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c e l e b r i t y

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Dear Doctor

with Dr Chris Steele

Diet DOS


Eat well for beer heal





Dr Chris Steele, MBE Live a longer, happier life with ITV This Morning’s resident doc

1 Cover 2020.indd 1



for digesve heal



helping your heart in association with SPRING 2020 | £3.99 ISSN 1758-597X

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42 Dr Chris Steele, Mbe In Conversation

In conversation with Dear Doctor, one of the nation’s favourite TV celebrity doctors tells us his thoughts on the latest topics in health and better living

Today’s Serious & Common Conditions 15 fighting Prostate Cancer

As one of the most common cancers affecting men, what are the latest treatment breakthroughs for prostate cancer?

21 stoma and stigma

Bowel cancer can require significant post-operative care, so what are the best ways to ease discomfort and maintain hygiene?

22 plants for your pain

Arthritis is a common condition and can limit your lifestyle if untreated. So how do you go about easing joint pain without surgery?

25 eds, the invisible illness

Ehlers-Danlos Syndrome is a littleknown disorder, yet it has many highprofile sufferers. We find out what it is and what can be done to improve the life of people with EDS

4 dear doctor with dr Chris Steele

04, 05 CS2 Contents.indd 4


Multiple Sclerosis is a littleunderstood condition with no current cure—and why does it seem to be on the rise? We look at the latest thinking and treatments


Can a new range of high-tech apps help us to keep track of our heart health? It’s the trend that’s bringing medical advice from the doctor’s waiting room straight to your door

37 Tooth TECH

With dental health in the UK in crisis, particularly in the young, we look at why it’s vital to look after your teeth, and what you can do to help your dentist help you

42 Coronavirus— The Myths, The Facts

With the coronavirus COVID-19 spreading from China all over the world, we look at what it is, why it’s a threat to public health, and what we can do to keep ourselves safe

47 do you know your limits? With alcohol abuse an increasing concern for the healthcare system, a reminder of the NHS’s recommended safe levels and what they mean in real terms

Health and Fitness 49 NON-TOXIC MAKEUP

Is your makeup doing your skin and the environment more harm than good? We look at the safe organic alternatives and how to spot them on the shelves


Just because you want a quick meal doesn’t mean it has to be an unhealthy additive-packed blowout. We present a tasty recipe anyone can fix in minutes


If you have difficulty digesting certain foods, could you be are lactose intolerant? We look at the signs


It's tasty and natural, but did you know that coconut water has scientifically proven health benefits too?


The importance of folates to eye health is not always recognised. We find out the facts about what the eye needs


Eye cataracts are a major cause of sight loss around the world, but there are now simple surgical procedures using ingenious technology to protect the essentials of your vision

IMAGES © Shutterstock; 123RF


06/03/2020 14:16



soon be nodding off… if you see what we mean

Quick looks at some products designed to boost your wellbeing


Dental care is one thing, but dental beauty is another—how orthodontics can give us all Hollywood smiles


Have you tried manuka honey? It’s said to have health-giving properties as well as a fantastic sweet taste


Our pets’ health is as important to us as our family’s, but sometimes we spoil our animal companions rather than looking after them well


It’s the latest health trend, but is there any real value to CBD oil? We bust a few myths to bring you the real story


It’s the hottest controversy in modern medicine—can components of cannabis be used safely in medical treatment? We find out from pioneers The Sapphire Clinic


CBT, or Cognitive Behavioural Therapy, could be a ‘talking cure’ for many mental illnesses—but what is it, and why isn’t it more widely available?


They call the gut your ‘second brain’, and it’s true that it influences more than the obvious physiological functions. So what should we do to keep our digestive tract happy and healthy?


It’s important to keep up your vaccinations, but never more so that when you’re off on holiday. We present a handy checklist of must-know information for travellers


Can’t get to sleep? Is it stress, a poor lifestyle or just the wrong curtains? Read our sleep guide and we hope you’ll

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Life Starts at 60 98


We have an ageing population, but in many ways life for the over-60s just seems to get harder. We take a close look at the issues involved, and how medicine and politics can help


A knee joint replacement operation is one of the most common routine surgeries carried out by the NHS. How does it work and what can it achieve?


For anyone strapped for cash but sitting on a valuable property, equity release can be a valuable financial tool. We find out the facts behind it



For older people, the bathroom can present hazards that make life difficult—we consider some of the stylish bathroom designs making life easier and smarter


Keeping safe at home can be a challenge for the elderly, but utility companies, charities and app manufacturers are charging to the rescue


From stairlifts to grab-rails, ramps to specialist beds, there are lots of ways to help older people to live safely and comfortably in their own homes. We look at some of the best.



Smart technology for the older generation? It’s not such as bad idea. Whether it’s a health-checker on your phone or a way to preserve memories, these apps are golden


It’s a new way to live your life, in a community that offers security and care in a social setting. So could a retirement


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IMAGES © Cour tesy of ITV’s This Morning

Welcome W e’re very lucky to live at a time when medical advances mean that our health and longevity are generally improving. We all have access to health information, and we should have access to treatment, though with the NHS under increasing pressure it’s important that we don’t take this for granted. With health subjects like coronavirus, obesity and diabetes constantly in the news, no-one should be unaware of the best ways to take care of yourself and your family and to live a longer, fitter and happier life. Yet there are many areas of concern, such as the rise in cases of obesity and related conditions such as diabetes, high blood pressure, heart attack and stroke. Very often a change in lifestyle is an enormous help and can avoid the necessity for medical intervention —lowering sugar intake, getting more exercise and giving up smoking can make all the difference. Improvement in our general health and positive actions such as getting more exercise can also have tremendous benefits to our mental health, an area which is getting more attention, but which still suffers from a certain amount of stigma, as well as a worrying lack of resources. While tremendous progress is being made in areas of medical research such as cancer, at the same time there are conditions such as dementia which currently can’t be cured. While we hope for a breakthrough, in many cases the best that can be done is to adjust our surroundings to make life easier, by adapting our homes or changing our living situations. You’ll find help and advice on all these issues in this featurepacked issue of Dear Doctor. Perhaps most important to remember is that our health is largely in our hands—a positive attitude and a willingness to take good advice can help us all to live longer, happier and healthier lives!

Dr Chris Steele, MBE

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At the Heart of Health with Dr Chris Steele MBE

Dr Chris Steele from ITV’s This Morning talks to Chris Jenkins about some of the most vital issues in health and fitness, how we can look after ourselves better and how we can live longer, happier lives


Starting out as a medical practitioner in Manchester’s student quarter of Fallowfield over 40 years ago, and becoming one of the most famous doctors on British television today, our Guest Editor Dr Chris Steele can be seen regularly on ITV’s weekday show This Morning, when he tackles the nation’s health and medical concerns. Dear Doctor asked him about some of the most pressing health issues today. Dear Doctor: What would you say is the biggest health issue in the UK today, and how can we tackle it? Chris Steele: Three or four years ago, I would have said it was smoking. But now obesity is exploding, whereas smoking is going down. It’s not just about being overweight; you increase your risk of several cancers and diabetes. People underestimate diabetes; it can lead to stroke, heart attack, kidney failure, and circulation problems such as gangrene. Obesity is an epidemic now, so diabetes is booming. The only solution is for people to get off their backsides! TV doesn’t help. People are sitting on their backsides at home, they have their evening meal and sit in front of the TV for five hours. People do know they are overweight; they know they have got to move their feet and watch their mouth. I just say to people: “I want you to walk. Go for a 15-minute walk, that’s not much, is it? You’ll lose weight. Do this every day, start walking a bit further, do it very gradually.” We had a guy on This Morning called 8 dear doctor with Chris Steele

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The only solution is for people to get off their backsides! TV doesn’t help. People are sitting on their backsides at home, they have their evening meal and sit in front of the

TV for five hours.

Charlie, he was 45 stone and luckily he lived in Manchester and not very far from me. So I took him for a walk each day. On the first walk he was sweating and aching within five minutes. But the next day we did 10 minutes, the next day 15. Charlie went and did the London Marathon; he lost 20 stone in the first year and 30 overall. As for dieting, keep it simple and you will follow it. Nearly all the major killers are lifestyle related. Heart attacks, several cancers – our lifestyle has got a huge impact on what we are facing. We know there are at least a million

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dear doctor with Chris Steele 9

06/03/2020 13:10


people in the UK walking around with diabetes undiagnosed. Now this is the problem, with diabetes you don’t get any obvious symptoms until something goes wrong. People will say, flippantly, oh yes, it’s just sugar in the blood, as if it’s a minor condition. But let me just take you through the risks associated with diabetes, starting with the head: • increased risk of stroke • high risk of losing your sight • high risk of heart attacks • high risk of kidney failure • for men, risk of erectile disfunction • legs—amputation through gangrene Now all of these conditions are due to the arteries to those parts of the body becoming narrowed and furred up. And that’s what diabetes does, it affects the arteries that supply all your major organs. Another big health risk is a lack of vitamin D. I don’t take many supplements but the one I do take is vitamin D. It’s a ticking time bomb— kids are now getting rickets because they’re lacking vitamin D. People need 15 minutes each day in the sunlight, or if you can’t get sunlight, oily fish contains a lot of vitamin D. The medical profession has learnt a lot about vitamin D in the last 10 years alone. There’s been a lot of research about links to heart disease and cancers. We still don’t understand the full power of vitamin D. DD: So how can patients help their doctor to help them? CS: Before you go and see your doctor, write down the questions you want to ask. I do it myself when I go to my own GP. I would also recommend bringing someone with you because often you don’t remember everything that’s said, especially with something serious. And don’t be afraid to ask your doctor to explain: What does that mean? Can you write that down for me, doctor? There’s nothing wrong with seeking information on the internet, but it’s what you do with the information that matters. Do not ever self-diagnose. The internet is a tremendously useful 10 DEAR DOCTOR WITH CHRIS STEELE

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source of information, but don’t act upon it, get professional advice before you do anything. DD: Where do you see the next big medical breakthroughs coming? Perhaps in the field of bowel or prostate cancer research? CS I think the next big breakthrough will be at cell-level, and in the field of cancer research. I had skin cancer on my face and This Morning came to my hospital and filmed the operation. It was so clever, the surgeon stitched it up in the shape of a Z so you can’t even see a scar. I’ve got one on my back, and another on my leg too, I’ve had skin cancer four times all due to sun bathing and sun-beds. Twenty-five years ago we didn’t know about the link between sun and skin cancer and sunbathing. People are much more aware of the dangers now, especially in relation to children. It’s so important to take care of the whole family because the moment when a child burns, that

Do not ever self-diagnose. The internet is a tremendously useful source of information, but don’t act upon it, get professional advice before you do anything. might be the source of skin cancer decades later. DD: Do you think there are still areas where the public need better health education/ Do you think your live TV demonstrations help? CS: The first controversial thing I battled for, and for some time, was a live breast examination. At first the editors and producers said no, but I

Skin Cancer treatment has improved tremendously

06/03/2020 16:05


battled and battled and eventually they said, ‘Okay then, as long as it’s done in the best possible taste.’ It was ground-breaking television, having never been done before, globally. After I’d performed the examination we had all sorts of reactions. Some viewers called in to say how they found it disgraceful that we showed a bare breast on morning television, while others wrote in to thank us, saying because of the show they had done a self-examination and found a lump and caught breast cancer early. After the breast examination I said I wanted to do a testicular examination and I came up against a brick wall with that one! I kept asking and eventually they said yes, but there were very strict stipulations that we had to stick to. It had to be done in the best possible taste, we had to use a hospital-style screen so it looked clinical and the man was not allowed to show his penis, which I thought was funny considering we were going to be showing his testicles! We had to be very careful because we’d have been fined £30,000 if we’d broken the rules. After the show had taken place, an old lady called in and said ‘I think it’s disgusting. I was sat at home eating my sausages and it put me right off my breakfast!’ Well, I had to laugh at that one! On the positive side, we had parents calling in to the show asking us to show it again so they could show it to their son, and nurses using it in training. DD: The work of support groups for conditions such as Ehlers-Danlos syndrome is increasingly high-profile. You’re well known for your work on smoking prevention – what other causes do you support? CS: I’ve worked with Coeliac UK for a long time, even before I was diagnosed with coeliac disease myself. I work with lots of charities, though, including skin cancer charities, bowel cancer charities, lung cancer charities and The Butterfly Group, a charity set up to help care for those with immune, auto immune and chronic disorders.

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Cancer research promises exciting breakthroughs.

e My best advic

see ou go and “Before y n o r, write d w

your docto t ns you wan the questio lf se it my to ask. I do to my o g I when own GP.”

DD: There has recently been a rise in campaigns associated with vaccination not only for children, but increasingly aimed at adults, too. What are the key things we should be looking out for and how important is it for people to get vaccinated? CS: Meningitis vaccines are not being taken up by teenagers, the very ones who are going to university, and who will be meeting hundreds and hundreds of new people. That could be where they catch meningitis. There are many different vaccines for meningitis: there’s the meningococcal

vaccine, there’s mumps, measles and rubella (MMR). The one that they want the adolescents to have contains four strains of meningitis. There’s meningitis A, there’s meningitis C, W and Y. And the W [strain] is the most aggressive and has increased tenfold in the past six years. Only one third of 17 to 18-year-olds are taking up the offer of this vaccination. There’s viral meningitis which actually can be quite mild, but bacterial meningitis is the one we’re talking about in terms of these vaccinations. The meningitis gets in your system and causes septicaemia and causes gangrene. The symptoms are headaches and fever, vomiting, neck stiffness and dislike of strong light. People talk about the meningitis rash, which is a rash on the skin and if you press a glass onto it the rash doesn’t go pale, it stays there. If you’re looking at the skin rash from meningitis, that’s late down the road; that’s a sign of meningitis septicaemia. One in 10 cases of meningitis are fatal. Those that aren’t fatal can cause deafness, blindness, epilepsy and loss of limbs. If you’re an adolescent, get DEAR DOCTOR WITH CHRIS STEELE 11

06/03/2020 14:21


vaccinated—get injected, not infected. DD: Do the elderly get a bad deal in current medical treatment? Are there any signs the situation will improve? CS: With dementia there’s nothing powerful out there yet in terms of a cure, such as the cancer treatment just mentioned, although a huge amount of research is going on. It’s a growing problem because we’re living longer. When I was a young doctor, we didn’t see many cases of dementia, but today there are more people with the condition because we have this large elderly population, so when a breakthrough does come it will be very welcome indeed. DD: Charities like Age UK suggests that older people should be screened for conditions like bowel cancer and high cholesterol levels. How important would you say these regular medical checks are? CS: I think with age, these sorts of checks are very important. Bowel cancer screening tests are sent out to

Vaccinations are essential for a healthy society


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There are many different vaccines for meningitis: there’s the meningococcal vaccine, there’s mumps, measles and rubella (MMR) everyone in the post. But people are repulsed by their own poo! So they’re [the NHS] not getting a huge response. Other things I would suggest: know your numbers. Your numbers are your blood pressure, your cholesterol and your blood sugars. Blood pressure; it’s a killer and can cause heart failure, heart attacks and stroke. Most patients have no symptoms when they have high blood pressure. So how do you know you’ve got it? You don’t know, so get it checked. Your pharmacist will do it for you free of charge.

Blood cholesterol? No symptoms. So how do you know your levels? You get a blood test. Blood cholesterol causes heart attacks and strokes; it’s the biggest killer in our communities. And blood sugar. Most people with a raised blood sugar have no symptoms. High blood sugar is the diabetes, the heart attacks, the strokes, the blindness, the gangrene—everything. I would say from the age of 50, get your blood pressure, your blood cholesterol and your blood sugar checked once a year around your birthday. DD: Are you worried about mental health issues and the lack of provision for treatment, particularly for young people? CS: It’s a big problem, mental health; there’s a huge stigma attached to any type of mental illness. I’ve had depression—bad—a few times. It affects every aspect of your’s affecting your mind and your mind is working all the time and with depression, you wake up in the middle of the night, it’s dark, it’s quiet, you’ve got nothing but your low mood with you. During the day, you’ve got no interest, no appetite. I call it the ‘Loss Syndrome’. Loss of interest in everything; your job, your family, your friends. One of the best treatments for depression is CBT (cognitive behavioural therapy). It’s extremely effective, but try and find a CBT therapist? They are few and far between. They’re rare and we need more of them. As GPs, we get slaughtered for writing prescriptions for anti-depressants but when a patient comes in…you’ve got to give them some hope. Anti-depressants are a very effective tool in treating depression. CBT is non-medical, non-pharmaceutical with no side effects. Talking therapy is very effective for mental health disorders; we just need more of it. DD: On the subject of depression, sleeplessness seems to be a growing problem and it’s often put down to stress. How do you combat stress? CS: Gardening! I love gardening and I

06/03/2020 16:06


Dr Chris’ message: get walking


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Take a ten-m on-stop, ay, n out every d s out, ten te u in ten m e ck. So you’r minutes ba ty n e ily tw taking a da walk! te u in m

have so many plants, my wife goes mad because I’ll come home with yet more plants. Gardening is a great stress reliever. If you ask people, do you sleep well, a huge proportion will say no they don’t. It’s like asking people, do you get tired all the time—and a lot of people will say, yes, I often feel tired. The medical profession abbreviates that in notes as TATT, ‘Tired All The Time’! It’s a very common complaint. In fact, the body is coping quite well. Then again there could be genuine reasons for not sleeping well. Some people think that alcohol will help them sleep. It can help you get off to sleep, but the quality of sleep you get after alcohol intake is very poor quality sleep; you don’t get the deep, restorative, restful sleep. Also we come back again to lack of exercise. What are people doing? Sitting in front of the television for hours every

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OFFICE COORDINATOR Adam Linard-Stevens PUBLISHED BY Copyright © 2020, Celebrity Angels. All rights reserved COVER IMAGE Courtesy of REX/Ken McKay

One of the best treatments for depression is CBT (cognitive behavioural therapy). It’s extremely effective, but try and find a CBT therapist... night—so you go to bed and expect to get eight hours of deep, sound sleep? Come on! But this, of course, is only my personal opinion. My best advice? Take a ten-minute walk out every day, non-stop, ten minutes out, ten minutes back. So you’re taking a daily twentyminute walk! As I’ve said already, I do despair about the obesity problem, so my key message is: get walking! •

Dear Doctor with Dr Chris Steele Celebrity Angels Suite 2 143 Caledonian Road King's Cross London N1 0SL Tel: 020 7871 1000 Fax: 020 7022 1694 For sales enquiries call: 020 7871 1000 Copyright © 2020, Celebrity Angels. All rights reserved. All material in Dear Doctor with Dr Chris Steele magazine is wholly copyright and reproduction without the written permission of the publisher is strictly forbidden. The views expressed in this publication are entirely those of the authors and do not necessarily represent those of Celebrity Angels. The information in this publication is carefully researched and produced in good faith, however, neither the publisher nor the editors accept responsibility for any errors. The Celebrity Angels Series is published in the UK under licence by Damson Media Limited. Damson Media Limited is registered in England and Wales under registration no. 07869300.


06/03/2020 14:25




06/03/2020 14:03


Why Celebrities Are Standing Up Against Prostate Cancer Research is making great strides in treating the most common cancer in men, so why do celebrities feel they have to speak out to raise awareness of prostate cancer?


hen celebrities including Stephen Fry (seen below), Jim Broadbent, Nile Rogers, Bill Turnbull, Jemma Redgrave and Ray Clemence spoke out in support of charity Prostate Cancer UK’s ‘Men, We Are With You’ Campaign, they spoke from personal or family experience. In the UK, prostate cancer is the most common cancer in men, with more than 47,500 diagnoses every year. One man dies of prostate cancer every 45 minutes in the UK, that’s more than 11,500 men per year, and it could affect up to one in every eight men. Around 400,000 live with and after prostate cancer. Age, ethnicity and family history are factors, but public awareness of the disease, its symptoms, consequences and treatment remains low. In Stephen Fry’s case, he says that he was luckily diagnosed at a fairly early stage during investigations of another condition, and was successfully treated. But there is no national screening programme as there is for other conditions such as breast cancer, so there is a risk of late diagnosis and subsequently more difficult in treatment. The prostate is a gland in men, the size and shape of a walnut (though it can grow larger with age), which sits underneath the bladder and surrounds the urethra, the tube that carries urine out of the body. The main function of

the prostate gland is to make semen, the fluid that carries sperm. But the prostate gland is subject to several conditions, including enlargement or inflammation (prostatitis), and prostate cancer, when cells in the gland begin to grow in an uncontrolled way. Some prostate cancer grows too slowly to cause any problems or affect how long you live (it’s often said that many men die ‘with’ prostate cancer, though not ‘of’ prostate cancer.)

For this reason, many men with prostate cancer never need any treatment. However, some prostate cancers grow quickly, and are more likely to spread to other organs, in in these cases treatment is needed to stop it spreading.


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A prostate cancer which is contained inside the gland (known as localised or early prostate cancer) is often benign and causes no problems, so it’s often diagnosed only as part of tests for other conditions. If there are symptoms, they can involve difficulty in urinating, and can come on very slowly, over several years. Effects are usually noted in men over 50, and are more common in black men and those with a family history of prostate cancer. One reason why most men with early prostate cancer don’t have any signs or symptoms is because of the way the cancer grows. Early symptoms usually show only if the cancer grows near the urethra and presses against it, affecting urination. But because prostate cancer usually starts to grow in a different part (usually the outer part) of the prostate, early prostate cancer doesn’t often press on the urethra and cause symptoms. So changes in the way you urinate are more likely to be a sign of a very common non-cancerous problem known as an enlarged prostate, or other health problems. Nonetheless any such symptoms are a sign that you need to get checked out by your GP.

Symptoms can include: • Difficulty starting to urinate or emptying your bladder • A weak flow of urine • A feeling that your bladder hasn’t emptied properly

IMAGES © Shutterstock

• Urine dribbling after you finish • Feeling the need to urinate more often than usual, particularly at night • Sudden urges to urinate and leakage 16 dear doctor with dr Chris Steele

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THE PSA TEST The PSA test is a blood test that measures the amount of prostate specific antigen (PSA) in your blood. PSA is a protein produced by normal cells in the prostate and also by prostate cancer cells. It’s normal to have a small amount of PSA in your blood, and the amount rises slightly as you get older and your prostate gets bigger. A raised PSA level may suggest you have a problem with your prostate, but not necessarily cancer. You can have a PSA test at your GP surgery. You will need to discuss it with your GP first. At some GP surgeries you can discuss the test with a practice nurse, and they can do a test if you decide you want one. Unfortunately the PSA test is indicative but not definitive, as PSA levels can be affected by many other factors, so you will need other tests for a diagnosis of prostate cancer.

If prostate cancer spreads from the prostate into other parts of the body, it can cause symptoms of advanced prostate cancer, including: • Pain in the back, hips or pelvis • Problems getting or keeping

an erection • Blood in the urine or semen • Weight loss While all of these symptoms can also be caused by other health conditions, they should all be reported to your GP for investigation. There is no definite way of diagnosing prostate cancer without a visit to the doctor. A GP or a specialist nurse can carry out a range of tests, including a urine test to rule out a urine infection, a prostate specific antigen (PSA) blood test, or a digital rectal examination (DRE). Depending on the results you may then need an appointment with a specialist at a local hospital.

06/03/2020 14:32


PROSTATITIS Prostatitis is not a form of prostate cancer, but the name given to a set of conditions caused by an infection or inflammation of the prostate gland. It is not the same as having an enlarged prostate. Prostatitis is a common condition which can affect men of any age, but is most common in younger and middle aged men, typically between 30 and 50. Symptoms can include problems passing urine and abdominal pain. Causes and treatment can be problematical, but stress and bacterial infection are two root causes.

Treatment If a PSA test together with other tests including a biopsy, MRI, CT or PET scan diagnose prostate cancer, there are many options for treatment, including:

Active surveillance –


Some research suggests that high PSA level in your 40s could predict the likelihood of you getting prostate cancer, or fast-growing (aggressive) prostate cancer, in the future, so if the test suggests you’re at higher risk, you and your doctor may decide to do regular PSA tests. But the PSA test alone is not a definite sign of prostate cancer, one reason why there is no national screening programme as there is with breast, cervical and bowel cancer. It’s been argued that screening may do more harm than good, as it could encourage more men to have invasive biopsies, which can cause their own health problems, and could cause unnecessary worry in cases of slowgrowing cancers. •

most c younge ommon in r aged m and middle en betw een


Typical treatment of prostate cancer includes a high dose of radiotherapy to kill cancer cells, but due to the prostate being close to other organs and tissues there is a risk of side effects such as rectal pain, bowel and urinary leakage and erectile dysfunction. SpaceOAR Hydrogel, a NICEapproved water-based hydrogel spacing device, is Inserted by needle into the space between the prostate and rectum, under anaesthetic. The gel fills the cavity between the prostate

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External X-ray beam radiotherapy – radiation

(brachytherapy), cryotherapy (cold treatment) or HIFU (Highintensity focused ultrasound) to destroy the cancer cells

Hormone therapy – control of testosterone production, which controls cancer development Surgical prostatectomy –

THE SPACEOAR SOLUTION New prostate technology reduces side effects from radiotherapy

a programme of monitoring slow-growing localised prostate cancer, rather than treating it straight away, to avoid or delay unnecessary treatment and its side effects

and rectum, creating space which allows the oncologist to deliver radiation to the prostate while reducing exposure to surrounding healthy tissues. Professor Amit Bahl, Consultant Clinical Oncologist and Clinical Director at The Bristol Haematology and Oncology Centre, says “Now, I am able to say to patients that I can perform a small procedure that will reduce these side effects and minimise radiation exposure to healthy organs and tissues. I haven’t had anyone turn it down yet.”

removal of the prostate gland in cases of localised prostate cancer

All these treatments can have side effects such as urinary problems, erection problems and chronic fatigue, and a good deal of research is going into new techniques to reduce these. GenesisCare’s SpaceOAR® Hydrogel, for instance, is injected before the start of radiotherapy to reduce radiation exposure to the rectum during treatment, meaning fewer side effects and better post-operative quality of life.

For more help and advice about symptoms diagnosis, treatment and outcomes for prostate cancer, talk to a GP or visit the Prostate Cancer UK website.


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New prostate technology reduces side effects from radiotherapy New advancements in prostate cancer mean that men who underwent radiotherapy in a randomized clinical study reported fewer bowel, urinary and sexual side effects at median 3-year follow-up compared to control patients thanks to a new hydrogel spacing technology.2 Prostate cancer is currently one of the most common cancers in the UK. Typical treatment plans include a high dose of radiotherapy that aims to effectively kill cancer cells so they cannot spread any further. Due to the prostate being close to other organs and tissues, such as the rectum, there is a risk of long-term damage and side effects such as rectal pain, bowel and urinary leakage and sometimes erectile dysfunction. New gel solution can reduce side effects of radiotherapy SpaceOAR Hydrogel, a NICE approved water-based hydrogel spacing device, available across the UK via private and co-pay providers has recently been adopted by NHS England’s Innovation Programme. Inserted via a fine needle into the space between the prostate and rectum, under anaesthetic, the gel fills the cavity between the prostate and rectum, creating about 1cm of space. This allows the oncologist to deliver radiation to the prostate and reduce exposure to surrounding healthy tissues. The only prostate-rectum spacing device to be supported by a 222-patient randomised control trial and over 50,000 implants world-wide, this has had very positive patient outcomes.2,3



SpaceOAR Hydrogel SpaceOAR hydrogel is clinically proven, minimally invasive spacer designed to minimise urinary, sexual, bowel side effects and protect quality of life for prostate cancer patients undergoing radiation therapy.

Professor Amit Bahl is the Consultant Clinical Oncologist and Clinical Director based at The Bristol Haematology and Oncology Centre, was the first to use this new technology when it became available on the NHS Innovation Technology Programme (ITP) earlier in the spring. Professor Bahl says: “When looking at treatment options, the risks of these procedures are low but it’s understandable that patients are worried about them when they include terms such as ‘rectal toxicity’. Together with worries over erectile dysfunction or urinary incontinence, it can make the choice between radiotherapy and surgery quite tough. “Now, I am able to say to patients that I can perform a small procedure that will reduce these side effects and minimise radiation exposure to healthy organs and tissues I haven’t had anyone turn it down yet.” A 15-20-minute treatment under anaesthetic The treatment itself is minimally invasive and takes around 15-20 minutes as a day procedure, under general or local anaesthetic, depending on the patient. Professor Bahl explains: “Essentially, it is a fine needle through the perineum, into the peri-rectal fat. The idea is to dispense the gel between the posterior part of the prostate and the anterior part of the rectum, where the prostate touches the rectum. The gel then forms a soft spacer to separate these tissues. Once the patient has undergone radiotherapy, the gel is broken down by the body and naturally absorbed in about six months.”

Spacer means radiotherapy clinicians can be more accurate This technique gives about a centimetre of additional space for the clinician to see a clearer margin between the organs during radiotherapy. “The prostate moves when a patient breathes,” adds Professor Bahl, “And, despite all technical advances, without that additional gap, we just can’t be as accurate. What this means is that essentially the outcomes are the same but the long-term side effects are much better.” That was certainly the case for 71-year old Alan Clarke, who was the first patient to have the hydrogel treatment at Bristol earlier this year. Alan was first diagnosed with prostate cancer back in 2010. He says: “It came about after a random check on my PSA level; my GP sent me for a biopsy as my results were borderline and it turned out that there were cancer cells within my prostate. I had to have 37 doses of radiotherapy, five days a week for seven weeks. “It was a complete surprise for me as I had never expected to be told I would have cancer.” Men should talk more about prostate cancer For ex-motor mechanic, Alan, this was his first experience of prostate cancer. “A lot of men don’t talk about prostate cancer, and they should. This was the first I had really heard about it, but I would end up going to work in the morning and back to the hospital in the afternoon for my treatment. I just got on with it and didn’t really ask questions.”

1. NHS. 2018. Prostate Problems. [ONLINE] Available at: [Accessed 9 September 2019]. 2. Hamstra DA, Mariados N, Sylvester J, et al. Continued benefit to rectal separation for prostate radiation therapy: Final results of a phase III trial. Int J Radiat Oncol Biol Phys. 2017 Apr 1;97(5):976-85. 3. Data on file with Boston Scientific

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“Now, I can perform a small procedure that will reduce radiation exposure to the rectum and minimise long-term side effects for my patients. I haven’t had anyone turn it down yet.” Luckily, Alan’s treatment worked. Over the past nine years, he has had regular checkups, but earlier this year, his PSA results showed that something was wrong. Alan says: “When I heard that the cancer had come back, I knew that there would be complications because of my previous treatment. I had a big holiday to Australia coming up to celebrate my step-daughter’s and great-granddaughter’s birthdays, so I just hoped I would be able to go.” Day surgery allowed me to continue my travel plans Alan met Professor Bahl at The Bristol Haematology and Oncology Centre and was told about the gel. Alan was deemed a good patient to receive the spacer as he was more likely to receive potential side effects due to his previous treatment. On the day, Professor Bahl simply mixed two syringes together, inserted the needle into the space – where the gel sets – within seconds. Alan was allowed home later that day and, after one dose of high-intensity radiotherapy, he was allowed to travel the next month.

“We have always been big on travel in my family, so I’m very glad the treatment allowed me to continue with my plans so quickly with no real side effects. I’ve now got a cruise booked to Canada in October and can’t wait to see what it’s like in the autumn.” Spacer gel being rolled out across NHS England Now the spacer gel is available in several hospitals across England, and is covered by all major private insurance providers, but Professor Bahl is hoping it will be made available more widely in the future. Professor Bahl says: “We are very grateful that the NHS ITP programme is embracing new technologies and that hospitals across the UK will benefit. Equally, I would say to patients that, if it is not being offered in your local hospital then there is the option of discussing with your clinical oncologist regarding other avenues for availing this treatment.”

The ITP programme aims to approve a reimbursement for all men considered eligible to have the new spacer gel inserted. In studies, its use has been shown to reduce life-changing side effects, such as rectal complications, by 75% compared to control patients at a median of 3 years of follow-up.1 Alan highly recommends the treatment. He says: “I had anaesthetic so, in terms of the waist down, I was numb. A little uncomfortable over the next few days but that was to be expected. Now, my life is back to normal; I go on long haul flights, shopping trips with the wife and do the gardening. If you’re considering radiotherapy, I would say, ‘go for it.’”

Results from case studies are not necessarily predictive of results in other cases. Results in other cases may vary. There are risks associated with all medical procedures. Please talk with your doctor about the risks and benefits associated with SpaceOAR Hydrogel. Potential complications associated with SpaceOAR Hydrogel include, but are not limited to: inflammatory reactions, infection, bleeding, and pain or discomfort from the injection.

This article is co-sponsored by Boston Scientific. URO-672615-AA JAN 2020

CAUTION: The law restricts these devices to sale by or on the order of a physician. Indications, contraindications, warnings and instructions for use can be found in the product labelling supplied with each device. Information for use only in countries with applicable health authority registrations. This material not intended for use in France.

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02/01/2020 15:54


Stoma and Stigma Living with the post-operative effects of bowel cancer needn’t be so hard, as Dear Doctor discovers


owel cancer or colorectal cancer is the fourth most common type of cancer in the UK, with over colorectal 34,000 new cases in the UK each year. More than 102,000 people in the UK currently live with a stoma bag, either temporarily or for the rest of their life. Beginning in large bowel (colon) or back passage (rectum), bowel cancer often requires surgery, resulting in a colostomy (formed from the large bowel) or an ileostomy (formed from the small bowel). In each case a section of bowel is brought out through an opening in the abdomen (a stoma) and a pouch or bag fitted to collect waste from the bowel. The stoma can be temporary or long-term, but in either case will require care and attention from doctor and patient. In most cases a stoma nurse will make regular visits or the patient will be assigned to a stoma clinic for help and guidance.


While living with a stoma bag may have an impact on diet and everyday life, modern fittings are more discreet, easier to change, and are better at containing odour. There are also many specialised products which make it easier to take care of a stoma, such as spray films which provide

secure adhesion and protection from liquids, single-use wipes for general cleaning, and protective barrier creams. Adhesive remover wipes and sprays make it easier to remove adhesive dressing, particularly important where skin is sensitive, and emollient sprays can deliver soft paraffin to the skin without it needing to be touched. A stoma nurse will be able to advise on what products are most suitable, as well as pointing out simple lifestyle changes that can help in stoma management. A stoma nurse will also help a patient through the mental and emotional side of dealing with a stoma. Lifestyle aspects such as feeling uncomfortable wearing certain clothes may require some adjustment. Support groups such as www. bowelcanceruk. and can offer plenty of help and information. •

Peel-Easy makes stoma bag removal easy Peel-Easy assists with pain-free Bowel Cancer Awareness Month removal of aims adhesive dressings each April to increase or ostomy pouches. gentle, awareness of bowel The cancer and silicon-based formula completely raise funds towards treatment. dissolves adhesive. It’s drivenmedical by charities including  Effectively and painlessly Beating Bowel Cancer and Bowel removes adhesive and Cancer UK, aimingdressings to eliminate residue from the Bowel Cancer byskin 2050.

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06/03/2020 14:34


Plants for

Your Pain A

Ar thritis and joint pain can be a daily challenge, and conventional drug and surgery solutions have side effects. So could natural therapies be an option?

rthritis and joint pain can keep you from your everyday activities, including the adventurous ones, like going for a walk or a hike, to the mundane, such as loading the groceries from the car and into the kitchen. There are many different therapies for arthritis and joint paint, including disease-modifying anti-rheumatic drugs, biological treatments, janus kinase (JAK) inhibitors, over-the-counter painkillers, physiotherapy and surgery. However, given the chronic nature of pain caused by arthritis, patients are likely to attempt to manage their symptoms with alternative or complementary treatments when they are overwhelmed by side-effects or ineffective medication. Just how effective are these alternative and complementary natural therapies for arthritis and joint pain? Dear Doctor investigates.

Phyto-actives Phyto-actives are the active ingredient in traditional medicinal plants that give them therapeutic value. You may also know phyto-active medicine by the name Ayurveda, one of the world’s oldest medical systems. There isn’t much research about phyto-actives yet; however, a preliminary clinical trial in 2011 found that conventional and phyto-active treatments for rheumatoid arthritis had similar effectiveness. The conventional drug tested was methotrexate and the phytoactive treatment included an assortment of 40 herbal compounds. If you are thinking about pursuing phyto-active treatment for arthritis or joint pain, doctors recommend 22 dear doctor with dr Chris Steele

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that it not replace conventional care for now; however, it can be used as a complementary treatment. Speak to your GP about any alternative and complementary therapies you are using to give them a full picture of how you manage your health. This will help to ensure coordinated and safe care.

Aloe vera Aloe vera is one of the most commonly used herbs in alternative medicine. Known for its healing and calming properties, it’s popular for treating small skin abrasions or sunburns. You may

already have a bottle of aloe vera gel in the cabinet. But it’s not just sunburns that aloe vera is good for, it can also be applied topically to sooth aching joints. If you are planning to try aloe vera to treat joint pain, please note that it’s not a substitute for your regular treatments but can be used as a complement to other medication.

Boswellia Boswellia, also called frankincense, is praised by alternative medicine practitioners for its anti-inflammatory capabilities. It’s derived from the gum

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of boswellia trees indigenous to India. The herb is thought to work by blocking substances that attack healthy joints in autoimmune diseases such as rheumatoid arthritis. While there is promising evidence of boswellia in animal studies, it should be noted that no human trials have yet been undertaken.

Eucalyptus Topical forms of eucalyptus leaves, which are widely available in Western markets, are used to treat arthritis pain. Eucalyptus is also used in oral medication, and topical oil extracts are used for a variety of conditions. Eucalyptus leaves contain tannins, which may be helpful in reducing swelling and the pain that arthritis causes. Some patients find it useful to use a topical eucalyptus treatment, followed by a heating pad or hot water bottle to maximise the effects on swollen joints. Before using any eucalyptus treatment, be sure to test yourself for allergies. Put a small amount of the product on your forearm for a ‘patch test’. If there is no reaction in 24 to 48 hours, it should be safe to use.

Thunder god vine Thunder god vine is one of the oldest herbs used in Chinese medicine.

Extracts from skinned roots are known to suppress an overactive immune system, which makes it a popular alternative treatment for autoimmune diseases such as rheumatoid arthritis. If using, apply directly to the skin in topical form. Before trying thunder god vine treatments, speak to your GP about whether its right for you. Your GP may also be able to advise about best practices for finding and using treatments with thunder god vine, as if it’s made incorrectly it can be poisonous and cause serious side effects including nausea and hair loss.

Turmeric A yellow powder made from the turmeric

IMAGES © Shutterstock

Anti-inflammatory foods

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plant, turmeric is used in cooking to make curry. But it also has many health benefits, including anti-inflammatory properties. Lab studies on rats have found that turmeric may slow the progression of rheumatoid arthritis, and curcumin, the active ingredient in turmeric, has been used in folk medicine for years. Unlike other types of herbs listed here, it works best when consumed, rather than applied topically. Further study may show that turmeric and these other natural substances have their part to play in arthritis therapy, and alongside conventional medicines their use promise a wider range of options for sufferers in the future. •

• Tomatoes • Olive oil • Green leafy vegetables • Almonds and walnuts • Fatty fish • Berries • Turmeric • Broccoli • Avocados • Bell peppers • Mushrooms • Grapes • Dark chocolate

06/03/2020 17:12


The Invisible

Illness Ehlers-Danlos syndrome (EDS) is a rare condition, not always obvious to non-sufferers. So how does it affect those living with ‘the invisible illness’?


DS (Ehlers-Danlos Syndrome) is often thought of as an invisible disability, because it is not always obvious to non-sufferers. A genetic disorder of the connective tissue, conditions like EDS were described by Hippocrates in 400BC, but in modern times the syndrome was named after two physicians, Edvard Ehlers and HenriAlexandre Danlos, who identified it at the turn of the 20th century.


Ehlers-Danlos Syndromes are a group of rare conditions of the connective tissue, inherited from one parent or both, and causing pain and swelling of the connective tissues when completing the simplest of tasks. The connective tissues provide support for our skin and bones, as well as tendons and ligaments, so the condition usually causes problems for these parts of the body. The different types of the syndrome are often characterised by joints and skin that stretch further than

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normal, frequent dislocation of joints, and tissue fragility. There is often extensive overlap in the different types of EDS however, as they can often display the same symptoms, and diagnosis can be made difficult by misdiagnosis as hypochondriasis, depression or chronic fatigue syndrome.


EDS has recently been put in the spotlight by celebrities revealing what it is like to live with the condition. Jameela Jamil, actress and activist (shown right), announced that she had EDS on an Instagram post early in 2019. After telling followers she suffered with the condition, she then took to Twitter, saying that: “EDS is having to lie with your legs above your head every evening because of the pain and swelling from being on your feet,” and then asked followers, “what is your EDS experience?” Last year the Ehlers-Danlos Society presented Jamil with its Patient Advocate of The Year award.

STATS Though EDS is thought of as a rare condition, affecting something like one in 5,000 people, recent studies led by EDS sufferer Dr Joanne Demmler of Swansea University Medical School suggest that the true figure may be as high as 1 in 500 DEAR DOCTOR WITH DR CHRIS STEELE 25

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Actress Lena Dunham (shown below) also revealed she suffered with the chronic condition, after a paparazzi shot showed her walking with a cane. On Instagram she posted a photograph of herself using a cane and wearing her nightgown, writing: “This is what life is like when I’m struggling most with chronic illness. An Ehlers-Danlos Syndrome flare means that I need support from more than just my friends…so thank you, sweet cane!” She proceeded to say, “For years, I resisted doing anything that would make my physical situation easier, insisting that a cane would make things weird. But it’s so much less weird to actually be able to participate than to stay in bed all day,” showing her followers that accepting help such as using a cane is one way of managing the condition. The fact is that EDS cannot be cured, it can only be managed, so treatment is largely supportive in nature, including physical therapy and bracing.


While there are several variations of the condition, most types of EDS share common symptoms including an increased range of joint movement, or ability to stretch joints further than usual (joint hypermobility), fragile, stretchy skin, musculoskeletal pain, and scoliosis (curvature of the spine). While there is no cure for any of these symptoms, it is possible to manage their effects with lifestyle choices and

supportive equipment. In severe cases it will not be possible to engage in contact sports or heavy lifting, but in many cases a medical professional will advise lower risk activities such as swimming and pilates, as these help the subject to stay fit and healthy without putting too much strain on the joints. In some cases it has been suggested that oxygen therapy can increase energy levels, reduce pain,

TYPES OF EDS There are many sub-types of EDS, related to 19 different genetic disorders, and symptoms vary widely, from hyperflexible joints which can be prone to dislocation, to osteoarthritis (wearing of the joints), deformity of the fingers or spine, muscular pain, fragile skin which tears and bruises easily, skin folds, and pseudotumours.

IMAGES © Shutterstock

Hypermobile EDS This is the most common form of EDS. People with Hypermobile EDS experience loose, unstable joints that dislocate easily, and joint hypermobility. They may also experience fatigue and digestive problems, as well as issues with internal organs and dizziness. There are currently no tests to confirm this type of EDS definitively - it is usually diagnosed based on physical examination as well as looking at medical history.

Classical EDS This type of EDS usually affects the skin more than the joints. People with Classical EDS usually have extremely fragile skin that can break and bruises easily. Wounds are usually slow to heal and hernias can be common with this form of the condition.


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speed healing and combat infection, but for everyday relief medical orthoses—tailor-made garments with strategically placed elastomeric fabric panelling - may be used on various areas of the body including the upper and lower limbs, cranium, or spine, applying transitional forces to realign the body. This can be very helpful in many cases of EDS, and indeed in neurological conditions and in sports medicine applications. The repositioning of the limbs stimulates the body’s sensory systems and reprogrammes the brain, helping the muscles to operate in a new state of optimal alignment. With proper care, the orthosis can be worn most of the time and should last for many years (unless it is outgrown). The use of an orthosis in conjunction with an active therapy programme can often have a powerful and positive effect on the quality of life of an EDS subject, improving their biomechanical function and encouraging independence. For more information on EDS support and research, visit the website at or call the freephone helpline on 0800 907 8518. •

A Writer’s Story Author Angela Wheeler writes on her blog: “I look 32, something close to slender, healthy, fit - and I can’t move for the pain. I’m tired. The heavy soreness sucking me down. My bed is my uncomfortable partner. Invisible condition. Chronic pain. Ehlers Danlos III. Empty meaningless words, I wish I could flesh them out with the weight of my limbs, with the ache, so you could see it. Just once. Today is not a good day. Today is not a good day. My legs don’t work properly and my knees are like two overripe oranges, fit to burst, spongy, about to turn bad. And my shoulder has gone. A net of taut knots has replaced it, pulling me in the wrong direction. And my neck has a shard of painful rock driven into the side of it. And I look fine.”

Vascular EDS Vascular EDS is considered one of the rarer types and also the most serious. This type of EDS affects the blood vessels and internal organs. This can often lead to organs splitting open causing life-threatening bleeding. The symptoms similar to other types, however, include extra hypermobile fingers and toes and often unusual facial features. Often, Vascular EDS will cause thin skin with visible blood vessels, particular on the upper chest and legs. Kyphoscoliotic EDS This is also a rare type of EDS. The main characteristic of this syndrome is curvature of the spine, which starts in early childhood and often gets worse in teenage years. Sufferers often have elongated limbs and sunken chest.

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06/03/2020 14:38

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17/01/2020 14:24


Living with MS New figures have shown that Multiple Sclerosis is a more common condition than we realised. Here’s what you need to know


recent study shows that more than 130,000 people, 20 percent more than originally thought, are living with Multiple Sclerosis in the UK. MS is a disease that damages the body’s nerves and makes it harder for people to manage everyday tasks. It’s a lifelong condition that often causes serious disability, which is why this rise in numbers is worrying. The study, published by the charity the MS Society, suggests that the risk in figures is not due to an increased risk of the disease, rather an ageing MS population, better diagnostic methods and improved recording of medical data. The report suggests that many people diagnosed with MS are struggling to get the help and support that they need. Dr Susan Kohlhaas, Director of Research and External affairs at the MS Society says: “These figures confirm what we already suspected – that there are many more people living with MS in the UK than previously thought.” “While the NHS is getting better at diagnosing and recording cases of MS, unfortunately in many important ways, society is getting worse at supporting people with the condition. Compared to just a few years ago, fewer people with MS receive social care support and key welfare payments – and we hear far too many stories of


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people struggling to stay in work without the adjustments they need.” Public Health England (PHE) generated the new figures with the MS Society. “MS is relentless, painful and disabling and people with the condition desperately need to Government to step up and create an expanded and sustainable social carte system, overhaul the way benefits are assessed, and strengthen rights for employee support,” said Dr. Kohlhaas.


MS is one of the most common causes of disability among adults. The symptoms of MS vary very widely from person to person and can start one of two ways: either with individual relapses (attacks or exacerbations) or with gradual progression. The disease is commonly diagnosed in people in their 20’s or 30’s, although it can develop at any age. It is more common in women than in men.

The symptoms include:

IMAGES © Shutterstock

• Fatigue • Difficulty walking • Vision problems • Problems with thinking, learning and planning • Problems with balance • Numbness or muscle stiffness/ spasms. There is currently no cure for Multiple Sclerosis, but it is possible to treat and manage the symptoms. Treatment on the specific symptoms and difficulties that the person experiences, and can include managing relapses of symptoms with steroid medicine or reducing the number of relapses a person has with diseasemodifying therapies. Symptoms such as muscle spasms and stiffness are very common in MS and can usually be improved with physiotherapy. Techniques involved are stretching exercises to help ease restricted movement. If a patient’s muscle spasms are a severe cause of discomfort then doctors may prescribe muscle relaxers. People with the disease can also have severe mobility problems due to muscle

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spasms and weakness. Treatments for this can involve an exercise programme, medicines for dizziness and mobility aids such as wheelchairs or a walking stick.


The exact cause of MS is at the moment unknown. It is considered to be an autoimmune disease, which characterises a condition where the body’s immune system attacks its own tissues. In the case of MS, the immune system attacks the myelin sheath in the brain and spinal cord. This causes the myelin sheath becomes inflamed which can disrupt messages travelling along the nerves. This disruption leads to symptoms of MS.


When somebody close to you is diagnosed with MS, you may find yourself in the position of becoming their carer. Extra money from welfare benefits such as Carer’s Allowance or carer’s grants are often offered to families who suffer with MS, and you shouldn’t pass up these opportunities just because you are a member of the family. You may be just as much a ‘carer’ as a paid professional from outside the family. The changes which have to be made once a diagnosis of MS has been established can be gradual. The MS Society reports that many people have positive stories to tell, as relationships

have become stronger and deeper amid the struggles of MS. But practical issues can become a burden and issues such as depression and anxiety can become significant when symptoms become too much. The MS Society recommends keeping open channels of communication to support networks and medical professionals, regular medical can help MS sufferers and their families feel less isolated. There are additionally online resources that may help, such as online forums, and groups, as well as charities such as the MS society, who offer support to family members as well as people with MS. •

MS SUPPORT Sources of support and advice for MS sufferers and their carers incude: • THE MS SOCIETY, www.mssociety,

tel. 0808 800 8000 •CARERS UK,,

tel. 0808 808 7777

•JOINTLY, a website and app developed for carers:


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Use Your Smarts to

Save Your Heart

Can smart technology contribute to health monitoring? From fitness training to medical-grade heart monitoring, we find out about the latest go-go gadgets

IMAGES © Shutterstock


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aking control of your health can sometimes be as simple as making a New Year resolution to ‘detox’ or ‘get fit’, yet we all know that many gym memberships are wasted as enthusiasm wanes over the course of the months. But there’s a new wave of smart technology competing to bring health, fitness and medical monitoring under your control, using wearable devices connected to the best of artificial intelligence and cloud computing. Better health could be no further away than your smartphone. The wrist-worn smartwatch is by far the most popular type of ‘wearable’. From the Apple Watch to models from Garmin, FitBit, Huawei and many more, smartwatches usually connect wirelessly to a mobile phone or laptop so they can notify you of calls, messages, emails and social media alerts. But many are specifically designed to track fitness and health, displaying your heart rate, calorie consumption, step count, blood pressure and sleep patterns. Using a range of apps they can be programmed to monitor health goals such as weight loss and running targets, and in many cases they can be worn around the neck or clipped to a belt as an alternative to being worn on the wrist.


For swimmers, much of the same technology can be built into goggles. The Form Swim has a heads-up display showing metrics such as time, stroke count, calories and (using a compatible monitor) heart rate, and will all communicate back to a phone app. A headset from Modius sends electrical pulses to the vestibular nerve to influence your sleep patterns, while the stamp-sized Beddr SleepTuner sticks to your forehead and tracks breathing quality, oxygen saturation and movement to help you analyse sleeping problems. PowerDot 2.0 Uno works with an app to provide electrical stimulation of muscles to reduce pain and improve exercise recovery, while Whoop Strap 3.0 combines a wristband and an app to track workouts and help plan exercise and recovery programmes. Smart clothing such as the Hexoskin can offer built-in electrocardiogram and heartbeat monitoring, breathing rate and step tracking, and monitoring of load, fatigue and heart rate recovery – all while connecting by Bluetooth to your Apple or Android phone or tablet, while Nurrv Run’s sensor insoles track foot-strike, step-length, balance and more metrics to deliver a personalised report on your running style.

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But one product with perhaps the most potential for influencing the way patients can work with healthcare professionals is the AliveCor KardiaMobile, a smart electrocardiogram device which can capture an ECG in just 30 seconds, analyse it for signs of conditions such as atrial fibrillation, bradycardia or tachycardia using cloud-based artificial intelligence, and share information with your healthcare professional for more detailed analysis. Costing £99, the KardiaMobile is valuable in monitoring cases of atrial fibrillation, an irregular heart rhythm which can lead to stroke or heart failure. It can also monitor cases of bradycardia (slow heartbeat, which can lead to shortness of breath, chest pain, fainting and heart failure), and tachycardia (fast heartbeat, which can lead to stroke and heart failure). AliveCor developed an ECG app for the Apple iPhone in 2010, and refined this into a cloud-based artificial intelligence database and a credit card-sized sensor. The system has now been approved for use in the USA and Europe. The patient puts his fingertips on the sensor (which can be clipped to the back of a smartphone) and holds it to his ankle or knee for 30 seconds, and the ECG is displayed on the smartphone and can be e-mailed to a physician.

After about a month of product use, the software builds a heart profile of the specific user, a datadriven model that can detect problems, including how the electrical system within a heart is firing. Premium features such as cloud storage and security and medication tracking are available for £9.99 per month or £99 per year, and for professional applications, the KardiaPro platform enables doctors to monitor all their patients using Kardia devices, including for atrial fibrillation, providing a patient-by-patient dashboard of ECG data. The platform alerts doctors when a patient’s device detects an abnormality so they can read the a full ECG. The cloud-based platform can indicate signs of an oncoming stroke and can track patient risk factors, including weight, activity and blood pressure, analysing them using AI to alert doctors to potential issues. With doctors’ time becoming more precious (and expensive if you are a private patient), products like AliveCor KardiaMobile and other smart devices might be the way for all of us to help to monitor our own health and fitness, and get on with our lives instead of spending time in waiting rooms. •


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Your Heart and Digital Health With millions of people being affected by heart disease and even more at risk, it’s important to be proactive about your heart health. And with new advancements in technology, you can take your health into your own hands. AliveCor has created technology that is changing the future of healthcare. AliveCor’s KardiaMobile is a medical-grade ECG that fits in your pocket or on the back of your smartphone. In just 30 seconds, you can detect heart irregularities like atrial fibrillation, tachycardia, bradycardia and more. Thanks to modern technology, ongoing research and better accessibility to health services across the globe, the future of heart health has never looked better.

06/03/2020 14:48


Tooth Tech

for a Brighter Smile We may be some way off making visits to the dentist enjoyable, but technological strides are easing the pain of tooth care

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IMAGES © Shutterstock

ecent technological innovations have made visits to the dentist less painful and more effective— whether it’s for what they used to call a ‘scale and polish’ or serious surgery, digital developments offer more effective and comfortable treatment for everyone. Digital scanning, for instance, can produce high-definition 3D images inside the patient’s mouth, delivering low radiation imagery with exceptional diagnostic clarity. Accuracy in planning and treatment improves, hopefully reducing the number of follow-up visits required. For deeper imaging, digital X-ray systems can produce instant visualisations viewed using interactive software, so the dentists and patient can understand the condition with no delays to treatment.


Digital bite scanning system allows the dentist to have a better understanding of the dynamics of biting, chewing, speaking and other jaw movements, again offering more accurate treatment 38 DEAR DOCTOR WITH DR CHRIS STEELE

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PRINTING PARTS In dental labs, and increasingly in dentists’ own surgeries, 3D printing technology is being used to create dental models, aligners and night guards in a matter of hours rather than days, and 3D printing is also being used in the production of permanent crowns. and reducing follow-ups, while wireless, handheld scopes which enhance normal tissue fluorescence can help to detect abnormalities such as oral cancers. The dreaded drill can in some cases by replaced by a dental laser, which can be used to treat hypersensitivity, tooth decay, and gum disease, as well as being used in tooth whitening. Another alternative to drilling is air abrasion, useful when surfaces have to be minutely treated, and calming or nervous patients

who dislike the noise of the conventional drill. Operating microscopes and intraoral 3D imaging cameras can be used to give clearer diagnoses and better understanding of what is happening in the patient’s mouth on an external screen, so the days of ‘open wide and say aaahhh’ may be coming to an end, while a process known as JVA (Joint Vibration Analysis) uses sound recording software to interpret problems with jaw movement and to identify problems with biting forces. For cosmetic dentistry, ‘digital smile designing’ using graphic software to create images of the likely outcomes of procedures such as straightening, gap narrowing or implants, can reassure the patient before committing to a procedure, and they can even have a ‘trial smile’ manufactured to test out before deciding.


For nervous patients, a combination of a light mask and a headphone system delivering electromagnetic frequencies to interrupt the release of adrenaline and

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cortisol can have a calming effect, while even basic processes such as scaling, the process of removing plaque and tartar from teeth, are benefitting from technological improvements. Manual teeth scaling with a handheld scraping instrument was standard in the past, but modern dentists and hygienists are increasingly using ultrasonic scaling devices instead. These devices use ultrasonic vibrations to knock plaque and tartar off and away from the teeth, in a process which is at least as effective as manual scaling at removing tartar from tooth surfaces, and which can also work in shallow gum pockets that are shallow. The small tips of ultrasonic scaling instruments can also clear deposits from deeper pockets, and dislodge accumulated plaque and tartar by spraying them with coolant. Another advantage of ultrasonic scalers is that they introduce oxygen bubbles into deep gum pockets, disrupt the bacteria which thrive there. Faster than manual scaling, ultrasonic scaling is also better for weaker teeth; unlike manual scaling, which requires a scraping force to be effective and can cause damage to enamel, ultrasonic scaling has been shown to create less

tooth damage, and so is particularly suited to older patients where tooth enamel may be weak.


In the home, the app-connected ‘smart toothbush’ which monitors and corrects our brushing habits and offers different brushing modes, is expected to be a big hit of the 2020 consumer technology shows, while researchers in Pennsylvania State University are looking into “catalytic antimicrobial robots”, actually groups of tiny iron-oxide nanoparticles in a solution that can be controlled by magnets to scrape away at bacterial biofilms inside teeth. “Existing treatments for biofilms are ineffective because they are incapable of simultaneously degrading the protective matrix, killing the embedded bacteria, and physically removing the biodegraded products,” said Hyun Koo, one of the researchers of the study published in Science Robotics. “These robots can do all three at once very effectively, leaving no trace of biofilm whatsoever.” With other expected innovations such as long-distance examinations by ‘teledentistry’ and dentists learning using augmented reality, the future for our teeth has never looked so shiny. •

Check it’s a Cavitron® You deserve the best. Ask your dental hygienist about the most comfortable, effective hygiene treatment, see if they use Cavitron® – the world’s leading ‘ultrasonic scaler’.

What does it do? • Scaling - the process of removing plaque and other stubborn deposits from teeth • Ultrasonic - the advanced technology that makes the scaler tip so effective at ‘vibrating’ the deposits off your teeth

Why is it better? • More comfortable - the ultrasonic action is gentler than alternatives • Faster - its efficiency speeds up treatment • You’ll love the results

Take the comfortable route to a lifetime of healthy teeth

• Brush twice and floss at least once every day • Regularly visit your hygienist • Ask if your hygienist uses Cavitron® for maximum comfort and effectiveness • Ask if your hygienist regularly tests the wear of the Cavitron® tips (inserts) for maximum performance

Check it’s a

They’re your teeth and you need them. Check you’re getting the treatment you deserve!


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AND SHINE! We all know the importance of attending your dental practice for regular hygiene appointments. Clean, healthy teeth not only feel great, but also enable us to eat, speak and smile with confidence, whilst tooth decay and extractions can lead to pain and often bring the need for extensive dental treatment. Furthermore, poor oral health has been linked with systemic health conditions such as heart disease, stroke and diabetes.

“The beauty of the Cavitron® ultrasonic scaler is that it gets rid of hard deposits more efficiently which can make the treatment time shorter and more comfortable.”

“Having patients who are well informed and interested means we can have more meaningful discussions about the most effective treatment and ongoing care.”

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HOW TO GET THE WOW FACTOR! Oral hygiene advice: Julie Deverick, dental hygienist with over 30 years’ experience, and President of the British Society of Dental Hygiene & Therapy, says that above all, your dental hygienist and therapist should not only provide treatment in the surgery, but should also give you advice on how to look after your teeth and gums at home, as only a good, regular oral hygiene routine will ultimately keep them healthy and looking great.


when treatment is required, you want to know your clinician is using the best equipment. For hygiene care this is often an ultrasonic scaler, such as the Cavitron®. This equipment uses vibration to gently remove deposits from your teeth and is generally considered the most efficient and comfortable way to give a really deep clean, remove stains and restore oral health.


your clinician should always check that they are using the techniques and instruments that suit your particular condition, so they can deliver the best quality treatment. For instance, the Cavitron® has a number of different ‘inserts’ or tips that are used for different areas of the mouth, and Cavitron® ultrasonic scalers come with wear guides, to ensure clinicians know when inserts are worn – worn inserts decrease the efficiency of the treatment you receive, making it longer and less effective.

Julie says that dental hygienists and therapists find that the better informed their patients, the more successful they are at maintaining healthy teeth and gums. She said, “As hygienists and therapists, part of our role is to inform patients about the treatment they are receiving. Having patients who are well informed and interested means we can have more meaningful discussions about the most effective treatment and ongoing care.”

So next time you visit the hygienist, be open, ask questions and give feedback on the treatment you have received. If you experience sensitivity, let your clinician know. Find out about the treatment they’re planning and make sure both you and they are satisfied that it’s right for you.

To find out more about the Cavitron® and Smart Scaling, visit or speak to your hygienist.

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21/01/2020 15:09



the Myths, the Facts With the rapid global spread of a new coronavirus from China, how will our health ser vices cope, and will we have to get used to a world with COVID-19?


n January 2020, health workers discovered a new coronavirus spreading from Wuhan, China. Eventually named COVID-19, the progress of the virus prompted what might well be described as a worldwide panic. Tallies of the infected grew rapidly, and though in most cases the effects of the virus were mild and short-lived, there were instances of deaths, usually among older or more vulnerable patients. But this wasn’t exclusively the case, as there were also reports of deaths among medical staff. With China undertaking emergency measures including travel restrictions to stop the spread of the disease, cases of cruise ship passengers being confined to ship, medical supplies such as face masks selling out, and large sports, arts and social events being cancelled all over the world for fear of spreading the infection, it began to look as if nothing could stop COVID-19. But was the fear and panic justified? As scientists tried to establish how the virus was spread, and worked on a vaccination which they admitted could take the best part of a year to perfect,


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COVID-19 began to look like a worse threat than previous infections such as SARS (Severe Acute Respiratory Syndrome, which broke out in 2002). So researchers are asking a question that has huge implications for public policy: What will a world be like with COVID-19 circulating permanently in the human population? That may seem like a dark fate to consider, but “it’s not too soon to talk about this,” said Dr Amesh Adalja, an infectious disease specialist at the Johns Hopkins Centre for Health Security. “We know that respiratory viruses are especially difficult to control, so I think it’s very possible that the current outbreak ends with the virus becoming endemic.”


Coronaviruses make up a large family of viruses that can infect birds and mammals. Currently, there are five coronaviruses circulating in human—the one that began circulating in January joining four others, including OC43 and 229E that were discovered in the 1960s as well as HKU1 and NL63 that were discovered after the 2003-2004 SARS outbreak. It’s not known how long these


First described in detail in the 1960s, the coronavirus gets its name from a distinctive corona or ‘crown’ of sugary proteins that project from the envelope surrounding the nucleus. The virus’s makeup is encoded in the longest genome of any RNA-based virus—a single strand of nucleic acid roughly 26,000 to 32,000 base-pairs long. There are four known genuses in the family, named Alphacoronavirus, Betacoronavirus, Gammacoronavirus, and Deltacoronavirus. The first two infect mammals, including bats, pigs, cats and humans. Gammacoronavirus mostly infects birds such as poultry, while Deltacoronavirus can infect both birds and mammals.

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Did you know?

IMAGES © Shutterstock

Coronaviruses make up a large family of viruses that can infect birds and mammals. Including the outbreak of COVID-19 in Wuhan, there are five coronaviruses currently circulating in humans.

viruses had existed in people before scientists noticed. SARS (severe acute respiratory syndrome) was caused by a coronavirus known as SARS-CoV, but after two outbreaks in 2002 and 2004, there have been no known cases. The four current coronaviruses are responsible for an estimated 25 percent of all colds, with OC43 and 229E more occurring more often than the others. While all four coronaviruses can cause pneumonia and sometimes death, this is rare enough that good studies on the matter aren’t available. In one of the few studies on strains of coronavirus, researchers measured the infection rates of OC43 and 229E during four winters (1999-2003) in Rochester, New York, among some 3,000 participants, including healthy outpatients, adults with cardiopulmonary disease and patients hospitalised with acute respiratory illnesses. The study found that among healthy patients, the most common symptoms were a runny nose, cough and congestion lasting about 10 days. No one in the study

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even experienced a raised temperature. “For the most part, they cause common-cold-type symptoms,” said Richard Webby, an influenza expert at St. Jude Children’s Research Hospital. “Maybe that is the most likely end scenario if this thing becomes entrenched.” However, among patients with weakened immune systems, like the very young, very old or already ill, the picture is bleaker. The study found that intensive care was required for 15 percent of those infected with OC43 and 229E, and about one-third of the patients admitted to the hospital with these infections developed pneumonia. One of the 229E patients and two of the OC43 patients died.


Drug makers are already working on a vaccine to counter the spreading COVID-19 coronavirus. However, such a vaccine will most likely take years of development and testing, as well as almost £1 billion in funds, before it can be deployed. “For a new coronavirus vaccine to be

By the numbers Current estimates put the fatality rate of COVID-19 at around two percent, although that’s almost certainly an overestimate, since mild cases of the disease aren’t being counted. Here’s how that stacks up against other illnesses:

The seasonal flu has a 0.1% fatality rate 1917 Spanish influenza had a 2.5% fatality rate SARS had a 10% fatality rate MERS had a 37% fatality rate Ebola has a 50% fatality rate


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For the most part, [coronaviruses] cause commoncold type symptoms. —Richard Webby, influenza expert at St. Jude Children’s Research Hospital

available for large populations, I would say it’s a matter of two years minimum,” said Dr Stanley Plotkin, who has been involved in vaccine research since 1958 and played a big role in developing the rubella vaccine in the 1960s. Research on a coronavirus vaccine has a lot of value for public health, but it won’t yield a quick cure. And this may not be enough of an incentive for pharmaceutical companies that will have to commit large amounts of money to research that could fall short, or that might only yield a vaccine after the current outbreak has ended. Governments and non-profit groups will open their wallets when outbreaks dominate headlines, but that funding has historically withered when attention dies down. Such was the case in previous coronavirus outbreaks, including SARS in 2002-03 and MERS (Middle East Respiratory Syndrome) in 2012. In those cases, funding and resources for a vaccine ran out after the viruses were contained. Continuing such research could have helped fight the current outbreak. However, if coronaviruses begin to infect enough people regularly, there will be a greater business incentive to develop a vaccine and other countermeasures.


It’s possible that COVID-19 becomes a fifth community-acquired coronavirus, eventually settling down to something like the other four already circulating. However, the other possibility is that it follows the pattern of the seasonal flu. Viruses can’t tolerate high heat and humidity, which is why infections are less 44 DEAR DOCTOR WITH DR CHRIS STEELE

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NHS advice

If you are worried about coronavirus, here’s the NHS advice. If you have travelled from China, Thailand, Japan, Republic of Korea, Hong Kong, Taiwan, Singapore, Malaysia, Macau, Italy or Iran to the UK in the last 14 days you should immediately:


Stay indoors and avoid contact with other people as you would with the flu.


Where possible, contact a friend, family member or delivery services to carry out errands on your behalf or to take children to school.


Follow this advice even if you do not have symptoms of the virus.

2 3 

Call NHS 111 to inform them of your recent travel to the area.

In Scotland phone your GP or NHS 24 on 111 out of hours. If you are in Northern Ireland, call 0300 200 7885.


Report any symptoms such as cough, fever or shortness of breath.


Do not use public transport or taxis until 14 days after your return.

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✔ Wash your hands with soap and water often—do this for at least 20 seconds ✔ Always wash your hands when you get home or into work ✔ Use alcohol-based hand sanitiser gel if soap and water are not available



prevalent in warmer, humid months. If the new coronavirus follows this pattern, the containment efforts plus the arrival of summer should drive infections to near zero. But like the flu, that doesn’t mean it’s done. “One scenario is that we go through a pandemic,” said Stephen Morse of Columbia University’s Mailman School of Public Health, an epidemiologist and expert on emerging infectious diseases. “Then, depending what the virus does, it could quite possibly settle down into a respiratory illness that comes back seasonally.” Could COVID-19 mutate like the flu, causing new infections each year? Researchers aren’t sure yet. The genome of the novel coronavirus consists of a single strand of RNA. Microbes with that kind of genome mutate notoriously quickly. However, the coronavirus may not change in a way that alters its function, said biologist Andrew Rambaut of the University of Edinburgh, who has been analysing the genomes of the COVID-19 from dozens of patients. “It is transmitting quite well already so it may

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not have to ‘evolve’ to be endemic.” The toll of a seasonal-flu-like coronavirus also depends on ‘herd immunity’—which is again scientifically uncertain. Exposure to the four endemic coronaviruses does produce some immunity, but not permanently. “There is some evidence that people can be re-infected with the four coronaviruses and that there is no long-lasting immunity,” Dr Susan Kline, an infectious disease specialist at of the University of Minnesota. “Like rhinoviruses [which cause the common cold], you could be infected multiple times over your life. You can mount an antibody response, but it wanes, so on subsequent exposure you don’t have protection.” Subsequent infections often produce milder illness, however. Since COVID-19 is new, “this first wave will be particularly bad because we have an immunologically naive population,” Adalja said. Future waves should pass by people who were exposed (but not necessarily sickened) this time around, Morse said, “but that assumes this virus doesn’t develop the tricks of flu,” which famously tweaks the surface molecules that the immune system can see, making

✔ Cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze ✔ Put used tissues in the bin straight away and wash your hands afterwards ✔ Try to avoid close contact with people who are unwell

{DON’T} ✘ Rely on face masks—they’re unlikely to block a virus and can give you a false sense of security ✘ Do not touch your eyes, nose or mouth if your hands are not clean

itself invisible to antibodies from previous exposures. If that sounds like a bit of a scientific shrug of the shoulders, time alone will tell if the current coronavirus scare turns into a worldwide health problem, or, like other widely publicised outbreaks before it, it quickly becomes just another in health flash in the pan. • DEAR DOCTOR WITH DR CHRIS STEELE 45

06/03/2020 14:52

HAVE YOU A PROBLEM WITH DRINKING? ONLY YOU CAN DECIDE! To answer this question, ask yourself the following questions and answer them as Honestly as you can. 1. 2.

Is drinking making your home life unhappy? Does your drinking make you careless of your family’s welfare?


Have you lost time from work because of drinking?


Has your ambition decreased since drinking?


Is drinking jeopardising your job or business?

10. Have you ever felt remorse after drinking? 11. Are you in financial difficulties as a result of your drinking? 12. Do you crave a drink at a definite time daily?


Do you drink because you are shy with other people?


Is drinking affecting your reputation?

14. Does drinking cause you difficulty in sleeping?


Do you drink to escape from worries or trouble?

15. Do you want a drink the next morning?


Do you drink alone?

16. Do you drink to build up your confidence?

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13. Do you seek an inferior environment when drinking?

17. Have you ever had a complete loss of memory as a result of drinking? 18. Has your doctor ever treated you for drinking? If you have answered “YES” to any one of the questions, there is a definite warning… If you have answered “YES” to any two, the chances are that you have a problem… If you have answered “YES” to three or more, you almost certainly have a problem…

“THE ONLY REQUIREMENT IS A DESIRE TO STOP DRINKING” Take action now and give us a call on 0800 917 7650… We are here to help!

06/03/2020 17:18


Do You Know Your Limits? We all know that alcohol is safe is used within healthy limits— but what are those limits and how do they relate to real life? Dear Doctor presents a simple guide.

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t’s perfectly normal to enjoy drinking alcohol in moderation, and health services give us guidance on safe limits in terms of units. But many people are confused by what these units mean and how they work. Dear Doctor has put together this simple guide which should help you to keep within recommended alcohol consumption limits. Alcohol units are simply a way of keeping track of the amount of alcohol you consume and correlating it to how much will be left in your blood after a certain amount of time. For example, 14 units of alcohol can be regarded as the equivalent of 6 pints of average-strength beer, or 10 small glasses of lowstrength wine. Men and women are advised not to drink more than 14 units a week, according to the NHS. Medical professionals also recommend that you spread your drinking over three or more days if you regularly drink as much as 14 units a week. If you want to cut down, a good way to do so is to have several drink-free days each week. Apps such as Drink Free Days can help you do this. Knowing your limits is important. If you find that you are often struggling to function without alcohol, you need it to socialise, or you crave it often, it is worth going to see your GP for additional help. •


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04/03/2020 09:24


The Clean

Cosmetics Movement

Do you know what’s in your makeup? Fewer than one in five chemicals in personal care products have been assessed for human and environmental safety


n average, women use 12 personal care products each day and men use six. But as the clean-living movement has swept through our cupboards and cabinets, the next logical step is taking a closer look at what we’re putting on our face. Our makeup is filled with chemicals and ingredients that we wouldn’t want in our eyes or on our lips if we knew about it. Natural and organic makeup had a poor reputation for many years for being a sub-standard alternative to regular eyeliner, nail polish and foundation choices. But recently, the clean beauty industry has really stepped up its game, and now there are non-toxic alternatives that work just as well or even better.

READ THE LABEL When looking for clean alternatives to your current mascara and lipstick, it’s better to read the ingredients list than the marketing language. Makeup that’s truly natural won’t include synthetic preservatives, artificial colourants, artificial fragrances or heavy metals. It’s also likely to cost more—clean beauty

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Did you know? Toxic makeup is nothing new. The ancient Greeks used heavy metals on their skin, and Egyptian queens wore black kohl eyeliner that was made with lead.

products are made with high-quality ingredients and don’t have cheap fillers. Plus, they’re usually manufactured in smaller batches, rather than massproduced.


Your skin will absorb whatever you put on it, whether it’s an artificial fragrance that could lead to irritation and dryness, or nourishing and nutrient-rich natural moisturiser like cocoa butter. One key rule for beauty products is straightforward and simple to remember: if you can’t eat it, don’t wear it. Liquid foundation, for instance, may have cocoa butter or various nutrientrich oils to provide a smoother, more youthful look. Extracts of white tea, grapes, apricots, and pomegranate seeds provide antioxidant protection and may inhibit

collagenase and elastase, two enzymes that break down the integrity and elasticity of the skin. And opting for clean products produced in smaller batches from companies that prioritise ecofriendly production can help alleviate your personal contribution to the environmental burden. Organic beauty options aren’t just good for you—they make the environment around you beautiful as well. •

AVOID THESE INGREDIENTS • Formaldehyde • Phthalates • Ingredients listed as “fragrance” • Toluene • Aluminum • Benzoates • Isopropyl Alcohol • Parabens • Paraffin • Propylene Glycol • Sodium lauryl sulphate


06/03/2020 14:53


Healthy & Tasty

Chicken Ramen Bowl


here’s a lot of advice out there on how to eat healthily, and if we’re being honest, it can sometimes feel like too much to think about, particularly when you’re running into the house after a long day at work to a pile of unfinished chores and obligations—and you’re hungry on top of everything else. But in reality, healthy eating doesn’t have to be a chore. What’s important is that you stick to the basics and find recipes that work for you. Try this healthy chicken ramen bowl recipe.

Healthy Chicken Ramen Bowl If you’re casting about for a simple and tasty meal to make on weeknights, look no further than this healthy chicken ramen bowl. You only need one pot and around 20 minutes—before you know it, you’ll be slurping up this perfect balance of noodles, veggies, protein and broth.

Ingredients 2 eggs 4 cups chicken broth 1 1/2 tsp. soy sauce 2 chicken breast fillets 6-8 oz. ramen noodles 1 cup sliced cabbage 1 cup shredded carrots 2 green onions, chopped Hot chili oil to taste

Instructions 1. Add whole eggs (shell on) to a medium size saucepan and cover with enough water to cover eggs by one inch. Bring to a boil, remove from heat. Cover saucepan and let sit for seven minutes. Remove eggs with tongs or a slotted spoon and submerge in a bowl of ice water. Set aside. This process will yield soft set eggs which are typically used in ramen bowls. If you prefer you can hard boil eggs instead. 2. Meanwhile, in a separate soup pot add chicken broth and soy sauce and bring to a boil. Add the chicken breasts and continue cooking until thoroughly cooked (about eight to ten minutes). Remove chicken breasts from broth, let cool to touch and shred with two forks. Return shredded chicken to broth. 3. Add ramen noodles to pot with broth and shredded chicken. Cook noodles according to time indicated on package (around three to five minutes). Add additional chicken broth or water as necessary. Add salt/pepper to taste. 4. Peel and halve eggs, set aside. 5. Remove soup from heat. Add cabbage and carrots. Serve immediately. Garnish with one egg half and chopped green onions. Drizzle chili oil according to taste.


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Indomie prawn single.indd 1

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Arla LactoFREE.INDD 1

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H T i W T U H YOUR G **



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Do You Need to

CUT OUT DAIRY? Around 65 percent of the human population have some form of lactose intolerance. Dear Doctor has put together the ultimate guide to help you understand what it is, why it happens and how to manage it.


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n the UK, between one and two in every ten people suffer from lactose intolerance. While it a very common condition, it does take some getting used to and requires certain dietary and lifestyle changes. Lactose intolerance is a digestive problem where the body in unable to digest lactose, a sugar found in dairy products. In serious cases, those with lactose intolerance need to cut a whole range of foods out of their diet, including milk, cheese, cream and butter. People with lactose intolerance do not produce enough lactase, an enzyme produced in the gut which breaks down the sweet sugar lactose found naturally in the milk of most mammals. Without sufficient lactase, lactose stays in the digestive system, producing symptoms such as stomach pains, bloating and diarrhoea.


Depending on why the body is not producing enough lactase, lactose intolerance may be temporary or permanent. Some people may be able to have a small amount of dairy products, such as a small amount of milk in their tea or coffee, without it triggering any symptoms. Some more severe cases, however, may trigger symptoms even with the tiniest amount and therefore need more careful management. Lactose intolerance can develop at any age, although is most commonly experienced between the ages of 20 and 40. It can, however, affect babies and young children. Some common symptoms of lactose Intolerance are as follows: • Flatulence • Diarrhoea IMAGES © Shutterstock

• A bloated stomach • Stomach cramps • Stomach rumbling • Nausea • Constipation

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The symptoms’ severity depends on the amount of lactose you have consumed and the overall sensitivity of the intolerance.

Lactose intolerance and coeliac disease


The symptoms of lactose intolerance can be uncomfortable and have an effect on your quality of life if unresolved. Certain symptoms can also be similar to other conditions, such as irritable bowel syndrome and milk protein intolerance, which is a reaction to the protein in cow milk. Because of this, it is important to see your GP for a diagnosis before proceeding to remove any dairy from your diet. It is important to remember that lactose intolerance is not the same as a milk or dairy allergy. This is because food allergies are caused by an immune system reaction to a certain type of food, usually causing symptoms involving a rash, itching or breathing problems. The main difference is that if you have consumed something you are allergic to, even the smallest bit will be enough to trigger a reaction, while lactose intolerance usually allows a small amount of lactose without triggering any problems. This does, however, vary from person to person.

When people are first diagnosed with coeliac disease, a gut disease involving intolerance to the gluten found in wheat, the lining of the gut often has damage caused by eating gluten, which can mean that the body does not make enough lactase, what enzyme is made does not work properly, or the subject may not be able to digest lactose. This can cause uncomfortable gut symptoms which are often similar to the symptoms of coeliac disease. Once the subject is following a gluten free diet, the gut is able to heal and they are able to digest lactose again. Therefore, lactose intolerance is usually temporary. Following a gluten free diet means that most people with coeliac disease do not develop lactose intolerance.


Unfortunately, there is no cure for lactose intolerance—however, cutting down on food and drink that contains lactose can help control the symptoms. You can switch these foods with lactose-free alternatives such as lactose-free cows’ milk and soya milks, yoghurt and cheeses. You can also incorporate naturally dairy-free foods into your diet, such as rice, oats, almond, hazelnut, coconut, quinoa and potato milks. You may also find it helpful to take calcium and vitamin D supplements. There are also lactase substitutes, which are drops or tablets that you can take with meals to improve your lactose digestion.


06/03/2020 17:25



Lactose helps your body to absorb a variety of minerals that are important for the development of strong and healthy bones. Therefore, lactose intolerance can sometimes cause complications as insufficient minerals are being absorbed. This may result in an unhealthy amount of weight loss and increases the risk of conditions, such as:


Malnutrition happens when the food you eat does not give you the nutrients essential for a healthy diet. This can result in fatigue or increased risk of mental health issues. It is easy to avoid, however, as those with lactose intolerance in the Western world have a range of foods available to them to ensure that they are getting the nutrients they need without consuming any lactase. There are simple ways to get around these mineral deficiency conditions, for example, plenty of non-dairy foods such as juices and breads include calcium. Bony fish such as sardines or whitebait have a high level of calcium, and greens such as kale and broccoli are

additionally very helpful in ensuring the body absorbs enough calcium.


A disease where your bones become very thin and weak which increases the risk of breaking and fractures – in more severe cases, ribs can break when sneezing or coughing. It usually develops slowly over several years and is often only diagnosed when bones actually start to break. Osteopenia, a low bone-mineral density, is less likely to lead to breaking bones, and is usually found in people

over 50, although it is possible to get it younger if it is a complication due to lactose intolerance for example. Regular exercise is essential for both conditions, and a prevention tool which is especially important for those with lactose intolerance to ensure it does not become a complication. There are also certain weightbearing and resistance exercises you can do which are specially designed to help prevent the conditions. It is also a good idea to take supplements, such as a vitamin D tablet, every day to ensure your body is getting the amount that it needs. •

Arla LactoFREE Arla LactoFREE offers natural dairy goodness* without the lactose. The lactose is removed using a special process, which successfully maintains the same level of protein, vitamins and minerals found in ordinary dairy — meaning it doesn’t lose its benefits and great taste. If you find that you’re experiencing gastro-intestinal discomfort after consuming foods that contain lactose, then you may benefit from switching to LactoFREE products** You’ll find the full range of LactoFREE products including milk drink, cheese and yogurts in the chilled aisle at major retailers. *All LactoFREE products are natural sources of calcium, phosphorous and protein. LactoFREE milk drink and LactoFREE Cheddar are also sources of Vitamin B2 and B12. Vitamin B12 contributes to the reduction of tiredness and fatigue. Calcium is needed for the maintenance of normal bones. Protein contributes to growth in muscle mass **Easier Easier to digest for those who may have gastro-intestinal discomfort caused by lactose intake. 56 DEAR DOCTOR WITH DR CHRIS STEELE

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06/03/2020 17:15



The Benefits

of Coconut Water Coconut water has become popular in recent years due to scientifically backed claims that it is great for your health. So what’s inside the shell?


oconut water is not only refreshing and tasty, but it also has a whole array of health benefits that have come to light in recent years. It’s loaded with important nutrients and minerals, helping many boost their immune systems and live a healthier lifestyle. Here are some of the main benefits of drinking coconut water.

HEART HEALTH Coconut water may actually be helpful in reducing heart disease risk. A study by the National Institutes of Health found coconut water had reduced the blood cholesterol and triglycerides in those that drunk it. While scientists think that a great deal of coconut water will need to be consumed to reduce your risk of heart disease to a great level, the risk will still be lower after drinking coconut water regularly.


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ANTIOXIDANT PROPERTIES Coconut water contains antioxidants that can protect your cells from damage. Free radicals are unstable molecules produced in your cells, which can increase risk of disease. More free radicals are produced in response to stress or injury, and when this happens on a regular basis, your body enters a state of oxidative stress, thus damaging your cells and increasing your risk of disease. Studies have found the coconut water can reduce levels of oxidative stress, which strongly suggest that it contains powerful antioxidants that work to reduce production of free radicals.


Coconut water is considered to be the perfect drink for restoring hydration after exercising. When we exercise, electrolytes are lost, minerals that play important roles in the body such as

maintaining fluid balance. It is thought that coconut water can help replenish electrolytes quickly and effectively after exercise.

HEALTHY SOURCE OF HYDRATION Coconut water is very low in calories and carbohydrates, and is therefore a great source of hydration if you are looking to go on an exercise regime.

CONTROLS BLOOD PRESSURE Coconut water may actually be able to help lower blood pressure levels and potentially decrease the risk of a blood clot forming in your arteries. Studies have shown that in people with high blood pressure, coconut water improved blood pressure in 71 percent of participants. Coconut water is often described as more refreshing and enjoyable than regular water, and while it’s at its best when it comes directly from the coconut, you’ll find it stocked in many food and health stores in a form without without added preservatives – check the label for details, and enjoy! •


06/03/2020 15:09


Keeping an Eye

on Folates

Our eyes are complex organs, in need of careful treatment and maintenance. So what is the role of folates in keeping them sparkling and healthy?


e all know that our eyesight is important. Without it, life can be a real challenge, and while there are plenty of options open to those of us who struggle to see well, from cataract surgery to laser sight correction, it pays to do all you can to prevent eye problems early in life.

Eat Well Good eye health is certainly very dependent on what you eat. Making sure you give your body all of the essential nutrients you need for 58 dear doctor with dr Chris Steele

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maintaining good vision is the ideal way to start. Nutrients such as omega-3 fatty acids, lutein, zinc and vitamins C and E can all help ward off age-related eye problems. Particularly good foods that help with eye health include green leafy vegetables such as spinach and kale, as well as oily fish, eggs, nuts and beans. Certain nutrients help maintain proper eye function as well as protecting your eyes from harmful lights and participating in reducing the risk of AMD (age-related macular degeneration).

Nutrients Your Eyes Need Even today, deficiencies in micronutrients are still widespread among young and old and frequently cause illness. If the deficiency is not treated, costly operations or therapies will only be effective to a certain extent or for a short time. A diminished quality of life caused by impaired vision is an enormous problem for the affected person, not to mention a burden on the entire healthcare sector. Vitamin A is essential for your

06/03/2020 15:09



IMAGES © Shutterstock

You don’t have to instantly write off problems of ageing eyes as normal. Folate supplements can be essential in reducing the risk of AMD and maintaining your healthy vision as you age, and maintaining a healthy weight can also help to protect your vision from the effects of ageing. This is because being overweight affects blood pressure and increases risk of diabetes, which both often correlate with glaucoma and diabetic retinopathy.

eyes’ light-sensing cells, known as photoreceptors. If the eyes do not get enough vitamin A, you may experience night blindness, dry eyes and other severe eye-related conditions. In fact, vitamin A deficiency is one of the most common cause of blindness in the world. The primary source of vitamin A in the human diet is beta carotene, a type of plant pigment called a carotenoid that exists in many colourful fruits and vegetables. When carotenoids ae consumed, the body converts the pigments into vitamin A. Antioxidants such as lutein and zeaxanthin are not so widely recognised, however they can play an important role in your eye health. They function as a natural sunblock and protect your eyes from harmful blue light. Studies have correlated the intake of these antioxidants to be proportional to the amount in your retina. Omega 3 fatty acids can benefit

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those with dry eye disease. Deficiency in this particular nutrient can impair vision even in children. While Omega 3 fatty acids can help dry eye diseases and reduce the risk of diabetic retinopathy, it doesn’t necessarily provide an effective treatment for AMD. Alpha tocopherol, a form of vitamin E with particularly powerful antioxidant properties, can combat free radicals, which damage tissues throughout the body including proteins in the eye. This damage can result in the development of cloudy areas called cataracts on the lens. Some studies have shown that vitamin E can prevent cataracts and improve lens clarity, though others question whether it can slow the progression of cataracts.

FOLATE STORY It has been found that folate, or vitamin B9 as it is also known, reduces the risk of glaucoma, which can cause blindness and severe visual impairment. Folic acid is a man-made equivalent of folate and vitamin B9. Their importance was first recognised by English haematologist Lucy Wills in India in the 1930s. She examined pregnant women with different eating habits and discovered that diets deficient in certain foods caused changes in the overall health revealed in blood tests. She found that both mother and child could be helped with a yeast extract, and in later years, the folates contained in the extract were identified and synthesised. The function of folates is not entirely understood, but they are responsible for transporting basic chemical building blocks in plants, animals and humans. These building blocks are required most notably in

growth phases (pregnancy) but also later in all of the organs. Folates are converted as required in many reactions controlled by enzymes, and are extremely important for proper functioning of the organism. The concentration of folate varies greatly in individual organs, with three different organic receptors playing a part in transporting folates through membranes such as the blood/brain barrier. The delivery system is quite sophisticated, and so can easily be disrupted by folate deficiency. When deficiencies are not treated, they often cause chronic diseases or deformities during the growth phase, such as spina bifida. The human organism can’t synthesise folates, so has to meet its needs through diet or supplementation. While foods with high folate content include green vegetables, eggs, milk and animal, food folates all exist in a


06/03/2020 15:10

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Sunny Sense

Sunglasses shouldn’t be worn constantly, as they can block healthy light frquencies and cause eye strain and headaches


Studies have repeatedly shown that smoking increases the risk to your eyes. For example, it increases risk of age-related macular degeneration (AMD), cataracts, glaucoma and diabetic retinopathy and Dry Eye Syndrome. Smokers were found to be three to four times more likely to suffer from AMD than non-smokers.

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reduced form and are very susceptible to oxidation—in other words, a large proportion is lost during storage and cooking. Dietary folates can also be polyglutamated (combined with glutamic acid), which makes conversion during digestion necessary. The folic acid often used in supplements is a stable, oxidised form, of which only trace amounts are found in nature. Certain dietary supplements also provide additional intake of zinc and riboflavin which are minerals that help retain healthy vision. Vitamin B is essential for supporting normal homocysteine metabolism in the eye— this is because healthy eyes require substantial amounts of energy and oxygen.

BEAT BAD HABITS Many people overlook the importance of protective eyewear. While we are so used to being able to see well, it is often the case that we forget how vital protective eyewear can be, especially in

certain scenarios. Sunglasses for example, are not usually considered as a safety precaution, rather a fashion accessory that provides comfort on sunny days. However, the right pair of sunglasses can actually massively protect your eyes from the sun’s ultraviolet rays, especially if you are spending a lot of time outside. In fact, too much exposure to the powerful UV rays hugely increases your chances of cataracts and AMD. It is important to choose a pair of sunglasses that actually work to protect your eyes, rather than those that are purely made for fashion purposes. UV protection sunglasses can be a bit more expensive, however they are worth it. If you use hazardous materials at work or even at home, protective eyewear is essential. Jobs such as those in construction or manufacturing often require employees to wear protective goggles, and damage to your eyes can also be caused by hot oil when you are cooking. • DEAR DOCTOR WITH DR CHRIS STEELE 61

06/03/2020 15:10


Seeing Stars Cataracts are ver y common—the main cause of impaired vision worldwide. In England and Wales, it is estimated that around 2.5 million people aged 65 or older have some degree of visual impairment caused by cataracts


or years, Rob felt like he was swimming underwater. His vision had become so poor that he couldn’t do basic things like reading or driving. A cataract was clouding his eyesight, but it had developed slowly over the course of several years, and Rob hadn’t realised what was happening. At first, he found he had a hard time reading in low light—but that seemed to him like a normal aspect of ageing, so he never had it checked out. By the time Rob did visit a doctor, his cataracts

62 dear doctor with dr Chris Steele

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had developed to such a point that everything was dull and fuzzy. He was told by an optician that he would need cataract surgery, a straightforward procedure in which the blurred and clouded lens is removed and replaced with a clear artificial lens. The day after the procedure, Rob reported waking up to astonishing results. “Everything looks so different,” he reported. “The blinds had bold pink colours that I never saw on them before. I thought, are they supposed to be so colourful? Then, I looked outside my kitchen window and perched on

What are the symptoms of cataracts?

• Blurred, misty or cloudy vision • Difficulty seeing in dim or very bright light • Bright lights may be dazzling or uncomfortable to look at • Colours may look faded or less clear, with a yellow or brown tinge • Double vision •

Seeing haloes (circles of light) around bright lights, such as car headlights or streetlights

06/03/2020 15:11



Cataracts are the leading cause of blindness in adults.

If you or a loved one do develop cataracts, there’s no need to worry— cataract surgery is the most routine surgery performed in the UK. If you start to develop any of the symptoms— blurred, misty or cloudy vision; difficulty seeing in dim or very bright light, or seeing haloes in bright light;


Source: WHO

the roof behind our house was a bird! I could see it in such detail.” Rob is among the 300,000 people in the UK whose vision problems are solved with cataract surgery annually. Cataracts affect an estimated 30 percent of people ages 65 years or older. It can be hard to spot developing cataracts at first, but it’s important to learn to recognise the signs.

IMAGES © Shutterstock

CATARACT BASICS The lens of the eye is mostly made up of protein and water. This protein is structured in a very precise way, to keep the lens clear and allow light to pass through. However, as we get older, some of the protein can begin to gather together, causing cloudiness in a small area of the lens. This is a cataract, and without treatment, it can continue to grow, impacting more of the lens and causing the symptoms to become worse. Cataracts can rob you of your vision; in fact, they are the leading cause of blindness in adults. While there are certain practises that may reduce the risk of developing cataracts, including healthy eating, protecting eyes from the sun, abstaining from smoking and excessive alcohol, and exercise—if cataracts do develop, there is no medical treatment or lifestyle change that can reverse the process, they must be treated surgically.

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colours appearing faded; and double vision—make an appointment with an optician, who will do a series of tests to determine your eye health. If your optician thinks you have cataracts, you may be referred to an eye specialist (ophthalmologist) for more tests and treatment. Cataract surgery is a straightforward


✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

Use eye drops as instructed Take it easy for the first 2 to 3 days Use an eye shield at night for at least a week Take painkillers if needed Bathe or shower as usual Wear an eye shield when washing your hair Read, watch TV and use a computer Use a shield, old glasses or sunglasses outdoors

✗ ✗ ✗ ✗ ✗ ✗ ✗

Rub your eye Allow soap or shampoo to get into your eye Drive until you get the all-clear from your doctor Do any strenuous exercise or housework Wear eye make-up for at least four weeks Fly without seeking advice from your doctor Swim for four to six weeks

Do not:✗


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procedure that doesn’t take much longer than half an hour. Dr Allon Barsam of says “Cataract surgery is the most commonly performed surgery in the world, it is very safe and does not take long; you are typically going home from hospital or clinic the same day. An eye surgeon like myself will replace the clouded natural lens with a small acrylic lens called an Intraocular Lens (IOL). “Monofocal IOLs can give you clear distance vision (e.g. driving, watching TV) but you need glasses for near (e.g. reading, using a mobile phone) and intermediate (e.g. cooking, using a computer) activities. Monofocal IOLs are available on the NHS. Multifocal IOLs can give you glasses-free vision for most activities at any distance; however, these IOLs are only available with privately funded surgery.”

CATARACTS IN YOUTH Although cataracts are often thought of as a problem of the elderly, they can also occur in younger patients. Some researchers theorise that our excessive exposure to video screens are a cause of vision problems, including cataracts. Patients who suffer from diabetes, hypertension, high myopia and obesity are also at risk of developing cataracts earlier in life. Traumatic eye injury,

use of steroidal medications, smoking, excessive alcohol consumption and ultraviolet light exposure can also lead to cataracts. Cataracts can also occur in babies and children, although this is very rare, happening in about three in every 10,000 children. While the cause isn’t always clear, risks for congenital or childhood cataracts include genetic faults inherited from the parents that caused the lens to develop abnormally, certain genetic conditions including Down’s syndrome, certain infections picked up by the mother during pregnancy including rubella and chickenpox, and an injury to the eye after birth. These cataracts are typically fixed with surgery.

PREVENTION There’s no sure-fire way to prevent cataracts, but making certain lifestyle changes may reduce your risk or lower your odds of getting them earlier in life. Eating a diet rich in antioxidants like vitamins C and E may prevent

cataracts—and if you already have them, it may slow their growth. Quitting smoking will deliver a number of benefits, among which is boosting the health of your eyes. Smoking creates free radicals, chemicals that harm cells in your eyes, which can lead to cataracts and other complications. Talk to your doctor about programmes and medication that can help you quit smoking. Other practises that can protect your eyes include wearing sunglasses, limiting your alcohol intake and keeping your blood sugar in check. And of course, scheduling an eye exam every two to four years will help your doctor spot problems early on. •

EAT FOR YOUR EYES A diet rich in the following will help preserve your eyesight late into life. Look for foods that contain: • Vitamin E found in almonds, pine nuts, sunflower seeds, broccoli and spinach • Dark green, leafy vegetables and colourful fruits • Antioxidant vitamins such as vitamin C and beta-carotene • Foods containing omega-3 fatty acids such as fish, nuts and seeds


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06/03/2020 15:13


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Ethical, modern, and gentle approach to high quality treatment Would you like a lovely smile? At Redhead Orthadontics, based in both Fulham and Portland Place, we offer a range of a range of brace solutions for teeth straightening, from advanced lingual braces, Invisalign clear aligners and classic fixed braces. We have been treating both adults and childeren for the last 20 years. We encourage children to be referred from the age of 8-9 years of age, so that any abnormal tooth and jaw developement can be detected early. Alex Redhead is a specialist with extensive experience in lingual braces and other invisible solutions.He is not limited to any orthodontic system, so he can help you choose the best system for you.

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IMAGES © Shutterstock

Braces are a common form of treatment to straighten teeth. But do you know about the many other types of or thodontic treatment available?


06/03/2020 15:14


Find out about the Oral Health Foundation National Smile Month 18th May to 18th June 2020


round a third of children in the UK end up needing orthodontic, or toothstraightening treatment. In Britain, we are lucky enough to have free orthodontic care on the NHS for younger people under the age of 18. It is always advisable to get braces sorted sooner rather than later, not just because of the cost, but because the longer you leave your uncorrected teeth, the worse aligned they will become. While the most common form of orthodontic treatment is braces, there are many different types which are suite to different problems.

Why Orthodontics is used

Orthodontic treatment is necessary for people who have crowded or 70 dear doctor with DR Chris Steele

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crooked teeth as this can cause problems for everyday life. Some people may also experience difficulty and discomfort when their teeth don’t align properly. This can mean that it is harder to look after gums and the teeth are more likely to become damaged. Abnormal positioning of teeth can also affect the shape of the face. While the primary reason for orthodontic treatment is dental health, it can also have a cosmetic aspect, as many orthodontic problems can affect appearance an correcting them can boost confidence. Braces for example, straighten teeth and provide an incentive to stay away from sugary foods, meaning teeth also remain whiter. Certain orthodontic treatments can also be used to treat a cleft lip or palate.

Who can have orthodontics?

Orthodontic treatment is usually only considered when all a child’s adult teeth have come through. This however, depends on the state of their teeth. If it is clear that, as adult teeth start coming through, there is a problem, dentists can refer children at an earlier stage. Treatment for adults can begin at any age, however the options are usually more limited and not included on the NHS. Dentists will usually only refer you to an orthodontist if you have a good standard of general oral hygiene, as orthodontic treatment can often increase risk of gum disease and tooth decay.

06/03/2020 15:14


Types of treatment

There are many different types of orthodontic treatment and the type that you receive will depend on the problem you have. The treatment usually begins with an X-ray, plaster models of your mouth and taking photographs of your teeth to assess the situation. Your orthodontist will usually give you a treatment plan and outline if there are more than one option available for your problem. Here are the four main types of orthodontic treatment available on the NHS:

Fixed braces

Fixed braces are the most common and well-known type of orthodontic treatment. They are a non-removable brace which is glued to the front of each tooth and linked with wires: this is to help your teeth straighten up over a prolonged period of time (the exact amount of time depends on the severity of the crookedness of the teeth). People with fixed braces are advised to avoid certain foods and drinks, such as toffee, hard sweets and fizzy drinks, as they can damage the braces quite significantly. It is also advised to cut down on sugary foods as these can stain your

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teeth, ultimately leaving you with white spots where your braces where once they get removed.

Removable Braces

Removable braces are usually used to correct minor problems, or as an additional part of fixed brace treatment. These are usually made from plastic and cover the roof of the mouth and clip to some teeth. They can only carry out limited teeth correction. These braces should usually only be taken out for cleaning or a precaution during certain activates.

Functional Appliances

This usually entails a pair of removable plastic braces which are joined together and designed to fit on both the upper and lower teeth. They are often used to treat positioning problems of your upper and lower jaw or teeth. Most people who receive this treatment need to wear them all the time for them to function correctly. It is very important to follow your orthodontist’s instructions with these kinds of braces, as if they are not used in the correct way, they will not work as hoped. It is, however, alright to remove the appliances when cleaning or eating.


Headgear is usually used with other orthodontic treatment and is not considered a proper form of treatment on its own. It is used to correct the positioning of back teeth. People only have to wear headgear during the night.

Additional treatments

Other orthodontic treatments may be useful to some people, however they can only be accessed privately.


While braces are often necessary for your dental health in the long run, while you have them it can be more difficult for you to look after your teeth and it certainly takes a bit more effort. This is because as well as having to take care of your teeth, you also need to consider the effect cleaning will have on the brace. The main way you can effectively look after your braces is to clean them regularly and properly. To brush your braces, hold your brush at a 45-degree angle to clean around the wires and pins. Taking the time to brush each tooth individually will help ensure that no bits of food get stuck in your braces so that they do not get clogged up and cause more damage to your teeth. It is also important to visit the orthodontist regularly when you have braces. This is because you will often need adjustments made to your appliance such as tightening your braces. After a routine adjustment of your braces, you may feel tightness or slight pain. If this does not quickly fade or if it becomes extreme, you should consult your orthodontist as something may be wrong. It is also important to continue with regular checks at your dentist, as having braces can sometimes mean you are more at risk of gum disease and tooth decay. Visiting the dentist regularly can make sure you monitor your teeth and keep any infections at bay. To clean your teeth while you have braces can be a bit trickier, but certain products are specially designed to make it easier, such as electric toothbrush heads that are designed specially to be gentle yet effective when going over braces. • dear doctor with DR Chris Steele 71

06/03/2020 15:15


NHS watchdogs endorse honey as first defence against coughs1 Advice published by Public Health England and NHS watchdog NICE (National Institute for Clinical Excellence), confirms what many of us have known for years: honey should be the first line of treatment for coughs.1 The advice follows experts’ concerns that doctors too often prescribe antibiotics for coughs and colds. People suffering from a cough should drink honey and lemon rather than take antibiotics, the recommendations declared. Experts are increasingly worried that over-use of antibiotics allows superbugs to evolve and resist treatment – making antibiotics useless against more serious infections. And if using a honey, why not upgrade to a Manuka honey for its proven antimicrobial properties that other honey does not display?

Dr Hilary Jones, Television GP and Health Professional for more than 20 years, is a big fan of Manuka honey, he says: “The advice from Public Health England is to try honey for a cough before visiting your GP. I recommend it to my patients, but if you are going to buy, be sure to choose a brand that has been independently tested for strength and purity.

Dr Tessa Lewis of NICE said: “In the committee’s view, taking a spoonful of honey or a honey and lemon drink is a good first step for selftreatment of a cough. Honey is a natural remedy which has been tried and tested for generations.”2

Dr Hilary Jones: GP and Health Professional

NICE’s paper cited a 2014 study of 568 people which found a 10g spoonful of honey significantly reduced the frequency and severity of coughs within a day.3



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Monofloral 375g

Manuka Honey





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Grand Total  By ticking this box you give us consent to contact you with special offers from Manuka Pharm. Products and delivery dates are subject to availability. Your contract for supply of goods is with Manuka Pharm. Cheques/postal orders must be made out in GB Pounds Sterling (£). Full terms and conditions are available on our website or upon request. Offer must end at midnight on 30th September 2020. T&Cs: Privicy policy:

Sources: 1. 2. 3. Oduwole O, Meremikwu MM, Oyo-Ita A, Udoh EE. Honey for acute cough in children. Cochrane Database of Systematic Reviews 2014, Issue 12. Art. No.: CD007094. DOI: 10.1002/14651858.CD007094.pub4. (as cited by NICE in

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The Sweet Promise of

Manuka Honey Manuka honey is praised for its health benefits as well as for its luxuriant taste—but what’s the stor y behind this sweet success?


anuka honey is produced by bees which act as pollinators of the bush leptospermum scoparium, commonly known as the manuka bush. It originates in New Zealand and is widely praised for its health benefits as well as its taste—but is there any truth to the legends? It certainly seems true that manuka honey has antibacterial properties. It contains a natural antibiotic, methylglyoxal, which has led to it being used to treat sore throats, wounds and even tooth decay. It’s also said to have antiviral, anti-inflammatory and antioxidant qualities, leading to it being used since ancient times to treat burns, boils and sores. The claim is that honey maintains a moist wound environment while providing a protective barrier—at least that’s the line adopted by the American Food and Drugs Administration, which accepted manuka honey as an option for open wound treatment in 2007. Studies have shown that manuka honey enhances wound healing, promotes tissue regeneration and can even help in pain relief.

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Bee aware The Manuka honey trade is overseen by the Unique Manuka Factor Honey Association (UMFHA) which awards licences to qualifying manufacturers and grades products according to their UMF factor

A French study in 1993 investigated the effects of applying a manuka honey dressing on 40 patients with non-healing wounds—88 percent showed improvement, the conclusion being that the honey created an acidic environment promoting oral health. Apparently its anti-bacterial properties can reduce harmful bacteria associated with plaque, gum inflammation and tooth decay, without destroying bacteria needed to keep balanced oral environment. A study in New Zealand in 2003 showed manuka honey chews are good for reducing plaque and gingivitis. Manuka has also been used as a cough suppressant, to reduce excessive mucus production after chemotherapy, to treat upper respiratory infections in cases of cystic fibrosis, to reduce gastric ulcers and to treat acne and IBS. There are a few cases where manuka honey is not recommended, such as for anyone with an allergy to bees or honey, diabetics who might find it affects their blood sugar levels, or babies under the age of one where there may be a risk of botulism—but otherwise it sounds like a delicious way to enjoy the health benefits of a sweet natural resource. •


06/03/2020 15:16


I Dental Dilemmas

in Dogs and Cats

We all love our pets. But do we do ever ything we can to take care of them, par ticularly their teeth?

t’s estimated that around 12 million people in the UK have household pets, and most of them will understand the importance of proper feeding, exercise, and regular check-ups at the vet. But many of us don’t know the importance of maintaining their dental hygiene. Dental problems in a cat or a dog can be painful and prevent them from eating, as well as greatly affecting their health and happiness in general. Many people aren’t aware that household pets can get gum disease too, which is why it is crucial to keep their teeth in order to the best of your ability. Your vet can give you helpful advice on how to look after your pets’ teeth and spot the warning signs if there is anything wrong.

Prevention over cure Just like humans, cats and dogs can experience dental problems. And also like humans, prevention is better than a cure. Often, getting treatment for dental problems at the vet can be expensive, and while we usually wouldn’t hesitate to give our beloved pet the treatment they need, it’s always best to take precautions and look after your pets’ teeth before problems get out of hand and a visit to the vet is in order.

How to spot the signs One of the main symptoms of dental problems in dogs and cats is lack of appetite. If your pet isn’t eating as much as usually, or eating nothing at all, this could be because dental discomfort is causing reluctance to eat. Healthy teeth should be mainly white. If your pets’ teeth are looking very discoloured, it’s

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How to brush pets’ teeth

probably a good idea to take them to the vet as soon as possible, even if they aren’t displaying any other symptoms. Swollen and/or bleeding gums, and build-ups of plaque (gingivitis) are also bad signs of potential gum disease, and can lead to as kidney and heart issues. Daily teeth brushing and regular checking by a vet will help, as gingivitis can require medication such as cyclosporine or antibiotics, or even extractions of teeth including the root tips. It is also important to see whether any of your pets’ teeth have come loose, a sign of late gun disease. This can be harder to check, and you may need a vet’s assistance. If you are bowled over by your pets’ breath, this could be a sign of poor dental health or gum disease. While it isn’t exactly abnormal for your dog to have bad breath, if it is particularly awful and different to usual, this is probably a sign that their teeth need to be checked over.

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80% of dogs have some form of dental problem, and untreated gum disease can be fatal, causing complications to their heart and kidney health.

Cats and dogs accumulate plaque on their teeth just like we do, and if left untreated, can cause gingivitis, and in severe cases, this leads to tooth loss. One of the best ways to prevent this is by brushing their teeth. Brushing cats and dogs teeth is a fairly similar procedure and is simple once you get your pet used to the routine. It’s best to start them young. Firstly, buy toothpaste that is specially designed for your animal. Human toothpaste will not work, and if it contains fluoride it may cause illness - toothpaste made for cats and dogs is designed to be used without water and dissolved in the mouth straight away. Before you start, you will want to get your pet used to the taste of the toothpaste. Do this by putting a small amount on your finger and getting you cat or dog to lick or smell it. Do this for a few days to get your pet familiar with having it in their mouth. It is best to do this gently, rather than forcing it on your pet. Cats can be especially unforgiving if you stick your finger too close to the mouth.

USING A TOOTHBRUSH Use a toothbrush specially designed for your pet and if you have more than one cat or dog, get one for each of them to prevent the spreading of bacteria. Toothbrushes for toddlers can also work for this, as they have softer bristles. Normal adult toothbrushes will probably feel too rough on your pets’ gums. Choose a regular time for tooth brushing to try and get your pet into a routine. Make sure you don’t try to do it when your pet is agitated or excited— you both want to be as relaxed and comfortable with each other as possible. Try to have your pet’s back to you, as this is a less confrontational approach and will make your pet feel more at ease. This is more important with cats than it is with dogs. Slowly push the gums back and simply touch the brush on their teeth at first, to

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Experience how easy it is to get started

Day 1 -3 Put some toothpaste on your index finger. Let your dog lick the paste off your finger. Gently slide your finger along the teeth and gums.


Day 4 – 14 Repeat the process with the oral cleaner on your finger to wipe off plaque from teeth and gums.


Day 15 and beyond Introduce the toothbrush.














There is no substitute for toothbrushing!


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get them used to having something in their mouth. Reward your pet after you have done this. Again, do this for a few days to get your pet used to it. When you’re ready to start brushing their teeth, do so very briefly, for only a few seconds at a time so your pet can become used to it. Brushing also massages your pet’s gums, which can accelerate healing, and strengthen the gums so your pet is less likely to suffer gum problems later on. It is always wise to give your pet a treat afterwards to reward their patience. For cats with dental disease or oral health issues, prescription diets are specifically designed to help improve dental health.

Make sure that your pets have a good supply of fresh water to help keep their mouths clean, and give cats chew toys as a substitute for the bones they would get in their diet in the wild. Look for toys made specially for cats which are no harder than your fingernail, otherwise they may cause tooth fractures.

made to hug dogs’ teeth in order to reach all areas of the mouth. You can even get battery powered toothbrushes for your pet, ideal if your pet already has existing teeth problems, as they work to get rid of the built up plaque in hard to reach areas. To get on top of your dogs’ dental hygiene from the start, try dental chew treats which are specially designed to treat your pet as well as to maintain dental hygiene by working to remove plaque and promoting strong teeth. For cats, most pet shops sell dental hygiene products that contain catnip to make them more appealing. But don’t wait until your pet shows signs of distress before getting their teeth checked—cats, particularly, are good at hiding their discomfort, so we must do everything we can to ensure their dental health. •

PET DENTAL CARE PRODUCTS The pet care industry is well up to speed with the necessity for special products for dental care, and you will find the major retailers and online businesses will have a range of useful designs, such as double-headed toothbrushes specially

PLAQUE PLAGUE Plaque accumulation can lead to gingivitis in both cats and dogs, and PetMD lists predisposing factors including:

• • • • • • • • • •

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Old age Crowded teeth Soft food Open-mouth breathing Bad chewing habits Lack of oral health care Uraemia and diabetes mellitus Autoimmune diseases FeLV (Feline Leukaemia) FIV (Feline Immunodeficiency Virus)


06/03/2020 15:18


CBD: Separating Fact from Fiction CBD, or cannabidiol, is the current health craze, but what is it, what are its real benefits, and what are the myths surrounding it?


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BD, or cannabidiol, is now an ingredient in hundreds of products aimed at the health market, from oils and capsules to gummies and vapes—but where does it come from, what can it offer, and why is it so misunderstood? Most of the confusion surrounding CBD comes from the fact that it’s derived from the hemp or cannabis plant, which is also the source of marijuana. But there are important distinctions between the two, both medically and legally. While recreational marijuana legalisation is a hot topic, there is every possibility that it will spread from Canada, the Netherlands and some states of the US to other parts of the world. This is partly tied in with, but should not be confused with, legalisation of marijuana for medical use in some cases such as particular forms of epilepsy.

THC AND CBD CBD, though derived from similar plant sources and claiming some similar health benefits, is not addictive, has never been illegal and according to its 80 DEAR DOCTOR WITH DR CHRIS STEELE

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proponents has no health dangers. The main reason for this is that while marijuana contains tetrahydrocannabinol (THC) which is psychoactive (gets you high) and addictive, CBD doesn’t. While marijuana users positively look for enhanced THC levels (and plant breeding programmes select for them), CBD contains almost no THC. THC is produced in unfertilised hemp plants, and affects a receptor in the brain called CB1, causing a ‘cerebral high’. CBD on the other hand is extracted from fertilised hemp plants which produce little THC (under 1 percent). CBD reacts with 5-HT1A receptors in the brain, working as an anti-depressant, anti-inflammatory and anti-oxidant.

SO WHAT’S THE POINT OF TAKING CBD? Because it’s practically impossible to overdose on CBD (unlike on say opiate painkillers, steroids, aspirin or alcohol), there are no recorded cases of death by overdose, and indeed it’s often argued that it has no addictive properties. But it is claimed to have a lot of positive effects, including pain reduction,

hormone level control, de-stressing, sleep enhancement, weight control and more.

STRESS TEST It’s not clearly understood why this should be so, but research indicates that the endocannabinoid system, part of the body’s nervous system, plays a role in the endocrine system’s control of homeostasis—in other words, the way hormones regulate bodily functions. If CBD does indeed affect the endocannabinoid system, such as by reducing the secretion of the stress hormone cortisol by the adrenal glands, it could have all sorts of benefits. If you are interested in trying CBD products, the wise advice would be to find a supplier with the highest standards of cultivation, extraction, purification and supply. Though some point out that CBD use dates back to 400BC with Hippocrates, the father of Western medicine, and possibly even before, this is, after all, a new and exciting field. Time, research and experience will tell whether CBD is in fact the natural wonder drug some make it out to be. •

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Medical Cannabis THE FACTS Changes to laws have made access to medicinal cannabis possible. But what can it do, and who can it help? We ask the experts from the UK’s first CQC registered clinic

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Dr Michael Platt, Medical Director of Sapphire Clinics, and Dr Simon Erridge, Academic Clinician at Imperial College London and Business Development Director at Sapphire Medical Clinics, answered our questions, the first being how the changes to the law have affected prescribing practice. “In practice this means that some patients who have exhausted conventional therapies are able to receive 82 DEAR DOCTOR WITH DR CHRIS STEELE

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Cannabis has been used for its medical properties throughout time, with evidence of its use extending back to 8,000 years ago – Dr Michael Platt, Medical Director, Sapphire Clinics

a prescription for medicinal cannabis” the doctors explained. “Only doctors on the specialist register of the GMC are authorised to prescribe cannabis medications, and satisfy the guidelines issued by GMC (General Medical Council), NHS England and MHRA (Medicines & Healthcare products Regulatory Agency). “Sapphire Medical Clinics was the first UK medical cannabis clinic registered by the CQC - we have sought to develop a treatment care pathway that is the gold standard for the profession which places patients, their health and safety at the centre of how we operate.” Sapphire’s team includes specialists in the fields of Pain Medicine, Neurology, Paediatric Neurology, Gastroenterology, Psychiatry, Palliative Care Medicine, and headache and migraine neurology – all areas in which medicinal cannabis can be of benefit. Patients are seen at the clinic on a second-opinion basis, with the aim of working with their usual GPs and consultants to provide specialist insight into both specific conditions and the potential suitability of medical cannabis. Sapphire Clinics has been instrumental in the formation of the

IMAGES © Shutterstock


ollowing a long campaign conducted largely by parents looking for treatment for their children suffering from certain forms of epilepsy, as well as by adult sufferers of chronic pain and concerned physicians, on 1 November 2018 the law in the UK regarding medicinal cannabis was changed. In an amendment to the Misuse of Drugs regulations 2001, medical cannabis was re-scheduled from a schedule 1 drug (meaning it was regarded as having no medical benefit) to a schedule 2 drug (allowing doctors to prescribe medicinal cannabis in certain situations). This hasn’t entirely clarified the situation – some parents say they are still having to import drugs at great expense because they can’t get medicinal cannabis prescribed by their GP or specialist. Commercially available drugs can take the form of pills, patches or oils containing different combinations of THC (Tetrahydrocannabinol, the psychoactive component of cannabis) and CBD (Cannabidiol, a component which does not cause a ‘high’). Public confusion between these two is part of the “image problem” of medicinal cannabis, and it’s certainly true that the use of cannabis in medical treatment is a controversial subject, often confused with campaigns for the legalisation of the drug for recreational use. To clear up the subject once and for all, we went straight to the experts from Sapphire Medical Clinics, which was the first UK clinic to be registered with the CQC (Care Quality Commission) to prescribe medicinal cannabis.

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Benefits Modern recreational cannabis users seeking a greater ‘high’ have pursued synthetic products with high tetrahydrocannabinol (THC) constitution, as this is the psychoactive compound responsible for the associated ‘high’. It is these high THC levels that are most greatly associated with risk of psychosis. “When prescribing medical cannabis we ensure that patients start with appropriately low doses of the active ingredients Cannabidiol (CBD) and THC. Patients are gradually titrated on their dose, depending on the benefits and the side-effects. This ensures minimal


UK Medical Cannabis Registry, the only national registry on medical cannabis prescribing. “This commitment to providing a gold standard of clinical practice with highest consideration of patient care is what I ultimately believe was instrumental in achieving our registration with the CQC” says Dr Platt.


But what are the common misconceptions surrounding the use of medicinal cannabis that have to be dispelled? “The biggest misconceptions surrounding medical cannabis are regarding both its safety and risk of addiction” he tells us. “Medical cannabis has been used for its medical properties throughout time, with evidence of its use extending back to 8000 years ago, with reports of it being used by dignitaries such as Queen Victoria for its painrelieving properties. “Medical cannabis is remarkably safe with no reported deaths from toxic doses. The toxic dose derived from animal studies would also be impossible for humans to consume. This is important to be aware of when contrasting their safety

“As a specialist in pain medicine I have seen a vast number of patients utilising recreational cannabis for its medicinal benefits… their personal stories are fascinating, including the clinical benefit that they have derived from these products, however, I worry for them as the products they use are unregulated opening them up to risk from potential contaminants, in addition to not providing a stable dose of medication. Medical cannabis has shown efficacy in treating chronic pain in observational studies.”

Nausea & Vomiting

“A synthetic cannabinoid, Nabilone, has been specifically licensed in the UK for chemotherapy induced nausea and vomiting.”

Anorexia and Cachexia

side-effects, reduced psychosis risk and keeps the patients safe, whilst optimising symptom control”. Medical researchers are still investigating the importance of the body’s endocannabinoid system, a network of neurochemicals and receptors which appears to have functions in the nervous, immune, digestive, and musculoskeletal systems, regulating a wide range of bodily functions. For this reason, researchers hope to discover applications for medicinal cannabis in a wide spectrum of conditions. Evidence for its effectiveness is still coming in. Dr Platt outlines some of the main possibilities:

on spasticity symptoms in Multiple Sclerosis and has positive effects on pain and bladder dysfunction. Nabiximols (Sativex) has recently been approved by NICE as part of their medical cannabis evaluation for Multiple Sclerosis patients with spasticity on the NHS.


“Several trials have demonstrated the benefit of CBD (Cannabidiol) in treatment-resistant epilepsies of childhood, notably Lennox-Gastaut and Dravet Syndrome. This has led to NICE approval for Epidiolex, a CBD product, to be available on the NHS for these patients. There have been striking case studies on the benefits of small quantities of THC–however this has yet to be studied formally in a scientific setting.”

(muscle wasting) There is evidence to support the use of medicinal cannabis in cases of appetite loss and muscle wasting cause by chronic disease such as cancer


Medical cannabis has some effect


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profile with other medications. In my specialism, pain medicine, for example it has been truly saddening to see the huge toll of lives lost to the opioid crisis in the United States. We are starting to see similar trends in the UK. “Opioids have never been designed for the treatment of chronic pain yet have been utilised due to the lack of suitable alternatives to treat pain in both the community and hospital-based medicine. To have another instrument in my armoury to treat chronic pain which avoids this is certainly exciting.”


"It’s probably also true to say that cannabis is less addictive then perceived. Medical cannabis users do not develop a physical dependence on cannabis in the same way that someone might associate with alcohol or illicit drugs–rather they can be psychologically addictive due to its effects in susceptible individuals. “This affects less than 10 percent of those who use it recreationally, and fewer still who use it for medicinal purposes” says Dr Platt. “Medical cannabis has a low propensity to cause psychosis. Conventionally people have drawn links between cannabis use and psychosis, however this is only a relatively recent development in cannabis’ history.” Treatment typically starts with 84 DEAR DOCTOR WITH DR CHRIS STEELE

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REFERRALS Patients may ask their GP or specialist to refer them to Sapphire through an online referral form, a traditional paper referral to Sapphire Medical Clinics at 10 Harley Street, or by contacting the staff directly at evaluation by a consultant specialist in the relevant disease, and where medical cannabis is thought appropriate, one of a range of treatment is prescribed. “These products will include pure isolates of cannabinoids (e.g. CBD-only products), combination products (e.g. Sativex), whole-plant extract oils and unprocessed flower. This will allow our clinicians to provide a personalised approach to prescribing for each patient” says Dr Platt. So is treatment with medicinal cannabis safe? Sapphire Clinics has developed its own ‘best practice’ clinical governance structure based on experience in Canada, Italy, Holland and Germany, where cannabis prescription has been available for several years. Sapphire Clinics also adopts all the recommendations of UK regulatory bodies, and discusses all treatments within a multi-disciplinary team to ensure

the highest standards of practice. The key phrase is always ‘start low, go slow’ to minimise side effects and optimise clinical efficacy. Sapphire Clinics conducts academic studies on medicinal cannabis use and has founded the UK Medical Cannabis Registry to develop an anonymous treatment database, compiling vital longterm clinical data on a variety of different conditions treated with medical cannabis. Patients can access their own health information through the Patients Know Best scheme, and can share this with their GP, family and carers if they choose. So what is the long-term outlook for use of medicinal cannabis in the UK? Dr Platt says: “It is important to recognise that whilst the benefits of medical cannabis are widely reported it is not a magic bullet that will be a ‘cure all’. However, prescriptions of medical cannabis will increase—especially as more clinicians are convinced of its potential benefits for patients as the research base develops. They will however require the regulatory framework to prescribe, which currently doesn’t exist properly within the NHS.


“The benefit is likely to be that this is another medical treatment option that may provide benefit to treating patients' health complaints. For chronic diseases this is particularly important as medications are often accompanied with a wide range of side effects. “The largest impact is likely going to be seen in those conditions where we’ve already seen dramatic impacts such as childhood epilepsy and chronic pain. In the case of childhood epilepsy there are particularly stark cases of children having significant reduction in their seizure burden improving their quality of life massively. “Having another potential medication which has a better safety profile than opioid medication certainly excites me as a pain specialist as to how I may help improve patients’ lives. The potential impacts of this not only on the healthcare system but also on an economic basis in terms of improved employee productivity cannot be overstated. •

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Talking it Out Cognitive Behavioural Therapy can be an effective way of approaching mental health problems—so why is it not more widely used?

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nyone who has suffered a mental health problem, or has experienced it in a member of the family, will know that it can be difficult to see ‘light at the end of the tunnel’. People can feel unable or unwilling to seek help because they don’t imagine it can be any help, or perhaps they are reluctant to feel reliant on medical treatment. However, doctors are coming to recognise that there are many good reasons to guide patients towards non-medical treatments which can be successful, such as Cognitive Behavioural Therapy (CBT). It’s perhaps natural to wonder whether a ‘talking treatment’ can be as effective as a medical one, but CBT has been shown to be effective in many cases, and since it has none of the possible side-effects of drug treatment, there are many instances when it’s recommended as an initial course. CBT is a type of talking treatment that focuses on how your thoughts and attitudes affect your feelings and behaviour. It brings together the ideas of cognitive therapy, which examines the things you think, and behaviour therapy, which examines the things you do. CBT focusses on the link between the two and how this may be contributing to your particular problem. CBT can be used with a variety of different mental health problems, such as clinical depression, anxiety, schizophrenia, bipolar disorder, obsessive compulsive disorder (OCD), psychosis and more. The National Institute for Health and Care Excellence (NICE) recommends CBT particularly for depression and anxiety. There are formal adaptions used in the treatment of other mental health problems such as eating disorders, OCD and phobias.

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HISTORY CBT was developed by psychiatrist Aaron Beck in the 1960s. Beck’s theory was that patients had an internal dialogue going on in their minds, almost as if they were talking to themselves. He realised that they would only report a fraction of this kind of thinking to him, but that the link between thoughts and feelings

NICE recommends CBT in the treatment of the following conditions:

• Anxiety disorders (including

panic attacks and post-traumatic stress disorder) • Depression • Obsessive Compulsive

Disorder (OCD) • Schizophrenia and psychosis • Bipolar disorder

was very important. He introduced the term automatic thoughts to describe the instant feelings that may pop into the mind, and found that often, people weren’t even aware of them. Beck found that identifying these thoughts was a contributing factor in helping patients overcome difficulties. CBT treatment sees you working with a therapist to identify and challenge negative thinking patterns that may relate to your overall problem. The therapist will use learning methods to change the way you think and feel about certain situations and enable you to change your behaviour in future. For example, if you feel anxiety about meeting friends, and therefore cancel plans and distance yourself, a therapist can help talk you through and examine the thinking patterns that cause this anxiety.

WHO BENEFITS? CBT is usually a short-term treatment, so you will not be expected to continue for longer than around 12 weeks. For example, one-hour long sessions may be distributed over a 12-week period. Sometimes the sessions may be more regular depending on the problem. The treatment you receive for


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mental illnesses is a very personal decision and differs from person to person. Some people find CBT very effective, while others prefer other methods. Before deciding on whether to seek CBT treatment, it may be helpful to ask yourself the following questions. Are you comfortable thinking about your feelings? CBT involves helping you become aware of your emotions and anxieties, which can be uncomfortable and distressing for some. While stepping out of your comfort zone during therapy is not necessarily a bad thing, if the thought of getting in touch with your emotions on a deeper level makes you very uncomfortable, than perhaps CBT isn’t for you. Is short-term therapy right for you? CBT is meant to be a short-term treatment. If you think your problem needs a long-term solution, then you might want to consider continuing therapy. For complex problems this is often the case, as a short-term therapy may not be enough to cover the complications of a mental illness. Do you have a clear problem to solve? Mental health issues are not always straightforward, and often, you might not even know what the problem is. CBT is less suitable if you are feeling generally unhappy or unfulfilled, and more suitable if you have a clear aspect of your life you want to work on. Often general counselling or therapy sessions can help figure out what a problem is better than CBT therapy, which works by focusing on a problem that is already clear.

unmanageable. Doctors are sometimes criticised for prescribing antidepressants too quickly, but sometimes this is the only immediate option available. There are private CBT therapists available if you are in a position to pay rather than wait on an NHS list. Certain charities are also able to offer help however waiting lists can also be long, depending on the problem. Mental health charity Mind also gives advice on how to practise CBT yourself at home, although a therapist is greatly recommended if your issue is severe. However, practising some CBT techniques by yourself can help while you are on a waiting list to see a therapist. You can do this through self-help books or online. •

There is also good evidence that CBT is helpful in treating many other conditions, including: • Chronic fatigue • Chronic pain • Physical symptoms without

a medical diagnosis • Sleep difficulties • Anger management

THE PROBLEM It’s unfortunate at a time when CBT and other talking therapies are clearly in such demand that there is a lack of resources in the NHS, leading to long waiting-lists. In many cases a crisis which would benefit from immediate attention goes untreated because the postcode lottery of waiting times is 88 DEAR DOCTOR WITH DR CHRIS STEELE

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 Your GP Surgery If you are struggling with your mental health, it is advised that you make an appointment to see your GP as soon as possible. Your GP can advise you on what to do from there, and if they think CBT is appropriate, they may refer you to a specialist.

 Improving Access to Psychological Therapist (IAPT) The IAPT is an NHS funded programme which offers CBT treatment for various mental health problems such as anxiety and depression. You can get in touch with them directly by selfreferring, however unfortunately, waiting lists can be long due to high demand. You can check whether these services are available near you on the NHS Choices website.

 A Community Mental Health team Your community Mental Health Team (CMHT) often has nurses, doctors, occupational therapist and psychologists working with them who can provide CBT. HERE ARE WAYS TO LOOK FOR A CBT THERAPIST THROUGH THE PRIVATE SECTOR:

 The British Association for Counselling and Psychotherapy (BACP) This is a membership organisation and a charity which has a ‘find a therapist’ directory, which features registered and non-registered therapists. They also offer how you can find the right therapist for you.

 The British Association for Behavioural and Cognitive Psychotherapists (BABCP) This organisation has a register of CBT therapists who have specialist skills and knowledge, who have undergone relevant training and supervision.

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Colomint Peppermint oil capsules provide natural peppermint oil which has been proven to help support healthy digestion and may help eliminate digestive discomfort and indigestion. Each capsule has a gastro resistant coating which prevents it from breaking down until it reaches the gut where it’s needed the most.



Available to buy from Pharmacies and online at

FREE FROM: Parabens, Sugar, Alcohol, Gluten, Dairy, Lactose, Peanuts & Soya + No artificial colours or flavours


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Digest We’ve all heard the phrase ‘you are what you eat’, but how much of it is true? Cer tainly there are signs that the modern diet can cause digestive problems


he digestive system is a delicate and complex one involving a group of connected organs. The digestive system works to break down food we eat and turn it into energy which we rely on for healthy activity and growth. However, with modern diets including a range of unessential sugars, fats and processed foods pushed on us by the food industry, sometimes our bodies are put off-balance, and digestive problems have become common. Fortunately there’s growing awareness of causes of dietary imbalance and the natural remedies you can consider to aid your digestion.

Did you know? A Mintel survey in 2016 suggested that 86 percent of Brits suffer from gastrointestinal problems, with 30 percent attributing them to stress, 26 percent to poor diet, 17 percent to lack of sleep, and 14 percent to alcohol consumption or viruses.

Your Digestion Diet

more risk of constipation as your body is unable to absorb the nutrients in your food. Probiotics, ‘friendly bacteria’ commonly found in certain types of yogurt, have all sorts of digestive health benefits.

An ideal diet for your digestive system includes plenty of leafy green vegetables, fruits and whole-grain foods. Foods high in fibre are essential for good digestion. Fluids are also essential. Plenty of water helps the fibre in your diet work properly. Without enough water, there is

Digestive conditions can be serious enough to affect quality of life, and it’s not always clear what causes them or how they should be treated. So what are the most common?

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Digestive Complications

Indigestion is where your body struggles to digest food, either because of poor eating habits such as excessive seed or amount, or due to an underlying medical condition. Symptoms can include ‘heartburn’ or acid reflux, stomach acid travels up towards the throat and causes a burning sensation. If this happens frequently, it could be a sign of gastro-oesophageal reflux disease (GORD). Indigestion can often be treated by dietary changes such as cutting out coffee, alcohol, chocolate and spicy foods for example. Irritable Bowel Syndrome or IBS is a common digestive condition which effects around 1 in 5 people in the UK, more women than men. Symptoms often develop around the age of 20 to 30, and include constipation or diarrhoea, along with bloating, trapped wind and cramps. Unfortunately, there is no cure for IBS, however your GP will usually advise some diet and lifestyle changes in order to your help your digestive system process food less painfully. dear doctor with dr Chris Steele 91

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HEALTH & FITNESS Coeliac Disease is diagnosed in around one percent of the UK population, though it’s thought that around 24 percent could be undiagnosed. The disease is basically an allergy to the protein gluten, found in grains including wheat and barley, and causes inflammation of the small intestine. Depending on the severity of the condition, complete avoidance of gluten in the diet can be necessary.

Natural Wonders

s which can help with the There are certain natural remedie come in the form Many of these natural remedies balance of the digestive system. life. y dail to incorporate into your of supplements, which are easy acids and enzymes, which means d to be resistant to your stomach gne desi Supplements are often ess. instead aid in the digestive proc they do not get broken down, and



IMAGES © Shutterstock

Peppermint taken as an oil or tea is said to relax the digestive system when absorbing food, easing discomfort. Islam Pearson of Greenliving Pharma says: “Peppermint has been used as a natural remedy for thousands of years. “To help heartburn and promote healthy digestion, gastro resistant/ enteric coated peppermint oil capsules taken three times a day before meals are recommended to ensure that the peppermint passes through the stomach intact and finally gets released in the small intestine where digestion occurs, and it is needed the most.”

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Chamomile Chamomile has anti-inflammatory properties can ease cramping or bloating that occurs when your body is having trouble digesting foods. Chamomile can, in particular, help with acid reflux, because the herb can assist in lowering gastric acidity. It is believed that chamomile tea can be used with as much effectiveness as a supplement, and has even been considered to hold the same benefits as taking more recognised medical compounds such as paracetamol or ibuprofen.

In Eastern and Western tradition, ginger is regarded both as a culinary ingredient and a digestive aid. It’s regarded as effective in easing stomach pain by acting as a carminative, soothing the intestinal tract by eliminating excessive gas. A study from the European Journals of Gastroenterology and Hepatology found that ginger stimulates saliva, bile and gastric enzymes to aid digestion and helps speed up the movement of food from the stomach moving to the small intestine. Ginger supplements are available, however you can also take it in forms of tea, tonics and food additives. So if your digestion isn’t what it should be, you may benefit from eating a more natural diet and testing the benefits of traditional solutions. •

Planning your next trip? Don’t forget your vaccinations Did you know? !

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Some countries require proof of vaccination before entry is permitted


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Book today at or call 0333 0098 100 London Travel Clinic.indd 1

23/01/2020 15:43


Your Guide to Travel


Going abroad is exciting but challenging, which is why it’s impor tant to know which travel vaccinations you need to get in order to stay well on your trip


t can be overwhelming to have to sort out travel vaccinations before flying abroad. What vaccinations do you need? Can you get them for free? Where can you get them? Dear Doctor answers all your questions to make preparing for your trip as stress-free as possible.

WHAT DO YOU NEED? What vaccinations you need depends entirely on where exactly it is you’re going. Booking an appointment with your local travel nurse is a good first step, as 94 DEAR DOCTOR WITH DR CHRIS STEELE

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they will talk with you about your trip and the risks. They will be able to advice you on the vaccinations that are absolutely necessary and the vaccinations that are optional, depending on the kind of trip you are taking. Some countries require proof that you have been vaccinated against certain diseases before entering the country, for example Saudi Arabia requires proof of vaccination for certain types of meningitis. Yellow fever vaccination must be documented on an International Certificate of Vaccination or Prophylaxis.

It may be that depending on the type of traveling you are doing, you are more at risk of certain types of disease. For example, if you are travelling to rural areas, backpacking, camping or taking a long trip rather than a package holiday. You should make sure to inform the nurse or GP of any activities you may be undertaking on your trip as well.

WHEN AND WHERE You should try and book an appointment with a travel nurse or doctor at least eight weeks before you travel to ensure that

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IMAGES © Shutterstock


the vaccinations are given enough time to work and become effective. Some vaccines also require several doses which means you need to make several appointments, meaning that it’s best to give you as much time as possible. Your travel nurse of GP can advise you on which vaccinations you can get at the surgery and what vaccinations you need to get elsewhere. Your local GP practise will likely offer a few, but you can choose to visit a private travel clinic or a pharmacy which offers travel health care services. Private travel clinics tend to offer more specialist advice as staff are likely specifically trained to advise on travel health care. This means they can give you advice on other health conditions that you can manage on your trip, such as protecting yourself from malaria, and on any other medication that is tailored to activities you may be dong, such as altitude sickness tablets if you are doing high altitude trekking.

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Some travel vaccinations are available on the NHS and you can access though your local GP surgery. They include polio (given as a combined diphtheria/ tetanus/polio jab), typhoid, hepatitis A and cholera. These vaccinations are free because they protect against diseases thought to represent the greatest risk to public health if they were brought back into the country. The vaccinations you have to pay for can be equally vital, though for less common conditions. For example, Hepatitis B is important if you are traveling to a high-risk country, or for people with existing conditions which makes them more vulnerable. If you are more at risk of contact with blood or body fluids (usually people who are involved in certain types of work such as nurses and doctors) it is important to make sure you have a hepatitis B vaccination. Japanese encephalitis vaccination is advised for those traveling to Japan, as is meningitis vaccine for people traveling to places such as Saudi Arabia. If you are traveling to a place where you will be in close contact with animals, your nurse or GP may advise a rabies vaccine. This takes place over a few sessions, which means you have to book them in in advance to make sure that they become effective before you travel. Yellow fever is also essential for travelling to parts of Africa, but is not available on the NHS, so you will have to go to a specialist clinic. •

LONDON TRAVEL CLINIC London Travel Clinic are travel health experts who provide best-in-class service to our customers. All consultations, vaccines and medicines are administered by experienced travel health professionals.

+ Our clinical team have over 60 years combined experience in travel healthcare. With each booking, our nurses will provide you with a bespoke service, tailored to fit your individual needs. We have well equipped travel vaccination clinics in and around London, which stock a comprehensive range of vaccines, including yellow fever, along with anti-malarials and travel health accessories.


Each clinic is staffed by highlyskilled and experienced team of professionals, who are passionate about travel healthcare, working across both clinical and administrative functions.


Did you know that your travel insurance may not be valid if you haven’t been vaccinated?


To ensure you have all the correct information before your trip, book in for a consultation via our website



06/03/2020 15:30


Sleeping Soundly The effects of sleep deprivation are all too real. If you’re an insomniac, here’s how to nod off more easily


f you’ve ever spent a night tossing and turning, you already know how you’ll feel the next day—tired, cranky and like your head is in a fog. But it turns out that missing the recommended seven to nine hours of nightly shuteye does more than make you feel groggy. The long-term effects of sleep deprivation are serious. It drains your mental abilities and puts your physical health at real risk. Poor sleep is linked with all kinds of health problems, from weight gain to a weakened immune system. With a world full of distractions, sleep can become one of the last things we get to in our busy modern life. But the serious consequences should make getting good sleep one of your top health priorities. The NHS estimates that one-third of Brits will suffer from insomnia at some point in their lifetime. You may have insomnia is if you regularly: • • • • • • • •

Insomia accidents

A Mintel survey in 2016 suggested that sleep deprivation was a factor in some of the biggest disasters in recent history, including the 1979 nuclear accident at Three Mile Island, the massive Exxon Valdez oil spill and the nuclear meltdown at Chernobyl in 1986.

SLEEP SANCTUARY All too many of us use our bedrooms as a second office or sitting room—watching TV, using smartphones, even eating. But this makes it hard for us to doze off at the end of the day. Your mind should subconsciously associate your bedroom with sleep.

Start creating a sleep sanctuary first by banning blue light from electronic devices. Leave phones in another room at night—or, if they must come into the bedroom with you, enable a ‘night mode’ setting that will minimise the blue light effects after a certain hour. Perhaps the most important element of sleep is your bed. An uncomfortable pillow or mattress can make it hard to drift off, and when morning comes, wake up. A heavy blanket can leave you waking up in sweats, and one that’s too thin can cause shivering and wake you up. Invest in a comfortable mattress, good pillows and bedding that’s the right type for your body temperature.

LIFESTYLE CHANGES What you get up to during the day can have a big impact on how you sleep at night.

Find it hard to go to sleep. Wake up several times during the night. Lie awake at night. Wake up early and cannot go back to sleep. Still feel tired after waking up. Find it hard to nap during the day even though you’re tired. Feel tired and irritable during the day. Find it difficult to concentrate during the day because you’re tired.


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Curb your caffeine. Up to 400mg of caffeine a day is a safe amount for most healthy adults. Caffeine content in beverages varies widely, but that’s roughly the amount of caffeine in four cups of brewed coffee, 10 cans of soda or two energy shot drinks. It’s not just the amount of caffeine consumed— when you consume it has a significant effect on how you sleep as well. A 2013 study found that drinking even one strong coffee in the afternoon can knock an hour off your nightly sleep. If possible, limit your caffeine intake to the morning and drink your cups of coffee in moderation.

Don’t sleep on a full stomach. Try to avoid eating for at least three hours before bed to avoid being troubled by heartburn and acid reflux, which can disrupt your sleep at night. Stomach acid can reflux into your gullet much more easily when you’re lying down. If you do get heartburn, prop the head of your bed up on a couple of bricks to let gravity do the work.

Get active. Exercise is a great way to improve sleep, especially in the morning or afternoon. Physical activity raises your body temperature a few degrees. When your internal thermostat drops back to its normal range, feelings of drowsiness are triggered, and it can help you drop off to sleep. Exercise can help in other ways as well by reducing stress and tiring you out.

Limit your alcohol. Anyone who’s ever felt drowsy after two or three cups of wine may think that alcohol helps you sleep, but the truth is actually far from it. Several hours after your nightcap, the alcohol in your system will raise the body’s level of stress hormones, which will increase the heart rate and can result in waking you up. In fact, alcohol is at the root of almost 10 percent of cases of persistent insomnia. For better sleep, limit your alcohol intake, and try to keep it to several hours before bed when possible.

WHAT CAUSES INSOMNIA? The most common causes of sleeplessness are: • • • • • •

The NHS estimates that one-third of Brits will suffer from insomnia at some point in their lives.

I’VE TRIED EVERYTHING! If you’ve tried everything—limiting alcohol and caffeine, exercising in the mornings, eating three hours before bed, meditating, warm baths and creating the most relaxing sleep oasis you can possibly imagine—it might be time to seek medical intervention. You might want to see a GP if changing your habits hasn’t worked, you have had trouble sleeping for months and your insomnia is affecting your daily life in a way that makes it hard for you to cope. While you can get sleeping aids from a pharmacy, they will not get rid or your insomnia and they have many side effects. A GP will try to find out what’s causing your insomnia, so you get the right treatment. GPs now rarely prescribe sleeping pills to treat insomnia owing to side effects and possibilities of dependency. Instead, they may refer you to a therapist for cognitive behavioural therapy, which can help you address some root stresses that are keeping you from sleeping. •

IMAGES © Shutterstock

• •

Stress, anxiety or depression Noise A room that’s too hot or cold Uncomfortable beds Alcohol, caffeine or nicotine Recreational drugs like cocaine or ecstasy Jet lag Shift work


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Longer, Better, Healthier

How Life Could Improve With Age With lifestyle awareness and medical research, we should all be able to live longer and in better health—but what can we all do to help?

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ccording to charity The Centre for Ageing Better (www., in the UK we are living longer than ever before, and the age profile of our society is changing rapidly. Within 20 years the number of people aged 65 and over will increase by more than 40 percent, and the number of households where the oldest person is 85 and over is increasing faster than any other age group. No-one complains about the prospect of living longer, but there are implications for society and government which will be profound. Providing financial and medical support for the elderly will be the most significant, and of course if health can be maintained longer in life, that becomes easier. In 2018 the Office for National Statistics reported that people in their early to mid-70s are more satisfied with life than any other age group, and can feel more connected with their communities, families and friends—but individual circumstances vary wildly and there is a great deal of inequality in terms of wealth, security and health.

QUALITY People aged 65 and over are a large and rapidly growing group—there are almost 12 million people aged 65 and over in the UK, with 3.2 million aged 80 and over and 1.6 million aged 85 and over. The majority of people over 50 are grandparents—67 percent of women and 58 percent of men—many of whom provide weekly care for their grandchildren. Sixty percent of people over 50 live in urban areas, with 25 percent living in rural areas. The CAB reports that issues such as housing stock, home adaptations and employment opportunities for the over50s need urgent attention if quality of life is not to slip into decline. Worryingly, progress made on pensioner poverty in the 1990s is beginning to reverse, with persistent poverty amongst the population aged 65 and over on the rise. Both the number of 100 DEAR DOCTOR WITH DR CHRIS STEELE

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Did you know? Of the 12 million people in the UK aged 65 or over, over 14,000 are aged over 100 Source: ONS

years people will live and how many of those years will be healthy varies hugely across the country and between the richest and poorest. The lowest life expectancy at age 65 for men and women is in Glasgow, where men can expect to live on average another 15 years and women 18 years. In contrast, men in Kensington and Chelsea can expect to live another 22 years and women in Camden, another 24 years. But perhaps a more significant question is how many of those years can

be lived without disability. Both men and women aged 65 in the UK can expect to live about another ten years without disability, but they can both expect some disability in their remaining years, on average nine for men and 11 for women. More than half of people over 65 have at least two chronic health conditions, many which affect their daily lives, and require help with activities such as dressing, bathing or showering, eating, getting out of bed, and using the toilet.

BENEFIT By the year 2036, the Centre for Ageing Better estimates that one in four of the population will be over 65—so will they fare better or worse than today’s older generation? While most people don’t expect perfect health in later life, most hope that their health and physical condition will be ‘good enough’ to do the things that matter to them; to work, to socialise, and to be able to look after themselves. The reality is that a longer

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life is not an unalloyed benefit if it is accompanied by debilitating ill-health. Almost a fifth of adults responding to a survey in 2014 had experienced a common mental health disorder (depression, anxiety, panic disorder, phobias and obsessive-compulsive disorder) in the previous week, and nearly half of people aged 55-64 aren’t physically active enough, with almost 1 in 10 (8 percent) of men between the ages of 55-59 struggling with daily activities. Of course, retaining health into later life is very much dependent on lifestyle decisions such as eating a healthy diet and getting enough exercise. Alcohol is a causal factor in more than 60 medical conditions, including mouth, throat, stomach, liver and breast cancers; high blood pressure, cirrhosis of the liver and depression, and in England in 2017/18, there were an estimated 1.2 million hospital admissions related to alcohol consumption (7.2 percent of all hospital admissions), 3 percent higher than the previous year. In the same period there were 338,000 admissions for conditions directly caused by alcohol, 15 percent higher than ten years previously. Levels of alcohol consumption are relatively high in mid-life, and habitual and high-risk drinking is most common

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amongst people in this age group. Nearly one in ten men in the 55-64 year old age group drinks over 50 units per week (the recommended level is 14 units). Although overall smoking rates have declined over time, 22 percent of people aged 45-54 are smokers. Perhaps most significantly, levels of obesity are high amongst those approaching later life, with more than seven in 10 people aged 45 to 64 in England either overweight or obese.

ACTIVE The CAB’s report The State of Ageing concludes that tackling the causes of preventable ill health and disability, such as smoking, poor diet, lack of exercise and excessive alcohol consumption are just as vital as the government implementing economic, structural, social and health policies that the evidence shows work to enable more people to live healthy, active lives. The report concludes “The fact that we are living longer is a great achievement. But making the most of these extra years requires fundamental changes across society. Without a radical rethink from the government, businesses and charities, more people risk missing out on a good later life. There is much to gain if we take action now, but also much to lose if we fail.”

When We’re 64 A new book by Louise Ansari published by Green Tree/ Bloomsbury gives essential guidance to making sure you have a fabulous later life. The ultimate practical guide to later life, When We’re 64 – Your Guide to a Great Later Life includes all the essentials on working longer, how to fund retirement, volunteering, where to live, what kind of house you’ll need, how to stay healthy – and still live a full life if you get a health condition – and how your attitude towards ageing could actually increase your lifespan. There are sections on relationships with family and friends, as well as caring for older relatives and how to navigate the system, plus a sensitive look at loneliness amongst other areas. Filled with expert advice and new evidence and tips on how to age well, When We’re 64 is an eminently readable light-hearted look at how to plan and prepare for what could be the best years of your life. Louise Ansari, Director of Communications at the Centre For Ageing Better, is donating royalties from When We’re 64 to North London Cares, a community network of young professionals and older neighbours who hang out together and help one another.


06/03/2020 15:35


The Telomere Enigma

and eight times more likely to die from infectious disease. In young cells, an enzyme named telomerase maintains the telomeres, but telomerase runs out with age (though it can also be manufactured excessively in some types of cancer). Some companies now offer ‘telomere length testing’ to determine the average state of your telomeres, and it’s suggested that lifestyle changes involving diet, exercise and healthy living can improve their condition. But can any measures actually extend lifespan? Companies offering dietary supplements based on plant extracts, which are claimed to lengthen short telomeres, leading to rejuvenated immune systems, increased bone

density and improved energy and feelings of vitality, may be on to something, if telomerase is the key to protecting telomeres and enhancing healthy lifespan. So could telomerase be used to “immortalize” human cells? Dr Cawthon’s study suggests that lifespan could be increased by five years by increasing the length of telomeres in people with shorter ones, and that average lifespan could be increased by 10 to 30 years. However, he concluded that there are many other major factors in ageing, such as oxidative stress (the damage caused to DNA, proteins, and fats by oxidants); glycation (where the energy-giving sugar glucose binds damagingly to proteins and lipids); and genetics. But Dr. Cawthon says that if all processes of aging could be eliminated and oxidative stress damage could be repaired, “one estimate is people could live 1,000 years.” •

IMAGES © Shutterstock

Some researchers believe that the route to managing ageing and illhealth lies in telomeres, structures in the body’s cells which protect the genetic material in DNA when it replicates. Telomeres have been compared to the plastic caps on the end of bootlaces, protecting the ends of the chromosomes from wear and playing a part in the cell duplication process to produce new skin, blood, bone and other cells. The trouble is that the telomeres erode each time the cell duplicates, which can be around 50 to 70 times in a lifetime, and eventually they wear out. The cells are then no longer able to duplicate and become senescent, causing the effects of ageing. Geneticist Richard Cawthon and colleagues at the University of Utah found shorter telomeres are associated with shorter lives. Among people older than 60, those with shorter telomeres were three times more likely to die from heart disease

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03/03/2020 15:40


Getting Mobile Again

Knee Replacement Surgery If you’ve reached the point where your joints are aching, replacement surgery can be an option. Here’s what you should know as you consider this life-restoring procedure


or anyone whose knees are sore and creaky, the loss of mobility can be a severe impediment to life, and the prospect of replacing the faulty joint with a new, metal-and-plastic substitute can be enticing. The surgery is often promoted as easy and without drawbacks, and able almost to restore lost youth. But don’t jump into it without knowing the alternatives: “Kneereplacement surgery is not like getting

a tyre change at a pit stop,” says orthopaedic surgeon David Lewallan. “It’s a major procedure and isn’t something that has to be done unless your symptoms can’t be controlled with simpler measures.” While patients shouldn’t wait until their knees are entirely broken down before considering replacement surgery, deteriorating joints can be treated by making lifestyle changes to reduce strain on your knees in the short term.

Too soon for surgery? The lower end of the thigh bone (femur) and the upper end of the shin bone (tibia) connect to form the knee joint. In a fully functioning, healthy knee joint, a smooth cartilage covers the ends of each bone where they meet, allowing the bones to glide over each other, producing a smooth, easy, pain-free movement of the knee. If the cartilage experiences injury or wears away with time, movements of the knee can become stiff and painful. Without the cartilage there to smooth their movement, the two bones of the knee joint rub together, causing painful swelling of the joint. But one reason why surgeons

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Conditions That Cause Knee Damage • Rheumatoid arthritis • Haemophilia • Gout • Disorders that cause unusual bone growth • Death of bone in the knee joint following blood supply problems • Knee injury • Knee deformity with pain and loss of cartilage

calculate the need for knee replacement surgery, or arthroplasty, with great care is that replacement knee joints don’t last forever. If you have the operation done, say, at 45, it may need to be done again later in life. While the number of surgeries performed has more than doubled in the past 20 years, there’s a move towards knee replacement being judged appropriate only for those whose arthritis or other conditions are at an advanced stage, causing severe pain, and impaired physical function like an inability to climb stairs, get out of a chair or walk without aids. Make sure to monitor your pain and regularly consult with your GP about what’s right for you. Before you hop on the operating table, there are a number of non-surgical options and lifestyle changes that may help manage the pain that comes from natural wear and tear on joints over time, or from more serious conditions such as arthritis. Exercise, eating healthy and limiting alcohol intake are all important when it comes to managing stress on your joints. Regular exercise and managing your weight can build muscle mass that help your joints move more easily and reduce the amount they carry around. Eating a diet rich in fruits, vegetables and vitamins will manage inflammation, and by association, the pain that comes

Selecting surgery

While adults of any age can experience knee-pain symptoms requiring surgical intervention, many people start to experience wear and tear on their joints at around age 50 and beyond, and research suggests surgical replacements for patients older than 65. So, when will patients see the most benefit from surgery? You may be a good candidate for a knee-replacement if you experience any of the following: • Pain, swelling and stiffness. It might be time for surgery if it hurts so much when you walk or go up and down the stairs that it’s hard to get through your day. Another sign is that your knee is painful at night or when you’re resting.

• Quality of life. If pain seriously limits what you can do every day, you may want to talk to a surgeon. Many people turn to surgery when their symptoms are bad enough that they’re unable to function, but in some cases, intervening before that can drastically improve quality of life.

Two types of kneereplacement surgery Total knee replacement – Both sides of your knee joint are replaced Partial (half) knee replacement – Only one side of your joint is replaced in a smaller operation

• Other treatments haven’t worked. Doctors always try to start with simpler solutions before moving on to surgery, so if you’ve tried anti-inflammatory medication, cortisone shots for pain and swelling, physical therapy and perhaps even weight loss—you may be a good candidate for surgery. • Knee deformity. If you notice you’re becoming bowlegged or knock-kneed, it might be time to consider surgical intervention.

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Don’t let knee pain hold you back. If your knee is keeping you from doing the things you love, it’s time to take action.

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At BMI Healthcare, we specialise in care for bones and joints. Whether you’ve suffered an injury or are living with a condition such as arthritis, we’re here to help you find a way to ease the pain. With more than 50 hospitals across the UK, you’re never far from a BMI consultant specialist. They’ll offer tailored advice, so together we can decide on the best treatment for you.

09/01/2020 16:59

Do you know the 7 most common causes of knee pain? Knee pain has all sorts of causes. Whether you see your condition below or are still seeking diagnosis, we’re here to help you take control of your pain and put you on the path to recovery. 1. Osteoarthritis This is when wear and tear causes the knee joint to deteriorate, often causing pain and swelling. 2. Bursitis Bursitis also causes pain and swelling, because the protective sacs (bursa) in your knee are damaged or worn down. 3. Patella tendonitis If you’re very active and have pain in the front of your knee, you may have patella tendonitis. 4. ACL injury Tearing or rupturing your anterior cruciate ligament (ACL) is the most common knee injury in the UK.

Whether it’s a course of physiotherapy or a complete joint replacement, our multidisciplinary team is here to make you feel informed and cared for from start to finish. There are no waiting lists when you go private, meaning you could be back on your feet faster. And with our flexible payment options, it’s more affordable than you think. When you choose BMI Healthcare you can expect: ■ A consultant appointment within 48 hours ■ Rapid access to a bespoke treatment plan ■ Two flexible payment options, 0% finance available*

5. Meniscus tear This is a common sports injury, though it’s possible to tear your meniscus off the pitch. It’s the cartilage between your thigh and shin bones. 6. Runner’s knee When it comes to patellofemoral pain syndrome (PFPS), also known as runner’s knee, the clue is in the name. It’s very common among runners. 7. Baker’s cyst A fluid-filled sac that can develop at the back of the knee, a baker’s cyst can be caused by an injury or can develop if you have arthritis.

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with it. Alcohol also plays a role in inflammation, so moderating your intake is important for those experiencing joint pain. Before resorting to surgery, doctors will also suggest trying anti-inflammatory medication, such as ibuprofen, to see if that will help manage the pain. Another option are hydrocortisone or steroid injections, which are used to treat swollen and painful joints after an injury or in arthritis. The hydrocortisone is injected directly into the painful joint and will help relieve pain and swelling. Their benefits can last for several months.


If you’ve consulted with your doctor and decided that the only way forward is surgery, prepare yourself by staying as active as you can in advance of the date of your procedure. Strengthening the muscles around your knee will aid your recovery. If you can, continue to do gentle exercise, such as walking and swimming, in the weeks and months before your operation. You can be referred to a physiotherapist, who will

give you a list of helpful exercises. After your surgery, be prepared for a gradual recovery and don’t expect to be running and jumping any time soon. You’ll usually be in the hospital for three to five days after the operation. Once you’re able to be discharged, your hospital will give you advice about looking after your knee at home. You’ll need to use a frame or crutches at first and a physiotherapist will teach you exercises to help strengthen your knee. Most people can start walking without aids around six weeks after surgery and start driving around the same time. Full recovery from kneereplacement surgery can take up to two years, as scar tissue heals, and your muscles are restored by exercise. The British Orthopaedic Association (BOA) is the leading society for orthopaedic surgeons in the UK, with member surgeons amongst the most highly-skilled and qualified surgeons in the country. Choosing to get your hip replacement done by a highlyexperienced BOA member surgeon will reduce the risk of post-surgery complications occurring. •


Don’t Let Knee Pain Hold You Back If knee pain is stopping you from doing the things you love, speak to a BMI Healthcare specialist. Our consultants will help you understand the cause of your pain and put together a bespoke treatment plan just for you. Whether you need physiotherapy or surgery, you’re in safe hands with BMI Healthcare. We will keep you feeling informed and in control throughout. If this is the kind of service you are looking for, then get in touch today. And remember, there are no waiting lists if you come to us. We can help you find a consultant near you and can usually get you an appointment within 48 hours at one of our hospitals nationwide. We also offer flexible payment options, meaning private treatment is more affordable than you think! Find out more at or call us on 0800 092 9082.


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06/03/2020 15:42


Retirement Dreams As you get older and approach retirement, could equity release be the way to finance your dreams for later in life?


quity release is an increasingly popular way to secure your finances later in life. The idea is simple enough–a financial arrangement which allows you to access the equity, or cash value, of your home, while you’re still living in it. Effectively, those who pursue equity release are borrowing money against the value of their house and repaying nothing until it is sold— typically upon death or when moving into a retirement home. The equity can be taken as a

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Did yo

u know

? UK hom e ow n e r release s d over £ 1 b n of equi ty in Q3 of 2018 alone

lump sum, in several smaller amounts or as a combination of both. The number of retirees choosing equity release is on the rise. In 2019, roughly 67,000 equity release customers unlocked some of their property wealth. Numbers are set to increase further as equity release becomes a practical consideration along with other retirement savings options. But is equity release is the right option for you? We weigh the pros and cons.

IMAGES © Shutterstock

Realise Your

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EQUITY RELEASE TIPS • If you think you’re likely to go ahead with an equity release plan, here are a few tips to keep in mind.

• Don’t borrow the full amount


Most people rely on pensions, savings, investments and other resources to fund their retirement, but with benefit structures changing, the age of retirement in flux and the unpredictability of the market, it can be hard to plan. When reviewing your finances, you’ll realise that your home is probably your biggest asset. Using some of its equity to make retirement easier is an option that may be available. Depending on the value of your home, equity release could allow you to release some of its value in the form of a taxfree lump sum. It gives you the ability to remain in your home and use the money for almost any purpose. You are eligible for an equity release plan if you are over 55 years of age and a UK homeowner with a property that’s worth more than £70,000. 110 DEAR DOCTOR WITH DR CHRIS STEELE

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It’s important to be aware that equity release could affect your entitlement to state benefits and will reduce the value of your estate. There are two main types of equity release plans, lifetime mortgage and home reversion.


The more popular version of equity release, a lifetime mortgage is a type of loan secured against your home which releases a tax-free cash lump sum—or, with certain plans, you can take smaller amounts as and when you need them. When you die or move into long-term care, the property is usually sold and the lifetime mortgage paid back. As with most loans, interest is added, so the amount you pay back will be greater than the initial loan amount. The fixed interest rate agreed at the time you take out the plan builds up as compound

you need in one go. The sooner you borrow, the more expensive it is, as the interest has longer to compound. So, borrow as little as you need now, and wait as long as you can to do it again. For example, if you think you may need £40,000 from your home to cover 20 years, only take what you need now and wait to take more until needed.

• Ensure you use a company that’s a member of the Equity Release Council. This trade body’s members promise a ‘no negative equity’ guarantee, so your estate will never owe more than your home is worth.

• Check the effect on benefits. Having cash rather than a property can affect your entitlement to pension credit and universal credit.

06/03/2020 15:43


interest over the years. You can decide whether to make regular monthly interest payments, however, unlike a standard mortgage, you don’t have to make any monthly repayments. The plan is usually repaid from the proceeds of the sale of your home when you die or move permanently into long-term care. You may qualify for an enhanced lifetime mortgage, depending on your lifestyle and medical factors, which are taken into consideration on application of the plan. It could allow more cash to be released from your property than a standard lifetime mortgage. You could qualify based on one or more of the following:

• Being a smoker • Weight concerns • High blood pressure • Diabetes requiring medication • Medical conditions such as angina, heart attack, cancer, multiple sclerosis or Parkinson’s disease • Retirement due to ill health


The alternative, a home reversion plan, involves selling all or part of your home to a plan provider in return for a cash lump sum (usually higher than the sum you can raise from a lifetime mortgage). While all or part of your home then belongs to the plan provider, you can remain living there for the rest of your life. A home reversion plan is not a loan, and as such there is no interest to pay. However, if your property increases in value, you will only benefit from the increase in value of the proportion you still own. When the property is sold, the reversion company receives its share of the sale proceeds. For a home reversion plan, you need to be over 65 years of age.


While an equity release plan will reduce the amount of inheritance you can leave, you can ensure that there’s something

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to leave behind with inheritance protection, which enables you to select a percentage of the property value that you want to protect. The higher the percentage you select, the smaller the maximum loan amount available to you. Some equity release plans offer interest payment plans, a flexible arrangement to reduce or prevent interest from accruing on your loan. These payments can be made as and when you wish, or sometimes can be paid regularly by standing order.


If you are thinking about unlocking some of your home’s equity to boost your retirement finances, it’s important to speak to an independent specialist. Whether it’s the right option for you depends on a number of facts and careful consideration. But equity release might just be what lets you live your best life in retirement. •


KEY EQUITY RELEASE Key, Equity Release That’s Right For You

There are all sorts of reasons that homeowners aged over 55 turn to equity release to help with their finances, but the first question Key Equity Release believe needs answering is whether it’s right for you. PERSONAL Key’s equity release advice is unique to you, delivered by qualified experts, who will take the time to understand your needs. They’ll search Key’s product range to ensure they recommend the right plan for you. TRANSPARENT Key ensure you consider alternative options, including downsizing or using other forms of borrowing, and if equity release isn’t right for you, they’ll tell you. SUPPORTIVE There’s no pressure to go ahead. Your adviser will give you all the information you need about equity release for you to make an informed decision in your own time. FREE ADVICE While some advisers may charge an advice fee, all of Key’s expert equity release advice is completely free, so you can find out if it’s right for you without it costing you a penny. Key Equity Release plans involve a lifetime mortgage, which is a loan secured against your home. Equity release will reduce the value of your estate and may affect your entitlement to means-tested benefits. Request your free guide with answers to your questions about equity release

FREEPHONE 08004087166 or visit


06/03/2020 15:43


We’ve paid o� our existing debt and can now enjoy our retirement M

r and Mrs Fitzgerald have lived in their London home for the past 22 years. Having bought it for £76,000, it has been their biggest investment by far, increasing in value by £349,000. However, with their interest-only mortgage coming closer to an end and £25,000-worth of credit card debt hanging over them, the couple were beginning to worry.

“£25,000 sounds like a lot of money, but it mounts up very quickly, even without trying. The problem is, we tried to pay the minimum, but they just don’t go down in a drastic manner. The interest rate is so high on credit cards you never seem to get to the bottom. The couple felt the only option was to sell their home. However, they couldn’t �nd anything they liked.

“We liked our house and the local area. This is why we looked into equity release. It gave us the answer. It allowed us to stay in our home and pay o� the existing mortgage along with our credit card debts.

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“We were visited by one of Key’s advisers who gave us all the information we needed. We told him what we wanted, he gave us several options to do di�erent things. He went away, did his research and then got back to us with some proposals. “We discussed our options and agreed on a plan suitable for us.

“For others in a similar position to ourselves, I would de�nitely advise speaking with an equity release adviser if they have equity in their property, which most people my age will. “For us, equity release was the answer. We had money to re-decorate the front room which needed doing and we are able to enjoy nice meals out.”

To �nd out how much cash you could release try our free online calculator at or call 0800 408 7166

23/01/2020 15:57



What is equity release? Your questions answered

Equity release is a way for homeowners over 55, whose property is worth at least £70,000, to release tax-free cash from their homes. It is an increasingly popular way for people in, or approaching, retirement to boost their finances. Will I still own my home? Yes and with Key’s plans you can stay in it for as long as you like, subject to your plans, terms and conditions. However, you should always think carefully before securing a loan against your home. Do I have to make monthly repayments? No – Key Equity Release plans involve a lifetime mortgage, which is a loan secured against your home. There are typically no monthly repayments as the loan, plus roll-up interest, is repaid when the plan ends. How much can I release? This depends on your age, how much your house is worth and your general health. Key customers had access to £90,298 on average between January and June 2019. Is equity release safe? Yes. You need to receive qualified advice before committing to Equity Release, which is exactly what you get from Key. We are members of the Equity Release Council and authorised and regulated by, the Financial Conduct Authority. Will I still be able to leave an inheritance for my family? Absolutely. Some of the plans include an option to ringfence a set percentage of your home’s future value so that it’s protected and can be passed on to your loved ones when your plan ends. We always encourage people to discuss plans with family as equity release will reduce the value of your estate and may affect your entitlement to means-tested benefits.

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Is equity release right for you? There are all sorts of reasons that homeowners aged over 55 turn to equity release to help with their �nances, but the �rst question Key Equity Release believe needs answering is whether it’s right for you. Personal Our equity release advice is unique to you, delivered by quali�ed experts, who will take the time to understand your needs. They’ll search our product range to ensure they recommend the right plan for you. Transparent We’ll ensure you consider your options, including downsizing or using other forms of borrowing, and if equity release isn’t right for you, we’ll tell you. Supportive There’s no pressure to go ahead. Your adviser will give you all the information you need about equity release for you to make an informed decision in your own time. Free Advice While other advisers may charge a fee, all of our expert equity release advice is completely free, so you can �nd out if it’s right for you without it costing you a penny. Equity release that’s right for you.

Order your free Key Equity Release guide for the answers to all of your questions

Call free on

0800 408 7166 Monday to Thursday 9 – 8pm, Friday 9am – 5.30pm, Saturday 9am – 5pm

or visit

23/01/2020 15:59

Is bathing a washout these days?

Bathing is so important to health and wellbeing, but this everyday task can become a chore and even dangerous. We discuss the benefits of renovating your bathroom. s we age, conditions such as arthritis can affect our flexibility and strength, making everyday tasks such as bathing stressful, instead of the relaxing experience it should be. The problem is, most bathrooms are designed for able-bodied people and require more strength and flexibility than you might think.

Ready, steady, bathe If you are struggling to get around now, it might feel as though your home is no longer suitable for your needs, or that you can’t bathe without the help of another person to steady you. Good personal hygiene is essential in maintaining overall health, well-

No mess. No stress

being and independence, so if your

Having a new bathroom installed can be a stressful experience, with multiple tradespeople to arrange and pay, plus the hassle of disposing of the old bathroom suite once complete.

bathroom is due to be refurbished,

This becomes increasingly

it’s worth thinking about getting it

apparent as we get older.

ready for any mobility issues you

Baths require the ability to lift

might face in the future, now.

yourself out, putting the full weight of your body on your arms.

Wash away your worries

Showers are often not at floor

Bathing Solutions has been

level, or are over a bath, needing a steady balance and the strength to lift your leg safely over - and all of this on a potentially slippery surface. Creating a safe, useable bathroom is essential as you get older. Research carried out by

creating intuitive, easily accessible bathrooms for more than 25 years. We’ve helped thousands of people to maintain their independence in their own home, just by making a few simple but effective changes.

Give yourself a fresh start

Our entire range of products is

Nobody likes having their home disrupted by renovation work, but having an easy-access bathroom fitted might not take as long as you think. Some jobs are finished in as little as three days and our expert team will always treat your home with respect, cleaning everything up afterwards.

Bathing Solutions has found that

designed with mobility in mind,

the rate of injury in the home is

including walk-in baths, walk-in

high, with 45% of over 55s saying

showers and wet rooms, plus a

they, or an elderly relative, have

variety of safety accessories such

injured themselves.

as handrails, non-slip flooring and

Falls account for an astonishing

Our end-to-end service is designed to take the stress out of renovating your bathroom. Our expert team provides a fully managed solution, which means we will design and install your bathroom - and take away your old suite - all for one, inclusive cost.

foldaway shower seating.

75% of all injuries in the home,

We also provide thermostatic

and if you already have existing

mixers and fillers which allow for

health issues, the injuries

easy, safe filling of the bath at the

sustained can be serious.

correct temperature.


Your bathroom shouldn’t be unusable for more than half an hour at a time during the re-fit

Call us on 0808 256 5212 or visit our website for more information Bathing Solutions.indd 1

17/02/2020 10:38

The solution to your SHOWERING NEEDS




Create a bathroom that works for you, with BATHING SOLUTIONS Create a bathroom that meets your unique bathing needs, with a wide selection of easy-access baths, walk in showers and wet rooms available. Let us help you make the best use of the space you have and provide a solution to the issues you face when bathing. Fully guaranteed product range FREE no-obligation quote Project-managed, from design to completion One, all-inclusive cost *Dependent on survey


Home visit

Call today for a



Call us on 0808 256 5212 to book a FREE no-obligation consultation with a member of our team. Please quote Ref: P3DRCS

Bathing Solutions.indd 2

We will come and see you at home, so we can assess the space you have and come up with the best solution for your mobility needs. 17/02/2020 10:39


Functional & Fashionable

Bathrooms You no longer have to choose between stylish and safety-conscious in the bathroom— design and practicality can go hand-in-hand

Door policy

A good first step in making your bathroom more accessible is to install a sliding door, which creates considerably more room for wheelchair mobility. If that’s not practical, it’s advisable for the door to open outwards, rather than in.



hen accessible bathroom design is done well, it’s the perfect marriage of form and function. And thanks to recent advances in accessible bathroom design, it has never been easier to create a stunning sanctuary that’s safe for everyone to use. Here’s what you need to look out for when fitting your bathroom with the must functional appliances and accessories— along with tips on how to keep it fresh and modern.

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IMAGES © Shutterstock


Eliminating the high bath side that must be climbed over to get into the tub is the first step in making your bathroom accessible. Replacing the tub with a shower or a walk-in unit with a folding or built-in seat will be a major help with mobility problems. This allows you to stay seated while showering, while also benefitting from space to stretch your legs. A walk-in shower keeps a bathroom

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struggle with the movement yourself. Another option would be a smaller but taller walk-in tub that is more compact and upright. These baths have low-level access doors and slip-resistant surfaces inside. They are designed with seats inside, so there is less exertion required for the user to sit and bathe than there would be in a deeper bath.


Wet rooms provide the most stylish, contemporary and luxurious solution to bathing difficulty. For anyone who finds the step-up tray a barrier to traditional showers—even the lowest shower trays have a small threshold—or if you are wheelchair-bound, a wet room with nonslip tiles may be the choice for you.


When it comes to the bathroom sink, you’ll want to look for something set at a comfortable height for a wheelchair user with no pedestal or plumbing in the way. This lets wheelchair users pull right up to the basin with no obstacles.

HEIGHT HINT All bathroom accessories— including soap holders, towel racks or shelves—should be installed at a height of no more than 120cm from the floor, in order to make them wheelchair accessible.


For the flexibility they offer, wall-hung cupboards are a great option for fitting a bathroom with more accessible elements. They can be hung at any height, allowing them to suit individual needs. Wall-hung cupboards also make a contemporary design statement, as well as minimising any obstructions to easy movement around the bathroom.

down and standing from conventional designs can be one of the most difficult things required of disabled people, and it’s something that happens several times a day. Personal Assistants rate helping clients transfer from their wheelchair to the toilet as their most stressful activity, and handling people in this way is the biggest cause of injuries to care workers. If needed, a hoist or toilet lifter will provide a great deal of assistance to anyone who doesn’t have the strength or flexibility to get on and off and toilet unaided. With support arms, which can be moved out of the way when not required, the seat moves up and down and tilts, so that you are eased into a standing or sitting position as required.


Grab rails are a good place to start when it comes to making your bathroom more accessible. These supports will help disabled persons in the bath or shower, as well as with the toilet. Grab rails used to only be available in white—but these days you can find them in practically any colour, shade and design, adding some much-needed choice for those decorating their home bathroom. The shapes of grab rails have evolved as well, with some options with a smart ribbing to make them easier to hold when wet. •


looking fresh and open, and with all the stylish tile options available, installing one will be a high-class upgrade for your bathroom.


If you find that standing for long periods of time doesn’t work for you, you may prefer to fit your bathroom with a walk-in bath. There are several different types of accessible baths, including models that have leg-lifters that can help raise and lower you into the bath, so you don’t

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For a safe bathroom environment to reduce the risk of potential falls, consider replacing the tiles in your bathroom with a low-slip option. These days, there are plenty of options when it comes to tile shape, size and colour. Try embracing the utility-chic trend with a monochrome colour scheme or go for something industrial with “brick” tiles in black and white.


These days technology can solve every problem–even toilet designs. Sitting DEAR DOCTOR WITH DR CHRIS STEELE 117

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ore accidental deaths occur in the home than on the road, about 3,000 a year in the UK. Here are some of the top safety tips from experts.


smoke and carbon monoxide

Fit smoke and carbon monoxide detectors, check them regularly for battery life, and have your heaters, flues, chimneys and air vents checked for efficiency.


Gas and electricity

If you are elderly, disabled, chronically sick, visually or hearing impaired, you can join the Priority Service Register run by gas and electricity suppliers. This entitles you to a free annual gas safety check. If you smell gas, call the National Gas Emergency number, 0800 111 999. SGN ( offers a simple gas safety device to keep people with dementia or autism safe at home. The locking cooker valve is fitted free to existing gas cooker pipework and when the valve is locked, the gas supply to the cooker is stopped, eliminating the risk of the cooker being unintentionally turned on or left on. A carer or relative can easily turn the valve on using a key when the cooker is required.

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steps to get smart, get safe


Make sure you have adequate lighting throughout the house, particularly on stairs. For night-time use, a safety nightlight plugged into an electrical socket will give enough light to see by without using up too much electricity.


Trip and fall hazards

Around 1,500 people over 65 die every year in the UK as a result of a fall in their home. Make sure your furniture and other items are arranged safely and don’t cause any obstacle. Keep trailing electrical cables hidden away or taped down. Don’t place loose rugs on polished floors or at the top of stairs, and fit grab rails where helpful on stairs or in bathrooms. Don’t reach for high objects without using a proper step ladder.



Don’t dry clothes on a heater, and take care with open fires, gas cookers and candle flames, putting a guard in front of the hearth. Make sure

that trailing sleeves, skirts or dressing gowns don’t catch alight.


Electrical items

Unplug electrical equipment when not in use, particularly hot items such as curling tongs and e-cigarettes. Use the correct charger for any rechargeable item, and don’t leave it charging overnight. Don’t site heaters near curtains. Electric blankets are among the most dangerous electrical items. Don’t use them if they are over ten years old, or show any signs of wear. Roll rather than folding to store, and don’t pile other blankets on top.


Getting help

Keep emergency numbers to hand and programmed into a cordless or mobile phone. Look into emergency response systems, which often work with an alert button you can wear around your neck—many local authorities run these schemes at reasonable costs. •

IMAGES © Shutterstock

Keeping safe at home is par ticularly impor tant if you are elderly or disabled. We round up some of the top tips



dear doctor with DR Chris Steele 121

06/03/2020 15:45


Getting a Handle

on Disability

From easy-grip handles to motorised scooters, it’s amazing how many solutions there are to the ever yday problems of disability

IMAGES © Shutterstock


t’s amazing how much help the elderly or disabled can get from simple adaptations to the home and everyday products. Tasks which can be impossible without aid become manageable again with the properly designed tools for the kitchen, bathroom or garden. Some of them, like mobility scooters, are major purchases, but in many cases, a small adaptation can make all the difference.

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Grab rails

Grab rails can be fitted easily and are a great help in bathrooms and elsewhere in the house. Designs in plastic coated steel are ideal for wall-fitting in the bathroom and toilet, while bath rails can be clamped to the side or attached by suction. Newel rails fit to staircases, angled grab bars are particularly useful helping the user stand or sit, foldaway rails are useful when space is short, and

outdoor grab rails can be provided in garden-friendly colours.

Walking frames

The classic four-legged design remains one of the most popular types, while models with two front wheels are sometime easier to handle. Add-ons such as caddies and net bags make life easier around the house or while shopping, while variations such as reciprocating designs (which ‘walk’

06/03/2020 15:48


with you), rollators (four-wheeled designs with brakes) and knee walkers can be of help in specific cases.

Reaching aids and handles

Reaching aids and ‘grabbers’ which make it easier to pick up objects without bending come in a number of forms, including folding, rotating and suction cup types. For the kitchen, garden and bathroom, specially adapted handles for taps, cutlery and tools are an enormous everyday help, as are devices such as one-handed can openers and extra grip door key turners.

Tables and trays

Over-bed tables on castors can often also be used over armchairs, and some incorporate standing aids. Adjustable height and angle make it easy to set the table to the ideal position for reading, writing, or using a laptop.

For help and advice on independent living, visit the website of the charity Disability Living Foundation at

Chair raisers

Though specially adapted chairs designed to help users sit and stand are available, in some cases all that’s needed is a bit more height, in which case a raiser adjustable to the position of the chair’s feet can do the trick. Uplift seat assists will aid in rising from a chair, while incar rotating seat cushions and grab handles can help car drivers get in out easily. For negotiating stairs, of course the stairlift, for straight or curved stairs, is an invaluable aid.

Wheelchairs and scooters

Wheelchairs vary from simple folding types to highly adjustable powered models, and special types designed to help negotiate stairs. Accessories such as cushions, gloves, trays, covers, clothing and bags help to customise the products, while at the higher end of the market, mobility scooters in three- and four-wheel designs are suited for everything from shopping expeditions to on-road use.•

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dear doctor with DR Chris Steele 123

06/03/2020 15:49

Worried about Mum? Unobtrusive support for peace of mind from Memo Hub.

Is Mum warm enough? Is she eating regularly? Has she made herself a cup of tea? Memo Hub offers answers to these questions and provides reassuring insight into your loved one’s wellbeing. Memo Hub® prolongs independence for the individual whilst providing reassurance to their families creating a modern home based care solution. The system consists of the Memo Hub®, a selection of unobtrusive sensors and the Memo App which displays this sensor data to a loved one or carer. Users can see reassuring activity and set alerts for worrying activity. You can personalise these alerts to what matters to you and your family. Panic buttons and fall detectors are available to make emergency calls to a family member, carer or a 24/7 response centre. Memo Hub® is easy to install, does not need Wi-Fi and fits in with your lifestyle. The simplicity and accessibility of the app is excellent, it is something that I know is there all the time, also the fact that it is something Mum can live with, it doesn’t feel like it is taking away from her independence. Paul, Leicestershire.

For more information please visit our website or email us at Memo Hub is a registered trademark of Alcuris Ltd. © 2020

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05/03/2020 09:25


There’s an App for That The older generation are not generally the target audience for high-tech gadgets. But many smartphone apps can make their everyday lives easier

IMAGES © Shutterstock


aron used to call his parents five or six times a day to ensure that everything was okay. As an only child, and one living about an hour’s drive away, he always worried—especially about his mother, who had just been diagnosed with dementia. Had she made it home from her daily walk or did she get lost? What about with daily tasks that took her out of the house? These days, Aaron still calls home quite a bit, but just to check in. But h’s found peace of mind thanks to one of the many smartphone apps on the market that assist with elderly living. The one Aaron’s family uses gives them access to a GPS tracker, inactivity tracker, fall alerts and SOS alerts. It’s made Aaron’s life much simpler, but also allowed his parents to age in the comfort of their own home, maintaining their dignity as they enter their later years. This is just one app designed to make life easier for the older generation –

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there are plenty of other examples too.


Tapping into the internal sensors in your smartphone, fall alert apps sound an alarm to anyone who’s been designated to receive signals—some will give initial contacts a short period, i.e. 45-60 seconds, to confirm they have received the alert before triggering a call to emergency services. For mobile seniors who would be significantly injured by a fall, although otherwise are in good health, an app like this allows them and their family members some peace of mind, as well as independence.


It’s estimated that 50 percent of the two billion prescriptions filled each year are not taken correctly, and the main reason is simply forgetting. Medication reminder apps can help with this problem, and of the

many choices out there, both free and paid, one will be right for you. Slightly more sophisticated than the built-in ‘reminders’ app on your smartphone, medication reminder apps will allow you to set a schedule for multiple medications, making sure that you take the right tablets at the right time by sending an alert.


Sometimes it can be hard to read the small print. If you find that it’s nearly always hard, consider looking for an app that can help with magnification and lighting—fine text and dim lighting being a common problem for senior eyes.


Charity Age UK recommends Kindio, an app that helps older people tell their life story on video, capturing important memories and wisdom built up during their lifetime to share with current and future generations of their family. • DEAR DOCTOR WITH DR CHRIS STEELE 125

06/03/2020 15:49

You don’t have to buy to

live life to the full Our retirement communities are all about enjoying life to the full, with company when you want it, help when you could use it, and even care when you need it.

And our three options mean you can do it your way.



Bit of both

Enjoy all the benefits without having to sell your property

Part exchange* and we’ll be your guaranteed cash buyer

Part buy, part rent for more financial flexibility

We’re here to make it happen

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Aspire to


What will your lifestyle be like in retirement? There are now plenty of choices for people who look for comfor table and suppor ted living solutions

Rising signs


s you reach retirement age you may decide that you need more than just a house, you need a home which will offer support and care as part of a retirement community. The demand for homes specially designed for people over 60 is increasing, and there are many ways to access them depending on the level of support you feel you need. The decision to go for a retirement living property may be a big one, but it can have profoundly positive effects on your quality of life, offering security and comfort which can be difficult to access in housing which makes no special allowances for older residents. Retirement living, in short, is different from elderly care and nursing homes, as it offers an independent way of living yet with support when needed, while nursing or care homes offer constant support to elderly people who need round-the-clock help. 128 dear doctor with DR Chris Steele

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Around 416,000 people in the UK aged 60 and over live in some type of assisted living. This is around four percent of the population aged 65 or over, rising to 16 percent of those over the age of 85. What is retirement living?

Retirement living provides a new way of life to over-60’s. The idea started off in the USA, and retirement communities are now very popular around the world. But demand is growing, particularly since there are different types of retirement living, and the individual can choose which type is best suited to them depending on their needs and situation.

There are two main types of retirement living arrangement. First, there are retirement villages designed for people who are still able to take care of themselves and lead an independent life– however on-site assistance is provided to make life easier and give residents peace of mind with features such as 24-hour security. One of the most important aspectss included in this type of independent retirement living is the sense of community. Retirement can be a difficult scenario for many people, and retirement living often provides opportunities for socialising with others in the same stage of life as well as activities and chances to get out of the house. Second, another level of support is assisted living, which also provides independent homes, but with a higher level of on-site help and assistance for those who find it hard to carry out everyday tasks for themselves.

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The decision to go into retirement living is a big one and can involve complex financial questions. However, there are some sure signs that it may be worth looking around to find a retirement village that works for you. Here are some of the most common reasons as to why people look into retirement living:

Medical conditions If an individual is suffering from ongoing and worsening medical conditions, it might be a good idea to consider retirement living so that they can have 24-hour help if it is needed, while still maintaining a sense of independence.

Isolation Retirement living offers a great number of solutions to those who have experienced loneliness and isolation in their retirement. From putting you closer to people going through the same stage of life, to offering activities that get individuals out the house and active, retirement living can be a great way to deal with this very common problem. •

NZ leads

Roughly five percent of the elderly community in New Zealand lives in a retirement village. The idea has more recently begun to take off in the UK, where the figure is currently more like 0.5 percent.

Monetary issues As we get older and the world continues to change in terms of technology, it can be more difficult to keep on top of paying bills and other finical responsibilities. Retirement living can offer help in this area and make sure that monetary responsibilities are as easy as they can be. Do be aware that in some cases a retirement property may attract an ‘exit fee’ when sold - make sure you and your beneficiaries understand the terms included in the purchase contract.


McCarthy & Stone is the leading developer and manager of retirement communities in the UK, offering a choice of high-specification, low maintenance apartments, located within social communities and designed to help you live independently for longer

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•Takes away the burden of maintenance chores, releasing your time to enjoy the things you really love • Well-equipped and low maintenance apartments allow you to live independently for longer • Enjoy being part of a warm and welcoming community when you want to, but have your privacy when you need it • Enjoy facilities such as onsite restaurants, reading rooms, landscape gardens and even wellbeing suites • Choose the option that suits your personal circumstances – buy outright, rent, or part buy, part rent.


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