Swiss Medical Days
Swiss Medical Days
A unique experience, in the amazing ambience of our favourite luxury Spa Retreat Hotels/magic clinics – located in beautiful Switzerland. Additionally enjoy highly effective therapies shaped especialy for you by world classed professional guidance – to refresh and empower your physical and mental wellbeing.
She always seems about to smile… easy-going… full of creative energy and love… when you look at her, you realize that the family genes are still hard at work. Her grandfather Charlie spent many happy years in the French part of Switzerland with his wife Oona O’Neill, and this family knows the secret to being healthy and happy: just smile.
– Laura, you have a very famous surname. How do you feel about being part of the Chaplin family? What does it mean to you?
– It’s a privilege. I’m honored and it’s a chance… I mean, it’s not easy to make my own name for myself, I always kind of exist in reference to him, but for me it’s a privilege more than anything else.
– And do you feel that you have inherited the genes of your famous grandfather? How has it affected your life and creativity?
– Of course he influenced me. A grandfather with such artistic genes… I think it kind of rubbed off on me a little bit. I also grew up in Vevey, which is a place where artists came all the time and there was so much artistic input in this house. There was such a great influence. His idea of art having an important message is something I try to live up to. I like to try to do what I love and to be good at it, I guess.
– Is it difficult for people, doing what they love?
– It’s definitely not easy. There are challenges. There are moments when you will struggle, you will have to fight, and you just have to believe in yourself. Sometimes it takes time. For example, it took my grandfather a long time to get to where he ended up and I think you just have to believe in yourself, be passionate about what you do, and be patient about getting to the right place.
– What have you really inherited from your grandfather?
– I’m very fair in public, like him. I’m a humanist, like him. I believe in laughter, thanks to him. I’m a bit of a perfectionist and sometimes I can be strict on myself with what I do.
– And what do you get from your grandmother?
– I would say my soft side. I’m a very family-oriented person, I have a big family and place that importance and that value upon the family… It’s probably from her, her kind and gentle manner.
– How big is your family? How many grandchildren?
– There are a lot of us. My grandfather had 8 children with my grandmother, and they have at least 5 kids, so we’re almost 30, we grandchildren.
– Do you have contact with each other? Do you really feel a part of Chaplin’s family?
– Yeah, of course we have relationships. I know most of them, and it’s hard because we’re all over the world so it’s hard to see each other often but we definitely stay in touch.
– Your lifestyle comes from the family. Do you have some rules for a healthy life?
– Just to be happy, to love, to smile a lot, just to enjoy life. That is the way to be healthy. I mean, I had the most magical childhood. In our house, we laughed and there were many great, happy moments, some of the happiest moments in my life. Being happy is an important part of being in good health.
– But it’s not easy to be happy every moment of your life because very often something goes wrong…
– Of course we have up and downs; it’s normal, it’s life. We have emotions, but if you really want something, then you can achieve it. You just have to begin and maybe force yourself to smile a bit more, force yourself to laugh a bit more, and it will come more naturally. But there are also a lot of other ways – you can watch comedies or you can listen to music or you can surround yourself with friends and family. Even my animals can make me laugh sometimes or I can even laugh at myself sometimes because I do something clumsy or forget something. So it’s just a way of thinking, and sometimes you’re forcing it.
– By the time you were 18, you had already worked as a model for Tommy Hilfiger and others. Models have to be very slim, and a lot of girls want to be models, and they damage their health. What do you think about this problem?
– I think it’s tragic, because to be beautiful you have to be beautiful on the inside and you have to feel good on the inside to show it on the outside. To encourage people to risk their health for beauty is just completely absurd, because beauty for me comes from within.
– At the age of 19 you worked as a TV presenter. Working on TV is very stressful. How it was for you?
– When I think back, I say, «Oh my God, how did I do it?» Because of my age, I think about a lot more stuff now but back then I didn’t realize, I just went and I did it, and it was very stressful. There was a lot of pressure. But if you just believe in yourself and enjoy the moment then it makes things go much easier.
– What about your art? What is painting for you – a profession or a way to express your personality?
– I’ve been doing art since I was tiny so it’s a way to express myself. It’s kind of my way of getting to know my grandfather, to capture moments that make me feel good and make me happy and I do it because I love to do it.
– What do you think: is it possible to treat people with the help of the arts?
– Lots of things, the whole aspect of color therapy, can enhance moods, as I’ve said in my art. And I like to deliver an important message, a positive message, and if you have a piece of art that makes you feel good inside, then I’m a happy person and I know that what I’m doing has a purpose, and that is why I do it above anything else.
– We see that the main ideas in your art are women, horses and your grandfather. Why have you chosen these motifs for your work?
– These are the three things that I am passionate about, the three things that inspire me, that really represent who I am. I also get inspired a lot through the circus, having grown up with a dad who went on tour with a circus, we travelled a lot with them, and then we had performances in Montreux. So the contortionists inspired me a lot, and being in the fashion industry, having worked as a model, all those elements kind of inspired me in that regard. Then I have horses, I’m a horse rider, I ride daily, I compete in show jumping competitions for pleasure and I had three little ponies on the manor and in the garden that were my toys. I’ve been riding for as long as I can remember. It kind of brings me a lot of happiness and well-being. And then the third thing is, of course, my grandfather, and this is kind of my way to offer tribute to him, to give back something after everything that he gave to me, to continue his philosophy, to bring humor into the world, to enjoy happiness. And it’s kind of my purpose to get to discover him. A lot of people say to me, «Oh, your grandfather was like this, like that». It is kind of a relationship that I never had with him. And I enjoy doing it so much.
– In most of your paintings I see this heart…
– I have always loved to draw hearts since I was tiny. It just has a good feeling, a good shape. It’s also a logo. This is a drawing I did when I was 16. I had a tattoo when I was 18 because my mother didn’t let me do so before that, and today it’s my logo. I think it has a positive effect and I just like it to be discreet because I think that sincere love is discreet.
– Some of your paintings you make with your fingers. Why?
– I enjoy painting with my fingers because it allows me to be messy, to be more spontaneous, and to make something quite unique because I wouldn’t remember which finger I used, or where. It’s much more spontaneous because I use all my fingers, both hands, and it gives things a bit more texture. With my paintbrush I am more conventional and keep everything clean and perfect. With my fingers, I cut loose a bit more.
– Was your grandfather such a positive, humorous person in life as he was in his films?
– In his daily life – yes. When he would play with kids, he was like a clown. He loved to make people laugh, he would always joke around and try to make people laugh. But when it came to work he was very strict, very much a perfectionist and very, very serious. He valued every little thing.
– Your book’s title is «Lachen ist der erste Schitz zum Gluck». And what about health? Do you think there is a connection between laughter and health?
– Definitely. Of course. I mean, I’ve seen it first-hand through my grandfather, who left me such a perfect example. I have people come up to me every day and say, «Oh, your grandfather… back in the day, we didn’t have this or that but we watched Chaplin films and those were our best moments», and all these little stories where my grandfather brought them so much happiness, so I see the effect he had on them. And I’ve seen it through my own experiences, my own work with a foundation and also with the ‘clinic clowns’. I’ve seen how children forget their pain and suffering through humor.
One of my favourite quotations from my grandfather is, «A day without laughter is a day wasted». And I think that life is short, there are so many things to smile about, you just have to try to find those things that are worth smiling about. I mean, there are so many beautiful things to smile about, you just have to look for them.
– But how it is possible if something goes wrong every day?
– I think that everybody is entitled to his own emotions and there’s time for everything. I can’t say I never cry – of course there are times when I’m sad, I mean, I need that time to be sad to then be happy again. It’s allowing your emotions, allowing you… to express yourself, just trying to make time for smiling, to vanquish those sad times. It’s the most important thing, because the sad times must be few and the happy times many.
It’s all in us, we have it in us. It’s something, as I said, that we just need to want to do, it’s something we have to encourage ourselves to do. As a child we laugh up to three hundred times a day and as a grownup we laugh maybe ten times a day. It seems that with age we forget because as we get older we get more responsible, and there’s more stress and more factors that come into life and I think that it’s important just to remind people that we have it in us and the proof is there, it’s good for you, so try to encourage yourself to do it. I am not saying it’s easy, but it’s better than going to see a doctor to get medication. It’s the first step to reaching happiness. You have to feel it inside. And we all have it inside. It’s free. In my book there are so many studies that I’ve written about, there are so many different aspects to it. There’s also nutrition. There are so many different things that we can eat and that can make us feel better: bananas, cashew nuts, red berries, vanilla, chocolate, all of which I love. Also, different spices – vanilla, chili, cinnamon, etc. We can try to eat food which will help stimulate the serotonin in our bodies to induce a better mood and feel better and be more positive.
It’s funny because I didn’t realize: I love all these happy foods, they are my favorite things.
– Could you tell us some secrets for our readers about face and body care? What do you use?
– I love coconut oil. It is my favorite. And you can use it for your face, hair, and body.
– You are living in the French part of Switzerland, but what is your favorite place?
– My favorite place in the world is my childhood home, but after that… There are so many places that I love. I love the mountains. I love the sea for a short break. But I’m more a mountain girl, I like the fresh air and nature, the green trees and fields, so, I mean, in Switzerland there are thousands of places that I could list.
I love Africa. We’re going at the end of this year for another foundation which I’m very excited about.
– A healthy life requires strong discipline but actresses and artists don’t usually like rules. It’s possible to combine creativity and discipline, yes?
– You have to. Although my creativity is probably much more important than my discipline, I think you have to have some discipline because if you don’t have discipline you don’t have goals, you don’t have structure and you don’t have aims or ambitions, so you need to have both.
– Do you think your mission is to make people smile like your grandfather did?
– Yes, definitely. I love realizing my mission. I want to remind people to laugh more, to smile at each other more, to enjoy the moment, to share a smile, to share a laugh.
– Why did you chose to be an ambassador for «Moi Pour Toi», an organization which supports the street children of Bogota?
– I was approached at my first exhibition by someone, and he asked me if I would like to become the ambassador and godmother of that foundation, and I said that I can’t tell you unless I just see with it my own eyes. So a month later he took me out there and I painted with the kids and I was actually in the middle of construction work here in the valley and there were a lot of details on my house that were not finished and I was very stressed about it. And when I went out there to Colombia, all these kids were wearing nothing but had the happiest faces, they were smiling and just enjoying life, and as soon as I got there… how could I complain about my silly problems? The kids just filled my heart with joy. From that moment I couldn’t say no. And that was also the idea for my book.
– Could you tell us about your dreams?
– My biggest dreams are to spread happiness, to spread joy and to find myself on a farm surrounded by nature and by my horses and by people that I love. It’s not that extravagant but rather quite simple, but I think all simple things are precious.
– Do you have any hobbies?
– Yes. I have a wine collection of two reds, two whites and a champagne in which I collaborated with a vineyard, Alexis Jaquerioz in the Martigny in Valais. It is a winery that supported me at my very first exhibition and then asked me if I would do a collection with them. We had a lot of exchanges on my taste and the content of the bottle and what would suit the label, so I’m very happy with that. I also have some watches – Gagnebin, Swiss made. Automatic watches, two designs for men, two designs for women, each limited to twenty per piece with my artwork and, of course, perfectly made, Swiss, very well made, and you can see all the movement in the back. I’m very proud of these watches. And then I also have the jewellery, smile jewellery, which is just a small thing to remind you to smile, and at the same time it also supports two foundations, one which encourages laughter and the other which supports the environment.
– Thank you very much.
Articular cartilage and bone cultivated from an individual’s own tissue, an ideal chest without artificial implants, paralyzed patients who recover … this is nowhere near everything that regenerative medicine can do. At University Hospital Basel, scientific research in this area has been proceeding in parallel with intensive practices for many years. Professor Dirk Schaefer, Head of the Plastic, Reconstructive, Aesthetic and Hand Surgery Department, tells us how regenerative medicine is pushing the boundaries.
— Professor Schaefer, your team researches body tissue cultivation. How do new technologies, which you’ve called Tissue Engineering, help people nowadays and what can we expect in the future?
— Work on the Tissue Engineering project has been going on for more than 2 decades. About 15 years ago, our team of 4 or 5 clinical professors plus a full professor working in the experimental surgery laboratory began growing cartilaginous and bone tissue from our patients’ materials. Later we started to grow nerve tissue from these so-called autogenous materials. To get cartilaginous tissue, we make a nasal septum biopsy, and to create a 5cm diameter sample, we need only 6 millimeters of a patient’s own tissue, without noticeable scars! We are already using this method for nose recovery after tumor removal and for knee joint defects.
Bone tissue is grown from autogenous cells of fat tissue. During the operation, we take adipose cells and put them into a special piece of equipment, and in two hours we get enough cells to create bone tissue, which is very convenient for the treatment of fractures. All of this can be realized over the course of one operation. The distinctive advantage of this method is that there is no need to take bone tissue from, for example, hip bones, as this can cause serious pain after the procedure.
We have found a way to grow large amounts of bone in order to use this method in restoring the defects of big and/or long bones in the areas of the hand, extremities, head, skull and chin.
Our clinic also conducts research in the area of nerve tissue creation, which can later be grafted onto a patient. It is important that the new tissue should not be defective in order to avoid problems with sensitivity and nervous system complications. Cultivated nerve tissue can be used after traumas of a strangulated nature, when some part of the nerve is missing.
— Why exactly is adipose tissue the source material?
— Adipose tissue is a perfect and almost unlimited source for autogenous stem cells. We take the necessary amount of adipose cells via a minimally invasive method and use them to regenerate bones and nerves. Earlier, when it was necessary to reconstruct bone tissue, surgeons used artificial materials, but those materials could not be fully integrated into the human body, so problems appeared in later years. There are no serious consequences with the transplantation of autogenous human material implants, as these tissues are fully integrated into the human body and they take over functions of the damaged tissue.
—This is to say that from any autogenous material, whether bone or adipose tissue, you can almost create a new person, can’t you?
— In the early 1990s, there were some publications which stated that soon we would be able to create… maybe not a full human, but some of their parts, such as a hand or a leg. But the predictions proved to be too visionary, as the human body is a really complex and highly developed structure. We have learned to purposefully replace certain tissues of the human body, such as cartilaginous, bone and nerve tissues. But in the case of complete organs, artificial prosthesis and donor organs for transplantation are still used.
— How actively is the method you are talking about used in practical medicine?
— Cultivated cartilaginous tissue is used in the treatment of articular cartilage defects, which occur as a result of injuries and accidents among sportsmen, for example. We can reconstruct cartilaginous nasal tissue after the removal of a tumor. We also use this method when treating thumb joint arthrosis, which is found in around one third of all women. In some severe cases, we have to remove this joint in order to reduce pain and here we work on its reconstruction. There are some plans afoot to use this technique in ear reconstruction. Bone tissue can be applied to any part of the human skeleton.
— You mentioned nervous tissue regeneration. Does this give hope to paralyzed patients?
— Yes. We work closely, for example, with the Swiss Paraplegic Centre. Today, it is possible for paralyzed patients to recover certain functions after skiing or motorbike accidents. For example, by changing the nerves’ location, it is possible to restore prehensile function to the hand. This is a wonderful outcome! If a person who was unable to move his arm can raise a spoon to his mouth after the operation, it means he can partly serve himself and become independent.
— How does your method help people with severe facial injuries following a car accident, for example? You work in this area, don’t you?
— Each case, of course, is individual. Today we are able to correct big scars on a patient’s face after thermal and chemical burns. A small number of centers can transplant faces or facial components, but this always involves immunosuppressive measures and is still considered to be experimental. There is a risk of infectious contamination or rejection of the grafted tissue. This is the reason we follow the methods of autogenous tissue grafting. By expanding the skin and using fat stem cells and microsurgical techniques, we can fully restore the surface of an individual’s face. Of course, this is all based upon the condition that the patient’s eyes function and the face muscles and bones have not been damaged.
— Is the aim to restore the beauty of a patient’s face?
— The aesthetic part of this work is also important. There is a direct link between appearance, good health and social status. That is why we try hard to maintain an attractive face after an operation.
— Do you often have to deal with the consequences of unsuccessful plastic surgery?
— Yes. It’s pretty common. Among patients from other countries, we have had some cases of complications after inappropriate use of medicines for the face, the misuse of breast implants, and problems as a result of liposuction. Some situations have been extremely serious, right up to sensory loss and functional impairment. The new method helps in cases where tissue regeneration is necessary.
— What is the treatment plan in the case of severe skin damage?
— The treatment program consists of several stages. First of all, it is necessary to seal the wounds. After that we examine the skin, its structure, texture, and tone, in order to take the opportunity to cover defects by mobilizing the skin and transplanting it into the defect. If there are scars, we arrange them in such a way that they are less noticeable. I always recommend replacing one big part of the skin instead of many small ones. If you arrange the skin correctly and have previously examined its form and structure, the scars become less noticeable. In each individual case, we prepare a personalized treatment plan.
— Is it possible for the autogenous tissue to replace artificial breast implants?
— In certain cases it is possible. Sometimes after childbirth, the feeling of a foreign body appears in the breast and a woman decides to get rid of her implants. As a result of their removal, a disparity in the skin and breast volume appears, so the next stage is lifting, which can be accompanied by the implantation of autogenous tissue from the hip or other parts of the body. It is a minimally invasive method of treatment which takes 3–4 days, including a consultation with a physician and preparation for surgery.
— If patients want to correct their appearance and look for a good surgeon, can they consult you? Or do you send them to cosmetic surgeons so as not to lose focus on the projects you are working on?
It is important to distinguish between such words as aesthetic and cosmetic. The term «cosmetic surgery» is freely used in media and society, but it is not a medical term. Anyone can call themselves a cosmetic surgeon. Our specialization is plastic, reconstructive and aesthetic surgery.
We are acting on a changing state (the aging process, the consequences of an accident, a developmental defect), meaning that we can bring somebody from an altered situation to an — in general — accepted normal or natural state For example, a woman with a big crooked nose doesn’t correspond to the normal ideal of beauty, so we can help her with aesthetic surgery. Another issue is when ordinary or even quite beautiful people, for whatever reason, want to change their body and sometimes exaggerate some of its parts, make them abnormal or supranatural — this is called “cosmetic” surgery.
In that regard, we at University Hospital Basel have a great responsibility. We educate and develop the competency of our colleagues and young specialists and pass on our knowledge and ethics to them. To prevent this uncontrollable passion for surgical operations without consideration of the consequences, it is important to educate the younger generation upon which ideals of beauty are imposed by the mass media. This year, we plan to open the first educational division of aesthetic and plastic surgery in a University Department anywhere in the world.
— What helps an individual to stay healthy and look younger for longer?
— As you get older, some changes are going on in your tissues. The skin loses its elasticity and the amount of subcutaneous tissue decreases. If this is accompanied by a long-term unhealthy lifestyle, such as smoking, alcohol abuse, or sunbathing, then the skin doesn’t change for the better. In such cases, we tell the patients: «Our options are limited.» This must be taken into account during an operation. I think a good diet, vitamin balance, normal sleep, lack of bad habits, skin care and fluid balance control, as well as physical exercise, are very important things.
— You are a graphic designer, according to your first degree. Do you have the opportunity, from time to time, to take a break from all this work and visit an exhibition?
Of course I do! We live in Basel, which is the Capital of Culture and the location of the famous ART Basel. Here we have a lot of museums of fine art, where you have the chance to see something new. While traveling, I take the opportunity to visit museums in other cities. It is a real pleasure for me, as I have a great fondness for art! While viewing pictures you can understand a lot about yourself, about the world. Looking at them, I often think that we should take things as we find them.
Professor, Head of the Plastic, Reconstructive, Aesthetic and Hand Surgery Clinic of University Hospital Basel, Doctor of Medicine, Doctor of Philosophy.
He was born in Bonn and is 54 years old. From 1984 to 1986, Dr. Schaefer studied graphic design at the Bodensee School of Art in Constantsa (Germany). Since 1986, he has devoted himself to medicine, graduating with a Bachelor Degree from the University of Illinois, the Virginia Medical College and the Albert Ludwig University of Freiburg, where he defended his dissertation in 1992.
From 1992 to 2000, Dr. Schaefer worked at the University Medical Center of Freiburg, at first in the general surgical unit and then in the Plastic and Hand Surgery Clinic. Since 2002, he has worked at University Hospital Basel. In 2010 he became Head of the Plastic, Reconstructive, Aesthetic and Hand Surgery Deparment of University Hospital Basel.
He is a member of the Swiss Medical Association, a Council Member of the Swiss Society of Plastic, Reconstructive and Aesthetic Surgery (SGPRÄC), a Member of the German Society of Plastic, Reconstructive and Aesthetic Surgery (DGPRÄC), a National Delegate in the International Confederation for Plastic, Reconstructive, and Aesthetic Surgery (ICOPLAST), and a Council Member of the German-speaking Association of Peripheral Nerves and Vessels Microsurgery.
There is a disease that can turn the most cheerful man into a morbid hypochondriac. It hurts, leads to depression, and stifles the joys of life. Plastic induration, or chordee, is an illness that can be found in every twentieth European male: that’s millions of men!
For many years, the only solution was the surgeon’s scalpel. The Swiss clinic alta uro offers a unique method of treatment and combined therapy, thanks to which it is sometimes possible to avoid painful surgery fraught with complications. The Deputy Chief Doctor of the Clinic, Dr. Gernot Bonkat, tells us about this new and effective technique.
— Dr. Bonkat, how common is a pathology like chordee?
— Unfortunately, it is not as rare as we would like to think. Plastic induration, or, as it is also called, Peyronie’s disease, is one of the most common diseases of the penis. The problem is aggravated by the fact that most men are ashamed of this defect and feel too embarrassed to go to the doctor. Therefore, it can be said that patients who go to clinics are only the tip of the iceberg. The question of what the real statistics on this disease are remains to be seen.
— This is unfortunate. What should prompt a person to visit an urologist? What are the main symptoms of this disease?
— It’s hard not to see them. In plastic induration, scars and calcinosis (calcination) appear in the outer shell of the cavernous body of the penis. Early detection of the disease is hindered by the fact that in most cases it can be noticed only when the penis is in a state of erection, meaning its length in this pathology will be 4–5 cm less than average. Moreover, a specific characteristic of the disease is a significant curvature of the penis (chordee) during erection; the angle can reach 90 degrees. Usually this is a bending deflection going upwards, but there is sometimes bending going to the side or downwards. It is clear that full sexual relationships are out of the question.
— Do you mean physical pain?
— Not only that. Curvature and the shortening of the penis and related erectile dysfunction, as well as pain during sexual intercourse, affect the mental state of a man. First of all, his self-esteem suffers, which often leads to depression and isolation from society. Such an emotional state, characterized by increased irritability or alternatively apathy and melancholy, is a serious challenge for his partner.
— Please tell us more about how the disease usually proceeds.
— Doctors distinguish between two phases. The fact is that 2–3 years after the onset, the plastic induration, as a rule, pauses and the inflammatory phase transitions to the stable one. But the course of the disease depends on many factors and it is impossible to predict what its consequences will be in one case or another. Sometimes the disease completely passes, even without the intervention of doctors, but nonreversible chordee with a significant shortening of the penis may occur. The only solace for those who suffer from this malady is that it never transitions to the cancerous stage.
— What diagnostic methods are used before starting treatment?
— Many patients with plastic induration suffer simultaneously from an insufficient erection, so-called erectile dysfunction (ED), and testosterone deficiency. In order to choose the optimal treatment, it is necessary to conduct an accurate diagnosis. Usually, such patients are prescribed an interfacial penile ultrasonic examination and control of the cavernous body with an injection of medicine to induce an artificial erection. Thus the evaluation of the plaque, the length of the penis and the degree of its curvature is carried out. The blood supply to different parts of the penis is also investigated with an ultrasonic examination in the regime of color Doppler, or duplex ultrasound that maps the blood flow. I would like to note that all these examinations are absolutely painless. Patients often tell us after the completion of diagnostic procedures, «I imagined this would be much worse.»
— Can a patient alleviate his condition without consulting a doctor?
— As scientists have not yet found an absolute answer to the question of the causes of this disease, it is difficult to give any recommendations regarding its prevention and therapy. Moreover, a truly effective medicine has not yet been created. Many patients who try to avoid surgical interference waste precious time with useless medication, after which they still have to rely on a costly operation, often burdened with complications.
— What kind of complications? What risks does a patient take if he decides on an operation?
— As I said, one of the consequences of the disease is a significant contraction of the penis, with a shortening of about 3–7 cm. This is terrible in itself for the patient. And any surgical intervention on the penis inevitably leads to its subsequent shortening by another 1–2 cm, no matter which operating technique is used. Moreover, each of these methods has additional risks.
For example, transplantation, i.e. resection of the squama and overlap of the defect with the skin graft, often leads to damage to the posterior nerve tract. Also, the patient has lost sensitivity in the skin and the balanus. Besides this, in the area of the skin graft, a so-called venous defluvium can form. Thus, patients who were operated upon with this method subsequently suffer from erectile dysfunction and a lack of orgasm more often than after Nesbit’s Corporoplast with wedge-shaped excision. Nesbit’s operation, as well as the plication process, have their deficiencies, such as the fact that the postoperative shortening of the penis becomes more significant than in operations using skin grafts.
— It is hard to imagine that there are men who consciously go for an operation to shorten the penis.
— With certain indications, surgical intervention is inevitable. All serious, experienced surgeons are aware of this problem and explain the possible consequences to their patients, so that’s why I encourage men to critically examine the numerous online offers which assure people that they conduct operations without shortening the penis. It does not matter which method of surgery is used. Patients with plastic induration will never hear such promises from a real expert in this field.
— What should be done then? Is there an effective alternative to these kinds of operations?
— Fortunately, there is. At alta uro clinic, we offer our patients a conservative new multimodal therapy concept. It includes initial medical treatment, then mechanical therapy, and, finally, extracorporeal shock wave therapy with calcified squama. This combination therapy can stop the development of the disease in 90% of cases at the initial stage. And furthermore, within a year or two, in 70% of patients there is an improvement. This means that plaques no longer form and the length of the penis does not decrease. It is also important that the patient begin treatment as soon as possible without wasting precious time. As quickly as possible, as soon as you notice the first signs, such as pain during an erection, plaques, or curvature of the penis, you should act.
This therapy helps even in the most seemingly hopeless cases, when the disease has been around for 2–3 years, and the patient has a strong chordee. But even in this situation, surgical intervention can be avoided.
— But if you still need to «go under the knife», what method do you recommend?
— Among experts in the field of plastic induration, there is unanimous consensus that it is not worth hurrying «to go under the knife», as you say. Certain conditions must be in place for this. It is necessary, for example, that the chordee should not have changed during the last 6 months, or even 9–12 months, as we should make sure that there has been no progression. Another indication is constant pain. Concerning the choice of the method of surgical intervention, it can be said that Nesbit’s operations with plication or the resection of plaques and tissue transplantation in this case are equivalent. I repeat that advertising statements that insist that, after surgical intervention, there will be no shortening of the penis contradict the results of studies of serious authors and should be approached critically by the patients.
Doctor Gernot Bonkat
He studied medicine at the universities of Munich and Würzburg in Germany. He graduated from a medical residency in urology at the University Clinic Basel in Switzerland. In 2014, Dr. Bonkat attained the position of Associate Professor of the University of Basel. Since 2016, he has been the Chief Doctor of alta ro in Basel.
Dr. Bonkat is an active member of various urological communities, including the European Association of Urologists, the Endourological Society, and the Association of Urology in Germany. In 2015, he headed the section «Infection in Urology» of the European Association of Urology. He is a believer in using the latest diagnostic methods in the field of infections of the genitourinary system, as well as tuberculosis of the genitourinary tract. Since 2009, Dr. Bonkat has been a senior researcher at the Biomechanics and Biocalorimetry Laboratory of the University of Basel. In 2012, he worked as a principal investigator at the Department of Urology at Tygerberg Hospital in Cape Town, South Africa. He is the author of more than 150 articles, books and reports.
Treatments using vitamins and minerals are not a new-age myth, but a very effective way to improve health and tackle many health problems. In the Grand Resort Bad Ragaz medical center, this unique line of work, which has been christened «orthomolecular medicine», is headed by the doctor of medical sciences Dr. Christian Hoppe.
– Dr. Hoppe, could you briefly explain what orthomolecular medicine is?
– Well, briefly, it is a doctrine of micronutrients. The macronutrients are fats, proteins and carbohydrates, and the micronutrients are vitamins, minerals, amino acids, and fatty acids. Orthomolecular medicine is a whole field of medical knowledge. Two Nobel laureates have received awards for research in this field.
– What is your approach to treatment with micronutrients?
– The idea is an individual focus of treatment. Until now, in most clinics doctors have prescribed vitamins and other micronutrients for their patients blindly, without a preliminary examination (which should include a study of blood, saliva or a feces analysis in scatology). But in such a case we cannot be sure of the effectiveness of the treatment, because it has been conducted without taking into account the individual characteristics of the physiology of that particular person. It is likely that a combination of mineral substances prescribed blindly will not include the exact micronutrients that the patient needs most.
Moreover, with this approach it is possible to violate the main principle of medicine ─ to do no harm ─ if the dosage is too small or too large, and this is unacceptable. Therefore we always recommend a full diagnosis for a patient and only then, based on the results of the analysis, do we devise an individual treatment program with micronutrients.
– How is the diagnosis carried out?
– First of all, it is based on special laboratory studies that measure the amount of micronutrients not only in the blood serum but also inside the cells. There is also a coprological study, which takes more time ─ the results are ready after about three weeks.
This is a fairly new field of knowledge, although about 6,000 studies on this topic are published annually. The fact is that millions of bacteria live in our body and they haven’t yet been properly studied, and therefore we are still expecting new discoveries in this field.
Of course, the patient will not be able to get recommendations for treatment after just one visit to the doctor; that’s simply not possible. He will have to come to us twice, for diagnosis and then for treatment. The necessary combination of nutrients and recommendations for their use will be ready by his second visit.
– But could the recommendations be sent by e-mail?
– Theoretically, yes. However, recommendations are not enough. We also provide patients with counselling: we explain how to manage stress, and we develop a set of physical exercises that enhance muscle activity. It is necessary for people to understand that if you just take a pill, the problems will not disappear. Micronutrients are only a part of the therapy, albeit a very important part.
One of the most serious problems today is inadequate nutrition. Of course, we hear that it’s not like that: that now, on the contrary, healthy food has become very popular, that stores are opening in which not only fresh but also ecologically pure products are sold. This is true, and it’s good that the media is promoting a healthy lifestyle, including proper nutrition. But the fact remains that almost every day I see patients of different ages who have all the signs of lack of vitamins, minerals, and micronutrients, and these are wealthy people, who are able to monitor their health and buy good quality fresh products. What does this say about other, poorer people?
– Which micronutrients are most often lacking?
– A classic example is vitamin D, especially in Europe and especially in the winter months. This applies more to the residents of big cities, where there is not enough flora and greenery. People spend almost all their time indoors and they do not produce vitamin D. Then there is iron deficiency, which is more common in young women.
The lack of these two necessary components leads to problems such as sleep disorders, depression, and deterioration of quality of life in general. Isn’t it bizarre that very young people start using antidepressants? Instead of slightly adjusting their levels of vitamin D or iron, they are prescribed the strongest medications; these can be prescribed for up to six months and they just cause greater harm to health!
– I know that an equally serious problem is a lack of vitamin B12. For which category of people is this most common?
– A deficiency of vitamin B12 is most common in the elderly, but this depends largely on the individual characteristics of the body. Some people feel great if their level of vitamin B12 is at the upper limit, while others, on the contrary, feel great if it is close to the lower limit. Therefore, for me, as a doctor, it is important not only to have the results of laboratory investigations on hand but also to see the patient, to know as much as possible about him, and to ask in detail about problems with his well-being. Only after that can I put together the necessary combination.
Unfortunately, due to the fact that micronutrients are becoming more popular today, the number of so-called «experts» who do not have the appropriate education and professional qualifications in this area is increasing. They conduct laboratory investigations, but when it comes to the correct interpretation of the results, they lack experience and knowledge. Moreover, in many countries, doctors do not pay much attention to such indicators and do not consider the situation to be serious, and so the patient becomes less anxious and gets used to his condition – and his quality of life worsens.
– Is it possible to get advice on nutrition during a consultation? What, for example, should be included in one’s diet in order to replenish the levels of missing trace elements?
– Again, it is possible only after a complete examination which, in addition to traditional analysis, includes measurement of the percentage of adipose tissue, analysis of body composition, ECG with exercise, and assessment of the lungs and heart. This is the basis for determining further treatment, so the doctor should prescribe a general examination, determine the general health risks, and listen to the patient’s complaints.
The aim of the therapy is firstly to reduce health risks, secondly to improve one’s working capacity, and thirdly (the most important for me), to help the patient develop a feeling of satisfaction with the state of his health. All this cannot be achieved by just giving a person a mixture of micronutrients. If, for example, you eat properly but do not sleep well at night, your health will not improve.
– So everything becomes clear with the diagnosis. How long can the treatment itself take?
– The course of therapy usually lasts 3 to 6 months, and then we conduct a second test. If there is any progress, you can continue working in the same direction but with a different dosage. This process, strictly speaking, is a lifelong thing. The goal is the preservation of vivacity, health and youth.
Other important aims are body cleansing (a detox module) and weight loss ─ here we offer programs of one week or more. Both of them, of course, start with an examination of the patient.
A detox program includes analysis of endogenous and exogenous toxins in a special detoxification laboratory, an ultrasound of the liver, cleansing of the gastrointestinal tract, and a consultation with a nutritionist who not only evaluates and gives a detailed analysis of dietary and food preferences, but also develops an individual cleansing diet. Doctors also devise a plan of special procedures such as lymphatic drainage, body massage, detoxification, daily Kneipp therapy in the thermal water of the Ragaz and, of course, personal recommendations for visits to the sauna, a fitness program, and relaxation sessions.
Thanks to this combination therapy, the body is completely cleansed and the patient becomes charged with vivacity, energy, vitality, and a strengthened immune system. This is due to the fact that as a result of detox procedures, metabolic blocks are destroyed and the optimal balance of the metabolism is restored.
– And what is special about your weight loss program?
– This program is very popular as people are becoming larger and larger every year, and often there is a deficiency of iron and vitamin D. It provides a comprehensive examination of various organs (liver, kidney, heart, and thyroid) and an analysis of the body’s composition and the patient’s diet. Then the nutritionists start to create an individual diet and develop a course of gradual weight loss. The program includes full board with meals (it’s necessary to drink two liters of Ragaz thermal water daily), as well as a starter package which includes whey protein isolate, L-carnitine and a mixture of multivitamins and minerals as a food supplement or food substitute.
– I would like to ask a question that interests many women. Is there a vitamin that slows down aging?
– Only unscrupulous doctors pick one element and promise: «By taking this, you will live longer and look younger.» It is not going to work. It is just a business. But if you take a more serious approach to the problem and choose a complex of mineral nutrients, you really can live longer.
There are two types of anti-aging programs: «I want to live as long as possible» and «I’m 60, but I want to look like I’m 40». My theory is to stay healthy and, accordingly, live longer and better. As for rejuvenation and beauty, this is a field for beauticians. In my program, nutrients and nutrition are crucial.
In this conversation, I have covered only a small part of such a broad topic as orthomolecular medicine. I am sure it is the future.
Doctor of Medicine and Member of the Swiss Association of Physiotherapists and Rehabilitation Specialists.
From 1989 to 1996 he studied at the Medical Faculty of the University of Bern. During his studies he worked in a psychiatric clinic at the University of Berne under the leadership of Dr. Kurt M. Bashman. In 2002, he received a doctorate in medicine.
Since 2004 he has specialized in the field of physiotherapy and rehabilitation medicine. He has experience of working as a sports doctor and chiropractor. From 2003 to 2006 he was a consultant at the Adelheid Rehabilitation and Recovery Clinic.
Since 2006, he has been a practicing physician at the Health Center of the Grand Resort Bad Ragaz and the leading doctor of the Swiss Olympic Medical Center (SOMC).
In 2008, he underwent training in orthomolecular medicine.
When your teeth grow unevenly, you can forget about a Hollywood smile. Usually, malocclusion is corrected in childhood, but if not, you can try for perfection in adulthood. Braces can become your «point», a fashion accessory, or an invisible device that corrects the position of the teeth. The crucial thing is that a professional should evaluate the kind of braces that are suitable for each particular patient. One of Switzerland’s leading dentists, Michael Meier, tells us about the different types of braces and what kind of results can be achieved with them.
— Dr. Meier, 20-30 years ago, only children had braces. It was believed that it was already too late to change anything by the time one was an adult.
— Fortunately, there are no age limits these days. You can make corrections to the teeth with braces at the age of 40 or 50. Another thing is that there is an individual design for each age. We need to assess the specific situation — how teeth develop, and how to influence this process. The main point is for a professional orthodontist to draw his conclusions: when to put in braces, what model to choose and how long the patient should wear them for.
— But what is the most favorable age for the correction of occlusion?
— There is no standard age; it all depends on each specific case. As you know, at six years of age the milk dentition falls out and permanent teeth appear. A family doctor, observing a child, can see whether they are growing evenly. And if something is wrong, if some teeth are growing crookedly, you should consult an orthodontist and he will make a decision. There are no universal recommendations: sometimes it is better to put the braces in early to achieve the desired effect, sometimes later, but to correct curvature in childhood is easier. In addition, it is important to adjust the position of the teeth, because their appearance changes as you grow up, and it is better that the jaw develops correctly.
It should also be taken into account that fixed braces require a high «dental IQ» – i.e., a person should be educated in the field of dental hygiene and understand how to take care of his teeth, because when one has braces, the risk of development of caries increases. In other words, the child should realize that he should not eat a lot of sweets, should not drink soda, and must regularly brush his teeth.
— Tell me, are teeth necessary for beauty only, or do they also affect the health of the oral cavity?
— For health, it is important how you occlude your teeth. If there is a gap in the teeth or the jaw does not move enough, a person can not chew normally. So, basically, teeth are a matter of aesthetics. Moreover, if a patient wants to perform an aesthetic restoration of the teeth with the use of veneers (special decorative linings), the braces will most likely be installed in terms of treatment. Veneers simply will not take to uneven teeth.
— And what kind of braces would you recommend for adults?
— Most adult patients do not want profound changes but only a slight change in the position of the teeth. The invisible braces from the company Invisalign, a scientifically based and proven method used worldwide, handle this task perfectly. They have already been used by millions of people. The braces are a mouth guard made of a transparent material that is almost invisible on the teeth.
First, one should make a computer model. We send pictures and materials to the headquarters of the company and in return receive a video showing how the teeth will change after the correction is completed. The company produces mouth guards — 12 pieces for the entire treatment period. They are numbered; the patient himself changes them every 14 days, and the teeth gradually shift to the desired position. Every 5-6 weeks you need to come in for a check-up with a doctor. If the patient cannot come, he should wear the previous model. If something goes wrong, the dentist sends the mouth guard to the central office, and they do the correction.
— Do you need to wear the mouth guard around the clock?
— One should wear it 22 hours per day, taking it out only at mealtimes. I would not use Invisalign braces for children. They require self-discipline; you need to look after the oral cavity more carefully. And children might forget the mouth guard, or take it off and lose it. For them, it is better to wear fixed braces. And for adults, in the case of strong tooth movements being required, traditional fixed braces are better suited to the task. There are also ceramic braces, which are not very noticeable on the teeth.
— Are there any contraindications?
— No, but there is an important condition. Before putting on the braces, you need to completely cure caries and inflammation of the gums and soft tissues. Any correction should be done on a healthy basis; otherwise it’s like building a house on sand instead of a foundation. Wearing the braces can seriously aggravate the condition of soft bone tissues, right up to the loss of teeth. In addition, it is necessary to check whether there is bone disease — for example, in diseases such as osteoporosis, there is a high risk of complications.
— Might the patient feel pain or discomfort?
— Only at the beginning, in the case of conventional braces, but the skin from the inside of the cheeks is not injured.
— Once, braces with diamonds were popular. What is trending now?
— Now it is important to put in braces based on the indications. For adults, ceramic or sapphire braces are better. The price of the latter is higher as they have a number of advantages — high strength material, no metal, no excessive salivation, no injury to the tongue. There are lingual brace structures called Incognito; they are put onto the inside of the teeth. The advantages of the Incognito system are fast and easy installation, invisibility, and comfort. But there are also disadvantages. The lingual constructions sometimes affect diction; however, many patients adapt quickly to this. The only ones, who know that you have braces installed are you and your orthodontist, but the results will soon be seen by everybody.
MD, Doctor of Dental Sciences, graduated from the Department of Medicine at the University of Zurich in 1998, after which he worked for one year in the Department of General Internal Medicine at the Hospital of Canton Zug, and approximately three years as a research fellow at the University of Zurich’s Institute of Forensic Medicine. From 2002 to 2006 he worked as a doctor’s assistant in the Zurich Dental Center, then in 2006 he began to work independently at a private dental practice. In 2011 he became one of the founders of the Kinder-
Permanence by Swiss Medi Kids Zurich AG pediatric center. He also owns the Perfect Smile Ragaz GmbH dental clinic in the Grand Resort Bad Ragaz medical centre.
Patients from all over Switzerland as well as from other countries of the world are always trying to get an appointment with the professor of the University Hospital of Zurich, Peter Bauerfeind. The modern unique technique used by the professor literally allows him to perform miracles, and with the help of simple endoscopy not only to detect emerging tumors, but also to successfully treat the early stages of esophageal and stomach carcinoma, avoiding chemotherapy, irradiation and surgery. Is it possible to prevent a terrible illness? And what can modern medicine offer in the fight against disease? That’s in today’s interview.
— Intestinal cancer is the second most common among the oncological diseases. American scientists noticed a curious pattern: after analyzing the data from the beginning of the 20th century to the present day, they found that the number of diseases began with an increase, and then started to decrease. It’s impossible to say why this happened, since it is not related to the work of doctors. Today, intestinal cancer occurs in approximately 5% of the population: 3% in women and 6-7% in men. And it does not matter whether it is in Europe, Asia or America — the figures are the same. Gastric and esophageal cancer is less common. However, esophageal Barrett’s carcinoma is the only type of carcinoma, the incidence of which is increasing from year to year. One common cause is being overweight.
— Apart from the people who are overweight, who else is at risk of contracting one of these diseases?
— Esophageal squamous cell carcinoma is definitely related to tobacco and alcohol, and Barrett’s carcinoma, as I have already said, is related to obesity. As for intestinal cancer, it has often occurred in people who consume low-fiber products and eat too much meat.
— At what age do you think it is necessary to conduct a screening examination?
— If a person is not in an at-risk group for colon cancer, one can start doing it at the age of 50. However, recently, there were discussions with increasing frequency about the need of early diagnostic procedures, because the disease began to manifest itself at an earlier age. So, in Italy, an examination is conducted at the age of 45. Those who have a genetic predisposition to oncology need to take care of this 10 years before the age at which a relative was diagnosed with cancer. For example, if that disease manifested itself in a 40-year-old mother, then the children need to undergo medical examinations at the age of 30. Campaigns for the early diagnosis of colon cancer are being widely conducted in Switzerland and other European countries. They are extremely important, as they attract the attention of ordinary citizens, to make them think it over and not postpone the appointment with the doctor.
For the esophagus and stomach, it is better not to delay and undergo medical examination at the age of 40, and even at the age of 30 if the patient is in an at-risk group or has symptoms.
— And how frequently one should undergo medical examinations?
— It is preferable to repeat an examination of the large intestine every 10 years, and of the stomach and esophagus annually, especially if a person is in an at-risk group.
— Which diagnostic techniques of carcinoma at the earlier stages are the most effective?
— It has become possible to detect a precancerous condition and a tumor in the esophagus, stomach and large bowel. Today, many people undergo endoscopic examinations for preventive purposes. Due to the high-tech endoscopes, which are much more sensitive than the previous ones, we can see the slightest changes that occur in the digestive organs.
— Can we detect the cancer during a common gastroscopy?
— Yes: during the examination, we look at the areas that look suspicious by visual inspection; for example, we see changes in tissues, inflammatory processes. To prove the presence of an oncological disease, tiny samples are taken during the examination and send to the pathologist.
— But it turns out that one can do it without surgical interference?
— Yes, this is so. In the past, a patient with a malignant neoplasm, even if it was not yet a carcinoma, was sent to surgery and a part of the stomach or esophagus was removed. Today the situation has radically changed; the method of submucosa resection is used instead.
— Could I, without being a specialist in this field, describe this process in a figurative way: during endoscopy, it seems that you pull out a tumor, and if everything goes well, then the patient leaves you in an hour without cancer? You can forget about the endocavitary operation, after which the risk of various complications is known to be estimated at 20%?
— Whether a full operation is necessary is decided on the basis of tissue examination of the esophagus or the stomach in each concrete case. Only a few criteria are important: the depth of penetration of the tumor, its aggressiveness, risk of penetration in the lymph nodes, etc. If these indicators are not beyond the critical ones, then the affected area can be cleared by using the endoscopic method. So, at the stage of early disease recognition, you can do without surgery and without chemotherapy.
— How long has this method been used?
— It started to be discussed 20 years ago. The first to experiment with the submucosa resection were Japanese doctors; then they passed the torch to Europe. The Japanese often have gastric cancer, but they rely on surgery only in extreme cases due to their philosophy. Probably that was the reason why they thought about how to treat cancer with sparing techniques. Then the technique was adapted for esophageal and colon diseases. I was able to learn this unique technology.
We have been using this method in our practice for 15 years already; we have performed more than 300 such operations.
— How long does the operation last?
— Depending on the size of the neoplasm, from 20 minutes to 3.5 hours. We use general anesthesia only in the case of a long procedure. For example, I prefer to perform endoscopic resection of large carcinomas with complete anesthesia. Most commonly we use the usual sedation
— How big is the danger of carcinoma relapse after the extraction? Can it appear elsewhere?
— This depends on the tumor stage found in the resected tissue. In general, the risk is small if the tumor is superficial. If the tumor invades deeper areas, the risk of affected lymphnodes increases. Then sometimes surgery or radiation chemotherapy is necessary. It is necessary to understand how important it is to detect the disease early to get rid of it. This is the only way to avoid surgery.
— Are there any effective methods of prevention?
— The best prevention for colon cancer is to have a screening colonoscopy.
— Could you please give an example from your practice that would clearly illustrate the effectiveness of the resection method?
— Recently, a foreign patient was treated in our clinic. Thanks to the timely medical examination, he was diagnosed with an esophageal cancerous tumor. The doctors offered him a radical operation, which he refused. But he completed a course of radiotherapy and chemotherapy that destroyed almost the entire tumor, except for a small fragment. The next stage of treatment was a new course of chemotherapy and radiotherapy. My colleagues and I decided to perform a resection and extract the tumor fragment endoscopically. And it gave us a positive result — nothing was left of the cancerous tumor. Today the main task of the patient is to regularly attend examinations.
Professor of medicine, head of the endoscopy department of the Clinic for Gastroenterology and Hepatology at the Zurich University Hospital.
He was born in the German city of Selb. He studied chemistry at the Technical University of Munich and medicine at the University of Cologne. In 1986 he received a doctorate in medicine.
He started his professional career in the Department of Surgery at the Technical University of Munich. He worked and studied at the Lausanne University Hospital, Triemli Hospital in Zurich, the Liestal Hospital, the University of Maryland, and Basel University Hospital. Since 1996 he has been a physician at the Zurich University Hospital. He is the author of more than 120 articles and scientific works on endoscopy and gastroenterology.
Giving birth to a child is a pivotal moment in the life of any woman. Sometimes it takes years and a long struggle with health issues to conceive. Professor Christian Breymann, one of Switzerland’s leading gynaecologists, can tell you thousands of stories of how long-awaited children have arrived in this world. He can also reassure you that it is never late to have a child. With Professor Breymann responsible for pregnancy management, any future mother can feel safe: all his decisions are bound to be the correct ones. His clinic, with the associated Zurich Obstetrics and Gynaecology Center, delivers over 1000 children each year. There is a joke among his ex-patients that Prof. Breymann’s care guarantees beautiful children.
— Professor Breymann, what is the right moment for a woman to go to your center — when the pregnancy has already begun or while it is being planned?
— It is best to start with prenatal consultations, meaning when the pregnancy is just being planned. We have to compile a complete medical history to understand whether it is safe for the future mother’s body to go through all of the steps from conception to childbirth. Women frequently appear to have chronic conditions or complications after abortions. Another factor is age. So, such mothers-to-be need special medical attention: a full physical examination, a hormonal balance check and the measuring of blood concentrations of vitamins and minerals are necessary.
Studies confirm that pregnancy goes more smoothly if the concentration of nutrients and hormones in the female body is balanced. In cooperation with the largest Swiss vitamin manufacturer, I have been able to develop a special formula. There are no equivalent products, as mine contains vitamins, minerals, berry extracts and many other valuable nutrients. If, say, a lack of D vitamin or iron is detected, we tailor the formula specifically for each patient.
— What stages are there in your work with a mother-to-be?
— The first is a conceptual examination and consultation, and an examination of the medical history. The second is the actual pregnancy management. There are three important points here: a genetics and ultrasound scan at about week 12, then, at week 20, an examination of the child’s morphology and diagnostics of its organs, especially the heart, and screening as well; and, finally, growth monitoring at week 30. By that time, the diagnostics of organs and genetics are completed. If that goes well, in most cases there will be no further problems.
Our Center cooperates closely with other clinics and specialists from many fields. If there is a sudden need for an additional test or another specialist consultation — for instance, if a consultation with a cardiologist in the case of heart arrhythmia is needed — it can all be organized very quickly. The most surprising thing is that sometimes it is not only women who need a consultation. We recently had a case where it appeared that our patient’s husband had problems with his lungs, so we contacted a specialist and the next day, the man was sent off to an appointment with a specialized clinic.
— Nowadays more and more women are tending to become mothers at quite a mature age. This is known to increase the risk of complications significantly.
— ‘Mature pregnant women’ are one of our major specializations. This group of patients includes women who become pregnant at around the age of 40 or later. We examine them most thoroughly and offer them a special program of pregnancy management.
In all cases, it is me personally who performs all the tests, like the ultrasound scan, organ diagnostics, and placental diagnostics. Besides this, genetic studies of the fetus are performed and additional consultations are given. In this way, we can minimize all the risks.
— Data on women of fifty and even sixty years old who have given birth to children are frequently published. How old was your oldest patient?
— 55. She was a famous photographer. It was her first child, so we went with a caesarian section. Our team managed her all the way through the pregnancy. Needless to say, she was very happy!
— What risks to a child’s health can a mature mother’s age pose?
— There was a study conducted in the Fertilization Center we collaborate closely with. They gathered statistics on the state of health of newborns whose mothers were over 40. Unfortunately, they are not as good as those of young obstetric patients. However, medicine is progressing and I keep saying that thorough examinations carried out by professionals before and during pregnancy are sure to minimize the risks. Every time a patient comes to me for an ultrasound scan, I personally examine the child’s organs, check the state of the placenta and blood vessels, and monitor all the parameters. And I do this regularly, starting from week 20, while many doctors do not do this.
— What overall evaluation can you give to modern, middle-aged expectant mothers?
— The majority of women who want to have a child at around 40 years of age are from large cities. They have been building their career, they have achieved a certain position, and they can afford high-quality medical service. Such women tend to be more aware of their health and healthy eating and exercise, so their physical condition is often quite enviable. But, on the whole, modern women in their 40s and 50s seem to treat their health with more respect that in the past. It means that the chances of producing a healthy child are very good.
— Doctors often recommend that mature women have surgery rather than a natural delivery.
I disagree with this. I do not oppose natural childbirth for mature pregnant women, even though many doctors consider it too risky.
If there are no medical contraindications, a woman is free to choose the way she wants to deliver. We discuss all of the benefits and drawbacks, but it is the patient who makes the decision. It is a different story if the expectant mother has diseases like heart defects, diabetes, or liver dysfunction, or the fetus is too big or is in a breech position. Then we operate. It can happen that a woman chooses a caesarian section without any indications. At the same time, there are patients who insist on natural delivery at the age of 45. I support any decision.
— It is said that the caesarian sections in your center are unique. Do you use special methods?
— We do. An example is the Misgav Ladach method, which allows the surgeon to cut through a smaller volume of tissue but which involves more manipulation. We introduced the method just several years ago, but we are now seeing the excellent results it brings.
The operation lasts 20–30 minutes and the blood loss is comparable with that of a natural delivery. It is even preferable from this point of view. The patient stays in hospital for 5–6 days. She can get out of bed on the first day.
We provide high-quality care for mother and child and the likelihood of infection is minimal. That is why famous women and celebrities’ wives come to us from England, Monaco and other countries, countries with their own luxury-class medical service.
Recently, our center has been the basis for the medical paper, «Patient satisfaction level in reduced-trauma caesarian section». According to the results of the study, over 90% of patients were satisfied with the outcome. We are planning a series of scientific publications based on this research.
— Caesarian section is usually offered in the case of complications. For instance, breech birth is a common problem. Some specialists recommend changing the position of the fetus mechanically, but others are categorically against it.
— Delivery with the breech position is always a risk, so I recommend caesarian section. One can deliver a child in the breech position, but it depends on many factors: the woman’s weight, the baby’s weight, and the details of its position. But even if all the conditions favor a natural delivery, we still operate in 90% of cases because a caesarian section allows a woman to deliver a healthy baby without birth trauma, vacuum or hypoxia.
As for changing the baby’s position, it is practiced in some hospitals but it is forbidden in ours: this process involves changing the position of the placenta along with the fetus. This can be extremely dangerous.
— How often do patients from abroad have to come for appointments with you during pregnancy?
— It depends on the woman’s health and the development of the fetus. Some visit us several times during the most significant periods for diagnostics — usually weeks 10, 20 and 30 — and, naturally, before the delivery. Others require more frequent visits. Sometimes we see the mother-to-be only once or twice shortly before the planned caesarian section. There are women who pay one visit after another, as they feel safe here. For example, I have a patient from Malta who has even come for an ultrasound scan.
— If a pregnancy is getting complicated, does it mean that the woman must spend all nine months in the proximity of the clinic?
— Each case is different. The higher the risk, the more often I need to see the patient. But if there is a good doctor in her country, there is no need to come to us all the time. I trust my colleagues.
— Even in the smoothest pregnancy, there is still a chance that the newborn will need specialized care.
— We are prepared for all unexpected situations. As the pregnancy progresses, I anticipate possible scenarios. Not long ago, one of our foreign patients had a baby with renal dysfunction. Because we knew about it in advance we contacted specialists from a child healthcare clinic right away, thanks to our network of contacts.
— What else does your clinic specialize in, apart from pregnancy and delivery management?
— Of course, perinatal care, obstetrics and delivery are our major specialization. We have over 30 years of experience in this sphere. But we also deal with general and operative gynaecology. Also, we give recommendations as to hormonal therapy and hormone replacement therapy in the post-menopausal period.
— In Russia, prejudices against hormonal medicines have persisted for years. While contraceptives are now widely used, hormonal replacement therapy for women at the start of menopause still raises quite a lot of questions and concerns.
— When a woman reaches menopause, the level of estrogen in her body falls in a short period of time and the first postmenopausal symptoms occur. The changes affect practically every organ. Some of them do not manifest themselves visually: for example, bone weight loss. I strongly believe that hormone replacement therapy is, along with a healthy lifestyle and good nutrition, the only way to age in a less traumatic way. If you put 20 women of the same age in front of me, I can definitely say who is receiving hormone therapy and who is not. It is visible without special tests.
I am not referring to anti-ageing measures: hormone replacement therapy is not about prolonging youth. It is about alleviating the effects of age-related changes, allowing them to happen in a less traumatic way. In addition to hormones, food supplements, antioxidants, mineral substances, calcium and much more is necessary. It goes without saying that constant monitoring and regular medical check-ups are important. Hormones must be taken in the right dosage and form, be it a patch, tablets or jelly, to avoid overloading the liver.
— At what age should hormone replacement therapy be started?
— The most important thing is not to start it before the menopause. The body must manifest symptoms of a deficiency in certain substances. It is necessary to measure hormone levels and assess them, and only then to make a decision. Many women come to us at the age of 42–45 — that is too early. While there is menstruation, no hormone replacement therapy is prescribed.
— It is thought that hormone replacement therapy increases the risk of breast cancer. Is this true?
— There is an ongoing discussion and it depends which preparations you are using. Surprisingly there are even situations where menopausal hormone replacement therapy (MHT) can lower the risk of breast cancer. According to the research, many women who develop cancer have coexisting risk factors such as smoking or being overweight, or there are other unfavorable factors like hereditary ones. Anyway, hormone replacement therapy must be supervised by a physician. It is necessary to monitor how the woman feels and perform regular breast check-ups. Besides, for those who have had their uterus removed there is no need to receive progesterone; just estrogen is sufficient.
There are certain rules to be followed. This method is very effective if used with expertise. It yields visible results: the skin becomes firmer, and the hair and nails get stronger and shinier and the bones less fragile. Nothing is better than hormone replacement therapy for stabilizing bone tissue and preventing osteoporosis and vaginal atrophy.
— Nonetheless, prolonging youth and preserving beauty is a highly popular field of medicine. Can you offer women anything in this area?
— Sure. Systematic hormone replacement therapy in combination with the right diet and food supplements provide comfort for the body. Meanwhile, one’s appearance can be preserved thank to hormonal dermatological products manufactured by our partners.
Professor of Medicine. Honorary professor of Gynaecology and Obstetrics in Zurich University, co-director of the Obstetrics and Gynaecology Center (Zentrum GGS), Seefeld, Zurich. Pfizer prize winner 2009 (as a co-author) for research in the field of cardiovascular diseases. Full member of the German Association of Perinatal Care, the Association of Gynaecological Endoscopy (AGE Germany), the International Society of Umbilical Cord Blood, and NESA (New European Surgical Academy).
The schedule of the world famous Swiss heart surgeon Paul R. Vogt is very busy. His life consists of a succession of clinics and operating rooms, as well as planes and trains which carry him to the most remote corners of the world to do the work of the EurAsia Heart Foundation.
The interview is scheduled for early Saturday morning. I am met by an extraordinarily agile person with the movements of a dancer. “You are very similar to Mikhail Baryshnikov. Have you been told this before?” The words come of their own volition. “No,” the professor answers in a detached manner. I seem to distract him with this absurd question, to pull him out from the depths of his inner world, where he is focused on more important problems. He gives the impression of an extremely restrained and closed person, but behind this is a person fanatically dedicated to saving lives, a self-sacrificing enthusiast to whom thousands of people «trust» their own hearts.
— Professor Vogt, you are one of the leading heart surgeons in the world, with both recognition and status. You could enjoy them, limiting yourself to working in the comfortable conditions of the Swiss clinic. Nevertheless, you devote the lion’s share of your time to charity: you operate on patients throughout the world, you train local experts and you run the EurAsia Heart Foundation. How did it all start?
— The history of the Foundation began in 2000, when I went to China as a part of our first mission. I performed some relatively simple surgery that was filmed and then shown to other doctors. This video was very popular among Chinese universities. Asian colleagues asked if the «doctors from the European Union» (as they called us) could come more often to them to train their specialists in their clinics and on their own patients.
Then there was a trip to Vietnam, where I appeared in a children’s clinic which was critically overcrowded with patients. I was told that there were 8,500 children on the waiting list for surgery. They were lying around everywhere: on the floor, in the beds, several people to each one. At the same time, it was possible to conduct only two surgeries per week. This hospital, overcrowded with children and their parents, and the impossibility of providing timely assistance to all of them, made a strong impression on me. I realized that I had to do something. Then the idea of an organization which would involve itself systematically in the professional development of doctors on site to increase the number of experts capable of carrying out complex surgeries came to me.
— How big is the need in other countries for such assistance?
— In Vietnam, where 82 million people live, 10,000 children with heart problems are born every year and another three thousand are diagnosed with various cardiac diseases. But only 6,000 heart surgeries are performed! By comparison, in Germany, with 80 million inhabitants, this figure is 60–90 thousand surgeries every year (starting sometime in the 1970s). At the same time, in the hospital in Myanmar, there is only one pediatric heart surgeon, who has 5,000 children in the queue for surgery! Can you imagine? And this list is growing and every day more than one child dies!
In China, 100,000 babies are born every year who are then diagnosed with heart diseases. They all need qualified medical assistance. At the same time, in the whole region, young specialists facing difficult cases understand that they are not properly qualified, because in these countries there are no traditions or continuity in cardiovascular surgery as there are, for example, in Switzerland. And all the rapid developments in cardiology, cardiac surgery and related disciplines like resuscitation and anesthesia, which have been going on for the past 30–50 years, pass them by.
— It turns out that today it is more important to help not with money, but with training, right? It is more than a matter of expensive equipment — it is that there are just not enough hands, isn’t it?
— Wherever we go, whatever city, country or clinic we get to, everywhere they tell us about new buildings and expensive equipment. Millions and billions are invested in equipment and construction, but, in my opinion, too little is invested in the education of doctors and staff. It is possible to help 90% of patients by means of locally available equipment, but the person is treated not by an instrument but by the doctor using it.
Therefore, we teach doctors and staff to work more effectively with the equipment that is available. Imagine if we took all the equipment with us and then took it back. It wouldn’t yield any results! Another example. Suppose a Vietnamese, Chinese or Russian doctor comes to Switzerland to study here in the department of heart surgery. But for two years he will be able to work only as an assistant unless he is allowed to conduct the simplest surgery, even just once. And in his country, on the other hand, we assist him during surgery, demonstrating how to best use the means available. In my opinion, this is the best possible kind of education and professional development.
— You receive thousands of inquiries every year. How do you decide in favor of a particular clinic?
— The request comes not from the hospital, but from the Ministry of Health of the country in question. I cannot, at the request of a colleague whom I meet, for example, at a congress, come to his clinic and start training. An official request is required.
We see what is needed for a specific department of heart surgery, whether there is a solid team of specialists ready to study and work together, because our goal is to leave behind a team of doctors who can work perfectly without us, having gained new knowledge and experience. Then a larger number of patients will receive good medical care. If we face problems, then we ask the local management to join us and make certain changes. If nobody wants changes, then we stop working.
— How long does such local professional development take?
As a rule, our cooperation with clinics is designed for a period of four to eight years. During this period, it is possible to achieve the desired result. We do not work by the principle of «here today, gone tomorrow». I call this surgical tourism.
— And what examples of successful cooperations with clinics are you proud of?
— First of all, the Department of Heart Surgery at the University of Yangon (Myanmar) comes to mind. In 2009, when I first arrived, there were about 100 surgeries a year. The mortality rate was extremely high. Today, with a lot of missions behind us, we can say that this university has a reliable team of doctors. They have two operating rooms, fully technically equipped. Experts can operate on a wide range of diseases in adult patients, and the mortality rate is the same as in our clinic in Switzerland. They cope with the most difficult cases and focused on children’s cardiac surgery themselves.
In addition, until the end of April 2014, I worked in Donetsk, in the department of cardiac surgery of adult patients. I have not been there for three years, but I still have good contacts with the doctors and I know that they will continue what they have started.
— How many people are there in your team?
— About 120 people work with the Foundation. Of them, 50 are doctors of various specializations. There are physicians from Switzerland, other European countries, Japan, Australia, America…We create international teams for each mission.
It is clear that most doctors cooperate with us on a part-time basis, since they have their basic practice. When we are going to a new clinic, first we analyze what will be required from us: training in the fields of cardiology, anesthesia, intensive-care medicine, surgery or artificial ventilation of lungs. It is also important not to squander funds. Based on this, a group of training specialists is formed. It can happen that only one surgeon or cardiologist will go, or a surgeon with a resuscitator or a cardiology equipment specialist. We never travel as a big team. The main principle is working hand in hand with the experts on site: our anaesthetist with their anaesthetist, our surgeon with their surgeon, our resuscitator with their resuscitator. The most valuable thing is for us to stand next to the local doctor during the surgery and assist him.
— How many surgical operations have you conducted?
— Over 3,100 plus 9,000 consultations. Over 12,000 patients have passed through our hands. I would like to point out that diagnostics is also a large part of the work. It sometimes happens that the patient is told that he needs complex surgery, whereas it is enough for him to take medication and be monitored regularly by a specialist. So, preventing unnecessary interventions has the same value as the surgeries themselves.
— How is the Foundation financed?
— Of course, like all charity foundations, we exist through donations. The life of one child costs 1,000 dollars. We do not take money for our activities and conduct all surgery and training free of charge, but there are local running expenses that have to be covered by the Foundation’s budget. Today, the need for such assistance is estimated in hundreds of millions of children’s lives.
— Tell us about a case that you remember when, in practice, the work of the Foundation helped to save a young patient?
— There are a lot of such cases and we often remember these children. For example, David from Ingushetia, who was diagnosed with arachnodactylia, an insufficiency of connective tissue membrane. His mother left her job to take care of her son, since he had to come 22 times to Moscow for additional examinations. In Russia, nobody took up his case. In the German clinic, they were ready to operate for 85 thousand euros, but this sum of money was too much for David’s parents. The boy grew weaker and weaker; he could not live a normal life. We met him while carrying out joint consultations with doctors in the North Caucasus. We performed an ultrasound examination and told him, «Of course, it is complex surgery, but we can carry it out and it should be in St. Petersburg.» It cost about 3 thousand euros, which the parents paid to the St. Petersburg Pediatric Medical University, where we regularly and successfully conduct our missions. The surgery lasted almost 12 hours and was successful. Now David goes to school, and last year he wrote me an SMS that he felt well. He does sports and lives as he wants to live. He is an absolutely normal young man with a healthy heart and he is developing well.
— How difficult is it to deal with small patients? After all, an adult understands when he has complex surgery and makes every effort to survive and he can explain in detail his state of health and feelings.
— With children it is the same, but on a different level. Surgeons often have to deal with unexplained phenomena. Once I performed very complex surgery on a four-month-old girl in Russia, whom all other surgeons refused because they did not know how to help her. She was, in fact, doomed. But we took up the surgery. It may sound unusual, but we worked together with the child. Her body responded to every movement, every manipulation of mine. This unconscious desire for life and for victory over death is sometimes more powerful than any verbal communication. When the surgery was over and the baby emerged, the first thing she did was smile at me and mischievously show her tongue.
— People travel to rest. You travel to work again. How do you relax?
— When I am at home, I like to read. I am fond of international politics, I go in for sports. And you know, during my trips I get to know the country much better than if I went there 10 or 20 times as a tourist. I discover the countries through people, through my patients.
Paul R. Vogt
Doctor of Medicine, Professor of Cardiovascular Surgery, President of the EurAsia Heart Foundation. In 1983, he graduated from the Medical Faculty of the University of Zurich. He worked as an assistant physician in the field of heart surgery and vascular surgery at the University Hospital of Zurich under the guidance of Professor Marco Turin. In 1992, he defended his thesis. In 1997, he headed the Department of Heart Surgery and Vascular Surgery at the University Hospital of Zurich. He is has been invited to clinics and universities in Germany, China, and Myanmar. He is an Honorary Doctor of the Pavlov First Saint Petersburg State Medical University and Professor of the Department of Neonatal Surgery and Cardiac Pathologies of Newborn and Premature Children of the State Medical Pediatric University, St. Petersburg, Russia.
Information about the Foundation
The humanitarian medical organization EurAsia Heart was founded in Zurich in 2000. Leading cardiac surgeons in Europe under the guidance of Professor Paul R. Vogt combine their efforts to train colleagues from the countries of Eurasia in the field of cardiology and cardiovascular surgery.
EurAsia Heart is active in Russia, Uzbekistan, Myanmar, Cambodia, China, Vietnam, Eritrea, Armenia, Bulgaria and other countries.
The international group of experts of EurAsia Heart consists of, among others, specialists from Yale University, the University Clinic of Vienna, the German Children’s Centre of St. Augustine, the Children’s Clinical Hospital of Zurich and the Tomsk Children’s Centre.
EurAsia Heart’s Board of Trustees includes businessmen, entrepreneurs and doctors. Ex-President of Switzerland Dr. Adolf Ogi and former German Chancellor Gerhard Schroeder are co-presidents of the Patronage Committee. Monitoring of the activities of EurAsia Heart is carried out by the Swiss Government of Internal Affairs and is supported by the Swiss Agency for International Cooperation and Development.
Russia is one of the most prominent partners of EurAsia Heart. For 12 years, EurAsia Heart has been actively working in St. Petersburg, Novosibirsk, Penza, Petrozavodsk, Tomsk, Yaroslavl, Krasnodar, Voronezh, and Belgorod. The support of the President and the government, implemented by the national Russian project «Zdorovje» («Health»), in combination with the international educational and scientific activities of EurAsia Heart, could raise the Russian federal centers of cardiovascular surgery to a world-class level and stop the outflow of patients abroad.
You can make donations to the EurAsia Heart Foundation using the following bank details:
Branch No. 7806 VTB 24 (PAO)
c/s (correspondent account) 30101810300000000811
North-Western Main Branch of the Bank of Russia
BIK 044030811; INN (Taxpayer Identification Number) 7710353606
29 V. Morskaya St., lit. «A», St. Petersburg, 190000
EurAsia Heart Foundation – A Swiss Medical Foundation
Bank: St. Galler Kantonalbank AG
9001 St. Gallen
IBAN: CH92 0078 1509 1392 0020 1
Post account: 61-980375-6
IBAN: CH65 0900 0000 6198 0375