Dear Doctor with Dr Chris Steele: Summer 2019

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c e l e b r i t y

a n g e l s

Dear Doctor

with Dr Chris Steele

Healthy Exercise








What Is


And Staying Healthier!



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

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SUMMER 2019 | £3.99 ISSN 1758-597X

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One of the nation’s favourite celebrity doctors shares his thoughts on health care, getting older and what we can all do to improve and maintain our wellbeing


It’s one of the most common conditions affecting sight. We look at the symptoms, causes and treatment of this worrying disorder.




It can happen with no warning, and can devastate lives. Learn to recognise the symptoms of stroke and find out what to do to minimise the damage it can cause.


Are you covered if you go on holiday with a pre-existing medical condition? All you need to know about the ins and out of travel insurance



If you want speedy attention, a choice of locations and a variety of treatments, is private health insurance the best way to go?


It’s enough to make you cry, except you can’t—but what causes dry eye syndrome, and what can we do to prevent or treat it?


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Osteoporosis and other bone disorders aren’t just an ailment of the elderly, but doctors are making great strides in understanding this worrying condition.


Leaps in understanding of the conditions of epilepsy are suggesting whole new directions for treatment. Meanwhile, how can we cope with this serious condition?

Today’s Serious and Common Conditions 21 THE IRRITATION OF DRY EYES


It’s entirely preventable, but too many of us are exposing ourselves to conditions which may damage our hearing. We consider the ways to avoid the causes and treat the effects.

Financial Matters Everything you though you knew about making a will may be wrong—we suggest some vital advice for taking care of your family after you’ve gone




Investigations into the potential of stem cell therapy raise ethical questions, but hold out great

potential for medical breakthroughs. We examine some of the possibilities


Dysphagia, the inability to swallow, can be aside effect of many conditions, and can cause severe discomfort and difficulty, but a whole array of techniques can be applied to tackle it.


It’s a serious and increasing condition, and it’s vital that we understand the effects of UV rays on the skin and the possible consequences of our sun-loving lifestyle.


While food intolerances can be annoying, full-blown allergies can have serious and even fatal consequences. Our report on the causes and treatment is essential reading.


Worrying for men, hair loss can be particularly distressing for women. But what are the causes of hair loss, and how can we keep our locks full and healthy?


A condition which is poorly understood and often not treated until it becomes serious, uterine fibroids should concern every woman.

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which are really good or you, and which are just a passing trend.


















You don’t need much of them, but you can’t get by without them—so should you reach for supplements to make sure your micronutrients aren’t in short supply? How some common plants have contributed to our understanding of medical science, and the role they can play in complementary medicine.

If you want to stay fit, shouldn’t you want your dog to be fit too? Fortunately, the two can go handin-paw. Read our guide to canine diet and exercise.

Hemp oil, CBD, medicinal cannabis —what are the facts behind the headlines, and which products could bring you the benefits of natural therapy? Coconut water could be the next big thing in health drinks and sports hydration, but why is this exotic substance being hailed as the health drink of the moment?

The importance of a balanced and healthy bacterial culture in your gut can’t be underestimated. We look at the diet you should adopt to beautify your microbiome. We all love our pets, but are we all aware of the health dangers they can represent? Whether you’re a dog-lover or a cat-worshipper, these are the furry facts you need to know.

The world needs to rethink its attitude to ageing if it hopes to cope with demographic trends. A World health organisation reports gives some pointers to a healthier future.



Can the gym clothes you wear improve your fitness performance? From smart trainers to moisture-wicking tops, we check out the trendiest and healthiest styles for exercising.

Life Starts at 60









Is it a fad, or the way to go for a healthy future? We examine the thinking behind veganism, the supposed health benefits, and why our planet may need more vegans. From hot yoga to exercising with your dog, there are lots of exercise fads to choose from. We sort out

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Incontinence is a distressing enough condition, but its consequences can be more worrying as it can cause skin damage. A better understanding of the causes and treatments is essential.


Skin tags, moles, warts, liver spots —all conditions which give rise to a good deal of misleading mythology. So what should you believe and what needs sloughing off?


It’s a small male gland but can cause a lot of problems. Now new treatments are making it easier to tackle this troublesome organ without the sideeffects of the past. As we get older our money worries should decrease, but that’s not always the case. Some sideways thinking suggests ways you can benefit now from thinking of the financial future. Hypertension, or high blood pressure, is a condition many of us may suffer without any awareness. Read here for an explanation of why it could pay you to take the pressure off.


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Insurance Choice are travel insurance specialists based in Warwickshire who share your passion for travel. We know nothing’s better than booking your next adventure; whether you’re hitting the slopes or soaking up some rays, one essential you should not leave home without is travel insurance (worryingly, one in five people do). We are specialists in arranging cover for those with pre-existing medical conditions (an illness or disease that you have had advice or treatment for, or symptoms of). We also help anyone suffering a serious condition access travel insurance. Benefits can include Unlimited Emergency Medical Cover (including Repatriation), Increased Cancellation up to £100,000 and no upper age limits (benefits vary by product).

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It’s a tricky subject, and one many of us will have to face, but is urinary incontinence an inevitable consequence of getting older?


Is the NHS really being brought to its knees by the implications of dealing with a diabetic nation, and what can we do about our diet and lifestyle to avoid the dangers?




If you have gappy teeth, there’s no need to frown—modern dental surgery can restore your smile with a range of high-tech treatments such as dental implantation.


How modern technology, from something as simple as a stairlift to smart appliances and monitors, can make it easier for us to stay fit and healthy in our homes for longer.





Going on a cruise can be as good for your body as it is for your mind, if you follow our water-bound guide to combining leisure with exercise.

Medical tourism 132 FINLAND

The first stop on our world tour of healthcare options for the medical tourist is the land of lakes, saunas, snowmobiles, and a happy healthy population.


A well-regulated and hightechnology healthcare system is exactly what you would expect from Germany, our next stop on our tour of world medical facilities.


Slap in the centre of Europe, Lithuania is pulling out all the stops to make sure medical tourists know about its worldclass medical facilities and professionals.

However old you are, you should be able to enjoy a holiday without worries—so follow our guide for the top tips to planning, packing and protecting yourself for the best breaks ever.




Ouch! None of us like vaccinations —but in an uncertain world, it pays to play safe. We give you the sharpest tips for healthy and worry-free travel.

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From its health-giving mineral water to treatment using bees, Slovenia is increasingly the medical tourist’s destination of choice.

e all know that the population of the UK is ageing—around 18.2 percent were aged 65 or over in mid-2017, compared with 15.9 percent in 2007. By 2027, this number is projected to grow to 20.7 percent. This is a tribute to the work of the NHS, the role of which after all is to help us to live longer, healthier lives. But improvements in life expectancy in the UK have stalled, whether due to cuts in social services or to unhealthy lifestyles, and this is a wake-up call that we all have a part to play in looking after our own health. The best we can do is to be aware of the most common and serious conditions, and to monitor our own health as well as seeing our doctor or nurse regularly. Conditions such as cancers, eye disease, prostate conditions, skin complaints, allergies, hypertension and incontinence are all best treated if caught early. Prevention is of course better than cure, and we must be aware that how we treat our bodies is an important factor in our long-term well-being. Healthy diet and exercise remain the best ways to keep fit and well, and with wonderful technical advances such as regenerative medicine and implantable technology opening up the potential for longer, healthier and happier lives for all of us, we should all be able to enjoy our old age to the full. I hope you enjoy this wide-ranging issue of Dear Doctor and come away armed with the information you need to maintain your health and well-being!




Dr Chris Steele, MBE

Portugal has long been a favourite holiday destination, but now it can add a modern and wide-ranging choice of medical treatments to its many attractions. DEAR DOCTOR WITH DR CHRIS STEELE 7

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celebrity PUBLISHER & CEO Kevin Harrington EDITOR Chris Jenkins, Kayley Loveridge SUB EDITOR Elika Roohi, Annalisa D'Alessio DESIGN Jason Craig, Friyan Mehta FEATURES WRITER Hannah Foskett EDITORIAL ASSISTANT Anetha Sivananthan, Maria Mellor PRODUCTION DIRECTOR Joanna Harrington PRODUCTION COORDINATOR Ava Keane OFFICE COORDINATOR Adam Linard-Stevens PUBLISHED BY Copyright © 2019, Celebrity Angels. All rights reserved COVER IMAGE Courtesy of ITV's This Morning; Shutterstock


r Chris Steele has for many years been the resident doctor on ITV’s This Morning. He was voted Health Journalist of the Year in 2007, received a Lifetime Achievement Award from the Guild of Health Writers in 2010, and in the same year received his MBE in recognition of his services to the medical profession and broadcasting. Chris Steele qualified as a doctor in 1968 and worked as a GP in South Manchester from 1970. He became interested in treating his patients who smoked in the early 1970’s and became a pioneer in this field. He is now recognised as an international expert in smoking cessation and nicotine addiction. He has been a health advisor and flag-bearer for many Government health initiatives, such as the flu vaccine, and acts as a health ambassador and patron for numerous charitable causes. With the benefit of 40 years of experience as a practicing GP, Chris has had the privilege of informing the general public on all manner of health issues nationally. He takes a particular interest in health matters affecting the fastest-growing part of the population—the over-50s.


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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 © 2019, 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.

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Keeping Fit and Well

with Dr Chris Steele MBE

IMAGES © Cour tesy of ITV’s This Morning; Shutterstock

ITV This Morning’s Dr Chris Steele talks to Chris Jenkins about the impor tance of diet and exercise, the implications of longer life expectancy, health treatment for women and the future of medicine

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Q. We’re all becoming more aware of what we eat, how it affects our long-term health and the effects it can have on the planet. Do you think people have a good understanding of the importance of diet and options such as vegetarianism, or are they perhaps misled by fads? Chris Steele: The biggest killers— heart attacks, strokes and cancer— have a major common cause, and that is ‘lifestyle’. Our lifestyle strongly influences our ‘death style’. The major factors in our modern lifestyles today are what we eat, our activity and our unhealthy habits... i.e. diet, exercise and drugs of leisure (tobacco, alcohol). The evidence is convincing that we eat too much red meat and processed meats, which are linked to heart disease and various cancers. We consume too much sugar in our food and drinks. Most people must now have a basic understanding of how important diet is, yet change is slow to occur. I’m not a vegetarian, but I do eat more than my five portions of fruit and vegetable every day—especially the deeply coloured and bright coloured foods... I always have a rainbow on my plate! Vegetarians and vegans make a personal choice, and to be honest I fully respect their decision and in particular how disciplined they can be. They will know that they may have to supplement their diet because of the absence of certain vitamins etc. Fad diets, I am very wary of, especially those endorsed by non-expert celebrities, who may know very little about nutrition yet pontificate widely across their huge social platforms! Q. As we are living longer, and perhaps suffering more from the conditions brought about by old age, is medical science keeping up? Are conditions such as sight loss, prostate problems, incontinence and Type 2 diabetes being better cared for?

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Most people must now have a basic understanding of

how important diet is, yet change is slow to occur CS: We are living longer, as life expectancy increases in most of the Western world. As a result, our ageing bodies suffer more from those diseases brought about by degeneration of the various bodily systems. Fading sight, becoming hard of hearing, osteoarthritis, poor mobility and balance and of course one of the worst consequences of ageing—dementia. Cancer becomes more common as we age, but there have been huge dramatic steps in curing many cancers, due to new surgical techniques, radiotherapy, chemotherapy and the ‘new kid on the block’, immunotherapy.

Medical science is trying to keep up and it’s fighting a valiant battle to ease these problems and even delay their downward progression. I keep an eye on health headlines in the press and medical journals, and nearly every day some new breakthrough research is published—we live in an exciting time! Q. Do women get a fair deal in health treatment? Are treatments for conditions such as endometriosis limited because they are underresearched? What can be done to eliminate any gender bias in treatments? CS: Overall, I don’t think women get the best deal in some areas of healthcare. Latest research showed that when men present at A&E with chest pain, the immediate potential diagnosis is heart attack, whereas this was not in the case in female patients, where other factors such as indigestion, acid reflux and muscular pain were considered first. Now, there could be a genuine reason for this, because it’s been found that women dear doctor with DR Chris Steele 11

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experiencing a heart attack do not always suffer the ‘male’ symptoms of tight or heavy chest pain, radiating down the left arm or up into jaw. Other female disorders such as endometriosis and ovarian cancer need a lot more research and as every disease area is underfunded, progress often depends on funds raised by the charities that support these disorders and the sufferers. Q. Do we need to think about caring for the elderly in different ways, such as using technology in the home rather than taking people into residential care? CS: The size of the elderly population is increasing year by year. I strongly believe we need to try and keep as many old people in their own homes, if they can manage or be helped by family and our care systems. Independence is vital to these proud old folks, and it’s so important that they remain in their familiar surroundings, rather than being placed in the strange surroundings of a care home. Of course, the cruel disorder of dementia takes away their thinking powers, their memory and ability to perform even the simplest of tasks and then the only answer for the distressed family and the patient is professional attention in a residential care home. Modern technology, with in-home cameras, alarms, light and cooker switches etc. already makes a huge difference if the elderly person has not lost any of their mental facilities and is fairly mobile within their home. However, who knows what advances we will see in this rapid technology revolution in coming years?

CS: More and more cases of skin cancer are being detected each year, mainly because it is increasing in the general population but also because people have become more aware of the early signs and are therefore seeing their doctor earlier. Skin cancer results from exposure to ultraviolet rays from the sun or even sun bed use. I’ve had skin cancer three times, basically as a result of being a sun lover and sun bed user 40 years ago, when we weren’t really aware of the dangers. Luckily my skin cancers were not the most serious type, which is malignant melanoma.

Cancer becomes more common as we age, but there have been huge dramatic steps in curing many cancers

The rise in skin cancer results a lot from cheap air travel and holidays in the sun. Soon after arriving at our holiday destination, we rush to the poolside or beach to soak up the sun aiming to develop that healthy tan to show off once we get back home! It’s not easy, but you should start with short periods in the sun and then gradually increase your expose yourself to the sun over your holiday period. The important message is DO NOT BURN! This applies particularly to children and teenagers. I burnt badly as a teenager and developed skin cancer 40 years later! Always apply high factor sun creams that give protection against UVA and UVB rays and keep reapplying them throughout the day. Q. This year’s World Health Day celebrates the 70th anniversary of the World Health Organisation, with the theme ‘Everyone, Everywhere’. With at least half the world’s population unable to access full

Q. There’s been a worrying rise in the incidence of skin cancer—is this entirely down to the sunbed industry, or to climate change, or are there other factors? What can we do to be aware of the risks and so improve our skin health? 12 dear doctor with DR Chris Steele

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healthcare, do you think Universal Health Coverage by 2030 is a practical goal? CS: The World Health Organisation has been remarkably successful in improving health, especially in Third World countries. I believe its most successful interventions have been in supplying clean water to millions across the African continent, plus the advances it has made in its vaccination programmes in preventing many communicable killer diseases. Its theme this year is ‘Everyone, Everywhere’ and the target is to really improve healthcare to the millions who just do not have the basic healthcare facilities.The WHO states that at least half of the world’s population are unable to access full healthcare. This is truly shocking, considering the excessive wealth (and waste) enjoyed by ‘civilised’ countries. I only hope they achieve, or get close to, their goal of ‘Universal Health Coverage’ by 2030. Q. The NHS has a comprehensive calendar of health campaigns ranging from Epilepsy Awareness Day to Stress Awareness Month, Action on Stroke Month and even National Stop Snoring Week. Do you think these campaigns do any longterm good, or are they just a bit of fun and fund-raising? CS: There are so many campaigns designed by the NHS aimed at stopping smoking, awareness of epilepsy, strokes, stress etc. I think they all do some good, purely by raising the awareness of these conditions and educating people more about these disorders and what is available as help to those who need it. One important aspect of such campaigns is raising money for the cause—money is often much needed by those doing research in these areas. Campaigns really form part of a much wider front when attacking problems in the healthcare arena, for example the ‘Stop Smoking’ campaign,

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added to the banning smoking in public areas, placing shock images on cigarette packets, concealing cigarettes at the point of sale etc. Basically, a campaign on its own is not enough—it has to form part of a multifactorial extensive public education programme. But every little bit helps! Q. How can we all do our bit to promote our own better health in old age? Are holidays, exercise and activities as beneficial to our mental and physical well-being as medical treatment? What would be a sensible exercise regime for the older reader? CS: To improve one’s health at any age, here’s a simple piece of advice: Eat less - move more. Many of us are over-eating, and over-eating unhealthy foods, such as high fat and high sugar items. Not many are over-eating fruit and veg! Many of us are too inactive—sedentary jobs, then sitting for hours watching TV in the evenings. The consequence of this is the epidemic of obesity prevalent even among our children. To achieve old age and especially better health in old age, it’s imperative

that we modify our lifestyles by changing our diet and getting active. Such measures will reduce our chances of heart disease, strokes, cancers, dementia, arthritis and the vast array of diseases brought on by diabetes (Type 2). It’s never too late to make changes, and recent research shows that even 10 minutes of mild to moderate exercise twice a week has huge benefits. For the older person this could just be a walk to the shops or pottering around in the garden. Any exercise/activity is better than none, as is any improvement in your diet... it ain’t rocket science! Of course, holidays and activities that involve meeting other people do improve our mental and physical wellbeing. Social contact amongst the elderly is valuable, as so many are left alone in their homes seeing no-one day in and day out. In my practice we used to visit our elderly patients every month, and for many, the doctor and the meals-on-wheels person were the only people they’d see. Isolation and loneliness are a big problem with many of our elderly folk—they just need a bit of company and a chat! • dear doctor with DR Chris Steele 13

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COUPLES AGED 50+ Protect your home from future care home fees

PAUL KING, Head of April King Legal

Does this sound familiar to you?

“We’ve made our Wills, leaving everything to each other first and then to the children.” These are known as Mirror Wills. Sounds reassuring enough, doesn’t it? But your children could end up with very little - or even nothing at all. If your surviving spouse has to go into care, they will have to use their assets to pay for their care until they get down to the lower limit. Therefore, it’s not a good idea to leave your half share of the home to your surviving partner but instead leave them the use of your share. This can be achieved by making new Bloodline Wills.

These legitimate steps must be taken while you are both alive and in reasonably good mental health. It is therefore important for couples to act NOW! Most of our clients come to us having already made standard Mirror Wills, or they’ve been meaning to make a Will but simply haven’t got around to it. With Bloodline Wills, yourself

and your spouse/partner each leave your half share of the home to the children in Trust, but state that they are not to receive it during the lifetime of the surviving spouse/partner. This half would then NOT be included in any future means test calculations for care fees. The surviving spouse is free to sell their share of the home, raise cash or move house. Your children are powerless to intervene but simply have to wait for their inheritance, as they would have done previously.

April King Legal have prepared a jargon-free guide to protecting your hard-earned assets. Get in touch for your FREE copy today. Your details remain confidential and will never be passed to any third party. This invaluable information guide explains why we do NOT recommend giving the house to your children during your lifetime (deliberate deprivation) or selling up and moving into an annex in their garden! It also includes details of Lasting Power of Attorney and our special Bloodline Wills which help prevent your children and grandchildren from losing their inheritance due to a child’s divorce, remarriage or financial difficulties.

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Protect Your Assets With a First-Class Will Making a will is normally a good way to protect your assets, but it can have pitfalls. Read on for some sound advice

DISINHERITED For instance, if the survivor chooses to remarry, the whole of the house could pass to their new spouse on their death, bypassing any children of the first marriage. Another problem is that if the survivor has to go into a nursing or residential home, and is the sole owner of the property, the Local Authority can charge the cost of care against the value of the whole house, and again, the children are effectively disinherited. One effective way to avoid these problems is to change the way the home is owned from Joint Owners to Tenants in Common. This is a straightforward process, and need not involve the mortgage company if the property is mortgaged. As Tenants in Common, each owner owns one half of the property and can use their own will to do whatever they wish to with their share of the property on their death. Their options could include leaving

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the property to their children, so that if the surviving spouse remarries they will only own their own half of the property, and can only give their share to their new spouse. In this case, the Local Authority can only charge the cost of care against the half of the house that they own, so the children inherit at least half of the value of their property.

PROVISIONS If the owner of the other half of the house does not want to sell their share, recent case law suggests that the effective value of the house could be nil, so the Local Authority may not be able

to charge any care costs against the value of the property. Other provisions, such as a Life Interest Trust, can delay the gift, preventing the surviving spouse being forced out of the home, and ensuring access to the capital if the house is sold, and a Discretionary Trust can protect income to care for an underage, disabled, vulnerable or elderly relative. So, if you want to protect your family property, don’t automatically assume that a ‘mirror will’ is right for you; consult a property solicitor and make sure your will works for you as well as for your family. •

IMAGES © Shutterstock


ost of us understand the importance of making a will—dying ‘intestate’ makes your property subject to complex inheritance laws, and if you have no relatives, it can pass to the Crown. A more common situation is that a couple co-own their home and make ‘mirror wills’, so on the death of one, the home automatically becomes the sole property of the survivor, who can do what they want with it; but this situation carries its own problems.


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Covering Your Condition What are your best moves if you need travel insurance, but have a pre-existing medical condition? We look at some of the options


ravel insurance might take second priority to the fun of booking your holiday, but it’s one area which should be top of your to-do list, particularly if you have a preexisting medical condition. Any condition which has required previous medical advice, diagnosis or treatment, such as high blood pressure, high cholesterol, diabetes, respiratory problems, joint inflammation and chronic illnesses such as cancer or stomach problems, may require completion of a detailed questionnaire. Your insurer may then impose certain restrictions, exclusions or special terms. Be prepared to disclose all the facts, as in the case of a claim, your insurer can access your medical records.


Medical costs abroad can be very high, so if you do need treatment for a preexisting condition but are not covered, you could be in for a shock. So when selecting a travel insurance policy, look for the amount of emergency medical cover offered (this can be unlimited if you find the right policy), any age limits, extras like a 24-hour helpline, an excess waiver option, cover for travel disruption, and possibly special cover for cruises or business trips. It is possible to get cover for terminal illnesses if you require it, though this is not offered by all insurance agents. Cover can usually begin immediately so long as the trip has not started, so you are always ready for your next adventure.•

Travel Insurance Top Tips ✓ Arrange insurance as soon as the trip is booked, so you have immediate cancellation cover ✓ Consider accepting an excess clause to keep down the cost ✓ For cruises, look for extras such as missed port cover and cabin confinement. Remember that skiing and winter sports normally require special cover ✓Check your policy’s cover for adverse weather and natural catastrophe

INSURANCEWITH TRAVEL Travel insurance is the last thing that we think of after a medical diagnosis, but some conditions can increase your travel insurance costs by over sixty times. Insurancewith was founded from personal experience of this problem. Ten years on, they’ve helped thousands of people with often complex or varying medical histories get away for less than other providers on the market. + Worldwide, European or UK cover for 1,000s of conditions + Up to 95 percent cheaper than

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other high street providers * + Founded from personal experience + £1 from every policy donated to charity + Winner of the British Travel Awards Best Travel Insurance Provider 2016

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The charities they work with help you with everyday problems, while Insurancewith can help when you want to travel. Use the discount code ‘DD19’ for 20 percent off call centre prices, or visit www.insurancewith. com/DD19 for more information.


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25/04/2019 12:48

Private health insurance

Going Private

With the NHS under pressure, is private health insurance a good way to ensure you get the best treatment? We consider the options


here’s never a good time to be ill, particularly if you’re self-employed or have a family to support, but private health insurance can take some of the worry out of getting timely healthcare. Good though NHS treatment can be, waiting times are a continuing source of concern, and being able to turn to private medical treatment can alleviate that worry. But what are the other advantages of private medical insurance (PMI)? Apart from speed of diagnosis and treatment, the main advantages of private treatment are that you get more choice of when are where you are treated, whether it be a private hospital or a specialised treatment facility, along with possible access to some medicines and procedures which may not be available on the NHS. Another advantage is that you will normally be

able to get access to a private room, with more flexibility on facilities such as visiting hours. Traditionally, private healthcare has been seen as expensive, but now it’s common to use price comparison sites to shop around for deals. This may not, though, give you access to the whole of the market or give you a bespoke quote, so a health insurance broker may be an option. Look for a broker which is regulated by the Financial Conduct Authority, free to consult and not tied to a particular provider. That way you can be sure that the advice you receive is impartial and tailored to your circumstances, including your age, employment status and so on. Bear in mind that some chronic conditions, such as asthma and diabetes, are covered by NHS treatments and would rarely be covered by a healthcare insurer. •

SAVINGS You may be able to save on your health insurance if you –

✓ Add an excess so you cover your charges up to a certain limit ✓Take a ‘six-week option’, accepting NHS treatment if available within six weeks ✓ Accept a reduced list of hospitals or types of treatment cover ✓ Insure through a company

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your whole family

HEALTH INSURANCE BROKERS When taking out private medical insurance, it is important to seek impartial and honest advice. Health Insurance brokers will tailor a bespoke plan for you and offer advice on what is best for you to do, unlike many comparison sites or direct insurers, who will not be able to advise you. Healthcare Clarity is an experienced and trusted health insurance broker, with all advisors being IF7 accredited. The personal service they offer means that even if you have pre-existing medical conditions, they will speak to the underwriters

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at each insurer to gain you the most favourable terms and give you peace of mind that your policy is tailored around your needs. If you need assistance with a difficult claim, your advisor will be able to support you. Whether you are new to health insurance or are looking to review a current policy, Healthcare Clarity offers a free advisory service. Healthcare Clarity Limited is a trading style of TRM Financial Ltd, an appointed representative of The Right Mortgage, and are authorised and regulated by the Financial Conduct Authority, FCA No. 725622

dear doctor with DR Chris Steele 19

30/04/2019 13:36

The innovation in dry eye Dry eye is a common condition that affects the tear film – important for lubricating and protecting the eye’s surface. eye drops contain two key components. The first, cross-linked hyaluronic acid, provides lasting lubrication to the eye’s surface. The second, Co-enzyme Q10, supports the recovery of damaged cells.

the eye health company

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VISU/UK/VIXL/0056 Date of preparation: February 2019

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Glaucoma help Have you been diagnosed with glaucoma? Glaucoma results in damage to the optic nerve at the back of the eye which can lead to vision impairment. This is why you have ‘visual field’ checks at your glaucoma check-ups - to check for any damage progression.

How can Co-enzyme Q10 help?

Running Dry Itchy, irritated, dry eyes can be a major annoyance—but are they the sign of deeper health problems?


ur eyes produce tears to wash out debris and protect the cornea, the clear outer layer of the eyeball. But a lifetime of sun, wind, stress and general wear and tear, may cause the eye to produce fewer tears. Around your 50s, it’s normal to notice a burning or stinging sensation, or alternatively to find your eyes brimming with tears for no reason. Symptoms can include itching, burning, aching, fatigue, redness, blurred vision and light sensitivity. Also common is ‘foreign body sensation’, the feeling that grit or some other object or material is in your eye. Conversely, another symptom can be watery eyes, caused by dryness over-stimulating the production of the watery component of tears. This reflex tearing does not stay on the eye long enough to correct the underlying dry eye condition. Causes of dry eyes can include airflow from air conditioning and fans, heat and ultraviolet rays from the sun, atmospheric pollen, contact lens wear, side effects from medication and chlorine from swimming.



A consistent layer of tears is essential for eye health, and there are three major components to the tear layer—oily lipids produced by glands in the eyelids, an aqueous component produced by the lacrimal glands and a mucous-like component produced by the goblet cells in the white of the eye. Problems with any of these sources of tear film components can result in tear instability and different symptoms of dry eyes. Fortunately, some dry eye symptoms can be alleviated without medication, and most symptoms can be treated with over-the-counter eyedrops or night-time application of gels. Follow our advice to manage your dry eye syndrome: • Check your medication – Ask your doctor if dry eyes might be a side effect • Eat well – Control your insulin level with three healthy meals a day including whole grains and less sugar and processed food • Avoid pollution and irritants, and don’t rub your eyes, which can disturb the tear film

Many parts of your body generate new cells as old ones die. However, the cells in your eyes affected by glaucoma do not – so they need looking after. CoQ10 helps protect these nerve cells by providing energy to help them function correctly and through its protective antioxidant properties. CoQ10 occurs naturally in the body, but the amount in your eyes can decrease by up to 40% with age. COQUN® eye drops contain CoQ1O and are a new add-on treatment to antihypertensive glaucoma therapy.

Speak to your ophthalmologist or visit VISU/UK/CQN/0011 Date of preparation: February 2019

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the eye health company

Have you been diagnosed with glaucoma? Glaucoma results in damage to the optic nerve at the back of the eye

•which Follow procedures can lead tohygiene vision impairment. This is why youfor have 'visual field' checks at your glaucoma check-ups - to check for any damage contact lenses progression. • Keep hydrated can Co-enzyme Q10 help? •How Use artificial tears to provide Many parts of your body generate new cells as old ones die. However, lubrication the cells in your eyes affected by glaucoma do not – so they need •looking Remember toprotect blink! if after. CoQ10 helps these Particularly nerve cells by providing energy toa help them function correctly and through itsblink protective using computer screen, try to antioxidant properties. CoQ10 occurs naturally in the body, but the every five amount in your seconds eyes can decrease by up to 40% with age. COQUN® eye drops contain CoQ1O and are a new add-on treatment to

antihypertensive glaucoma therapy. For optimum eye health, introduce nutrients such vitamins C and E, Speak to youras ophthalmologist or visit lutein, zeaxanthin, zinc, omega-3 fatty acids and beta-carotene into your diet. Try a salad with dark leafy greens, such as kale and spinach, with roasted carrots and sweet potato. Top with toasted pumpkin seeds for a delicious dinner that will prolong your eye health for another day. •

VISU/UK/CQN/0011 Date of preparation: February 2019


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COQUN速 eye drops contain CoQ1O and are an add-on treatment that works alongside the antihypertensive glaucoma therapy that your ophthalmologist has prescribed.1 COQUN速 helps protect the nerve cells in your retina by providing energy and through its antioxidant properties. Ask your ophthalmologist about COQUN速 eye drops at your next appointment. Reference: 1. COQUN 速 IFU (last revised on 18/O5/2O17).

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12/02/2019 09:52


Seeing Through



Glaucoma is the most common cause of sight loss in working age people. What causes it, and how can it be treated?

laucoma is a term describing a group of eye conditions that affect vision, in which the optic nerve connecting the eye to the brain becomes damaged. Glaucoma often affects both eyes, usually in varying degrees, though one eye may develop glaucoma quicker than the other. Glaucoma can affect anyone but is most common in adults over 70. It occurs when the drainage tubes (trabecular meshwork) within the eye become slightly blocked. This prevents eye fluid (aqueous humour) from draining properly, causing a build-up of pressure. This intraocular pressure can damage the optic nerve and the nerve fibres from the retina (the light-sensitive nerve tissue that lines the back of the eye). As glaucoma develops slowly over many years and doesn’t tend to have visible symptoms in its early stages, many people aren’t aware of it until they have a routine eye test. But there are symptoms, such as blurred vision or seeing rainbowcoloured circles around bright lights that should prompt you to have an immediate examination. Left untreated, glaucoma can cause serious loss of vision, including blindness, so early detection and prevention are key.

IMAGES © Shutterstock


Glaucoma can be treated with eye drops, laser treatment or surgery. Early diagnosis is important because any damage to the eyes cannot be reversed— treatment can only aim to control the condition and minimise future damage. Eye drops taken one to four times a day are the main treatment for glaucoma. There are several different types available, and some have side effects

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such as eye irritation, so you may have to experiment to find one that suits you. If eye drops are ineffective you may be recommended for laser treatment under local anaesthetic. The laser will open up the drainage tubes within your eye, allowing fluid to drain out and reduce pressure. Surgery is a rare option where other treatments are ineffective, and can be carried out under local or general anaesthetic.


You are entitled to a free NHS eye test if you are over 40 years old and have a firstdegree relative (mother, father, sister or brother) with glaucoma, are over 60 years old, or an ophthalmologist thinks that you are at risk of developing glaucoma. Eye tests not only detect cataracts and glaucoma, they also pick up other medical problems, such as diabetes and

Did you know? In England, about 480,000 people have chronic openangle glaucoma. Among white Europeans, about one in 50 people over 40 years of age and one in 10 people over 75 years of age have chronic open-angle glaucoma.

high blood pressure, before they become symptomatic, so if you’re eligible, take advantage of this opportunity to keep on top of your eye health. If you can’t leave your home because of illness or disability, contact your optician—sometimes they can visit you at home. • DEAR DOCTOR WITH DR CHRIS STEELE 23

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23/04/2019 16:30


Better Hearing

Better Living

We think of hearing loss as an inevitable consequence of ageing, but both the causes and treatments are becoming better understood


en million people in the UK suffer from hearing loss. Sudden cases of hearing loss at any age of course require immediate examination by your GP, but more commonly symptoms come on gradually over the years. A simple examination is often enough to establish causes and treatments; if not, a visit to an audiologist and a series of hearing tests may be necessary. Sudden loss of hearing may be due to build-up of earwax, ear infection, a perforated eardrum caused by injury or loud noise, or Ménière’s disease, an inner ear disorder. Treatments include medicines or eardrops.

IMAGES © Shutterstock


More gradual hearing loss may be due to fluid in the ear, a bony growth (otosclerosis) or a build-up of skin cells (cholesteatoma). But gradual hearing loss in both ears is usually caused by ageing or exposure to loud noises over many years and may be permanent. Fortunately help is at hand in the form of modern hearing aid technology. Recent advances include devices using Bluetooth to link to mobile devices, smart internet connectivity,

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Hearing Solutions UK Discretion, comfort & reliability We’re proud to offer a fantastic and technologically advanced selection of hearing aids, sound amplification devices and choice of service options. From initial assessment, customer discussion and prescription, to your aftercare and product maintenance, we strive to provide the highest standard of care to each and every one of our customers. Our range includes super-discreet virtually-invisible devices from the world’s leading manufacturers and we’ll make sure we provide you with the best and most comfortable solution possible with the appropriate level of technology. Our bespoke service means the solutions we offer you are completely suited to your lifestyle. We may recommend the simplest ready-to-wear, low-cost sound amplification device or another solution with amazing connectivity to your television, computer or mobile phone. We want what’s best for you and your lifestyle! improvements in rechargeable battery performance and programming with a separate remote-control unit. The variety of shapes and styles, from almost invisible ones inserted into the ear canal, to hearing bands looking like designer headphones, each has its pros and cons—for instance, BTE types generally have larger batteries, but they

are easier to replace. While most hearing aids are designed only to amplify sound from in front of the wearer, some types offer a ‘360 degree’ experience. Ask your GP or consultant audiologist or contact the Action On Hearing Loss charity website for more advice. • DEAR DOCTOR WITH DR CHRIS STEELE 25

01/05/2019 13:40


Strike Back Against Strokes


n June 2017, Jean Fray watched with pride as her daughter Marcia was married. After the ceremony, she felt unwell, and soon lost consciousness. She was rushed to hospital in Bristol, where it was confirmed she’d had a brain haemorrhage. Jean’s children, Marvin, Marcia and Bethany, and their father, Les, were given the devastating news that Jean might not recover, and, still in their wedding outfits, the family stayed by her side until she tragically passed away. Jean, a 60-year-old primary school teacher, was fit and healthy and seemed fine on the morning of her daughter’s wedding. She was one of 100,000 stroke victims in the UK each year. On the day of her funeral three weeks later, her mother, Audrey, also


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died from a stroke. Marvin, Marcia and Bethany are now campaigners for stroke awareness on behalf of the UK Stroke Association. “We have learned that strokes can impact anybody at any time. They are life-changing for the survivors and their families, as well as those that are left behind.”

WARNING SIGNS Strokes are still the fourth single largest cause of death in the UK, though you are now twice as likely to survive a stroke compared to 20 years ago. There are over 1.2 million stroke survivors in the UK, and bodies such as the Stroke Association campaign for awareness, fund research and manage recovery services. But what is stroke, what are the

warning signs, what can be done to avoid it and what are the prospects for recovery when it happens? A stroke occurs when the blood supply to part of the brain is cut off. Like all organs, the brain needs the oxygen and nutrients provided by blood to function properly. If the supply of blood is restricted or stopped, brain cells begin to die. This can lead to brain injury, disability and possibly death. There are two main types of strokes: ischaemic, where the blood supply is stopped because of a blood clot, accounting for 85 percent of cases; and haemorrhagic, where a weakened blood vessel supplying the brain bursts. In a related condition known as a transient ischaemic attack (TIA), the blood supply to the brain is temporarily interrupted. This causes what’s known

IMAGES © Shutterstock

Strokes can happen to anyone at any age, and the consequences can be devastating. We look at the causes, symptoms and prospects for recover y

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as a mini-stroke, often lasting between a few minutes and several hours. TIAs should be treated urgently, as they’re often a warning sign you’re at risk of having a full stroke in the near future. Seek medical advice as soon as possible, even if your symptoms resolve. All strokes are a medical emergency, and urgent treatment is essential. The sooner treatment is received, the less damage is likely to happen. If you suspect that you or someone else is having a stroke, phone 999 immediately and ask for an ambulance.

STROKE SYMPTOMS The NHS suggests that the main symptoms of strokes can be remembered with the acronym F.A.S.T.: FACE – The face may have dropped on one side, the person may not be able to smile, or their mouth or eye may have dropped ARMS – The person may not be able to lift both arms and keep them there because of weakness or numbness in one arm SPEECH – Their speech may be slurred or garbled, or the person may not be able to talk at all despite appearing to be awake TIME – It’s time to dial 999 immediately if you see any of these signs or symptoms Certain conditions increase the risk of having a stroke, including: • •

Hypertension (high blood pressure) High cholesterol levels Atrial fibrillation (irregular or fast heart rate) Diabetes

TREATMENT AND RECOVERY Treatment for strokes depends on the type and what part of the brain was affected. The initial treatment is usually medication, including anticoagulants to dissolve and prevent blood clots, medicate to reduce blood pressure and

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TIA FACTS People over 60 years of age, and people of Asian, African or Caribbean descent are at higher risk of having a TIA or mini-stroke. (Source – NHS)

to reduce cholesterol levels. In some cases, surgical procedures may be required to remove blood clots, treat brain swelling and reduce the risk of further bleeding in cases of haemorrhagic strokes. It’s a sad fact that many people who survive a stroke are left with long-term problems caused by injury to their brain. Some people need a long period of rehabilitation before they can recover their former independence, while many never fully recover and need support adjusting to living with the effects of their stroke. Local authorities should provide free reablement services for anyone

assessed as needing them. These services help the person recovering from a stroke to learn or relearn the skills necessary for independent daily living at home. Some people will become dependent on some form of care for help with their daily activities, such as washing and dressing, or to provide companionship. Influenza-type infections can be very serious if you’re recovering from a stroke, so you should make sure to get a free flu vaccination from your GP.

PREVENTION You can significantly reduce your risk of having a stroke through leading a healthy lifestyle, and remember that strokes don’t just affect adults. Every year around 400 children in the UK will have a stroke, according to the Stroke Association.


Eating a healthy diet Taking regular exercise

Drinking alcohol only in moderation

Not smoking

Managing conditions such as high blood pressure or cholesterol levels

If you’ve had a stroke or TIA in the past, these measures are particularly important because your risk of having another stroke is greatly increased. Jean Frey’s children set up a Strike Back Fund in her memory, and with the support of family, friends and colleagues, have won a fund-raising award by collecting over £30,000 for the Stroke Association. Marcia said “We want to help stroke survivors and families, and to fund more stroke research. We’re also keen to raise awareness about stroke and its risk factors as it’s not discussed as much as other diseases, despite having such a devastating impact on people’s lives.”• DEAR DOCTOR WITH DR CHRIS STEELE 27

30/04/2019 14:22


Sing a Little Song for… My Bones? Scientists are testing a radical new way to fight the bone disease osteoporosis. Could the sound therapy method help millions of sufferers?


TRIAL PERIOD A small trial of the new therapy is now underway at the National Spinal Injuries Unit at Glasgow’s Queen Elizabeth Hospital and, if successful, it could have broad implications for methods to treat bone diseases, particularly osteoporosis. “The lab-based experiments on stem cells have been remarkably repeatable across several labs in the UK and the trial will investigate whether it will work in patients,” said Professor Stuart Reid, from the University of Strathclyde, who helped develop the technology. 28 DEAR DOCTOR WITH DR CHRIS STEELE

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Around three million people in the UK suffer from osteoporosis, leading to 500,000 broken bones each year. Processes already exist to combat the condition, but these are expensive and complex. Nanokicking, if successful, is revolutionary for its simplicity and accessibility. “If we get positive results then there will be an immediate scale-up of the project and we will see how we can roll this out for the benefit of the wider population,” Professor Reid said.

OSTEOPOROSIS Osteoporosis causes bones to become thin and porous, which decreases bone strength and leads to an increased risk of breaks. One in three women and one in five men will suffer from osteoporosis in their lifetime. Fractures from osteoporosis are more common

note The musical elp that could h es is n save your bo third close to the ove harmonic ab. middle C than incidents of heart attacks, strokes and breast cancer combined. The condition is difficult to detect until a patient has suffered a broken bone, at which point doctors will be able to advise about the loss of bone mass. However, it’s possible that there may have been so much bone mass lost by this time that it is difficult to treat. That’s why the potential that of nanokicking to reverse the effects of osteoporosis is so encouraging. •

IMAGES © Shutterstock

illions of people suffering from osteoporosis—a disease that weakens bones, making them fragile and more likely to break—could be cured by having a ‘quiet musical note’ played to stem cells in their body, coaxing them to slow down and reverse the effects of the serious condition. Researchers at the University of Strathclyde in Glasgow are pioneering this groundbreaking development in ‘nanokicking’ therapy, which transforms stem cells by blasting them with low frequency vibrations. The possibilities of nanokicking (so called because very low amplitude vibrations ‘kick’ the stem cells) were discovered in 2013 by Scottish researchers who were searching for a way to turn stem cells into bone cells. They discovered that a quiet internal hum of around 1000Hz would do the trick.

30/04/2019 14:27

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Fighting Fits Epilepsy affects one in 103 people but is imperfectly understood. We look at the fantastic strides being made in diagnosis and treatment


pilepsy is usually diagnosed in childhood and in people over the age of 65, but it can affect anyone. It’s perhaps more common than most people realise, affecting approximately one in 103 people. The visible symptom of epilepsy is recurrent seizures, caused by too much electrical activity in groups of neurons in the brain. The effect of the seizure depends on the area of the brain involved and can range from what used to be called ‘petit mal’—a short episode of loss of awareness of surroundings—to severe convulsions and loss of bodily control. In affected people, seizures can be brought on by stress, hormonal changes, alcohol, irregular sleep patterns and, in rare cases, flashing lights. Fortunately, medical science is making great strides in understanding the brain chemistry behind epilepsy and in developing more effective therapies—possibly even cures.


Anti-epileptic drugs work by controlling the electrical activity in the brain that causes seizures. They do not cure epilepsy and are not used to stop seizures while they are happening. AEDs work best if they are

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taken regularly, around the same time each day. Up to 70 percent of people could stop having seizures entirely with the right AEDs (Source: Epilepsy Society). In late 2018, the government decided to reschedule some cannabisbased products for medicinal use. Specialist doctors in the UK can now prescribe medicinal cannabis to people with a limited number of conditions, including epilepsy. NICE (National Institute of Health and Clinical Excellence) is drawing up formal guidance on the prescribing of medicinal cannabis, consisting of the non-psychoactive substance cannabidiol or CBD. The guidance is expected to be published in October 2019 and to say that children with epilepsy that do not respond to conventional treatments may be considered for CBD treatment if prescribed by a specialist after referral by a GP.


Deep brain stimulation therapy may be used for people whose epilepsy is difficult to treat and who cannot have epilepsy surgery to separate or remove the part of the brain that causes seizures to happen. DBS therapy involves implanting electrodes into specific areas of the brain and

then stimulating these areas with small regular electrical impulses. The treatment is being assessed by NICE but is not yet available on the NHS.


Surgery to remove or separate the part of the brain causing seizures is becoming increasingly sophisticated. MRI (magnetic resonance imaging), CT (computerised tomography) or EEG (electroencephalogram) scanning may help to diagnose conditions which can be improved by surgery. Around 70 percent of people who have temporal lobe surgery find that the surgery stops their seizures and they become seizure-free, and for a further 20 percent, their seizures are reduced. Most though will still take their AEDs for some time. •

GENE GENIES A 2018 study by the International League Against Epilepsy (ILAE) Consortium on Complex Epilepsies, involving nearly 45,000 participants, discovered 11 new genes associated with epilepsy

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31/01/2017 15:14


The Stem of Healing?

What if it were possible to accelerate the body’s own ability to heal itself? This is the promise of regenerative stem cell medicine


Rebuilding Regenerating soft tissue requires the use of materials such as biodegradable polymers that can be made into structures similar to human tissue. The material acts as ‘scaffolding’ for the cells to grow into, producing a matrix to heal the injured site.

heal previously irreparable tissues or organs. At the heart of regenerative medicine is the use of stem cells, a kind of cell that can regenerate almost indefinitely. ‘Pluripotent’ stem cells can develop into any cell type in the body. This extraordinary flexibility means they have the potential to treat many different diseases and conditions that currently have no cure, like Type 1 diabetes, blindness, Parkinson’s disease, heart disease and arthritis.

IMAGES © Shutterstock

egenerative medicine may sound like the stuff of science-fiction movies, but it is in fact a cutting-edge branch of science that combines the disciplines of tissue engineering and molecular biology to replace human cells, tissues or organs, or regenerate them to their normal levels of functionality. The field holds the promise to engineer damaged tissues and organs by stimulating the body’s own repair mechanisms to functionally

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The earliest form of regenerative medicine was blood transfusion— something which is commonplace in most clinical settings nowadays. But researchers are now taking the idea further, experimenting with transplanting bone marrow to help patients with radiation damage or blood cancers to make new, healthy blood. Regenerative medicine researchers made a major breakthrough in September 2014, when surgeons at a research hospital in Kobe, Japan, transplanted a particular kind of cell that helps eyesight into the eye of an elderly woman suffering from agerelated macular degeneration. “We’ve taken a momentous first step,” said Japanese ophthalmologist Masayo Takahashi at the time. While research into regenerative medicine has yielded exciting breakthroughs so far, the road from a successful trial to medical practice is long. Health authorities who grant approval for new therapies must be satisfied that a new treatment is safe and works. 36 dear doctor with dr Chris Steele

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Regenerative medicine treatments also tend to be very expensive, because they require special production facilities and highly skilled staff. With health budgets being squeezed everywhere, high costs are a serious issue for hardpressed health services.

ETHICS And there’s another potential hurdle in the way of the spread of regenerative medicine: the use of stem cells, which are harvested from human embryos. Controversy over the moral, ethical and legal issues involved is likely to continue even as the technology advances. Stem cell therapy holds great potential in the treatment of the symptoms of ageing. To fully understand the causes of ageing, we have to distinguish between two different types—intrinsic and extrinsic ageing. Intrinsic ageing is the one we all cannot avoid and refers to the natural process of ageing to which we are all subject. Extrinsic ageing is the outcome of various lifestyle and environmental factors which can be the cause of premature or early ageing, and here

we have choices to make. The main factors in extrinsic ageing include smoking, alcohol, pollution, UV light, lack of exercise and too much refined sugar and carbohydrates in the diet. These variables all produce ‘free radical’ chemicals, which cause damage to cells. Moreover, as you age, your cell production rate drops dramatically. Research organisation Swiss Medica noted a decrease of 45 percent at 35 years old. At the age of 65, cell production rate falls further with a shocking decline of 95 percent.

Symptoms The most recognisable symptom of ageing is the loss of skin elasticity marked by wrinkles and loose skin. This is a by-product of the glycation process, where excess sugars attach to collagen fibres which lose their elasticity and durability. The new bonds created during the glycation process between collagen fibres and sugar modules are known as advanced glycation end products, or AGEs. Alongside the ageing of the skin, AGEs contribute to the ageing of the brain through impairments to cognitive

IMAGES © Shutterstock


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functions. AGEs are equally responsible for chronic degenerative disorders such as cataracts, arthritis, renal failure and macular degenerative eye disease. But stem cell therapy holds out the promise of improvements in these degenerative conditions, as stem cells work to replace and repair damaged issue. There are three main categories of stem cells, comprising of adult stem cells, embryonic stem cells and induced pluripotent stem cells. Adult stems cells are known as multipotent—they can only develop into certain types of cells in the body. For example, blood stem cells are only capable of replacing the different cells found in the blood, but pluripotent cells produced by scientists and embryonic stem cells from human embryos can develop into almost any kind of cell.

STEM CELLS Potentially, then, stem cell treatment can help lessen the effects of ageing, without disrupting normal functioning. Themesenchymal stem cell is a multipotent type of adult stem cell found in bone marrow, the principal function of which is to repair skeletal tissues in the bone marrow. Mesenchymal stem cells have provided promising leads in the pharmaceutical sector, with research being undertaken to determine their effectiveness against Multiple Sclerosis (MS). Mesenchymal stem cells (MSCs) are also promising for another reason— they present far less in the way of ethical issues than their alternative, embryonic stem cells extracted from embryos at four to five days old. With stem cells treatments, you are given complete control as the treatments utilise your own stem cells and can be injected where required. While invasive treatments such as Botox can freeze facial muscles and reduce facial expressivity, stem cell treatments can rejuvenate skin cells,

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Benefits of stem cell treatments In addition to benefits to the skin such as reduction of fine lines, wrinkles and age spots, stem cell therapy can potentially support other areas of health affected by ageing including • Heightened memory and increased focus with stronger response rates • Better sleep quality • Improved eyesight • Weight loss • Increased libido • Hair loss prevention

improving their elasticity. In a typical session of stem cell treatment therapy, a patient would receive 200 to 300 million stem cells. The hope is that this large infusion of cells would have a far-reaching impact, replacing damaged cells from decades

ago. The treatment looks like it could be highly beneficial to one of the major sources of premature ageing, damage from UV light rays.

THE FUTURE As long ago as 2009, a study on mice by W.S Kim et al. demonstrated the injection of stem cells immensely reduced the appearance of wrinkles triggered by UVB radiation. The stem cells were found to have recovered fibroblasts affected by UV light rays and maximised their secretion of collagen. So, is stem cell treatment the ‘magic bullet’ in the fight against ageing? Certainly, it’s a promising area of research, but in the meantime we can all do a lot with diet, exercise and lifestyle to help our cells to age gracefully. But it seems certain that the next few years will see amazing breakthroughs in regenerative medicine—in the near future we may be able to replace organ donation with the use of ‘grown’ organs, treat burns with immediate skin replacement, replace damaged bones with ‘offthe-shelf’ tissue, restore vision with one operation, or cure diabetes. The possibilities truly seem endless. •


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Regenerative Treatments Stem cell and PRP treatments are able to treat a wide range of issues such as arthritis and joint pain


egenerative medicine, i.e. stem cell and platelet rich plasma (PRP) treatments has gained a massive popularity and interest in the last ten years. They are used in many different specialities, such as neurology, oncology, haematology, orthopaedics to name the few. Regenerative orthopaedic has emerged as a new branch of orthopaedic treatments, which in many cases allows to avoid or considerably delay a serious operations such as joint replacements. Obviously, regenerative orthopaedic is not an answer to all orthopaedic problems but growing clinical and experimental evidence shows its effectiveness. WHY STEM CELLS AND PRP? Stem cells are present in every part of our body during our life. They regenerate and replace damaged cells and are responsible for our good health. They bore a unique ability to develop into almost any kind of cells. For example stem cells stored in our bone marrow easily develop into a new cartilage, muscle, ligament or tendon. With age the number of stem cells present in various parts of our body, such as joints drops down. This is one of the reasons why we have more pains and aches when we age. The good news though is that the number of stem cells in our bone marrow remain unchanged! Hence a skilled doctor can take them from there and place where they are most needed, like in an aching knee. Obviously sometimes the damage is beyond repair, for example in the severe arthritic joint. In such case stem cells might not help. PRP is a different story. We all know that platelets are those tiny cells in our blood responsible for clotting. But this is only part of the story. Platelets though contain dozens of enzymes and proteins which bore incredibly potent anti-inflammatory ability. They are able to kill the inflammation in the joint and other tissues much faster and better than any antiinflammatory painkiller or injection.

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WHY REGENEXX? Regenexx is a network of over 40 regenerative orthopaedic clinics all over the world. They are present in US, Asia, Middle East and Europe. Regenexx provides training for their doctors, supports them and provides the latest developments in the regenerative orthopaedic. Regenexx carries out its own research and publishes peer review papers. Moreover, Regenexx clinics have performed over sixty thousands procedures and the results have been analysed and published. Regenexx holds several patents and has developed over eighty different procedures using stem cells and PRP in regenerative orthopaedic. WHY ALGOCELLS? We are proud to be the first Regenexx clinic in the UK and the second in Europe. Our doctors have had a vast experience in the treatment of chronic pain and in using injection techniques for joints and spine pain before they joined Regenexx. On top of it they received an extensive training in Regenexx clinic in Colorado and became the affiliate certified Regenexx providers in the UK. Algocells uses its own laboratory and state of art treatment facilities. We have treated patients from the UK, Switzerland, Russia, Poland, Scandinavia, Pakistan, South Africa and Dubai. Our treatments are carried out in line with the highest Regenexx standards. Our doctors are members of Interventional Orthopaedic Foundation (IOF) and have participated

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in several IOF training courses. We are a signatory of Orthobiologic Ethics Consortium, a voluntary organisation gathering likeminded professionals concerned about ethical use of stem cells. WHAT WE TREAT? We treat mild and moderate arthritis in knees, shoulders, hips as well as in small joints: ankle, wrist, elbow and even fingers and toes. We also treat various joints injuries, such as rotator cuff tear in the shoulder, ACL tear and meniscus tear in the knee and many many more. We treat spine problems, such as facet joints problems, discs, stenosis and so on. We always assess MRI scans and carry out a thorough clinical examination as well as ultrasound scanning prior to the treatment. How to contact us? Website: Facebook: Telephone (Mon-Fri 9-5): 0800 689 14 74 Email:

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Derek isn’t a young man – but he’s not an old fool either! And he knew that the nasal spray that his doctor was recommending was not going to help. “When he told me to my face that I didn’t have silent reflux disease I knew that nobody was listening to my symptoms. He had helped me through my wife’s tragic illness earlier, but he seemed not to listen to what I already knew about my own condition”.

Derek suffered from silent reflux - IQoro® was the answer! Derek’s problems started in the winter of 2017 with a runny nose when out walking. At first he thought it was just a cold, but the cold didn’t disappear as they usually do, and instead the problem worsened to include thick mucus in the throat, voice box and nose. Derek went through a morning routine of clearing this before he was able to speak. Being retired, with time on his hands, and an avid reader, he researched the subject in the local library in his English coastal village. “It all made sense, it all hung together. The mucus was being produced by my body to protect my throat, vocal chords and voicebox from the acidic reflux that I was experiencing. I wasn’t feeling the heartburn that usually accompanies a Hiatal hernia, but that’s what the problem was. That’s why it’s called ‘silent reflux’”. He is right. A Hiatal hernia occurs when the top of the stomach can intermittently slide up through the diaphragm (the Hiatus) because of a weakening in this muscle wall (a hernia). This allows stomach acids to reflux and cause discomfort and attack the soft membranes of the upper digestive and respiratory tracts. When the most obvious of these symptoms are not apparent - perhaps because of the thick defensive mucus that the body produces - it is often not correctly diagnosed. “Armed with my new knowledge and now aware of a new Swedish treatment that claimed to exercise the hernia in the • EASY TO USE • 90 SEC TRAINING/DAY • SCIENTIFICALLY PROVEN EFFECT

diaphragm back into shape, I made a new appointment with my GP. He didn’t think that I had silent reflux disease, but prescribed me PPI medication anyway!”. Disappointed but not discouraged, Derek ordered an IQoro neuromuscular training device and started his 1½ minutes per day training in August 2018. Just a few weeks later he wrote to IQoro to say that he that could feel the positive effect of the partial vacuum produced when training, that he was almost free of phlegm during the day, and that his post-nasal drip had disappeared. Derek continues his training, on a reduced daily basis, to this day. Today, more than 10,000 patients across Europe train with IQoro to address the underlying causes of certain swallowing, digestive and respiratory conditions. This revolutionary method is underpinned by a series of peer-reviewed, internationallypublished clinical studies. IQoro is a CEmarked Class 1 Medical Product and is recognised by the National Institute for Health and Care Excellence (NICE) as “the only device available for treating Hiatus Hernia with oral neuromuscular training and the intended place in therapy is as an alternative to long-term Proton Pump Inhibitor medication, or to Laparascopic Fundoplication surgery”.


FSDD at Valid until 31-05-2019

IQoro® is a neuromuscular training method that is both a preventative and a rehabilitating treatment. Stimulates and strengthens the muscles that are weakened by: - hiatus hernia - snoring and sleep apnoea - dysphagia and swallowing difficulties Read more and order at Contact us at or Telephone 020 396 607 23

Breathe. Eat. Smile. Talk.

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g n i o G n w o D the g n o r W Way


Dysphagia, the inability to swallow, is a little understood and potentially dangerous condition, but what are the causes and possible treatments?


he word Dysphagia describes difficulty in swallowing, normally a reflex action which we don’t think about. Sufferers soon discover that without this simple reflex, everyday life can become difficult. Dysphagia is normally a symptom of another condition, such as stroke, head injury, multiple sclerosis, dementia, oral cancer, COPD (Chronic obstructive pulmonary disease) or gastrooesophageal reflux disease (GORD) where stomach acid leaks back up into the oesophagus. But it can occur without any of these conditions being present. Children can also have dysphagia as a result of a developmental or learning disability, such as cerebral palsy. Symptoms can include coughing or choking when eating or drinking, bringing up food, a sensation of having food stuck in the throat, persistent salivation or inability to chew food. Dysphagia can lead to malnutrition, tooth decay and pneumonia, but perhaps the most worrying aspect is the way it disrupts everyday social life, as sufferers find it impossible to eat naturally or to sleep confidently. If you experience the symptoms of dysphagia, a visit to your GP will aid

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diagnosis. A cure cannot be guaranteed, but dysphagia has a range of possible treatments depending on its cause.


The most common type of dysphagia, oesophageal dysphagia, may affect around 10 percent of the population and is caused by hiatal hernia, where the aperture in the diaphragm through which the oesophagus passes is widened. Common symptoms include acidic indigestion, reflux, heartburn, chronic cough, a feeling of ‘a lump in the throat’ or of a blockage in the chest, or difficulties in swallowing solid food. Hiatal hernia is relatively benign, but if untreated may lead to more persistent symptoms. A relatively new approach to treatment of hiatal hernia is the use of a neuromuscular training device which strengthens the muscles used in the swallowing process. By retraining the body’s natural nerve pathways to activate the muscles in the face, mouth, pharynx, oesophagus and diaphragm, the symptoms of dysphagia can be controlled, and with time hopefully eliminated. Treatment for other forms of dysphagia may be managed by specialists

including a speech and language therapist (SLT), a dietitian and, possibly, a surgeon. SLT can teach new swallowing techniques, while changing the diet to softer or liquified foods can make it safer to swallow. If necessary, feeding can be done through a tube into the nose or stomach, or surgery can be performed on the oesophagus to widen it, or to insert a metal stent. For anyone who struggles with symptoms of dysphagia without understanding the problem, a diagnosis can be the first step to improving quality of life and hopefully returning to a comfortable, natural relationship with food and drink. •

CHEW ON THIS We take the swallowing reflex for granted, but it’s actually very complicated, requiring the smooth operation of up to 22 muscle pairs and seven cranial nerves.


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Skin Cancer Focus Skin cancer is the most common form of cancer in the UK. Most skin cancers can however be cured if detected early.


kin cancer is an uncontrolled growth of skin cells and most often develops on skin exposed to ultraviolet (UV) radiation. It can also develop on parts of the skin that have not been directly exposed to sunlight. Many are at risk of getting skin cancer, but people with a certain skin type and family history

(genetics) are at higher risk. Melanoma, often growing from a mole or as a new lesion resembling a mole, is one of the more aggressive forms of skin cancer and can be a major health concern if it is not caught early. Not counting the many cases of the other forms of skin cancer, melanoma is the fifth most common cancer in the UK with around 13,500 new cases each year in the UK. For melanoma, early detection is key. When it comes to finding melanomas, patients are often the ones to sound the alarm. Ordinary people can and should get better at noticing changes on their skin. Keeping an eye on your

skin is one way you can be proactive about your own health.


It’s important both to look out for changes in your existing moles and to be aware of any new moles or marks on your skin. Below the age of 35 years, it is completely normal to develop new moles. After that age, it becomes less common. In adults, over 70% of melanomas show up as new moles or marks on the skin.

Keep track of skin changes with the camera on your phone.


Melanoma is the 5th most common cancer type in the UK Source: Cancer Research UK

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skin to look out for new moles and marks and take close-up photographs of moles you want to keep an eye on. Then you can later compare and see if anything has changed.

The ABCDE and “Ugly Duckling” ASYMMETRY


The two halves of the mole don’t look the same.

Pay extra attention to moles larger than the end of a pencil (6mm).



The edges of the mole are rugged or uneven.

Any mole that is changing or growing.



If a mole has multiple colours or the colour changes, get it checked out.

Be extra attentive to new pigmented lesions if you are over 35 and remember to check areas you don’t look at often, such as your back. A sore that doesn’t heal within a few weeks or a lesion that itches or is bleeding are also clear signs that you need to get it checked. If you are in doubt, see your doctor.

Any mole and mark which appears different than the other spots on your skin.


Check your skin for changes regularly and remember to examine your entire skin. Every skin is different so getting to know your skin’s appearance is important. A regular head-to-toe skin self-exam is key. During your skin checks take wide area photos of your


Miiskin is the first app to be dermatologically endorsed by the Skin Health Alliance. It’s a photo app to document skin changes over time and is built for convenience and security for those serious about keeping track of their skin and moles. Importantly, the app does not provide any diagnoses or risk assessments on the photographs. With the app you can compare close-up photos taken at different times right within the app to see if anything has changed. It also lets you photograph wider areas of your skin and to access and compare the photos on your computer or tablet to look out for new moles and marks.

Right now you can get a 30-day free trial of Miiskin Premium for full access to the app.

Get 20% off Miiskin Premium £23.49 > £18.49 / yr

Go to Dermatologically endorsed by the Skin Health Alliance.

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Visit for more skin cancer information. Healthcare professionals can contact Miiskin for free educational leaflets.

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Skin Cancer

With rates of skin cancer increasing faster than any other cancer in the UK, it’s time to put the facts, symptoms and risk factors under the microscope


hile there are many other skin conditions that are not cancer, especially in older people, skin cancer is one of the most common cancers in the world. There are more than 100,000 new cases of non-melanoma skin cancer being diagnosed each year in the UK, so understanding the specifics could play a crucial role in protecting your skin and ensuring an early diagnosis. 44 dear doctor with dr Chris Steele

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BE SURE If you notice anything unusual on your skin that doesn’t go away in a month, show it to your doctor. Taking photographs so that you’re able to monitor any changes can also be beneficial

Knowing the facts

The three main types of skin cancer are basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and malignant melanoma. These diseases are either referred to as ‘non-melanoma’ or ‘melanoma’.

Non-melanoma The term non-melanoma distinguishes a group of cancers that slowly develop in the uppermost layers of the skin and are

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often named after the type of skin cell from which they develop. BCC usually appears as a small, shiny pink or pearlywhite lump, with a waxy appearance. It can also look like a red scaly patch, can contain darker pigment, and may grow bigger or develop into an ulcer. BCC accounts for around 75 percent of all skin cancers. SCC can also bleed and develop into an ulcer—it appears as a firm pink lump with a rough surface and is often tender to the touch. If you’ve previously had a non-melanoma skin cancer, your risk of developing another one in the future is increased as these cancers are often multiple.

Melanoma Melanoma is a more dangerous and less common type of skin cancer that can spread to other organs in the body. The most common sign of melanoma is the appearance of a new mole or a change in an existing mole. In most cases, these will have an irregular shape and contain more than one colour. The mole may also be larger than normal and can be itchy or bleed. Around 70 percent of all melanomas in the UK are superficial spreading melanomas, meaning that they grow across the skin before moving downwards into the deeper layers. More common in people with pale skin and freckles, melanoma is the fifth most common cancer in the UK, excluding non-melanoma skin cancer.

IMAGES © Shutterstock


Overexposure to ultraviolet (UV) light from the sun is thought to be the main cause of non-melanoma skin cancer and melanomas. Some other factors that can increase your chances of developing skin cancer include: • A previous skin cancer • A family history of skin cancer • Pale skin that burns easily • A large number of moles or freckles • Artificial tanning sunbeds and sunlamps • Medication or medical condition that suppresses your immune system


The main treatment for skin cancer is surgery and involves removing the

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Check your moles with ABCDE The most common sign of melanoma is the appearance of a new mole or a change to an existing one. While most moles are harmless, you can check them by referring to the ABCDE of moles:


Asymmetrical— melanomas are an irregular shape


Border— melanomas have a notched or ragged border


Colours— melanomas will be a mix of two or more colours


Diameter— a melanoma is usually larger than 6mm in diameter


Enlargement or elevation— a mole that changes size over time is more likely to be a melanoma

Did you know? Skin cancer affects more men than women and is more common in the elderly cancerous tumour and some of the surrounding skin. Other treatments for non-melanoma skin cancer include cryotherapy (freezing), anti-cancer creams, radiotherapy and a form of light treatment called photodynamic therapy. At least 90 percent of non-melanoma skin cancer cases are successfully cured. If melanoma is diagnosed and treated at an early stage, surgery will usually be successful, too. If the disease isn’t diagnosed until an advanced phase, treatment will mainly focus around slowing the spread of the cancer and reducing symptoms with medicines.


Unfortunately, skin cancer isn’t always preventable, but you can reduce the risk of developing it by avoiding overexposure to UV light. Use a high-factor sunscreen to protect from sunburn, avoid sunbeds and dress sensibly in the sun, particularly if you have pale skin and numerous moles. Regularly checking your skin for signs of skin cancer can lead to an early diagnosis and increase your chances of successful treatment. • DEAR DOCTOR WITH DR CHRIS STEELE 45

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Figuring Out

Food Allergies Recent headlines remind us that food allergies are on the rise and can be extremely dangerous. But what are the causes, symptoms and treatment?


espite years of research, the causes of allergies remain somewhat mysterious. What is without doubt is that they are on the rise. From oral allergy syndrome to intolerance, here’s how to pinpoint your food sensitive symptoms.

LIVING WITH ALLERGIES The most common type of allergic reaction to food is known as an Immunoglobulin E-mediated food allergy, where symptoms almost always develop a few seconds after eating the food. These include tingling or itching in the mouth, rash, swelling, dizziness and nausea or vomiting. In the most serious cases, severe allergic reactions, known as anaphylaxis, can include breathing difficulties, raised heart-rate or loss of consciousness, and can be lifethreatening. 46 DEAR DOCTOR WITH DR CHRIS STEELE

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WHAT’S THE CAUSE? Food allergies occur when the body’s immune system mistakenly treats proteins found in food as a threat, releasing chemicals that cause the symptoms of an allergic reaction. While almost any food can cause an allergic reaction, the foods that are mostly responsible in adults are peanuts, tree nuts, fruits, fish and shellfish. Exactly why people develop allergies to food is unknown, although risk factors include family history and having other allergic conditions, such as asthma, hay fever and eczema.

ORAL ALLERGY SYNDROME If you experience itchiness or mild swelling in your mouth and throat immediately after eating fresh fruit or vegatables, you could have oral allergy

Did you know? More people per year are hospitalised due to food hypersensitivity (which includes allergic reactions) than through food-borne disease Source:

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syndrome. This is where allergy antibodies mistake certain proteins for pollen. Symptoms usually aren’t severe and you may even be able to deactivate the allergens by thoroughly cooking any fruit or vegetables. For more information, visit the Allergy UK website.


If you think you have a food allergy, seek a professional diagnosis from your doctor. While commercial allergy testing kits are available, some are based on unsound scientific principles, so it’s best to consult the experts. The best way of preventing a reaction is simply to avoid the food that causes it. Your doctor may also recommend an antihistamine to relieve the symptoms of a mild or moderate allergic reaction. Speak to a dietician before making any radical changes to your diet, particularly if you are cutting out milk. Adrenaline is the most effective treatment for anaphylaxis—people with food allergies are often given an auto-injector pen containing doses of adrenaline that can be used in emergencies.


The number of people with food allergies has risen significantly over the last few decades. The reason is unclear, but theories revolve around changing diet and the ‘hygiene hypothesis’, which suggests that our immune systems may not receive the sufficient early exposure to germs that is needed to tell the difference between harmless and harmful irritants.

IMAGES © Shutterstock


In contrast to a true food allergy, a food intolerance does not involve the immune system or an allergic reaction and is not life-threatening. Instead, symptoms come on more slowly and only if you eat a reasonable amount of the trigger food. A food intolerance is a difficulty digesting certain foods such as lactose, gluten and caffeine. Symptoms tend to include stomach pain, bloating, wind or diahorrea; or skin rashes and itching. There are no tests for food intolerances, so it is recommended to monitor your

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own symptoms and the food that you eat. Keep a food diary noting what you eat, symptoms and timing. Try excluding suspect foods from your diet for two to six weeks, one at a time. Observe the effect that this has and then reintroduce the food slowly, to measure any changes. By checking food labels, you’ll learn which sorts of foods to avoid.


With age come certain changes in digestive function. For example, older adults are more likely to be lactoseintolerant and experience bloating, wind or diarrhoea after eating dairy products. However, symptoms could also be put down to decreased elasticity and slower emptying of the stomach, bacterial overgrowth in the small intestine, slower or weakened contractions in the large intestine, and even medications, age-related illnesses and bad eating habits. See a doctor if you are experiencing any symptoms, but you may just need to adjust your eating habits and lower your expectations on how much you can indulge. •

May contain… UK food businesses must declare whether they use any of the 14 key allergens as ingredients in food and drink, including cereals containing gluten, peanuts, nuts, milk, soya, mustard, lupin, eggs, fish, crustaceans, mollusks, sesame seeds, celery and sulphur dioxide. Precautionary allergen labelling, for example ‘may contain nuts’, indicates there’s a risk of the unintentional presence of an allergen in the food. After the death of 15-yearold Natasha Ednan-Laperouse, who suffered an allergic reaction to sesame seeds after eating a Pret A Manger baguette in 2016, stronger food labelling laws are being proposed, with all packaged food such as sandwiches and salads being required to list the full ingredients.


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The Root of the Problem

Female hair loss can be a uniquely distressing condition, but what are its causes and the best options for treatment?


hile men can often come to terms with typical male pattern baldness, it’s probably not a sexist statement to say that hair loss can be uniquely distressing for women—often seen as a woman’s ‘crowning glory’, hair demands careful treatment at the best of times, and it can be

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psychologically damaging when it’s affected by any of the common causes of loss. Unlike in men, in women, hair loss is generally seen evenly across the scalp, rather than in bald patches. There are many possible causes. Diffuse hair loss, the most common type in women, is a gradual thinning, where hair replacement

becomes slower, leading to sparse growth and scalp visibility. Causes can be stress, circulatory problems and hormonal imbalance.

FOLLICLES Another condition with a hormonal basis is androgenetic alopecia, often linked to events such as menopause, childbirth or stopping or starting use dear doctor with dr Chris Steele 49

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to the root of the problem and begin treatment.

TREATMENTS Hair lotions containing minoxidil are a common treatment for androgenetic thinning (female pattern baldness or FPB). Its use often leads to a slowing or stopping altogether of balding and thickening of the hair. This condition and alopecia can also be treated by massaging into the scalp hair stimulants containing ingredients such as phyto-oestrogens, which inhibit harmful enzymes and metabolites. A recommended treatment for traction alopecia is a follicle builder containing ingredients such as arginine, an amino acid used in the synthesis of proteins; while agerelated thinning can be treated with stimulants containing retinyl palmitate, an antioxidant which also encourages the growth of new skin cells. •

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of oral contraceptive pills. Hormonal changes cause shrinkage of the hair follicles, leading to eventual hair loss. Late onset thinning is due to age-related hormonal changes, while alopecia areata, a common but little understood condition can result in some or all of the body hair being shed. Another possible cause of hair loss is pregnancy, which can affect hair production by slowing the growth cycle, resulting in shedding after birth. Hair loss can also be caused by chemical damage such as bleaching, dying or relaxing, which can cause hair damage and scalp irritation; by bodily injury, surgery or even ‘traction alopecia’, a side-effect of over-tight plaiting or tying. Unfortunately, the stress caused by any of these conditions can aggravate the situation, so the best advice in case of hair loss is to see a trichologist as soon as possible, get

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Understanding Fibroids The Patient’s Choice

Uterine fibroids affect thousands of women, but awareness is low and there is a wide range of treatment choices. We consider the options


terine fibroids, non-cancerous growths that develop in or around the womb, are more common than you might imagine - up to 80 percent of women develop fibroids by the age of 50. In 2013, it was estimated that 171 million women were affected worldwide. But a 2017 report by the All Party Parliamentary Group on Women’s Health (WHAPPG) which surveyed 2600 women with endometriosis and fibroids revealed a high level of dissatisfaction about attitudes of the medical establishment to the conditions, and with the 52 dear doctor with dr Chris Steele

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information given out about treatment options and possible complications. Worryingly, one in four women wait on average four years before receiving treatment for fibroids. So there is still much to be done to raise awareness of fibroids, before areas such as earlier diagnosis, quality of life considerations, and patient choices in treatment can be resolved.


Uterine fibroids, sometimes called uterine myomas or leiomyomas, consist of muscle and fibrous tissue, varying in

size from that of a pea to a melon. Fibroids typically appear during the middle and later reproductive years, from 30 to 50, and normally decrease in size after menopause. Their cause is not entirely clear–there’s certainly a hereditary factor, and apparently a link to oestrogen hormone levels. Other factors may include obesity, age of first period, number of children, exercise levels, diet and race (women of Afro-Caribbean origin being particularly prone). The different types of fibroid are described according to their location.

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The most common type, intramural, are found in the muscle wall of the womb, while subserosal fibroids develop outside the wall of the womb into the pelvis and can become very large, and submucosal fibroids bulging into the uterine cavity are frequently associated with bleeding symptoms. Fortunately, uterine fibroids are benign–they very rarely develop into cancerous types. Many women have them without experiencing any symptoms, only being diagnosed as part of a routine gynaecological examination. Diagnosis can be by hysteroscopy, using a thin telescope-like device; by MRI scanning, or by sonohysterography, where fluid is injected into the uterus to assist ultrasound imaging.


If the fibroids cause no symptoms, normally they do not require treatment. But in some cases, they can cause a range of symptoms, including:

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• Painful or heavy periods • Abdominal or lower back pain • Pressure on the bladder causing a frequent need to urinate • Difficulty getting pregnant • Discomfort during sex • Constipation Because these symptoms can have other causes, it’s sometimes difficult to diagnose uterine fibroids. Where treatment is indicated, options depend on their size and position of the fibroids, severity of symptoms, and the woman’s choices. Some treatments address only the symptoms, while others can shrink fibroids as well, and some remove them altogether.


Women should seek advice from the doctor regarding the most appropriate treatment options for them. Medical treatments including nonsteroidal anti-inflammatory drugs such as ibuprofen and paracetamol will treat symptoms of pain and bleeding. Medications of the gonadotropin releasing hormone (GnRH) agonist class, such as leuprorelin are often used

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for around six months before surgery, while ulipristal acetate can be used both pre-surgically and long-term for the treatment of moderate to severe symptoms of uterine fibroids. Other options include tranexamic acid, which reduces bleeding from the womb lining; goserelin acetate, which stops the ovaries producing oestrogen; progestogen; or treatment with an intrauterine device which releases the hormone levonorgestrel, which prevents the womb lining from thickening. If these treatments are ineffective, a gynaecologist may suggest surgery.


The most effective treatment is a complete hysterectomy, removal of the womb. This may be recommended in cases of large fibroids or severe bleeding, where the patient doesn’t wish to have more children. Modern surgical procedures for hysterectomy can be minimally invasive, though there is a fairly long recovery period. Less drastic alternatives include myomectomy, where fibroids are removed from the wall of the womb; hysteroscopic resection or morcellation, where a hysteroscope is inserted through the vagina to remove submucosal fibroids from inside the womb; or uterine artery embolisation (UAE), carried out by a radiologist, which blocks the blood vessels supplying the fibroids, causing the cells to die.

Did you know? There’s no certain way to avoid developing uterine fibroids, but it’s advisable to: • Keep your weight within healthy limits • Eat a sensible diet with plenty of fresh fruit and vegetables • Take the combined oral contraceptive pill (though this isn’t recommended just to prevent fibroids) • See your GP if you have any persistent fibroid symptoms

For milder cases, endometrial ablation is an outpatient procedure which removes the womb lining using laser energy, a heated wire loop, or hot fluid in a balloon. Recent guidelines from the National Institute of Health and Care Excellence (NICE) direct clinicians to consider the impact on quality of life of heavy menstrual bleeding, and that a woman’s priorities and preferences should be taken into account when choosing treatment – but there’s still some way to go before this important condition receives the attention and treatment priorities it deserves. • DEAR DOCTOR WITH DR CHRIS STEELE 53

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Understanding uterine fibroids with Dr Pixie McKenna Dr Pixie McKenna is a General Practioner and star of radio and television with decades of experience in women’s health. She is best known for her leading role in the BAFTA-winning medical series ‘Embarrassing Bodies’ and programmes such as ‘Food Hospital’ where she acts as an advocate for empowering and educating women to prioritise their health. Here we speak with Pixie about the importance of women listening to their bodies, seeking medical care early and creating a platform for discussion around women’s health.

Photo credit: Louise Young

Heavy periods: Time to question the norm!

Challenging the norm

One treatment doesn’t fit all

One of the most common problems experienced by women is heavy and painful periods. However, as a GP, Pixie encounters many women who believe heavy and painful periods are ‘normal’ and are unaware that a widely unknown cause of them are uterine fibroids: non-cancerous growths of the uterus, which up to 80% of women will develop in their lifetime.

There are many options available to help women manage uterine fibroids, which can be discussed with a GP. The first treatment options offered, which can include hormonal contraception and anti-inflammatory drugs, will aim to treat heavy bleeding and reduce pain. Should your symptoms worsen, or your fibroids grow whilst on these treatments, further medical options may be offered to lessen the symptoms and reduce the size of the fibroids.

Whilst half of women with fibroids do not experience symptoms, for those that do, the symptoms can range It is advisable to try medications and regularly follow-up from mild to severe. Alongside heavy and painful with the GP to continue to discuss your treatment plan. periods, other symptoms include abdominal and/or For some patients, surgery to remove lower back pain, a frequent need uterine fibroids may be an option. to urinate, constipation and pain or “As custodians of the Pixie adds, “Every woman is unique. discomfort during sex. A treatment suitable for one woman, family’s health, it is Pixie explains that “if you have may not be suitable for another. The heavy and painful periods, don’t commonplace for type of treatment given will depend just assume it’s normal, feel on a multitude of factors including women to put the empowered to visit your GP”. the severity of symptoms, the location She emphasises the significance needs of others ahead and size of the fibroids and most of getting treated as soon as importantly, a woman’s preferences.” of their own and delay you experience symptoms, seeking medical help and recommends, “go to your How to do your bit appointment armed with a diary for themselves.” Pixie advises that “fibroids are a journaling your symptoms, their real problem and by being more severity, and how they made you open about our experiences, we can feel. Going prepared will help you tell your story and support women to discuss their symptoms and seek make a treatment plan with your GP.” support from others. Driving the conversation is key to This is particularly important as Pixie describes that in raising awareness of the condition.” some patients these symptoms can start to interfere If you are experiencing symptoms, it is important to seek with their normal daily life. “Some women have talked medical care and share your experience with family and about their fear of bleeding through their clothes, friends. The earlier a woman seeks help, the quicker which prevents them from playing sports, socialising symptoms such as heavy bleeding, pain and discomfort or going on holiday and can make working life can be addressed. Pixie adds “a great place to start is difficult.”, where you can learn more about the diagnosis and treatment of fibroids and hear stories Pixie observes that “as custodians of the family’s from other women living with them”. Pixie concludes, “it health, it is commonplace for women to put the is important to let women know they are not alone, and needs of others ahead of their own and delay seeking don’t have to suffer in silence.” medical help for themselves.”

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Gedeon Richter has a long-standing heritage in women’s health and takes pride in supporting women to maintain control of their well-being. Gedeon Richter recognise that although up to 80% of women will experience uterine fibroids at some point in their lifetime, many are unaware of the symptoms and may therefore suffer in silence. Dispelling the myths around fibroids! ✗ Common misconception

✓ The real picture

Fibroids are uncommon

Up to 80% of women have fibroids in their lifetime (with/without symptoms)

Fibroids are cancerous

Fibroids are non-cancerous but can grow in size

Hysterectomy is the only treatment for fibroids

Many medical and surgical treatments are available for fibroids

If you have fibroids or just want to know more about them, visit:

Here you’ll be able to find out more about:

? What are uterine fibroids? ? What are the associated symptoms? ? How are they diagnosed? ✓ Available treatment options Testimonials from women

DON’T SUFFER IN SILENCE Please note that this website has been developed and published by Gedeon Richter UK Ltd. and provides information which is intended for educational purposes only. It is important to always consult your own doctor if you are in any way concerned about your health. UK/GYN/0319/0047a; March 2019

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02/04/2019 14:34


Vitamins, Minerals

and You

With conflicting nutritional advice bombarding us from every side, it can be hard to decipher what you should actually be eating. One thing we do know? You need the right micronutrients—here’s how to get them


enturies ago, British sailors learned about the vital importance of micronutrients, when they discovered that living for months without fresh fruits or vegetables—the main source of vitamin C—caused scurvy. Although understanding of the issues is far more advanced today, both with respect to our access to medicine and nutrition as well the upgrades in our modes of transport, many people around the world still suffer from a variety of nutrient-deficiency diseases. And while true vitamin and mineral deficiencies—where the lack of a single nutrient leads directly to a specific ailment—are rare in the United

Kingdom, there’s still a risk of vitamin and mineral insufficiency. We know, of course, that we need the right amount of nutrients like protein, carbohydrates and fats to stay healthy. These are called macronutrients (sometimes referred to as “macros”). However, the human body also needs a very small amount of many essential micronutrients to remain healthy. There are nearly 30 of these crucial vitamins and minerals that your body cannot manufacture in sufficient amounts, and although you don’t need much of them (hence, “micro”), you do need them. Here’s how to make sure your diet is full of micronutrients.

One in five people in Britain is lacking in vitamin D. (Source -


Vitamin D, sometimes called the sunshine vitamin, is one important nutrient that can be hard to get enough of in our modern lives. It’s estimated that 1 billion people globally are vitamin D deficient today—and you’re more likely to be at risk the further north you live. A lack of vitamin D can cause weakened bones, fatigue, a compromised immune system, depression, hair loss, muscle pain and a whole host of other problems. So, if you live in the United Kingdom, notorious for its grey skies, how are you meant to get enough of the sunshine vitamin? The NHS advises that healthy adults should be able to get the vitamin D they need from being outside between March and September. Vitamin D is also found in food such as red meat, certain types of fish and eggs, as well as some fortified cereals and non-daily milks. Because of the risks of exposing children to direct sunlight without proper protection from clothing and sunscreen, the NHS advises parents to give children under the age of four vitamin D supplements. Speak to your doctor about how much to give your child.


Another important micronutrient, many people find themselves iron deficient. When there’s a shortage of iron, your cells don’t retain enough oxygen, affecting the circulation of blood, which


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Vitamin A deficiency is the leading cause of blindness in children (Source – World Health Organisation)

causes fatigue, weakness, irregular heartbeats, pale skin, cold hands and feet, headaches and chest pain. Women of childbearing age are at a particularly high risk because of menstruation. To make sure you’re getting enough iron, fill your diet with beef and other meats, beans, lentils, dark leafy green vegetables, tofu and iron-fortified cereals. If you suspect you have low iron, visit a doctor—you may have anaemia, which can be treated with iron supplements.

IMAGES © Shutterstock

Stumped by supplements

So, what about all the other micronutrients—are supplements the answer? There have been many studies of the subject, but some come to conclusions apparently without rigorous medical research, and many disagree with each other. A nutritionist would tell you that when it comes to a well-rounded diet, the best way to get the right nutrients

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is to eat plenty of fresh fruits and vegetables, legumes, whole grains, lean sources of protein and healthy fats. “You should ideally try to meet your vitamin and mineral needs through your diet rather than supplements,” said Dr Howard Sesso, associate professor of medicine at Harvard Medical School. With your diet, diversity could be the key to getting the micronutrients needed. A good place to start is to look at the colours of the food on your plate—the more variety, the better. One way of checking for micronutrient deficiencies is to schedule an annual blood test. In addition to spotting vitamin deficiencies, your blood test results can assess your general state of health, check for any infections, monitor your cholesterol and see how well your organs are working. Consider this a part of your regular check-up and ask your doctor next time you visit.•

How to get your nutrients • Vitamin B6 – Chicken, cereals, bananas, pork loin, potatoes with skin • Vitamin C – Tomatoes, citrus fruit, sweet peppers, broccoli, kiwi fruit • Vitamin E – Sunflower seeds and oil, almonds, safflower oil, peanut butter • Magnesium – Whole wheat, legumes, nuts, seeds • Zinc – Oysters, beef shank, Alaskan king crab, turkey

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The Power of


Many people think nature is the best path to health. So what do we know about the secret medicinal life of plants?


raditional remedies based on plants and other natural ingredients certainly have their place in modern medicine—let’s not forget that medical breakthroughs such as painkilling morphine and aspirin, and the leukaemia treatment vinblastine, were derived from plant sources, as were many other pharmaceuticals. So what are some of the most useful plant ingredients, and what can they be used to treat?

Feverfew is a member of the Asteraceae/Compositae family. Its name is a corruption of the word ‘febrifuge’—a medicine used to allay fever. Feverfew leaves are used medicinally. They are rich in sesquiterpene lactones including parthenolide, as well as volatile oils and tannins. It is primarily used as a migraine prophylactic and in cases of arthritis, and has anti-inflammatory, 58 dear doctor with DR Chris Steele

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anti-rheumatic and vasodilatory actions.

Fennel (Foeniculum vulgare) is a perennial herb used as a flavouring from ancient times. The seed is used medicinally—it contains large amounts of volatile oils and flavonoids, and is mainly used in the treatment of mild, spasmodic digestive complaints such as flatulence and colic in children, and indigestion, bloating, upper respiratory catarrh and heartburn in adults. It is also diuretic and has been used in the treatment of urinary stones. Valerian (Valeriana officinalis) is a common perennial herb the root of

which contains volatile oils (including valerianic acid) and valepotriates. It has long been prescribed by herbalists as a treatment for insomnia. During the Second World War, shell-shock and ‘bombing neurosis’ were treated with valerian, which is often used in combination with St. John’s Wort to treat symptoms of anxiety. Of course, before you use any natural health treatment you should check with your medical professional that it does not conflict with any medical treatment you could be taking. But used wisely, you may find that natural remedies based on plants may be the secret path to better health. •

IMAGES © Shutterstock

St. John’s Wort (Hypericum perforatum L.) is a perennial plant native to Europe. The herb is primarily used in the treatment of mild to moderate depression as well as anxiety and neuralgic pain. It has what is known as a thymoleptic action, which results in an improved sense of well-being. It is contra-indicated for use in conjunction with some drugs, including warfarin.

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Bio-Health: Specialist in herbal medicines and food supplements. Purity, safety, efficacy. Bio-Health Ltd. is one of a few remaining wholly owned UK manufacturers of Herbal Medicinal products, based in the County of Kent, known as the “Garden of England”. All products are manufactured in premises licensed by the “Medicines and Healthcare Regulatory Authority” (MHRA) London, England (License No.MIA/15817). Accordingly they conform to all EU regulations. When made in Kent, products carry the “Pure-fil” trademark which guarantees they are totally additive free, suitable for vegetarians and vegans, and do not contain genetically modified ingredients Whilst “Proud to be made in the UK”, ingredients are sourced throughout the world. All herbal raw material is tested against published Pharmacopoeia standards. Herbal ingredients are from Organic, wild crafted or cultivated plants and conform to accepted scientific standards, i.e. British Pharmacopoeia.

Please see our full range of Herbal medicines, vitamins and minerals, and food supplements on our website. Proud sponsors of the Kent, Surrey, Sussex Air Ambulance Service.

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Balance is important in all aspects of your life. Giving your gut a chance of balanced gut bacteria is as symple as Symprove. Unlike some dairy based probiotics our water-based supplement ARRIVES in a live state, SURVIVES the harsh environment of the stomach and is then able to THRIVE in the gut.

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ALL ABOUT THE GUT In recent years the science and interest around the gut has become a hot topic of conversation. Gut health isn’t just about digestion in that it can affect a myriad of other systems in the body. Most of the current gut health chat centres around the gut microbiome, aka the trillions of microorganisms that live and reside in the gut, with some experts considering the microbiome an organ in its own right due to the complex and crucial processes that gut microbes perform. Given that microbes in general out number our human cells by an estimated 1.5:1, and with most of these residing in the gut, you can start to appreciate just HOW vital a role they may play in our overall health and wellbeing. It is therefore of upmost importance to nourish and support our microbiome for a healthier and happier gut.


Eve Kalinik Nutritional therapist

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In order to support a thriving microbiome, we need to supply diverse and plentiful sources of fibre. Fibre is not something we can digest ourselves but it does provide essential fuel for gut microbes.Focus on variety rather than quantity so try to take this from a wide range of sources such as vegetables, fruits, nuts & seeds and whole grains as they all contain different types of fibre that satisfy the appetites of different gut bugs. They have their own flavour preferences like us it seems! We can also ingest beneficial bacteria directly through fermented foods such as cheese, yogurts, kefir, kombucha, sauerkraut and kimchi that may also have a positive effect on the microbiome too although we are not yet sure if the microbes in these foods survive and make it to the gut. That being said they taste great, have been used for centuries for digestive purposes and provide a lot of other nutritional benefits. If you really want to focus on the survivability of microbes then look towards SYMPROVE, a water-based food supplement, has evidence that the 4 strains of beneficial bacteria contained in it reach the gut and like to set up a happy home there too.

In addition to this these bacteria having arrived alive, encourage a positive shift of the overall balance of the microbiome. Clever stuff indeed!

THE GUT GRENADES Factors that may negatively impact the landscape of our microbiome include lack of sleep, excessive amounts of alcohol and caffeine, medications particularly antibiotics and anti-inflammatory drugs as well as stress. With those in mind ensure that you prioritise sleep with a gentle pre-bedtime routine that allows you and your microbiome to wind down, keep your caffeine and alcohol consumption to a reasonable amount (1-2 cups/glasses per day with a couple of days off the latter per week), take certain meds exactly as directed by your Health Care Professional and find ways to manage your stress. This last one is a vital part of supporting the health of your gut since a stressed mind leads to a stressed microbiome. Think about using mindfulness apps, breathing exercises, gentle yoga, cooking, walking, even washing up can be meditative if you want it to be. Whatever helps you and your microbiome to “rest & digest�.

08/02/2019 14:39


A Good Gut Feeling The term ‘gut health’ is used frequently, but what does it mean, why is it impor tant and how can you achieve that essential healthy balance?

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o understand ‘gut health’, it’s important to realise that not all the bacteria living in our bodies are bad for us. In fact, many found in the intestinal tract are essential for digestion and contribute to our overall physical and mental health. The microbiome—the ecosystem of bacteria living in the gut—develops early in life and can have a profound influence over conditions such as obesity, depression, diabetes and even cancer. Both diet and lifestyle can affect the microbiome, so it’s important to keep it balanced throughout your childhood and adult life. ‘Good’ bacteria in the gut, known as probiotics, generally amount to around 85 percent of the total and limit the spread of the 15 percent of ‘bad’ bacteria, or pathogens. Probiotics also contribute to the breakdown of food to extract nutrients. Probiotics stop reproducing when food is not available, so you should never have an over-supply.

IMAGES © Shutterstock


Food intolerances that are the result of difficulty digesting certain foods could be caused by poor quality of bacteria in the gut. This can lead to difficulty digesting the trigger foods and unpleasant symptoms such as bloating, gas, diarrhoea, abdominal pain and nausea. This is different to food allergies, which are caused by the immune system reacting against certain foods, though there is some evidence that food allergies could also be related to gut health. A healthy balance of bacteria in the gut is called equilibrium, and some researchers believe that a lack of equilibrium can contribute to conditions such as Crohn’s disease, ulcerative colitis, irritable bowel syndrome, kidney disease and high cholesterol levels leading to heart disease. It’s even speculated that poor gut equilibrium may affect brain chemistry, contributing to disorders such as autism, anxiety, depression and chronic pain. It’s also possible that the pituitary gland, which controls appetite, can be affected, leading to over-eating and obesity.

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THE MICROBIOME Most of us have between 300 and 500 different kinds of bacteria in our gut, most of them beneficial. Many facets of modern life such as high stress levels, too little sleep, eating processed and high-sugar foods and taking antibiotics can damage our gut microbiome.

Probiotic supplements


‘Probiotics’ can ease allergy symptoms and reduce lactose intolerance, though there are many different types, and they don’t work in the same way for everyone. Probiotics are found in foods such as yogurt and cheese; fermented vegetables like kimchi and sauerkraut; and pickled vegetables, like onions and gherkins. They can also be bought in live bacteria cultures like bifidobacteria and lactobacilli. ‘Prebiotic’ foods—those which promote growth of probiotic bacteria— include fruits such as bananas, vegetables including onions and asparagus and soybeans and whole wheat. Prebiotic food also encourages the uptake of calcium in the gut. You can combine prebiotics and probiotics to create a symbiotic diet which prolongs probiotic lifespan. Try bananas and yogurt, or stir-fried asparagus and tempeh, which is made of fermented soya beans.


Key to achieving gut equilibrium is avoidance of overeating; good hydration; healthy activity, and inclusion of high-fibre foods in the diet. High-fibre foods include fruit, vegetables, pulses, nuts and wholegrains. Vegetables from the sunflower family (artichokes, radicchio, lettuce, tarragon, chicory and salsify) and the lily family (leeks, chives, shallots, onions, garlic and asparagus) are particularly helpful to gut bacteria. Highly processed foods should be avoided. They often contain ingredients

Probiotic supplements, many of which come in the form of a yogurt-based drink, contain live bacteria which are naturally found in the gut. Water-based supplements, and those which do not use freezedried bacteria, are claimed to improve bacterial survivability through the digestion process. Probiotic supplements are classed as foods rather than medicines, so their effectiveness for particular conditions can’t be guaranteed, but NHS advice is that they appear to be safe, and that if you want to try them and have a healthy immune system, they shouldn’t cause any side effects.

such as preservatives designed to slow the processes of oxidation and bacterial growth, or emulsifiers which prevent oils and fats from separating. These can have a negative impact on gut bacteria, as well as affecting the mucous lining of the gut and interfering with the signal of ‘satiety’—or feeling full—leading to overeating. It’s also wise to limit the use of antibiotics. While these can be lifesaving and should be used when essential, unnecessary use will kill probiotic bacteria as well as pathogens, so their impact on gut health may linger long after the condition they were used to treat has gone. Taken together, these tips for maintaining your gut health should yield long-term benefits for your whole system. • DEAR DOCTOR WITH DR CHRIS STEELE 63

01/05/2019 12:43

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Smart Snacking Sometimes you’re simply too busy to prepare and eat a nutritious meal. Having some healthy snacks on hand can fill that gap


ou know it, we know it— everyone needs to be better behaved with snacking. In the UK, 30 percent of young women report skipping meals in favour of snacking throughout the day. In Scotland, half of all sugar in an average diet comes from sweet treats, often eaten as snacks. And in America, onequarter of the average calories per day comes from snacks. It’s true that eating small and frequent meals—rather than two or three large ones—is linked to a lower Body Mass Index (BMI), but this doesn’t mean that your habits are in the clear. Whether our snacking harms or helps us depends on what those snacks are.

IMAGES © Shutterstock


Limited time is by far the number one reason we skip meals in favour of easy snacks. Unfortunately, easy snacks such as crisps and sweets are often bad for us. But good planning can go a long way to helping you avoid the pitfalls of unhealthy snacking. Instead of waiting around until you’re inevitably hungry mid-day

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(and then susceptible to the allure of something pre-packaged from your closest grocer), make a point to load up on healthy options when you do your regular shopping. To quench those afternoon cravings, pick up individual packets of low-salt nuts and dried fruit to make your own trail mix—add in some dark chocolate chips, rich in antioxidants, if you have a sweet tooth.


Another day at the office means another birthday, welcome, goodbye or “just because I baked last night” occasion. When everyone else is enjoying unhealthy snacks in the office kitchen, it can be tempting to join in. If possible, encourage your coworkers to celebrate with fruit or cheese platters. If this isn’t an option, suggest that celebratory sweets only be put out during lunchtime. This will benefit not only your own health, but that of your officemates as well.


If you find yourself a victim of the midafternoon slump, a quick sugar rush

HEALTHY SNACK IDEAS • Apple and peanut butter • Cottage cheese with flaxseed and cinnamon • Chia seed pudding • Edamame beans • Pear with ricotta cheese • Olives

isn’t the solution you’re looking for. Opt instead for a piece of fruit like an apple—a natural source of caffeine—or a banana—a better energy boost than an actual energy drink, according to a 2012 study. If you manage to prepare your snacks ahead of time, try a chia seed pudding. The simple snack is made from mixing chia seeds with a non-dairy milk and soaking overnight. This easy meal can be brought along with your day in a small container and will give you a burst of energy from the protein, fibre and hydration you’ll be getting. • DEAR DOCTOR WITH DR CHRIS STEELE 65

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Are Your Pets Killing You? There’s no doubt we’re a nation of pet lovers, but do you know the health risks your pet can expose you to? We round up some of the biggest risks


here’s no doubt that the UK is a nation of pet lovers; statistics from the charity People’s Dispensary for Sick Animals (PDSA) show that 49 percent of us own a pet—25 percent a cat (giving a total of 11.1m cats in the UK), 24 percent a dog (8.9m) and two percent a rabbit (around 1m). There are also significant numbers of other pets including indoor birds, guinea pigs, hamsters, rats, ferrets, gerbils,


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tortoises and turtles, horses and ponies, lizards and snakes, frogs and toads and even insects Studies show benefits of owning a pet, ranging from mood improvement and stress reduction to improved recovery rate and allergy prevention, but while pets can benefit our health in a number of ways, they also have the potential to cause human illness. Your fluffy feline Mr Snookums may not be planning to harm you deliberately, but pets can have an

adverse effect on your health and that of your children. So what are the main risks and the warning signs to watch out for?


Allergic reactions to pets (commonly cats or dogs, but also horses, rodents, reptiles and birds) is caused not by their fur, but by proteins in flakes of their dead skin (dander), saliva and dried urine. Shed pet fur can, though, carry pollen,

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dust mites, mould and other allergycausing substances. Cat allergens are particularly persistent and can remain in homes long after the cat is no longer there. Symptoms of pet allergies can include sneezing, coughing, eye irritation, eczema and even anaphylactic shock. The charity Allergy UK offers the following tips: • Keep pets outside, or at least out of the bedroom • Wash pets and their bedding once a week • Groom pets outdoors • Install air filters, fans or ventilators in your home • Use a vacuum cleaner with a High Efficiency Particulate air (HEPA) filter • Use antihistamines before visiting a friend who has pets • Wash your hands after being touched or licked by a pet


It’s the most common cause of infectious diarrhoea in the UK, but infection with Campylobacter is rarely life-threatening. It’s a common cause of diarrhoea, cramps, abdominal pain and raised temperature. Individuals with weak immune systems, young children and the elderly are most at risk. Although most cases of campylobacteriosis are caused by exposure to contaminated water and food such as meat and eggs, it can also be contracted through exposure to the faeces of an infected animal, notably dogs and cats. It is most common in puppies and kittens younger than six months, but around half of stray animals carry the bacteria and shed it in their faeces.

the faeces of animals, and humans can contract it by coming into contact with infected faeces or contaminated soil and sand where such faeces have been. Hookworm infection in humans most commonly causes the skin condition called cutaneous larva migrans (CLM), in which the hookworm larvae penetrate the skin, causing a red, itchy and sometimes painful rash. More rarely, hookworm can infect human intestines, causing abdominal pain and diarrhoea. Roundworm infections can usually be successfully treated with medication. One of the most common is toxocariasis. Most people infected with it do not develop symptoms, but it can cause inflammation and vision loss in one eye (ocular toxocariasis), or abdominal pain, fever, fatigue and coughing due to damage to various organs (visceral toxocariasis). Ringworm, actually a fungus, can be transmitted from dogs to humans, though it is rarely serious except in children and people with suppressed immune systems.


Salmonella is commonly carried by reptiles such as snakes, lizards and turtles, and can be easily contracted

by humans simply by skin-to-skin contact. Symptoms include diarrhoea, raised temperature and abdominal cramps, and can last four to seven days. Most people fully recover without treatment, but others may need to be hospitalized.


Though the rabies virus is not present in wild or domesticated animals in the UK, it is present in dogs, cats and wild animals such as foxes or bats elsewhere in the world, particularly in Asia and Africa, so your pet could catch it if taken abroad. Symptoms in animals include excess salivation, paralysis and unusual shyness or aggression. It’s an extremely serious disease which kills 59,000 people worldwide every year, attacking the nervous system and causing fever, paralysis and, if untreated, death, so if there is any suspicion of infection in an animal or anyone bitten by the infected animal, immediate medical attention to both animal and human is required.


So-called ‘parrot fever’, psittacosis or ornithosis, can actually be carried by all birds, including parrots, parakeets, macaws, cockatiels and poultry,

IMAGES © Shutterstock


Dogs and cats can be infected by tapeworm, roundworm or hookworm if they swallow infected fleas that carry worm larvae while grooming. It’s not common for the worms to be passed to humans, but it can happen, particularly when a child swallows an infected flea. The hookworm parasite can be shed in

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particularly turkeys and ducks. It’s a bacterial disease which can be contracted by humans through inhalation of birds’ urine and faeces. Symptoms include high temperature, nausea and vomiting, diarrhoea, fatigue, chest pain and shortness of breath. Severe cases can progress to inflammation of the brain, liver and other internal organs, reduced lung function and pneumonia. Between 25 and 50 cases are confirmed in the UK each year (Source: uk), but once diagnosed correctly the condition responds well to antibiotic treatment.


Toxoplasmosis is caused by a singlecelled parasite found in undercooked or contaminated meat, and also in cat faeces—not through skin contact, but by accidental ingestion. Though it rarely leads to symptoms, when it does these may include swollen glands, muscular pain, and in severe cases damage to the eye, brain and other organs. Pregnant women, the elderly, young children and people with weakened immune systems are at highest risk of developing symptoms from T. gondii infection. Treatment combines antibiotics and antimalarials.


Cute little kitties love to scratch and don’t always mind whether it’s a


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door post, a sofa or your leg they’re destroying. It’s usually not aggressive behaviour—it’s mainly territory marking—but scratching and biting can pass on a bacterium called bartonella henselae, which around 40 percent of cats, most commonly kittens, carry without showing symptoms. CSD, or bartonellosis, can cause swelling, pain and tenderness, and in severe cases headache, fever, loss of appetite and fatigue. Children under five and people with weakened immune systems are most likely to experience severe symptoms, but most can be treated with painkillers and anti-inflammatories until the infection subsides. CSD seems to be much more widespread in the USA, where a major study was published, than it is in the UK, where the NHS advice is “While cat owners can be reassured that their pets are unlikely to kill them, everyone should know about hand washing and safety around pets.”


Tetanus is rarely a problem with animal bites, as an effective tetanus vaccine is given as part of the NHS childhood vaccination programme. In 2016, there were only four cases of tetanus in England. But deep cat bites, particularly to the hands, can also cause other infections such as cellulitis, sometimes leading


The PDSA says that over 90 percent of pet owners in the UK agree that owning a pet makes them feel happy, and 88 percent feel that pet ownership improves their overall quality of life.

to complications such as sepsis. The National Institute for Health and Care Excellence (NICE), says: “a cat bite injury, particularly to the hand, can be devastating in terms of infection and permanent disability if not treated appropriately”. Despite some widely-reported cases of long-term damage to extremities, this is rarer than scare-mongering ‘Killer Kitty’ headlines might suggest. So, what are the top tips for preventing pet-related health problems and making sure we can share our homes in safety? • Wash your hands – Hygiene is key for preventing most pet-related infections. After contact with pets, their saliva or faeces, wash your hands thoroughly with warm, soapy water. • Clean scratches or bites immediately – Severe wounds may require medical attention. • Faeces disposal – Pick it up hygienically and dispose of it safely, especially from areas where children play. • Vaccinate – Keep your pet’s vaccinations, de-worming, flea treatment and routine evaluations up to date • Give your pet a toy to bite, rather than your hand! •

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Healthy Dog, Happy Owner


aving a dog in the family can be a great source of fun and comfort, but equally, an unwell or unhappy animal can be a

worry. If your dog seems unwell, a trip to the vet is in order, but there’s a lot you can do to maintain its health before that stage. Here are our top canine health tips: • Nose – A warm, dry nose isn’t necessarily a bad sign if he’s eating and drinking normally, but look for soreness, discharge or excessive scaliness • Eyes – Should be bright and moist. Some blackish residue is normal, but look for discharge, watering, squinting or redness • Ears – Look for excess wax, discharge, swelling or odour • Teeth and gums – Look for brown tartar build-up, redness, odour or lumps • Skin – Check for irritation, flea bites, rashes, lumps and bumps • Nails – Check for ingrowing nails, particularly the dew claws • Bottom – Look for swelling or redness around the anus or glands Regular exercise is an essential health


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routine for dogs, as obesity can lead to arthritis, cardiovascular disease, liver disease and insulin resistance. Most dogs need to be walked at least once each day, though this varies according to breed, age and fitness. Of course this is your chance to get some exercise too! Apart from bonding with your pet, walking benefits your cardiovascular fitness, blood pressure, muscle and bone health and stress levels.


As with the human diet, there’s currently a great interest in alternatives to overprocessed, additive-laden foods, and a move towards more organic, ethically produced. Nutritious dog foods with potato and pea instead of grain, for instance, are said to benefit coat condition, digestion, mobility, bone and joint development, the immune system and weight control— something we could all perhaps do with! So don’t let your dog fall into your own bad habits of inactivity, poor diet and snacking on junk food—feed, exercise and examine him or her properly, and you’ll both feel the benefit. •

Fish4Dogs Food At Fish4Dogs we’ve been making delicious and nutritious fish-based food and treats for happy, healthy dogs for over 12 years. We use fish in our food and treats because we believe that fish is the best protein. Fish not only tastes delicious, it has a strong, appealing smell that dogs love and is full of Omega 3, helping with coat and skin conditions, joint mobility, digestion and brain and eye development. We love to see dogs healthy and fit and our food and treats are developed with nutritionists to provide great everyday feeding and healthy, rewarding treats. IMAGES © Shutterstock

Looking after your dog’s health can be good for you too. We check out the top canine health tips

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A Stepby-Step Guide to Youthful Skin


rom the age of around 20, collagen production declines and we start to see fine lines and wrinkles on the skin. We might also experience dry, flaky patches and other conditions. While a sensible skin care routine and ‘anti-ageing’ cosmetics can help, if you reach the stage where you think more direct action is needed, there are also many hi-tech medical procedures to choose from.


As with any clinical procedure, the 72 dear doctor with DR Chris Steele

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safety and success of a dermatological treatment depends on the skill and experience of the practitioner, so make sure yours is qualified and comes recommended by previous satisfied customers. You should expect a no-obligation consultation before any treatment and a full explanation of the proposed treatment and why it is right for you. The range of possible treatments is wide, and of course costs vary, so consider all the options. Dermal Filler injections formulated from hyaluronic acid, a sugar

compound which occurs naturally in the skin, can restore volume, add definition and smooth lines. They should be done only under the supervision of an experienced and professional aesthetic injector, particularly for the more delicate facial areas. One of the best-known cosmetic treatments, Botox (Botulinum toxin) is a protein produced by the bacterium Clostridium botulinum, which reduces the appearance of wrinkles by paralysing the muscles. But there are many alternatives to this option. Resurfacing Laser is a cutting edge

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Whether it’s a medical procedure, a cosmetic treatment or a change in lifestyle, there are plenty of ways to care for your skin and improve its appearance

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There is no incision, and this ‘lunchtime facelift’ gives immediate results lasting for about 18 months.


treatment used to reduce fine lines, wrinkles, uneven pigmentation, scars, open pores and sun damage on the face, neck, décolletage and hands, penetrating deep into the epidermis to remove old and damaged cells, stimulating production of new collagen. Skin Peels involve the application of a non-toxic chemical solution to the skin, removing the top layer of dead skin cells and encouraging new ones to grow, with results including evening of skin texture and tone, reduced appearance of fine lines and wrinkles, and reduction of sun damage and inflammation caused by acne. Non-Surgical Fat Reduction uses ultrasound waves to selectively target fat cells without affecting neighbouring tissue. The fat cells become more permeable after treatment, allowing the transport out of the cell of triglyceride fats which are eliminated by the body’s systems over a few days. Thread lifts using PDO (polydioxanone) or PLA (polylactic acid) treat loose skin around the mid to lower face. Dissolvable threads are inserted into the face using a cannula, lifting loose skin and improving its texture. 74 DEAR DOCTOR WITH DR CHRIS STEELE

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Dry Skin Myths Dryness doesn’t cause wrinkles—in fact oily skin types may tend to have larger pores and seem to be more lined when wrinkles appear.

Of course prevention is better than cure, so follow our tips to stave off the time when you feel medical procedures are the only option. To relieve dry skin, stay hydrated, stick to mild soaps and cleansers with lukewarm (not hot) water and moisturise regularly. Wrinkles appear from around the age of 30 as there’s a decline in the skin’s natural ‘scaffolding’ and firming substances including collagen, elastin and hyaluronic acid. To help reduce the visibility of wrinkles, protect your skin from the sun, get lots of sleep and explore active ingredients in your cosmetic routine. Age spots or ‘liver spots’ are flat brown, grey or black spots caused by excess melanin, usually occurring on sun-exposed areas. Use a broadspectrum sun cream that helps protect against two different types of UV rays. Skin tags are small, raised growths made of loose collagen fibres, usually flesh-coloured and commonly appearing on the eyelids, neck and

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Top tips body folds. Skin tags are harmless, but can become irritated. Speak to your doctor about cauterization, cryotherapy or ligation, and ignore old wives’ tales about cutting them off yourself or using iodine to reduce them. Peptides, protein fragments made from amino acids, are popular for treating stretch marks, wrinkles and wounds, while retinoids derived from vitamin A are widely recommended for their ability to minimise the appearance of fine lines, wrinkles and pores, and even tackle sun damage and acne. This ‘miracle ingredient’ works by increasing cell turnover and stimulating collagen and elastin production, making the skin appear hydrated and eventoned. Suitable for any skin type, it’s best applied at night. Vitamin C is one of the post potent antioxidants, particularly effective as a serum, and can brighten skin, promote an even skin tone, neutralise damage from free radicals and minimise the appearance of fine lines and wrinkles. Apply your serum in the morning to keep it separate from your retinol, and try combining vitamin C with other micronutrients, such as zinc and vitamin E, for better results. Alpha hydroxy acids (AHAs) work to exfoliate the uppermost layers of skin. Glycolic acid and lactic acid are among the most popular and well researched. At concentrations of five percent and above, these acids can

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The best skin treatment strategy is a healthy, balanced diet, protection from UV rays, using a humidifier, and quitting smoking. Finally, remember to keep your nails trimmed— this can prevent you scratching yourself when applying those all-important skin care products.

soften the signs of sun damage, assist the absorption of important ingredients and ‘teach’ the skin to better retain its natural moisture. Look at AHA-based creams, serums or toners, and consult a specialist about higher-strength AHA facials to revitalise your complexion. •



Take Perfect Care of Your Face with ZAHEDA® Skincare

The first step in any beauty regime should be cleansing. The Laser Treatment Clinic offers cuttingedge science-led formulations from ZAHEDA® Skincare that are gentle yet effective and respect the skin’s natural balance for a healthy glowing complexion. ZAHEDA® Skincare founder Zaheda Hafez utilized her 20 years clinic experience and collaborated with specialist cosmetic scientists to create innovative formulations containing an exclusive complex of marine actives, botanical actives and essential oils. ZAHEDA® Skincare ingredients include Wakame Sea Kelp and Marine Plant Extract, rich in vitamins B1, B2, B3, B6 and B12, delivering powerful collagen boosting benefits for clear, supple, plump, more youthful-looking skin. Contact the clinic to talk to a skin specialist about any questions or concerns. Whatever your skin type or skin concern they have the solution for you.

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Living the


Wa y

his year is definitely veganism’s ‘ketchup moment’—when pent-up interest in the topic suddenly bursts out. Starting with the Veganuary movement, when the charity claimed to have persuaded 14,000 people to sign the pledge in one day, hardly a restaurant, cookbook or institution has been able to resist addressing the topic. So what exactly is veganism? Is it just ‘extreme vegetarianism’, or a lot more? According to the Vegan Society, the idea of veganism dates back at least 2,500 years to Pythagoras and Buddha. Both promoted a vegetarian diet but also, more to the point, the principle of ‘the emancipation of animals from exploitation by man’. 78 DEAR DOCTOR WITH DR CHRIS STEELE

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Whether for health or ethical reasons, taking up a vegan lifestyle is said to have many benefits. But do the claims add up? So, true vegans give up meat and dairy, but they also oppose more hidden animal by-products, which include wearing leather, eating honey or consuming gelatin.

HEALTHY WORLD Vegans argue that all commercial farming and fishing is cruel to animals—even the collection of eggs and milk. But some of the other exclusions might seem less obvious. Gelatin for instance is manufactured from animal by-products, bones and skin, while harvesting honey, though perhaps not cruel in itself, is said to disrupt the natural cycles of bees. Vegans also say that meat and dairy consumption is unhealthy, promoting heart disease, diabetes and cancer.

They also point towards the unsustainability of certain types of commercial farming. Animal agriculture currently uses about 70 percent of agricultural land and is one of the leading causes of deforestation, biodiversity loss and water pollution. It’s the second highest source of emissions after transportation, and by 2050 some researchers say animal agriculture could be responsible for 80 percent of the allowable greenhouse gas budget.

VEGAN DIET The Vegan Society suggests recipes from curry to cake, pasties to pizzas, all using plant-based ingredients, and many acceptable substitutions such as oat or soya for cows’ milk, vegan butter,

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• Eat at least 5 portions of a variety of fruit and vegetables every day • Base meals on potatoes, bread, rice, pasta or other starchy carbohydrates (choose wholegrain where possible) • Have some dairy alternatives, such as soya drinks and yoghurts (choose lower fat and lower sugar options) • Eat some beans, pulses and other proteins • Choose unsaturated oils and spreads, and eat in small amounts • Drink plenty of fluids (6 to 8 cups or glasses a day) • Cut down on foods that are high in fat, salt or sugar

FASHION VICTIMS Veganism is not just about diet, it’s also about avoiding the exploitation of animals for any purpose. Vegans stand united against the wearing of fur, but one of the most controversial subjects is the wearing of leather. The fashion industry is the fifth most polluting on the planet, equal to livestock, and the leather industry takes a particular toll on the animals and people involved, as well as the environment, as its byproducts include chromium, lead and formaldehyde waste. It’s sometimes argued by nonvegans that leather, as a by-product of the meat industry, doesn’t cause additional animal suffering; but many vegans reject this on principle. Some will accept the wearing of second-hand leather goods, while others don’t. It’s also a dilemma for vegans that all medicine in the UK must be

tested on animals before it is deemed safe for human use. The Vegan Society does not recommend avoiding prescribed medication, but suggests that vegans should ask for medication that does not contain animal products such as gelatine or lactose. It’s also recommended that vegans support charities that do not support animal testing. Another aspect of the vegan philosophy is choosing not to support animal exploitation in entertainment, such as dog or horse racing, or even in visiting zoos or aquariums, though supporting sanctuaries for rescue animals is supported. For some people, veganism is a process rather than an overnight decision, and certainly it’s necessary to weigh up all the factors before you take the step of adopting this increasingly popular dietary and ethical lifestyle. •

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cheeses and yogurt, agar for gelatin, tofu for eggs, maple or agave for butter, beet sugar for refined sugar and soy or rice for meat or even ice-cream. If you are following a vegan diet it is important to include protein from foods such as nuts, seeds, beans and pulses to ensure your intake of calcium, vitamin D, iron, vitamin B12, zinc and omega-3 fatty acids—all nutrients that are harder to get in a vegan diet. Nutritionists also suggest filling your diet with lentils, chickpeas, tofu, soya versions of milk and yogurt, cashews, pistachios, flaxseed, chia and pumpkin seeds, buckwheat and quinoa. Watch out for coconut oil, which is often found in vegan products but is high in saturated fat.

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Fit or Fad?

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This Year’s Hottest Fitness Trends From working out on your commute to cycling underwater, some workout trends seem to take off faster than others 80 dear doctor with dr Chris Steele

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training (HIIT) at the moment, but you don’t need to be advanced to do a ‘hard work, short rests’ workout. According to the Journal of Strength and Conditioning Research, HIIT burns 25 to 30 percent more calories than resistance training, cycling and treadmill running. If you’re a beginner, start by exerting maximum effort in a movement for 20 seconds, followed by two minutes of active recovery (walking, marching etc.), once a week. Benefits of this method include burning more fat in less time, heightened metabolism, lowered blood pressure, improved insulin resistance and increased oxygen consumption. HIIT can also be tailored to suit your fitness level and preferences, and doesn’t require a gym—try downloading an at-home HIIT app. However, it’s often said that HIIT isn’t

Did You Know? The following workout classes actually exist: twerking classes, animal flow (where you make ‘beastly’ movements), doga (dog yoga), cardioke (cardio and karaoke), running backwards (it uses up more energy than moving forward) and mermaid fitness


n 2019, there are more fitness choices than ever before, but not all of them will get your stamp of approval. While living an active lifestyle should come down to personal preference, trying every up-and-coming class to find out what works for you seems increasingly impossible. Here, we put the wellness world’s latest takeovers to the test, so that you can focus on getting healthier and stronger, and having fun.

HIIT Every fitness influencer seems to be promoting high-intensity interval

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for the faint-hearted, and this should be taken literally when considering your health. If you’re feeling worn down or have pain surrounding your joints, HIIT can increase your risk of injury. Regardless of your fitness level, this type of training should not be done every day.

Hot yoga Hot yoga—as the name suggests— involves practicing yoga in heated and humid conditions, typically around 40C. While there are many different types of hot yoga, the practice typically refers to Bikram yoga, where a yogi can expect to flow into a series of 26 demanding poses and breathing exercises for 90 minutes. Benefits of turning up the heat include increased flexibility, detoxification of the body (you can expect to sweat A LOT), increased circulation, weight loss, heart health 82 dear doctor with dr Chris Steele

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and elevated mood. While we’re definitely there for hot yoga, there are some important things to keep in mind before heading to a class, such as the increased risk of heat exhaustion. As you’ll likely be glistening with sweat before you even begin, drink water throughout the day, before your class, and immediately after your hot yoga session. Don’t be afraid to bring a bottle to your mat and take breaks to refresh, but be mindful that bending your body with a belly full of water is not particularly fun.

Intermittent fasting Currently one of the world’s most popular health trends, intermittent fasting (IF) focuses on when you should eat. The pattern cycles between periods of fasting and eating, often involving 16-hour fasts followed by an 8-hour time period in which to eat all meals. For example, you might eat

between 11am and 7pm, generally eating two or three meals between this period. Contrary to the often-repeated motto ‘breakfast is the most important meal of the day’, IF often means that you don’t eat your first meal until later in the day. The benefits of this pattern naturally begin with weight loss, but also include insulin resistance, reduced inflammation, improved heart health and cost-effectiveness. Nevertheless, there is definitely still controversy around IF and little is known about any possible side effects. The NHS advises that you consult a doctor before fasting, and potential dangers have been pointed out regarding certain medications (especially for diabetes). You should not fast if you are underweight, have an eating disorder, are pregnant or breast-feeding or you are under the age of 18.

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INFRARED SAUNAS From Los Angeles and the likes of Lady Gaga, Jennifer Aniston and Gwyneth Paltrow, comes another modern health trend—infrared saunas. Spending 40 minutes sat in a sauna heated with infrared lamps could burn up to 600 calories, say supporters. The infrared rays are said to penetrate skin tissue and actually heat up the body from the inside out. At around 45C, the rewards for sticking out the sweat are said to include muscle and joint pain relief, increased metabolism, boosted immune system, improved skin, reduced stress and detoxification. In a study that measured sweat, participants using a normal sauna lost 98 percent water and two percent toxins, whereas the infrared group lost 85 percent water and 15 percent toxins, including heavy metal and cholesterol. Again, remember to keep hydrated!

WEARABLE TECH It’s a technology-led world out there, and our health is no exception. Gone are the days when a watch or ring were just accessories—the latest tech has popularised wearable devices that track calories and sleep, measure heart rate, and remind you to get active. These wearables not only provide many lifestyle functions, but also encourage proactive healthcare. These devices keep patients engaged in their own health, support medical professionals in making a diagnosis, and can help doctors or caregivers to monitor vulnerable patients. While they are useful, it’s important to remember that features such as heart rate monitors may not always be accurate, and these devices should not be solely relied on for any medical diagnosis. •

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Try this trend You may not need another excuse to surround yourself with furry friends, but owning a pet can actually improve your fitness—just ask social media. Whether you’re mirroring each other’s downwardfacing dog or taking your cat to class, exercising with your pet will have health benefits for the both of you, and will be sure to initiate you into the latest trend. Try this workout with your dog: • Warm up jog—Use a lead to help control your dog’s speed and take the same route often, to help them know what to expect. • Squat and throw—Stand with feet shoulder-width apart, holding a dog toy in both hands. Hinging at the hips, push back and lower

down into a squat (keep the chest lifted). As you rise, jump up, arch your back and throw the dog toy as far back over your head as possible. Let your dog fetch and repeat. • Reverse lunge with twist and treat—Feet hip-width apart, clasp your hands in front of you, holding a broken-up dog treat. Step one foot back and lower into a lunge, twisting your torso over your front thigh at the bottom of the move and letting your dog run to your side. Repeat on the other side and reward your pup with a treat at the top of every other rep. • Burpee fetch—While standing, throw a dog toy as far as you can. Next, perform as many burpees as possible until your dog returns with the toy. Repeat.


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Live Long and Prosper I n 2015 the World Health Organisation’s Report on Ageing and Health concluded that comprehensive public health action on population ageing is urgently needed. This will require, the report said, fundamental shifts, not just in the things we do, but in how we think about ageing itself. The report outlined a framework for action to foster healthy ageing built around a new concept of ‘functional ability’. With the UK’s NHS feeling the effects of an ageing and increasingly unhealthy population, how can we expect world attitudes to age and health to evolve in the coming decades?


Contrary to widespread assumptions, the report found that there is very little evidence that added years of life are being experienced in better health than was the case for previous generations at the same age. “Unfortunately, 70 does not yet appear to be the new 60,” says Dr John Beard, Director of the Department of Ageing and Life Course at WHO. “But it could be. And it should be.” The WHO suggests that making investments in healthy ageing will have valuable social and economic returns, both in terms of health and well-being of older people and in enabling their ongoing participation in society.

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We all want to live long and healthy lives, but how do we define these terms and what can we expect from the future?

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The report starts from the assumption that everyone in every country should have the opportunity to live a long and healthy life, but emphasises that the environment we live in can favour health, or be harmful to it. Environment is highly influential on our behaviour, our exposure to health risks (for example air pollution, or violence), access to quality health and social care and the opportunities that ageing brings. The WHO’s Healthy Ageing concept is about creating the environments and opportunities that enable people to be and do what they value throughout their lives. Everybody can experience Healthy Ageing, says the WHO. Being free of disease or infirmity is not necessarily a requirement for ‘healthy ageing’, as many older adults have health conditions that, when well controlled, have little influence on their wellbeing.


The WHO defines Healthy Ageing as “the process of developing and maintaining the functional ability that enables wellbeing in older age”. Functional ability is about having the capabilities that enable all people to be and do what they have reason to value. This includes a person’s ability • • • • •

To meet their basic needs To learn, grow and make decisions To be mobile To build and maintain relationships To contribute to society.

Functional ability is made up of the intrinsic capacity of the individual, relevant environmental characteristics and the interaction between them. Intrinsic capacity comprises all the mental and physical capacities that a person can draw on and includes their ability to walk, think, see, hear and remember. The level of intrinsic capacity is influenced by a number of factors such as the presence of diseases, injuries and age-related changes. Environments include the home, community and broader society, and all the factors within them such as the built environment, people and their relationships, attitudes and values, health and social policies, the systems

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The WHO’s key considerations of Healthy Ageing are: • DIVERSITY: There is no typical older person. Some 80-year-olds have levels of physical and mental capacity that compare favourably with 30-year-olds. Others of the same age may require extensive care and support for basic activities like dressing and eating. Policy should be framed to improve the functional ability of all older people. • INEQUITY: Much of the diversity in capacity and circumstance observed in older age is the result of the cumulative impact of advantage and disadvantage across people’s lives. The relationships we have with our environments are shaped by factors such as the family we were born into, our sex, our ethnicity, level of education and financial resources. Healthy Ageing is the focus of the WHO’s work on ageing between 2015 and 2030, replacing the previous Active Ageing policy framework developed in 2002. Healthy Ageing, like Active Ageing, emphasizes the need for action across multiple sectors, enabling older people to remain a resource to their families, communities and economies. that support them and the services that they implement. Being able to live in environments that support and maintain intrinsic capacity and functional ability is key to Healthy Ageing.


The WHO says “As people age, their health needs tend to become more complex with a general trend towards declining capacity and the increased likelihood of having one or more chronic diseases. Health services are often designed to cure acute conditions or symptoms and tend to manage health issues in disconnected and fragmented ways that lack coordination across care providers, settings and time. Health systems need to be transformed so that they can ensure affordable access to evidence-based medical interventions that respond to the needs of older people and can help prevent care dependency later in life.” •

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Hemp Oil

The 21st Century Panacea?

Hemp oil and CBD products are becoming enormously popular—but what are the health benefits and how do you choose a product?


Cannabis is a family of plants with two primary classifications—Indica and Sativa. Hemp is a member of the 88 DEAR DOCTOR WITH DR CHRIS STEELE

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Cannabis Sativa family, while marijuana can be considered a member of either the Indica or Sativa families. Cannabis contains a variety of different compounds called cannabinoids, the most common of which are Tetrahydrocannabinol (THC) and Cannabidiol (CBD). Marijuana is abundant in THC, with concentrations between 15 percent and 40 percent, while hemp contains a very low concentration of THC (0.3 percent or less). Recent changes in the law in the UK have legalised the strictly controlled use of THC in restricted medical circumstances such as treatment of some rare forms of epilepsy, but otherwise THC is still a banned substance in the UK.


Hemp and marijuana share certain familial similarities, but they also have crucial differences. Hemp is primarily used for industrial purposes, such as production of paper, clothing, building materials, biofuel, food products, oils and more. With the fast-growing popularity of CBD across the globe, hemp is also used to produce a wide variety of THC-free CBD products. Cannabidiol (CBD) oil is essentially a concentrated solvent extract made from

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emp oil and CBD products are incredibly in vogue—it’s as if they are the panacea for all the ailments of the 21st century. But there are so many products on the market and such a range of claims for their benefits that it can be hard to establish the real advantages and select a suitable product. There’s a good deal of myth and misunderstanding surrounding hemp and CBD products, so first, a little demystification: what are the differences between hemp, cannabis, marijuana and CBD products?

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cannabis flowers or leaves, dissolved in an edible oil such as sunflower, hemp or olive oil. The exact conditions and solvents applied have a great impact on the taste, colour and viscosity of the final product. CBD Oil can refer to a full-spectrum oil from the Cannabis Sativa plant, or to hemp seed oil, which comes from just the seeds of the hemp plant. You won’t get high on hemp oil, as it comes from food-grain strains of hemp which must contain less than 0.3 percent THC. Hemp seed oil comes from the small seeds of the cannabis sativa plant. The seeds do not contain the same levels of compounds as the plant itself, but they still have a rich profile of nutrients, fatty acids and bioactive compounds. Hemp oil is not the same as CBD oil, which uses the stalks, leaves and flowers of the hemp plant. Fullspectrum hemp oil that also contains plant matter may contain other effective compounds, which may help with certain health issues, such as inflammation.


There are several different ways to use CBD oil, including capsules, orally with a dropper or spray, in a moisturiser or lotion, or through vaping. But what are the claimed benefits of hemp oil and CBD products?


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• Skin health – The fatty acids in hemp oil are said to be nutritious and to benefit skin health generally, including conditions such as eczema, dermatitis, psoriasis and acne • Brain health – Polyphenols in hemp seed oil may help brain functions • Heart health – Alpha-linoleic acid, one of the components of hemp seed oil, appears to reduce the risk of cardiovascular disease • Inflammation – Hemp oil or CBD oil are often used for pain relief, particularly in cases of swollen joints • Muscles – Full-spectrum hemp oil containing CBD may help with general stress and muscle tension

It’s important to note, though, that as CBD oils are sold as ‘food supplements’ rather than medicines and are not tested to the standard required of medicines, manufacturers are forbidden from making any direct claims for their health benefits or offering medical advice. The Advertising Standards Authority and Committee of Advertising Practise state “If the product is not a licensed medicine, marketers should not make any medicinal claims in their ads. The ASA and CAP considers that claims that a product can “cure”, “restore”, “prevent”, “avoid”, “fight” or “heal” (and similar) are likely to be considered as medicinal and advertisers of non-licensed CBD containing products should avoid making reference to them.”


As hemp oil and CBD come into more common use in an increasing number of areas, research into the potential benefits may expand, and then it’s quite possible that there will be more support for their claims. Until then, a lot of the evidence is anecdotal, so if you’re keen to try them out, you may well be adding valuable insights to the growing interest in these fascinating natural products. •

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Coconut water is promoted as a low sugar, healthy drink alternative to soft drinks and fruit juices. So what are the benefits of this drink from paradise?

The Water

of Paradise?

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pressure and stroke. Potassium’s vasodilator properties means it allows blood vessels to relax and increases blood flow, thereby reducing the likelihood of clots occurring.


In a study published by Health Line, rats placed on a high-fructose diet were treated with coconut water, to test if damage caused by free radicals declined. Not only was there an evident decline in free radical damage, but also of improvements in insulin levels and blood pressure. Another beneficial compound found in coconut water is cytokinin, which acts as powerful antioxidant against free radical damage in cells. Studies by alternative medicine researchers suggest that coconut water vinegar can decrease liver damage, by improving antioxidant activity and reducing inflammation.


For individuals suffering from the pain of kidney stones, coconut

water may be a better alternative to just drinking plain water. Keeping hydrated with water is the number one recommendation for preventing kidney stones from forming, and the high potassium content of coconut water is said to help dissolve kidney stones. If nothing else, coconut water is a good bet for bucking you up after exercise—in addition to restoring your hydration it will replenish lost electrolytes including magnesium, sodium and calcium. Give it a try next time you hit the gym! •

Nutty for coconuts Because coconut water is usually sterile, it has been used in emergencies as a substitute for intravenous fluids. Coconut in all its forms, whether as oil or coconut cream, is the most used fruit in the cosmetics industry.

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he rise in coconut water’s popularity marks a shift in consumer choices, perhaps promoted by the introduction of the sugar tax in 2018, and the emphasis placed on a low-sugar diet to reduce the risk of diseases such as diabetes and dementia. Not to be confused with coconut milk (which mixes the water in the shell with an emulsion of the white coconut flesh), coconut water contains significantly lower amounts of sugar, ranging from 3g to 6g per 100ml, than the typical fruit juices and soft drinks found at your local supermarket. While the low sugar level is a plus in itself, coconut water’s sugar is also bound to fibre, which prevents it from being instantly absorbed into your body’s bloodstream. Alongside this low-sugar perk, coconut water contains potassium, which promotes heart health and provides essential support to the body’s muscular system. A typical 100ml serving of coconut water contains 185mg of potassium, a valuable aid in the fight against the risk of high blood


30/04/2019 15:20


Salving Your Skin

Incontinence is a manageable condition, but can lead to other problems, such as skin irritation. We consider the solutions where standard cleaning products won’t do



As tempting as it may be, and although it appears like an obvious go-to, talcum power is a definite ‘no’ for treating skin affected by incontinence. Talc clogs the pores and makes the skin dryer; the fragrance on top only serves to foster irritation. In addition to avoiding talc, do 94 DEAR DOCTOR WITH DR CHRIS STEELE

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WATER MYTHS It’s a myth that we need eight glasses of water a day—most of this is supplied in our food. Unless you have symptoms of dehydration, you needn’t drink if you’re not thirsty. not use products containing alcohol, as this will only exacerbate the irritation. Regular washing is an essential requirement to treating incontinenceaffected skin, so be sure to wash the skin twice a day and remember to finish by gently patting down the

area, not rubbing. Washing is ideally performed immediately after urinating or defecating. Of course, a regime of bladder training whereby you slowly increase the time between each trip to the toilet may help you to improve control over urination and be of long-term benefit to the source of the problem. Dietary changes involving cutting down on alcohol or caffeine intake are another fantastic method of gaining control and giving you the autonomy to decide when you go. Additionally, regular exercise and consuming less of certain acidic fruits such as lemons, fruit juices and grapefruits, will allow you to recover further control and independence over your body. •

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eft untreated, skin damage caused by incontinence can become a persistent condition. Basic cleaning products such as the usual shower gels or soaps can be too abrasive on already damaged skin, hence the importance of using specialist products exclusively designed to treat skin damage created by incontinence. Broken skin is highly susceptible to infection of both bacterial and fungal types; the most common type of infection caused by incontinence is a yeast infection. Antifungal medication, for example Diflucan, can be prescribed by your doctor to kill the fungus internally, in conjunction with antifungal creams such as miconazole and terconazole which can be applied topically on a regular basis to treat the skin. Another reason to avoid using general shower gel or body wash products in the treatment of skin damaged by urinary incontinence is that they often contain fragrances, parabens, sulphates and latex, ingredients which can aggravate the skin and lead to further breakdown. There are certain other risk factors which increase the likelihood of urinary incontinence creating skin damage; these include dry skin, receiving medication for other illnesses and being older.

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3M™ Cavilon™ Durable Barrier Cream

Freedom from sore skin. Sore skin caused by incontinence can be prevented. Cavilon barrier cream’s unique formula creates an invisible, breathable protective skin barrier. It stops urine coming into contact with the skin, letting it heal naturally and protecting it from further damage. It also moisturises, helping to soothe while it protects. Cavilon barrier cream has been specially formulated to be completely hypoallergenic and pH-balanced, with absolutely no added latex, parabens, colour additives or fragrances, so it is safe to use on children and adults even if the skin is sensitive or broken. • As used by health care professionals • Clinically proven to protect skin from incontinence related damage1 • Does not clog or reduce the absorbency of pad linings2 • Wash off resistant – only needs applying morning and evening 1 Bale S, Tebble N, Jones V, Price P. (2004) The benefits of implementing a new skin care protocol in nursing homes. Journal of Tissue Viability 2004; 14(2)44-50.

To purchase Cavilon Barrier Cream go to: To claim your 10% discount* enter this promotional code at checkout 3MTEN

2 Hart J, (2002) Assessment of the incontinence pad blocking potential of Cavilon DBC compared with Sudocrem and Zinc and Castor oil. Nursing Scotland 2002, Issue July/August.

*Promotional offer valid until 31 July 2019.


J455014. 3M and Cavilon are trademarks of 3M Company. © 3M 2019. All rights reserved.

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14/03/2019 16:15


What to Wear to Work Out

IMAGES © Shutterstock

Active wear is having its moment, leaving behind the days when drab T-shir ts and baggy shor ts were the norm for working out. Here’s our essential style guide

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ctivewear is really in the spotlight right now—you’re just as likely to see the rich and famous in spandex leggings as in designer pieces, while “athleisure” wear is becoming acceptable in the office. But do these trendy looks offer any real health and exercise benefits, or have they become completely enslaved to style and fashion? When looking for gymwear, should you prioritise trends, comfort or practicality, and does it really matter? Research published in the Journal of Experimental Social Psychology says it does—revealing a direct correlation between what we wear and how we perform, as well as our motivation levels and even likelihood of injury. So let’s look at how what you wear to the gym can impact your workout, the top tech trends of workout gear and—of course—how to look your best.

DRESS FOR SUCCESS The psychological phenomenon known as “enclothed cognition” suggests that what a person wears can trigger mental changes that positively affect their performance and confidence.

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Use this trick to up your workout game next time you hit the gym. Instead of a baggy t-shirt, which can actually make your workout feel harder, opt for a sweat-wicking tanktop made specifically for exercise. It will trick your brain into feeling confident about the squats you’re about to do, and as a result, help you get a better ‘leg day’ workout. Many sports injuries occur because of the lack of appropriate equipment, and this includes clothes. Whatever you’re doing, look for clothing for that specific activity—this will protect against impact, strain or overheating. It’s also a good idea to invest in good quality compression wear, which will increase circulation and blood flow to the heart—delivering much needed oxygen to working muscles, reducing fatigue and soreness by managing lactic acid accumulation, helping to improve power, endurance and recovery.


As we work our way towards the tech golden age, it’s starting to seem more and more likely that we’re going to run there. Trainers that sync with your smartphone have been

A DAMP DON’T Once you’ve put together your workout wardrobe, you want the garments to last for a little while. Never let your gym clothes sit around while they’re damp, as that’s a sure way for odour and mildew to develop. Instead, try to wash your dirty gym clothes as soon as possible using a sports detergent.


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What to pack in your gym bag • • • • • • • • • • •


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throw off the alignment of your feet and, as a result, your knees and hips. The rule of thumb is to wear your shoes for about 300 miles before replacing them. If you’ve lost track of your mileage, examine the treads on the soles of your shoes. When they start to wear out and you can no longer see the design of the tread, it’s time to get a new pair.

CONTROL YOUR TEMPERATURE An intense gym session will get the sweat flowing and your heart rate and core temperature raised. Wearing light, breathable and sweat-wicking fabrics will leave you feeling dry and comfortable, maintaining your body temperature and ensuring your perform at your best. Low quality and cheap active wear can contain synthetic materials that irritate the skin. Exercising increases the flow of blood to your skin, so it’s important to wear light, breathable

fabrics to avoid itching and rashes. Sweat, dehydration, and washing your workout attire in harsh detergents can all contribute to skin issues. Another thing to watch out for is whether your clothing is too tight— leggings that are too small can cause leg cramps, and tight sports bras can actually constrict your breathing. Small shorts can cause chafing on the inner thighs, which can even lead to infection. Avoid all of these problems with appropriate active wear.

STAY SUPPORTED Research shows that women change the way they run, depending on the type of bra they are wearing. A good sports bra, perhaps one of the most important pieces of your workout gear, not only provides you with vital support—it could help you set a new personal record as well. When dressing for a workout, skip the old, stretched out sports bras (and never wear a regular bra), as the movement from exercise can lead to

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available for a while now, providing useful information to athletes such as distance run, total steps taken and calories burned. However, Nike is pushing the frontiers further with the Adapt BB—a shoe that uses pressure sensors in the sole to trigger automatic lacing. Nike designed the shoe specifically for basketball players, as their feet can expand almost half a size during play. A level of fit that feels comfortable at the beginning of the game, might not 20 minutes in. The shoe received a serious vetting by the company before hitting the market—including from Boston Celtics’ ‘small forward’, who put the shoe through an exhaustive training period. If you’re not going to splurge hundreds of pounds on top-of-theline, high-tech trainers, you should make sure that the pair you are wearing to workout aren’t worn out. Old shoes provide less cushioning and shock absorption, which can

Workout clothes Sports bra Trainers Breathable socks Workout-friendly headphones Sports watch Hair ties or clips Quick dry towel Toiletries Water bottle Combination lock

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upper back and shoulder pain postworkout. Sports bras generally fall into two categories: those for low to medium-impact sports and those for high-impact sports. If you’re going to be doing a high-impact sport, like running, aerobics or mountain biking, make sure that you’re wearing a highimpact sports bra. Leave your jewellery behind when you hit the gym—you risk damaging your ring by banging it against a weight or snagging it on a machine and sweat can dirty up the metal of a necklace or cause an allergic reaction. However, wearing a dedicated sports watch will take your workout to the next level. If you’re not committed to investing in a FitBit, or one of the many

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alternatives currently on the market, opt for a simple and cheap watch that offers a stopwatch function for you to time your mile splits. If you’re looking for more sophisticated data about your workout, consider a fitness tracker or smartwatch. These devices can help you track steps taken, distance covered, calories burned and your heart rate.


An often-overlooked but equally important part of your gym excursion is your gym bag. A sneaky trick for making sure you actually get to the gym is to pack your workout bag ahead of time. Fill it with all necessities like a good water bottle, headphones, a quick-drying towel

and a protein bar, and then leave your handily packed bag in plain sight. It’s so convenient, it will be harder to come up with a good excuse to skip your workout. If, like most of us, you are trying to fit your workout into your already busy day, it feels tempting to just wear your gym clothes to the office. Luckily, trends are headed in this direction with the rise of ‘athleisure’. If you’re planning to sweat in the clothes that you’re also going to be answering emails in, try to pick muted colours and simple designs. It also helps to invest in pieces made of quality fabric and to accessorize well. An elegant coat or statement shoes will bring your outfit from the gym to the office. •


01/05/2019 09:27


Improving the State

of Your Prostate It’s only the size of a walnut, and only men have one. So how can the prostate be such a pain?


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rostate problems are common, particularly in men over the age of 50. A small gland found only in men, the prostate surrounds the tube that carries urine out of the body (the urethra), and produces a thick, white fluid that gets mixed with sperm to create semen. The prostate gland is about the size and shape of a walnut but tends to become enlarged with age. It’s not entirely clear why, but it’s as if the prostate is trying to draw attention to itself because it’s not being used as much as it once was— certainly a Harvard Medical School report concluded “high ejaculation frequency seemed to protect against prostate cancer”. Although the dangers of prostate cancer are widely discussed, most cases of prostate enlargement are actually relatively benign, just inconvenient. As the prostate enlarges, Benign Prostatic Hyperplasia (BPH) can restrict flow of urine through the urethra and cause

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symptoms such as: • Frequent or urgent need to urinate •

Increased frequency of urination at night (nocturia)

• Difficulty starting urination • Weak urine stream or a stream that stops and starts • Dribbling at the end of urination • Inability to completely empty the bladder • Less common symptoms can include urinary tract infections, blood in urine or inability to urinate.

BPH BPH does not increase your risk of developing prostate cancer, will sometimes clear up by itself and may be treated in a number of ways. Simple measures such as reducing the amount you drink (especially tea, coffee and alcohol) before bed can sometimes help

control the symptoms. Medication can help reduce the size of your prostate and relax the muscles of your bladder. Treatments for BPH include medication such as alpha blockers or anticholinergics to relax the muscle in the prostate gland, 5-alpha reductase inhibitors to shrink the prostate, diuretics to speed up daytime urine production and desmopressins to slow down urine production. In severe cases, surgery may be necessary. The conventional treatment is transurethral resection of the prostate (TURP), which is effective, but can lead to loss of sexual function, bleeding and incontinence. TURP involves coring out the central part of the prostate using an electrical loop inserted into the urethra via an endoscope. The loop cuts tissue and seals blood vessels, removing parts of the prostate in slivers. But great strides are being made with minimally invasive treatments such as Prostate Artery Embolisation (PAE), which restricts the blood supply to the prostate; and with green light

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laser or steam ablation, which have less chance of causing side-effects than conventional surgery.

PROSTATITIS Less common than BPH is prostatitis, inflammation of the prostate gland, which can occur in men of any age. Symptoms include pain in the pelvis or when urinating, and difficulty in urinating or ejaculating. Prostatitis is treated using a combination of painkillers and alpha-blockers, which can help to relax the muscles of the prostate and bladder neck. Full recovery is usually possible within a few weeks or months.


St Bartholemew’s Cancer Institute in London is experimenting with genetically modified flu virus to attack prostate cancer cells, holding out hopes of a cure rather than just prolonging life. Though the symptoms of prostrate problems can be a pain, the outlook for most conditions is good. If you have any problems, check yourself in for an examination, and you’ll soon be on the pathway to prostate health.•

THE REZūM ALTERNATIVE An innovative treatment to help men suffering with enlarged prostates is set to be rolled out across the country after the treatment was initially trialled at Charing Cross and Basingstoke hospitals. The treatment, known as Rezūm, uses small applications of steam to shrink an enlarged prostate, easing symptoms including difficulty passing water and frequent toilet visits. Rezūm does not require anaesthesia, shows symptom improvement within three to eight weeks and minimises side-effects.

IMAGES © Shutterstock

By far the most serious prostate condition is prostate cancer, the most common type of cancer in men, with

more than 40,000 new cases diagnosed every year. Chances of developing prostate cancer increase with age and are also raised in certain ethnic groups including Afro-Caribbeans. But the outlook for prostate cancer is generally good because, unlike many other types of cancer, it usually progresses very slowly. Many men die with prostate cancer, rather than as a result of having it. Prostate cancer therefore does not always need to be treated immediately—sometimes, it may initially just be monitored, and only treated if it gets worse. As with other cancers, if the condition does become critical, there are a range of treatments available including hormonal therapy, chemotherapy, radiotherapy or surgical prostatectomy to remove the entire prostate.

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30/04/2019 15:27


Realise Your Value Equity release is an increasingly popular way to secure your finances in older life, but there’s a lot to know before you decide whether it’s for you


In a lifetime mortgage, one of the two main type of equity release, you take out a mortgage secured on your property provided it is your main residence, while retaining ownership. You can choose to ring-fence some of the value of your 104 DEAR DOCTOR WITH DR CHRIS STEELE

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property as an inheritance for your family and can make some repayments or let the interest roll up. The loan amount and any accrued interest is paid back when you die or when you move into long-term care.


In home reversion, the other type, you sell part or all of your home to a home reversion provider, in return for a lump sum or regular payments. You have the right to continue living in the property until you die, rent free, but you have to agree to maintain and insure it. You can ring-fence a percentage of your property for later use, possibly for inheritance. At the end of the plan your property is sold, and the sale proceeds are shared according to the remaining proportions of ownership.


With a lifetime mortgage, you can normally borrow up to 60 percent of the value of your property, dependent on your age and its value. With home reversion you’ll normally get between 20 percent and 60 percent

Be aware of these issues • Equity release can be expensive compared to an ordinary mortgage • Home reversion plans normally give you much less than the open market value of your property • Money you receive from equity release might affect your entitlement to state benefits • You will have to pay arrangement fees of around £1,500-£3,000 • With an interest roll-up plan there will be less for you to pass onto your family as an inheritance of the market value of your home (or the part you sell). You should check whether or not you can release equity in several payments or in one lump sum. It’s a complex proposition, and before considering equity release, you should take advice from an independent financial adviser who is a member of the Equity Release Council. •

IMAGES © Shutterstock


quity release is a class of financial services helping you to access the equity (cash value) of your home, while you’re still living in it. It’s available if you are over 55 and can be taken as a lump sum, in several smaller amounts or as a combination of both. Effectively, you are borrowing money against the value of your house and repaying nothing until it is sold— typically on your death or when you move into a retirement home. It is guaranteed that you will not have to pay back more than the original value of the house; if you live longer than expected, or the value of the property drops, any difference is absorbed by the lender. The lender is effectively gambling that house prices will continue to rise.

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Enjoy life knowing you’re in safe hands

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26/03/2019 16:31


Too High

to Handle

Hyper tension, or high blood pressure, affects more than one in four adults in the UK. Here’s how to manage it before it becomes serious


ypertension, also known as high blood pressure, rarely has noticeable symptoms. In fact, adults can go through the majority of their life unaware of their blood pressure— though it may be a contributing factor behind feelings of being tired or shortness of breath. However, over the long term, hypertension is a leading cause of life-threatening diseases including coronary artery disease, strokes, heart failure, atrial fibrillation, peripheral vascular disease and chronic kidney disease. It’s also behind vision loss, dementia, sleep apnoea and chest pain. 106 dear doctor with DR Chris Steele

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The NHS advises all adults over 40 get their blood pressure checked at least every five years—this, the NHS notes, is easy and could save your life. A blood pressure test can be done in a doctor’s office, at most pharmacies and even at home with a kit. While doctors aren’t sure what causes hypertension overall—the underlying cause of the overwhelming majority of high blood pressure cases can’t be found—there are several factors that can exacerbate the problem.

Sans salt

People living on the northern islands of Japan eat more salt per capita than

Avoid this exercise If you suffer from hypertension, exercise is one of the top ways to get your blood pressure into better shape. However, fitness advisors warn those with hypertension to stay away from HIIT (high-intensity interval training) workouts. If you’re planning to take up the fitness fad and aren’t sure about your blood pressure, it’s worth getting it checked, as HIIT can raise the heart rate to dangerous levels in hypertensive patients.

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anyone else on earth, and they also have the highest rate of hypertension. A diet high in salt is one of the biggest causes of hypertension—and as the recommended salt intake for adults is 1 teaspoon (6g) per day, it’s easy to go overboard in our modern diet. While the temptation is great and the risk can feel small in your day to day life, controlling your salt intake is imperative. Other foods to avoid include delicatessen meats, frozen pizza, pickles, canned or premade soups, canned tomato products, sugar and soft drinks. It’s recommended to reduce or eliminate your alcohol intake as well. Those looking for more detailed guidelines can check out the Dietary Approaches to Stop Hypertension, or DASH diet. The diet was created by researchers who noticed that hypertension was far less common in people who followed a plant-based diet. To that end, DASH emphasises fruits, vegetables and lean proteins and discourages red meat, salt and added sugars and fat.


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Before your blood pressure gets too high and brings with it an entire menu of life-threatening diseases, there are several lifestyle changes that can help mitigate your risk. Exercising, eating more healthily, limiting your alcohol, stopping smoking and cutting your caffeine intake will all help lower your blood pressure and reduce your risk of hypertension illnesses. Nutrition researchers recommend eating foods such as leafy greens, bananas, fish, berries, oatmeal and pomegranates. Above all, it is recommended to reduce your salt intake, first and foremost.

Define “hypertension” The heart pumps blood into blood vessels, which carry blood throughout the body. Blood pressure is the term describing the measure of the forces of blood pushing against blood vessel walls. Hypertension is dangerous because it makes the heart work harder to pump blood out to the body. there’s still hope. Researchers at the University of Edinburgh have pinpointed cells in the immune system that could be key to tackling high blood pressure. The study, published by the European Heart Journal, revealed a new role for specialised white blood cells called ‘macrophages’, that are central to the body’s immune system, discovering that macrophages scavenge for and eat certain molecules (the hormone endothelin)— which brought down the blood pressure of mice involved in the study.


For those still struggling to lower their blood pressure, you may want to consider a change of scenery. A landmark study published last year found that residents who live in “walkable” cities had a lower risk of hypertension than those who lived in cities where the primary mode of transport was driving. To measure the walkability of a city, researchers considered the residential and retail density, public transport, street-level movement and proximity to attractive destinations, among other factors. Poorly designed spaces tend to inhibit walking and physical activity, which promotes a sedentary lifestyle. This in turn is a detriment to residents’ health. “Well designed cities of today will be healthy cities of tomorrow,” said Dr Chinmoy Sarkar, an assistant professor at the Healthy High Density Cities Lab of the University of Hong Kong and lead author of the study. •


For the hypertension cases that can’t be solved entirely through a change of diet, exercise or other behaviour,

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Do you experience bladder leaks when you cough, sneeze, exercise or urgently need the toilet? 1 in 3 women do… It doesn’t have to be this way NEW Pelviva can help you regain bladder control and get you back to living your life the way you want to. Pelviva is an award winning disposable, discreet and easy-to-use Pelvic Floor muscle re-trainer for the treatment of bladder leakage in women. The Pelviva treatment has been clinically proven to improve bladder leaks in 84% of women in just 12 weeks.1 Pelviva treats the cause of bladder leaks by using a unique technology that re-trains Pelvic Floor muscles. Many women cannot do pelvic floor muscle exercises correctly – Pelviva does this for you and adjusts to your body to optimise treatment results. Put an end to awkward and embarrassing moments. Rapidly rediscover life without leaks.

Pelviva is now available directly at or call 0800 681 6008 Pelviva device not to scale

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References: 1. Oldham J, Herbert J, McBride K. Evaluation of a new disposable ‘tampon-like’ electrostimulation technology (Pelviva®) for the treatment of urinary incontinence in women: a 12-week single blind randomized controlled trial. Neurourology Urodynamics 2013; 32(5):460-466. doi 10.1002/nau.22326

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How to Laugh Without Leaking It can be one of the more embarrassing and distressing health conditions, but urinary incontinence needn’t take over your life

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rinary incontinence, the unintentional passing of urine, is such a common problem that as the population ages, not even the NHS has a clear idea how many people are now affected; a 2003 study estimated it at 24 percent of people over 60 worldwide, while a 2015 estimate gave a figure of 14 million in the UK. So if you do suffer, you’re certainly not alone. Part of the problem in diagnosis and treatment is that there are at least four forms of urinary incontinence, including the stress, urge, overflow and total types. Just as there are many different

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types of urinary incontinence, there can be many causes. Stress incontinence is usually the result of the weakening of or damage to the muscles used to prevent urination, such as the pelvic floor muscles and the urethral sphincter, either through childbirth, obesity, neurological conditions such as Parkinson’s or some medications.

FIGHT THE URGE Urge incontinence is usually the result of overactivity of the detrusor muscles, which control the bladder, so-called ‘overactive bladder’. Causes range from urinary tract infections to inadequate fluid intake.

FOUR FORMS Stress incontinence – When urine leaks out at times when your bladder is under pressure, for example, when you cough or laugh Urge incontinence – When urine leaks as you feel a sudden, intense urge to pass urine, or soon afterwards Overflow incontinence (chronic urinary retention) – When you’re unable to fully empty your bladder, which causes frequent leaking Total incontinence – When your bladder can’t store any urine at all, which causes you to pass urine constantly or have frequent leaking


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KEGEL EXERCISES First described in 1948 by American gynaecologist Arnold Kegel, pelvic floor muscle training can help strengthen the muscles that hold up the bladder and stop it leaking. A specialist will assess whether you’re able to contract your pelvic floor muscles, and by how much. An individual exercise programme will be developed based on your assessment and should consist of a minimum of eight muscle contractions at least three times a day, maintained for at least 3 months.

Overflow incontinence is often caused by an obstruction or blockage to your bladder, which prevents it emptying fully, including an enlarged prostate gland in men, bladder stones, constipation or nerve damage from bowel or spine surgery. Total incontinence may be caused by a problem with the bladder from birth, a spinal injury, or in women a bladder fistula. Certain factors can increase the chances of urinary incontinence developing, including pregnancy and vaginal birth, obesity, a family history of incontinence and increasing age (particularly in the over-80s)—though incontinence is certainly not an inevitable part of ageing. Any of the common types of urinary incontinence can be embarrassing and uncomfortable but most are manageable, so the first step is to overcome any possible feelings of embarrassment and see your GP for an examination, which should be the first step towards effective treatment. Diagnosis is normally done by


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discussing the symptoms and possibly keeping a journal of fluid intake and how often you urinate; then a pelvic examination for women or rectal examination for men.

WHAT’S THE TREATMENT? The most straightforward treatments for urinary incontinence are in your own hands—they can include lifestyle changes such as losing weight and cutting down on caffeine and alcohol, exercising the pelvic floor muscles by squeezing (Kegel exercises) and bladder training, where a specialist will teach you ways to wait longer between needing to urinate and passing urine In practical terms, you may also benefit from the use of incontinence products, such as absorbent pads and handheld urinals. If these methods don’t work, your GP may recommend medication or surgery. The standard medication for stress incontinence, duloxetine, can help increase the muscle tone of the urethra, which should help keep it closed. Unfortunately, it has some

possible side-effects, including nausea, dryness of the mouth, tiredness and constipation, so it isn’t for everyone. There are also possible side-effects of sudden withdrawal, so duloxetine prescription will be assessed after two to four weeks to see if it is beneficial. For urge incontinence or overactive bladder syndrome, your GP may prescribe an antimuscarinic such as oxybutynin, either as tablets or in a patch. A low-dose version of a medication called desmopressin may be used to treat nocturia, which is the frequent need to get up during the night to urinate, by helping to reduce the amount of urine produced by the kidneys. Botulinum toxin A (Botox) can be injected into the sides of the bladder to treat urge incontinence and overactive bladder syndrome.

SURGERY In some cases, a course of EMS (Electrical Muscle Stimulation) may

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assist in in the treatment of urge urinary incontinence by strengthening weak pelvic floor muscles. Contraction of the pelvic floor muscles is stimulated by low-level electrical impulses delivered to the nerves that supply these muscles, as well as the bladder and bowel, through an internal vaginal or anal electrode. If medication and EMS are ineffective, there are surgical options such as a colposuspension or tissue sling (where the neck of the bladder is lifted and fixed in place); enlargement of the bladder; or implantation of an artificial urinary sphincter or a device to stimulate the nerve that controls the detrusor muscles, or to stimulate the sacral nerves at the bottom of the back. Some of these surgeries require use of a catheter afterwards—a continence adviser will teach you how to place a catheter through your urethra and into the bladder to drain it.

PREVENTION It’s not always possible to prevent urinary incontinence, but there are several steps you can take to reduce the chance of it developing. • • •

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of cases. This method involves injections of fillers into damaged tissue around the urethra in order to keep the area tight. Ian Milsom, Professor of Gynaecology and Obstetrics at the Sahlgrenska Academy and Head of the Gothenburg Continence Research

Centre (GCRC), said “Unfortunately we are not actually curing the condition in that many cases. “Surgery aside, the results delivered are poor. And the problems are only going to get worse in the future because the population, as we know, is ageing.” •

TIPS FOR WOMEN The British Association of Urological Surgeons (BAUS) gives the following advice for women doing pelvic floor exercises: • Get into the habit of doing your exercises regularly and linking them to everyday activities such as speaking on the phone • Use the exercises to prevent leakage before you do anything which might make you leak • Drink normally – Six to eight cups (two litres) per day, avoiding caffeine and alcohol if you can • Avoid going to the toilet “just in case” – Go only when you feel

that your bladder is full • Watch your weight – Extra weight puts more strain on your pelvic floor muscles and your bladder • Avoid constipation – Straining can put excessive pressure on your bladder and bowels • Allow three to six months before you expect to see results, but continue them for life to prevent problems recurring or worsening

Controlling your weight Avoiding or cutting down on alcohol and drinks with caffeine Keeping fit—in particular, exercising your pelvic floor muscles Reduce drinking in the hours before bed

While surgery can be distressing, in some cases it is the only effective option. A study in Sweden in 2017 concluded that surgery ranks well ahead of other methods, delivering success within three months in 82 percent of cases, while pelvic floor exercises rank second with 53 percent, followed by drug treatment with 49 percent. Bottom of the pile was treatment using so-called bulking agents, which was only successful in 37 percent

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life starts at 60+

IMAGES © Shutterstock

Diabetes: Time For a Change?

Would the tabloid threats of diabetes “bankrupting the NHS” make more sense if we understood more about this lifethreatening condition? 112 dear doctor with dr Chris Steele

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e’ve all seen the scare stories—“Huge rise in UK diabetes cases threatens to bankrupt NHS”, says one headline, “UK public do not understand diabetes threat” says another. But what is the reality of the current ‘diabetes panic’? The cost to the NHS of dealing with diabetes has risen from £591m in 2007/8 to £1.01b in 20017/18—but experts from Diabetes UK say the real cost could be ten times higher as the NHS deals with complications from the disease, including strokes, blindness and amputations. There were over 26,000 lower limb amputations related to diabetes in England from 2014 to 2017, an increase of 19.4 percent from 2010-2013. Yet public understanding of the condition, its causes and treatment seems to be poor.


There are two main types of diabetes, with different causes and treatments (a third type, gestational diabetes, occurs in pregnancy and typically resolves after childbirth). Diabetes, or diabetes mellitus (DM), is a metabolic disorder in which the body cannot properly store and use sugar. Sugar metabolism should be controlled by insulin secreted by the pancreas, but in diabetes this process fails, causing dangerous levels of unmetabolized sugars to build up in the blood.


Around 10 percent of diabetes sufferers are Type 1. The cause of Type 1 diabetes (formerly known as juvenile onset diabetes) is imperfectly understood. It seems to be a problem with the immune system knocking out insulinproducing cells in the pancreas. It usually manifests early in life but can appear in adolescence or later (Prime Minister Theresa May was diagnosed in her 50s). Complications of Type 1 diabetes can include dental and gum diseases, eye problems and sight loss, foot problems including numbness and ulceration, heart disease, nerve damage, stroke and kidney disease. Type 1 diabetes is fatal if untreated, and there is no cure. Diabetes patients have to get used to a routine of injecting insulin, often several times a day, and monitoring their blood sugar levels using pin-prick tests and a glucometer. Alternatives such as insulin pumps and electrodebased testing are now increasingly common. Type 1s can be prone to low blood sugar episodes, known as hypoglycaemia or a “hypo”, when they miss a meal, exercise too much or drink alcohol on an empty stomach. Symptoms include dizziness, tiredness, sweating, trembling and palpitations. An immediate treatment is to have a sugary snack, but in severe cases an injection of glucagon may be required. Conversely, excessive insulin can cause hypoglycaemia, or extremely low blood sugar, and lead to nausea, sweating and shaking, so it’s essential that Type 1s measure insulin carefully and eat a consistent diet that balances blood sugar levels as much as possible.


For the 90 percent of diabetes sufferers who are Type 2 (formerly known as late onset diabetes), symptoms usually appears later in life, as a result of the body becoming resistant to insulin. Because the hormone doesn’t work properly, blood glucose levels rise, and more insulin is released. Sometimes this causes damage to the pancreas, lowering insulin production and causing

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higher and higher blood glucose levels. Around 3.5 million people in England now have Type 2 diabetes—it’s the leading cause of sight loss and lower limb amputation and can contribute to kidney failure, heart attack and stroke. Age, obesity, unhealthy diet, and genetic and ethnic factors can be significant— people with a South Asian background, for example, are particularly at risk. Common symptoms of Type 2 diabetes are feeling thirsty, urinating frequently, particularly at night, loss of weight and slow healing of wounds. Type 2 sufferers can require medication, or even a similar sort of insulin injection regime to Type 1s— but Type 2 diabetes can be managed through adopting a healthier diet, losing weight and becoming more active.


If your blood sugar levels are above the normal range, but not high enough to be diagnosed as having diabetes, the condition is known as pre-diabetes. The NHS Healthier You Programme is designed to help pre-diabetics to reduce the risk of developing Type 2. Prediabetes normally causes no symptoms, so it’s important to get your GP to test for the condition. Recommended methods for managing pre-diabetes include a healthy diet of fresh foods including fruit, vegetables, nuts and grains, avoiding high-sugar and fried foods and alcohol, exercising for at least 30 minutes a day and reducing BMI (body mass index) Until diabetes is more widely understood, there’s a risk that sufferers from Type 1 will continue to face serious health challenges, and the rise of Type 2 diabetes will go on unchecked. • DEAR DOCTOR WITH DR CHRIS STEELE 113

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Dentum - the first point of call in Croatia for patients from the UK Absolutely brilliant clinic. Was apprehensive about going outside UK to have my dental work carried out, but would recommend Dentum to everybody! Very clean state-of-the-art clinic, friendly helpful staff, lovely accommodation provided free by Dentum. Dental work at a fraction of the cost of the UK and spending your spare time in their lovely city. Only a few hours away on a plane! Very impressed with Dentum. Alan A., Edinburgh


entum is a premium dental clinic in Zagreb, Croatia’s capital, that offers high-end treatments. The team consists of 11 dentists, 11 dental assistants and 10 patient care consultants, who coordinate patient travel details, appointments and post-treatment care. Due to the clinic’s focus on dental tourism, the entire staff speaks English, German, Italian and French at a high level of proficiency. Our clinic wins its patients over with our fully customised VIP service for every patient that includes:

• Free accommodation • Free first visit • Seven partner imaging centres in the UK • Free airport transport service • Highly educated staff

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Going the

Extra Smile

It can be costly and protracted, but is dental implant treatment the best way to make your mouth happy again?


t’s by no means certain that we will lose all our teeth with age—that all depends on the care you take of them during your lifetime. But though the figure is falling, a 2018 survey showed that four percent of the UK population have no remaining teeth. But dental technology has made great strides in the last 20 years, with new materials and techniques offering solutions for a wide range of problem teeth. One of the most exciting developments, the dental implant, can now be applied to most types of failing or missing teeth.

IMAGES © Shutterstock

ROOTS In dental implant work, a cylindrical screw fixture (usually made of titanium), essentially an artificial root, is surgically implanted into the jawbone, and fused to it using a chemical called hydroxyapatite. An abutment is screwed into the fixture, then a prosthetic tooth (essentially an old-fashioned crown) fixed onto the abutment. A properly fitted implant can last decades, and the technique is applicable to many different situations involving missing, broken or worn-down teeth–for instance a single missing tooth, a bridge to fill a gap between two teeth, a stabilising procedure for an ill-fitting denture, or even complete replacement dentition, upper or lower.

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CONFIDENCE Dental implants can restore confidence both in your looks, and in eating–certainly they are a much more reliable option than the conventional denture, and have the advantage of helping to preserve facial structure by preventing the bone deterioration that can occur when a tooth is missing. Dental implant treatment can involve multiple procedures taking up to three months for the lower jaw or six months for the upper jaw, depending on the type of treatment being considered and the condition of the teeth and jaw. If the bone present is deficient, a bone graft may be required. Conversely, some types of implant can be done in a day.

Though the cost of dental implants can be considerable, certainly compared to a denture, with proper maintenance a dental implant can last a lifetime, so it could be the best investment your mouth will ever make. •

Tooth tip The two main types of dental implants are endosteal, placed in the jawbone, and subperiosteal, placed under the gum but on or above the jawbone, used where there is not enough healthy natural jawbone available.

dear doctor with DR Chris Steele 115

01/05/2019 12:28

Howz is the smart home monitoring system that’s bringing families closer together. Developed by a physiotherapist, it helps the ones you love stay independent for longer by quickly learning routine through discreet and easy to use sensors and an app. Simple to install, no intrusive cameras, just the peace of mind you and your family deserve.

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Home Comforts

Staying safe and comfortable in your home can be a challenge as your agerelated needs increase, but technology can provide valuable support

IMAGES © Shutterstock


s we grow older, it can become difficult to cope with simple things around the home—climbing stairs, cleaning, preparing meals and washing clothes, for instance. Moving into a care home isn’t always the solution, as it can be expensive, disrupting and involve giving up a lot of freedoms. A study by the Good Care Group shows that seniors who stay in their homes live longer, have better physical and mental health and can be cared for more economically than if they go into a care home.

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The role of in-home healthcare services will be crucial, but a great deal can now be done with modern technology to make independent living easier. For instance, home monitoring systems using energy-use data and connected home technology can empower the elderly, or those with additional needs, to live independently for longer. By monitoring the energy usage of electrical appliances and gathering information from sensors that detect

factors such as movement and temperature, the system can build up a pattern of daily behaviour. Through an app, users can then check in on their family and receive alerts if normal routine is broken. Such systems can be set up quickly and easily using smart plugs, so no additional wiring is involved. In addition to providing real-time alerts of sudden changes of routine through an app or associated websites, the system can supply regular reports, making it possible to highlight less obvious changes in behaviour. DEAR DOCTOR WITH DR CHRIS STEELE 117

01/05/2019 11:21

Age UK Stairlifts

Stay safe & independent in your home Call today to find out more

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0800 620 0716 Age UK Stairlifts are provided by Handicare Accessibility Ltd, in association with Age UK Trading CIC. Handicare will raise a minimum of ÂŁ1.2 million during 2018/2019 for Age UK (registered charity no.1128267). Contact us for information.

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5 things you should know about buying a stairlift

To make it easier for you to decide if a stairlift would help you to stay safe and independent at home, Handicare has created this five-point plan.

1. Consider the options

Ask a professional to assess medical needs first. An occupational therapist can offer guidance on the best course of action and products, and then you can make your choice. Some people consider moving their bedroom downstairs if they have access to bathroom facilities on the ground floor. Many people prefer to install a stairlift as it has the minimum impact on their lifestyle.

2. Check the house

A stairlift can be a significant investment in terms of cost yet it could positively impact your life if you have mobility problems, bringing freedom to move around the house and making it possible to stay in the home you love. It can be tempting to wait until it’s absolutely necessary before buying a stairlift, but many people who invest in one say they wish they’d done it sooner. Handicare is one of the largest manufacturers and installers of quality straight and curved stairlifts in the UK. Handicare and Age UK Trading CIC work together to offer quality home adaptations including stairlifts and accessible bathing solutions at reasonable prices. Visit for more information.

Whether a stairway is straight, curved or has a number of landings there could be a stairlift to suit your needs. It’s important to have room for feet, knees and head and also to store the seat and rail. Handicare will visit your home and carry out a detailed assessment. A stairlift is fitted to the stairs, not the wall, so no structural alterations are needed – making it possible even in rented accommodation. In many cases it can be fitted in less than a day.

significant expense, but there are options available to make buying one more affordable. Refurbished stairlifts, with new track, are often available. It is possible to apply for a grant through a number of sources. It is important to bear in mind, however, that not everyone will qualify for certain types of financial aid, and a stairlift grant is not guaranteed, even if you are in need of one. For more information, visit stairlift-advice/financing-a-stairlift

5. Maintain your stairlift in good working order Handicare offers Age UK customers a warranty with the purchase of their stairlift and a 24-hour no-fees call-out service for the first two years, which covers any spare parts that might be needed.

For free advice or to arrange a home visit contact Handicare or 0800 620 0716

3. Give it a go

If you know someone who has a stairlift, ask if it works for them – and ask for a trial run. Most stairlifts are easy to use, operated manually by the user with a button or joystick. Ask if they would recommend the company they used, but contact at least three to compare service and prices.

4. Look at the cost

Investing in a stairlift that has been specially manufactured for an individual staircase can be a

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Modern stairlifts come in several types, so there’s almost certainly one suitable for every sort of house. There are types for straight stairs, curved stairs and even outdoor steps (and an alternative for outdoors is a step lift for wheelchairs). Curved stairlifts are made to measure for each individual staircase; the narrow tubular track takes up little space, and some types will run up the narrow side of the stairs so it leaves the widest possible area free. Often the chair will swivel at the top of the stair to allow easier exit, and accessories such as safety belts and harnesses can aid security. Fitting of stairlifts is straightforward, normally taking only a few hours, and little structural work is usually needed. The system is usually powered by rechargeable batteries, so it will work even in the case of power failure. Stairlifts can often be supplied in a range of colours to fit in with your décor, and in most cases, they can be removed when they are no longer needed, leaving only minor fitting marks. One way to avoid the inconvenience of stairs altogether, if you have the space


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Co-founder of Howz, Louise Rogerson says, “Smart home technology is one way to help people live independently for longer. A smart home monitoring system should be reassuring, easy to set up and adept at collecting data to build a picture of typical routines, so it can let the user know when something is out of the ordinary. It’s all about helping people gain the insight they need to spot any changes early. in your house, is a through-the-floor lift. Types available include platform designs suitable for wheelchairs or enclosed cabins large enough for an ambulant user, a wheelchair user or a wheelchair with attendant. After use the lift can be sent back downstairs to make space, and the aperture panel in the ceiling closes itself. When needed again the lift is summoned with a remote control. Some models feature extras such as interior lighting, telephone, smoke alarm and other handy gadgets.


Once you’re upstairs, bathroom safety aids come into their own. While assistance in showering, bathing and using the toilet may be necessary eventually, assistive aids can help the user be independent as long as possible. Sometimes all that is necessary is a simple design change, such as raising the height of a toilet or fitting a grabhandle on a shower wall; shower stools and trolleys can also be a help. In some cases, such as when the user is in a wheelchair, more extensive bathroom adaptations may be needed. Sometimes a simple device, such as support belt with handles, can be an aid to a carer who could not otherwise cope.


IMAGES © Shutterstock, Wessex

Of course, not all independent living technology has to be hi-tech. The stairlift was invented by CC Crispen in the 1920s—he called it the ‘inclinator’.

The first stairlift may have been made for King Henry VIII, whose jousting injury (as well as his bulk) made it difficult for him to climb stairs.

01/05/2019 12:23


pillow lift can turn a conventional bed into a one where the head and shoulder area can be adjusted at a more modest cost than a specialist bed. The pillow lift rests on the mattress, held in place by the user’s own body weight, so it doesn’t require fiddly fixings, and can be easily adjusted with a hand control. Adjustable beds may also include a massage unit, to help ease aching muscles and joints, to help you sleep better and improve mobility in the morning.


Of course, there are cases of severe immobility where even a wheelchair will not do the job, and here devices such as mobile lifts can reduces the effort for carers and make it easy to lift and manoeuvre

patients. A mobile lift requires very little force or special training to operate, and can be steered easily in confined spaces, turned and reversed with the least effort. The size of the patient becomes less of an issue, even when the carer is physically smaller. Transfer lifts can cope with a whole range of situations, from lifting in and out of bed to a wheelchair or commode, or even into a vehicle. As the population inevitably ages, demand for assistance in independent living will only increase, and aids like these will make it possible for us to live safely and comfortably in our own homes for much longer. •

IMAGES © Shutterstock

IMAGES © Shutterstock, Wessex

Another common situation is having to turn a patient in bed. Here sliding sheets and turning sheets can help a carer to keep the patient mobile, preventing friction which can cause ulceration and relieving the serious discomfort of pressure sores. In the bedroom, adjustable beds developed from designs used in hospitals and nursing care have proved very successful. The wide range of models available includes adjustable head and foot, high-low action, cotsided, single and double sized, with the two sides controlled independently. An adjustable bed can help with all kinds of medical conditions such as poor circulation, joint and muscle pain, indigestion and pressure sensitivity, and if you spend a lot of time in bed or are completely bedridden, it’s helpful to be able to adjust it to support you sitting up to eat, read or watch television. Alternatively, a product such as a

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01/05/2019 12:23

A life of wellness is a life of travel Why is it that when we come back home after travelling, even if it was a busy or long journey, we feel refreshed and reenergised? That’s the magic of travel, the ability to nurture something deep inside everyone, that voice that tells you to get out there and discover. Collette’s worldwide travel collection features over 160 comprehensive land tours, river cruises, rail journeys, singlecity stays, and more across all seven continents of the world. We pride ourselves in building the perfect itineraries, getting the best professional tour managers, and making sure our travellers are taken care of at every step in their journey. Since 1918, we have shared our love of travel with our guests, showing them that travel is good for your health. Come join us, and find out how.

For more information, or to book, call us on 0800 060 8093 or visit

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Costa Rica: A World of Nature From £1,999pp | 12 Days, 24 Meals • • Arenal Volcano

Stay at a Tortuguero National Park eco-lodge, surrounded by forest. Sample different types of pineapple on an organic plantation. Choose to explore the Arenal resort or relax in a hot spring.

Exploring the Alpine Countries From £2,149pp | 12 Days, 17 Meals • • Matterhorn

Watch a Mozart Dinner Concert in the elegant St. Peter’s Restaurant. Stay in Oberammergau, known for woodcarvings and the Passion Play. Relax in the village of Zermatt, and breathe in the fresh air of the Alps.

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Choose a relaxing yoga class or a morning walking tour of Udaipur. Delve into Indian culture during a henna tattoo and bindi demonstration. Visit the Taj Mahal at sunrise, when the first rays glisten on the marble.

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Your Guide to

Travelling as a Senior You’re never too old for an adventure—whether you’re relaxing on a cruise ship, taking the grandkids away or exploring the scenery closer to home, put your health first with these senior holiday tips

Manage your medication

Thousands of people travel with medication each day—the key is to be prepared. Before planning a trip away, have a check-up with your doctor— especially if you use prescription medicine. Request enough to cover your trip as well as a surplus supply in case of emergencies. Your doctor will also be able to answer any questions that you may have, advise you on how to manage your routine, and assist you with any medical notes or vaccinations that you might need. Remember, different countries have different rules on what is considered a ‘controlled substance’, how much is allowed, and how it needs to be declared, so do your research. You should always keep a 124 dear doctor with dr Chris Steele

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Top Tip!

Pill boxes are perfect to take on holiday—they ensure that you remember to take your medication every day and are easy to carry copy of your prescription on hand and carry any medication or equipment in its original, correctly labeled packaging. When you arrive you can transfer enough for your stay into a pill-box. Pack the majority in your main suitcase but have a supply in your carry-on bag, just in case the airline loses your luggage.

Save money

The presumption that retired people have large amounts of disposable income is often false. However, retirement does bring with it a flexibility to travel outside of the

usual time constraints and book in the ‘shoulder seasons’ between high and low times, avoiding peaks. Senior travellers can take advantage of low season prices and enjoy quieter trips with cooler weather—ideal for sightseeing. Keep in mind that certain retreats, such as ski holidays, will not operate on the typical seasonal schedule. When looking to save money on your holiday, try scouring the Internet for deals, keeping an eye out for senior citizen discounts or concessions and calling up providers before you book. Often, if you don’t ask, the discount won’t be applied. Consider booking your trip well in advance to save on travel prices and research any ticket schemes that may be available, such as the senior rail card if you’re catching the train.


If you have a health issue, disability or low mobility, you may need to do your own research to secure facilities that will make it easier for you to get around. For example, most cruise ships are very disability-friendly, but

IMAGES © Shutterstock


s you grow older, you may find yourself with a more extensive list of things to consider when planning a holiday. From prescription medication to quality travel insurance, these tips will keep your health in check and verify that travelling only gets better with age.

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WHEN TO TRAVEL November—March: Low Season April—Mid-June: Shoulder Season Mid-June—August: Peak Season September—October: Shoulder Season

the London tube network will be less accommodating. It’s important to plan your holiday itinerary in advance, checking locations for the likes of step-free access, lifts and ramps. If you are travelling in the UK, check that your accommodation complies with the National Accessible Scheme (NAS). Overseas, you could schedule a guided coach tour or plan your holiday with a specialised operator.


Solo travelling is having its moment, and many older travellers are choosing to go abroad alone on group tours or cruises. When travelling alone, make sure that a family member or friend is informed of your holiday itinerary and

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that you notify a staff member of your daily excursions. Check local customs online before jetting off and plan transport in advance. Make sure to never flash your wallet or advertise that you are unaccompanied, as this may make you a target to pickpockets or thieves. There are also benefits to a guided holiday, where the stress of booking hotels, transport and excursions is taken off you. An expert tour guide can introduce you to local landmarks, cultural highlights and experiences you might otherwise have missed, and the social element of guided group travel can be one of its most enjoyable aspects.


As you get older, you may notice that the cost of insurance cover increases. Some insurers do not cover those in the senior age bracket at all, so it’s important to shop around and compare prices to find the best package. The ‘best’ may not be the cheapest option however, particularly if you’re of a certain age. Seniors need quality travel insurance that will cover any existing medical conditions and protect them from unforeseen circumstances. More expensive policies will often include added benefits not offered to younger travellers or those travelling with medical concerns.

Three Reasons Why Guided Travel is Good For You How does guided travel help keep your mind, body, and spirit healthy?


Mind – You’ll be able to rest your mental muscles and just take in the sights and sounds of new places, with your itinerary being planned for you, your hotels booked and your driving taken care of.


Body – You’ll feel great without feeling overexerted when you walk through incredible cities or exotic locales, and then rest and rejuvenate at your accommodation with built-in free time.


Spirit – Shaking hands with new friends in distant places, seeing stunning landscapes you’ve never seen before, trying a delicious new dish— all of these experiences feed the spirit.

Visit or call 0800 060 8093 for more information.


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Did you know? Travel insurance for 80-yearolds is 17 times more expensive than it is for 55-year-olds Source: This is Money

Remember, certain activitybased trips may require a special form of cover; even reasonably safe ventures like safaris. When choosing insurance, read the fine print and check policies carefully before making a commitment. Know what you’re covered for and whether there are any maximum age limits enforced by the provider. It is very important to declare all medical conditions that you may have. If you do not, the company has a right not to pay out in the event of a claim.


A newly coined term, ‘Grey Gapper’, describes someone over the age of 55 who has decided to take a ‘gap year’. 126 DEAR DOCTOR WITH DR CHRIS STEELE

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of people aged 55 and over are taking a ‘grey gapper’, or long break, to travel the world Source: Post Office

Think less of partying students, more about visiting those places that you may not have had the opportunity to when you were younger or had a full nest at home. Many travellers in later life are ticking off their to-do lists. A survey by the Post Office revealed that 13 percent of ‘grey gappers’ had partaken in an extreme activity such as bungee jumping, water skiing or parasailing. If you’re planning multiple trips over a 12-month period, a multi-trip insurance policy may be the best option for you. These policies can save you time and money and usually allow an unlimited amount of trips in a specific timeframe. •

When holidaying as a senior, there will likely be some extra preparations that you’ll need to consider:  Luggage: Make sure that you aren’t struggling with the weight of your suitcase and ask for help if needed  Spares: Ask yourself if you need to pack an extra pair of reading glasses, or spare batteries for your hearing aid etc. in case they get lost or damaged when travelling  Comfort: Pack a blanket and pillow if you’re travelling for an extended duration  Car hire: As with insurance, rental companies will differ in how they treat people over a certain age  Clothing: Pack appropriate outfits for the designated climate and research whether your accommodation has laundry facilities—you may be able to pack lighter if so  Protection: Depending on your destination, you may need to carry mosquito repellent or protective sunscreen when on holiday  Safety: Pack a medical kit with bandages, antiseptic, sterile syringes, electrolyte sachets and diarrhoea and constipation tablets

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Holiday health matters


ravel health is a complex area of medicine. Outbreaks can impact recommendations more frequently than you might think, so it is always important to seek expert advice before you depart. The ideal is four to six weeks before you go, but remember that short-notice advice is always better than no advice at all. We know that many myths float around regarding travel health. But can you tell your fact from fiction?



FICTION: Everyone is at risk from mosquitoes—the truth is that not everyone reacts to bites in the same way, and it really does just take one bite. This is particularly dangerous if you are in a country where malaria, yellow fever, zika or dengue are prevalent.



FICTION: Many vaccinations offer long-term protection, particularly if you’ve had boosters, and some even offer lifetime protection. There is rarely a need to start from scratch, but you should always consult an expert who can advise further.

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FACT: This is true. Bite prevention is the only real way to protect yourselves in countries where mosquitoes are present. Multiple studies show that insect repellents with any of these following four ingredients will work (if used correctly): DEET, Picaridin, PMD or IR3535. In addition, experts recommend wearing long-sleeved loose-fitting clothing, sleeping under mosquito nets, and steering clear of standing water where mosquitoes are particularly fond of congregating.



FACT: This is true. Protective immunity is far from guaranteed, and usually only applies (in a limited way) to those who were born and raised in the malarial country and repeatedly exposed. Any immunity these individuals would have had wanes rapidly on moving to a country with no risk of malaria.



FICTION: One size does not fit all. People visiting the same destination, even on the same trip, can often receive different advice. This advice is based on medical conditions (past and current) and previous vaccination history, as well as on planned accommodation and activities. The last thing anyone wants is to become ill while away, or shortly after returning home. Put simply, wonderful memories are the only souvenirs that you would want to bring back, and MASTA are perfectly placed to help make that happen. Visit one of over 200+ clinics across the UK, and leave with that all-important peace of mind, knowing that you are as prepared as you can be for your travels. •

Use our free online vaccine checker and book an appointment

22/02/2019 11:47


One Stop Shot Travel vaccinations may be no fun, but for the older traveller in par ticular they can be a necessity


ven if you don’t have a phobia about needles, it can be no fun having travel vaccinations. But for the older traveller in particular, they can be an essential element in safe travel abroad. Travel vaccinations normally fall into one of three categories—Required, Recommended and Considered. Each is dependent on the destination and in some cases the time of year. You can find out more at www.fitfortravel.nhs. uk. For instance, these popular holiday destinations currently carry the following guidance:

• CUBA Recommended: Tetanus. Consider: Diphtheria, Hep A, Hep B • EGYPT Recommended: Tetanus, Hep A. Consider: Diphtheria, Typhoid, Hep B, rabies

IMAGES © Shutterstock

• INDIA Recommended: Diphtheria, Tetanus, Hep A, Typhoid. Consider: Hep B, rabies, cholera, TB, Encephalitis

• JAMAICA Recommended: Tetanus. Consider: Diphtheria, Hep A, Hep B

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• UGANDA Required: Yellow fever. Recommended: Diphtheria, tetanus, Hep A, Typhoid. Consider: Hep B, rabies, cholera, TB, meningitis

• SAUDI ARABIA Requires proof of vaccination against certain types of meningitis for visitors arriving for the Hajj and Umrah pilgrimages If you’re only travelling to countries in northern and central Europe, North America or Australia, you’re unlikely to need any vaccinations. In the UK, the NHS routine immunisation schedule protects you against a number of diseases, but not all the infectious diseases found overseas, so when you are travelling abroad you must allow time to consult your GP or a private travel clinic. Some vaccines need to be given well in advance to allow your body to develop immunity, and some involve several doses spread over weeks or months, so don’t leave it until the last minute. You may be more at risk of contracting some diseases, if for example you are older, in poor health, travelling in rural areas, or you are on

TOP TIP When you get your travel vaccinations, it’s a good opportunity to update or boost your standard vaccinations such as flu, chickenpox, HPV, pneumonia, meningitis and shingles long trip rather than a package holiday. You should ask if your GP practice is signed up to provide free NHS vaccinations for travel, as not all are. Vaccinations for polio, diphtheria, tetanus and some others are available free on the NHS, while hepatitis B, meningitis, rabies and others will normally be charged for, and yellow fever is available only from designated centres. The cost of travel vaccines that aren’t available on the NHS will vary, depending on the vaccine and number of doses you need, so bear this in mind when budgeting for your trip. • DEAR DOCTOR WITH DR CHRIS STEELE 129

30/04/2019 15:45



For Good Health A cruise holiday can be a relaxing and entertaining experience, but have you ever thought it could also be good for your health? There’s a growing trend around ‘fitness cruises’, which do as much good for your body as mind

Relax and learn

If you’re interested in relaxation, a ‘mindfulness’ cruise could be right for you, concentrating on instructional lectures and expert-led classes on subjects such as mindfulness, improving sleep patterns, nutrition and spirituality and even laughterimmersion workshops. These cruises may also include excursions for yoga classes in natural surroundings such as rainforests, Tai Chi and Pilates sessions in spectacular gardens and trips to hydrothermal pools.

Spas at sea

Combining sensible diet with a gentle exercise regime, ‘spa cruises’ may include mornings of yoga lessons, pool swimming sessions, afternoon hikes ashore and—for the more adventurous—paddle-boarding, kayaking or snorkeling. Round off the 130 dear doctor with DR Chris Steele

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day with a Core Fusion beach boot camp, then enjoy a relaxing massage or meditation class in the evening. Another related option is the beauty spa cruise, incorporating aromatherapy, music and arts classes and holistic therapy. For a touch of real luxury, some cruises offer en-suite treatments including saunas, heated ceramic loungers and unlimited in-room spa treatments.

and golf and soccer simulators—many even have a jogging track. If you want to include a cultural element in your fitness regime, a jogging cruise to a cultural centre such as Amsterdam will take you around museums, markets and landmarks while you run. So, if you can avoid the 24-hour buffet, open bar and rich diet at the Captain’s table, a cruise holiday really could be good for you in body and mind. •

Gym and slim

For a more targeted approach, gymand-slim cruises, often hosted by well-known fitness gurus, will help you to achieve your fitness and weightwatching aims. Exercise programs can include customized fitness regimes, water aerobics, gym exercise classes, biking and boating outings and thermal spas, all complemented by tailor-made nutritionally planned diets, often with vegan and holistic options.

High energy

For the really energetic, some liners now feature basketball courts, batting cages, climbing walls, trampolines, TRX Suspension training, spinning classes

Healthy Holiday Into the idea that your cruise vacation can benefit your body? Here are some other treatments available onboard. • Seaweed wraps • Caviar facials • Electroporation • Gemstone anti-ageing sessions • Thalassotherapy (seawater treatment) • Salt saunas

IMAGES © Shutterstock


hile you’re entitled to relax and chill out on a cruise holiday, it can also be an opportunity to rebalance your mind and body as part of an overall health regime.

01/05/2019 13:37

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& 0844 998 3907 or see your ABTA Travel Agent Offers subject to availability and may be withdrawn without notice. Book by 31st March 2019. Terms and conditions apply visit Prices are per person based on two adults sharing a twin cabin. h Land by launch or tender. Excludes gratuities at £7pp per night. Calls cost 5p per minute plus your telephone company’s access charge. Operated by South Quay Travel & Leisure trading as Cruise & Maritime Voyages ABTA V9945. C014/C020/G045/R022/G032 4842

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11/02/2019 11:53


Medical Tourism:


Finland’s tiny population is served by a health system which is attracting increasing numbers of medical and health tourists. We find the secret of happiness

Did you know? Finland had the highest survival rate for leukaemia patients from 2010 to 2014, at 95.2 percent, better than the UK, Germany or Switzerland. Source: The Lancet

and was head physician for the Finnish Summer Olympics team between 1988 and 2000.



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Health-care visitors to Finland are particularly interested in diagnostic services, fertility treatment and perinatal care, as well as dental care. Other areas of interest are oncology, cardiac and vascular diseases, bone and orthopaedic surgery, as well as rehabilitation. Päivi Antila, project manager, Health Tourism Finland, says: “Finnish private hospitals and clinics are very competitive in cancer treatment, a variety of demanding surgeries such as spinal surgeries, as well as orthopaedics and sports medicine. We see the potential to receive a much bigger number of (visiting) patients in the coming years.” Famous Finnish clinics include Hospital NEO, for orthopaedics and sports medicine, made famous by surgeon Sakari Orava, who has completed over 20,000 procedures,


Of course, the cool summers and snowy winters of Finland, which has 70 percent forest coverage, present enjoyable attractions for the tourist, including the country’s 188,000 lakes, Northern Light spotting, famous midnight sun, trips by dog-mushing or snowmobile and other outdoor adventures. The seaside capital Helsinki, well served by the nearby international airport in Vantaa, is justly famed for its restaurants, saunas, neoclassical buildings, design galleries and the nearby medieval town of Porvoo. For this and many other reasons the Finns are said to be the happiest people in the world and Finland the ideal place to enhance your physical and spiritual well-being. •

IMAGES © Shutterstock


erhaps it’s because Finland topped the World Happiness Report in 2018, based on factors such as freedom, honesty, welfare, good health and generosity, that medical tourism to the northern European republic is rising. Finland also has a well-earned reputation for safety and stability, but of course there’s more to it than that—the results achieved by Finnish healthcare are world class, particularly in areas such as decreasing cancer mortality. Finnish research groups have contributed to many breakthroughs in diagnostics, cancer treatment and prevention, cardiovascular diseases and neurological conditions. Finnish healthcare is based on early detection, prevention and universal provision, and Finland has a long tradition of receiving overseas patients.

It’s common for medical tourism facilitators in Finland to provide full service packages to their customers, including transportation and accommodation. Alternatively, clinics will often recommend nearby partner hotels in their vicinity. Clearly, Finns love the health-giving aspects of the sauna—there are 3m in the country—and trends such as Sauna Yoga and Sauna Pilates can deliver a sense of well-being. But Applied Sauna Yoga is also a significant treatment option for conditions such as arthritis, fibromyalgia and chronic joint pain.

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Would you travel for

premium joint replacement surgery?


oxa is one of the leading European hospitals fully specialised in joint replacement surgery, and the only one of its kind in Finland. Providing care that is individualised, evidence-based and extremely high-quality, we are able to give our customers a chance to rediscover the joy of physical activity. Our services include replacement surgery for hip, knee and other joints. We perform over 4,500 joint replacement operations every year in our seven operating theatres, and we employ over 250 professionals who are fully specialised in joint replacement surgery. Our orthopaedic specialists perform an average of around 200 operations per year, so our personnel are very competent and have plenty of experience in joint replacement surgery. Our customer satisfaction is first class, with 98 percent of customers recommending our services.

How to access individual treatment at Coxa:


Learn more about our services at

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Send a no obligation enquiry about potential surgery to roope.tahka@ We assess your surgical needs without any obligation on your part. When a shared decision has been made to proceed with the surgery, we create an individual treatment plan for you, and advise you on how to prepare for the surgery. We can help with all preparations. Tampere is around 200 km north of Helsinki, the capital of Finland, easily accessible by plane or train. Find out more about Tampere at Coxa is within the Tampere University Hospital, and Hotel Norlandia Care Tampere, a high-quality patient hospital offering comfortable and convenient accommodation is in the immediate vicinity. After discharge, we monitor your condition by annual online questionnaire, and contact you if you require further attention. You may also contact us at any time. Read our patient stories at https://www.

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We measure our success using the international Oxford Score system, based on assessments by the patients themselves of the effect of the joint replacement surgery on their lives. The best possible score is 48, and the median score for the 889 patients who had knee replacement surgery at Coxa was 22 before the surgery, and 43 a year after the surgery. The median score for the 705 patients who had hip replacement surgery increased from 19 to 47 in a year. • So, how about travelling to Finland for your joint replacement surgery?

Hospital for Joint Replacement Coxa Niveltie 4 , 33520 Tampere, Finland Enquiries: Roope Tähkä

Tel. +358 40 7538 549

19/03/2019 09:53


Medical Tourism:


It invests more financial resources into medical development than any other EU country, so it’s no wonder Germany is becoming a top destination for medical and health tourism

Since 2013, medical tourists to Germany have been protected by laws guaranteeing a choice of doctor and hospital, a second opinion regarding treatment, doctor-patient confidentiality, choice of treatments and information transparency.


Oncology is the top specialty for medical tourism—there are over 40 specialized oncological centres in Germany which specialize in the treatment of over 300 types of cancer. Other prominent areas include cardiac bypass surgery, neurosurgery using endoscopic and laser techniques, orthopaedics including knee and hip replacement, transplantations, infertility and epileptic disorders.



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Unsurprisingly, the capital city of Berlin is the most popular medical tourism destination, with more than 130 clinics, 70 rehab facilities and around 140,000 hotel beds. Major clinics such as the German Heart Centre, the ChartiteUniversitätsmedizin Berlin, and the municipal hospital group Vivantes have services to suit international patients including multilingual contact persons, interculturally-trained staff and special comfort areas. The German healthcare system is one of the most well-regulated in the world; all services are controlled on the state level, and all hospitals must be approved by certain certifications.


In addition to high-tech medicine, Germany also has an excellent infrastructure for preventative care, rehabilitation and the treatment of chronic diseases. Wellness tourism in Bavaria is an important economic factor, as spas account for 58 percent of local tourism revenue. With a range of hotels near the hospitals, a broad range of cultural offerings and shopping centres in the towns and cities, and plenty of opportunities to recuperate in the great outdoors, a trip to Germany should be a pleasant one for patients and carers alike. •

IMAGES © Shutterstock


ermany has among the highest numbers of physicians per head of population, at over 300,000, and among the highest figures for healthcare expenditure and medical research per capita too (second only to Switzerland among European countries); so, unsurprisingly, it has become a popular destination for medical and health tourism. The country has 2,000 hospitals, which treat 18.5 million people annually. In 2018, 255,000 people from 177 countries received medical treatment in Germany, including visitors from Russia, the Middle East, the Netherlands, UK, Austria, as well as a small amount from the USA and Israel.

Although healthcare in Germany is not cheap, medical tourists do not pay more than German citizens. There are some visa requirements for medical travel to Germany, depending on your country of origin and the likely period of your stay. Before arranging medical travel to Germany, a patient needs to make a prepayment to the account of a clinic. This prepayment includes a preliminary cost of diagnostic and treatment procedures. After treatment, a hospital recalculates all the charges. If a final price is lower or higher than a prepayment, a patient gets unused funds back or pays extra.

01/05/2019 13:43

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The Three Days Vein Special Day 1: ◆◆ 90 minutes thorough ultrasound-diagnostic by Dr Netzer (i.e.. Your later surgeon is personally evaluating the vascular problems of Your legs) ◆◆ Dr Netzer and You are carefully planning and talking through the next day`s minimally invasive procedure ◆◆ You will have any time You wish to ask Your personal vascular surgeon about pros and cons, risks and benefits oft he procedure ◆◆ Consultation with Your later anaesthetist Day 2: ◆◆ Minimally invasive Vein treatment: day surgery in top-level clinic ◆◆ 24/7 availability of Your personal vascular surgeon Dr Netzer after the procedure guaranteed Day 3: ◆◆ Post-op control ultrasound done again by Your personal vascular surgeon Dr Netzer ◆◆ Flight back home

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How we can help You to get a first individual diagnostics and treatment proposal together with a quotation? Either call us (English speaking staff) or send us an email: ◆◆ describe your leg conditions in your own words ◆◆ if there are any medical reports available, send them ◆◆ take some simple JPG-pictures of Your legs and email them to us Dr Netzer himself will assess the information received, and our staff then come back to you, either asking for some more details or already being able to give you a concrete proposal of diagnostics, treatment, post-op care and costs.  |  +49-89-24 24 34 38 (English; German, Turkish & Italian speaking staff) Dr Florian J Netzer, Institut Dr Netzer München, Herzogstrasse 58, D-80803 München, Germany

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comes from overseas medical tourists, so the facilities are very much geared to the visiting patient, with multi-lingual staff and high standards of care and accommodation.


Medical Tourism:


Situated at the geographical centre of Europe, Lithuania offers quality healthcare, affordability and beautiful destinations—and now there’s even more to attract medical tourists


t’s an exciting time for health tourism in Lithuania, as a new agency was set up at the start of 2019 specifically to promote visits to the Baltic country. The new tourism agency Travel in Lithuania will be responsible for improving awareness about Lithuania abroad and developing inbound and local tourism. For health tourists, though, the attractions of Lithuania are already well-known. Situated at the geographical heart of Europe, Lithuania is on the dividing line between Western and Eastern traditions, and has a history stretching back to the year 1009. It was a major power in the 16th century and is now an active member of the EU and NATO. Lithuania has one of the fastest 136 DEAR DOCTOR WITH DR CHRIS STEELE

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growing economies in the European Union, and this is reflected in continuous improvements to everything from transport infrastructure to medical facilities.


Lithuania is a relatively new destination for UK based medical tourists, but visitors from other European countries have been taking advantage of the superior care there for years. Lithuania has world class medical professionals and facilities, and almost all citizens are covered by free, state provided healthcare. However, the private sector is also well developed, offering the finest facilities to attract people to spend extra money on private health insurance. Much of the business of these clinics

One of the biggest attractions of Lithuania has to be the cost of care, which as staff costs are lower, can be between 30 percent and 50 percent cheaper than the UK. Equally, food, drink, travel and accommodation are inexpensive—you can eat out for about €5—so you can probably combine your flights, treatment and a holiday for less than the cost of your procedure at home. With its efficient roads and motorways and an improving international rail system, as well as affordable flights to modern airports with quick and cheap connections across Europe, Lithuania is affordable both as a treatment centre and as a holiday destination.


With well-equipped private hospitals and staff trained and qualified in Western Europe and the United States, Lithuania is a centre for cosmetic dentistry, cosmetic surgery including breast, ear, nose, eyelid and botox treatments, liposuction, cancer treatment, obesity surgery and organ transplant. For health tourists, the towns of Birstonas and Druskininkai are especially well known for their restorative mud baths and mineral springs, which, if you believe the folklore, have remarkable healing powers.


Combining a holiday with your healthcare makes great sense in Lithuania, with so much to see and explore while you are there. With its mild summers, picturesque winters, unspoiled countryside and beautiful sandy beaches, whenever you visit and however long you stay, you’ll find the best of both worlds in Lithuania, with modern facilities as well as historical charm. •

30/04/2019 15:47


About the modern dental clinic

Odontika in Vilnius, Lithuania


dontika, a modern dental clinic in Vilnius, the capital of Lithuania, has for 13 years delivered quality, affordable, advanced dental treatment for foreign and local patients. We offer a wide range of procedures, with the most highest quality, affordable prices and most extensive guarantee in Eastern Europe.


• Our team of qualified professionals offers all types of dental treatment through applying modern digital technologies for therapeutic and endodontic treatment, including implantations, prosthetics, aesthetic, cosmetic and orthodontic treatment, oral hygiene, teeth whitening, treatment of children’s teeth and preventive care. • The main reason why more than 1000 patients from different countries visit our Odontika clinic is our commitment to immediate and professional dental treatment. • With our modern digital dental equipment we offer solutions ranging from simple aesthetic corrections to more complex prosthetic and surgical procedures.

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Modern laboratory Our modern digital laboratory for the production of teeth restorations is situated in the clinic, equipped with a 3D scanner and the newest, fastest, convenient and precise CEREC system for the restoration of damaged teeth. Advanced technologies For advanced diagnostics, we use digital 3D X-rays and an intra-oral scanner, and for thorough surgical treatment and accurate dental implantations without any gum cutting, we use 3D printed surgical guides. Shorter treatment time Our dental prosthetic procedures use a system that allows us to produce the missing part of the tooth within minutes, so depending on the severity of the case, a dental prosthetic procedure may be performed in just one or two visits. High qualifications Our physicians continuously participate in professional training programs and have been recognized for their high level of professional qualifications, so they are able to use the most advanced treatment technologies.


• We offer an exclusive treatment schedule for you by considering the complexity of your case and the required type of procedure. The technologies we use enable us to complete high-quality treatments precisely and in a short period of time. • For us, communication between the patient, the dentist and the clinic staff is very important. Before scheduling a visit to our clinic, you can contact our team to receive answers to all of your questions. • If you are travelling to our clinic from another country, it is possible that just one visit could be enough for the treatment. • For our patients from abroad we offer full dental tourism services, including airport pick up, dental treatment and accomodation offering the most competative prices in the area. • Tel. +00 370 614 42098

26/02/2019 11:56


Medical Tourism:



There’s more to Slovenia than its famous Donat Mg mineral water. From spas to honey-bees, it’s becoming a European centre of health and medical treatment

n Slovenia, they say “Kar je dobro se samo hvali”*, and this Central European republic makes good on the promise by offering a continental climate with warm summers and a Mediterranean feel on the coast, combined with the refreshingly crisp snowfall of the Alps. Though it’s small, with a population of only 2.5m, Slovenia has a great deal to offer to the tourist, and particularly the health or medical tourist. From its capital Ljubljana to the major cities of Maribor, Celje, Kranj and Velenje, and the resorts of Portorož, Terme Čatež and Rogaška Slatina, Slovenia has a well-deserved reputation for medical advancement, safety, fluency in foreign languages and high standards in service and efficiency.


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Bee healthy One of the more unusual treatments available in Slovenia is ‘apitherapy’, a form of homeopathy using aromas from beehives to help cure asthma and all sorts of respiratory problems, while honey and wax are used for skin treatments.

Slovene doctors train all over the world and are used to using stateof-the-art medical equipment. Basic principles of effectiveness, safety, timeliness, continuity and efficiency are at the heart of the Slovene medical system, and special emphasis is put on personally tailored treatment. As part of the medical process, there’s a thorough diagnostic routine, and after treatment you can be sure of superior rehabilitation services.


In the many thermal spas, a range of internal disorders and musculoskeletal conditions are treated. The therapeutic thermal and mineral springs are mostly located in the spas and health resorts in Pannonian Slovenia but can also

01/05/2019 13:45

MEDICAL TOURISM be found at the coast and in Alpine Slovenia. According to legend, when the winged horse Pegasus landed on the ground, healing mineral water burst onto the surface. This water is called Donat Mg and has the highest magnesium content in the world. Among the most well-known resorts is Rogaška Slatina, one of the oldest resorts in Europe, specialising in the treatment of the gastrointestinal and musculoskeletal system and rehabilitation programs. The rich mineral consistency of the Donat Mg mineral water from local sources is said to confer its healing power, and you can choose to experience its effects by taking a mineral bath or enjoying a drinking treatment designed to help you achieve better health and well-being. At the Rogaška Medical Centre, holistic, professional and individual medical treatment is provided by experts in diagnostics, surgery, rejuvenation, beauty, nutrition, physical therapy and massage therapy. Beauty treatments performed by experts using natural cosmetics offer to eliminate the results of stress, improper nutrition and the pace of life, rejuvenating the body and soul through effective, noninvasive and pleasant treatments using the Afrodita cosmetics line.

*That which is good, praises itself promenade of the Spa Park in the heart of Rogaška Slatina offers the special charm of a mighty avenue of sycamores and horse chestnuts, leading to hiking trails which can take you right into the dramatic local peaks. Elsewhere in Slovenia, the spa Terme Donelske Toplice specialises in diseases of the musculoskeletal system, while Terme Smarjeske Toplice is recommended for diseases of the central and peripheral nervous system.

Just half an hour from the capital in the south-eastern part of Slovenia is the popular spa resort Terme Catez. Surrounded by picturesque forests and vineyards, at 145 meters above sea level it’s famous for its beneficial oxygen-rich air. Since the resort is adjacent to the Croatian border, it’s also within easy reach of Zagreb. Perhaps it’s Slovenia’s approach to systematically including wellness and mindfulness programmes into a multitude of treatments, as well as its natural assets, expertise and uniqueness which makes it increasingly popular with the health and medical tourist. •


Other well-known spas include Thalasso Strunjan; Terme Catez, famous for its rarefied air; and Terme Olimia, set in untouched natural surroundings and recommended for rest and quiet, while Portoroz, a city situated on the northern coast of the Adriatic Sea, is a famous tourist attraction, renowned for its high-quality modern airport and hotels, yacht marina, sandy beaches (the only ones in Slovenia) and casinos.

Fore! Some Slovenian spas offer therapies aimed at golfers, combining the healing effects of thermatic spa water sources with medical and wellness treatments.

IMAGES © Shutterstock


Specialisms of the Rogaška Medical facility include surgery to address problems with mobility in the arms and fingers, vascular surgery, and aesthetic plastic surgery, such as procedures on the skin, ears, eyelids, lips and hair. Also available are gynaecological procedures such as diagnostic hysteroscopy, biopsy and histological examination; laryngology to correct problems with breathing and sleep; orthopaedic services and more. Rogaška Slatina also offers experienced massage therapists and revitalising saunas, where you can treat yourself to mixture of the beneficial effect of the mineral and thermal water and the intimacy of world-class relaxation services. The beauty of the area invites you to enjoy the surrounding countryside—the

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Medical Tourism

Medical Tourism:



To the long list of reasons to visit Por tugal from food, beaches and history to sunny weather, you can add the incentive of high-quality medical treatment

ortugal has long been a favourite destination for UK holidaymakers, with its sun, sand and legendary surf enough to attract throngs of visitors to its shores. But now there’s another reason to visit the country: medical tourism. Portugal’s foray into medical tourism is not just an endeavour of

142 dear doctor with DR Chris Steele

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the private industry—the government has made medical tourism a top priority, establishing a multi-sector task force working alongside the health and economy ministries, as well as the private sector, to establish rules and regulations for the medical tourism industry. The private sector has long prepared for it by establishing international

patient services in top private hospitals and enabling communication support (about 30 percent of medical personnel in Portugal speak English) and insurance liaisons for foreign clients. Prior to launching itself onto the medical tourism stage Portugal already boasted life expectancy higher than the European average and a neonatal mortality rate lower than the continent’s

30/04/2019 15:54

Medical Tourism

IMAGES © Shutterstock

Top Tourist Destinations in Portugal Try the capital Lisbon for authentic food such as pasteis de nata, explore the calçadas (traditional mosaic walkways), hear the wistful melodies of fado drifting from cozy restaurants and enjoy the nightlife of Bairro Alto. Madeira’s subtropical islands are the trendiest destinations for hiking, winter sun retreats and eating exotic food, plus, the capital Funchal offers one of the best New Year’s Eve parties in the world. The second largest city, Porto features old, colourful buildings, stunning mosaic architecture, gardens, medieval palaces, and cathedrals. Known for its famous Port wine, Porto’s stretches of vineyards make up most of the nearby Douro Valley. Of course the Algarve is one of the best places to mix warm weather, hiking expeditions, trendy beaches, and even trendier social scenes. Each of the major cities is worth visiting— including Albufeira, Lagos, Vilamoura and Portimão, and many neighborhoods in the Algarve (if not most), are more English-speaking than Portuguese.

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average. The ratio of doctors to patients is equally impressive—Portugal boasts 4.4 doctors for every 1,000 inhabitants, compared to the U.K.’s 2.8 doctors per 1,000 patients or Europe’s 3.4 per 1,000 average.

But why Portugal?

With the medical tourism field booming, and with tons of exotic, beautiful locales that double as options for your needed procedure, it’s natural to wonder, why Portugal of all places? In Portugal, the Health sector is prominent and fast-evolving, developing significantly over the last few decades. Today, its healthcare system is highquality, equipment is the most modern, and a national regulatory organisation regularly assesses facilities. The country also has a vibrant and innovative Research & Development ecosystem, characterised by the presence of world-class institutions and scientists in areas such as neurosciences, cancer, immunology, regenerative medicine and nanomedicine. This on top of the country’s state-of-the-art facilities and highly-qualified workforce. In terms of products and services, Portugal is internationally recognised as a supplier of high-quality pharmaceuticals, medical devices and other technologies. In fact, Portuguese companies have been exporting such goods to highly demanding and exacting markets like Germany, France, the U.K.,

Spain, Belgium and the USA for many years. Portugal’s health tourism prices are competitive, and of course the postprocedure options for rest, relaxation and recuperation are second to none.


Ophthalmology in Portugal has advanced significantly in recent years. The country’s hospitals and medical facilities offer state-of-the-art technology with multidisciplinary teams that have specialisations in all areas of eye care. If you’re seeking medical care for retina issues, glaucoma, cataract and refractive surgery, paediatric ophthalmology, orbit or oculoplastic, then Portugal is the place for you. Ophthalmologists in Portugal have excellent training and are consistently found to be among the best in the European Board of Ophthalmology Exam.


Hospitals in Portugal contain every necessary resource for effective diagnosis and treatment for all types of cancer. State-of-the-art diagnosis, treatment and palliative care are all provided, according to a multidisciplinary approach of a comprehensive cancer centre. If you need radiotherapy, Portugal has linear accelerators with the dear doctor with DR Chris Steele 143

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Destination –


The capital of Portugal is an ancient city with a modern welcome—particularly for the medical tourist


he bustling and dazzling city of Lisbon, with its famously welcoming ways and year-round amenable climate, lies at the mouth of the Tejo River in the western Iberian Peninsula in Portugal. It is mainland Europe’s westernmost capital city, and the only one along the Atlantic coast. Here, centuries-old history lives side-by-side with the contemporary. The Lisbon region as a whole forms one large “resort”, with greenflanked mountains and golden sandy beaches playing host to myriad leisure activities. A truly exceptional tourist destination, as proven by the many awards it has won in recent years, Lisbon is also rapidly acquiring a welldeserved reputation as a destination for Medical Tourism. With its amenable climate all year round, first class accommodation in the city and the surrounding region and its many internationally renowned centres of medicine and science, patients and their travelling companions can be sure of a comfortable stay. The fully up-to-date hospital and research facilities that conform to the most rigorous international standards, the cutting-edge technology and highly qualified medical staff plus the competitive prices all combine to make Lisbon a top choice for those seeking medical treatment. Health units are internationally oriented, with teams of specialist staff ready to look after patients from all over the world.

Welcome to


LISBON FACTS  The airport serving the Portuguese capital is just seven kilometres from the city centre and has daily flights to all the world’s major cities  European capitals are just two or three hours away, with the average flying time to Brazil, New York, Luanda or Moscow about seven hours  Lisbon has one of the mildest climates of any European city, with about 260 days of sunshine a year  Portugal has been a member of the European Union for almost three decades and adopted the Euro from the start


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Medical treatment, culture, leisure and shopping in the same visit

Choose Lisbon for your medical tourism, and you can tailor your trip to perfection, whether you want to simply relax and soak up the sun or enjoy a round or two on some of Europe’s finest golf courses. If you have more time and feel like it, Lisbon provides a multitude of experiences. While its magnificent beaches and a fine climate all make this a perfect holiday destination, as a relative newcomer to the field of medical tourism, Lisbon offers a combination of western European standards with keen prices. Lisbon offers a modern, western way of life, with excellent infrastructure and clean, well-equipped clinics with highly trained staff. Portugal’s capital is also excellent value in terms of living expenses and treatment costs. Even as capital of Portugal, Lisbon is one of the most affordable cities in Europe, and this great value extends to private medical care. Lisbon’s private clinics offer a much wider range of services than other healthcare tourism destinations, extending beyond cosmetic procedures to include routine surgery too. Lisbon has positioned itself as a centre of excellence in healthcare, and an ideal destination for the medical tourist.

Medical centres in Lisbon ELOHIM A centre for natural therapies and alternative therapies, natural medicines, health, wellness and personal development.

HOSPITAL DA LUZ The staff of the Hospital Da Luz respond to all emergencies and have all the necessary means to provide assistance to seriously ill patients through a set of differentiated clinical services with advanced technological support.


The Best Medical

Care in a Very Special Place: Lisbon Medical Services in Lisbon              

Cardiovascular Surgery General Surgery Cardiology Gynaecology Oncology Orthopaedics Ophthalmology Diagnoses & Check-ups Rehabilitation Obesity Treatment Sports Medicine Dental Medicine Medically Assisted Reproduction Plastic and Reconstructive Surgery and much more

Offering well-being treatments, and treatment of pathologies of the osteoarticular, musculoskeletal, circulatory, respiratory, dermatological and neurological systems.

MALO CLINIC An international brand with more than 23 years of history, innovation, ingenuity, rigour and dedication, born from a small dental practice. More than two decades gathering knowledge, developing techniques and forming new teams and caring for patients. Founded in 1995 by Paulo Malo and nowadays recognized worldwide for its know-how.

QUALIHEALTH 24-hour medical care for foreign patients in Lisbon.

FEMÉDICA Over 200 employees and 22 years of experience offering training and medical facilities for events and emergencies.


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Medical Tourism

Top surgical teams in Portugal have extensive experience in all surgical procedures currently recommended for the treatment of obesity, including minimally invasive surgery by laparoscopy and robot-assisted surgery. Outside of surgery, medical professionals in Portugal can offer a range of care with regard to obesity including family medicine, nutrition, clinical psychology, internal medicine, endocrinology and gastroenterology.

Plastic surgery

potential to perform image-guided single-dose radiotherapy, as well as IMRT (Intensity-modulated radiation therapy). You can also seek brachytherapy (radiation therapy), intraoperative brachytherapy in low-risk breast cancer, and Gamma Knife stereotactic radiosurgery for injuries of the central nervous system. Surgical treatment is performed by highly differentiated, internationally known surgeons in technologically advanced operation theatres, including operating rooms prepared for minimally invasive surgery and robot-assisted surgery.

Obstetrics and gynaecology

Hospitals in Portugal are prepared to support women throughout their adult lives through a comprehensive, high quality and patient-centred approach to women’s health. The country boasts very good neonatal health indicators, owing to its highly trained obstetric assistants during pregnancy and childbirth. 146 dear doctor with DR Chris Steele

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Gynaecological services offer a complete surveillance of women’s health at all stages of their lives, including oncological disease screening and menopause surveillance. Expert surgeons perform conventional, hysteroscopic and laparoscopic gynaecological surgery.

Assisted reproductive technology

Treatment for fertility issues can be prohibitively expensive in the UK, which can cause those seeking to conceive to turn elsewhere. In Portugal, state-of-the-art facilities offer diagnosis, fertility tests, full couples’ studies, medical-surgical therapies and assisted reproductive technology (ART).


Obesity is one of the biggest public health challenges facing us today, and sometimes more than a change of lifestyle is required. Studies have found that surgical treatment for obesity results in the significant improvement of quality of life in 98 percent of patients.

Portugal offers the best of the best in plastic and reconstructive surgery. The medical sector in the country has recognised that cosmetic surgery has acquired a growing relevancy in the Western world, and it has dedicated its resources to the field accordingly. Patients seeking cosmetic surgery in Portugal will find highly trained doctors who can perform a variety of procedures with top-of-the-line equipment. Beyond your scheduled appointment, patients will find 24/7 care when necessary to support them through their procedures.

Brexit? No worry

Amid the U.K.’s uncertainty with Brexit, Portugal has seized the moment to offer British citizens something concrete. Turismo de Portugal’s London office announced recently, “Following the uncertainty and the threat of a no-deal Brexit, the Portuguese government has prepared a contingency plan to avoid, as far as possible, disruption for British travellers to our country.” After the U.K. leaves the EU, the European Health Insurance Cards (EHICs) held by British travellers will cease to be valid, but Portugal has stated that UK visitors will still qualify for emergency medical treatment. Anything more than emergency medical treatment will have to be covered, as would have always been the case, but with this announcement like this, British travellers can be certain that Portugal will still have a warm welcome for them—either for medical reasons or just for a holiday. •

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Medical treatment, culture, leisure and shopping in the same visit Choose Lisbon for your medical tourism destination and tailor your trip to perfection, whether you want to simply relax and soak up the sun, or enjoy a round or two on some of Europe’s finest golf courses. Portugal’s capital has an intimate charm and is renowned for its magnificent beaches, ideal climate, and thriving city life, creating the perfect holiday destination. Lisbon offers European standards of treatment at cost-effective prices, excellent infrastructure and clean, well equipped clinics with highly trained staff. The private hospitals and clinics offer a wide range of services extending beyond cosmetic procedures to include routine surgery too. Turismo de Lisboa Ad.indd 1

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