry out other procedures such as liposuction of the abdomen, particularly round the sides. From time to time, abdominoplasty is also combined with a similar procedure where skin on the back is also tightened. The two procedures together – called belt lipectomy – are usually performed in individuals who have lost a tremendous amount of weight.

The depth of the penetration depends on the size of the needles. When short needles are used, only the epidermis is penetrated. Tiny channels are created which increase the penetration of topical serums applied to the skin – this will make them more effective. Certain types of skin rollers can be used at home regularly by the client or used by beauticians during facial procedures to enhance the result. When longer needles are used, the deeper layers of the skin are penetrated. This process, which should only be performed by trained medical staff, activates the skin’s natural wound healing. Certain chemicals are released in the skin, which stimulate the fibroblasts to produce more collagen and elastin. Skin needling is a revolutionary approach to skin rejuvenation with minimal downtime. Even the stars of Hollywood are using this technique to give a smooth and youthful appearance to their skin. The most famous celebrities reported to have used this treatment are Angelina Jolie and Brad Pitt. How does skin needling compare with other skin resurfacing treatments? The objective of all skin resurfacing and rejuvenation treatments is new collagen production. When procedures such as resurfacing laser (CO2), chemical peels and dermabrasion are used, the surface of the skin is

removed – this, in turn, stimulates the skin to produce new collagen and repair itself. With microneedling, the stimulation of new collagen production occurs without the removal of the surface layer of the skin, which is called the epidermis. Hence microneedling is far less invasive and has a lower risk of complications. These risks include scarring, sun sensitivity, skin colour loss or hyperpigmentation. How is the procedure performed? Medical skin needling is performed by trained medical personnel. Since the dermal layer is going to be penetrated, local anaesthetic needs to be applied prior to the procedure. First, the skin is cleansed well and then an anaesthetic cream is applied to the area. After about 45 minutes, the cream is cleansed off and the treatment starts. The doctor passes the skin roller over the skin in forward and backward motions and then changes the direction and repeats the process. This cycle can be repeated up to three times. Minimal pressure is applied but pinpoint bleeding needs to occur for maximum effect. The skin is then wiped clean with saline.

Cosmetic Surgery • Page 07 • Doctor’s Orders

DO: How common are cases where an abdominoplasty patient would also require a buttock lift? JB: Not many abdominoplasty patients want a buttock lift as well. When they do, it is either because of sagging skin following dieting or because of sagging buttocks due to age. Both procedures may be performed during the same session.

Forget smart…

this is genius

DO: What are the possible or potential risks that an abdominoplasty carries? JB: The main risks are bleeding and infection. There is also a risk of the wound breaking down or not healing well, leading to unsightly scars. Any surgical procedure that lasts longer than an hour may lead to thrombosis in the deep veins of the legs, particularly in women who are taking the oral contraceptive pill. The abdominal skin is usually numb after an abdominoplasty and sensation returns gradually over a period of time. However, there is a risk of the abdomen remaining numb permanently. Following abdominoplasty, it is not unusual for fluid to collect under the skin for some time afterwards. Drains – plastic tubes leading to vacuum bottles – are usually left in place to suck this fluid out. Once the drains have been removed fluid may still build up. This may require tapping the fluid with a needle and syringe. Rarely the fluid may become localised within a small cavity that persists. In such a case this collection, known as a seroma, may have to be drained surgically in order to remove the tissue lining the cavity and to obliterate the space to prevent recurrence of the collection.

The new Da Vinci SmartLipo at Transforma is a recent introduction and the most powerful SmartLipo laser available on the island. SmartLipo is a novel technique that is performed by the most experienced SmartLipo doctor in Malta. The procedure is used to decrease localised fat deposits in healthy people with normal or ideal weight. Its main aim is to target stubborn areas of fat that remain in spite of exercise and diet regimes. It is not a solution for obesity.

T CONCEAL DON’T

DO: Depending on individual circumstances, how long will an abdominoplasty and post-op recovery take? JB: A routine abdominoplasty takes two and a half to three hours. This usually includes suturing the muscles in the midline and possibly some liposuction around the sides of the abdomen. The patient is hospitalised overnight. Recovery takes at least three weeks and the surgical wounds are normally healed in about one week. If the muscles have been sutured the patient should avoid lifting for six weeks.

before

DO: Is there any post-op maintenance which a tummy tuck patient would need to observe? JB: Patients do not need to undergo any special long-term post-operative maintenance. However, they should be careful not to put on weight as this will affect the overall result. Not all the abdominal fat is removed during an abdominoplasty. Therefore it is possible to gain weight in the tummy area after the operation if the patient does not maintain a normal, healthy diet. Exercise also helps to keep the abdomen in shape following surgery. Strengthening the muscles helps to make the abdomen flatter and makes the patient look more trim. • Mr Joseph E. Briffa MD FRCSEd FICS is a consultant plastic and reconstructive surgeon. Mr Briffa qualified as a doctor in Malta in 1986 and trained in surgery in Malta and in plastic surgery in the UK. Mr Briffa is a consultant plastic surgeon within the Maltese National Health Service. He is also the Maltese representative and examiner on the European Board of Plastic Reconstructive and Aesthetic Surgery.

before

After

Products containing high doses of Vitamin A are applied and the skin is moistened to prevent excessive dryness. Which areas of the skin can be treated? Any area can be treated. In fact, skin needling can treat sensitive areas which other treatments have to avoid, such as below the eyes, around the lips, the neck and the back of the hand. How many treatments are required? Multiple treatments are usually necessary to achieve significant improvement in the appearance and depth of the lines and scars. The number required depends on how the individual responds to the treatment and the extent of the damage at the start. On average, about three sessions are necessary

before

After

This works by a system of lipolysis, where the membranes of fat cells are broken down, turning fat into an oily substance. This is then excreted naturally by the body through the liver or through aspiration, where the dissolved fat is sucked up through a needle and removed from the body on the same day. The procedure is carried out in a theatre environment – thus ensuring sterility and peace of mind. Although minimal swelling, bruising or discomfort may be experienced, most people return to normal activity after the procedure. SmartLipo is a walk in, walk out procedure that produces excellent results in size reduction. For details on SmartLipo, contact Transforma on 2142 3838 or e-mail [email protected]

After

in the first year with repeat maintenance sessions yearly. Treatment effects are cumulative and will be seen usually within six to eight weeks after the treatment. However, studies have shown that collagen formation can continue for up to 12 months after just one treatment. Recovery time after skin needling is minimal and you can return to work the following day. Within the first 24 hours the skin is slightly swollen and reddened, with the appearance being similar to mild sunburn. Light grazing over treated areas may occasionally appear due to over aggressive needling but it usually resolves within three to five days. • For more information, contact Transforma, the Cosmetic Clinic, on 2142 3838 or e-mail [email protected]

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Weight • Page 09 • Doctor’s Orders

InnovatIons In

WEIGHT LOSS

A series of small changes helps you maintain a healthy weight, says lifestyle consultant Claire Spiteri.

A leading gastroenterologist explains how the new generation gastric balloon helps patients lose more weight. curls into shape when it reaches the stomach. Even if the balloon should lose all its fluid, this catheter will prevent the balloon from travelling out of the stomach where it can be safely recovered during a gastroscopy. Moreover, the new balloon can now be left in place for a year. All this translates into greater weight loss. While the average weight loss to be expected from the old Who is eligible for a balloons would be around 15kg, gastric balloon? With with the new gastric balloons, Gastric balloons are not the new an average of 35kg can be lost inserted just for aesthetic gastric balloons, over a year. reasons. Patients considered an average of Weight loss is maintained for intra-gastric balloons are 35kg can be even after the balloon is reseriously overweight. Usually moved. However, patients can the Body Mass Index is taken lost over a expect to regain a few kilos. At into consideration. A good year. this stage, the dietician’s support candidate for a gastric balloon is is very important to help the patient someone who is obese or excessively maintain weight loss. • overweight and has repeatedly tried to lose weight through sensible exercise regimes and a controlled, weight loss diet. The BMI needs to be above 35 or else is above 30 and is associated with conditions that are made worse by obesity such as high blood pressure, diabetes, back pain, arthritis or heart disease. he gastric balloon is a reversible procedure in which a silicone balloon is inserted into the stomach and inflated with liquid. This balloon occupies space within the stomach and reduces the amount of food the stomach can hold. This makes a person feel full even with small meals.

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What does the procedure involve? Patients are first assessed by a consultant to see whether they are eligible for the procedure. They will also be seen by a qualified dietician who will support them while the balloon is in place and also after it is removed. The gastric balloon is a day procedure. The balloon is inflated after a gastroscopy is performed to make sure that there are no stomach conditions that can hinder its safe insertion. The deflated balloon is then inserted through the mouth and is then inflated through an attached catheter.

What is new about the balloons being used today? Gastric balloons have been in use for several years. However, until now, these were fixed in size and had to be removed after six months. The new generation balloon is adjustable and its size can be decreased or increased while it is still in the stomach. This is done through a simple gastroscopy. This is important as patients often stop losing weight after a few months. Now the balloon can be inflated further and the patient can lose more weight. The new adjustable balloon has a specially designed uncrushable catheter system which

Maintaining weight loss

besity is quickly becoming a top health problem. Moreover, the problem is not in isolation because there are many serious health concerns associated with being overweight and obese, including diabetes, joint problems, stroke, heart disease and high cholesterol. After getting rid of extra body weight, staying in good shape is a primary goal. It’s possible to ward off many serious medical problems simply by maintaining a healthy weight. Exercise and eating right are the foundations of good health and are vital parts in any plan to lose weight or maintain a healthy weight. However, by not making permanent changes in your lifestyle, you will be doomed to follow one fad diet after another, losing lots of weight only to gain it back. This yoyo dieting has been found to be even more dangerous than being overweight, and can lead to serious health problems. The best diet plan is one which you follow for the rest of your life.

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To maintain a healthy weight, it is better to make a series of small changes rather than attempting a radical change.

The gastric balloon could be for you if: • You are obese or excessively overweight. • You have repeatedly tried to lose weight through sensible exercise regimes and sensible diets, but without success. • You are not eligible for weight loss surgery. • You want to lose an average 35kg over a year. For more details on the new generation gastric balloon, contact Saint James Hospital on 2329 1129 or e-mail [email protected]

Regular exercise will help build muscle while losing fat – this extra muscle tissue will also help you lose additional weight. An exercise routine does not need to be overly strenuous in order to be effective. Make sure to go for a daily 30-minute walk – this helps improve the digestive system and increases the metabolism level. Taking a walk several times a week can work wonders. Eating a well balanced diet is the other part of the process of maintaining a healthy weight. It’s important to follow a healthy diet that you can maintain for the rest of your life. However, give yourself the occasional treat – this moderation will help you avoid the cravings that can destroy your dieting efforts. Don’t underestimate a healthy breakfast as this helps you keep your energy levels constant throughout the day. Also, increase your water intake – you should drink around eight gasses of water every day as water helps flush out all the toxins from your body and you will be able to maintain healthy body weight and hydration. Avoid massive late night dinners as these accumulate fat. You should have dinner at least two hours before going to bed, and your dinner should consist of the right portions. Behavioural strategies can help you maintain a healthy weight. Avoid eating as a response to stress and use exercise, activity, or meditation to cope instead of eating. A return to old habits does not mean failure. Paying renewed attention to dietary choices and exercise can help sustain weight loss. Identifying situations such as negative moods and interpersonal difficulties and incorporating alternative methods of coping with such situations rather than eating can prevent relapses to old habits. •

Tipping the scales According to the Health at a Glance: Europe report, published by the European Commission and the Organisation for Economic Co-operation and Development, Malta has among the worst child obesity rates in Europe. The report shows how, at 29.5%, Malta has the highest rate of obese children in Europe. Among adults, Malta has the third highest obesity rate. •

Doctor’s Orders • Page 10 • Weight

Fat’s not good Excess body fat is a major threat to our health, says lifestyle consultant Claire Spiteri. ost people’s primary motivation for weight management is to improve their appearance. Equally important, however, are the many other benefits of proper nutrition and regular exercise.

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Weight management through the reduction of excess body fat plays a vital role in maintaining good health and fighting disease. In fact, medical evidence shows that obesity poses a major threat to health and to a long, healthy life. Excess body fat is linked to major physical threats like heart disease, cancer and diabetes.

Mind over eating matter Being overweight or obese is a symptom of deeper issues, says psychotherapist Amanda Grech. arious factors are linked with the causes of being overweight or obese, including psychological and emotional factors such as childhood experiences, depression, life crisis and grief. Social and cultural factors also play an important role in weight management, including lifestyle, accessibility to high calorie food, and the motivation to engage in physical exercise. In psychotherapy, one way of looking at overweight eating patterns is that they reflect the manner in which a person had to adjust to a difficult situation usually in childhood. One of the roles of psychotherapy is to look beyond eating patterns and uncover what adaptive function the eating habits serve. Underneath the overeating pattern could be a developmental need which was unmet or an inner void brought about by suffering. In the case of the latter, we need to differentiate between feelings of hunger and feelings of emptiness. This may be the case in adolescents or children who are experiencing grief. In such cases, adults can support children, in a gentle and caring way, to differentiate between hunger and emptiness. One can also teach adolescents how to take care of themselves by cooking – this will empower them and balance feelings of sadness and helplessness. There are various psychological theories which look at our relationship with food. From a humanistic-existential perspective, the relationship with food is perceived as a reflection of our relationship with the world. Children learn to eat appropriately as they go through different developmental phases, each of which reflects the way the child relates to the world. For instance, when the baby is born the food comes fully prepared for digestion, thus the baby

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merely sucks and swallows. This is similar to the baby’s experience of the world – the newborn accepts new information without criticising it. Later on, a baby’s increased participation in choosing what comes from the environment is reflected in its ability to bite with the incisors. The eruption of molars marks the chewing stage where the child can masticate the food. Likewise, the toddler is chewing on the world, criticising and resisting what it doesn’t want. This process is fundamental for the development of an individual identity. From this perspective, chewing food echoes a healthy tendency to evaluating information and accepting only that which resonates the inner truth. On the other polarity, swallowing food reflects a pattern of accepting the environment without adequate assessment. This could lead to lack of satisfaction in eating, resulting in overeating. Knowing your eating patterns and being in touch with bodily sensations is very important. If you are not aware of the food you eat because this is gobbled down in secret, this might lead to overeating. Sometimes people who overeat are encouraged to keep an eating diary in order to become aware of the amount of food they eat. The diary will make you conscious of the food you are eating and also of how you are eating it. • Ms Grech is a registered and European certified psychotherapist.

Once you have decided to accept change and manage your weight, the hard part is over.

Obese people also tend to have high cholesterol levels, making them more prone to narrowing of the arteries by deposits of plaque. There is also a delicate balance between blood sugar, body fat, and the hormone insulin. Excess blood sugar is stored in the liver and other vital organs – when the organs are full, the excess blood sugar is converted into fat. But there is hope. Moderate weight loss (of fat, not muscle) and a healthy, active lifestyle have been found to lower health risks and

medical problems in 90% of overweight patients. Once you have decided to accept change and manage your weight, the hard part is over. Sure, there is plenty of work to be done, but it really doesn’t matter how long this new process takes. When you improve your energy levels, physical and psychological performance, the fun and excitement experienced will make the change well worth the effort. Unfortunately, there are a few people who never succeed to reach their optimum weight through natural measures. Yet today, medical advancement has presented us with interventions that help highly obese people to lose weight too. Nobody is deprived of the wonderful benefits of ideal weight. •

Losing weight Losing weight often demands commitment and a change in lifestyle. Moreover, it can impact the person psychologically as much as physically. Some people do not manage to lose weight on their own and need support, while others do manage to lose weight, yet do not succeed in maintaining weight loss. Each person is unique, and so is the experience of losing weight. At times, a person needs support to re-establish a new identity. When someone is overweight, they identify with an overweight person. This identity supports persons to define themselves and gives them a clear sense of who they are, which is psychologically important. Some people may find it hard to let go of their overweight persona – the Each reasons can be various, person is including the familiarity unique, and so that this identity brings is the experience with it, like the sense of of losing belonging if obesity runs weight. in the family. Building a new identity after weight loss at times implies being seen as healthy and desirable. Some people find it difficult to get in touch with the attractive aspect of their personality, possibly because due to past experience they learnt that attractiveness, love and abuse are equal. In such case, the person needs support to work through the shame instilled by the new concept of self. •

Doctor’s Orders • Page 12 • Health

Become an alpha thanks to

3

Omega-

Omega-3 packs health benefits for everyone. For women

For children

Early use of Omega-3 in the first year of a baby’s life significantly reduces the risk of type one diabetes.

Omega-3 is important in all stages of life but especially when children are young, because at that stage it can influence infant development. Omega-3 is safe to use during pregnancy for both the foetus and the mother. Supplementation with Omega-3 during pregnancy reduces the incidence of food allergy and eczema in childhood. Several trials of early Omega-3 supplementation found there was improvement in neurodevelopment including IQ in those who received Omega-3. Early use of Omega-3 in the first year of a baby’s life significantly reduces the risk of type one diabetes and respiratory infections. Development, behaviour as well as improvements in reading, spelling and behaviour also appear to be influenced by Omega-3 (Oxford Durham study). On the other hand, it was found that children with attention deficit have low Omega-3 levels.

For athletes

Omega-3 has been found to be helpful in a number of areas particular to women, including increasing uterine blood flow and facilitating pregnancy. Supplementation with Omega-3 during pregnancy lowers the risk of premature birth and can increase the length of pregnancy and birth weight by promoting foetal growth. There is also some evidence that supplementation with Omega-3 might help to prevent pre-eclampsia, postpartum depression, menopausal problems, postmenopausal osteoporosis, and breast cancer. A study into hot flushes in menopausal women also found a significant reduction in women taking Omega-3.

For mothers

Omega-3 has the potential to enhance athletic performance by improving blood flow to muscles and increasing oxygen delivery to heart muscles. It also has the effect of reducing inflammatory hormone production and improving recovery from injury. Omega-3 is one of the few treatments to have improved exercise-induced asthma which does not respond to the normal asthma treatments. It has also been shown that Omega-3 not only reduces cardiac risk for the general population but also for athletes. Combining exercise and Omega-3 supplementation improves cardiovascular and metabolic health and independently reduces body fat. Omega-3 is a useful addition to any exercise programme. It also reduces hunger sensation and increases satiety after a meal – this may have implications for weight loss programmes.

For movement

Pregnant women have to carefully consider what medication or supplements they take, as this could have a negative effect on their unborn child. Omega-3 contributes major benefits to the mother. It improves the mood, even in cases of major depressive illness. Also, postnatal depression is far more common in women with low levels of Omega-3. Omega-3 fatty acids are essential for normal brain development and there are numerous advantages to the unborn child from maternal supplementation with it. This includes reduced allergies and improved intelligence, learning and behaviour, exactly the sorts of advantages mothers would like to give to their children.

Freedom to move without pain and discomfort is fundamental to good health. Inflammation of the joints and muscles can impair normal movement. The correct balance of Omega-3 can help reduce this inflammation and improve mobility. The efficacy of Omega-3 fish oils in rheumatoid arthritis has been demonstrated in several clinical trials. Omega-3 promotes the production of anti-inflammatory hormones and competes with the Omega-6 fats which promote inflammatory hormone production. Further research shows that Omega-3 reduces the various factors involved in tissue destruction in osteoarthritis, confirming that Omega-3 improves the symptoms in this form of arthritis. A recent study found a marked decrease in the bone breakdown in people Combining with a diet high in Omega-3 compared exercise and to the normal western diet. Omega-3 Omega-3 supplehas also been shown to be important mentation improves for supporting joint and bone health which is vital for mobility. cardiovascular

and metabolic health.

For your heart

The underlying cause of heart disease is inflammation in the lining of the arteries. Thus, reducing inflammation is key to preventing of heart disease. Omega-3 is a very important natural anti-inflammatory agent which helps to prevent heart disease by reducing inflammation in the arteries. Japan, for instance, has one of the lowest rates of heart disease in the world, largely due to the high Omega-3 intake from their diet which is traditionally high in oily fish.

For your mood Omega-3 has a beneficial effect on mental health and on mood. In a direct comparison with Prozac, one gram of EPA was as effective as the drug in reducing depressive

Health • Page 13 • Doctor’s Orders

Saint James Hospital

Services

Feeling better iriam Kerr, a principal pharmacist at Saint James Hospital, started taking Omega-3 supplements about three months ago. “It all started when I read an article on Omega-3 written by Dr Cilia Vincenti in the local medical magazine Synapse,” says Ms Kerr. “Knowing that we had the Ideal Omega-3 test available at Saint James Hospital, I went to carry out the blood tests. The results showed that my Omega-3 level was low, and so I started taking Omega-3 caps.” Ms Kerr combines her Omega-3 supplementation with a healthy lifestyle. Her diet is mainly based on vegetables, white meat and fruit, and she goes for a daily 40-minute walk. “I also keep away from sugars and fats,” she adds. “Despite this, I never seemed to be able to shift the few extra kilos I have gained in the past years. However, since I started taking Omega-3, I have noticed a decrease in weight and have gradually lost three kilos. “To be honest, at first I did not think that this weight loss was due to my Omega-3 intake. However, after doing my research, I found some studies that were carried out with two groups of people who were all on a diet and who all exercised daily. The difference between the two groups was that one group was being given a daily dose of Omega-3, while the other wasn’t. The results showed how if you follow a healthy diet, exercise daily and have a good Omega-3 blood level, the rate at which you lose weight is faster than if you have a low Omega-3 blood level.” Apart from physical benefits, Ms Kerr finds that she is now able to concentrate more and cope better with daily stress. “I feel better,” she says. “Everyone has low episodes, but at the moment, I feel I can cope and get over them better. In fact, studies have shown that Omega-3 also has antidepressant properties.” •

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The Ideal Omega-3 Blood Test This test measures Omega-3 levels in the blood and sets you on your way to optimal health. Unlike other blood tests which may only be useful in one area, the Ideal Omega-3 Blood Test gives valuable information about every cell and organ in your body. The test also measures the correct balance of Omega-3 and Omega-6 in your body. This blood test is available at Saint James Hospital Sliema. For further information, call on 2329 1612 or alternatively e-mail [email protected]

UponpresentationofthiscouponatSaint JamesHospital,youwillget50%discount ontheIdealOmega-3BloodTest (fullprice€60).Termsandconditionsapply.



symptoms. Many patients are reluctant to take psychotropic drugs, so the option of an effective natural alternative with virtually no side-effects is good news indeed. There have been several studies showing an improvement in mood with Omega-3. Countries with a high level of Omega-3 in their diet have the lowest levels of depression. From these and other clinical studies, it appears that a healthy brain needs to have an optimal amount of Omega-3. •

Minor/intermediate/major surgeries Cosmetic Surgery Stress ECG Echocardiogram X-Ray CT Scan MRI Scan PET CT Scan Ultrasound Eye Laser Treatment Maternity Gynaecology Laboratory Tests Physiotherapy Dental Unit Pain Management Oncology Unit Renal Unit Orthopaedics Paediatrics Beauty Treatments Urology Clinic Neurology Ophthalmic Clinic ENT Clinic Cardiac Suite Sports Medicine Psychiatry Nutrition Male & Female Screening Packages Ambulance Services Immediate Medical Care Unit Outpatient Consultations

www.stjameshospital.com Tel: 2329 1000 e-mail: [email protected]

Food • Page 14 • Doctor’s Orders

Doctor’s Corner Continued from page 03

Thought for healthy food One of the main difficulties in eating the right food is its availability. The HCG programme is supported by delicious recipes that are easy to prepare.

During the cure VEAL STEW You need: 100gr hormone free veal • 1 tsp tamari • 1 spring onion • 3 large mushrooms • One stalk of steamed cauliflower • 1 peeled tomato • Salt and pepper • Tarragon. Method: 1. Warm the tamari in a pan, then add the onion until it becomes golden in colour. 2. Chop the veal in small pieces and add. 3. Season the meat with herbs, salt and pepper. If the mixture sticks to the pan, add a small amount of water. 4. Add the mushrooms and leave to steam. 5. Add the cauliflower and tomato. 6. Continue to stir. 7. Sprinkle with tarragon and serve.

During balance phase (three weeks after the last HCG application) MISO SOUP You need: 180gr diced carrots • 180gr diced onion • 90gr diced radish • 5-inch piece of dried seaweed • 180gr thinly sliced leeks • 1 tsp grated fresh ginger • 3 tbsp white miso. Method: 1. In a saucepan, combine the carrots, onion, celery, seaweed and five cups of cold water. 2. Bring to a simmer over a moderate heat. 3. Adjust the heat to maintain a simmer and cook, uncovered, until the broth is flavourful, about 20 minutes. 4. Strain everything through a sieve, then return to a clean saucepan. 5. Add the leeks and simmer over a moderate heat until they are tender. 6. Whisk in the miso. 7. Serve immediately.

At the end of Wayne Leadon’s fishing line are two recipes with plenty of net benefits.

What a catch

aint James Hospital not only strives and invests to give you the best healthcare services possible, but also provides a comprehensive service, including the best catering it can offer. Wayne Leadon, Chef de Cuisine at the hospital’s Catering Department, and his team make use of seasonal and fresh Maltese produce to create modern, innovative cooking. All food is cooked to order, and the department also offers bespoke cooking to patients with dietary requirements. It’s five-star cuisine with a five-star service.

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SMOKED FISH WITH AVOCADO, DILL POTATOES AND SAUCE GRIBICHE ServeS 4 For the fish, you need: 120gr smoked mackerel, cut into 4 pieces • 4 slices smoked salmon • 1 ripe avocado, diced • ½ tsp lemon juice • 2 medium-size potatoes • 1 tsp chopped dill • 1 tsp chopped chives • 2 tbsp low calorie mayonnaise • 1 small baby beetroot, cooked.

POACHED SALMON WITH SHELLFISH, SOFT-BOILED EGG AND OYSTER HORSERADISH FROTH

Life-changing moments

ServeS 4

I started the HCG treatment weighing 145 kilos. I had no energy and felt very insecure about my body. The first sixweek treatment was great and I lost 27 kilos by sticking to the very strict diet. I was never hungry and saw it as a challenge to cook nice meals with the little amount of ingredients that you are allowed to eat. I exercised every day and after six weeks, I had loads of energy. Six weeks later, I started the second treatment. In the meantime, I gained a bit of weight as I did not stick to the rules for the second phase. I started at 123 kilos and after four weeks I lost 15 kilos. I am in the middle of the third treatment and have lost 12 kilos already. The best part is that I feel good and can face any stress at work easily. Maarten-JanWaasdorp

You need: 200ml white fish stock • 4 pieces salmon escalopes, with skin on • 200gr clams • 200gr small fresh mussels • 200gr razor clams • 2 fresh oysters • 1 tbsp horseradish • 4 tbsp cream • Pinch of salt • 200gr spinach • 24 cooked and drained carrot cylinders (cut with an apple corer) • 4 eggs • 1 finely chopped shallot • 1 tbsp soya oil or butter.

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I would like to thank Dr van Lith for his incredible diet and his ongoing support during some difficult times. There is no doubt that the HCG programme works if you follow the rules and the feeling of pride and empowerment at the end is definitely worth the effort. Alison Walker

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For more information on the HCG programme, contact Transforma, the Cosmetic Clinic, on 2142 3838 or [email protected]

Your health questions... answered! If you have any queries or concerns regarding health issues, send us an e-mail at [email protected] and our doctors will answer your questions in the forthcoming issues of Doctor’s Orders. •

Method: 1. Bring the water to a boil in a small pan – this will be used for the soft-boiled eggs. 2. In another shallow pan, sweat the chopped shallot in one tablespoon of soya oil until it is translucent. 3. Add the fish stock, bring to a boil and simmer. 4. Place the salmon escalopes in the fish stock and cover with greaseproof paper – cook gently for about five minutes. 5. Place the eggs in the boiling water and the shellfish with the salmon. Cook for another five minutes. 6. Gently remove the salmon, shellfish and eggs with a spoon. 7. Pour the remaining fish stock in a blender and add the horseradish, oysters (and any water from them), cream and a pinch of salt. Liquidise to a smooth consistency. 8. Sauté the fresh spinach in the soya oil and warm the carrots. 9. To assemble the dish, place the spinach in a rectangular shape. Arrange the carrots on top and lay the salmon on the carrots. Arrange the shellfish next to the salmon. 10. Cut the bottom of the egg so that it stands on the plate. Crack the top to reveal the egg yolk. 11. Whisk the oyster and horseradish liquid until frothy and spoon over the salmon and shellfish. 12. You can also peel off the salmon skin when it is cooked, shape and bake in a little olive oil and salt until crisp. Then place in the egg yolk as a garnish.

For the sauce gribiche, you need: 2 hard-boiled eggs • 50gr finely chopped capers • 50gr finely chopped gherkins • 1 finely chopped shallot • 1 tbsp finely chopped parsley • 1 tbsp finely chopped tarragon • 45ml extra virgin olive oil.

Method: 1. For the sauce gribiche, sieve the egg yolks and chop the egg whites finely. Mix all the sauce gribiche ingredients together. 2. For the dill potatoes, peel and dice finely, boil in salted water, cool and drain. 3. Mix the potatoes, dill, chives and mayonnaise, and check for seasoning. 4. Mix the lemon juice and diced avocado gently. 5. Assemble the plate by first spreading two tablespoons of sauce gribiche in a circle. 6. Arrange the avocado in a slightly smaller circle and place the smoked salmon on top of the avocado. 7. Place the smoked mackerel fillet on top of the salmon. 8. Using a small teaspoon, arrange the potato salad on top of the mackerel fillet. 8. Garnish with pearls of beetroot and fresh dill. • Wayne Leadon is Chef de Cuisine at the Catering Department, Saint James Hospital.

Staying healthy doesn’t have to be an expensive experience. There are many things people can do to take care of their own health. But when they need a helping hand, first-class generics provide affordable assistance, something Actavis has been doing for years. Consult your doctor or pharmacist for further information. Visit our website on www.actavis.com.mt