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MDF Magazine Newsletter Issue 57 December 2018

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Summer <strong>Issue</strong> <strong>57</strong><br />

<strong>December</strong> <strong>2018</strong><br />

R25.00 incl. VAT<br />

Music therapy<br />

for MD children<br />

Beating Duchenne<br />

one step at a time...<br />

Dissecting<br />

Wobbles<br />

GET INTO THE GREEN SCENE


COMPETITION ENDS 31 DECEMBER <strong>2018</strong>


DF<br />

<strong>Magazine</strong><br />

05 <strong>MDF</strong> notice board<br />

06 National news<br />

10 MD information<br />

MD INFORMATION<br />

06 Muscular dystrophy awareness<br />

07 Facts about Duchenne & Becker muscular dystrophy<br />

10 The use of antioxidants in FSHD<br />

Events<br />

16 Music therapy for MD children<br />

18 Telkom 947 Kiddies Ride<br />

People<br />

20 Natarshja Meyer – an inspiration for others<br />

21 Hloni’s dream came true – visiting Disneyland<br />

22 Living with congenital myopathy – Lavinia Petersen<br />

24 Beating Duchenne one step at a time …<br />

25 Dissecting Wobbles<br />

27 By talking and knowing about CMT, people can<br />

understand Ella better<br />

28 While it’s not a cure, it’s buying us valuable time<br />

29 Family fund cure for George on living with Becker<br />

Regular Features<br />

36 The View from Down Here<br />

37 Doctor’s corner<br />

38 Sandra’s thoughts on …<br />

Research<br />

30 New insights into muscle fibre loss in Duchenne<br />

muscular dystrophy<br />

31 CMT gene therapy trial to start in 2019<br />

31 Update on DMD gene therapy trial<br />

31 Pain-free and more effective: improving how we monitor<br />

SMA<br />

C O N T E N T S<br />

Published by:<br />

Muscular Dystrophy Foundation of SA<br />

Tel: 011 472-9703<br />

Fax: 086 646 9117<br />

E-mail: national@mdsa.org.za<br />

Website: www.mdsa.org.za<br />

Publishing Team:<br />

Managing Editor: Pieter Joubert<br />

Copy Editor: Keith Richmond<br />

Publishing Manager: Gerda Brown<br />

Design and Layout: Divan Joubert<br />

Cover photo of Lemique Consulting CC courtesy of Sarie<br />

Truter<br />

Future <strong>Issue</strong>s:<br />

April 2019<br />

(Deadline: 8 March 2019)<br />

The Muscular Dystrophy Foundation<br />

of South Africa<br />

We are a non-profit organisation that supports<br />

people affected by muscular dystrophy and<br />

neuromuscular disorders and that endeavours to<br />

improve the quality of life of its members.


From The<br />

Summer is finally in full swing! Whether it’s long sunny days or showers and<br />

thunderstorms that you prefer, a typical South African summer has it covered.<br />

For most of us there’s the expectation that summer will be filled with long, hot,<br />

lazy days and sunshine from dawn to dusk. We anticipate getting the braai<br />

out and spending time outdoors with loved ones. Overall, summer is just a<br />

wonderful season with so much to offer.<br />

In this summer issue you can read about how the Foundation got involved<br />

with raising awareness for International Muscular Dystrophy Awareness month<br />

during September. This campaign was launched this year and we hope that<br />

it will grow in years to come. Hopefully it will be extended to the African<br />

continent next year.<br />

You can also read how small children care for those less fortunate than themselves<br />

by raising money and riding the 947 Kiddies Ride. Well done to our little Muscle Riders!<br />

You are absolute STARS!<br />

As always there are also various inspiring stories of some our members and their journeys with muscular<br />

dystrophy. As well as interesting news on events, MD information and research articles.<br />

Our thoughts and prayers go out to Pieter Joubert and his family. Pieter suddenly fell ill and had to be<br />

hospitalised. We eagerly await his return to the office in 2019.<br />

Thank you to everyone who supported us this year. Without you the Foundation will not be able to provide<br />

services to our very special members.<br />

Wishing you a magical and blissful holiday. Have a merry Christmas and a prosperous new year!<br />

Until next year!<br />

Kind regards,<br />

Gerda Brown<br />

We would like to Thank You<br />

Thank you to everyone who supported us during the<br />

past year and helped to make a difference in the lives<br />

of people who have muscular dystrophy.<br />

From all of us at Muscular Dystrophy Foundation of South Africa<br />

Wishing you a wonderful festive season,<br />

and may the New Year bring you joy,<br />

peace and happiness.<br />

4


Subscription and contributions to<br />

the magazine<br />

We publish three issues of <strong>MDF</strong> <strong>Magazine</strong><br />

a year and you can subscribe online<br />

to the magazine or by calling your nearest<br />

branch.<br />

If you have any feedback on our publications,<br />

please contact the National Office<br />

by e-mail at national@mdsa.org.za<br />

or call 011 472-9703.<br />

Get all the latest news on the fight<br />

against muscle-wasting conditions and<br />

the latest research updates. It is our editorial<br />

policy to report on developments<br />

regarding the different types of dystrophy<br />

but we do not thereby endorse any<br />

of the drugs, procedures or treatments<br />

discussed. Please consult with your own<br />

physician about any medical interventions.<br />

If you are interested in sharing your inspirational<br />

stories, please let us know<br />

and we'll be in touch to discuss this<br />

with you.The Foundation would love<br />

to hear from affected members, friends,<br />

family, doctors, researchers or anyone<br />

interested in contributing to the magazine.<br />

Articles may be edited for space<br />

and clarity.<br />

<strong>MDF</strong> SA database<br />

If you know people affected by muscular<br />

dystrophy or neuromuscular disorders<br />

who are not members, please<br />

ask them to contact us so that we can<br />

register them on our database. If we do<br />

not have your current e-mail and postal<br />

address, please contact your branch so<br />

that we can update your details on our<br />

database.<br />

How can you help?<br />

Branches are responsible for doing their<br />

own fundraising to assist members with<br />

specialised equipment. Contact your<br />

nearest branch of the Muscular Dystrophy<br />

Foundation of South Africa to find<br />

out how you can help with fundraising<br />

events for those affected with muscular<br />

dystrophy.<br />

Fundraising<br />

Crossbow Marketing Consultants (Pty)<br />

Ltd are doing invaluable work through<br />

the selling of annual forward planners.<br />

These products can be ordered from<br />

Crossbow on 021 700-6500. For enquiries<br />

contact the National Office by<br />

e-mail at national@mdsa.org.za or call<br />

011 472-9703.<br />

<strong>MDF</strong> ::<br />

<strong>MDF</strong> support information<br />

For more information about the Muscular Dystrophy Foundation, the benefits of<br />

being a member and details on how to become a member, call your nearest branch.<br />

CAPE BRANCH (Western Cape,<br />

Northern Cape & part of Eastern<br />

Cape)<br />

E-mail: cape@mdsa.org.za<br />

Tel: 021 592-7306<br />

Fax: 086 535 1387<br />

Address: 3 Wiener Street, Goodwood,<br />

7460<br />

Banking details: Nedbank, current<br />

account no. 2011007631,<br />

branch code 101109<br />

GAUTENG BRANCH (Gauteng,<br />

Free State, Mpumalanga, Limpopo<br />

& North West)<br />

E-mail: gauteng@mdsa.org.za<br />

Website: www.mdfgauteng.org<br />

Website: www.muscleriders.co.za<br />

Tel: 011 472-9824<br />

Fax: 086 646 9118<br />

Address: 12 Botes Street, Florida Park,<br />

1709<br />

Banking details: Nedbank, current<br />

account no. 1958323284<br />

branch code 192841<br />

Pretoria Office<br />

E-mail: swpta@mdsa.org.za<br />

Tel: 012 323-4462<br />

Address: 8 Dr Savage Road, Prinshof,<br />

Pretoria<br />

KZN BRANCH (KZN & part of<br />

Eastern Cape)<br />

E-mail: kzn@mdsa.org.za<br />

Tel: 031 332-0211<br />

Address: Office 7, 24 Somtseu Road,<br />

Durban, 4000<br />

Banking details: Nedbank, current<br />

account no. 1069431362<br />

branch code 198765<br />

General MD Information<br />

Cape Town<br />

Lee Leith<br />

Tel: 021 794-<strong>57</strong>37<br />

E-mail: leeleith@mweb.co.za<br />

Gauteng<br />

Pieter Joubert<br />

Tel: 011 472-9824<br />

E-mail: gauteng@mdsa.org.za<br />

Duchenne MD<br />

Cape<br />

Win van der Berg (Support Group)<br />

Tel: 021 5<strong>57</strong>-1423<br />

KZN<br />

Maxine Strydom (Support Group)<br />

Tel: 031 762-1592<br />

Cell: 083 290 6695<br />

Gauteng<br />

Jan Ferreira (Support Group – Pretoria)<br />

Cell: 084 702 5290<br />

Estelle Fichardt<br />

Tel: 012 667-6806<br />

Christine Winslow<br />

Cell: 082 608 4820<br />

Charcot Marie Tooth (CMT)<br />

Hettie Woehler<br />

Cell: 079 885 2512<br />

E-mail: hettie.woehler@gmail.com<br />

Facioscapulohumeral (FSHD)<br />

Francois Honiball<br />

Tel: 012 664-3651<br />

Barry Snow<br />

Cell: 083 66 66 270<br />

E-mail: barry.snow@worleyparsons.<br />

com<br />

Friedreich Ataxia (FA)<br />

Linda Pryke<br />

Cell no: 084 405 1169<br />

Nemaline Myopathy<br />

Adri Haxton<br />

Tel: 011 802-7985<br />

Spinal Muscular Atrophy (SMA)<br />

Zeta Starograd<br />

Tel: 011 640-1531<br />

Lucie Swanepoel<br />

Tel: 017 683-0287<br />

5


National<br />

September was<br />

Muscular Dystrophy<br />

Awareness Month<br />

Because public knowledge of muscular dystrophy is<br />

limited, attitudes towards people with muscular<br />

dystrophy are sometimes based on ignorance and can cause<br />

humiliation. Some might even believe that people with<br />

muscular dystrophy could do more if they just tried harder, or<br />

that they pretend to be unable to do something because they<br />

just don’t want to, and that if they were just to exercise more<br />

they would become stronger. When people are properly<br />

informed about muscular dystrophy, their attitudes and<br />

behaviour towards affected people become more reasonable<br />

and sensitive; thus, discussing disability increases<br />

understanding and tolerance. This helps to minimise the<br />

psychological stress that muscular dystrophy sufferers<br />

might otherwise experience when interacting with others.<br />

September was International Muscular Dystrophy Awareness<br />

Month, which is an important time for all persons affected<br />

by muscular dystrophy. In order to celebrate this special<br />

month, the National Office launched a new online awareness<br />

programme called “Get into the green scene” – green being<br />

the colour of the muscular dystrophy ribbon.<br />

The objectives of the programme were two-fold. Firstly, all<br />

the MDSA Facebook followers were requested to change<br />

their Facebook and WhatsApp profile pictures to the<br />

“Get into the Green scene” logo. Secondly, our Facebook<br />

followers and members were invited to share photos on our<br />

Facebook wall where they have “gone green”. From the<br />

photos it was clear that everyone had a lot of fun.<br />

Thank you very much to Lemique Consulting, Newcastle<br />

Post Office, West Rand School, the <strong>MDF</strong> branches and our<br />

members for making this campaign a huge success.<br />

6<br />

Muscles Green<br />

By Emile Smith<br />

My muscles became green<br />

It's quite a colourful scene<br />

I'm planted in the ground<br />

My wheelchair need sound<br />

Winter left me bleak<br />

I'm no more weak<br />

Can you see a blossom?<br />

It's green and I'm awesome<br />

I try my best<br />

Just chilax with the rest<br />

These muscles is bit slow<br />

My wheels on the go<br />

My muscles became green<br />

It's the colour of the winning scene.


MD<br />

Some facts about Duchenne and Becker<br />

muscular dystrophy<br />

What is Duchenne/Becker muscular<br />

dystrophy?<br />

Duchenne muscular dystrophy (DMD) is the most common<br />

and serious neuromuscular genetic disorder diagnosed in<br />

childhood. It is a progressive disorder that causes muscles<br />

to become weaker over time until it affects the whole body.<br />

DMD mostly affects boys and reaches across all races and<br />

cultures. Although genetic disorders are usually passed down<br />

from a parent to a child, Duchenne and Becker muscular<br />

dystrophy (BMD) can spontaneously occur even if no one in<br />

the family has had it before.<br />

Becker muscular dystrophy occurs when dystrophin is<br />

manufactured, although not in the normal form or amount.<br />

Because of this, people with Becker are more mildly affected<br />

and have a slower progression than people with Duchenne.<br />

As with Duchenne, Becker can be inherited from a parent<br />

or can be caused by a new or spontaneous mutation in the<br />

dystrophin gene. The symptoms of Becker can begin in<br />

childhood, the teenage years, or even later. PPMD’s<br />

mission and work extends to both Duchenne and Becker (both<br />

considered ‘dystrophinopathies’), but for simplicity we<br />

primarily refer to Duchenne.<br />

DMD is a “gender-linked or “X-linked” disorder. Males are<br />

born with one X-chromosome (from mom) and one Y-chromosome<br />

(from dad). Because males only have one X chromosome,<br />

if the X-chromosome they receive has a gene mutation<br />

that causes Duchenne, the male will be born with Duchenne.<br />

Females are born with two X-chromosomes (one from mom<br />

and one from dad). If females have one X-chromosome that<br />

has a gene mutation for Duchenne, the body will generally<br />

choose to “activate” the other normal X chromosome. If<br />

this happens, the female will be a carrier of Duchenne. This<br />

means that she can pass Duchenne on to her sons (her daughters<br />

can also be carriers) but she herself will have few, if any,<br />

symptoms of Duchenne. If the female’s body, for whatever<br />

reason, chooses to activate the X chromosome with the mutation<br />

for Duchenne, the female will still be a Duchenne carrier,<br />

but will also “manifest” symptoms of Duchenne. She<br />

will then be a “manifesting carrier” of Duchenne.<br />

What causes the symptoms?<br />

Parent Project Muscular Dystrophy writes as follows<br />

(©<strong>2018</strong>):<br />

Duchenne is caused by mutations in the gene that encodes<br />

for a muscle protein called dystrophin. Dystrophin is in<br />

every single muscle fibre in our bodies. Dystrophin acts as<br />

the glue that holds muscles together and the “shock absorber”<br />

that allows muscles to contract and relax without being<br />

damaged. Without dystrophin, muscles are not able to function<br />

or repair themselves properly. As muscles are used for normal<br />

day-to-day activity, tiny tears are created in the muscle.<br />

Because there is no dystrophin, the muscles can’t repair<br />

themselves by making new muscle, so the damaged muscle<br />

is replaced by fat and scar tissue. As muscle is replaced, the<br />

person with Duchenne loses muscle function and strength.<br />

There are many muscles in the body (skeletal muscles, heart<br />

muscles, breathing muscles, etc.). Because there are so many<br />

muscles in the body, many parts of the body can be affected<br />

by Duchenne. For that reason, people living with Duchenne<br />

need care for many areas of the body.<br />

What are the symptoms of DMD and which<br />

muscles are affected?<br />

The DMD fact sheet of the Muscular Dystrophy Foundation<br />

of South Africa (2000b) provides the following information:<br />

Most affected boys develop the first sign, which is difficulty<br />

in walking, at the age of 1 to 3 years. By approximately 8 to<br />

11 years they become unable to walk. By their late teens to<br />

early twenties the weakness is usually serious enough to put<br />

their lives at risk.<br />

Boys affected by DMD often walk on their toes with their<br />

abdomen pushed forwards and with a waddling gait. This<br />

is due to weakness of pelvic muscles, which normally<br />

extend to the hips in order to retain the upright position when<br />

standing. When these muscles are weak there is a tendency<br />

for the pelvis to tilt forward, and to compensate for this the<br />

7


MD<br />

affected boy pushes his abdomen forward (called lordosis)<br />

and his shoulders backward. Rising from the floor unassisted<br />

also becomes progressively difficult, which is also due to<br />

weakness of the muscles around the hips. At the same time<br />

as weakness of the hip muscles becomes evident, there is also<br />

weakness of the shoulder muscles so that the affected boy has<br />

increasing difficulty raising his arms.<br />

The confinement to a wheelchair increases the likelihood of<br />

contractures developing as a result of immobility. The sole<br />

of the foot often turns inward. The prolonged sitting in one<br />

position may result in the gradual curvature of the spine to<br />

one side and so compresses the lung on that side. This is referred<br />

to as scoliosis and can result in serious problems with<br />

breathing and chest infection.<br />

The heart is also affected in DMD and this may aggravate<br />

any respiratory problems.<br />

and thighs, while others that are less weak are often enlarged.<br />

The muscles of facial expression, speech and swallowing and<br />

the involuntary muscles (for example those of the bowel and<br />

bladder) are not affected in BMD.<br />

Things to remember when visiting an<br />

emergency room<br />

The DMD emergency card of the Muscular Dystrophy<br />

Foundation of South Africa (2017b) provides the following<br />

information:<br />

Duchenne muscular dystrophy<br />

Leg fracture<br />

• If ambulatory: Ask if internal fixation/surgery rather than<br />

casting may be possible. Surgery may help preserve<br />

walking.<br />

• If your child has had a fall or a leg injury and has rapid<br />

onset shortness of breath/difficulty breathing and changes<br />

in alertness (confusion, agitation, disorientation), this is an<br />

emergency; go immediately to the ER and alert staff that<br />

symptoms could be due to fat embolism syndrome (FES).<br />

Respiratory care<br />

• Risk: Respiratory failure. Please only give oxygen with<br />

close monitoring of CO2 levels; breathing may need to be<br />

supported (with BiPAP, for example).<br />

• If oxygen levels are low, assisted coughing (with cough<br />

assist machine or Ambu bag) may help.<br />

• Take your equipment (cough assist, BiPAP, etc) with you to<br />

the hospital/emergency room (ER); alert your neuromuscular<br />

team that you are going to ER/hospital.<br />

What are the symptoms of BMD and which<br />

muscles are affected?<br />

The BMD fact sheet of the Muscular Dystrophy Foundation<br />

of South Africa (2000a) provides the following information:<br />

BMD has a mild onset during childhood. Muscle cramps<br />

during exercise are often the only problem at first but a few<br />

affected individuals may also be late in learning to walk.<br />

From early childhood affected boys are unable to run<br />

very fast. During the teens or twenties, muscle weakness<br />

becomes evident causing difficulty in rapid walking, running<br />

and climbing stairs. Later it may be difficult to lift heavy<br />

objects above waist level. Individuals with typical BMD may<br />

become unable to walk in their 40s or 50s, or even later, but<br />

there are also more rapidly progressive variants of BMD in<br />

which the loss of mobility may happen in the 20s or 30s.<br />

Over a period of years some muscles become weak and wasted,<br />

especially certain muscles of the shoulders, upper arms<br />

General recommendations and precautions<br />

• Keep immunisations up to date and get influenza vaccine<br />

annually.<br />

• People taking daily, long-term steroids should avoid live<br />

vaccines when possible.<br />

• Always wear seat belts – in the car AND on the wheelchair/<br />

scooter.<br />

Anaesthetic precautions<br />

• Avoid inhaled anaesthesia.<br />

• IV anaesthesia is considered to be safe (with close<br />

monitoring).<br />

• People with Duchenne should NOT receive<br />

succinylcholine.<br />

• Local anaesthetics and nitrous oxide are safe for minor<br />

dental procedures.<br />

If vomiting and/or unable to take daily corticosteroids for 24<br />

hours<br />

• Go to a hospital emergency room.<br />

• Request substitute IV corticosteroid until oral medications<br />

are tolerated (6 mg of deflazacort equals 5 mg of prednisone).<br />

• Remind clinicals that high liver enzymes (AST/ALT) are<br />

normal for people with Duchenne MD.<br />

8


MD<br />

The BMD emergency card of the Muscular Dystrophy<br />

Foundation of South Africa (2017a) provides the following<br />

information:<br />

Becker muscular dystrophy<br />

Cardiac care<br />

• Patients with Becker muscular dystrophy can develop<br />

cardiomyopathy. Those with less severe muscle symptoms<br />

are at risk of severe heart involvement. All need regular<br />

heart checks.<br />

• Early ACE-inhibitor and beta-blocker usage slow the<br />

progress of cardiomyopathy.<br />

• Cardiac arrhythmias must be considered for patients with<br />

palpitations and/or dizziness/pre-syncope and investigated<br />

with ECG, 24-hour tapes or similar.<br />

Respiratory care<br />

• Chronic respiratory failure in Becker muscular dystrophy<br />

may present without the usual signs of respiratory distress.<br />

Subtle signs include early morning headaches, poor sleep<br />

continuity, fatigue, daytime sleepiness, reduced appetite<br />

and weight loss. Consider underlying respiratory failure in<br />

case of a chest infection.<br />

• If supplemental oxygen is required during a respiratory<br />

crisis, this must be carefully controlled. Healthcare professionals<br />

must be alert to the possibility of acute respiratory<br />

failure with an arterial blood gas assessment of oxygen,<br />

carbon dioxide and bicarbonate concentration. Non-invasive<br />

ventilation, with oxygen entrained, may be required.<br />

• Assisted coughing with chest physiotherapy and breathstacking<br />

techniques with an Ambu bag help to clear lower<br />

airways secretions. This can also be facilitated by a cough<br />

assist device. These interventions should be performed<br />

only by trained and experienced persons.<br />

Anaesthetic precautions<br />

• Use intravenous general anaesthetics only (avoid suxamethonium).<br />

• Inhaled anaesthetics should not be used.<br />

• Local anaesthetics and nitrous oxide are safe, e.g. for minor<br />

dental procedures.<br />

Recommendations and precautions<br />

• Immunisations should be kept up-to-date. Do not use live<br />

vaccines if using corticosteroids.<br />

• Wear a medic alert bracelet.<br />

NOTE: Liver enzymes (AST/ALT) will be high on blood<br />

tests: this is normal in Becker muscular dystrophy and is<br />

attributed to muscle breakdown. This should not prompt liver<br />

investigations unless otherwise indicated.<br />

Sources<br />

Muscular Dystrophy Foundation of South Africa. 2017a.<br />

Becker muscular dystrophy. Emergency card.<br />

Muscular Dystrophy Foundation of South Africa. 2017b.<br />

Duchenne muscular dystrophy. Emergency card.<br />

Muscular Dystrophy Foundation of South Africa. 2000a.<br />

Becker muscular dystrophy. Fact sheet, 30 May 2000.<br />

Muscular Dystrophy Foundation of South Africa. 2000b.<br />

Duchenne muscular dystrophy. Fact sheet, 30 May 2000.<br />

Parent Project Muscular Dystrophy. ©<strong>2018</strong>. What is Duchenne/Becker<br />

muscular dystrophy? www.parentprojectmd.<br />

org/care/for-families/for-newly-diagnosed/learn-about-duchenne-and-becker/.<br />

Suppliers of Medical<br />

Equipment<br />

CE Mobility<br />

Phone: 0860 236624<br />

Johannesburg, Cape Town, Durban,<br />

Port Elizabeth, Pretoria & Rivonia<br />

Website: www.cemobility.co.za<br />

Impact Medical Supplies<br />

Phone: 011 469-1750<br />

E-mail: impactmed@worldonline.<br />

co.za<br />

Website: www.impactmedical.co.za<br />

Clinical Emergencies<br />

Phone: 011 443-9093<br />

E-mail: clinical@icon.co.za<br />

Website: www.clinicalemergencies.<br />

co.za<br />

Solutions Medical<br />

Phone: 021 592-3370<br />

Website: www.wheelchairs.co.za<br />

Medmedical<br />

Phone: 011 640-5262<br />

Website: www.medmedical.co.za<br />

Medop cc<br />

Phone: 011 827-5893/4/5<br />

Website: www.medop.co.za<br />

Wheelchairs on the Run (Pty) Ltd<br />

Phone: 011 955-7007<br />

Website: www.wheelchairs-ontherun.<br />

co.za<br />

Radical Mobility<br />

Phone: 011 664-6069<br />

E-mail: www.radicalmobility.com<br />

Hands on Lifts (Pty) Ltd<br />

Phone: 011 918-7060/1<br />

E-mail: lynn@handsonlifts.co.za<br />

Website: www.handsonlifts.co.za<br />

Chairman Industries<br />

Phone: 011 624-1222<br />

Website: www.chairmanind.co.za<br />

Flybrother SA<br />

Phone: 011 425-4300<br />

Cell phone: 084 777 5105<br />

Website: www.flybrothersa.co.za<br />

Jessen Dakile (Pty) Ltd<br />

Phone: 011 793-6260<br />

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Sheer Mobility<br />

Phone: 021 552-5563<br />

Cell phone: 082 926 5414<br />

Website: www.sheermobility.co.za<br />

Shonaquip<br />

Phone: Cape Town 021 797-8239<br />

Phone: Pretoria 012 665-1211<br />

Phone: Port Elizabeth 079 524-4350<br />

E-mail: nina@shonaquip.co.za<br />

Website: www.shonaquip.co.za<br />

Botlhale Ke Katlego Trading (Pty) Ltd<br />

Phone: 083 424 7231<br />

Website: www.bkktrading.co.za<br />

9


MD<br />

The use of antioxidants in FSHD:<br />

What is the scientific rationale and what does<br />

the evidence show?<br />

By Adam Denny, PhD<br />

(Reprinted with the permission of June Kinoshita – FSH Society)<br />

In recent years, scientists around the world have begun to investigate the role of oxidative stress in FSHD. A <strong>2018</strong> study<br />

reported that muscle biopsies from people with FSHD had greater levels of oxidative stress markers when compared to healthy<br />

control muscle (Dias Wilson et al., <strong>2018</strong>). In another study, a stem cell-based model indicated that high oxidative stress itself<br />

can lead to increased DUX4 expression (Sasaki-Honda et al., <strong>2018</strong>).<br />

These findings indicate that DUX4 can increase oxidative stress, and that oxidative stress itself can increase DUX4<br />

expression, proposing a damaging feedback loop, although this hypothesis needs further investigation.<br />

What is clear in FSHD is the imbalance in reactive species and antioxidant defenses, the two key aspects underpinning<br />

oxidative stress.<br />

What is oxidative stress?<br />

Oxygen is essential to life, but it’s a double-edged sword. Certain oxygen-containing molecules are chemically very reactive<br />

and, if allowed to run amok in our bodies, can damage DNA, proteins, fats, and other components. To combat these “reactive<br />

species,” biology has evolved molecules called antioxidants that neutralize or repair the damage.<br />

Oxidative stress results when the production of reactive species outpaces the body’s antioxidant defenses. This imbalance can<br />

result in longterm damage. Increases in oxidative stress are beneficial in some circumstances, for example, to destroy cancer<br />

cells, but in disease, oxidative stress can be harmful.<br />

10


The role of oxidative stress in FSHD<br />

MD<br />

Most studies of FSHD and oxidative stress are conducted in laboratory models, so we have to be cautious about extrapolating<br />

these findings to humans.<br />

As depicted in the figure (above), lab studies have shown that DUX4 expression can induce a multitude of problems within<br />

skeletal muscle. These include impaired formation of muscle cells and increased inflammation, oxidative stress, and cell<br />

death.<br />

Given these lab findings, individuals with FSHD may well wonder if they should take steps to reduce the potential harm from<br />

oxidative stress.<br />

About antioxidants<br />

To combat oxidative stress, we have antioxidants—substances<br />

that can delay, prevent, or remove oxidative damage.<br />

There are two categories of natural antioxidants:<br />

enzymatic and nonenzymatic antioxidants. Enzymatic<br />

antioxidants are produced by our bodies and work<br />

through breaking down and protecting against the<br />

reactive species. Non-enzymatic antioxidants are a much<br />

larger class of antioxidants and work through disrupting<br />

the chemical reactions caused by reactive species.<br />

Some natural non-enzymatic antioxidants are made<br />

within our bodies, such as vitamin A and coenzyme Q10.<br />

When our bodies don’t make sufficient amounts, we can<br />

take them in pill form. Others stem from external sources,<br />

such as vitamins C, E, and K, along with zinc and selenium.<br />

Antioxidants from external sources are important to factor into a person’s diet. While these antioxidants are also available as<br />

pill supplements, many people prefer to obtain these antioxidants from a balanced diet.<br />

Antioxidant trials<br />

While antioxidants have shown promise throughout the<br />

years in laboratory studies, these results have been hard<br />

to replicate in clinical trials.<br />

One clinical trial investigated the effect of combined<br />

dietary supplementation of vitamins C and E, and minerals<br />

zinc and selenium in individuals with FSHD (Passerieux<br />

et al., 2015). The researchers found that supplementation<br />

did not improve the two-minute walk test, but it did<br />

improve muscle function: individuals could contract<br />

their thigh muscles (quadriceps) harder and for longer<br />

than they could before the supplementation.<br />

The participants who received supplementation also saw<br />

decreases in some of their oxidative stress markers and<br />

increases in certain markers of their antioxidant defense<br />

system.<br />

In another small clinical trial, a Dutch group (Van der Kooi et al., 2016) investigated the supplementation of folic acid and<br />

methionine in people with FSHD. Both supplements have antioxidant properties, and folic acid has previously been shown<br />

to boost DNA methylation, but this study found neither folic acid nor methionine had an effect on DNA methylation levels.<br />

11


MD<br />

Other ways to protect against oxidative stress<br />

Exercise is a very effective way to increase our antioxidant defenses. However, in order to obtain this benefit, one<br />

has to first use exercise to increase levels of oxidative stress. The body then responds by boosting its antioxidant<br />

defenses.<br />

While the oxidative stress produced in exercise is<br />

vital, the exact effect this may have on FSHD is not fully<br />

understood. The type, intensity, and duration of the<br />

exercise all may influence the outcome.<br />

Bankolé and colleagues (Bankolé et al., 2016) have<br />

shown that a combined strength and interval cycling<br />

exercise-training program significantly improved fitness<br />

and skeletal muscle function without negatively impacting<br />

muscle damage. While this study did not investigate<br />

the antioxidant levels of participants, it does highlight<br />

that certain types of exercise can be beneficial for people<br />

with FSHD regardless of the increases in oxidative stress<br />

induced by exercise.<br />

In conclusion…<br />

Research to date has shown some positive results, but important questions remain. First, oxidative stress has a strong link with<br />

FSHD cells in the test tube, but the relevance of oxidative stress in FSHD patients is unknown.<br />

Also, while antioxidant therapies have shown modest benefits, these results came from relatively small clinical trials. We need<br />

to conduct larger trials to understand if antioxidant therapies can protect muscles in people with FSHD.<br />

Editor ’s note: Adam Denny earned his PhD in the Department of Physiology at the University of Otago in New Zealand.<br />

Article available at: https://www.fshsociety.org/<strong>2018</strong>/10/the-use-of-antioxidants-in-fshd/<br />

References<br />

Bankolé, L.C., Millet, G.Y., Temesi, J., Bachasson, D., Ravelojaona, M., Wuyam, B., Verges, S., Ponsot, E., Antoine, J.C., Kadi,<br />

F. & Féasson, L. 2016. “Safety and efficacy of a 6-month home-based exercise program in patients with facioscapulohumeral<br />

muscular dystrophy: A randomized controlled trial”, Medicine, 95(31): e4497. doi: 10.1097/MD.0000000000004497.<br />

Dias Wilson, V., Thomas, C., Passerieux, E., Hugon, G., Pillard, F., Andrade, A.G., Bommart, S., Pincemail, J., Mercier, J.,<br />

Arbogast, S. & Laoudj-Chenivesse, D. <strong>2018</strong>. “Impaired oxygen demand during exercise is related to oxidative stress and<br />

muscle function in FSHD”, JCSM (Journal of Cachexia, Sarcopenia and Muscle) Rapid Communications, 1(1). https://jcsmrapid-communications.info/index.php/jcsm-rc/article/view/29.<br />

Passerieux, E., Hayot, M., Jaussent, A., Carnac, G., Gouzi, F., Pillard, F., Picot, M-C., Böcker, K., Hugon, G., Pincemail, J.,<br />

Defraigne, J.O., Verrips, T., Mercier, J. & Laoudj-Chenivesse, D. 2015. “Effects of vitamin C, vitamin E, zinc gluconate, and<br />

selenomethionine supplementation on muscle function and oxidative stress biomarkers in patients with facioscapulohumeral<br />

dystrophy: A double-blind randomized controlled clinical trial”, Free Radical Biology and Medicine, 81: 158-169.<br />

Sasaki-Honda, M., Jonouchi, T., Arai, M., Hotta, A., Mitsuhashi, S., Nishino, I., Matsuda, R. & Sakurai, H. <strong>2018</strong>. “A patientderived<br />

iPSC model revealed oxidative stress increases facioscapulohumeral muscular dystrophy-causative DUX4”, Human<br />

Molecular Genetics, September 12. DOI: 10.1093/hmg/ddy293.<br />

Van der Kooi, E.L., De Greef, No effect of folic acid and methionine supplementation on D4Z4 methylation in patients with<br />

facioscapulohumeral muscular dystrophy”, Neuromuscular Disorders, 16(11): 766-769. DOI: 10.1016/j.nmd.2006.08.005.<br />

12


13


Where the Big Five meet Sylvester the lion<br />

The Karoo National Park is famous for many<br />

wonderful reasons; however, in 2015 the most<br />

famous reason was the grand escape of Sylvester<br />

the lion.<br />

The story began during the night of 4 June 2015<br />

when a three-year-old lion escaped from the Karoo<br />

National Park, triggering a long and arduous chase<br />

lasting 24 days. This event had the nation watching<br />

and waiting with bated breath and saw the start of a<br />

wild goose chase involving many devoted individuals,<br />

sniffer dogs, helicopters and even a microlight.<br />

By the first week the media had run with the story<br />

and Sylvester was a nationwide sensation, with a<br />

select team of SANParks' trackers and honorary<br />

rangers in hot pursuit of the wanderer. Sylvester<br />

was finally darted on the 24th day of the search,<br />

having travelled approximately 371 km and been<br />

spotted a mere four times. Along the way he had<br />

killed 27 sheep, a kudu and an Nguni cow. Although<br />

Sylvester took his toll on local livestock during his<br />

three-week adventure. it is said that during this time<br />

stock theft in the region dropped to an all-time low!<br />

Before Sylvester’s escape the other male lions in the<br />

Karoo National Park had been making life very difficult<br />

for him, provoking his intention to roam. When<br />

Sylvester, fearing for his life, managed to escape<br />

again from the Park within a matter of months after<br />

his return, SANParks made the decision to move<br />

him to a new home.<br />

And so we leave Karoo National Park and turn our<br />

attention 350 km south east, where lies the Kuzuko<br />

contractual area of Addo Elephant National Park. It<br />

is home to the Big Five and now to one of Africa's<br />

most famous sons, Sylvester the lion.<br />

During the day you can look out over the Karoo<br />

Plains and Zuurberg Mountains, and at night you,<br />

and Sylvester, can look up at a canopy of a million<br />

stars. Perched on top of a hill, Kuzuko is located<br />

in a malaria-free region and provides luxurious<br />

accommodation, fine dining, cheetah encounters,<br />

nature walks, bushman painting exploration and<br />

guided game drives.<br />

Kuzuko has a fully wheelchair accessible<br />

chalet available for disabled visitors, providing<br />

plenty of space, all the required grab rails and a large<br />

roll-in shower. The unit is accessed by a well-lit<br />

paved path from the main lodge building. The lodge<br />

itself has an accessible viewing deck, dining room<br />

and lounge areas with shallow gradient ramps<br />

linking most points.<br />

Although visitors are expected to leave their<br />

vehicles at the park entrance, those using wheelchairs<br />

will be given the opportunity to drive their<br />

personal vehicle to the lodge entrance when<br />

needing to disembark or embark.<br />

The game drive vehicles are not specifically<br />

wheelchair accessible, but the rangers and<br />

staff will do whatever it takes to allow disabled<br />

visitors to enjoy their game drives! We found them<br />

to be extremely willing and helpful and very<br />

considerate when negotiating with the rugged<br />

terrain of the park.


These days Sylvester has settled down and found<br />

the company of a male buddy, Fielies, and together<br />

they have connected with two younger lionesses<br />

who have their own remarkable story to tell of<br />

survival against overwhelming odds – but that is for<br />

another day. Sylvester has found a territory he can<br />

call his own and, together with Fielies, they reign as<br />

the kings of Kuzuko.<br />

Kuzuko Lodge<br />

Contact number: + 27 (0)42 203 1700<br />

Email address: kuzuko@legacyhotels.com<br />

Web: https://www.kuzuko.com<br />

ACCESSIBLE HOLIDAY ACCOMMODATION<br />

The following establishments offer more wheelchair accessible accommodation which has been used and<br />

evaluated by a member of the <strong>MDF</strong>. If you have stayed at a venue and found the accommodation to be wheelchair<br />

accessible, please let us know so that we can add it to our database.<br />

Addo Elephant National Park<br />

www.sanparks.co.za/parks/addo/<br />

Cornerway House, Plettenberg Bay<br />

info@cornerwayhouse.co.za<br />

Excelsior Manor Guesthouse, Robertson<br />

www.excelsior.co.za<br />

FunkyTown, Jeffreys Bay<br />

www.funkytown.co.za<br />

Gubas de Hoek, Robertson<br />

www.gubas-dehoek.com<br />

Mountain Zebra National Park<br />

www.sanparks.co.za/parks/mountain_zebra/<br />

Rocherpan Nature Reserve<br />

www.capenature.co.za/reserves/<br />

Storms River Mouth<br />

www.sanparks.co.za/parks/garden_route/camps/<br />

storms_river/default.php<br />

West Coast National Park<br />

www.duinepos.co.za/<br />

Makaranga Garden Lodge, Kloof, Durban<br />

www.booking.com/hotel/za/makaranga-gardenlodge.en-gb.html<br />

15


Events<br />

Music therapy for MD children<br />

Music therapy<br />

Music therapy is the use of music and musical elements<br />

by a registered music therapist to promote, maintain,<br />

and restore mental, physical, emotional, and spiritual<br />

health. Music has non-verbal, creative, structural, and<br />

emotional qualities.<br />

Characteristics and need areas:<br />

• Need of independence<br />

• Feeling of accomplishment<br />

• Opportunities to participate in meaningful activities<br />

• Enjoyable and recreational experiences<br />

• Opportunities for expression<br />

How can music therapy address the need areas for an individual with<br />

muscular dystrophy?<br />

• Motor skills: Strengthening of muscles through movement and instrumental play. Music also<br />

provides motivation for movement and for improving the range of motion. Instrumental play and<br />

movement can improve coordination.<br />

• Communication skills are enhanced through the relationship with the therapist or group members.<br />

Turn taking and listening during sessions helps to enhance communication.<br />

• Cognitive skills are activated through composition and song writing.<br />

• Emotional support is given through the opportunity for frustration to be vented verbally and<br />

non-verbally and through verbal processing, song writing and instrumental expression.<br />

• Musical skills are exercised.<br />

• Social interaction takes place in music therapy and meaningful social relationships are built. This<br />

decreases isolation and boosts self-confidence. Music therapy provides space for unconditional<br />

positive regard and can build or restore self-esteem.<br />

16


Events<br />

The music therapist<br />

After designing realistic goals and target<br />

objectives to address identified needs,<br />

music therapists plan and implement individualised<br />

music therapy treatment programs with<br />

strategies, procedures, and interventions to<br />

develop skills necessary to achieve an<br />

optimum level of success or quality of life for<br />

individual clients, such as those with muscular<br />

dystrophy. Three clinical goals will be set for<br />

each individual or group.<br />

Music therapists document client responses,<br />

conduct ongoing evaluations of progress and<br />

performance, and make recommendations for<br />

future consideration. Music therapists work with team members and families, providing ways to include<br />

successful music therapy techniques that help to enhance the quality of life.<br />

For more information about music therapy in your area, please look at the website of the South African<br />

Music Therapy Association at www.samta.co.za.<br />

Music therapy session at West Rand School<br />

On 31 October, MD learners at West Rand School in Krugersdorp were treated to an amazing music therapy<br />

session lead by Mrs Estine Brown.<br />

At first they seemed apprehensive, unsure of what this lady with a guitar had in store for them. Soon all<br />

was revealed and they were all joined together in laughter, happiness and the pure joy of making music<br />

together.<br />

Afterwards they were treated further to gift bags from <strong>MDF</strong> Gauteng which contained various tasty treats.<br />

The day was an immense success, and each and every child had a fun-filled experience they would not<br />

soon forget.<br />

17


Events<br />

Telkom 947 Kiddies Ride <strong>2018</strong><br />

By Dr Sandeepa Rajbaran Singh<br />

Cayden Fourie, Dante Fourie, Ava Rudman, Juanru<br />

Roodt, Heinrich Muller, Beth van Til, Maheya Singh,<br />

Leyha Naicker, Kian Otto, Riley Vermaak, Henrico Verster,<br />

Dyllen du Plooy, Daniël Erasmus and Liam Dykstra<br />

may not have all the answers, but the one thing<br />

they know for sure is that “Improvement begins with I”.<br />

Motivated only by the desire to improve the lives of others,<br />

each of the junior Muscle Riders registered for the<br />

Telkom 94.7 Kiddies Cycle Challenge believing “I can<br />

make a difference”.<br />

Beneath bright blue skies and glorious sunshine, riders<br />

exchanged high-fives and encouraging hugs to slow<br />

the butterflies that fluttered in their tummies. The roar<br />

of excited cyclists, kitted and ready to go, were punctuated<br />

only by repeated safety checks. At the start line<br />

each of the children was already a champion, but that<br />

didn’t stop the zeal with which they furiously sped towards<br />

the finish line. With little beads of perspiration<br />

rolling down flushed rosy cheeks, the kids arrived at the<br />

finish knowing they had made a difference in the lives<br />

of their friends with muscular dystrophy.<br />

The reasons for choosing to ride are not only simple<br />

and true but also motivational enough to challenge each<br />

one of us into action! Riley Vermaak (aged 4), whose<br />

grandpa lost two sons affected by Duchenne muscular<br />

dystrophy many years ago, rode in support of anyone<br />

with this disease. Brothers Dante (3) and Cayden Fourie<br />

(6) rode to help their grandpa raise lots of money<br />

to buy wheelchairs for those who can’t walk. Cousins<br />

Maheya Singh (5) and Leyha Naicker (11) have grown<br />

up appreciating how blessed they are and realise that<br />

they need to help others whenever they can, especially<br />

when helping others feels so good! Grateful for the legs<br />

that Jesus gave him to be able to ride his bike, Juanru<br />

Roodt (5) took part in the race for friends who can’t<br />

walk, and he added that he was raising money to buy<br />

wheelchairs for them.<br />

On the day of the cycle challenge, these brave cyclists<br />

showed their parents and the community that they not<br />

only knew how to count but that they also knew what<br />

counts the most … kindness and generosity!<br />

18


19


People<br />

Natarshja Meyer:<br />

An inspiration<br />

for others<br />

By Mariska Meyer<br />

Natarshja is far from stopping her efforts to<br />

excel, achieve her goals and dreams, and exceed<br />

expectations. She would like to study tourism, and<br />

her dream is to visit holiday destinations and resorts<br />

to make sure they are wheelchair/disability friendly.<br />

Natarshja is my family’s biggest inspiration, and I<br />

know her future is bright and she will continue to<br />

achieve and excel in whatever she does.<br />

I believe I am the proudest mother as I write this.<br />

Our daughter, Natarshja Meyer, who is writing<br />

matric this year at the best school this side of the<br />

equator, Muriel Brand in Brakpan, is the biggest<br />

inspiration of them all. Our family has been<br />

through some tough, trying times, starting with my<br />

mother and my children’s grandmother passing<br />

away at a young age of 41, my three brothers being<br />

diagnosed with myotonic dystrophy, Natarshja being<br />

diagnosed with Friedrich’s ataxia, and losing my dad to<br />

murder in 2015, just after my husband left his<br />

company to go into business with my father and being<br />

unemployed since. Natarshja never lost hope,<br />

never gave up and always worked hard to achieve<br />

the goals she set for herself.<br />

We are blessed to call this young lady with a<br />

fighting spirit our daughter, who will never give up<br />

on her hopes and dreams and has the brightest<br />

outlook on her future.<br />

Note: Natarshja Meyer and Gert (a friend)<br />

attended Muriel Brand’s matric farewell at<br />

“Four One and Only”, Petit, Benoni.<br />

Natarshja’s hair and make-up were done by<br />

Jaco de Meyer (076 159 7356).<br />

The car was sponsored by GM Panelbeaters<br />

(Wynand van der Walt, 076 499 1584)<br />

I cannot ever remember Natarshja not being<br />

the biggest inspiration and motivator to always<br />

work to reach your goals and to never give up on<br />

your hopes and dreams. In 2016 at age 16/17<br />

Natarshja broke the u/18 javelin record for girls with<br />

disabilities, making me the proudest mother and the<br />

teachers jump for joy. In 2017 Natarshja found grade<br />

11 a bit difficult and challenging, with her health<br />

taking a dip to such an extent that teachers were<br />

concerned that the stress levels of grade 12 might<br />

be just too much for her fragile body and gentle<br />

personality. We decided to give Natarshja the<br />

option to leave school with a honourable grade 11<br />

certificate, which is still a very good achievement<br />

for a young lady with her challenges. Natarshja’s<br />

kind nature turned into the fighting spirit of a lion.<br />

She proclaimed she had not worked so hard over<br />

the years to give up at the finish line! This year<br />

she exceeded everyone’s expectations throughout<br />

the year and attended her matric farewell this past<br />

weekend.<br />

20


Hloni’s dream came true visiting<br />

Disneyland in Miami<br />

By Lerato Chiloane<br />

It all started when Lehlohonolo Chiloane was<br />

nominated by an MD social worker as a suitable<br />

candidate to have a wish fulfilled by Reach For A<br />

Dream.<br />

She was interviewed and had three dream<br />

choices: one was to visit Disneyland, which<br />

she chose. Our exciting journey started on 18<br />

September <strong>2018</strong> at OR Tambo airport, where we<br />

met with Melissa and Darren of Reach For A Dream<br />

for some drinks and itinerary explanation. We were<br />

given a lovely send-off. At 20:00 we boarded the<br />

plane heading for Atlanta. Hloni was very excited<br />

as she was doing an international flight for the first<br />

time. The staff of Delta airline were so friendly and<br />

helpful in catering for Hloni’s needs. The whole<br />

experience was just amazing for Hloni, from the<br />

movies on the plane to the food. On the 19th we<br />

arrived in Atlanta and took a connecting flight to<br />

Florida, where we were greeted by the sight of its<br />

many beautiful beach houses.<br />

last park we visited was Sea World, where we saw<br />

all the wonders of the sea.<br />

How we wished to have stayed for longer to enjoy<br />

the place, the people, and the amazing rides. When<br />

people heard we were from South Africa, they<br />

responded very warmly and asked us lots of<br />

questions about the country. We held our SA flag<br />

high with pride.<br />

The most amazing thing was sharing information<br />

about our Muscular Dystrophy Foundation of South<br />

Africa and hearing about the Muscular Dystrophy<br />

Association that is established over there.<br />

It was a truly amazing experience we were<br />

given, and we are grateful to the <strong>MDF</strong> social<br />

worker Rudzani and to Reach For A Dream for<br />

making Lehlohonolo Chiloane’s dream come true.<br />

We were welcomed by staff from Give Kids the<br />

World Village and taken by a shuttle vehicle to our<br />

destination, about 45 minutes away. The village<br />

is phenomenal, and once there you never want to<br />

leave. After the Disney itinerary was given to us<br />

and all procedures explained, we rested for the<br />

remainder of the day as we were still jet-lagged.<br />

Next morning, we had breakfast and left for the<br />

Disney World Magic Kingdom. The place was so<br />

beautiful. Hloni enjoyed all the rides as most of<br />

them were wheelchair friendly. We stayed until<br />

closing time, stopping only for lunch, and even then<br />

Hloni didn’t want to leave. On the second day of our<br />

adventure we went to Universal Studios where we<br />

saw many Hollywood characters; the most exciting<br />

part was The Wizarding World of Harry Potter. The<br />

21


People<br />

Living with<br />

Congenital Myopathy<br />

By Lavinia Petersen<br />

someone to help me as my legs were not strong<br />

enough for me to move around on my own. I loved<br />

going to school, learning and meeting new friends.<br />

At the age of 12 years (April 1998) I started walking<br />

on my toes as my ligaments were short and I had to<br />

undergo surgery on my legs. I was out of school for<br />

approximately six weeks. During that period I felt so<br />

helpless. In June of the same year I went to see an<br />

orthopaedic surgeon for my scoliosis. Consequently<br />

a spinal brace was constructed to control my spinal<br />

deformity. I hated every minute of wearing it, but<br />

I had no choice but to do so. I had to wear it to<br />

school, where the children teased me, and I had to<br />

sleep with it on. The only time I could take it off was<br />

when I washed myself. I was in between the Red<br />

Cross Hospital and Medi-Clinic, where I was treated<br />

by three specialists.<br />

I am Lavinia Petersen from Mossel Bay, a 31-yearold<br />

woman who was diagnosed with congenital<br />

myopathy, which is a muscular dystrophy (MD) that<br />

affects the muscles from birth. At the age of 1 year<br />

I started showing signs of MD when I frequently<br />

fell on my forehead. My parents, Ivan and Belinda<br />

Petersen, took me to a paediatrician in George.<br />

The doctor suspected that I had some sort of MD<br />

and he referred me to The Red Cross Children’s<br />

Hospital, where a muscle biopsy confirmed that I had<br />

congenital myopathy. The doctor told my parents<br />

that I would only live until the age of 9 years; what a<br />

shock that must have been for my parents. I had to<br />

visit Red Cross Hospital every year for check-ups.<br />

As time went by I had to go to school. My parents<br />

were told by the teachers to put me in a school<br />

for children with special needs, but my mother<br />

refused and I was allowed to remain at the school<br />

I was at. I had my challenges at school, especially<br />

when climbing steps to attend classes. I always had<br />

When I started attending high school in 1999, my<br />

mother went to the principal to arrange that I have<br />

classes in the same block because I could not walk<br />

far and climb so many steps. One time at school<br />

during break a friend asked me: “Are you not angry<br />

at God for making you go through all these things,<br />

being disabled?” I answered: “No, I’m not because<br />

God has a reason for making me this way and he<br />

has a purpose for me being here.” She said that<br />

she would have been angry at God. There was a<br />

time when I wanted to leave school because I could<br />

not cope with the workload, but God gave me the<br />

strength to go to school each day.<br />

In June 2001, I had another operation on the back<br />

of my neck muscles. The doctor at Medi-Clinic<br />

explained that it would be a long procedure and that<br />

my parents should remain calm when they saw me.<br />

When the nurses pushed me out of the operating<br />

room and into ICU, my mother collapsed when she<br />

saw me because I had a brace on with four screws<br />

in my head. I still have the scars of this operation.<br />

I had a lot of support from my family, teachers and<br />

friends. I could not attend school for six months.<br />

I could not walk alone or wash myself properly or<br />

wear proper clothes. During the night I had to call<br />

my parents to help turn me over on my sides. I got<br />

so tired of being helpless that I cried at times. My<br />

mom had to leave her work during this time to take<br />

care of me.<br />

22


People<br />

In 2003 I finished my matric, and between 2003 and<br />

2005 I completed a management assistant course. I<br />

started my first job straight after the exams.<br />

Today I am 31 years old, thanks to God’s grace. I<br />

believe God really has a purpose for me being here<br />

and everything that I went through. He was with<br />

me every step of the way. God blessed me with the<br />

most amazing parents. I can always count on them<br />

to help me. Going through all this since my childhood<br />

was not an easy road to walk, but every hurdle<br />

I crossed made me the person I am today.<br />

I would like to say thank you to my family and<br />

everyone who has played a role in my life.<br />

People should be reminded that even if we are<br />

disabled, we should be treated with the utmost<br />

respect, just as anyone would want to be treated. I<br />

want to inspire others and tell them not to give up<br />

but to believe in themselves.<br />

Convaid Rodeo 12 Inch special needs<br />

stroller for sale<br />

Includes:<br />

Tilt in space<br />

Adjustable hardware for left & right lateral support<br />

Firm left & right lateral supports<br />

Planer seat cushion - anti-thrust,<br />

H-harness<br />

3 Point positioning belt<br />

Fully adjustable foot plate to suit child's length<br />

Removeable & fully adjustable sun canopy<br />

Removable rear wheels<br />

Folds up, can fit in a car boot<br />

Excellent condition. This is really a fantastic stroller for special needs children.<br />

Rated for up to 35kg body weight. Reason for sale: my son has outgrown it. Price:<br />

R30000.00<br />

New would be +- R60000.00<br />

Contact: Francois on 0828893595<br />

Thank you, DStv for airing our advertisements about<br />

muscular dystrophy.<br />

We are most grateful for your support.<br />

23


People<br />

Beating<br />

Duchenne<br />

one step at<br />

a time...<br />

By Albi Viljoen<br />

We would like to introduce you to Jaco George<br />

Viljoen. Jaco is an 8-year-old boy who was born on<br />

the 12th of April 2010 at the Sunward Park Hospital<br />

in Boksburg.<br />

At the age of 7, with the world at his feet, Jaco dreamt<br />

of becoming a policeman, but his world and dreams<br />

were shattered on the 6th of November 2017 when,<br />

after a lot of testing, Jaco was diagnosed with<br />

Duchenne muscular dystrophy.<br />

Being the determined child that he is, Jaco decided<br />

that this was merely an obstacle in his life and not<br />

the end of it. His parents have done intensive<br />

research and Jaco is receiving various alternative<br />

treatments, which include biokinetics twice a week<br />

and hydrotherapy once a week. Jaco’s diet has also<br />

been changed to include only healthy eating with the<br />

exclusion of sugar and starch.<br />

Jaco is a firm believer in the story of David and<br />

Goliath and will tell you that he is David and DMD<br />

is Goliath and that with God on his side he will also<br />

defeat the enemy. With that thought, the NPO “Walk<br />

with Jaco” was registered to do various awareness<br />

and fundraising activities to support research in the<br />

treatment of DMD and to fund Jaco’s treatment. The<br />

Facebook page “Walk with Jaco” has his day-to-day<br />

stories and what is currently happening in this little<br />

warrior’s life. Please like his page and attend the<br />

various fundraisers were possible.<br />

Contact details for<br />

“Walk with Jaco” are albi@walkwithjaco.<br />

co.za and Albi at 060 540 1437.<br />

24


People<br />

In 2010 I was a complete and utter mess, from a psychological point of<br />

view. Yes, a muscle disease is a physical thing, but it’s also very much<br />

a battle of the mind. It presents psychological, philosophical and often<br />

spiritual obstacles that must be negotiated up here between our ears.<br />

For many years people encouraged me to write my story down,<br />

simply to share with others and maybe to encourage people in a similar<br />

position to me. But the truth is I was too young and too full of<br />

rubbish, too emotionally ‘crippled’ to put down anything of substance.<br />

But, eventually, after more than fifteen years of dealing with FA<br />

(Friedreich's ataxia) I started, little by little.<br />

That was eight years ago.<br />

By Andrew Marshall<br />

Once I started I found that writing my thoughts down without<br />

judgement – simply vomiting my raw emotions onto my keyboard – was<br />

incredibly and unexpectedly cathartic. Now, I am nowhere close to<br />

considering myself a ‘real’ writer, thanks to a combination of some pretty<br />

delicious dyslexia, instinctive procrastination/laziness operating at Olympic levels and super dodgy keyboard<br />

skills (which I suspect applies to a lot of you guys, too). But, after meeting my editor, Andrew Miller, and having<br />

him help me reshape the mess I had already created, guiding me in putting down more things he thought the<br />

reader would want to read, I finally had something. (Not only is Andrew an award-winning novelist, the author<br />

of multiple other books and someone who works as a full-time writer in both the business and literary worlds,<br />

he is also the ‘lucky’ beneficiary of spinal muscular atrophy type 2, a type of muscular dystrophy. He combined<br />

his writing expertise and his experience with his own disobedient body to add to my perspective, and he has<br />

helped me beyond comprehension.)<br />

The result, after eight long years of effort, is Dissecting Wobbles. A book that takes you through my childhood<br />

and that feeling of always being ‘different’, scrawny, clumsy. Then my Mom’s search for answers (and the<br />

eternal question: why isn’t Andrew like other children?). And, of course, the big bad diagnosis, followed by my<br />

weird, wild, rebellious teens.<br />

To be honest, some of it was really difficult to write down. The struggle with not being like everybody else<br />

is a lifelong battle, while girls and relationships (lack thereof!) have also been massive obstacles, as were<br />

occasional tangles with depression, alcohol and weed. It’s not easy to talk to the world about any of these<br />

things, or about moving into ‘adulthood’ and trying to find a place in society. But then the position I dreaded all<br />

though my life, close to total incapacitation, hasn’t been a breeze either. So, as hard as it’s been to be honest,<br />

there’s also been freedom involved in the process. Telling my story has given me a new way to relate to, and<br />

share with, other people.<br />

Of course, Dissecting Wobbles will also tell you about the wonderful and incredibly important people in my life,<br />

and some of the awesome things I’ve been lucky enough to experience, including swimming with dolphins,<br />

treetop ziplining, river rafting and skydiving. The skydive was organised by the <strong>MDF</strong> as a fundraising event,<br />

and I got a bunch of people to sponsor my plummet to earth at terminal velocity. Raising cash to help people<br />

in the same boat as I am felt phenomenal!<br />

Because I live an exceptionally privileged life and have had opportunities many of my boatmates only dream<br />

about, once overheads for the book have been covered 50% of sales will go to the <strong>MDF</strong>. The rest will be<br />

invested in an idea that’s been incubating for a while, so watch this space!<br />

Please have a look at my website (www.dissectingwobbles.co.za), and read the synopsis and samples. If you<br />

like what you see you can get it at any decent book shop. The tech savvy can also use loot.com or takealot.<br />

com, and a digital version is available on Amazon.<br />

Or if you want, email me directly on marshandyjames@gmail.com and I’ll sort you out…<br />

25


People<br />

Tony Caruso is taking on<br />

RideLondon for the second time<br />

Tony Caruso, 33 from Royston, Hertfordshire, will<br />

be taking on the Prudential RideLondon-Surrey 100<br />

for the second time this July in aid of Muscular<br />

Dystrophy UK.<br />

“I absolutely loved RideLondon last time, there is<br />

such a buzz about the event, and after a year out I’m<br />

ready to take on the challenge again for Sophie.”<br />

Tony’s niece and goddaughter, Sophie, was born<br />

with the very rare muscle-wasting condition,<br />

Ullrich muscular dystrophy. There are less than 300<br />

children who have been diagnosed.<br />

“To date, Sophie has undergone 8 different<br />

operations with more in the future. There is<br />

currently no cure for Sophie’s condition but there is<br />

hope. There are plans for a clinical trial of a new<br />

drug and lots of effort is being put in to understand<br />

more about the type of MD that Sophie has. That is<br />

why I’m taking part in RideLondon.”<br />

Tony was one of MDUK’s top fundraisers in 2016,<br />

raising an incredible £1140, more than double the<br />

target.<br />

“I achieved this through the persistence of<br />

chasing people. On Facebook, personal WhatsApp<br />

messages, sending round work emails, getting<br />

Sophie’s story out there. This helped to not only get<br />

donations from people who know Sophie, but also<br />

others who didn’t and wanted to help.”<br />

Tony is about to start a new job and the time off<br />

between has given him time to get some extra<br />

training in and follow people up for sponsorship.<br />

“I think Sophie is actually more excited about me<br />

starting my new job than me! My new job is for<br />

GoHenry, a child’s pocket money card that she has<br />

and loves!”<br />

Tony’s tips for the rest of #TeamOrange taking on<br />

this year’s challenge is to:<br />

“Look out for little towns and villages whilst cycling<br />

through Surrey. The cheers really give you a boost<br />

for another few miles.<br />

“Travel light! I took a backpack full of gels and food,<br />

but didn’t really end up using any of it. There are<br />

plenty of food and water stations along the way to<br />

top up if you need to. Do, however, try and carry as<br />

much water as you can and keep hydrated.”<br />

Article online at: https://www.musculardystrophyuk.<br />

org/your-stories/tony-caruso-is-taking-on-ridelondon-for-the-second-time/<br />

26


People<br />

“By talking and knowing about CMT,<br />

people can understand Ella better”<br />

Lucy Brady, whose daughter Ella, six, has Charcot-<br />

Marie-Tooth disease, says that raising awareness of<br />

the condition makes life easier for herself and her<br />

family.<br />

She said: “Ella calls her condition her ‘cheeky feet’,<br />

which gives people a starting point to ask questions.<br />

Because Charcot-Marie-Tooth doesn’t sound like it’s<br />

related to limbs, people sometimes get confused.<br />

They think, ‘What’s wrong with her teeth?’<br />

afraid to ask, ‘Why does your daughter have things<br />

on her legs?’<br />

“Children are the best at addressing it, because they<br />

do ask questions and then you can explain.<br />

“We live in a small town in Cambridgeshire, and<br />

quite a lot of people know Ella. Once I’ve explained<br />

muscular dystrophy to them, quite a few people<br />

have said, ‘Oh, I think that someone in my family<br />

must have had that.’<br />

“The best way to describe it is to say that her nerves<br />

don’t work the way that they should, so the signals<br />

her brain is trying to send to her feet don’t get there.<br />

Because these signals aren’t getting through, she’s<br />

getting muscle loss because they aren’t being used<br />

properly.<br />

“The diagnosis was a massive shock for us initially<br />

and we felt a lot of disbelief, but you just have to get<br />

on with it. We’ve always tried to tell her that if there’s<br />

something she wants to do, she should do it. We<br />

encourage her to cycle and use a scooter, and we<br />

go on day trips to lots of different places.<br />

“You get drawn into lots of appointments and treatment<br />

plans. You adapt, but life has changed a lot<br />

for us. We’ve had about eight different appointments<br />

in the last month. Luckily I’m self-employed, which<br />

makes it easier, but it does have quite an impact on<br />

your life.<br />

“A lot of people are interested in Ella, but because<br />

she wears splints you tend to get people staring and<br />

not asking questions. She’s oblivious, but as her<br />

mum I notice it. It would be nice if people weren’t<br />

“By talking and knowing about CMT, people can<br />

understand Ella better, and that helps us as well.<br />

“She had surgery in February on both of her feet to<br />

bring them into a better position. She’s a really busy<br />

girl so she doesn’t like being stuck in a wheelchair.<br />

We’re six months on so she’s done really well. She’s<br />

wearing ankle foot orthosis all day and she’s even<br />

got a little bit of control in the muscle of her left foot<br />

which she hasn’t had at all for about three years.<br />

We’re expecting an 18-month time frame to see if it<br />

has corrected more than just the foot position.<br />

“We seem to have got the feet straight, but now<br />

she’s suffering in her hands. We had hoped that<br />

we’d have a lot more time before that happened,<br />

but her fingers are curving and she’s losing a lot<br />

of strength and wearing hand splints at night. But<br />

she doesn’t let it get to her – she just gets on with<br />

things.”<br />

Article online at: https://www.musculardystrophyuk.<br />

org/your-stories/by-talking-and-knowing-about-cmtpeople-can-understand-ella-better/<br />

27


‘While it’s not a cure, it’s buying us valuable time’<br />

The fight for access to Spinraza<br />

Amy Cameron’s son Zac, three, was diagnosed with<br />

SMA Type 1 in November 2016. He began receiving<br />

Spinraza – the first and only treatment for the<br />

condition – last year, and Amy is now campaigning<br />

for all families affected by the condition to have<br />

access to the drug.<br />

Amy, from Alloa, Clackmannanshire, said: “When<br />

Zac was diagnosed with SMA, my world began to<br />

fall apart. SMA is a cruel condition and the future<br />

for our family looked increasingly bleak. But all this<br />

changed when we heard about Spinraza. Our spirits<br />

were instantly lifted.<br />

While it’s not a cure, it is buying us valuable time<br />

with Zac and enabling him to reach milestones we<br />

never thought would be possible, such as picking up<br />

his cup for a drink and moving his legs. Zac has so<br />

much to offer the world and this is the only treatment<br />

that is giving him the chance at life.<br />

“As parents, my husband and I are determined to<br />

secure the happiest life possible for Zac and his<br />

brother. Life is for living and making memories and<br />

we will face whatever challenges lie ahead together<br />

as a family.”<br />

Article online at: https://www.musculardystrophyuk.org/your-stories/162422/<br />

The Muscular Dystrophy Foundation of SA<br />

would like to thank the National Lotteries<br />

Commission for their support.<br />

28


People<br />

‘It’s so important to raise money<br />

for research’ Family fund cure for<br />

George on living with Becker<br />

George Booth, six, from Weston, Stafford, began<br />

getting muscle spasms in his calves aged two. As<br />

time went on, these became more frequent and<br />

painful, spreading to his thighs. When the spasms<br />

started to last for up to an hour, preventing George<br />

from being able to stand or walk, his parents Adam<br />

and Cerys took him to the GP.<br />

The doctor noticed that his calves were large and<br />

his muscles and tendons were tight. After more<br />

tests and consultations, he was referred to a muscle<br />

team at a local hospital. George was diagnosed with<br />

Becker muscular dystrophy following a DNA test, in<br />

January 2017.<br />

His parents and older brother Freddie set up the<br />

family fund, A Cure for George, to raise awareness<br />

and fund research into the condition. Since then,<br />

Adam has cycled a stage of the Tour de France this<br />

summer with five friends. Cerys and Adam’s brother<br />

Freddie, nine, made and sold bookmarks as part of a<br />

summer fete stall with other fundraising games and<br />

Adam’s employers also donated a Champagne bottle<br />

signed by six nations rugby players to the cause.<br />

In total the family fund has raised over £16,000 in<br />

less than 6 months.<br />

Adam, a project manager, said:<br />

“The hard thing about Becker is the uncertainty,<br />

because it affects people in different ways. We don’t<br />

know how quickly it’s going to progress, and how<br />

much it’s going to impact on George.<br />

“At the moment, he’s doing well. He uses a<br />

wheelchair to get to school and if we’re doing<br />

something involving a lot of walking, but he can still<br />

play rugby on a Sunday, just as long as he takes<br />

some breaks when he gets tired.”<br />

“It’s so important to raise money for research. It still<br />

surprises people when we tell them that there’s no<br />

cure for what George has. But between now and<br />

when he gets older, there’s lot of time for things to<br />

change. The scientists with the brains to do it are<br />

there, we just need to make sure they have enough<br />

money to fund the research.”<br />

Article online at: https://www.musculardystrophyuk.<br />

org/your-stories/its-so-important-to-raise-moneyfor-research-family-fund-cure-for-george-on-livingwith-becker/<br />

29


Research<br />

The following four articles are from the website of Muscular Dystrophy UK.<br />

(Published date: 07/09/<strong>2018</strong>)<br />

Professor Jenny Morgan and her team<br />

at University College London (UCL)<br />

have shown that a type of cell death<br />

called necroptosis has an important<br />

role in Duchenne muscular dystrophy.<br />

The study – published today in Nature<br />

Communications – helps improve our<br />

understanding of muscle fibre loss in<br />

Duchenne.<br />

Understanding muscle fibre death<br />

in Duchenne muscular dystrophy<br />

In this project, Professor Jenny<br />

Morgan and her team at University<br />

College, London used a mouse model<br />

to investigate a biological process that<br />

leads to muscle fibre death in Duchenne<br />

muscular dystrophy.<br />

This project was co-funded by three<br />

members of the Duchenne Forum –<br />

Muscular Dystrophy UK, Duchenne<br />

Children’s Trust and The Duchenne<br />

Research Fund. The Duchenne Forum<br />

is a group of charities working together<br />

to accelerate progress in the search for<br />

treatments and eventually cures for<br />

Duchenne muscular dystrophy.<br />

What did the research show?<br />

Muscle cells in people with Duchenne<br />

muscular dystrophy undergo an<br />

abnormal type of cell death, which is the<br />

basis of the muscle wasting.<br />

30<br />

New insights into muscle fibre loss in Duchenne muscular<br />

dystrophy<br />

There are two types of cell death<br />

mechanism: apoptosis and necrosis.<br />

An apoptotic cell digests itself and a<br />

necrotic cell explodes. In Duchenne<br />

muscular dystrophy, muscle fibres die<br />

by necrosis. Necrosis was believed to<br />

be a disorganized process, but it has<br />

been recently discovered that necrotic<br />

cells can be finely organized. This<br />

organized necrosis is called<br />

necroptosis.<br />

Professor Morgan, Dr Bencze and<br />

colleagues have investigated the role of<br />

necroptosis in Duchenne. When one of<br />

the proteins of the necroptosis mechanism<br />

was blocked in muscle cells<br />

grown in the lab, the cells were more<br />

resistant to some toxic treatments,<br />

which normally trigger cell death.<br />

The researchers also generated a<br />

dystrophic mouse model that is missing<br />

this protein; this protected cells<br />

from necroptosis. In these mice, muscle<br />

cell death and scarring (fibrosis)<br />

were decreased, and muscle function<br />

was improved. These results demonstrate<br />

that necroptosis is an important<br />

cell mechanism that is involved in<br />

dystrophic muscle damage. Targeting<br />

necroptotic cell death could therefore<br />

be a therapeutic strategy to counteract<br />

muscle loss in people with Duchenne.<br />

The team presented this work at<br />

conferences including the UK<br />

Neuromuscular Translational Research<br />

Conference and the 2017 World<br />

Muscle Society meeting, where they<br />

won a prize. They also published<br />

By Jenny Sharpe<br />

their findings in the scientific journal,<br />

Nature Communications.<br />

Why is this research important<br />

and what are the next steps?<br />

This work identifies for the first time<br />

necroptosis as a cell death mechanism<br />

in muscle. Although basic research<br />

such as this is a long way from a<br />

treatment, it is important to gain a<br />

greater understanding of how muscles<br />

are damaged in Duchenne muscular<br />

dystrophy. These results show that<br />

the proteins involved in this cell death<br />

pathway do have a role in the symptoms<br />

of Duchenne, but further work is<br />

needed to understand the mechanisms<br />

behind this. If a suitable molecule was<br />

identified to block the cell death mechanism,<br />

it could help to reduce the cell<br />

death of muscle cells and slow down<br />

the development of fibrosis. Such an<br />

approach could be used in combination<br />

with other treatments aiming to restore<br />

dystrophin to the muscle.<br />

How might this research impact<br />

on other neuromuscular conditions?<br />

It is likely that muscle fibres die by this<br />

type of cell death mechanism in other<br />

neuromuscular conditions. This would<br />

need to be investigated in cell and animal<br />

models of these conditions.<br />

Article online at: https://www.musculardystrophyuk.org/grants/understanding-muscle-fibre-death-in-duchennemuscular-dystrophy/


Research<br />

CMT gene therapy trial to start in 2019<br />

By Sofia Nnorom<br />

(Published date: 15/10/<strong>2018</strong>)<br />

Sarepta Therapeutics has announced that<br />

it will be working with Dr Zarife Sahenk<br />

from Nationwide Children’s Hospital in<br />

the United States to develop a gene therapy<br />

for Charcot-Marie-Tooth disease (CMT).<br />

The therapy – called NT-3 gene therapy –<br />

uses a harmless adeno-associated virus to<br />

carry a gene called neurotrophin-3 (NT-3)<br />

into the body. Neurotrophin-3 is important<br />

for the functioning of Schwann cells,<br />

which are vital for maintaining the health<br />

and survival of our nerves. CMT causes<br />

nerves to become damaged and eventually<br />

die, which leads to muscle weakness and<br />

loss of feeling. Therefore finding potential<br />

treatments to improve nerve growth and<br />

health is vital.<br />

Dr Sahenk has spent many years developing<br />

and testing NT-3 gene therapy. Her<br />

research has shown it can improve nerve<br />

health and function in an animal model of<br />

CMT. In Sarepta’s press release, Dr Sahenk<br />

said:<br />

Gene therapy represents a potential<br />

new pathway for the treatment of CMT<br />

Neuropathy. We look forward to collaborating<br />

with Sarepta, whose dedication to<br />

those impacted by neuromuscular disorders<br />

and to rigorous scientific exploration,<br />

echoes our own at Nationwide Children’s.<br />

A clinical trial to test the NT-3 gene therapy<br />

is planned to start in 2019. Although the trial<br />

will only be recruiting people with CMT<br />

type 1A, the NT-3 gene therapy could potentially<br />

treat other CMT sub-types and<br />

muscle-wasting conditions. Further research<br />

is under way to explore its potential.<br />

https://www.musculardystrophyuk.org/<br />

news/news/cmt-gene-therapy-trial-to-startin-2019/<br />

Update on DMD gene therapy trial<br />

By Sofia Nnorom<br />

(Published date: 04/10/<strong>2018</strong>)<br />

Sarepta Therapeutics has released an<br />

update on the four boys dosed in its<br />

ongoing gene therapy trial. The data<br />

was presented by Dr Jerry Mendell,<br />

the trial’s principal investigator, at<br />

the World Muscle Society conference<br />

yesterday.<br />

Building on Sarepta’s previous data,<br />

Dr Mendell shared results on the fourth<br />

boy treated with the gene therapy<br />

(AAVrh74.MHCK7.microdystrophin).<br />

Like the other participants, he had a<br />

significant increase in the dystrophin<br />

protein and a reduction in creatine kinase<br />

levels – a marker for muscle damage.<br />

So far, there have been no serious<br />

safety concerns reported for any of the<br />

participants.<br />

Dr Mendell also reported that all<br />

four boys have shown improvements<br />

in functional assessments (e.g. stair<br />

climbing, standing up and walking<br />

ability) compared to the start of the<br />

study. Whilst these preliminary results<br />

are very exciting and promising, it<br />

should be cautioned that this study is<br />

very small and has no controls.<br />

Sarepta is now planning to conduct a<br />

larger trial in the US – data from this<br />

trial will be used to seek marketing<br />

approval for the therapy. The company<br />

is mapping ways to expand its clinical<br />

program and will announce an update<br />

once it finalises its plans.<br />

In a press release, Doug Ingram,<br />

Sarepta’s president and chief executive<br />

officer said:<br />

“The encouraging results that we<br />

previously saw and reinforced in the<br />

fourth patient strengthen our resolve<br />

to rapidly move to a confirming trial<br />

and, assuming successful, to bring<br />

this therapy to the Duchenne community<br />

around the world with a sense of<br />

urgency.”<br />

Article online at: https://www.musculardystrophyuk.org/news/news/updateon-dmd-gene-therapy-trial/<br />

Pain-free and more effective: improving how we monitor SMA<br />

By Andrew Mickel<br />

Published 01/05/<strong>2018</strong><br />

Monitoring the progression of<br />

muscle-wasting conditions is essential<br />

to ensure they can be managed well.<br />

If you have spinal muscular atrophy<br />

(SMA), you may have experienced<br />

a test called electromyography on a<br />

clinical trial or during diagnosis. It<br />

tracks the loss of motor units, the links<br />

between the muscle and the nervous<br />

system which are gradually lost for<br />

people with SMA. But electromyography<br />

can be both painful and it is limited<br />

in how well it can monitor change.<br />

And with treatments like Spinraza now<br />

being developed, the need for effective<br />

testing to ensure patients get the right<br />

support at the right time has never been<br />

clearer.<br />

A new technique – discovered by<br />

accident<br />

A new research grant from MDUK will<br />

help develop a technique using MRI<br />

scanners to monitor motor units in a<br />

pain-free and more effective way.<br />

And like so many of science’s best<br />

discoveries, it was found by accident.<br />

Professor Andrew Blamire at<br />

Newcastle University has spent much<br />

of his research career trying to get<br />

scanners to take new measurements.<br />

But even he was surprised at the results<br />

of a recent test.<br />

31


Research<br />

He said: “A few years ago we were<br />

running tests using a technique that’s<br />

generally used to measure the structure<br />

of the brain. We were looking at<br />

the muscles of those with Duchenne<br />

muscular dystrophy, but when we got<br />

back the scans, we found we had some<br />

bad images.<br />

“They were described by others we<br />

were working with as ‘annoying artefacts’,<br />

a problem with the data. But we<br />

showed them to some colleagues who<br />

specialise in neurophysiology, and that<br />

was the Eureka moment – they told us<br />

they were motor units.”<br />

The MDUK research grant will fund<br />

Prof Blamire to fully examine how<br />

motor units could be monitored with<br />

MRI, and how it can be translated into a<br />

technology that can be easily deployed<br />

for people with muscle-wasting conditions.<br />

Crucially, the new technique could<br />

also be used as a way to track loss in<br />

clinical trials, helping to see how<br />

treatments work and finding the best<br />

ways to deploy them.<br />

Questions that still need<br />

answering<br />

The new technique – dubbed by the<br />

team as MUMRI, for motor unit<br />

magnetic resonance imaging – holds<br />

a lot of promise. Prof Blamire will<br />

now look at taking the initial idea and<br />

seeing if his team can turn it into something<br />

workable by answering some key<br />

questions.<br />

To start with, what precisely did Prof<br />

Blamire see in the scans? Were they<br />

single motor units, or was it several<br />

motor units firing at once?<br />

And how exactly will the team be able<br />

to isolate motor units to test them in a<br />

systematic way that will be helpful for<br />

clinicians? That second question could<br />

involve some new kit being developed<br />

so that individuals being scanned make<br />

precise movements that can be examined<br />

in a concise, systematic way.<br />

Using existing technology to<br />

tackle new problems<br />

While we think of MRI scanners as<br />

really large machines, there are some<br />

scanners designed just for limbs. Prof<br />

Blamire’s team will be looking to see if<br />

a new type of scanner could be set up to<br />

work in a clinic.<br />

Says Prof Blamire: “The sense from<br />

clinicians is that it would be great to<br />

have it as a device in their clinic. It<br />

could be a game changer for the way<br />

we work – they say there’s been no<br />

development in electrophysiological<br />

techniques in the last 50 years.”<br />

If a scanner can be built, it could have<br />

use for any condition involving the loss<br />

of motor nerves, or even the decline of<br />

muscle function in ageing.<br />

Dr Kate Adcock, Director of Research<br />

and Innovation at Muscular Dystrophy<br />

UK, said:<br />

“We are in such an exciting time for<br />

research into SMA. But to really get<br />

the most from emerging treatments, we<br />

need to understand how the condition<br />

progresses and how effectively we can<br />

manage it. This project is so exciting<br />

because it makes use of existing technology<br />

to do just that; it could mean the<br />

end of painful existing techniques and a<br />

new era in effective scanning. We look<br />

forward to seeing the results.”<br />

Article online at: https://www.musculardystrophyuk.org/news/news/painfree-and-more-effective-improvinghow-we-monitor-sma/<br />

Thank you, ITV Networks for raising awareness about muscular dystrophy.<br />

We are most grateful for your support.<br />

32


Take a deep breath and cough … yes, you can!<br />

“Breathing is the greatest pleasure in life” – Giovanni Papini<br />

By Brenda Morrow & Anri Human<br />

Taking a deep breath, sighing, yawning and coughing are<br />

things healthy people don’t usually have to think about.<br />

However, for people with neuromuscular diseases (NMDs)<br />

it may become more and more difficult to breathe as the disease<br />

progresses. They may also get frequent chest infections,<br />

which could be severe, needing antibiotic therapy and sometimes<br />

even hospital admission and ventilator support.<br />

These breathing difficulties result from weakness of the<br />

breathing muscles and a poor cough, as well as complications<br />

like chest wall deformities which restrict breathing.<br />

People with a weak, ineffective cough cannot properly clear<br />

secretions from the lungs, which puts them at risk of more<br />

recurrent infections and may eventually lead to chronic, permanent<br />

lung disease.<br />

The good news for people with NMD and breathing muscle<br />

weakness is that a number of techniques can be used to help<br />

them take a deep breath and clear secretions from the lungs.<br />

These techniques may be performed at home by oneself or by<br />

a physiotherapist and should be started as soon as the cough<br />

becomes weaker.<br />

A peak flow meter with a mask attached can be used to measure<br />

the strength of the cough (Figure 1). The person is asked<br />

to take a deep breath (as deep as possible!) and then cough<br />

as hard as possible into the mask. The resulting air flow (the<br />

peak cough flow) is then measured. If the peak cough flow<br />

is under 160l/min it means the cough is not strong enough to<br />

clear secretions from the lungs, and techniques to help cough<br />

effectiveness should be done daily. When the peak cough<br />

flow falls under 270l/min, it is time to start learning techniques<br />

to improve cough effectiveness, because we know<br />

that cough flow drops even further when you have infections<br />

of the upper airways (like a cold).<br />

Figure 1: Peak flow meter with mask attached for measurement<br />

of peak cough flow (strength of cough).<br />

There are different types of airway clearance techniques.<br />

Some aim to move secretions from deep in your lungs to<br />

the larger, central airways so they can be cleared easily from<br />

there. Examples are percussions (when the physiotherapist<br />

or caregiver claps the person’s chest with cupped hands); vibrations<br />

(manually or using mechanical devices); and positioning<br />

to drain secretions. These might be effective in moving<br />

secretions, but without an effective cough none of these<br />

techniques will lead to secretion clearance. Some breathing<br />

exercise have also been developed to help clear secretions<br />

(like deep breathing exercises, active cycle of breathing<br />

technique, positive expiratory pressure (PEP) therapy, etc),<br />

but these are not likely to work where there is severe breathing<br />

muscle weakness, as people with NMD cannot take a<br />

deep breath without assistance. These breathing exercises/<br />

techniques can however be adapted to be done with ventilation<br />

support (e.g. BiPAP), and your physiotherapist should<br />

be able to advise you about this.<br />

Other airway clearance techniques aim to clear secretions<br />

from the large, central airways, and these are essential in<br />

people with NMD and weak cough, usually after mobilising<br />

secretions into the main airways. These are sometimes called<br />

“cough augmentation” or “cough assistance” techniques.<br />

There are different parts to a cough, and all are needed for the<br />

cough to be effective. Firstly, you must be able to take a very<br />

deep breath in, then close the vocal cords (glottis) at the back<br />

of the throat to increase pressure inside the lungs, and then<br />

rapidly force the breath out with an explosive opening of the<br />

vocal cords with a cough. Depending on the type of NMD,<br />

any or all of these components of the cough might be missing<br />

and there are different techniques that can help.<br />

1. Helping the person to take a deep breath (inspiratory support)<br />

can be used to improve their ability to cough and expand<br />

the lungs, similar to when healthy people yawn or<br />

sigh. Techniques include the following:<br />

a. Manual insufflation – Air is actively pushed into the lungs<br />

using a self-inflating bag with either a mask or a mouthpiece;<br />

or insufflation can be done by adjusting the BiPAP<br />

or ventilator settings. The bag should be the right size so<br />

you don’t push too much air into the lungs, which can<br />

cause damage. Your physiotherapist or doctor should be<br />

able to advise on what size bag you should use. These bag/<br />

mask kits are readily available and fairly inexpensive in<br />

33


South Africa.<br />

b. Breath stacking<br />

i Spontaneous breath stacking: The person takes a breath in<br />

and traps the air (holds their breath), and then takes another<br />

breath, traps the air and so it continues until the lungs are<br />

“full”, after which a cough can be performed independently<br />

or with assistance. This technique is useful because it can<br />

be done independently, without the need for a second person.<br />

An example of this technique (without a cough) is given<br />

at https://www.youtube.com/watch?v=JlgeRoI5vCw.<br />

ii Manual breath stacking: Breath stacking can also be done<br />

using a self-inflating bag and mask/mouthpiece. The<br />

mouthpiece is placed in the mouth or the mask is placed<br />

over the mouth and nose. Multiple breaths are applied with<br />

the bag and “stacked” onto each other with glottic closure<br />

between each breath or (if glottic closure is a problem), a<br />

one-way valve can prevent air flowing out back into the<br />

bag. Once maximum expansion is reached, the person can<br />

either cough themselves or have a supported cough (with<br />

the assistance of a parent/caregiver). An example of this<br />

technique used by a gentleman with ALS is available at<br />

https://www.youtube.com/watch?v=I3YGh6bVsQM.<br />

c. Glossopharyngeal or “frog” breathing: Air is forced or<br />

gulped into the lungs using the mouth and tongue muscles.<br />

This technique has the advantage of being able to<br />

be performed independently. A video of glossopharyngeal<br />

breathing is available at: https://www.youtube.com/<br />

watch?v=9OswSaTG71I.<br />

2. Helping to breathe out (improving cough flow):<br />

a. Manually assisted cough (MAC): Cough flow is accelerated<br />

by applying an external pressure on the person’s abdomen<br />

and/or chest wall (Figure 2) during the expiratory<br />

phase of the cough. A second person is needed to perform<br />

a MAC.<br />

pressure to actively and quickly suck air out of the lungs,<br />

thereby simulating a cough. There have been reports that<br />

MIE is effective and safe, but care must be taken to start<br />

with low pressures so as not to damage the lungs, especially<br />

for young children. A demonstration is given at https://<br />

www.youtube.com/watch?v=M--uuDpGxMM.<br />

All these cough clearance techniques have some precautions<br />

or contraindications, and some are more widely available in<br />

SA than others, so it is important that an experienced physiotherapist<br />

first assess every person and together decide which<br />

technique would be the most appropriate. Some techniques<br />

can be done independently and others need a second person,<br />

and this must also be taken into account when making a decision<br />

about which technique to use, according to individual<br />

circumstances.<br />

What is happening in South Africa?<br />

(Local is lekker!)<br />

Cough augmentation<br />

A recent survey revealed that most South African physiotherapists<br />

prefer using MAC for cough assistance in people<br />

with NMD. They still prefer traditional airway clearance<br />

techniques like percussion and vibrations, and very few use<br />

breath stacking, glossopharyngeal breathing or MIE. We are<br />

currently working to improve physiotherapists’ knowledge<br />

and skills in airway clearance for people with NMD through<br />

workshops, educational newsletters and publications.<br />

Inspiratory muscle training (IMT)<br />

Previously (<strong>December</strong> 2017) we reported that there was an<br />

on-going study in Gauteng and Cape Town to determine the<br />

effect of IMT on lung function, cough effectiveness, lower<br />

limb and upper limb function/coordination as well as quality<br />

of life. In total 23 children between the ages of 8 and 18<br />

years participated, and this study was completed at the end<br />

of October <strong>2018</strong>. The preliminary analysis shows that the<br />

participants significantly improved their inspiratory muscle<br />

strength and their ability to cough!<br />

Watch this space for news of the final results of this study! <br />

For further information or any queries, please contact us at<br />

anrihuman@gmail.com (Gauteng), 012 521-4047, or brenda.<br />

morrow@uct.ac.za (Cape Town).<br />

Figure 2: Manually assisted cough demonstration on a<br />

dummy.<br />

3. Helping with both inspiration and expiration (breathing in<br />

and out)<br />

a. Combining one of the inspiratory support techniques with<br />

an MAC is very effective; an example is presented at<br />

https://www.youtube.com/watch?v=B_zJbMRuZT4.<br />

b. Mechanical insufflation/exsufflation (MIE) or “CoughAssist”:<br />

This is a fairly expensive machine that pushes air<br />

into the lungs (through a mouthpiece/mask/tracheostomy<br />

tube) and then rapidly switches to a negative (vacuum)<br />

Selected resources and recommended reading:<br />

Chatwin, M., Toussaint, M., Goncalvez, M.R. et al. (<strong>2018</strong>).<br />

Airway clearance techniques in neuromuscular disorders: A<br />

state of the art review. Respiratory Medicine, 136: 98–110.<br />

https://doi.org/10.1016/j.rmed.<strong>2018</strong>.01.012<br />

Morrow, B.M., Zampoli, M., Van Aswegen, H. & Argent,<br />

A.C. (2013). Mechanical insufflation–exsufflation in people<br />

with neuromuscular disease. The Cochrane Library, Dec 30,<br />

12: CD010044.<br />

Toussaint, M., Chatwin, M., Gonzalez, J. et al. (<strong>2018</strong>). 228th<br />

ENMC international workshop: Airway clearance techniques<br />

in neuromuscular disorders, 3–5 March, 2017, Naarden, the<br />

Netherlands. Neuromuscular Disorders, 28: 289–298. https://<br />

doi.org/10.1016/j.nmd.2017.10.008<br />

34


Our Voices – Our Life<br />

Experiencing Myotonic Dystrophy around the World<br />

Hello<br />

Like you, I live with Myotonic Dystrophy (DM1). I am also the facilitator<br />

of the largest support group for individuals living with the DM in<br />

Switzerland and an active member of several DM Community<br />

Organizations throughout Europe.<br />

As a support group facilitator, I have heard many very personal stories. I have heard people<br />

speak from their hearts about their experiences with this disease and their happiness to<br />

finally meet someone to whom they do not need to explain what our frequent tiredness feels<br />

like. I also feel the need and, often, the joy of people living with DM as they share what they<br />

have learned on their journey with Myotonic Dystrophy.<br />

Each one of these stories is important. Each one of them can help others to find<br />

comfort, understanding, motivation, and advice.<br />

As part of my life’s work, I am trying to connect the international DM community. Yet, in our<br />

multilingual world, this exchange is often difficult because of language barriers. Together<br />

today, you and I can break through the language barrier and help build a truly worldwide DM<br />

community.<br />

Here is how. With the assistance from contributors from the international DM-Community, I<br />

have designed a website at<br />

www.dm-voices.com<br />

On this website, we invite you to share your personal story of living with Myotonic Dystrophy.<br />

Your story will be translated into more than ten languages and DM-affected individuals<br />

around the globe can find new inspiration in your experience.<br />

From the submitted stories, an illustrated book will be developed, copies of which we will<br />

provide in three languages to interested DM Community Organizations around the world. The<br />

distribution of this book via the information channels of these organizations will be<br />

coordinated in time with a Project Celebration in Basel, Switzerland. This Project<br />

Celebration will involve all DM Community Organizations and all DM-affected individuals<br />

participating in this project.<br />

Share your story with us! Share it with the whole world and help us to send a wave of<br />

awareness, support, and community to those living with Myotonic Dystrophy.<br />

Best wishes,<br />

Erich<br />

Erich Maurer & Andreas Herzog, kontakt@myotonie.ch<br />

in collaboration with<br />

sponsored by


THE THREE PHASES OF ME<br />

By Hilton Purvis<br />

We often chat with friends about how, over time, one's views<br />

on matters change. Things which used to upset us in our<br />

youth just wash off one’s back today, or vice versa! It got<br />

me thinking about matters which used to "push my buttons"<br />

in years gone by, and those which do so today, and how my<br />

attitudes have evolved over time. I found that I could see<br />

my life in three distinct phases, the "freedom fighting", the<br />

statistics, and the acceptance.<br />

I use the term freedom fighter carefully, because although we<br />

were never actively militant, we were fighting for freedom<br />

in our society in the 1970's and 1980's. Back then there were<br />

no disabled parking bays, no PAUs at airports, no ramps, no<br />

disabled toilets. In short, nothing which would have warranted<br />

sticking the little blue international wheelie man symbol<br />

onto. The mindset of the time was very much that we should<br />

be staying at home or living in institutions, being looked after.<br />

My middle years, the 1990's, became the "statistical" years.<br />

The years of adding up the new facilities which were slowly<br />

becoming available. Adding up how many new disabled<br />

people I saw out and about in town, attending a sports game,<br />

or working in a company. These were the times of the access<br />

committees, the independent living centres, the amakrokokroko,<br />

and the beginnings of employment equity. Doors were<br />

opening, albeit on the periphery, and increasingly disabled<br />

people were visibly living independent lives.<br />

Of late, I have to admit to entering a phase of "acceptance",<br />

but I am not a person who naturally accepts things. I believe<br />

we are well short of where we should be as a disabled community.<br />

My acceptance is therefore that we have not achieved<br />

the level of integration into society which we should have. It<br />

also means that where I should be entering a phase of calm<br />

and tranquillity, the whole rocking chair on the stoep thing,<br />

I am still having my buttons pushed. It also takes something<br />

away from the previous two phases. I'm left wondering<br />

where we went wrong in the freedom fighting, and just what<br />

we were really doing during the statistical period.<br />

I think one of the mistakes we made in the 1990s was in<br />

adopting the belief that if we could show society that<br />

disabled people could live independently it would gain<br />

momentum and build steadily and progressively on the initial<br />

breakthroughs that were being made. We also believed, falsely,<br />

that civil society would do the right thing, see the light,<br />

and increasingly break down the physical barriers which we<br />

face every day (transport, parking, access, etc). Along with<br />

that we thought that there would be greater inclusion for s<br />

disabled individuals in schooling and education, employment<br />

opportunity, etc but this has also fallen far short. We<br />

never really made any inroads into the architectural industry,<br />

which is so important to our infrastructural independence.<br />

Coupled with this is a representational shortcoming in the<br />

development and construction industries and, saddest of all,<br />

in the field of education (schooling, colleges and universities).<br />

Perhaps during the "statistical" period of the 1990s we also<br />

became so preoccupied with notching up little victories that<br />

we lost sight of the greater battle plan. We also allowed ourselves<br />

to become fragmented, with no coordination and with<br />

the individual disability groupings looking after their own<br />

interests. Whilst there is nothing intrinsically wrong with this<br />

concept it does open the door for a loss of momentum and<br />

focus, which is what has happened.<br />

However, I do believe that during this "statistical" period<br />

we fell right into the statistical trap and allowed ourselves to<br />

accept a quota system. We are now expected to accept that<br />

only 10% of hotel rooms might have an accessible bathroom,<br />

or 5% of employees might have a disability. This has come<br />

back to hurt us. If we are to make any further development,<br />

quotas such as these need to be eradicated as soon as possible.<br />

Everything should be accessible. Every single school<br />

should be able to accept disabled learners. Every job should<br />

be available to disabled individuals.<br />

The hope that people would join us in our quest for freedom<br />

voluntarily has not materialised. In the 1990s I firmly believed<br />

that we needed willing participants rather than ones<br />

who had been coerced into meeting our needs. I was mistaken.<br />

These days, in my acceptance phase, I believe that legislation<br />

is the only way we are likely to make any progress.<br />

Unfortunately, in that regard we do not seem to have made<br />

any real headway either, and existing legislation is really just<br />

words on paper, without any real teeth. I have yet to hear<br />

of a building construction being stopped because it did not<br />

provide disabled access.<br />

It seems that society has been distracted from the initial<br />

goals. From an enlightened and promising start in the 1970s<br />

and some strong development in the 1990s, our quest has lost<br />

momentum with the result that the disabled community has<br />

fallen behind in terms of gaining their educational, employment<br />

and financial freedom. At this stage in my life I have to<br />

accept that we have fallen short of our aspirations; the real<br />

problem, however, is that acceptance doesn't sit well with<br />

me.<br />

36


Prof Amanda Krause, MBBCh, PhD MB BCh,<br />

Medical Geneticist/Associate. Professor.<br />

Head: Division of Human Genetics.<br />

National Health Laboratory Service (NHLS)<br />

& The University of the Witwatersrand.<br />

Please e-mail your questions about genetic counselling to national@mdsa.org.za.<br />

What are muscular dystrophies?<br />

Muscular dystrophies are a large group of muscle diseases that cause progressive loss of muscle strength and<br />

also loss of muscle bulk. The different conditions vary widely in their age of onset, from infancy to adult life. They vary in their rate of progression, their<br />

severity, which muscles are primarily involved and their genetic inheritance patterns. Both males and females can be affected, although some muscular<br />

dystrophies predominantly affect males. Although muscular dystrophies affect family members in a broadly similar way, there can still be significant<br />

differences between individuals. It is thus important to try to reach an exact diagnosis as it influences prognosis, management and genetic risk.<br />

How does muscular dystrophy present?<br />

People with a muscular dystrophy often report progressive weakness and difficulty with movements or tasks they were previously able to perform.<br />

Fatigue is a common feature. Initially the weakness may appear more severe on one side of the body, although typically both sides are involved. The<br />

weakness may begin in different ways in different individuals. Individuals may report muscle pain as a presenting or accompanying symptom. As some<br />

muscular dystrophies involve the heart muscle, a diagnosis of a cardiomyopathy may be the first indication of a muscular dystrophy.<br />

How are muscular dystrophies diagnosed?<br />

Diagnosis relies primarily on clinical assessment by an experienced doctor, typically a neurologist. The diagnosis may require additional blood tests,<br />

muscle investigations – including electromyography (EMG), or muscle biopsy to narrow down the exact diagnosis. Genetic testing has advanced in<br />

recent years and a specific genetic test or a broad test looking for a genetic fault in a few 100 genes simultaneously may assist in identifying the exact<br />

causative genetic fault and thus the precise diagnosis.<br />

Are all neuro-muscular disorders genetic?<br />

Not all neuro muscular disorders are genetic. It is important to distinguish non-genetic causes from genetic ones, as the management and treatment<br />

may differ dramatically. Any neuro-muscular disease should be fully investigated by a neurologist to ensure that the individual receives the most<br />

appropriate management.<br />

Can muscular dystrophy be prevented?<br />

If a muscular dystrophy is known to occur in a family, there are genetic tests available which can predict with high accuracy which other family<br />

members are likely to be affected. This is important as individuals at risk can be identified and managed from as early an age as possible. Although<br />

early management does not prevent disease, it may improve the period of time during which the individual is able to maintain good function. In<br />

addition, if parents know that they are at risk of having a child with a muscular dystrophy, either because of their family history or because they have<br />

had a previous affected child, it is important that they discuss their options with a genetic counsellor. Prenatal testing can identify an affected fetus as<br />

early as 12 weeks of pregnancy. Preimplantation genetic diagnosis is an option whereby parents can test embryos after in vitro fertilisation and only<br />

implant unaffected embryos in the uterus in order to achieve a healthy pregnancy.<br />

Doctor’s<br />

What treatment options are currently available?<br />

No single treatment is available for all muscular dystrophies. No cures are currently available either and people with muscular dystrophy should be<br />

aware of unrealistic claims made by companies or individuals. Broad principles do apply in management. It is important that people with muscular<br />

dystrophies try to maintain their strength and mobility as much as possible. It is helpful to work with a biokineticist who can advise on appropriate<br />

exercises. Aggressive exercise is discouraged but aerobic gentle exercise is encouraged within the individual’s capability. Increasingly specific treatments<br />

are becoming available which allow for extended periods of improved functionality. These treatments are specific to the genetic condition and<br />

often to the exact genetic fault or type of genetic fault.<br />

What can I do to help a friend or family member diagnosed with a muscular dystrophy?<br />

People with muscular dystrophies need to be supported through their disorder. It can be very frustrating for someone to lose previous abilities. Friends<br />

and family should try to ensure that they are referred to the appropriate support services to ensure that they maintain optimal function and get the best<br />

possible management. Referrals include medical professionals, allied health professionals, including psychologists and genetic counsellors. Support<br />

groups such as the Muscular Dystrophy Association can assist in directing individuals to appropriate services. They also provide contact with similarly<br />

affected individuals.<br />

37


Sandra’s thoughts on…<br />

Time – the best gift you can give someone<br />

By Sandra Bredell (MSW)<br />

“The greatest gift you can give someone is your time.<br />

Because when you you’re your time, you are giving a<br />

portion of your life that you will never get back” (author<br />

unknown).<br />

According to Frank Weil (2013), all of us have our own<br />

sense and understanding of “time”. It may reflect a very<br />

good experience we had or the frustration experienced<br />

when waiting on an answer or outcome of a particular<br />

situation. Although we can all associate with these kinds<br />

of experience, no one really knows where the concept<br />

actually comes from. We understand that there is a yesterday,<br />

today and tomorrow and that if time is lost you<br />

can never get it back and therefore time needs to be<br />

spent wisely. This can be seen as one of the principles<br />

of life. But as Mr Miyagi stated in the movie, Karate Kid,<br />

“I think you know the principles. Everyone does. But<br />

99% of all people don’t do what they know” (Foroux,<br />

2016).<br />

We also know that time is very important to human beings<br />

and plays a significant role in our lives. We need<br />

to really value and respect time, for as the saying goes,<br />

“time and tide waits for none”. Mother Teresa agreed<br />

by saying, “Yesterday is gone. Tomorrow has not yet<br />

come. We only have today. Let us begin” (Bhalla, 2017).<br />

Volunteering your time to an organisation that renders<br />

a service to the community, to a neighbour, friend, colleague<br />

or family member indicates that these people<br />

are important to you and therefore you want to give<br />

them the gift of time. This gift is a part of your life which<br />

you are giving away. We should give more than we<br />

take. Life is not about taking but all about what we are<br />

giving. “We make a living by what we get; we make a<br />

life by what we give” – Winston Churchill (Santi, 2017).<br />

You will be surprised by the fact that the more you give<br />

to others, the more you will receive. And here I am referring<br />

to time. We should rather think about what we have<br />

to offer than what we want from the world. “The effect<br />

you have on others is the most valuable currency there<br />

is” – Jim Carrey (Foroux, 2016).<br />

But when you give your time to others, you benefit a<br />

great deal yourself. Research has proved that helping<br />

others is a fundamental part of humanity. People are<br />

helping others at soup kitchens, welfare organisations,<br />

children’s homes; and then there are others who assist<br />

the community in case of a fire, natural disasters<br />

and crime. According to a study done by Professor<br />

Michael Norton (Harvard Business School), giving of<br />

your time to others, makes you feel good; and a professor<br />

of psychology at the University of California, Sonja<br />

Lyubomirsky, saw similar results when she asked people<br />

to perform five acts of kindness each week for six<br />

weeks (Marsh & Suttie, 2010). To see a smile and eyes<br />

filled with joy definitely makes it all worth it.<br />

So next time you are wondering about what to give to a<br />

friend or family member, consider the gift of your time.<br />

Offering your time to do something for them or to spend<br />

time with them is the best gift you can give.<br />

References<br />

Bhalla, S. 2017. “Importance of time…”. My Edu Corner.<br />

http://www.myeducorner.com/importance-time-essayspeech-article/.<br />

Foroux, D. 2016. “7 principles of life that everyone<br />

knows, but only a few follow”. Updated 2017. Huffpost.<br />

https://www.huffpost.com/entry/7-life-principles-everyone-knows-only-few-follow_b_11318702.<br />

Marsh, J. & Suttie, J. 2010. “5 ways giving is good for<br />

you”. Greater Good <strong>Magazine</strong>. https://greatergood.<br />

berkeley.edu/article/item/5_ways_giving_is_good_for_<br />

you.<br />

Santi, J. 2017. “The secret to happiness is helping others”.<br />

Time. http://time.com/4070299/secret-to-happiness/.<br />

Weil, F.A. 2013. “The meaning of time”. Huffpost. Updated<br />

2014. https://www.huffingtonpost.com/frank-aweil/the-meaning-of-time_b_4351464.html.


Family picnic at the Urban Park<br />

Cape Branch<br />

On 1st September we hosted our<br />

annual family picnic for affected<br />

members and their loved ones.<br />

We spiced things up this year by<br />

hosting an outdoor treasure hunt.<br />

What fun it was for both children<br />

and adults to explore the park to<br />

hunt down clues and fun goodies.<br />

Thereafter, we all celebrated<br />

awareness month together and<br />

shared a lovely picnic. Many<br />

thanks to everyone who came out<br />

to spend this special day with us,<br />

and to Mrs Gilda van der Merwe<br />

for planning and facilitating the<br />

event.<br />

IN MEMORIAM<br />

It is with great sadness that we bade farewell to Mr Basil Lerer on 10 July <strong>2018</strong>. Our sincere<br />

condolences to his family. You are in our thoughts. It’s always too soon to say goodbye.<br />

It is with very heavy hearts that we said goodbye to Vuyolwethu Stuurman on 12 June <strong>2018</strong>. Our<br />

sincere condolences to his family. We loved to see his gentle smile at our visits to Tembaletu School.<br />

Our deepest condolences to the Grobbelaar family on the passing of their daughter, Chante, on 26 July<br />

<strong>2018</strong>. Your family is in our thoughts.<br />

Condolences to family and friends. Ed.<br />

39


Cape Branch<br />

Grand West children’s outing<br />

On Wednesday 5 September <strong>2018</strong> our <strong>MDF</strong> children<br />

from Astra School enjoyed a fun day at our annual Grand<br />

West outing. We kicked off the day with a lovely brunch at<br />

Wimpy. Afterwards, the group got to go bowling and play<br />

arcade games at the Magic Company. What a joy it was to<br />

watch the faces of our MD children enjoying the thrill and<br />

excitement of all the activities on the day. This was once<br />

again a wonderful fun-filled day to remember, and each<br />

child returned home with a lovely goodie bag.<br />

Special thanks to Reach for a Dream for funding the lunch<br />

and for joining us on this special day, and to Mandy and<br />

Lawrence Green for funding the tokens. Also, thank you<br />

to Astra School for arranging for the children to be safely<br />

transported to the venue with staff to assist the children<br />

on the day.<br />

40


Cape Branch<br />

Awareness events<br />

The Cape Branch’s social service team conducted six different awareness<br />

campaigns during the last quarter. Many thanks to the schools, community<br />

centres, NPOs and clinics that hosted us. We greatly appreciate the<br />

opportunities to share information about muscular<br />

dystrophy within our surrounding communities.<br />

Pictures from APD Tygerberg<br />

Awareness Event and van Riebeeck<br />

Strand Primary School.<br />

Annual Golf Day<br />

A sincere thanks to the Goodwood Rotarians and Judy Bird for<br />

assisting in making a huge success of this event, held on<br />

12 October. A word of special thanks to Sanjay Narshi and<br />

Anne-Marie Stoman for their great support at the event.<br />

The National Lottery Commission<br />

We are very grateful for the funding received from the National<br />

Lottery Commission. We were able to purchase three motorised<br />

wheelchairs, two Bi-Pap machines and several cushions and<br />

mattresses, and to refurbish another B-Pap machine .<br />

A picture of 2 of the recipients of the wheelchairs purchased.<br />

41


Gauteng Branch<br />

Muscular Dystrophy Campaign<br />

SMS and stand a chance to win 1 of 3 Voyageur Schwinn bicycles<br />

The Blue Bottle Group has a team of cyclists that cycled with our logos<br />

on their jerseys at the Telkom 947 Cycle Challenge on 18 November<br />

<strong>2018</strong>. Additionally, the Blue Bottle Group bought three bicycles and is<br />

running an SMS campaign whereby, at a cost of R30 per SMS, people<br />

can stand a chance to win one of the bicycles. The campaign will run until the end of <strong>December</strong> <strong>2018</strong>.<br />

Please support people affected with muscle-wasting conditions by SMSing your name and email address to<br />

42351 and stand a chance to win 1 of 3 Voyageur Schwinn bicycles valued at R6 500 each.<br />

Muscular Dystrophy Foundation Gauteng wishes to thank the Blue Bottle Group and everyone who supports<br />

our cause!<br />

New wheelchair for sale<br />

Please contact Lindsay Walsh on cellphone number 0834692877<br />

if you would like to buy this brand new wheelchair for R60 000.<br />

42


Gauteng Branch<br />

Donation of a vehicle<br />

We would like to thank the Talia family for donating<br />

a Chrysler Voyager with motorised lift to us. The<br />

vehicle is a great help, especially in transporting the<br />

General Manager on a daily basis.<br />

Nazier and Fatima Talia have been very good to<br />

us over many years and we wish to thank them<br />

sincerely for the great donation. We are most grateful<br />

for their support and willingness to help when needed.<br />

Pictured: Robert Scott, Fatima Talia and<br />

Pieter Joubert<br />

Ezibeleni School outing<br />

On 6 September, MD learners from Ezibeleni School<br />

went for an outing to East Rand Mall. They were<br />

treated to lunch at Mugg & Bean, where they had<br />

a choice of folded fillers, toasted sandwiches and<br />

something to drink. They enjoyed the outing very<br />

much.<br />

Ithembelihle School outing<br />

On 26 September, MD learners from Ithembelihle School were taken on an outing to East Rand Mall, where they<br />

were treated to lunch at Panarotti’s. They had monster pizzas and something to drink for 21 people.<br />

43


Gauteng Branch<br />

Special delivery at<br />

Pretoria School<br />

Learners living with muscular dystrophy were<br />

treated with gifts on Wednesday 31 October<br />

<strong>2018</strong>.<br />

The learners are all part of the muscular<br />

dystrophy group which is run by the school<br />

physiotherapist and the school Social worker<br />

at Pretoria School. I, the muscular dystrophy<br />

social worker does group sessions with them<br />

once a month. The learners were very happy<br />

to receive gifts from the Foundation.<br />

Lionel Smook surprised with<br />

CE Power Chair<br />

We could not find parts for my old wheelchair, and<br />

our social worker, Mulanga Kharidzha, told me that<br />

there was a waiting list but they would try their best<br />

to help as soon as funds became available.<br />

On 31 October, staff from the office surprised me and<br />

handed over the wheelchair. I would like to thank the<br />

Foundation and Muscle Riders for assisting me with<br />

a power wheelchair.<br />

Thank you for helping all our members with<br />

specialised equipment.<br />

(Pictured: Mulanga Kharidzha, Pieter Joubert, Lionel and Rina Smook)<br />

Photography/Videography<br />

• Annual reports • Golf days<br />

• Awards<br />

• Entertainment<br />

• Conferences • Team building<br />

• Product launches<br />

info@strikeaposephotography.co.za www.strikeaposephotography.co.za<br />

Call: Dee-Ann 082 412 9650<br />

44


Our son Matthew Wilson<br />

By Cindy Frantzeskos<br />

We were very privileged to have had a son like a Matthew. I want<br />

to tell you about the remarkable young man he was.<br />

Matthew was born with Duchenne muscular dystrophy, but he<br />

never used his disability as an excuse for anything. He never<br />

even allowed me to park in the disabled parking – gotta love that<br />

one.Everyone who knew Matthew had some special moments<br />

with him. For me there were many along the way. There is a song<br />

that Matthew and I used to sing in the car on the way home when<br />

he was a toddler. “You are my sunshine, my only sunshine. You<br />

make me happy when skies are grey …<br />

Matthew was and always will be my sunshine. He was one of<br />

those rare human beings whom everyone loved. His smile could<br />

light up a room and he had beautiful sparkly eyes. He had a dry<br />

sense of humour, and he loved to joke with his group of close<br />

friends and of course his family. He nicknamed my brother “Victor<br />

DJ skip skip” – for obvious reasons.<br />

I must say he was also fortunate to have cousins whom he was close to and who spent time with him. He was also adventurous<br />

and embraced life despite his illness. He could put able-bodied people to shame. If I look back over the years, to<br />

when he was still able to walk, he would run races and be the last one running but with a huge smile on his face, waving<br />

at us. At the age of 11 years he went into a wheelchair, still living life as only he knew how.<br />

Matthew once won a four-wheeled motorbike in a competition (I was not even aware that he had entered – his Gran had<br />

posted the letter). We spent many weekends at the race track. He would be lifted on to the motorbike, and although he fell<br />

off many times and broke some bones, he was right back on again the next week. He then sold his motorbike and bought<br />

a boat! This was while holidaying in Plettenberg Bay, where he made many friends.<br />

One day Matthew went paintball shooting, and when he came back he said it was one of his best days ever – never mind<br />

all the bruises!<br />

He also went white water rafting in Parys with Kyle, one of his closest friends, and the organisers were super impressed<br />

at his determination. They would sometimes camp in our back yard in a tent, but this was 5-star all the way – with TV,<br />

PlayStation, everything in that tent.<br />

Matthew loved to play 30 Seconds and of course his PlayStation. He also loved music, all types of genre – from Robbie<br />

Williams and Queen to Eminem and Ed Sheeran – and he would sing along.<br />

Matthew loved to watch movies and he always chose ones that had a life lesson – except for Harold and Kumar. He loved<br />

Superman and obviously Wonder Woman, but Batman not so much (a rich man with gadgets).<br />

Matthew also loved the Manchester United soccer team. Where this comes from I have no idea. He was fortunate to go to<br />

Old Trafford and watch them play. When they came to South Africa he met the entire team, shaking hands with everyone,<br />

from Sir Alex Ferguson to Wayne Rooney and John O Shea. In fact he made us wait from 9 in the morning until 10 that<br />

night at the Palazzo Hotel to get all their signatures.<br />

He also loved fast cars and was given opportunities to drive in many – Maserati, Lambhorghini, Ferrari, McLaren, Audi R8.<br />

He also raced around Kyalami and met Kerry McGregor and Baby Jake, among others.<br />

He loved going out and would “organise” tickets to Prime Circle and Black Eyed Peas. I remember a long road trip to Sun<br />

City with a bus full of family and friends. His last outing would have been to Comic Con – he had booked those tickets<br />

months in advance, but life had other plans for him when, on 15 September, he left us to go on his next journey ….<br />

In his last few days Matthew decided to stay home in bed. - I don’t know how he found the courage to say to the doctor, “I<br />

don’t want to be on anything mechanical”. It broke our hearts, but as he said, he had had a good life.<br />

Your wings were ready but our Hearts were not. You are our hero and we will never ever forget you, Matthew!<br />

It is always too soon to say goodbye! Our sincere condolences. Ed.<br />

45


KZN Branch<br />

A huge thank you<br />

Muscular Dystrophy Foundation KZN Branch are most grateful<br />

for the support and wish to express our sincere gratitude to all<br />

our donors for their sponsorship and donations, as well as to<br />

all our members who have been a tremendous support to KZN<br />

Branch.<br />

Your generosity is greatly appreciated by the executive committee,<br />

staff and volunteers of the <strong>MDF</strong> KZN Branch.<br />

Casual Day <strong>2018</strong><br />

The Muscular Dystrophy Foundation KZN Branch sold 2 793 stickers<br />

and would like to sincerely thank the following volunteers, schools and<br />

companies that assisted us in our Casual Day sticker sales:<br />

Mercedes-Benz, Riverhorse Valley; Reutech Communication management<br />

and staff; Cathy Khoon Khoon and family; Nedbank Kingsmead<br />

Phase 2; Mrs Bhanjee and family; SA Homeloans, La Lucia; Effingham<br />

Primary School staff and pupils; Effingham Secondary School staff and<br />

pupils; U & G Fabrics, Overport, Durban; Parmalat; St Raphaels School<br />

staff and pupils, Montclair; Mason Lincoln Special School staff and pupils;<br />

Mobility Solutions; Briardene, Durban North; New Frontier Tours,<br />

Westville; Kandice Govender and family; Netcare, Kingsway; Weziwe<br />

Magoso; 45th Engen, Sherwood; Namitha Chabilal from Inkosi Albert<br />

Luthuli Central Hospital and her team; Neil and Duane Goldstone.<br />

Thank you once again for your support and assistance in the sale of stickers. We look forward to your assistance,<br />

support and contribution again next year!<br />

Annalie Harris is selling this Motorised Shopping Scooter with trailer, battery charger and user manual. Price is R25 000, however<br />

Annalie is open for negotiation. For more information, contact her at 084 370 5477.<br />

FOR SALE<br />

46

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