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c e l e b r i t y

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DearDoctor with Dr Chris Steele


Stars of C hannel 5 ’s The York shire Vet talk pet h ealth and nutr ition

Conditions and advice




Relieve stress and anxiety


Know the signs



Dr Chris Steele, MBE

AUTUMN 2017 | £3.99 ISSN 1758-597X

Live a longer, happier life with ITV This Morning’s resident doc

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26/09/2017 10:30

Moth infestation The UK is facing a marked increase in moth infestation. Historically limited to older and high-density housing, infestations are now being reported in rural areas and even in new-builds. Anyone who has experienced an infestation will tell you just how damaging it can be; from holes in jumpers to the disappearance of whole areas of carpeting! It can cost a small fortune to repair or replace such items.

Lost clothes and furnishings from moth damage?

Moth damage is often costly!

Here in the UK we have 2 main kinds of moths: 1. Common Clothes Moth (Tineola bisselliella) 2. Case Bearing Carpet Moth (Tinea pellionella)

A typical sight following an infestation!

There remains much ignorance about how to deal with an infestation. The main misunderstanding is, it is thought moths can just be repelled or trapped, but repelling just moves them on to another part of the home and any trap will only capture the adult male. Traps have their place as part of a treatment plan (they alert you to the presence of moths) but capturing the adults (those you see flying) will do little to prevent damage, as it is the eggs and larvae that causes the damage by eating their way through fibres to feed and grow. Stereotypically, Clothes Moths are drawn to light, but actually prefer darkness and warm, undisturbed areas to lay their eggs in drawers and wardrobes and behind skirting boards. Case Bearing Moths, commonly known as Carpet Moths tend to be low flying and whitish in colour and as their common name implies, they attack carpets, rugs and other soft furnishings. Adult moths do not have mouths and are not responsible for damage, so don’t be distracted by the sight of a flying moth as they are not the problem. You need to go after the eggs and larvae! The ONLY way to effectively deal with eggs and larvae is to kill them by chemical action. Either you must treat the environment items are stored in, for example drawers, wardrobes, storage trunks, treat the item itself (especially for those items either because of their size or the fact they are in-use, cannot be placed in storage), or better still treat both item and environment.


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There are many products on the market that have varying degrees of effectiveness and efficacy and it can be confusing which to choose. ACANA is an innovative company that has quickly established itself as a leader in moth products and the only brand that has a complete System of Care. All ACANA killer treatment products have proven effectiveness (independent laboratory tests) and utilise one of the most modern and effective active ingredients TRANSFLUTHRIN. They have been specially formulated to provide long-lasting protection from moths, their eggs and larvae. The lavender perfume freshens continuously and End of Life Indicators tell you when to renew. The ordered use of the ACANA System of Care will provide effective and ongoing protection from the damaging and costly effects of a moth infestation. It will also provide you with complete peace of mind! Take back control from the menacing moth. Try ACANA.

22/09/2017 14:04

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22/09/2017 14:04

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17/07/2017 09:15




IMAGES © Cour tesy of ITV’s This Morning

here is no doubt that we as a nation are going through an obesity epidemic, and it truly makes me despair. Obesity is the leading cause of serious health concerns facing the nation today including Type 2 diabetes, loss of limbs, high blood pressure, stroke and heart disease. Two thirds of British adults are diagnosed as either overweight or obese. Thankfully, we are beginning to observe a transformation in our relationship with food and exercise. More people are becoming educated in health for themselves and for their families; with a healthy, balanced diet and a regular exercise routine, we can begin to turn this around.

It has been estimated that one in four people in the UK will suffer from a mental health problem every year. The stigma attached to mental health is dangerous— we need to tackle this problem head on. There are simple things we can incorporate into our daily lives to bring about a sense of mindfulness and relieve symptoms of depression. These include maintaining a close, supportive network of close friends and family and taking time each day to check in with ourselves. The many choices we make in our daily lives when it comes to keeping fit, our diet and mental wellbeing all play a part in our overall health. Keep this in mind when you wake up tomorrow and work towards living a healthier, longer and happier life.

Dr Chris Steele, MBE

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26/09/2017 10:25


CONTENTS 10 Interview

Dr Chris, ITV’s This Morning’s resident doctor, speaks with Kayley Loveridge about the major health concerns we face as a nation today

Today’s Common and Serious Conditions 14 Looking after Your Heart

Heart disease is the UK’s biggest killer

16 Dupuytren’s Contracture

Dupuytren’s contracture is a serious condition that affects around two million people in the UK

19 Dry Eyes

Dry eye syndrome can affect anybody

21 Presbyopia

Presbyopia begins to rear its ugly head when we reach our 40s— could laser eye surgery be the answer?

23 Oral Health Alarm Bells

Oral hygiene is essential for a happy, pain-free life

25 Is Bariatric Surgery Right for You?

Dear Doctor outlines the myths, facts and science behind bariatric surgery

31 Coping with Crohn’s Disease

Crohn’s disease can take a physical and emotional toll on sufferers


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37 Living with Incontinence

Dear Doctor shines some light on the experience of living with incontinence

41 Cold or Flu?

Can you tell the difference between a bout of flu and the common cold?

42 Pneumonia: Know the Signs Detecting the symptoms of pneumonia can mean the difference between life and death

43 Taking Control of Fibromyalgia

Identifying fibromyalgia can be a difficult process. Once diagnosed, self-help techniques and treatments are available for sufferers

44 Understanding Meningitis Campaigns for meningitis awareness are growing with emergence in the UK

51 Alcohol Addiction

Dear Doctor delves into the topic of alcohol dependency, highlighting the key rehabilitation methods

52 Testicular Cancer: Checks, Risks and Treatments We aim to encourage men to converse freely on the topic of testicular cancer and perform self-examinations frequently

56 Prostate Diagnosis

Here’s what to expect when diagnosing prostate problems

57 Sexual Health & Wellbeing

Almost everyone has experienced an intimate health complaint during their lifetime

60 Free-from: Exploring Coeliac Disease

Coeliac disease affects one in 100 people in the UK—left untreated, it can lead to long-term health complications

62 Managing Allergies

Allergies can be a real pain if they aren’t managed properly

Your Health and Fitness 65 Good Food Guide

Navigate your way through the minefield of information on healthy eating with Dear Doctor’s nutritional food guide

69 Health Checklist

Add some innovation to your life with our top picks—from breath fresheners to moth killers

70 The Dairy Debate

Is dairy a friend or foe? We put an end to the long-standing debate

72 A Guide to Free Sugars

The concept of free sugars can be confusing and somewhat daunting

27/09/2017 12:19


74 Mind over Matter

Our mental wellbeing is just as important as our physical health— achieve a more positive outlook with Dear Doctor

76 Fertility Tips, Trackers & Tests Trying for a baby needn’t be complicated. Read our advice

78 Get Active

Perhaps one of the best self-help measures against a host of illnesses, physical exercise is the low hanging fruit of wellbeing

81 Identifying Vitamin D Deficiency

People who lack adequate levels of vitamin D can suffer grave consequences to their health

82 Understanding Supplements

Who are supplements designed for?

Life Starts at 60+ 87 Independent Living

Dear Doctor takes a look at products and devices available to help you live more independently

88 Happy, Independent Retirement

Retire with our useful tips on everything from health insurance to mobility

95 On the Rise

We outline the multiple uses and benefits of domestic home lifts for accessibility and improvements in mobility

96 Superagers: Keeping Your Mind Sharp

We investigate the secrets behind the superagers—seniors who have outstanding mental and physical traits that would rival a 20-year-old’s

99 Seasonal Affective Disorder

A slump in energy and low moods could be early signs of seasonal affective disorder—but what is it?

100 Age Well: Healthy Hair and Skin

As we age, physical changes in our hair and skin are a normal part of life

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103 Resolving Dry Skin Conditions

Discover the triggers, treatments and self-help techniques for some of the most common dry skin conditions

105 Best Foot Forward

Your feet deserve the best care possible—follow our tips on tackling dry and cracked feet

107 Diabetic Foot Care

Foot care is particularly important for those with diabetes

110 Parkinson’s Disease

Around 127,000 people in Britain suffer with Parkinson’s disease

112 The Latest in Knee Replacement Technology Dear Doctor investigates the newest advances in knee replacement technology

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114 Should You Choose Laser Therapy?

Laser therapy is becoming increasingly popular as more people suffering with acute and chronic pain seek less invasive methods of treatment

119 In Our Blood

While uncomfortable for many, DNA testing can give patients priceless insight into their genetic code

120 Coping with Alzheimer’s

Alzheimer’s is a disease that requires careful management and support— find out how carers and patients can control it


123 5 Things You Need to Know About Clinical Negligence

Dear Doctor clarifies the complexities of clinical negligence with five key facts that everybody should know

125 Funeral Planning

With funeral costs rising year on year, pre-planning your own will give you and your family financial peace of mind

128 Choosing a Private Doctor

One of the many benefits of private medical care is the freedom to choose your doctor


27/09/2017 12:39


celebrity PUBLISHER & CEO Kevin Harrington EDITOR Kayley Loveridge SUB EDITOR Annalisa D'Alessio ART EDITOR Friyan Mehta





COVER IMAGE Courtesy of ITV's This Morning; Shutterstock

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 © 2017, Celebrity Angels. All rights reserved. All material in Dear Doctor with Dr Chris Steele magazine and Dear Vet with Peter Wright & Julian Norton supplement 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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8 Reasons to Sterilise Your Pet

Discover the numerous benefits of having your pet neutered or spayed— from relieving the overpopulation crisis to improving overall wellbeing

OFFICE COORDINATOR Adam Linard-Stevens PUBLISHED BY Copyright © 2017, Celebrity Angels. All rights reserved

Common & Serious Conditions in Pets

From diabetes to rabies, being aware of symptoms and problems in your pet’s health can help early diagnosis and promote wellbeing



The stars of Channel 5’s The Yorkshire Vet, Peter Wright and Julian Norton, give us the inside scoop on pet health

FEATURES WRITER Phoebe Ollerearnshaw


Healthy Diet, Happy Pet

Provide your furry companion with the best possible care; try our nutritional tips for a healthy and happy pet


Fitness Regimes for Pets

Keep your pet fighting fit with our guidance on exercise and fitness—a healthy pet is a happy one


Keeping up Appearances

There is far more to pet hygiene than the occasional bath and a regular trip to the vet. Read on for a list of grooming rituals you should be performing regularly


Obedience Training: Grasping the Basics

Training your pet is very important; besides drawing boundaries and improving behaviour, it can vastly solidify your bond


Protect Your Pets Against Parasites

Pets have a mind of their own—unfortunately, this means their owners won’t always be able to control what they come into contact with


The Basics of Pet Insurance

Over 56 percent of pet owners do not have insurance, leaving them with hefty bills after each visit to the vet. Discover our simple guide to pet insurance


Looking After Exotic Pets

The environmental, behavioural and dietary needs of exotic pets can be challenging. Read Dear Vet’s handy guide before deciding to take one home

27/09/2017 12:45

Does your penis bend during an erection?

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20/09/2017 14:08


Live a Healthier, Happier Life

with Dr Chris Steele MBE Q. What is your main concern when it comes to the public’s health? Chris Steele: Obesity. We’re going through an obesity epidemic. Obese parents are having obese children. They’re eating high sugar content; they’re not getting exercise. The thing with obesity is that it’s the main cause of the diabetes epidemic. People do not understand the severity of diabetes. With diabetes you can go blind, you are subjected to heart attack, stroke, kidney failure, gangrene in the legs and amputation. People don’t know this about diabetes. With obesity, you have an increased risk of high blood pressure, stroke, heart attack and various cancers—breast cancer and colon cancer are all linked to obesity. It’s a massive problem and, honestly, I really despair seeing so many overweight people out there. I say they’re suffering from ‘Mad Couch Disease’. Q. Are you optimistic that people are beginning to listen to their bodies more and take better care of their physical health? CS: No. I’m not optimistic. Look at the evidence—you can’t deny that. The good side of the present situation is that people are more aware about what is dangerous and what isn’t through the internet and the media. But are they doing anything about it? No, they’re not. The current guidelines from Public

10 dear doctor with dr Chris Steele

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Health England (PHE) recommend 150 minutes a week [of exercise], so 30 minutes a day for five days a week and that’s been established for years and has failed completely. The latest research suggests that half of the adult population don’t go for a 10-minute brisk walk once a month. The advice I’ve always given patients is, ‘all I want you to do is to go out for a 10-minute walk every day. You’ve got to come back, so that’s 10 minutes coming back—that’s your 20-minute walk’. When you’re going out, count the lamp posts, because that tells you how far you’re going. You’ve got to start somewhere with exercise. The 150 minutes a week has just not worked, so you’ve got to think, ‘let’s get them started somewhere’ at the low level, non-threatening, enjoyable level.

It’s a big problem, mental health; [there is a] huge stigma attached to any type of mental illness. I’ve had depression— bad—a few times

Q. You have been a major advocate for mental health and wellbeing, having suffered from depression yourself. How important is it, in your opinion, that people seek help to fight mental illness, and do you have any advice for those seeking reprieve without medication? CS: It’s a big problem, mental health; [there is a] huge stigma attached to any type of mental illness. I’ve had depression—bad—a few times. It affects every aspect of your life... it’s affecting your mind and your mind is working all the time and with depression, you wake up in the middle of the night, it’s dark, it’s quiet, you’ve got nothing but your low mood with you. During the day, you’ve got no interest, no appetite. I call it the ‘Loss Syndrome’. Loss of interest in everything; your job, your family, your friends. One of the best treatments for depression is CBT (cognitive behavioural therapy). It’s extremely effective, but try and find a CBT therapist? They are few and far between. They’re rare and we need more of them. As GPs, we get slaughtered for writing prescriptions for anti-depressants but when a patient comes in…you’ve got to give them some hope. Anti-depressants are a very effective tool in treating depression. CBT is non-medical, non-pharmaceutical with no side effects. Talking therapy is very effective for mental health disorders; we just need more of it.

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

Dr Chris, ITV’s This Morning’s resident doctor, speaks with Kayley Loveridge about the major health concerns our nation is facing today

27/09/2017 09:54


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dear doctor with dr Chris Steele 11

26/09/2017 08:53


Q. Would you agree that a change in lifestyle that incorporates a healthy diet and plenty of exercise should be prescribed before medications to treat diseases such as Type 2 diabetes and heart disease? CS: I think if a patient’s come in and they’ve got Type 2 diabetes or heart disease, you have to prescribe medications that you know they will take. Having said that, with Type 2 diabetes, you can actually turn that around with diet and exercise. There have been some very good books by patients and by doctors written about how to turn your diabetes around. Type 2 diabetes can be effectively controlled by lifestyle changes. But even with patients with Type 2 diabetes, you give them advice regarding lifestyle and they can’t be bothered to do the exercise. They can’t be bothered and it’s unbelievable. With diabetes, you’re going to go blind, your kidneys fail, you can lose your leg to gangrene—what? Just because you won’t go for a 10-minute walk? We’ve got a lazy generation. Q. One in 100 people have coeliac disease; only 24 percent of those are officially diagnosed. How can people distinguish between a gluten intolerance and coeliac disease? CS: It’s very difficult for a patient to differentiate between gluten intolerance and coeliac disease. First of all, if you’ve got irritable bowel syndrome (IBS), then get tested for gluten intolerance or coeliac disease. That’s happened to me. My GP referred me to a specialist and he said, ‘I think you’ve got IBS’. They gave me peppermint oil capsules—which is a common treatment for IBS—but they didn’t do anything. Then he said, ‘Right, okay, I’m going to test you for coeliac disease’. So if you’ve got IBS that’s not responding to medication, go to your GP and ask to be tested for coeliac disease. It’s a blood test that will test for antibodies. If it comes back positive then you’re sent for a biopsy, which is a little tube in your intestine in that clinches the diagnosis 100 percent that you’ve got coeliac 12 DEAR DOCTOR WITH DR CHRIS STEELE

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[disease]. If you’re going for the blood test or the biopsy, eat gluten—do not change your diet beforehand. Because if you’re going to a blood test next week, and you don’t eat gluten because it gives you symptoms, then the test is a waste of time. If you’ve got a reaction to gluten—if it’s an intolerance or coeliac disease—you’ve got the symptoms. You’ve got bloating, abdominal ache, diarrhoea, you may have constipation and other symptoms like muscular weakness and tiredness because the antibodies formed attack all sorts of systems in your body. Every IBS patient, in my mind, has got coeliac disease until proven otherwise. Prove it otherwise with a blood test and a biopsy. Q. There has recently been a rise in campaigns associated with meningitis not only for children, but increasingly aimed at adults, too. What are the key things we should be looking out for and how important is it for people to get vaccinated? CS: Meningitis vaccines are not being taken up by teenagers, the

very ones who are going to university, and who will be meeting hundreds and hundreds of new people. That could be where they catch meningitis. There are many different vaccines for meningitis: there’s the meningococcal vaccine, there’s mumps, measles and rubella. The one that they want the adolescents to have contains four strains of meningitis. There’s meningitis A, there’s meningitis C, W and Y. And the W [strain] is the most aggressive and has increased tenfold in the past six years. Only one third of 17 to 18-year-olds are taking up the offer of this vaccination. There’s viral meningitis which actually can be quite mild, but bacterial meningitis is the one we’re talking about in terms of these vaccinations. The meningitis gets in your system and causes septicaemia and causes gangrene. The symptoms are headaches and fever, vomiting, neck stiffness and dislike of strong light. People talk about the meningitis rash, which is a rash on the skin and if you press a glass onto it the rash doesn’t go pale, it stays there. If you’re looking at the skin rash from meningitis, that’s

Current guidelines recommend 150 minutes of moderate-intensity exercise a week.

27/09/2017 09:54


Only one third of 17 to 18-year-olds are taking up the offer of the Meningitis W vaccination.

late down the road; that’s a sign of meningitis septicaemia. One in 10 cases of meningitis are fatal. Those that aren’t fatal can cause deafness, blindness, epilepsy and loss of limbs. If you’re an adolescent, get vaccinated—get injected, not infected. Q. The charity Age UK suggests that older people undergo key screenings for conditions like bowel cancer and high cholesterol. How important, in your opinion, is it that people undergo regular checks like these with their doctor? CS: I think with age; these sorts of checks are very important. Bowel cancer screening tests are sent out to everyone in the post. Around two thirds aren’t returned. It’s a kit with cardboard-like lolly sticks and you pass [stool] in the toilet, and you scoop some up on the little cardboard stick, put the date and seal it. You do three samples and you send it off. You’re going to have to do it [pass faeces] in some toilet paper or a plate or a saucer and then take a piece off and then put it on the card. But people are repulsed by their own poo! So they’re [the NHS] not getting a huge response. Other things I would suggest: know your numbers. Your numbers are your

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blood pressure, your cholesterol and your blood sugars. Blood pressure; it’s a killer and can cause heart failure, heart attacks and stroke. Most patients have no symptoms when they have high blood pressure. So how do you know you’ve got it? You don’t know, so get it checked. Your pharmacist will do it for you free of charge. Blood cholesterol? No symptoms. So how do you know your levels? You get a blood test. Blood cholesterol causes heart attacks and strokes; it’s the biggest killer in our communities. And blood sugar. Most people with a raised blood sugar have no symptoms. High blood sugar is the diabetes, the heart attacks, the strokes, the blindness, the gangrene—everything. I would say from the age of 50, get your blood pressure, your blood cholesterol and your blood sugar checked once a year around your birthday. Q. Finally, what three key pieces of advice would you give to our readers seeking to make small changes to live a healthier, happier life? CS: To live a healthier, longer, happier life. The tips to have a healthier, longer life are, first of all: walk. Walk every day. A 10-minute walk out every day, so you have to walk 10 minutes back. The

Research suggests that half of adults don’t go for a 10-minute brisk walk once a month.

second thing is to do with diet. Fruit, veg, fish, poultry, oily fish—especially salmon, tuna, herring, mackerel—less red meats and less processed meats. The third thing would be to read the labels for salt and sugar. People don’t know that sodium chloride is salt; they’re looking for ‘salt’ and thinking, ‘this is okay’. Go to the supermarket and look at the labels; which has got the least amount of salt and sodium chloride in it? Don’t add salt that often to your food. And with sugar, read the labels! Go for a lower sugar content or no sugar content. Those two steps are vital to your future health. It’s the quality of the years, not the number of years that is important. It’s your decision. •

With obesity, you have an increased risk of high blood pressure, stroke, heart attack and various cancers— breast cancer and colon cancer are all linked to obesity DEAR DOCTOR WITH DR CHRIS STEELE 13

27/09/2017 08:39


Looking after Your


Hear t disease is the UK’s biggest killer. According to NHS Choices, an average of 200 people—that’s one every seven minutes—die of the condition each day

Quit for good

Not only is smoking linked to all sorts of cancers, it can also have an extremely negative impact on your heart—quitting is the best thing you can do for your overall health. According to NHS Choices, a year after giving up smoking, your risk of a heart attack falls to less than half of that of a regular smoker. 14 dear doctor with DR Chris Steele

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Get moving

Physical inactivity is damaging—both to our heart and our mind. Aim to do around 150 minutes of moderateintensity exercise a week. This could be a 30-minute brisk walk, cycle or run five days a week.

Eat the rainbow

You should eat five—or more—portions of different fruits and vegetables every day. These are an excellent source of essential vitamins and nutrients vital to a balanced diet. Add fresh fruit to your morning yoghurt and include chopped veggies to your pastas and curries for a quick fix.

Banish saturated fats

Choose leaner cuts of meat, like chicken and turkey, to reduce the amount of saturated fat you consume.

Heart attack warning signs Severe chest pain—as well as pain in other parts of the body— is one of the biggest signs of an ensuing heart attack; sufferers will feel pressure and tightness in their chest. Other major symptoms include dizziness, sweating, shortness of breath, feelings of anxiety, nausea and coughing or wheezing. If you suspect the symptoms of a heart attack, call 999 immediately

Stay away from processed meats and opt for lower fat dairy products when possible.

More fibre

Eating more fibre dramatically reduces an individual’s risk of heart disease—you should aim for around 30 grams a day. Wholemeal bread, oats, bran, wholegrain cereal, fruit and potatoes (with their skin on) are all great sources of fibre.

Don’t add salt

In order to avoid high blood pressure, add less salt to your cooking and refrain from using it at the table. Adults should consume less than six grams of salt a day; check food labels, especially when buying ready-made meals.

IMAGES © Shutterstock


oronary heart disease (CHD) occurs when blood supply to your heart is reduced because of narrowed or blocked arteries. The condition is largely caused by an accumulation of factors: smoking, hypertension, high cholesterol, diabetes and a lack of exercise are the main culprits. While some risk factors are tied to lifestyle choices, there are some we simply can’t control; these are a family history of heart disease, our ethnic background, age and gender. As we get older we are more prone to suffering from CHD, but an individual’s risk is also heightened if they are a male, a member of a family with a history of heart disease or from a south Asian or AfricanCaribbean background. Having said that, from quitting smoking to physical exercise, there are various things we can all do to safeguard our health—read on for our handy guide to a happy heart.

27/09/2017 08:41



Eat fish at least two times a week. This should include oily fish such as anchovies, mackerel or salmon. Fish is a great source of omega 3 fats, which are known to protect against heart disease.


Try keep to the NHS-recommended daily alcohol limits. Men and women are advised to drink no more than 14 units of alcohol a week; it’s also recommended to spread the drinking over a few days. This will reduce the risk of CVD as well as obesity.

Did you know?


If you have had a heart attack, the recovery period can take several months. During this time, you’ll receive help and support from nurses, physiotherapists, dietitians, pharmacists and exercise specialists to help you get your health back on track. This process—called cardiac rehabilitation—will start in hospital.

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In addition to restoring your physical fitness, the process will also aim to reduce your risk of another heart attack. Take small steps when returning to work and doing everyday activities such as driving. Seek help from a mental health specialist if you feel like you may be depressed—heart attacks can be extremely traumatic. •

If someone has had a heart attack, it’s important they rest while waiting for an ambulance so as not to put any additional strain on the heart. If aspirin is available—and the sufferer isn’t allergic to it—the medication could help restore the heart’s blood supply


27/09/2017 09:55




Dupuytren’s disease is a serious condition that affects around two million people in the UK—Dear Doctor investigates


It is unknown why this disease develops in certain individuals, although there are some factors that make it more likely to appear. Genetics is one of the most outstanding factors—between four and seven out of every 10 people with the condition report a family history of it. Other possible causes can include diabetes, specific treatments for epilepsy, heavy drinking and smoking. 16 DEAR DOCTOR WITH DR CHRIS STEELE

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In more severe cases of Dupuytren’s disease, your doctor may decide that surgery is necessary to repair the hand structure. The two main types of surgery for the condition are

open fasciotomy and a fasciectomy. Corrective surgery can involve a number of risks and may not be suitable for frail patients. This type of procedure will therefore only be suggested if absolutely necessary. •

Surgical and non-surgical treatment options The most common treatment for Dupuytren’s contracture is a surgical procedure called ‘limited fasciectomy’ in which the affected tissue (the cord causing the contracture) is removed usually under general anaesthetic. Mild-to-moderate cases of Dupuytren’s can be treated with less invasive kinds of surgery, or sometimes with no surgery at all. In the early stage of the disease (before the cord has started to contract) there has been some experimentation with radiotherapy. A surgical procedure called ‘needle

fasciotomy’ can be used and consists in the surgeon using a blade or a hypodermic needle to cut through the cord without first opening the hand. In the last five years, a nonsurgical enzyme treatment has been developed. The surgeon injects it into the cord where the enzyme dissolves the Dupuytren’s tissues. A few days later, the surgeon gently stretches the cord until it breaks.

IMAGES © Shutterstock


upuytren’s contracture, also known as Dupuytren’s disease or Vikings disease, is a condition that causes one or more fingers to pull inward toward the palm, making it difficult for them to be fully straightened. The disease is named after the French surgeon, Baron Guillaume Dupuytren, who first researched it in 1834. The disease usually occurs in men over 50 and in women over 60, although cases of the condition have also been reported in children. Dupuytren’s contracture is caused by a thickening of the tissues under the skin of the palm which form nodules (small, hard lumps). The lumps can measure between 0.5 to one centimetre in diameter. The nodules are benign (non-cancerous) but can multiply and extend into ‘cords’, which will eventually pull down on the fingers. The condition may be mild and painless at first but can progressively worsen over time. While this condition may not be lifethreatening, it can be a burden and—in some cases—fairly disabling.

For more information on all treatment options, visit

25/09/2017 15:54

LEARN THE STORY ABOUT THE ”VIKING DISEASE” AND HOW IT’S TREATED If one or more of your fingers bend towards the palm of your hand and you can’t straighten them, you may have Dupuytren’s contracture. To find out more about Dupuytren’s disease and all the available treatments, speak to your doctor or visit

NP-2838 Date of preparation: September 2017

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20/09/2017 15:30

Are you looking for a longer lasting solution for Dry Eye Syndrome? Ask your optician about E-Eye, the revolutionary Intense Regulated Pulsed Light® therapy Rejuvenate your tear-lipid film to help restore clear and comfortable eyes The revolutionary new E-Eye offers a non-invasive, painless and safe therapy to help patients achieve longer term relief from their Dry Eye symptoms. Using patented Intense Regulated Pulsed Light® technology, the device safely stimulates the parasympathetic nerve which encourages the Meibomian glands to restore their normal function.


You will be comfortably seated in a treatment chair and an eye mask will be placed over your eyes


A special gel will be applied to the skin underneath your eye (on the cheek bone and temporal area)


Your eye care professional will administer a series of flashes to the area with the E-Eye


The process will be repeated for the other eye before the gel is removed

• Meibomian glands Treatment areas

Treatment takes just a few minutes and can be completed in three sessions over 45 days Clinical studies show 86% satisfaction rate after three sessions* In some cases, results can last up to three years

Painless, non-invasive and affordable

• Parasympathetic nerve

The Meibomian glands are sebaceous glands located at the rim of the eyelids. They supply the oily substance that prevents your eye’s tear film from evaporating.

Although three treatments are recommended over a period of six weeks, many patients start to notice a difference in their eye comfort within a few hours to days following the first treatment.

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Recommend the treatment

Don’t use eye drops anymore

82.6% Have symptom improvements

*Jennifer P. Craig, Yen-Heng Chen & Philip R. K. Turnbull, Ocular Surface Laboratory, Department of Ophthalmology, New Zealand National Eye Centre (2015) Prospective trial of Intense Pulsed Light for the treatment of Meibomian Gland Dysfunction

30/08/2017 09:02


Dry Eyes

Dry eye syndrome can affect anybody. It could be temporary or chronic— Dear Doctor takes a closer look


ur eyes are kept moist by tears. When your tear ducts aren’t producing enough liquid—or if your tears are evaporating too quickly—you may get the feeling of dry eyes. It can be annoying, painful and potentially itchy. For some, dry eye syndrome can be solved in a relatively short amount of time; for others, however, it may present permanent problems that will require additional medical attention.


Your eyes could be dry because of a number of environmental issues, such as dry air, wind or dust. Alternatively, dry eyes could be due to a physical issue caused by your body’s inability to produce enough tears. This could be the result of: • The ageing process, especially menopause. • Side effects of antihistamines. • Diseases such as rheumatoid arthritis. • A problem with blinking or the eyelid not closing as it should.

IMAGES © Shutterstock


The first step to treating dry eyes is to determine what is causing the problem. Is this an occasional complaint or a regular occurrence? Eye drops that mimic tears should provide you with temporary relief, but establishing whether the problem is caused by external factors or a physical disorder will help you in the long-term. If the problem is external it may be a case of stopping smoking, or getting an air humidifier to make sure the air in your house is moist enough. The heater you use may be drying out the air—stop using it for a while to see if the problem resolves itself. A doctor will be able to tell you if the cause is an issue with your body and will prescribe a solution suitable for you. This could come in the form of eye drops to encourage natural tear production, steroid eye drops or testosterone cream.

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There are also surgical options available. Your doctor may choose to block the punctum—the duct that drains tears from the eyes. They can do this with a temporary dissolvable plug, a more permanent non-dissolvable plug or by cauterising the duct so that it closes up.

Did you know? Tears are made of a mixture of water, oils, mucus and antibodies


You may decide to treat dry eyes yourself at home—you can try the following: A warm compress. Take a soft flannel or eye pad and soak it in hot water. The water itself will need to have been boiled before cooling at room temperature to a level you can handle. Place it over your eyes for 10 minutes, reheating the flannel in the water whenever it gets cold. This will warm the oils in your eyes and cause them to become more lubricated. Eyewear. You may want to consider investing in some protective eyewear. This could be wrap-around glasses to wear

during the day to protect your eyes, or goggles to wear at night that trap moisture. Eye massage. Perform an eye massage whenever your eyes feel overly strained or dry. You can do this by gently massaging your closed eyelids with one finger, or by taking a cotton bud and rolling it down the eyelid towards the eyelashes to oil out the glands. Diet. Research has found that omega 3 may benefit our eyes. The best way to get this vital compound is by eating oily fish or taking supplements. • DEAR DOCTOR WITH DR CHRIS STEELE 19

25/09/2017 15:55

AB Vision Ltd.indd 1

21/07/2017 11:14



Presbyopia begins to rear its ugly head when we reach our 40s—could laser eye surgery be a viable option for treating this common condition?

IMAGES © Shutterstock


resbyopia is the medical term used to describe age-related farsightedness. The condition is inevitable and typically occurs at around the age of 40. Presbyopia happens when the structure of the crystalline lenses in the eye lose elasticity and become stiff, making it difficult for the muscles to change focus from distant to near vision. Symptoms of presbyopia include eye strain, headaches and blurred vision when trying to focus on objects nearby. People with presbyopia can correct their vision with reading glasses. Those who would like a more permanent solution, however, may opt for laser eye surgery instead. Laser eye surgery works by using an excimer laser to reshape the cornea and correct visual impairment. The most common type of corrective laser surgery for presbyopia is monovision laser in situ keratomileusis (LASIK) laser surgery. With monovision LASIK, your surgeon will correct the vision in one eye for clearer distance vision while leaving the other eye slightly near-sighted. The outcome of monovision LASIK surgery is that patients will be able to focus more easily on near and far objects simultaneously. While monovision LASIK is an effective treatment for presbyopia, patients opting for this course of action may not experience perfect distance vision. The results of monovision laser surgery can also be replicated by wearing custom contact lenses. Speak with your ophthalmologist to decide which solution is best for your needs. •

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RISKS OF LASER EYE SURGERY Elective laser eye surgery is largely considered to be a safe routine procedure with a high success rate. While complications occur in less than five percent of cases, there are some risks to be aware of: Vision may be over or under-corrected. The laser treatment may remove too much or too little tissue in the eye which can impede optimal results. Development of chronic dry and red eyes. LASIK surgery may cause temporary dryness as it decreases lubrication in the tear duct. Your surgeon may suggest that you use eye drops during this time. Infection. Infection and inflammation are possible side effects—albeit rare— of monovision LASIK. It is therefore important to use medical eye drops as directed by your surgeon while your eyes heal. Sight disturbance. Patients may experience discomfort, sensitivity to light, glares in low-light environments and blurred vision soon after surgery. These side effects are common and should resolve within three to six months.


25/09/2017 15:57


Bad breath is an embarrassing problem that can happen to anyone, and it can be difficult to treat. The Breath Co. Fresh Breath Oral Rinse is GUARANTEED to prevent bad breath 100% of the time or your money back.

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21/09/2017 09:18


Oral Health Alarm Bells

Oral hygiene is essential for a happy, pain-free life

IMAGES © Shutterstock


ain in your mouth and gums can disrupt your life. Complicated treatments can be avoided if dental issues are detected early. Learn the symptoms to watch out for so you know when to visit your dentist, meaning less stress for you and a smaller impact on your life. There are a number of symptoms that may not seem significant at first but could be indicators of a more serious underlying problem. For example, bleeding gums is an issue dentists will tell you not to ignore; yet research has shown that nearly half of the population would ignore blood in their spit due to the fact that it doesn’t hurt. Bleeding gums could be an early sign of gum disease—talk to your dentist about how to deal with the problem before it gets worse. If you have a spot or sore in your mouth that doesn’t heal, you may want to do more than just treat it with soothing gel. An unusual lump or painful patch in your mouth that refuses to heal could be a sign of diabetes or, possibly, mouth cancer. While some people have more sensitive teeth than others, a sudden

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change in sensitivity could be an indicator of infection. A dental abscess—a bacterial infection that is close to the tooth’s root—can cause sudden sensitivity to temperature. Accompanied by pain and swelling around the jaw and neck, dental abscesses can be very serious and need prompt medical attention. If your sensitivity occurs more gradually, it could be due to eating too much acidic food or brushing your teeth too vigorously. Untreated dental abscesses can lead to root canal therapy which involves cleaning the root of infected pulp and replacing it with inert material. Bad breath can be caused by more than just a fondness for garlic. Bacteria in your mouth break down food and release gases that make your breath smell. This bacteria can also cause tooth decay and gum disease. If you want to keep your teeth for as long as possible, visit your dentist if you notice any loose teeth. Not only could this be a symptom of gum disease, a loose tooth can also exacerbate the problem by allowing food and germs to get stuck underneath the gum, leaving bacteria to fester. •

Top tips for healthy teeth Use the right toothpaste for you. If you have sensitive teeth, use toothpaste specifically made for that problem. Don’t forget to floss. The use of floss and mouthwash will remove all the nasty bacteria in your mouth. Don’t rinse out your toothpaste. Fluoride protects your teeth throughout the day so it is important not to wash it away after brushing. Use disclosing tablets. These handy tablets show where plaque sits on your teeth, helping you discover where you aren’t brushing properly. Use the right toothbrush. Choose a toothbrush that is small with rounded bristles to make sure you aren’t causing harm by over-brushing. Visit your dentist at least once a year. The recommended amount of time between dentist appointments is between 3 months and 2 years. Don’t leave it too late to discuss your problems and concerns.


25/09/2017 16:52



More info

Chris Deprez


+32 472 303 321 ECFS bvba.indd 1

13/09/2017 11:50


Is Bariatric Surgery Right for You?

Around 27 percent of adults in the UK are clinically obese. If diet and exercise have failed, weight loss surger y may be a viable option—Dear Doctor outlines the myths, facts and science behind bariatric surger y

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26/09/2017 09:53


ariatric surgery—also known as weight loss surgery—is an umbrella term for a variety of procedures that are performed to help people with obesity lose weight. While bariatric surgery may seem like a quick fix, most doctors will only suggest it as a last resort. During your initial consultation, your medical practitioner may wish to get a better understanding of what weight loss methods you have already tried. They may even suggest a new nutritional plan and exercise regime for you before suggesting the procedure. Bariatric surgery is sometimes an option for those who have been diagnosed with—or are at risk of developing—Type 2 diabetes or high blood pressure. The most common types of this procedure are: • Gastric band • Gastric bypass


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• Sleeve gastrectomy • Intra-gastric balloon There are a number of risks to consider when opting for surgery; many of the routes are invasive and can therefore incur complications. If you do decide that surgery is the only way forward, you will be referred to a specialist clinic to check your eligibility. You will undergo a number of tests to monitor your physical and mental health along with your dietary patterns. This may include blood tests and X-rays to determine whether it’s safe to proceed. While each procedure can lead to significant weight loss, each does have its own advantages and disadvantages.


A gastric band procedure consists of inserting an adjustable ring around the stomach which creates a small

pouch towards the top of the organ. This procedure allows the patient to feel full far quicker than they would normally as the stomach isn’t physically able to hold as much food. The band is connected to a small device, usually placed beneath the chest. Four to six weeks after the surgery, the band will be tightened for the first time by injecting the device with a salt-water solution. In

IMAGES © Shutterstock


26/09/2017 09:53


rare cases the band can move out of place or dislodge, requiring revision surgery. This type of operation is also said to be less effective than others in aiding with diabetes. While the gastric band controls portion size, it is up to the patient to follow a healthy and balanced diet.

Gastric bypass

This option involves the stomach being surgically stapled to form a small pouch at the top. The upper portion of the stomach is then connected to the small intestine, avoiding the rest of the stomach (effectively bypassing it). Less food will be needed to make you feel full and fewer calories will be absorbed from the food you eat. While results are proven to be very successful with this treatment, patients will usually need regular check-ups. After bypass surgery, you will also be

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required to take vitamin and mineral supplements—this is to prevent the onset of anaemia or malnourishment.

Sleeve gastrectomy

A sleeve gastrectomy is usually performed with a laparoscopy (a keyhole procedure). This involves cutting along the length of the stomach and removing a large portion of it. What is left is a far smaller stomach that allows less food to be consumed by the patient. This option allows food to enter and leave the stomach in the same way it did prior to surgery—unlike the gastric bypass. As the small intestines are not disconnected or altered in any way there is no need for supplements to be taken after treatment. However, some find this approach a little more daunting because it is irreversible—unlike the gastric band.

Intra-gastric balloon

The intra-gastric balloon is fitted by feeding a small, thin tube down the throat or by swallowing a pill with the tube attached to it. Once in the stomach, the balloon will be inflated with air or a saline solution. The balloon creates a smaller area for food to fit into the stomach. This is one of the newest options and is also only temporary—the balloon is removed after six months. By that time, the appetite of the patient will have reduced. This procedure should complement a healthy diet and exercise routine rather than replace it; a large amount of effort will need to be put in by the patient after the balloon is removed. This alternative method is particularly attractive to those who are concerned about invasive surgery—there is no cutting or stapling involved in the process at all. •

dear doctor with dr Chris Steele 27

26/09/2017 10:49

Affordable Weight Loss When all else has failed, bariatric surgery may be the best option for you. With low prices, quick appointments and a high success rate, Laser Clinic France puts you and your health first.


We arrange everything for your bariatric surgery, so you don’t have to. Our limousine service will take you straight to your hotel when you arrive in Paris. With 24/7 personal assistance, we look after you from the moment you arrive to the moment you leave us.


Your bariatric surgery will be undertaken at the hospital Jacques Monod, the largest NHS equivalent hospital in France, and English-speaking surgeon will take care of you. Modern and fully equipped with the latest technology, our hospital has over 2,000 private rooms with en-suite bathrooms. Moreover, if you bring anyone for support, they will be able to stay with you.


After your surgery, you will spend the remainder of your stay in a 4-star hotel. One of our surgeons will visit you to make sure they are satisfied with your progress. You will be given all necessary medication and a recommended diet and fitness plan.


Compare prices with UK prices and save up to 40%. Call now for the best prices and more information with no obligation.

DR. B. BOKOBZA YOUR INTERNATIONAL SENIOR BARIATRIC CONSULTANT AND SURGEON Dr Bokobza is the head of the department of General Surgery in the Hospital Centre of Le-Havre. He is a fully qualified and registered Surgeon and is a member of a number of Medical Associations and Medical Boards Dr Bokobza is a member of the following associations: • French Association of Surgery • French College of Digestive Surgery • French Society of Digestive Surgery • French Society of Gastro-enterology • Belgium group for endoscopic surgery • Society of American Gastroenterology and Endoscopic Surgery Dr Bokobza is also a serving board member of the following boards: • Board of the French Association of Laparoscopic Surgery • French Society of obesity surgery • French Society of digestive surgery • French Society of Surgery • Scientific board of the congress of laparoscopic surgery in Deauville • Congress of the SFCL in Paris Dr Bokobza is certified in liver transplantation, cancerology, digestive surgery and vascular surgery. He has also created a basic course in laparoscopic surgery for vascular surgeons in association with the French Society of Vascular Surgery, he has published 65 articles and has had 140 communications in congresses archives. He has operated in Belgium, Greece, Lebanon, Morocco, Antillas, France, Saudi Arabia, UAE and Kuwait as a teacher and surgeon.

LASER CLINIC FRANCE LTD Contact Tullia Law: 0033 68 65 67 031 French Laser Clinic - Rev5.indd 1

25/09/2017 11:57

Surgery in France

Advertisement Feature

TESTIMONIALS Helene B’s story

Rosemary’s story

‘I am so glad I let Tullia take control and ensure I would get the gastric bypass I needed.

‘For me, Christmas Day 2012 was the day my life changed. Feeling at my lowest ebb, Tullia at French Laser Clinic gave me hope. My life was on a downward spiral and I felt I had nothing to live for. I was very, very overweight.

My weight was a battle which I lost many years ago after many failed diets. When I saw myself in my dreams, I was never heavy. When I woke up and saw myself in a mirror I could not recognize who I had become. I would not allow pictures to be taken of me, and ultimately, I felt sad that there were very few pictures of me and my son. Thinking of the future, I felt that my son and I would perhaps miss having pictures of us together. But worst, I realised that my future was going to become more and more limited if I didn’t make some lifestyle changes. Not only that, I can now go on the roller coasters with my son, (I was not able to close the belt on some and felt too self conscious to go on anyway) There is no limit to the activities I can do, alone or with my child whereas before, just sitting on the floor was a nightmare at the thought of how I’d get up, forget doing it in public !I can now eat what I like (within reason), best (or worst) I even fancy fruits and vegetables! With my thanks to Tullia Law and her Team of Surgeons, Nursing staff, and everyone from the Laser Clinic (France) team.

Sheila L’s story ‘Thanks to Laser Clinic looking after me so well during this year, I have now lost a total of 35 kilos after having gastric sleeve surgery. The support they give before, during, and after the surgery is exceptional. I have been able to message Tullia anytime and she has always replied quickly, either by message or phone call. I had the opportunity to talk to the BBC in November 2015 to give a testimonial as to why I decided on a gastric sleeve and how I am now. This was a fantastic opportunity to let people know just how much I have enjoyed the last year and I wouldn’t hesitate to recommend Laser Clinic to anyone. I can now do a lot more activities with my family and I also have the confidence to go out in public. I am still getting used to buying smaller size clothes, but it is a good feeling. Not only has my shape and weight changed but also my outlook on life, which should now be a lot longer thanks to having the Gastric Sleeve. Thanks for all of your help, Tullia.’

I had read every diet book and tried every diet and nothing worked; not for long anyway. Could I trust a lady whom I’d never met, with a considerable amount of my money? Would I be able to cope in a hospital where I could not speak the language? What if it all went wrong? The wheels were soon in motion once I had made my decision and had told Tullia that I wanted to come to France to have a sleeve gastrectomy. Looking back now, making that decision was the hardest part of the whole process but is one that I shall never regret. I was a classic candidate for developing diabetes; I had breathing difficulties and my mobility was poor. I needed help in order to manage my daily life and I was registered disabled. Within weeks of having gastric sleeve surgery I felt like a different person! The weight dropped off me, I was able to take back my independence, I no longer felt so depressed and I could walk more comfortably without feeling pain and becoming breathless. I managed to lose seven stone and I was able to start making plans for my future! Tullia tracked my progress, and continued to encourage me. This, together with comments from family and friends, indicating that they could see a change in me, spurred me on. My life has changed in other ways too. I have been to China and managed to walk along a section of the Great Wall, despite the high steps which had to be negotiated! For those who are considering weight loss surgery, you need not be worried about taking such an important step. Tullia is a very kind, caring person who only wants the best outcome for those who put their trust in her. She is there every step of the way to make sure everything goes without a hitch from start to finish.’

Visit our website to read more testimonials

Visit our website: or e-mail: French Laser Clinic - Rev5.indd 2

25/09/2017 11:58



The number of people having stoma surgery is rising every year. Now, thanks to modern technology, there is a reliable way to prevent accidents caused by overfilling of the stoma pouch.

we measure it... you manage it The ostom-i™ Alert Sensor from 11 Health is a discreet, connected medical device, alerting ostomates in real time when their pouch needs emptying.

For more information visit: 11 Health & Technologies.Rev2.indd 1

02/08/2017 09:19


Coping with

Crohn’s Disease Crohn’s disease can take a physical and emotional toll on sufferers. Here is ever ything you need to know—from diagnosis to effective treatments


rohn’s disease is one of the two main inflammatory bowel diseases (IBD), with the other being ulcerative colitis. It is a long-term condition that is caused by an inflammation in the gut and digestive system. The most commonly affected areas are the colon and the ileum (the lower portion of the small intestine). Unexpected parts of the digestive system—such as the mouth— can also be affected. Crohn’s is a chronic disease, meaning that once diagnosed it is a lifelong affliction. While this sounds disheartening, patients often do experience long periods of remission during which their symptoms subside or disappear altogether. Many sufferers will find that they are subject to a cycle of ‘flare-ups’—or relapses—and phases of remission. This can make the condition unpredictable and harder to treat at times. Crohn’s disease usually first appears between the ages of 16 and 30, though it can plague people of any age. According to the NHS, there are approximately 115,000 cases of Crohn’s disease in the UK, but this figure is slowly rising.


It is important to identify the medical indications of Crohn’s disease early in order to seek adequate treatment. These indicators can range from mild to severe and can include: • Diarrhoea • Abdominal pain • Fatigue

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• Unintended weight loss • Blood and mucus appearing in stool • Fever • Anaemia (reduced levels of red blood cells)


Despite detailed research on the condition, there is no widely accepted answer as to how and why Crohn’s disease occurs in some people and not others. That being said, researchers have identified 200 different gene pools that are common in those with the complaint—this suggests that it may be inherited through DNA. According to the NHS, if a patient is an identical twin with Crohn’s disease, their counterpart will have a 70 percent chance of having the condition as well. There are various hypotheses as to why certain individuals are developing Crohn’s disease; one of them focuses on environmental factors. As the health

Get Support While suffering from Crohn’s can be challenging, support is available for those who are struggling. Besides the physical effects there are also a number of psychological ones to deal with. A number of forums are now available for people to share their experiences and encouragement—visit crohns-colitis-forum

dear doctor with dr Chris Steele 31

25/09/2017 16:03

Helping you

to enjoy

more Coming soon

Be the first to access our online care programme Coloplast Care helping you to enjoy a better life with a stoma What is Coloplast Care?


Helpful hints and tips from fellow ostomates and healthcare professionals, to inspire you to do more


The Ostomy check - a way of checking for common issues associated with your stoma and the surrounding skin, with personalised support and solutions

Registration is free and takes a couple of minutes visit

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16/08/2017 11:39


complaint has been found to be far more prevalent in western countries such as the UK—and less so in others like Africa—it can be assumed that there is a link between modern western lifestyles and the contraction of Crohn’s. While specific diets may not be the cause of the condition, changes can be made to alleviate discomfort and keep it under control. Likewise, a weak immune system is also said to play a role in the development of Crohn’s disease. Past illness is another high-risk factor that can lead to Crohn’s. In susceptible individuals, a previous childhood infection may have weakened the body’s immune system, therefore leading to Crohn’s disease in later life. One of the most prevalent risk factors is smoking; smokers are twice as likely to develop the disease compared to nonsmokers. Additionally, those with the condition say that smoking exacerbates their symptoms greatly, causing increased discomfort.


Once your doctor has diagnosed your condition, it is important to work together to find a treatment that is appropriate for you. There is no ‘cure’ for Crohn’s disease, however, there are various ways of managing it so you can go about your daily life unhindered.


The first course of action offered to patients is steroidal medication or corticosteroids. These are designed to reduce inflammation and keep symptoms of the disease at bay. Steroid medication either comes in tablet form or as a course of injections. While they can be successful they can also come with unwanted side effects such as increased vulnerability to infections, weight gain, swelling of the face and weakening of the bones.


IMAGES © Shutterstock

If symptoms reappear or flare up more than twice during a year, alternative methods may be necessary to tackle the condition. In this case, medication that suppresses the immune system may be mixed with prescription medicine— azathioprine and mercaptopurine are the

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25/09/2017 16:04


most commonly used types. This route also comes with possible side effects that may need to be monitored such as nausea, vomiting, liver problems, anaemia and pancreatitis.


If a patient suffers from very severe symptoms or is in generally poor health, there are other possibilities for treatment. Biological therapy is one such prospect, and it involves suppressing the immune system with naturally occurring biological substances such as enzymes or antibodies. This can be administered via a drip or injections delivered in hospital or at home. Some patients have reported allergic reactions during this therapy; therefore any suspicious signals of this should be reported immediately.


Your healthcare team will analyse your unique situation. If they believe the benefits of surgery outweigh the risks then they will put you forward for it. This is usually a last resort decision made if all other therapies have failed. The two main surgical procedures are resection and ileostomy. A resection involves the removal of the inflamed portion of the intestine and re-joining the healthy sections. An ileostomy is similar, but this procedure—on the other hand—diverts digestive waste away from the inflamed area, giving it a chance to heal properly. The end of the small intestine is rerouted to a hole made in the abdomen rather than being re-attached. Waste products are then diverted into what is known as a stoma bag, which is attached to the opening of the abdomen. The stoma bag will need to be emptied regularly, which may mean altering your daily routine. Some patients suffer from skin irritation around the entrance of the stoma bag; ensure to keep the area thoroughly clean and free from external dirt and oils. Your doctor should be able to advise you on the best ways of adapting to life with a stoma bag whilst caring for it properly. After the surgeon is happy that the colon has sufficiently recovered, a second operation will reconnect the intestine to the colon and remove the need for the stoma bag. • 34 DEAR DOCTOR WITH DR CHRIS STEELE

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New innovations in stoma care Stephanie Woodward has worked as a bowel disease nurse specialist for over 20 years and is now a chief nurse at 11 Health and Technologies Ltd. There have been no innovative products for stoma care since Stephanie began nursing—until now. 11 Health and Technologies have a patented device which uses Bluetooth™ wireless technology to send secure, real-time data to most mobile devices including smartphones, tablets and watches. This device will help prevent leakage from your stoma bag by sending an alert to your phone, tablet or watch.

Data may also be sent to your healthcare professional. Alfred, the device, fits easily onto your stoma bag. The app allows you and your healthcare professional to monitor your hydration and output, which may lead to prevention of further complications such as dehydration and kidney problems. Stephanie and her team at 11 Health and Technologies Ltd are very excited to be a part of the development of this innovative device, bringing stoma care into the 21st century. For more information, visit

25/09/2017 16:04

Crohn’s Disease and Iron Deficiency Anaemia Do you suffer from Crohn’s disease and often experience some of the following symptoms? • Tiredness • Lack of energy • Shortness of breath • Heart palpitations • Paleness of the skin If so, you may also have iron deficiency anaemia— contact your doctor who can perform a blood test and guide you on effective treatments. Iron deficiency anaemia (IDA) is a very common condition that affects many people across the globe. It is a disorder that frequently appears in inflammatory bowel disease (IBD) patients—especially individuals with Crohn’s disease.

WHY DOES IT AFFECT THOSE WITH CROHN’S? Date of prep: Aug 2017 | Job bag: NP-STX-UK-0009

In the developed world, the leading cause of iron deficiency is blood loss; menstruation and

Shield Therapeutics.Rev1.indd 1

gastrointestinal diseases are the main triggers for this. Crohn’s disease often involves blood loss in the stomach or intestine, which cannot always be matched by the body’s natural iron absorption processes. This can lead to a negative iron balance, affecting a large proportion of patients with Crohn’s disease.


Treatment for IDA in Crohn’s disease patients concentrates on replenishing iron levels without causing a worsening of Crohn’s disease symptoms. If you are concerned about iron deficiency anaemia, talk to a specialist in detail to get the professional help you need.

If you are dealing with Crohn’s disease there are various organisations you can consult for advice and support—visit for more details.

This awareness campaign is sponsored by Shield Therapeutics (UK) Ltd

27/09/2017 11:14

Laugh in the face of sneezing, cough without crossed legs Restore your pelvic floor, restore your confidence. INNOVO®’s clinically proven technology treats the cause of bladder weakness by strengthening your all-important pelvic floor muscle. Get back to doing everything you want to do with INNOVO®. Using a hand-held controller attached to a two-part garment (which you wear like a pair of shorts), INNOVO® sends targeted impulses through a set of conductive pads to safely and effectively strengthen the muscles in your pelvic floor. You can use INNOVO® in the comfort of your own home. Whether you want to sit, stand or lie down, each 30-minute session delivers 180 perfect contractions, working your pelvic floor muscle safely, comfortably, effectively.

Clinical studies show that: 93% of users had a significant reduction in leaks after just 4 weeks* 86% of users were defined as completely dry after 12 weeks* 90% of users would recommend the therapy to others**

Restore your confidence. Find out more at or call us on 0800 028 5687 (it’s free). Click & Collect from

*Soeder S, Tunn R. (2012) - Neuromuscular Electrical Stimulation (NMES) of the Pelvic Floor Muscles using a Non-Invasive Surface Device in the Treatment of Stress Urinary Incontinence (SUI); A Pilot Study. IUGA Poster Presentation Conference, Dublin, Ireland (2013) **Observational study on the treatment of stress urinary incontinence with Innovotherapy, April 2014

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25/08/2017 09:27


Living with


IMAGES Š Shutterstock

Dear Doctor breaks the taboo and shines some light on the experience of living with incontinence


ncontinence is a common condition that involves the involuntary passing of urine or stool. While this is a medical problem that predominantly occurs in older patients, it can also affect younger individuals. Despite being a common medical ailment, there still seems to be stigma and a large amount of embarrassment surrounding the topic. We aim to

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break the taboo by outlining the details of this condition along with effective treatments and possible preventative measures.

Urinary incontinence Urinary incontinence may include a small leak, an ongoing trickle after passing urine or even a total loss of bladder control. There are official terms for these subcategories:

Stress incontinence is the term used for certain instances (most commonly experienced by women) when small amounts of urine leak out while the bladder is under pressure. This may occur when laughing, sneezing or coughing. Urge incontinence involves a sudden urge to pass urine that proceeds or comes after a urine leakage. dear doctor with dr Chris Steele 37

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Overflow incontinence, also known as chronic urinary retention, is when a person finds it difficult to properly empty their bladder. This then leads to frequent leaking. Total incontinence is the most severe type of urinary incontinence. It means that the bladder is unable to store any urine at all. This causes the sufferer to pass urine constantly or experience very frequent leaking.

WHY IT HAPPENS Why you’re suffering from incontinence will depend on the specific type you suffer from. It is important to remember that incontinence is a symptom and not a disease itself; it’s therefore usually the result or a sign of something bigger— like an underlying condition. Some of the most common causes of urinary incontinence include consuming too much caffeine, smoking, weight issues, sudden changes in hormonal balance (most often due to pregnancy or menopause), childbirth, enlarged prostate and obstructions such as a tumor blocking the urinary tract. If you suffer from urinary incontinence, visit your doctor for a more thorough analysis of your condition.

these, after long periods of time, can weaken the anal muscles and cause issues with bowel movements. If you suffer from bowel incontinence, visit your doctor for a detailed evaluation of your physical state.

LIVING WITH INCONTINENCE Incontinence isn’t something to be ashamed of—there are coping methods and treatments available. It is also important to remind yourself that most types of incontinence won’t disappear on their own; ignoring the problem can lead to the condition worsening. In order to manage and treat both urinary and bowel incontinence, your doctor may begin by suggesting a change in diet and

lifestyle. Keeping fit and maintaining a healthy weight is beneficial for both strains of incontinence. You may need to review your diet and ensure that the food you consume allows you to avoid experiences of constipation and diarrhoea. Likewise, you may be told to cut down on alcohol and caffeinated beverages that trigger the production of extra urine from the kidneys. As a preventative measure, medical physicians recommend women practice pelvic floor exercises to strengthen their muscles and urine control. This is sometimes necessary after giving birth. If your incontinence begins to worsen—or if your symptoms become unmanageable—you may be recommended various forms of medication or even surgery. •

BOWEL INCONTINENCE Bowel incontinence—sometimes referred to as faecal incontinence— can range from minor soiling when passing wind to complete lack of bowel control. The experience has been known to vary depending on the person. This form of incontinence is far less common than urinary incontinence.

WHY IT HAPPENS In most cases, bowel incontinence is a result of another underlying medical condition. Long-term diseases that can cause it include diabetes, multiple sclerosis and dementia. Many of


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22/09/2017 16:05


Cold or Flu?

Can you tell the difference between a bout of flu and the common cold? Dear Doctor offers some insight


hough they can share many symptoms—like sore throat and coughing—the cold and flu are ailments caused by different viruses. In order to treat them correctly, and to avoid complications, one must learn how to tell the two apart first. Generally, the flu can be more serious than a cold; according to NHS Choices, thousands of people die every year from complications after catching the flu. Individuals over 65 and people with chronic conditions, kidney disease, lowered immunity or history of stroke are all at higher risk of complications arising from the cold or flu—everyone in these at-risk groups is eligible for a free flu vaccination on the NHS.


Developing gradually over one or two days, the cold is much more contagious during its early stages. Initial symptoms will include a runny nose and a sore throat—these may get worse over time. Patients should start feeling better after a few days, though more severe cases can see colds lasting for around two weeks.


REMEMBER Contact your doctor if you have symptoms of cold or flu and also suffer from a chronic condition such as asthma, diabetes or heart disease


Both cold and flu can be spread through infected bodily fluids. You may also catch these viruses if you touch an infected surface and then touch your eyes and nose. Protect yourself—and others—against these ailments by always coughing into a tissue, throwing used tissues away, washing your hands often with soap and having a flu jab every year. •

Common symptoms Colds tend to cause more nasal problems while symptoms such as fever, muscle aches and fatigue are more severe with flu. Some of the most common signs of these ailments are: Blocked or runny nose Pressure in your ears and face Loss of taste and smell High temperature or fever Muscle aches and pains Feeling exhausted Sore throat Headache Cough Sneezing

Flu, on the other hand, develops much faster than a cold. This is because you may be infected but not show any symptoms for as many as three days—at this stage, symptoms can hit suddenly and severely. Common symptoms include chills and fever. Recovery time is usually around a week, though feelings of weakness and lethargy may last for much longer than that. As the flu is caused by a virus—and not bacteria—antibiotics won’t treat it.

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26/09/2017 09:47


Pneumonia: Know the Signs

Detecting the symptoms of pneumonia can mean the difference between life and death—Dear Doctor shines some light on the subject


Pneumonia can usually be diagnosed based on the presence of certain symptoms or through a chest examination. It can be hard to differentiate between a common chest infection and pneumonia. For a more reliable verdict, your medical practitioner may decide to conduct a blood test or take a sputum sample.


The symptoms of this condition are very similar to that of a cold or flu. For this reason, patients can often misjudge their situation, causing the illness to go undiagnosed or ignored. It is possible to cure pneumonia completely; however, if it is allowed to progress it can become life-threatening. The most common marker of pneumonia is excessive coughing. 42 DEAR DOCTOR WITH DR CHRIS STEELE

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Patients are also known to experience fever, loss of appetite and feelings of weakness. Other signs to look out for include chest pains, quickened breathing, sweating or shivering and coughing up mucus.


This condition can affect people of any age, although the following may be at higher risk of contraction: • People with diabetes • Over 65s • People with long-term lung, kidney or heart disease • Babies and young children • People who drink or smoke excessively • People diagnosed with HIV • People with a weakened immune system


For milder cases, sufferers may be prescribed a course of antibiotics to take at home over a few days. Progressive cases of pneumonia may require treatment in the hospital. If the patient is unable to take oral tablets they will

be given an IV drip to receive fluids and medication. Some patients will also have access to oxygen if their breathing becomes too strained. •

Recovery According to the British Lung Foundation, recovery can be a slow process. Here’s what you can expect: One week. Fever should have subsided. Four weeks. Chest pains should be gone and mucus should lessen. Six weeks. Coughing will reduce and it should be easier to breathe. Three months. Only feelings of tiredness should remain. Six months. You should be back to normal.

IMAGES © Shutterstock


neumonia is a type of chest infection. Specifically, it comprises of the small air sacs in the lungs—called alveoli— becoming inflamed and filling with fluid, causing difficulties with breathing.

26/09/2017 12:08


Taking Control of

Fibromyalgia Identifying fibromyalgia can be a difficult process. Once diagnosed, sufferers may be able to manage the disease through self-help techniques and treatments


ibromyalgia is a chronic condition that can involve pain all over the body and heightened pain response to pressure. Other symptoms may include muscle spasms, muscle stiffness, fatigue, severe headaches, tingling and numbness in the extremities, hypersensitivity to noise and temperature and memory difficulties. Some sufferers even show signs of restless leg syndrome (an abnormality in the nervous system causing legs to move uncontrollably) and slowed mental processing (also known as ‘fibro fog’). Fibromyalgia can sometimes lead to other conditions such as depression, anxiety or irritable bowel syndrome.

REMEMBER Suffering from fibromyalgia can feel like a constant battle, but you aren’t alone. Seek out a local support group or join a forum—visit

brain such as serotonin, noradrenaline and dopamine. These aid the regulation of mood, appetite, sleep and behavioural response. Hormonal imbalances in the body’s nervous system could therefore explain why fibromyalgia causes feelings of extreme sensitivity to pain.


Diagnosing fibromyalgia can be difficult because symptoms are notoriously varied; this means it can resemble several other ailments. Associated conditions include osteoarthritis, rheumatoid arthritis and lupus. There is no definitive test to detect fibromyalgia; your doctor may arrange a blood test to eliminate other suspected conditions. Your physician will conduct a comprehensive examination alongside a thorough investigation into family history.


While there is no definitive cure, there are treatments that can alleviate symptoms and drastically improve sufferers’ quality of life. Because of the varied nature of the condition, treatment strategies will be based on your personal symptoms and needs. You may require several specialised

physicians to create a treatment plan for you—a rheumatologist, psychologist and neurologist being the most essential. Your medical team may also suggest some methods of self-help. Exercise is especially recommended for maintaining your overall health and alleviating symptoms; if high-intensity workouts are too strenuous, try brisk walking. Resistance and strength training can also be hugely beneficial, although you will need to follow a personalised plan to avoid injury to your muscles. Your medical specialists may also suggest some relaxation tips, sleeping advice and other coping mechanisms to make the condition more manageable. •

IMAGES © Shutterstock


A great deal of uncertainty surrounds the subject of what causes fibromyalgia, although it is believed to be—in part— due to genetic and environmental factors. Links have also been made between fibromyalgia and abnormally low levels of certain hormones in the

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25/09/2017 16:09


Understanding Meningitis Campaigns for meningitis awareness are growing with emergence in the UK; Dear Doctor takes a closer look SYMPTOMS

Meningitis requires immediate medical attention; if you or your child are suffering with any of the following symptoms, seek medical advice as soon as possible. Rash. The appearance of a rash on the body is a sign of meningococcal septicaemia. The rash looks like clusters of pin pricks and will not disappear under pressure. The rash occurs when the bacteria are released into the bloodstream and release endotoxins (poisons). The body’s natural defences have little effect on the endotoxins; these poisons can damage blood vessels. Septicaemia can cause liver damage and organ failure if left untreated. High temperature. If you or your child have an abnormally high temperature of 38C or above, seek medical advice.


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poisoning). Although rare, bacterial meningitis is aggressive and can spread within hours. This form of the infection can result in loss of limbs, irreversible brain damage and, in some cases, death. There are several serogroups of meningococcal bacteria, the bacterial form of meningitis: A, B, C, W, X, Y and Z. While meningitis can occur in people of all ages, babies, young children and teenagers are most susceptible.

Sensitivity to bright light. Sudden sensitivity to light may be a symptom of meningitis. Seizures. During the initial stages of meningitis, the swelling of the membranes surrounding the spinal cord and the brain may cause seizures. Seizures are typically brief and do not lead to any further medical problems.

IMAGES © Shutterstock


eningitis is an inflammation of the membranes (meninges) that protect the spinal cord and the brain. There are many types of meningitis; viral and bacterial being the two most common. Other types include fungal, parasitic and non-infectious meningitis. While viral meningitis is typically mild and has a high recovery rate, bacterial meningitis can be fatal and lead to septicaemia (blood

Cold hands and feet. A lesser-known symptom of meningitis, cold hands and feet can occur even when the sufferer has a high temperature.

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Diagnosis Your doctor is able to diagnose meningitis based on a series of diagnostic tests. Blood cultures. A blood sample will be taken and placed into a petri dish to observe whether or not it grows bacteria. Imaging. Your doctor may perform tests such as a magnetic resonance scan (MR) which may signify swelling or inflammation. An X-ray or computerised tomography (CT) scan may also be performed to see whether areas such as the chest show infections that may be associated with meningitis.

Aching muscles and joints. Aches and pains in the joints and muscles can become quite a severe symptom of meningitis and may impede mobility. Meningitis can be highly contagious; it can be spread by the swapping of saliva, coughing, sneezing and sharing utensils and cutlery. Meningitis is typically caught from those who carry the virus or bacteria in their nose or throat but who do not actually have meningitis themselves.


Once diagnosed, patients with meningitis—particularly those with bacterial meningitis—will need close monitoring during their treatment and will typically stay in hospital for anywhere between a few days and several weeks. Fluids may be given intravenously to prevent dehydration, antibiotics will be administered directly into a vein and patients may be given a course of steroids in order to reduce inflammation and swelling in the brain.


It could be a while before you or your child begin to feel normal

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after meningitis. While most people experience a remarkable recovery from the infection, it may leave behind some complications in others. Some of these may include: • Hearing loss • Recurrent seizures • Problems with memory and concentration • Vison loss • Loss of limbs • Joint problems such as arthritis • Learning difficulties and behavioural problems


You or your child may have access to additional support and treatment if you suffer from complications as a result of the infection. If meningitis resulted in amputation of limbs, rehabilitation and prosthetic limbs may be available. You may also be offered counselling and psychological support to help you come to terms with the trauma. Meningitis Now—the UK’s largest meningitis charity—offers advice and support for those who have suffered with the infection. You can join their growing community at

Lumbar puncture. Also referred to as a spinal tap, this test collects cerebrospinal fluid from the spine. Your doctor or surgeon will use this sample to determine whether or not you or your child have meningitis. In patients with meningitis, the fluid will exhibit low sugar levels, a high white blood cell count and increased levels of protein. The analysis of cerebrospinal fluid may also be used to determine which bacterium caused the meningitis. Source: Mayo Clinic

MENINGITIS: THE FACTS • 10 percent of bacterial meningitis cases result in death. Those who survive can be left with severe disabilities. • Babies and children under five years old and adolescents between the ages of 15 and 19 are most at risk of contracting meningitis. • Around 170,000 people die from bacterial meningitis worldwide. • The NHS offers teenagers and first-year university students a meningitis ACWY vaccine.


26/09/2017 11:42

Did you know?

55% of all meningitis cases are Men B while 45% are reported as other types.*

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Meningitis B Vaccination Service So, what is meningitis?

Meningitis is a serious infection caused by a virus or bacteria that, if left untreated, can become fatal. This infection causes the membranes that protect the brain and the spinal cord to become inflamed which can lead to brain damage and loss of sight and hearing. Meningitis can be grouped into two main groups: viral and bacterial. Viral meningitis is the most common type and patients tend to recover well. Bacterial meningitis, while rare, can be extremely dangerous and even lead to death. The most common cause of bacterial meningitis is the meningococcus, a type of microbe which can also cause septicaemia. There are several types of meningococcal bacteria including A, B, C, W and Y.

Signs and symptoms

Common signs of meningitis (not all signs may be present and can appear in any order): • Extreme fatigue • Nausea and vomiting • Fever • Confusion • Severe muscular pain • Severe headache • A rash (which will not fade under pressure e.g using the glass test)


Men B vaccination

Men B can affect all ages. Young children and those over 15 are more at risk (see graph below). The NHS currently only offers a Men B vaccination for children under the age of one as part of their routine immunisation programme. While doctors offer a vaccination against A, C, W and Y types to young people (under 25) +, the Men B vaccination is not currently available on the NHS to patients over one year.

Book your vaccination with Boots

For this reason, we provide a private Meningitis B Vaccination Service in over 350 Boots pharmacies for adults and children aged two and over**. Our trained pharmacists will determine if the Men B vaccination is suitable for you or your child. If suitable, two vaccinations will be administered either a minimum of eight weeks apart for those aged between two and 10, or a minimum of four weeks apart for those aged 11 and over.

Reported cases of Men B Age in years:

% of total cases

0 –4

5 –9

15 –24




51% 9.5%

Number of cases:

10 –14


15.5% 3%




Reproduced with kind permission from Meningitis Now. One year’s data (July 2015–June 2016), England only. Source: PHE (published Oct 2016) *PHE; Invasive meningococcal disease (laboratory reports in England): 2015/2016 **Subject to availability. Eligibility criteria and charges apply. + For details, see

Boots donates £1 for every person vaccinated to Meningitis Now For more information and current prices, go to

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15/09/2017 11:29


MATT’S STORY When former England rugby player Matt Dawson’s young son contracted meningitis, it was terrifying. Speaking with Dear Doctor, Matt remembers his son’s battle with meningitis W and tells us what he has been doing to help raise awareness Q. What were the initial signs that made you realise that something was wrong with your son when he first contracted meningitis?

Q. What was your experience whilst your son was in hospital? MD: He was in hospital from when we took him to A&E. He was put on a drip and was put


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to sleep pretty quickly. The rash was developing rapidly but he was made relatively stable at Chelsea and Westminster [hospital]. Then [he was] taken to the Great Ormond Street Hospital where he was in intensive care for nearly a week. He was then moved to the renal ward where he was struggling with his kidneys and had dialysis. We didn’t speak to him for 10 days. Once the [meningitis] bacteria had gone, he recovered remarkably quickly. Q. What are you now doing to raise awareness about meningitis? MD: I joined forces with what Meningitis Now and the Meningitis Research Foundation are doing in association with GlaxoSmithKline (GSK), raising awareness in their

Tackle Meningitis campaign. It’s really about trying to generate awareness in schools, clubs, associations and communities so that people have a basic understanding of the signs of meningitis so that you can act quickly. Q. What advice would you give parents or anyone who suspects meningitis in themselves?

IMAGES © Cour tesy of Wikimedia Commons, Blackcat

MD: When he woke up in the morning he was extremely crabby and upset, as if he’d had a rough night’s sleep, or had a virus or a headache—that sort of thing. My wife tried to give him some fluids, but he was very drowsy and it just got progressively worse throughout the day. There were lots of signs of meningitis, but we didn’t realise they were signs—we were just looking for that rash, as a lot of people do. It wasn’t until after lunch—he had a seizure as well—that I phoned our private doctor and Carolin [Matt’s wife] noticed that there was a faint rash developing and the doctor said to go to A&E.

MD: It’s such a rapidly debilitating disease that you’ve got to act fast and understand the signals like cold hands and feet, nausea, diarrhoea and lethargy. Also look out for early signs of the rash and go to your doctor. If it’s rapidly occurring, get yourself to A&E. There’s no time to be putting it off and thinking about dealing with it later. •

26/09/2017 11:45

Tackle Meningitis is a disease awareness initiative launched by GSK and former England Rugby player, Matt Dawson, using the influence of sport and teamwork to reach as many people as possible. Symptoms can develop very quickly and differ according to age. The distinctive rash associated with meningitis often appears later than other symptoms or not at all. It is a sign that the disease is advancing quickly, so it is important not to wait for the rash before seeking help There are several strains or ‘groups’ of meningococcal bacteria such as A, B, C, W, X and Y.

“I feel passionate about standing behind a campaign which uses the power and influence of sport and its ability to reach people of all ages.” Matt Dawson

Matt says: “I wish I had known more about meningitis and what to look out for. People only think of the glass test, but there are other lesser known symptoms that it’s very important to be aware of. In truth, I was fairly ignorant about how dangerous it can be, but thankfully we turned out to be incredibly lucky. With this disease, even a matter of minutes can make a huge difference to the outcome. UK/VAC/0074/17 Date of Prep Aug 2017

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“I feel passionate about standing behind a campaign which uses the power and influence of sport and its ability to reach people of all ages. Together we can tackle meningitis to give families the best fighting chance against this devastating disease.” If you are a school, sports club or community group, please help to raise awareness of meningitis by running an event in your local area.

Visit to download the ‘event in a box’ toolkit to help you run the event and learn more about how to prevent meningitis

Tackle Meningitis Meningitis and septicaemia: know the facts This disease awareness page has been produced and funded by GSK

24/08/2017 14:11

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26/09/2017 10:22


Alcohol Addiction According to NHS Digital, the total Net Ingredient Cost (NIC) for items prescribed for alcohol dependence in 2016 was £4.87 million. Dear Doctor delves into the topic of alcohol dependency, highlighting the key rehabilitation methods


he NHS recommends drinking no more than 14 units of alcohol per week. If somebody persistently feels the desire to have an alcoholic beverage and cannot go without, this is characterised as alcohol dependency or alcoholism. A number of health risks are significantly elevated in those who drink alcohol on a regular basis. Some hazards are temporary, while others can leave a lasting effect on your physical condition.


IMAGES © Shutterstock

Some individuals can develop a physical attachment to alcohol; reducing intake can therefore trigger withdrawal symptoms such as tremors, hallucinations and cold sweats. If you recognise that you suffer from alcohol dependency, seek help from a professional. There are various paths that can lead to successful recovery,

with detoxification, counselling and medication being the main ones. Start by visiting your doctor—based on your circumstances they will be able to suggest an appropriate course of action.


Prescribed medicines can alleviate alcohol cravings and lessen withdrawal symptoms. Depending on the severity of your condition, your medical practitioner will judge if these are necessary for you. The most common medications for treating alcoholism are chlordiazepoxide, acamprosate and naltrexone.


Various rehabilitation centres across the country offer medical detox programmes that assess your dependency level and offer appropriate medications if necessary. Most detox courses last between seven to 10 days but may be longer depending on your progress.


Counselling can be hugely beneficial to finding the root of a drinking problem. Methods like cognitive behavioural therapy (CBT) are used as a way of identifying destructive behaviour. Other helpful resources include Alcohol Concern’s national drink helpline (0300 123 1110) and Alcoholics Anonymous’ helpline (0845 769 7555).

Did you know? There were 1.1m estimated hospital admissions related to alcohol consumption in 2015/16 Source: NHS Digital

Short-term risks of alcohol misuse

Long-term risks of alcohol misuse

• Accident or injury such as head trauma • Loss of memory or personal possessions • Vomiting or—in more serious circumstances— alcohol poisoning • Dehydration and headaches • Loss of motor skills and stability • Asphyxiation from vomiting • Violent behaviour • Vulnerability to violent attacks

• • • • • • • • •

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Onset of stroke Heart disease Liver disease Liver cancer Bowel cancer Pancreatitis Domestic abuse Depression and anxiety Insomnia


25/09/2017 16:10


Testicular Cancer Checks, Risks and Treatments

We aim to encourage men to converse freely on the topic of testicular cancer and perform self-examinations frequently—let’s beat cancer together


esticular cancer accounts for only one percent of all types of cancers that occur in men; however, diagnosis rates climb with every passing year. This condition is also unusual when compared to other cancers as it tends to affect younger men—usually aged between 15 and 49—although it can


CS10.Testicular.Cancer.indd 52

present at any stage in life. Germ cell testicular cancer is the most common type, making up 95 percent of all cases. Germ cells culminate to make up the sperm in the body. There are two subcategories of germ cell testicular cancer: seminoma and non-seminoma.

Seminoma is a slow-growing form of cancer commonly found in men in their 30s and 40s. This type is usually found in the testes but can also spread to other places such as the lymph nodes. Seminomas now account for 50-55 percent of cases of testicular cancer in the UK.

25/09/2017 16:17


Did you know? Since the late 1990s, testicular cancer incidence rates in males have increased by more than 28% in the UK Source: Cancer Research UK

Non-seminoma grows more quickly than seminoma; the tumour is usually made up of a single type of cell but is sometimes mixed. There are four main subtypes of non-seminoma: embryonal carcinoma, yolk sac carcinoma, choriocarcinoma and teratoma.

TREATMENT The initial treatment option for most cases of testicular cancer is to have the affected testicle removed (orchiectomy). The removal of a single testicle shouldn’t affect fertility or regular sexual functions. Additional treatment plans will depend on the stage and type of cancer in the patient. In some cases, a course of chemotherapy or radiotherapy will follow the removal surgery. If the physician is confident in your condition, they may suggest surveillance for a few years afterwards. Seminomas have been known to respond well to chemotherapy and radiotherapy treatments. Non-seminomas may also demand a short course of chemotherapy or a combination of medications. If the cancer is progressive, additional surgery may be necessary.

IMAGES © Shutterstock

RISK FACTORS The likelihood of developing cancer will depend on a combination of factors such as age, genetics, diet and lifestyle. The precise cause of testicular cancer is still unknown, despite thorough medical

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Performing a self-exam Conduct a monthly check to detect any signs of testicular cancer in its early stages—it may save your life. Follow these simple steps: • Check one testicle at a time. • Gently roll the testicle between the thumbs and forefingers of both hands. • Feel for hard lumps, smooth or round lumps and changes in size or shape. What if I detect something irregular? Don’t ignore your symptoms. If you notice any of these indicators or pain in your scrotum, contact your doctor or urologist—a urologist is the most qualified practitioner to confirm this kind of diagnosis. Handy tip: the shower is the best place to conduct a testicular exam; the steam relaxes the skin and makes movement easier.

investigation. A few risks have been identified that may leave a person more vulnerable to developing the condition. These include cryptorchidism, family history and previous testicular cancer. Cryptorchidism. Men with cryptorchidism, or undescended testicles, are three times more likely to develop testicular cancer than those whose testicles descended at birth or not long after. For this reason, it is important for the testes to descend into the scrotum, if not naturally then through an operation called an orchidopexy.

Previous testicular cancer. According to the NHS, men are four to 12 times more likely to develop testicular cancer if they have previously been diagnosed with it. With this in mind, it is imperative that previous sufferers check themselves regularly for warning signs and attend follow-up appointments. •

Family history. Families with a history of testicular cancer often see the condition reappear in the younger generations. Some genes have been linked to the disease, leading some to speculate that it may be a hereditary condition. At the moment, this is still a theory; research on the link between testicular cancer and certain genes is still ongoing. DEAR DOCTOR WITH DR CHRIS STEELE 53

25/09/2017 16:18


20/09/2017 14:03

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Worried about your prostate health? Here’s what to expect when diagnosing prostate problems


rostate cancer is the most common cancer in the UK for men. Over 47,000 men are diagnosed annually, and more than 11,000 die as a result of it every year. The risk of getting prostate cancer increases as you get older but, as with all cancers, early diagnosis can dramatically improve chances of survival. There is currently no national screening programme for prostate cancer—if you are worried about it, discuss your concerns with your doctor; they will be able to recommend an appropriate test for you. It is especially worth getting tested if a close relative such as a brother or father has been diagnosed with prostate cancer, as your risk of getting it is two and a half times higher. Read on for a breakdown of the most common screening methods.



A digital-rectal examination, or DRE, is perhaps the most common test for prostate cancer. A doctor will insert a lubricated and gloved finger into the rectum as the prostate gland can be felt through the rectum walls. This 56 DEAR DOCTOR WITH DR CHRIS STEELE

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method is not always able to detect cancer, but it is often performed to rule out benign prostate enlargement. Enlarged prostates are common in men over 50 and will cause the gland to grow firm and smooth. Cancer, on the other hand, will make the gland feel hard and bumpy.


A biopsy is the final test for prostate cancer. It is usually performed on people at higher risk of the disease, including those who have presented symptoms in the PSA and DRE tests or those who are genetically at risk. A sample of the prostate is taken and sent to the lab where it is tested for cancerous tissue. The sample is taken using a needle; local anaesthetic will be given to minimise any discomfort. •

Prostate cancer symptoms • Needing to urinate more frequently. • Waking up often in the night to urinate. • Difficulty in starting to urinate. • Weak flow.

IMAGES © Shutterstock

Usually, doctors will recommend a prostate-specific antigen (PSA) test to measure how much is in the blood. PSA is a protein that is produced by normal cells in the prostate but also by prostate cancer cells. All men have a small amount of PSA in their blood, but abnormal levels could be a sign of an underlying health issue. Raised levels of PSA can indicate the presence of prostate cancer or another prostate problem. While it is not a conclusive proof of cancer, it is a good first step for doctors to determine whether more tests need to be done.

• Feeling like your bladder does not empty fully.

26/09/2017 12:12


Sexual Health & Wellbeing

Almost everyone has experienced an intimate health complaint during their lifetime. Identifying the signs early can aid diagnosis and kick-star t the healing process



Hygiene plays an important role in reducing the development of certain intimate health conditions. Both sexes should aim to wear fresh undergarments in a breathable fabric. Avoid underwear that is infiltrated with sweat as this can cause infections to develop. Another common cause of bacterial growth is the forced delay of urination. If you feel the need to go, do not to restrict yourself. Both male and female reproductive parts require thorough cleaning. Neglecting to wash the

penis properly can cause a buildup of dead skin cells. While this is usually harmless, it can lead to irritation and other complications. Women need to take particular care during their monthly cycle; tampons or sanitary towels should be changed every three to six hours.

Safe sex

‘Safe sex’ is the term used to describe methods of protection against sexually transmitted diseases and infections (STDs and STIs). Before commencing a sexual

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exual health is something that affects everybody. Unfortunately, feelings of embarrassment can prevent people from seeking help for their intimate health complaints. Our aim is to dispel such attitudes and encourage people to converse on the topic of sexual wellbeing. Educating the public on adequate health practices has never been more vital to reduce the spread of infections, change attitudes and improve health outcomes in our communities.

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relationship with a new partner, it is a good idea to discuss your sexual history with one another. During this conversation, you may want to agree on a preferred course of contraception. To prevent the spread of STIs you may wish to use a barrier during intercourse—condoms, female condoms and dental dams. Another way to reduce your risk of contracting an STI is to stringently sterilise shared sex toys. Also consider the available vaccinations you are entitled to, these can prevent diseases such as Hepatitis B or HPV.

Did you know?

A Family Planning Association study in 2016 found that out of 2,000 people, 1 in 5 said they thought it was embarrassing to buy condoms

Most common intimate health conditions are very treatable. Early diagnosis can prevent ailments from worsening, therefore recognising the warning signs is imperative.

Premature ejaculation. Early ejaculation during intercourse is a common problem in men. This can be a result of depression, stress, an overly sensitive penis or psychological conditioning. While the condition isn’t life-threatening, it can certainly have negative affects on self-esteem and personal relationships. Different forms of therapy are available for premature ejaculators. There are also various medications that can be prescribed to help with symptoms over time.

Erectile dysfunction. A large proportion of men have experienced the inability to get or keep an erection. If this proves to be a recurring problem, it is advisable to seek medical help. The causes of erectile dysfunction can be physical or psychological. Determining the trigger will allow your doctor to recommend a solution; this could involve a change in diet or medication such as Viagra. More serious cases can be treated with a penis pump.

Vaginal dryness. Vaginal dryness can occur at any age, although it is most prevalent in menopausal women. This condition can cause irritation, discomfort and burning or even narrowing and shortening of the vagina. Sufferers will usually have difficulty having sex and getting aroused. Your doctor may decide between some of the following treatments: vaginal lubricants and moisturisers, vaginal oestrogen or hormonal replacement therapy (HRT).



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REMEMBER If you are concerned about your sexual health, seek guidance from a professional. There are a number of available services within the UK such as general practices, GUM clinics and contraception centres— each provide confidential medical advice

Bacterial vaginosis (BV). Displacements in the pH balance of the vagina can trigger a number of intimate health issues—BV is one of them. A number of things can cause this pH imbalance: overwashing, an intrauterine device (IUD), certain antibiotics or your period. If untreated, BV can cause more serious complications such as pelvic inflammatory disease, miscarriage or premature labour. Medicated gels and creams are available to restore pH balances to normality. •

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Exploring Coeliac Disease Coeliac disease affects one in 100 people in the UK—left untreated, it can lead to long-term health complications


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Did you know? People with conditions like Type 1 diabetes, Down’s syndrome, Turner syndrome and autoimmune thyroid disease have an increased risk of developing coeliac disease

Symptoms of coeliac disease vary in terms of severity, and can often go undiagnosed if they are mild or unnoticeable. The most common symptom of this lifelong disease is diarrhoea, which occurs when the body is unable to properly absorb essential nutrients. Diarrhoea caused by this malabsorption can have a

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oeliac disease is an autoimmune disorder that is caused by the body’s reaction to gluten—a protein found in common grains including wheat, barley and rye. The immune system of a person with coeliac disease misinterprets healthy cells and substances for harmful ones. The body reacts by producing antibodies— blood cells that fight viruses and bacteria—that attack the lining of the small intestine. This reaction to gluten flattens and reduces the effectiveness of the tiny tube-like villi in the gut that are vital in aiding proper digestion. As a result, this damage makes it difficult for the body to absorb vital nutrients leading to symptoms such as weight loss and fatigue. There are some factors known to increase the risk of developing coeliac disease. The condition can be hereditary; the risk of contracting the condition is around 10 percent higher if a family member also has it. This risk increases to 70 percent if the patient has a twin sibling with coeliac disease. Sometimes, digestive system infections that weaken the body’s immune system—such as the rotavirus infection —contracted during early childhood can also trigger symptoms.

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GOOD TO KNOW Gluten can be found in many unsuspecting everyday food items. If you are suffering from symptoms of coeliac disease, avoid products that contain these grains:


Bread Cakes and baked products Pasta Sauces Soup


Beer Food colouring Malt (malted milk, malted biscuits, malt vinegar and milkshakes)


Some bread (such as pumpernickel) Cereals

strong odour and abnormally high levels of fat content that is greasy and frothy in appearance. Sufferers may also experience constipation, bloating, indigestion, vomiting, fatigue exacerbated by iron deficiency, difficulty conceiving and swelling of the limbs (oedema).

consuming a gluten-free diet, but it may take up to two years for the gut to fully heal. It is recommended that patients visit their doctor for an annual review to assess whether there is a need for further medical or nutritional intervention.


Continued consumption or exposure to gluten can lead to serious complications such as malabsorption (the body’s inability to properly absorb nutrients) and malnutrition (critical lack of nutrients in the body). With coeliac disease, the body may be unable to digest essential nutrients such as lipids (fats), carbohydrates, sugars, vitamins and minerals. Symptoms of malabsorption and malnutrition as a result of coeliac disease are similar to those of irritable bowel syndrome (IBS) and Crohn’s disease. These can include bloating, diarrhoea, fatigue, weight loss

Coeliac disease is typically treated by eating a gluten-free diet to prevent further damage and inflammation to the small intestine. Once diagnosed, patients will be referred to a nutritionist who will advise on ways to adjust to the new diet. Those with the disorder can safely eat many whole foods such as fruits, vegetables, rice, pulses, soya, buckwheat, almond flour and gram flour. When shopping, check labels for ‘hidden’ ingredients containing gluten. Symptoms of coeliac disease tend to improve within a few weeks of

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There are currently 500,000 undiagnosed cases of coeliac disease in the UK Source: Coeliac UK

and abdominal cramps. Furthermore, those with coeliac disease are more likely to develop an intolerance to lactose. Lactose intolerance occurs when the digestive system lacks the enzyme needed to break down sugars found in dairy products. Symptoms of lactose intolerance also include bloating, flatulence and diarrhoea. In some cases, coeliac disease can also lead to pregnancy-related complications. Pregnant women who consume gluten throughout their pregnancy are at increased risk of delivering a baby with a low birth weight. • DEAR DOCTOR WITH DR CHRIS STEELE 61

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Managing Allergies Allergies can be a real pain if they aren’t managed properly. Dear Doctor is here to assist with preventatives and treatment


rom gluten to bee stings, there are countless entities that our bodies may identify as a potential threat. Nowadays allergies are considered commonplace, with an estimated 21 million Britons suffering from at least one. While most allergic reactions are mild to moderate, on rare occasions an individual can suffer symptoms that are more severe and even life-threatening. Identifying your allergy early on is the first step in managing it.

• Red, dry or itchy eyes • Coughing and sneezing • Blocked or runny nose • Wheezing or difficulty breathing • A rash or hives on the skin • Worsening of asthma or eczema Consult your doctor if you believe you have an allergy. They should be able to confirm your triggers through a skin, blood or patch test. Once your trigger is identified, management of your condition will consist in two core components: treatment and prevention.

PREVENTION While it is hard to preempt contact with allergens, being extra vigilant to possible triggers around you will work in your favour. If your allergy


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is food-related, carefully check food labels and make a conscious effort to enquire about what ingredients have been added to dishes in restaurants. If your symptoms are severe, you may even decide to bring your own snacks to avoid unnecessary mix-ups. If you suffer from hayfever, you may want to apply a pollen filter to your windows or a nasal filter before you venture out. If dust mites are your enemy, avoid them with an allergen-proof duvet.

TREATMENT If you wish to avoid flare-ups, you should always be prepared with the right relief medication. If you simply need oral pills or steroidal spray for relief, ensure to carry these in

your bag with you. Stock up on these products in times when your allergy may be especially impairing. The same can be said for lotions or creams— keep these on hand whenever you may need them. If you are prone to severe reactions—for example, if you are at risk of anaphylactic shock—your doctor should provide you with an adrenaline auto-injector. It is important to keep this on you at all times, whether there is a risk of exposure or not. Your allergies shouldn’t affect your daily life as long as you take the time to prepare and mitigate their symptoms. If you are unsure how to manage your specific allergy, consult your doctor for more advice. •

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Common symptoms of an allergic reaction

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Our delicious organic soybean pastas are 100% gluten-free, high in protein and vegan friendly. Our Soybean Pasta ensures excellent health. At Orwell Health, we have worked closely with nutrition experts for years to develop fantastic soy pasta products with a wide range of health benefits. We pride ourselves on our products which are not only made from raw soybeans, but are also high in health-boosting nutrients including protein, phosphorus and calcium. Protein contributes to the maintenance of muscle mass. Protein is needed for normal growth and development of bones in children. Suitable for those with coeliac disease, vegans and those who are working to lose weight, our soybean pastas are low in sugar and fat, too. Our soybeans are 100% organic which means from start to finish, our farming process is free of chemicals, fertilisers, pesticides and other artificial chemicals.

Foods that make you feel good, inside and out.

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Good F

o o

Navigate your way through the minefield of information on healthy eating with Dear Doctor’s nutritional food guide


owadays, we are constantly bombarded with catchphrases like ‘detox’, ‘clean eating’ and ‘superfoods’. With the abundance of marketing on the subject of nutrition, it can be hard to identify what is fact and what is fiction. Can certain ingredients boost your overall wellbeing and are there

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particular food groups we should avoid completely? Dear Doctor is here to quell some common myths on healthy eating and provide you with a nutritional food guide you can trust. The term ‘healthy’ is generally applied to somebody who is considered to be in peak physical shape, without illness or injury. It could arguably be seen as a fluid concept; one person’s

optimal health may be different to another’s. There are a number of factors to take into account: age, height, metabolism, gene pool and general lifestyle. Improvements in health are made possible through consuming a balanced diet, performing regular exercise and avoiding damaging pastimes and addictions like smoking and excessive drinking.

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THE MAIN FOOD GROUPS Health organisations often reiterate that a balanced diet is the key to staying healthy. This translates to having a regular intake of each of the five main food groups. Each group has its own purpose and therefore should be taken in certain specific quantities. The NHS’ Eatwell Guide outlines the recommended diet proportions of each food group which can be roughly broken down into 37 percent carbohydrates, 39 percent fruit and vegetables, 12 percent protein, eight percent milk and dairy products, one percent oils and three percent occasional foods.

Organic soybean pasta Orwell Health is a family-run company based in Felixstowe. Their passion lies in helping people to feel nourished whilst enjoying some of their favourite meals. Their 100 percent organic soybeans are grown at Friendship Farm, in 25-year fallow land free from fertilizers, chemicals and pesticides. The food company only uses farm land that is sustainable. Soybeans have copious amounts of nutritious benefits including being gluten-free and suitable for coeliacs, vegetarians and vegans. Orwell Health’s soybean pasta is a great alternative to the standard pasta on shelves today. Orwell Health believes a healthy body makes a healthy mind. Join them in this exciting new journey towards a healthy future.

The key messages to take on board are: Eat at least five portions of fruit and vegetables a day (but more if possible). Try to consume a colourful variety; different fruits and legumes are packed with vital antioxidants and vitamins. Base your meals on starchy carbohydrates such as potatoes, rice, bread or pasta—these provide natural energy that your body needs. Choose wholegrain options with less added sugar and salt. Try to consume some dairy (or a dairy alternative—soy-based products are a good option). Aim to choose low fat options. Include protein in your diet—most of the protein should be obtained from beans and pulses, including some

Ensure you are eating little and often during the day to keep your blood sugar steady —Dr Marilyn Glenville, nutritionist and author of Natural Alternatives to Sugar (2016) 66 DEAR DOCTOR WITH DR CHRIS STEELE

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meat and two portions of fish a week (preferably oily fish that is packed with omega 3 and other minerals). Eat oil in small amounts and try to opt for unsaturated versions found in spreads and oil sprays. Aim to drink six to eight glasses of water a day. Hydration is an important part of digestion and everyday functioning. Consume less sugary drinks like fruit juice or caffeinated beverages—the latter tends to be dehydrating. Food high in fat, salt and sugar should only be consumed occasionally. These foods naturally provide less nutritional value as they lack useful nutrients and vitamins. Excessive amounts of these foods (including chocolate, biscuits and deep-fried products, to name a few)

can lead to elevated cholesterol levels and other health issues. They should be eaten in small quantities. According to the NHS, the daily recommended amount of calories is 2000 kcal for women and 2500 kcal for men. Your recommended intake may differ depending on activity levels; those who do rigorous exercise may need more calories for energy, while those who do very little exercise may be advised to consume less calories.

THE MYTHS There are a number of myths surrounding the topic of nutrition—but which are true?

Detoxing and fasting is good for you Now more than ever, new diets are springing up suggesting that the

Did you know?

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In 2015, only 26% of adults ate the recommended 5 or more portions of fruit and vegetables a day. Women were more likely to do so than men according to NHS Statistics on Obesity, Physical Activity and Diet England, 2017

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Looking for an interesting snack?

aweed. Consider trying se rm, it’s fo ied dr in le ab Avail lads or sa on ed kl great sprin ck Pa ed with even on its own. c, iron and zin , m magnesiu a tasty treat selenium, this is guilt e th t withou

way to a healthy body is to detox or fast. Fasting is particularly unwise; depriving the body of meals can cause lack of energy and electrolyte imbalances. Various teas, juices and supplements have also arrived on the health scene, promising to cleanse your liver or rid your body of toxins. Many of these products make false claims that have no real evidence to prove their efficacy. The purpose of most detox plans is to avoid a particular food type for a certain period, either for weight loss or cleansing purposes. You may be surprised to learn that your body naturally removes unwanted toxins through the liver, kidneys, skin and lymphatic system.

‘No added sugar’ means no sugar Branding is often made in a way that makes customers believe they are consuming a product that is good— 68 dear doctor with DR Chris Steele

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or better—for them when in fact this is not always the case. A label that reads ‘no added sugar’ is often misconstrued as meaning the item contains no sugar at all. Similarly, ‘reduced fat’ or ‘low salt’ labels do not always mean the products they are on are better for you than their regular counterparts. Some low fat options contain a disproportionate amount of sugar to make up for lost flavour. Make sure you check food labels properly to prevent any hidden surprises.

Snacking is bad for you Snacking doesn’t necessarily have to be bad, it all depends on what you are snacking on and how often. If snacking is managed strategically, it can positively contribute to a wholesome lifestyle. Dr Marilyn Glenville, nutritionist and author of Natural Alternatives to Sugar (2016),

advises to ‘ensure you are eating little and often during the day to keep your blood sugar steady’. This will mean you are less likely to suffer an energy slump and reach out for a sugar fix. First, it’s important to identify why you wish to snack—if your stomach is rumbling then go ahead. There is no real reason to ignore your body’s natural way of asking for sustenance. However, if you are simply bored or tired, you should seek a better alternative—take a walk, have a refreshing shower or drink a large glass of water. Avoid snacking on overly sugared food types, they may give you a sudden energy rush but soon you will find your body crashing. Instead, opt for something rich in fibre like a banana or protein-rich mixed nuts. If you decide on a larger snack, reduce your next meal accordingly. Remember, good nutrition is all about balance. •

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Health Checklist Add some innovation to your life with our top picks—from breath fresheners to moth killers


Acana’s System of Care products use the latest technology to provide effective and long-lasting protection from the damaging effects of moths, their eggs and larvae—giving you complete peace of mind. Products have an indicator for when they need replacing, and have a long-lasting lavender fragrance.


Orwell Health have developed a range of organic gluten-free pasta suitable for vegans and those with coeliac disease. Their gluten-free pasta is made from soybeans which also gives you an extra protein boost. The pasta comes in three different varieties: green soybean, yellow soybean and black soybean. Orwell Health guarantees that their products are not only nutrientpacked and great tasting, but have also been sustainably farmed.


Keep your gut happy with Alflorex—a daily supplement of good bacteria. Alflorex has been shown to reduce symptoms of IBS such as bloating, gas, abdominal pain and unpredictable bowel movements. Each capsule contains around one billion live bacteria to help maintain optimal balance in gut flora.

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Kill bad breath at its source with The Breath Co. They use pure, natural ingredients in their oral care products to kill bacteria and maintain gum health. Additionally, The Breath Co have created a chewing gum—The Breath Company Lozenges—that fights bad breath by preventing dry mouth and freshening up your breath.


O’Keeffe’s skincare range will keep you moisturised and help your skin stay smooth. Their specially designed Healthy Feet formula is guaranteed to improve extremely dry and cracked skin. Use it at bedtime and after bathing for maximum results—most people start seeing results after just a couple of days.


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The Dairy Debate Is dairy a friend or foe? We put an end to the long-standing debate once and for all


dairy products can be eaten regularly while others only occasionally. The NHS Eatwell Guide recommends that, in order to maintain a healthy diet, eight percent of our daily food intake should consist of milk or dairy products. Milk, yoghurts and small amounts of cheese should be favoured in your diet over butters and creams—which have higher amounts of saturated fat. Low fat options can, and should, be chosen if necessary. People who are lactose intolerant or vegan can turn to dairy alternatives including soy-based drinks, almond milk, rice milk and oat milk. These are often fortified with calcium and vitamins.

Those who are lactose intolerant are usually able to eat aged cheeses such as parmesan, Cheddar, Brie and Camembert. This is simply because the lactose levels in these varieties are much lower than those of others, making them easier to digest. As part of a balanced diet—balanced being the operative word—dairy is very important. Consuming too much can negatively impact your health. By following the NHS guidelines and limiting the amount of dairy with high levels of saturated fat in your diet, you can reap the benefits of this delicious food group without harming your wellbeing. •

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question that has divided medical and nutritional communities for years: is dairy good for our bodies? With various educators supporting opposite ends of the argument, it can be difficult to know what to believe. We analyse the facts on dairy and present you with both cases: for and against. Although dairy is a single food category, different items within it have separate nutritional values. Certain

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For Dairy products contain nutrients and vitamins that keep us healthy. Examples of these include protein (for growth and repair), calcium (for strengthening bones—especially in childhood), vitamin A (for good eye health), vitamin B12 (for healthy nerve and blood cells), riboflavin (for digestion and skin conditioning) and iodine (for regulating metabolism and the thyroid). Reduced-fat options are now widely available in supermarkets. Hard cheeses and reduced-fat cottage cheese or quark can contain as little as three grams of fat per every 100gram serving. Likewise, semi-skimmed and skimmed milk contain all the nutrients and benefits of whole milk—but with less fat. From the ages of one to five the NHS advises the consumption of whole milk and dairy products to boost calorie and vitamin intake. This period is vital for youngsters; whole dairy is considered a necessity in this early stage of growth. Milk is extremely hydrating. In fact, a specific study in the journal for Applied Physiology, Nutrition, and Metabolism by Ben Desbrow et al. in 2014 stated that it was more effective in rehydration than the majority of carbohydrateelectrolyte sports drinks. Various other studies have since made similar conclusions, claiming that it replenishes sodium levels more quickly than water.

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Against A lot of the fat in milk and other dairy products is saturated. Too much saturated fat in your diet can lead to excess energy intake or eventual weight problems.

Dairy can raise insulin levels in the body. Dairy (especially low fat milk) has been known to cause a spike in insulin. This rise in blood sugar is caused by a degree of lactose proteins; but these appear less frequently in high fat dairy products. Dairy’s insulinogenic properties can be negative, especially for those who are resistant to insulin.

Cheese is naturally high in salt. High levels of salt pose a health problem as excessive amounts can contribute to elevated blood pressure. Most regular cheeses such as Brie, Cheddar and Stilton can contain between 20 and 40 grams of salt per 100 grams. More than 1.5 grams of salt in 100 grams of product is considered high. Dairy has often been reported to aggravate acne. While this has been subject to debate, various sources point to dairy (milk in particular) worsening acne in sensitive individuals. One such example is Spencer EH et al. 2009, who found that higher milk intake was linked to acne. However, it’s important to keep in mind that various external factors can influence skin health; more research is needed on the topic.


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A Guide to

Free Sugars The concept of free sugars can be confusing and somewhat daunting; we provide you with advice on reducing your intake


ree sugars are not what their name may suggest: sugars that can be consumed with no guilt. In fact, the complete opposite is true. The World Health Organisation (WHO) defines free sugars as ‘all monosaccharides and disaccharides added to foods by the manufacturer, cook or consumer, plus sugars naturally present in honey, syrups and fruit juices’. Monosaccharides are made up of a single sugar molecule and include glucose, fructose and galactose. Disaccharides have two molecules; the most commonly known disaccharide is sucrose—or table sugar. Other examples in this category include agave nectar, molasses, treacle and maple syrup. Excluded from this group are sugars found in the cellular structure of whole foods such as raw fruits and vegetables, along with the lactose in milk products. This grouping also goes by another name—intrinsic sugars.


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Most people will be familiar with the term ‘added sugar’, which features on the majority of food labels. While there isn’t a concrete definition for added sugar, it tends to refer to the same group of sugars as free sugars. The Scientific Advisory Committee on Nutrition (SACN) has recently halved the recommended daily amount of free sugars from 10 percent of dietary energy to five percent or less. Per day this equates to roughly: Children four to six years: 19 grams (five sugar cubes) Children seven to 10 years: 24 grams (six sugar cubes) Children 11+ years and adults: 30 grams (seven sugar cubes) The revision of the SACN’s recommendations has been made due to strong indications that free sugars

have a negative effect on health. A Public Health England (PHE) report in 2015 stated: ‘Since carbohydrate recommendations were last considered in 1991, the evidence indicating that a high intake of free sugars is detrimental to several health outcomes has strengthened’. The governing body made their proposal after analysing the results from 11 controlled trials devised to study energy intake in relation to sugar proportion in diets. Obesity, diabetes and cardiovascular disease are just some of the possible outcomes of a regular diet with heightened consumption of free sugars.


Now we are aware of the recommended daily allowance, the question remains: how do we adhere to this amount? Most of the sugar we consume on a daily basis is hidden; mixed into baked goods

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or added to processed drinks. It is very easy to be fooled by certain products; marketing strategies are often used to manipulate customers into thinking that items are healthier than they really are. Free sugars can appear in unexpected places like sauces, ready meals and varieties of bread. During your weekly shop, take the time to check food labels for avoidable free sugars. Look out for the ‘Carbohydrate, of which sugars’ section of the label. Although this doesn’t specify the amount of free sugars, it can be a useful comparative to determine overall sugar content. If checking food labels is a daunting notion, consider using the Be Food Smart app. It allows

you to scan the barcode of a product and provides you with a coherent breakdown of what sugars, fats and other components are involved. Making simple swaps within your dietary repertoire can make all the difference to your daily sugar intake. Opting for water rather than fizzy drinks or fruit juices is one such step you could be taking. Choosing unsweetened wholegrain cereal as opposed to frosted varieties with chocolate or honey is another. For a healthy diet, we should be getting our energy from starchy wholegrain foods and balancing them with fruits, vegetables and proteins. Visit the NHS website for more information on healthy living. •

Sugar shocks

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Making the following simple swaps can make a huge difference to your sugar intake. Swapping orange juice (200 millilitres) for whole fruit saves five sugar cubes. Swapping regular cola (330 millilitres) for diet cola (330 millilitres) saves nine sugar cubes. Swapping flavoured milk (350 millilitres) for semiskimmed milk (350 millilitres) saves eight sugar cubes.

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Mind over Matter Our mental wellbeing is just as impor tant as our physical health— achieve a more positive outlook with Dear Doctor

met with stress, our brain releases a hormone called cortisol into the bloodstream; this process is what is commonly referred to as the ‘fight or flight’ response to an immediate threat. Once released, cortisol increases our blood sugar levels and heart rate. When the ‘threat’ has passed, our hormones reduce to a normal level. However, chronic stress can prove to be detrimental to our health. High levels of cortisol in the system for extended periods of time have been proven to increase blood pressure, the risk of heart disease and diabetes, weaken the immune system and decrease neurons, which can impede essential cognitive functions like memory. Excess stress can also deplete the levels of ‘happy’ hormones serotonin and dopamine which can result in other more severe mental health problems including anxiety and depression. These psychological disorders can sometimes manifest physically, causing heart palpitations, headaches and stomach complaints to name a few. A Labour Force Survey in 2016 found that work-related stress was mostly attributed to workload pressures such as tight deadlines and too much responsibility. According to the Mental Health Foundation, stress is also caused by financial problems, relationship issues and bereavement.

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Did you know? Around 4-10% of people in England will experience depression in their lifetime Source: Mental Health Foundation

Eliminate negative thoughts

A study by the National Science Foundation in the United States found that the average person produces around 12,000 to 50,000 thoughts each day with an estimated 95 percent of those repeated daily. It also found that the majority of those thoughts are negative. An assessment by the

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he body’s response to stress is a natural occurrence that, in evolutionary terms, helped our ancestors survive in the wild. Research has shown that moderate levels of stress can help us become more alert and perform better in typically difficult situations such as extreme sports or a job interview. When

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Comenius University in Slovakia that studied the role of the amygdala—the part of the brain responsible for our emotions—indicated that negative speech can damage otherwise healthy neural structures in the brain that regulate memory and emotions. This damage can increase our propensity to act irrationally and can also disrupt our sleep and appetite. Because of our ‘fight or flight’ response to threats, our brain reacts quickly to negative language, propagating feelings of stress, anxiety and depression. Unfortunately, the brain does not react in the same way to positive language. For this reason, we must consciously and consistently use positive language to forge a new neural pattern within our brains. According to the founder of Positive Psychology, Barbara Fredrickson, we should generate three positive thoughts for every one negative thought we have. Positive language helps to propel the motivation centres in the brain and can help us build emotional resilience to stress in the future. Positive affirmations can be a powerful tool in ‘rewiring’ our brains to help improve a sense of self-esteem, confidence and control. Try repeating

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positive affirmations daily such as ‘Today, I am brimming with energy and joy’, ‘I forgive those who have harmed me’ and ‘My body is healthy and my mind is brilliant’.


Get outside. A study by Zhejiang Hospital and Zhejiang Provincial Key Lab of Geriatrics in China found that a group of students sent to a forest for a two-night trip had lower levels of cortisol in their systems than those who had spent two nights in a city. Socialise. Mappiness app analysed three million submissions from over 50,000 volunteers. They found that, on average, people experienced an eight percent increase in happiness when they were with friends compared to just 0.7 percent when with their children. Change your posture. There is a powerful link between posture and mood. A philosophy known as ‘embodied cognition’ stipulates that the mind influences our body and vice versa. Changing your posture from a closed-in position to an open position with hands on hips—for example—can dramatically decrease levels of cortisol and increase feelings of confidence. •

Take a breath Deep breathing exercises can help you to focus on the present and relieve symptoms of stress and anxiety. Mindful, slow breathing works on a physiological level by lowering your heart rate, decreasing blood pressure and relaxing your muscles. Set aside some time each day to practice this technique anywhere, anytime, to bring about a renewed sense of calm: Sit or lay down somewhere comfortable—either in a chair that supports your back with feet flat on the ground and hip-width apart, or on a bed, arms slightly away from your sides. Breathe in through your nose slowly and deliberately and as deeply into your belly as you can, counting from 1 to 5. Hold your breath for 1 count before breathing out deeply through your mouth, counting from 1 to 5. Breathe rhythmically in and out in this way for around 3 to 5 minutes.


25/09/2017 16:45


Fertility Tips,

Trackers & Tests Trying for a baby needn’t be complicated. Read about the latest fer tility tips, trackers and tests


eciding to conceive is a magical time for couples. Making the joint decision to create a family and become parents can be a perfect way to solidify your happy life together. Before you embark on this journey, there are a few things to keep in mind. Modern advancements mean there are now multiple ways to measure your fertility and make conception simpler and more straightforward—you can now conduct fertility tests at home. Alternatively, if you have concerns, a doctor will perform more thorough checks if they believe them to be necessary. Here are just some of the ways to track your fertility for your own peace of mind.

there is still some skepticism surrounding them, many apps have been praised for their innovation. Along with tracking ovulation dates, more advanced models include risk assessments, hormone analysis and forums to share experiences with other users. Doctor-performed tests. If you are struggling to conceive, or have any concerns, your doctor will be able to perform the following check-ups: blood test, ultrasound, chlamydia test and semen analysis. Each can give an

indication on how fertile you are and what steps you should take in order to become pregnant. There are a few signs that may indicate that you suffer from decreased fertility. If you do notice any such signals, it is best to contact your doctor to discuss treatment and other options. If you have been trying to conceive for over a year or have a medical condition that could affect your fertility, contact your doctor. We suggest both partners see a physician; infertility is an issue that can affect both men and women.


NHS self-assessment tool. This is an online series of questions that automates advice based on your answers. It determines whether you should seek medical help with your fertility. The quiz poses general health questions along with others based on your sexual activity and history. Ovulation kits. If your period isn’t very regular it may be hard for you to determine exactly when you are ovulating. The most common ovulation kits will include a tab which will test the hormone levels in your urine. Once you confirm your ovulation dates, you can make sure you are having intercourse within that timeframe. Fertility apps. These are becoming the ultimate fertility aid. While 76 DEAR DOCTOR WITH DR CHRIS STEELE

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27/09/2017 09:06


What can affect fertility? WEIGHT

Women who are overweight or obese are more susceptible to a decreased ovarian function. Getting pregnant can therefore be a lot harder. The same can be said for women with lowerthan-average BMIs, as they are usually deficient in leptin (the satiety hormone). Low leptin levels can account for absence of periods, making conceiving far more difficult. Likewise, males who are overweight or out of shape can suffer from a low sperm count.


After a certain age, women’s bodies naturally begin to show decreases in fertility, eventually leading to menopause. Fertility is known to drop during the mid-30s. Planning for a family may be easier before that time.

IMAGES © Shutterstock


While smoking is known to damage the development of a growing foetus, it can also affect the likelihood of getting pregnant in the first place. Smoking considerably affects egg and sperm maturation, hormone production and embryo transport. It can also increase the chances of miscarriage or ectopic pregnancy.

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There are a number of STDs that can cause infertility if they are left untreated for long periods of time. Chlamydia and gonorrhoea are the main culprits of this—each can cause permanent damage to the fallopian tubes.

Did you know? Over 80% of couples where the woman is under 40 will conceive naturally within one year of having regular unprotected sex Source: NHS Choices


PCOS is one of the leading causes of infertility and is surprisingly common in women. Symptoms include irregular periods, excessive hair growth and difficulty in losing weight. Some women with PCOS may need a medical induction of ovulation to get pregnant, while others may not be able to at all— consult with your doctor if you think you may have PCOS.


You may be surprised to learn the extent to which environmental factors can disturb your fertility. Being in a stressful environment can make things more difficult for couples trying to start a family. Likewise, being exposed to harsh chemicals like pesticides, radiation or high microwave emissions can leave you at higher risk of infertility. • DEAR DOCTOR WITH DR CHRIS STEELE 77

27/09/2017 09:06


Get Active P

hysical exercise can do wonders for our health. According to NHS Choices, it can reduce the risk of some major illnesses—such as Type 2 diabetes, heart disease, stroke and cancer—by up to 50 percent and lower your risk of premature death by as much as 30 percent. The government advises 150 minutes of moderate exercise a week, yet many of us neglect to take our recommended dose. Technology has made our lives easier; accessible public transport cancels out the need for walking and fewer people 78 DEAR DOCTOR WITH DR CHRIS STEELE

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are doing manual work, shopping and chores. So what is the easiest way to get active in this modern age?


Every age group has its own fitness requirements. Being physically active doesn’t necessarily mean spending a hefty sum of money—and time—in a gym. The key is finding activities that you enjoy and can easily fit around your everyday schedule. For any type of exercise to positively affect your health, it needs to higher our heart rate, make us feel warmer and breathe faster.

For adults aged 19 to 64, the NHS advises two different types of exercise: aerobic and strength. In addition to two and a half hours of aerobic activity a week recommended by the health department, individuals in this age group should also aim to perform strength activities that work all the major muscles—legs, back, hips, chest, abdomen, arms and shoulders. Muscle strength is important for everyday movement. It also builds strong bones, regulates blood sugar and pressure and helps maintain a healthy weight. Lift weights (at least one set with eight

IMAGES © Shutterstock

Perhaps one of the best self-help measures against various illnesses, physical exercise is the low hanging fruit of wellbeing

25/09/2017 16:48


Top tips for staying active Getting active is important, but staying active and maintaining a healthy exercise regime is vital. Here are some top tips to help you stay motivated.

Set goals. Set realistic goals—you’re more likely to

Enjoy it. If you enjoy the type of exercise you do, you are

Variety. Once you are exercising regularly, don’t be afraid

more likely to keep it up.

Start slow. Build your activity level and intensity day by day and give your body enough time to adjust and adapt. Small changes. Walk to work or get off the bus a few

stops before your destination. Use your lunch break to go for a brisk walk and choose stairs over elevators.

to 12 repetitions), work with resistance bands, do sit-ups, heavy gardening or yoga to get all the benefits. Make sure to consult with your doctor before embarking on a brand-new fitness regime. They will be able to perform a full physical exam, letting you know your lung capacity, body mass index (BMI) and optimal weight.

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stick to them. Keep a diary and tick them off as you complete them.

to change up your routine. This way, you’ll never get bored and working out may not seem like a chore.

Socialise. Instead of meeting family and friends for a drink at the pub, organise a gym date.

Don’t give up. Your body will benefit from every single workout—but physical changes and benefits will take time.

Being active around the house— whether that is cooking, doing some housework or walking while doing other activities—is, perhaps, the easiest way of keeping fit. Find a friend to exercise with or join a walking group; both are great ways to get moving, meet new people and keep the mind in shape, too. Fitness classes

can keep you motivated; swimming and aqua aerobics are especially ideal for older adults as both activities relieve strain on the joints. Yoga and Pilates, while more advanced, are suitable for all ability levels. Both can stretch and strengthen the body and are best for building strength, balance and flexibility. DEAR DOCTOR WITH DR CHRIS STEELE 79

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Exercise and disability

Even with a physical disability, getting out and playing team sports can do wonders for wellbeing. If you can walk, there is no better—or easier—way to raise your activity levels. If you prefer cycling, there are tricycles, quad cycles, recumbent bikes, hand-powered bikes and power-assisted bikes for those unable to ride a regular bicycle. Look for Inclusive Fitness Initiative (IFI) gyms near you to take advantage of the allinclusive classes. Adapted sports are a great option, too.

REMEMBER If you feel any pain or discomfort while exercising, stop what you’re doing immediately. Consult a doctor if you encounter any negative effects like difficulty breathing, excessive sweating and lightheadedness

Mental wellbeing

According to NHS Choices, being active can help with mild depression. It has also been hypothesised that exercise can protect individuals from anxiety and bring a heightened sense of self-esteem and accomplishment. This is because physical activity causes chemical changes in the brain—and releases endorphins— which help boost our mood.

Did you know? One of the easiest ways to tell whether or not you’re exercising at a moderate intensity is if you can still talk but find it hard to sing the words to a song

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Being inactive

According to the Department of Health (DoH), inactivity is a ‘silent killer’. In addition to our recommended exercise, it’s also important to avoid prolonged periods of sitting or lying down—when possible. Common examples of these sedentary habits include watching TV, using a computer or sitting in the car for extended intervals. •

Facts & figures There’s overwhelming evidence demonstrating the benefits of exercise. It is medically proven that individuals who lead an active lifestyle have… • 35% lower risk of coronary heart disease and stroke • 50% lower risk of risk of Type 2 diabetes • 50% lower risk of colon cancer • 20% lower risk of breast cancer • 83% lower risk of osteoarthritis • 68% lower risk of hip fracture • 30% lower risk of falls • 30% lower risk of depression • 30% lower risk of dementia Source: NHS Choices

25/09/2017 16:48


The Importance of

People who lack adequate levels of vitamin D can suffer grave consequences to their health; we highlight the warning signs and effective treatments WHY IS VITAMIN D NECESSARY?

Vitamin D performs a multitude of valuable functions in the body. It reduces inflammation, promotes cell growth, improves calcium absorption and maintains calcium and phosphate levels in the body.


IMAGES © Shutterstock

Some of the main causes for vitamin D deficiency include: • Little exposure to sunlight • A diet lacking in vitamin D • Pregnancy or breastfeeding • Old age • Obesity and weight issues • Dark skin tones (skin with a higher concentration of melanin has more difficulty converting sunlight into vitamin D) • Conditions that undermine the ability to absorb vitamin D such as Crohn’s or coeliac disease • Chronic kidney or liver disease


Without enough vitamin D in the body, individuals can experience severe pains and weakness in their bones and muscles. On a larger scale, lack of vitamin D can lead to more serious

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complications. Many vitamin D-deficient patients suffer from impaired immune system function, which can leave them vulnerable to harmful infections. Rickets is another condition that is commonly associated with low vitamin D levels—it involves bones softening and is often diagnosed in children. Vitamin D deficiency can also cause subjects to develop a resistance to insulin, which in turn can negatively impact the processing of blood sugar.


Treating this deficiency is relatively straightforward; the goal is to

replenish vitamin D levels efficiently. This can be done through diet or by taking supplements. Food sources that are rich in vitamin D include red meat, liver, egg yolks, oily fish (such as sardines, salmon, mackerel and tuna) and fortified foods (specific spreads, cereals and milks). In terms of supplements, adults may opt for daily vitamin D capsules while children may take more suitable vitamin drops. If the symptoms of your deficiency are severe, you may wish to seek medical help. Your doctor can work on an appropriate treatment regimen designed just for you. • DEAR DOCTOR WITH DR CHRIS STEELE 81

25/09/2017 16:49


Understanding Supplements R

Who are supplements designed for? We investigate their use, what they are made of and who can benefit from them


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ecent years have seen a boom in the use of supplements across the UK, which may be explained by their increased availability. Supplements containing various minerals, vitamins and amino acids are being targeted at those wishing to stay at optimum health. Consumers also use them as a means of tackling signs of ageing, curing illnesses, regulating bodily functions and even losing weight. However, there is no concrete evidence that these extra vitamins effectively resolve such ailments. Ingredients ranging from

royal jelly and acai extract to zinc and calcium create a vast catalogue of options—a minefield for those who are less knowledgeable on their medical properties and nutritional values.

GET YOUR VITAMINS NATURALLY According to NHS Choices, most people don’t need to take supplements chiefly because it is possible to gain all the required vitamins and minerals by eating a balanced diet. The best way to do this is by covering all the major food groups—starchy carbohydrates, fruits

26/09/2017 14:47


REMEMBER Many supplements come as an effervescent tablet (one that fizzes). These can contain up to a gram of salt per tablet. Taking multiple effervescent tablets can be damaging, especially if your salt intake is already high— consider switching to oral capsules instead

and vegetables (at least five a day), protein and dairy—in as many meals as possible. The consumption of foods high in fat, salt or sugar, on the other hand, should be kept to a minimum.


At this age, it is recommended to give children supplements containing vitamins A, C and D—these can be administered via drops. These vitamins help to promote healthy growth and make up for any fussy eaters whose nutrient levels may be lacking.

Pregnancy and breastfeeding Women who are trying to conceive are advised to take folic acid daily until the 12th week of pregnancy to reduce the risk of neural tube defects in the foetus. Women with a family history of the condition or with diabetes may be recommended a higher dose. During breastfeeding, the mother will usually be advised to take vitamin D to prevent a vitamin D deficiency appearing in both her and the child.

Age 65 and above As we age, our body begins to lose the ability to create vitamin D. In light of this, it is recommended that over 65s take a vitamin D supplement. The same is true for those who are not exposed to a lot of sunlight or are bedbound. If you have any other condition that may demand the use of supplements, always consult your doctor who can

suggest an adequate course of action. Such conditions may include anaemia, thinning hair, joint problems or muscle cramps.

QUALITY CONTROL Supplements sold on the internet may not meet UK safety standards and are less likely to have gone through rigorous checks. There is also an increased risk of false advertising; a product may not contain precisely what it says or could possibly include harmful substances. Always buy supplements from a reputable source such as a known pharmacist, chemist or supermarket. Check the label carefully to ensure you are familiar with the ingredients. Make certain that it is absolutely necessary for you to take them—always consult a doctor or dietitian for guidance.

WATCH YOUR DOSAGE Be wary of taking vitamins in large amounts or over long periods of time—taking too much of a certain supplement can cause more harm than good. Various health organisations have issued warnings that exceeding the recommended dosage can lead to medical problems. •

IMAGES © Shutterstock

Individuals who are naturally deficient in certain vitamins and minerals may be prescribed a supplement by their doctor to keep their levels ‘topped up’. In this case supplements are hugely beneficial, as they can improve both health and vitality. It’s important to keep in mind that they shouldn’t be consumed in the place of a healthy diet. There are, however, circumstances when supplements are sometimes deemed necessary: during the early stages of childhood, pregnancy or senior years. Imbalances or deficiencies are known to occur during these periods; supplements are therefore prescribed as a counteractive method. The Department of Health (DoH) advises the following:

Age five and below

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26/09/2017 14:45

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20/09/2017 16:08


Scarlett’s IBS Story Lifestyle blogger Scarlett Dixon had long suffered with irritable bowel syndrome—until she found a solution at a networking event in 2016

IMAGES © Cour tesy of Alimentar y Health


or as long as fashion blogger and YouTube presenter Scarlett Dixon can recall, she has always suffered with symptoms of irritable bowel syndrome (IBS), a common disorder of the digestive system with symptoms such as bloating, abdominal pain and urgent and unpredictable bowel movements. ‘I remember having a sensitive gut going way back, even being sent home with a poorly stomach on my eighth birthday,’ she said. When she was at school and the pressure of exams and finals came around, the symptoms began to intensify with bouts of diarrhoea and constipation which lead to her suffering with anxiety. ‘At this stage I had a couple of blood tests and an ultrasound scan, which resulted in my IBS diagnosis at 14,’ she explains. Scarlett remembers being handed a leaflet about the condition and being told that she should just get on with life. ‘On a bad day I would need to go to the toilet 12 times a day,’ she added. Scarlett suffered with severe bloating, a common symptom of IBS, and resorted to buying a range of clothing sizes 12-16 to accommodate her fluctuating tummy. ‘I was trying to navigate being a teenager with all these embarrassing symptoms, and it was so all-consuming and unpredictable,’ she recalled. The lifestyle blogger remembered an experience in which she woke up in the middle of the night with excruciating stomach cramps and called 111, begging for an ambulance. ‘It sounds dramatic, but I honestly thought I was dying—it really was that awful and I couldn’t believe it wasn’t something really serious.’ After several unsuccessful visits to the doctor that resulted in being ‘told I needed to get my emotions in check

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and to get some counselling, or had anti-depressant medication pushed on me,’ Scarlett decided that enough was enough. She began to take matters into her own hands and that started with a closer look at her diet. In 2016, at a networking event held for bloggers, Scarlett was introduced to the probiotic supplement Alflorex. ‘I’d tried probiotics before, but the dairy type was no good for me and many have to be kept in the fridge, which is incompatible with my lifestyle,’ said the jetsetter. ‘Whatever they have done in terms of resetting my flora has really helped.’

Hear more ’s about Scarlett h experience wit IBS at xd ‘On top of the diet changes I have made it has really helped me to get in control of my symptoms and it feels so good,’ she added. Without Alflorex, something so simple as sharing a room with friends on holiday wouldn’t have been a possibility. ‘I feel like I have my freedom back.’ • dear doctor with dr Chris Steele 85

26/09/2017 09:50




Now she can live life to the full at home...

There are times when an older relative would love to live independently at home, but you’re worried about their wellbeing, especially if they’re infirm or affected by dementia. Well, now they can...thanks to GrandCare, an ingenious, easy-to-use ‘window on the world’ that keeps those you care for permanently connected to family, friends and their care circle.

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A simple demonstration is only a phone call away If you’d like to learn more call 0161 241 1777 for more information or to arrange a no-obligation demonstration. 0161 241 1777

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Living Did you know? If you are eligible, disability equipment and small adaptations in your home costing less than £1,000 are often provided free by your local authority Source: Age UK

door that allows low-level access for seniors with limited mobility.


Dear Doctor takes a look at the products and devices available to help you live more independently


ccomplishing everyday tasks can become difficult as we age and mobility becomes limited; but there are a range of products available to assist you both in and out of the house.

IMAGES © Shutterstock


Our increasingly busy lives leave us with little free time. When our elderly relatives are in need of extra care, this can be a problem. New software and devices have been developed over recent years that give caregivers the ability to care for their loved ones remotely. These include devices that can record how many hours a person sleeps, software that can provide medication prompts and sensors that monitor daily activity.

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As we age, we may begin to lose flexibility and strength, which can affect our balance and mobility. Standard toilets are built quite low which can make a trip to the toilet a chore. This is what makes elevated seats beneficial to elderly people. Products include commode seats and ‘toilevators’—a spacer that is placed beneath a toilet seat that adds inches to its height without changing its appearance. Walk-in baths and accessible showers are also a great alternative for individuals who require extra care getting in and out of the bath. This small modification to your home comprises of a bathtub with a

Grab rails can be an effective addition to your home, making moving from one place to another as easy as possible. Grab rails are typically attached to walls, though some companies also provide floor-to-ceiling rails. While they are usually placed in bathrooms, they can be installed anywhere around the house for additional support. Rails can provide you with balance and assistance to push or pull against when standing up.


Mobility scooters offer seniors with limited mobility an easy way to enjoy time outside of their home with independence. There are many mobility scooters available providing a variety of features appropriate for your specific needs. For example, some mobility scooters have tillers and controls that would suit those with arthritic fingers. • DEAR DOCTOR WITH DR CHRIS STEELE 87

26/09/2017 14:59


Happy, Independent


Dear Doctor demystifies the concept of retirement with useful tips on ever ything from health insurance to mobility—so you can live yours independently


s retirement approaches, there are a number of things to keep in mind—take our advice for a smooth transition into this significant period of your life.

Sort out your finances

Getting your finances in order is vital as you enter retirement; this step is key in securing your new way of life. You should start by calculating and claiming for your state pension. Most people will have also been saving into a pension pot throughout their working career, whether a personal or workplace one. There are a number of options for how you can use this money—you can choose to take out a cash lump sum, choose an income drawdown scheme or you can buy an annuity. When withdrawing a lump sum, it is important to remember that a certain amount is likely to be taxed. A drawdown scheme consists of reinvesting your pot in funds specifically designed for this purpose. Your income will vary depending on the funds you have invested in, making it a riskier option than annuity. An annuity allows you to set up an income for yourself with your savings. There are various factors to consider: do you want the flexibility of choosing where to invest your money or the certainty of a fixed income? Your age, lifestyle, family, health and care needs should all be elements that help to shape this decision. Talk to an adviser by visiting Pension Wise or the Pensions Advisory Service—both provide free impartial advice.

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26/09/2017 09:26




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13/09/2017 11:03

Hospital Care Within the Comfort of Your Own Home Our experienced team of nurses, physiotherapists and occupational therapists offer various recovery at home services for patients that have an acute illness. We pride ourselves on ensuring that we can offer you the treatment you want and expect, when you need it.

Our services which cover London and the surrounding areas include: •

Nursing care

Management of surgical drains


Medication administration

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Intravenous therapies


Complex wound care

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Blood monitoring


For more information call (020) 3137 5370 or visit Regulated and inspected by the Care Quality Commission (CQC)

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Staying active is important regardless of age. Whether you wish to keep up with vigorous exercise or do more relaxed activities, being outdoors always has a positive effect on wellbeing. Staying within the confines of your home or retirement community from day-to-day can be unhealthy—for the body and mind. Actively seeking a hobby outside of those boundaries is invigorating and a marvellous way to meet new people. If your budget is modest, try to visit your local parks or some of the nearby countryside.

IMAGES © Shutterstock


It can be easy to fall into the routine of spending your days in front of the TV or doing the same mundane activities. One of the benefits of retirement is being able to do the things you felt you couldn’t before—like learning a new

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Hospital care at home Home hospital care is fast becoming a popular choice for patients who prefer to be discharged from hospital early and continue the remainder of their treatment in the comfort of their own home. During their treatment, the patient remains under the care and accountability of a hospital consultant. Hospital care at home has various benefits for patients, such as offering them the opportunity to receive specialised one-toone attention from experienced nurses, physiotherapists and occupational therapists, such as those employed by HomeLink Healthcare. Patients receive care within a safe home environment, thereby reducing their potential exposure to hospital acquired infections. Patients can also maintain their lifestyle as treatment is usually provided at a time and place that is convenient for them— depending on the condition. This service even benefits hospitals by promoting earlier patient discharges, reducing admissions and freeing up beds.


26/09/2017 09:26


skill, reading more or to visiting that exhibition you never got to see. Testing yourself with interesting tasks will keep your mind sharp and fend off boredom. These pastimes don’t necessarily have to be physical; you could also take up painting, cooking or playing an instrument.

Consider your cover

During retirement many people start to consider taking on extra health cover. Private health insurance may not have been on your radar before, but as we age, our health inevitably declines— whether it is sight, hearing or blood pressure. It is best to do some thorough research on health plans that cater for seniors; remember to read the fine print and check if their offers are fixed. Some providers have strict rules on pre-existing conditions; this may affect the rate offered to you. While private healthcare isn’t essential, it can cut down waiting times and help ensure that you receive the best care to have you back on your feet and enjoying your spare time.

you take a fall—the emergency services can be called immediately. This option allows seniors to live without aid, providing a wider sense of freedom.

will be made much easier, giving you the independence to come and go when you please.

Stay mobile

One of the most common complaints among retired seniors is loneliness. After the children have moved out or a partner passes away, retirees often find themselves spending a lot of time alone. Many seniors have reported a lack of purpose after the structure of a career has ended. Getting in touch with old friends, forming alliances with neighbours and even getting involved in local societies can help you forge a network, which is really important during this time. Having companions nearby is also vital in case of emergencies; if your family isn’t close, it might be a friend you rely on during a time of need. •

Some seniors are held back by their lack of mobility. Enjoying retirement to the fullest can only be made possible if you are able to move freely by yourself. This problem affects some retirees more than others and unfortunately, this may result in these individuals having fewer opportunities to socialise. There are gadgets, however, that allow seniors to live a normal life without assistance. Home ramps create ease of access for wheelchair users, meaning safer entry and exit from the home. If walking long distances is hard, consider investing in a mobility buggy. Popping to the shops or enjoying the fresh air

Forge a network

Take precautions

Regardless of our fitness levels, as we get older it is smart to take precautionary measures to ensure personal safety. While nobody wants to suffer an accident, it is always a possibility. Personal alarms allow their user to move around freely without the worry of needing assistance. They usually consist of a small device worn around the neck or placed somewhere in the home. They also mean that if an accident does occur—for instance if


of pensioners say they would like to go out more often than they do Source: TNS Loneliness Survey for Age UK, 2014

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26/09/2017 09:26

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Future-proof your home with a Wessex Lift. With a space-saving design and stylish aesthetic appearance, there’s no better time to invest in one of our stunning home lifts.

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31/07/2017 16:22


On the Rise We outline the multiple uses and benefits of domestic home lifts for accessibility and improvements in mobility


ertical rise lifts can easily be installed within homes, helping residents move from floor to floor. The difference between a home lift and a stair lift is quite straightforward: rather than transporting you on a seat down the stairway, your home lift takes you between levels smoothly and safely—bypassing stairs altogether. Home lifts have seen a surge in popularity over the years, highlighting a growing need for independence in the elderly and immobile. They represent solutions for many individuals who are keen to uphold their sense of freedom and wish to continue their daily routines despite their physical restrictions.

IMAGES © Shutterstock; Wessex Lifts



of households with 1 or more disabled residents feel their home is not suitable for their needs Source: Disability in the United Kingdom Facts and Figures, 2016

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Various types of lifts are available on the market nowadays; making it easier to find one that is suited to your unique situation. From maneuvering a single step to descending multiple levels of the home, there are countless options to choose from. Most lift installers provide a tailored service, allowing customers to bend and adapt models as they see fit. Lift devices can be positioned beside the hallway or designed to transport you straight into your living room or upstairs bathroom. Home lifts can even be constructed for outdoor purposes, using the best materials to weather open-air environments. They can also accommodate for multiple passengers if needed. The malleability of this product means that your regular lifestyle can continue unhindered.


In the past an in-house carer might have been the only viable solution for people struggling with low mobility. Now vertical rise lift users can exercise more independence, making it possible for them to live alone. This marks a particularly significant leap forward for disabled or physically impaired individuals, allowing them to experience freedom like never before. From this perspective, home lift devices are having a positive impact on those who use them.


One of the most obvious benefits of installing a domestic home lift is the increased safety element it brings. Many accidents in the home occur when descending the stairs; this is especially true for elderly occupants. A gentle lift can dramatically reduce the chances of falls and preventable accidents. Many companies also offer a maintenance service, checking regularly that your lift is working to a high standard.


Being able to maneuver through our home freely is something we take for granted. Wheelchair users and people suffering from other incapacities can often be limited when choosing appropriate housing. A 2014 report by Leonard Cheshire Disability found that as many as 54 percent of those with mobility impairments who had looked for accessible homes said they were difficult to find. Only four percent said they were easy to find. With new lift devices and technology, people with disabilities may feel that they have more options; perhaps enabling them to get into the property market more easily. • DEAR DOCTOR WITH DR CHRIS STEELE 95

26/09/2017 09:27


Superagers: Keeping Your Mind Sharp

We investigate the secrets behind the superagers—seniors who have outstanding mental and physical traits that would rival a 20-year-old’s


ne of the most concerning aspects of growing older, for many, is the concept of losing mental capacity. As we age our brains begin to shrink in volume, this eventually leads to a decline in memory, productivity and efficiency. The age at which this change begins has recently been scrutinised. While it was originally believed to commence during our 50s, some sources suggest that human cognitive ageing can start earlier. ‘The natural decline of some of our mental abilities as we age starts much earlier than some of us might expect,’ according to Rebecca Wood, Alzheimer’s Research Trust. Professor Timothy Salthouse of the University of Virginia reinforces Wood’s theory with his research, which suggests that spatial visualisation and speed of thought

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both start to decline in our late 20s. However, a group of people that do not fall victim to this process are ‘superagers’. Scientists use this term to refer to seniors with outstanding memory and cognitive skills. The phrase was originally coined by Marsel Mesulam, a neurologist from Northwestern University, Chicago. A recent study conducted by Massachusetts General Hospital and Northeastern University in Boston analysed data taken from 40 participants between the ages of 60 and 80. The experiment measured the results rendered from this senior group, comparing them with those of subjects aged between 18 and 35. Participants were given a grammatical recall test whilst undergoing functional magnetic resonance imaging, which provides images of the brain in action.

Almost half of the seniors performed as expected while the other portion showed astounding mental capacity, which was on par with that of people in their mid20s. The individuals who performed as expected showed thinning in certain areas of the brain—a normal indication of cell loss and deterioration. These particular regions of the brain—such as the hippocampus, anterior insula, midcingulate cortex and medial prefrontal cortex—are renowned for their assistance in information retention, language and sensory input coordination. They also regulate thoughts, emotions, hormones and the immune system. The superagers, however, did not show such signs of thinning in these important regions— they were much thicker and showed healthier connectivity.

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IMAGES © Shutterstock

It is never too early to begin the preservation of your memory—this is known as cognitive reserve. While there is no specific way to sharpen your mind, there are some known factors that may reduce cognitive degeneration. These are: Mental exercise Forms of ‘mental exercise’ require us to expend considerable effort. Sudoku or memory apps may seem like a good option but are unlikely to dramatically improve cognitive coherence. Instead, trying to understand completely new concepts is more likely to maintain a healthy brain. Consider mastering a new language or a subject you’re not familiar with. Physical exercise The same hypothesis can be applied to physical exertion. In addition to being a great weight loss solution,

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regularly undergoing vigorous exercise can help us retain our brain’s working functions. The right kind of stress Stress—more specifically chronic stress—can have a detrimental effect on our health. However, some types of stress are said to be good for you—namely, the kind that come with hard work or the challenge of a new obstacle. Our nervous system is built in a way that allows us to combat this occasional stress, using it to get the job done. Plenty of shut-eye Sufficient sleep is known to clear out certain ‘wastes’ from the brain known as beta-amyloid plaques—these are linked to dementia. Our body works overtime during our sleeping hours to restore and improve our immune system, therefore getting the required hours is a must. Research into this particular topic is relatively new; there are aspects that are yet to be

Put your mind to the test To test your reasoning skills, verbal ability and short-term memory, check out the Cambridge Brain Sciences online 10-minute tests at

explored. At the moment, studies cannot definitively prove whether superagers are born or made. What we can establish, however, is that building the brain’s circuitry can be managed by regularly expending effort—whether that is mentally or physically. •


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Seasonal Affective Disorder A slump in energy and low moods could be early signs of seasonal affective disorder—but what exactly is it?

IMAGES © Shutterstock


easonal affective disorder (SAD) is a depressive illness that typically occurs between September and April when the days become shorter and darker. While it can affect anyone of any age, symptoms commonly begin between the ages of 18 and 30. The disorder— also known as ‘winter depression’— often improves when the spring and summer months arrive. From a medical point of view, it is still not entirely clear why people suffer with SAD. Some believe that the lack of sunlight during the autumn and winter months may impede the function of the hypothalamus in the brain, disrupting the body’s circadian rhythm. This may reduce the production of serotonin—the hormone connected to mood levels—and over-stimulate the production of melatonin, the hormone that makes you feel tired.

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The most common symptoms for SAD include feeling lethargic, problems with sleeping, anxiety, loss of libido, cravings for foods high in carbohydrates and sugar and a weak immune system. This malady is often diagnosed when sufferers have experienced two to three consecutive winters of SAD. The National Institute for Health and Care Excellence (NICE) advises that treatment for SAD should be approached as with any other form of depression. There are many ways to tackle depression, including cognitive behavioural therapy (CBT) and antidepressants.

BEAT SAD Spend time outside. Our brains haven’t adapted to modern living where a lot of us work in offices. A walk in the morning or a lunch break spent outside can help regulate melatonin and serotonin levels.

Did you know? SAD affects around 2m people in the UK Source: NHS Choices

Exercise. A regular workout can have a profound effect on our mood. Exercise releases feel-good endorphins in the brain—a brisk walk or light jog during the lighter hours of the day will help to relieve stress and regulate sleeping patterns. Eat healthy food. While carb-heavy and sugary foods might give a temporary boost in energy, they also increase insulin and lower blood sugar levels leading to unhealthy cravings. Keep carb and sugar cravings down with healthy protein-rich alternatives such as legumes and nuts. • DEAR DOCTOR WITH DR CHRIS STEELE 99

27/09/2017 08:47


Age Well: Healthy Hair and Skin

As we age, physical changes in our hair and skin are a normal part of life. We guide you on how to treat, manage and—possibly—prevent them


s time goes by, our bodies inevitably change. Some age-related physical transformations may even come as a surprise to those affected. Our hair and skin are, more often than not, the two features that will undergo the biggest changes. These are natural and should not be feared, but instead identified and tackled appropriately. There are various preventative methods and treatments to help your body adapt to the passage of time. 100 DEAR DOCTOR WITH DR CHRIS STEELE

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From the age of 60, individuals will start to notice changes in the condition of their hair. It may become thinner in diameter and may gradually shed more. Women in particular can suffer from a ferritin deficiency—a lack of iron stored in the hair which can lead to hair loss. This is usually caused by menopause, which speeds up age-related physical changes as a result of androgens being released into the body. As they

How to treat a dry scalp An effective method for treating a dry scalp and brittle hair is to nourish the affected area with stimulating anti-androgenic drops. These are available online or in pharmacies. You may consider trying moisturising masks; these can be left to soak into the hair follicles overnight for the best results. You can even take preventative measures such as using a gentler hairbrush with a cushioned base and rounded prongs to avoid extra hair breakage. If you feel that your hair has shown no improvement, consult with your doctor. They may prescribe supplements to boost your hemoglobin—the protein molecule in red blood cells that carries oxygen from the lungs to the body’s tissues—with vitamin C and iron.

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age, both men and women will notice that sebum (oil) levels in the scalp decrease, leading to a dry scalp and a more brittle texture to the hair.

IMAGES © Shutterstock


Your skin acts as a protective barrier between internal tissues and the environment. It is, therefore, only natural that the passage of time will leave its mark on this important organ. As you mature, your skin will naturally retain less moisture, causing dry patches more prone to wrinkles. The dermis, or middle layer of the skin, starts to break down more collagen and elastin as time goes on. As a result of this, the skin may change in texture, losing some elasticity and firmness.

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Environmental and biological factors may also start to affect the appearance of the skin. The degree to which these changes occur will all depend on your lifestyle: diet, activity level and even geographical location all have a part to play. Sunspots and freckles will emerge on those who have frequently used less sun protection than others over the years. Ageing skin is also more prone to conditions such as psoriasis—a noncontagious disorder that causes dry, red and flaky patches of skin often with silvery scales. This relatively common ailment will usually remain localised to certain areas on the body and can cause discomfort and itching around the scalp, arms, knees and elbows. •

Your skin will require new forms of care as you age. It will become increasingly important to replenish the moisture that is naturally lost from your body. Using an emollient moisturiser is recommended for penetrating the skin. Seek out lotions that are specifically designed for mature skin— some products are infused with collagen for an extra boost. For conditions like psoriasis, contact your doctor for a detailed review of your treatment options. They may suggest using a tar shampoo if your psoriasis is located on the scalp or a tar solution for bathing in. Smoking, high stress levels and dry climates can also exacerbate irritated skin—try to avoid these if possible. You should also aim to stay hydrated to prevent any further skin conditions or complications from arising. In regards to sunspots, try to take preventative action by wearing a high factor sunblock, even on days that are overcast. Seniors are also at higher risk of skin cancer. Be vigilant with any moles that look irregular in colour or shape, and make sure to seek medical advice if you notice something’s amiss.


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Resolving Dry Skin Conditions Discover the triggers, treatments and self-help techniques for some of the most common dry skin conditions Using emollients at home Emollients are often prescribed for dry skin problems and can come in ointment, cream or oil form. For the best results, use emollients on damp skin immediately after a shower

D IMAGES © Shutterstock

ry skin conditions can cause pain and irritation on a daily basis, disrupting people’s lives and routines. As a result of them, patients have also been known to suffer psychological distress. Fortunately, many of these ailments have applicable resolutions. Discover some of the most common dry skin conditions and how to treat them.


Eczema is very common in the UK; it involves dry patches of skin that become cracked and sore. Eczema is initiated by skin that is unable to retain moisture, causing it to become dry and irritated. Common triggers for eczema include

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allergens (dust mites, pet fur and pollen), irritants found in soaps and detergents, skin infections, hormonal changes and environmental factors. Doctors usually prescribe emollients (moisturising treatments), topical corticosteroids (to reduce swelling and redness) and selfhelp techniques to reduce scratching.


Psoriasis is an immune condition that causes redness, itching and inflammation of the skin and joints. The condition is instigated by the speeding up of the body’s skin production. In non-sufferers, this cycle typically takes a month. In psoriasis patients, however, this process can take as little as a few

days. This causes a rapid buildup of skin cells and initiates a scaling effect on the surface of the skin. Patches can appear on the face, neck, hands, knees and scalp. Topical corticosteroids, salicylic acid and vitamin D analogues are all treatment options offered by doctors to tackle psoriasis. Medicated shampoos may also be necessary for those whose condition is centralised on the scalp.


This condition causes persistent dry skin patches that are thick and sometimes resembe fish scales. The face and bends of the elbow are regions most commonly affected by ichthyosis. The condition is a result of a faulty gene that is passed on from parents—this defect disturbs skin regeneration. Symptoms of ichthyosis are usually exacerbated by cold and dry weather conditions but can improve in warm and humid climates. A daily routine of moisturising and exfoliating should be adhered to in order to prevent the buildup of skin cells. More extreme cases may require an emollient for extra care. • DEAR DOCTOR WITH DR CHRIS STEELE 103

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25/07/2017 08:51


Best Foot Forward Your feet deser ve the best care possible—follow our tips on tackling dry and cracked feet


any of us spend a lot of time on our feet; constantly being on the move can take its toll. Ill-fitting footwear and frequent impact on the soles of the feet can lead to dry and cracked skin. Without an adequate footcare regime, cracks can steadily worsen and become painful, keeping us from enjoying an active lifestyle. This becomes an even greater issue as we age; thinning of the skin and heightened sensitivity mean extra care should be taken. Follow our tips for beautiful and pain-free feet.

IMAGES © Shutterstock

SOAK Make yourself a footbath by filling a bowl with warm water. Mix in scented soap or oil for a more luxurious experience. Leave your feet to soak for at least five minutes. This will soften your skin and allow hard patches to be removed easily.

SMOOTH Use a foot file or pumice stone to rid yourself of hard and dead skin. This

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will be made easier after your feet have been allowed to soak. Focus on the heels and other areas that receive the brunt of the impact from walking. Consider using a foot scrub—these are great for smoothing roughly textured spots.

MOISTURISE Dry skin needs constant hydration and protection. The best way to achieve this is through a nourishing moisturiser or gel cream. Aim to moisturise your feet regularly—at least once a day—covering the whole foot and sole, avoiding only between the toes.

FILE AND CLIP Trimming your toenails is very important; it should be done regularly and with care. Using proper toenail clippers, cut straight across rather than at an angle. Avoid cutting down the edges, this can cause ingrown toenails to form. •

Repair dry feet Have you been left with uncomfortably dry skin on your feet from spending the summer in flip flops and sandals? Whether you enjoyed a British staycation or a holiday overseas, it is likely that your feet have been exposed to frequent changes in temperature, barefoot walks on the sand and dips in the sea. This may mean that the skin on your feet is now much drier than it was at the start of summer. To repair dry and cracked skin and to maintain moisturised and supple feet, it is important to regularly apply an intensive foot cream in the morning, before bedtime and as needed throughout the day. O’Keeffe’s Healthy Feet foot cream is a highly effective moisturiser, essential for healthyfeeling and hydrated skin. Its unique formula penetrates deep into thick and rough skin, providing relief for extremely dry, cracked feet. Your feet will be ready for the party season ahead!


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Foot complications are common in people with diabetes. It is estimated that 10% of people with diabetes will have a diabetic foot ulcer at some point in their lives.1 People with diabetes may have reduced nerve function due to peripheral diabetic neuropathy.2 This means that the nerves that usually carry pain sensation to the brain from the feet do not function as well and it is possible for damage to occur to your foot without feeling it. Standing on something, wearing tight shoes, cuts, blisters and bruises can all develop into diabetic foot ulcers.2 If you are diagnosed with a foot ulcer your health care professional will use a wound dressing to help protect your foot ulcer and encourage the healing process.

Flaminal® is a versatile wound dressing that has a number of positive effects on the ulcer including an antimicrobial action. The wound exudate containing microbes is absorbed into the wound dressing wherein it executes this antimicrobial action. It helps defend against infection and contamination of the wound and can help speed up the healing process.3,4 It is also effective against MRSA which is a type of bacteria that is resistant to a lot of antibiotics.3 Flaminal® is easy to apply. Ask your healthcare professional if Flaminal® is an appropriate treatment for your foot ulcer.

For more information please contact Flen Health at or Tel: +44 (0) 207 872 5460

Visit our website References 1. accessed on 28th July 2017 2. accessed on 28th July 2017 3. De Smet, K. et al. Pre-clinical evaluation of a new antimicrobial enzyme for the control of wound bioburden. Wounds. 2009;21:65–73. 4. De la Brassinne, M. et al. A novel method of comparing the healing properties of two hydrogels in chronic leg ulcers. J Eur Acad Dermatol Venereol. 2006;20:131–135. © Copyright 2017 Flen Health UK Ltd. Flaminal Forte, Flaminal Hydro and Enzyme Alginogel are registered trademarks of Flen Health SA.

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Diabetic Foot Care Foot care is par ticularly impor tant for those with diabetes. Taking precautionary measures to avoid ulcers and cuts is key

IMAGES © Shutterstock



oot-related complications are common for those suffering from diabetes. This is because the condition often involves a reduction in blood supply—especially to extremities like the legs and feet. The severity of these complications can vary depending on the patient. If untreated, they can eventually lead to peripheral neuropathy: a loss of feeling in the area. Around one out of 10 diabetics suffer with foot ulcers. These injuries may begin small but can grow larger, become infected or fail to heal properly. As they linger, more rigorous treatment may be needed to restore the area back to health. Remember that these lesions can be prevented with the right care— follow our handy tips for peace of mind.

One of the most important things to keep in mind is cleanliness. You may have a sanitary routine but you should take extra measures to ensure your feet are hygienic and free of infection. Try giving yourself a footbath each evening with a perfume-free soap, drying thoroughly with a fresh towel.



If you are diabetic, you should aim to visit a podiatrist at least once a year. If yours is a long-term condition, you should be eligible for a visit to an NHS podiatrist every year—talk to your doctor for more details on referrals.

Avoid walking barefoot, even in your own garden or on the beach. Steering clear of unnecessary scrapes and cuts is essential to preventing ulcers—these are more likely to develop without the right foot protection.

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If you do notice any loss of feeling, ulcers or deformation, contact your doctor or podiatrist immediately for the best advice on treatment WARD OFF GERMS

GET THE RIGHT FIT Inadequately fitting shoes can cause anyone discomfort, but for those with diabetes they may pose a serious health risk. Squeezing or rubbing of the feet can produce calluses, corns, ulcers or nail issues. Shoes made with natural materials like genuine leather will mould to the shape of your foot. You may even consider getting custom-fit shoes for extra security and peace of mind.

KEEP TRIMMED You should aim to keep your toenails trimmed and tidy—this will mean shoes are worn more easily and fewer places for bacteria to collect.

PUT YOUR FEET UP While diabetes shouldn’t restrict your ease of movement too much, you should aim to avoid long periods of being on your feet. Extra pressure on your legs won’t help the diminished blood flow, so it’s important to take it easy when walking. • DEAR DOCTOR WITH DR CHRIS STEELE 107

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21/07/2017 15:16


Parkinson’s Disease

Around 127,000 people in Britain suffer with Parkinson’s disease; Dear Doctor explores this complex and debilitating condition


he most common type of Parkinson’s disease is idiopathic Parkinson’s. This type refers to the loss of nerve cells in an area of the brain called the substantia nigra which leads to diminishing levels of the chemical dopamine. Dopamine is a neurotransmitter that sends signals throughout the body’s nervous system and helps control motor function and healthy cognition. When dopamine levels are dangerously low, the part of the brain responsible for mobility isn’t able to work properly which can lead to slow and abnormal movements—a common physical symptom of Parkinson’s. Specialists have not yet been able to identify what causes the loss of nerve cells that result in Parkinson’s disease. However, researchers have hypothesised that it may be in part due to environmental factors such as chemicals like pesticides and herbicides used largely in farming and industrial pollution. It has also been suggested that genetics may play a role in whether a person is susceptible to Parkinson’s disease, but the chances of this are low. According to Parkinson’s UK, this happens in five out of every 100 cases of the disease. The condition is progressive, meaning that it may worsen over time. At present there is no cure.


Symptoms for Parkinson’s disease can vary from person to person but 110 dear doctor with DR Chris Steele

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PARKINSONISM Parkinsonism is an umbrella term that describes various conditions with similar symptoms to that of idiopathic Parkinson’s disease. Vascular Parkinsonism Vascular Parkinsonism occurs when there is restricted blood supply to the brain. People who have suffered a mild stroke may suffer from vascular Parkinsonism. Most often, this affects individuals with conditions such as diabetes and heart disease. Those with vascular Parkinsonism are likely to experience similar symptoms typical of Parkinson’s disease including slowed and abnormal motor functions.

typically involve tremors. Tremors are uncontrollable trembling, shaking and involuntary movements of parts of the body such as the hands and arms. Other key symptoms associated with Parkinson’s disease include slow movement and rigid muscles, but not every sufferer will experience all of these symptoms. Individuals who have been diagnosed with Parkinson’s disease may experience a variety of other physical and psychological symptoms including anxiety, depression, memory problems, insomnia, loss of smell and issues with the bladder or bowels.

IMAGES © Shutterstock


While there is currently no cure for Parkinson’s disease, there are various treatments available to help reduce and control its main symptoms. Occupational therapy. This helps sufferers continue to perform everyday tasks when physical symptoms begin to impede their ability. Drug treatments. The most common form of treatment offered to those with

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Parkinson’s, drug treatments work to increase the levels of dopamine in the brain. These drugs also aim to stimulate the areas of the brain where dopamine is produced and block enzymes that break the chemical down. As with all drug treatments, medication used to treat Parkinson’s disease may come with side effects— these may vary depending on the type of drug administered. Common side effects include dyskinesia, hallucinations and impulsive or compulsive behaviour. Surgery. Surgical treatments are offered when symptoms of Parkinson’s disease cannot be controlled using medication. The most common surgery performed is deep brain stimulation (DBS) which is used to treat neurological symptoms of Parkinson’s such as tremors, rigid muscles and slow movements. A neurostimulator is implanted into the brain to deliver electrical stimulation to targeted areas in the brain that control movement. •

Drug-induced Parkinsonism Dopamine-blocking neuroleptic drugs that are commonly used to treat schizophrenia and manic depression may cause users to experience drug-induced Parkinsonism. This type is found in around seven percent of those diagnosed with Parkinsonism. In most cases, those with drug-induced Parkinsonism will recover shortly after ceasing use of the drug.

Did you know?

1 in 20

people with Parkinson’s first experience symptoms under the age of 40 Source: Parkinson’s UK


26/09/2017 09:43


The Latest in

Knee Replacement Surgery Knee damage can affect people of all ages, dramatically reducing their quality of life. Dear Doctor investigates the newest advances in knee replacement technology


dvances in technology are progressing certain medical procedures and catapulting them into new realms of discovery. With each new breakthrough, patients are presented with more positive outcomes and better opportunities for recovery. Arthroplasty—or knee

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replacement surgery—is among the procedures which have benefited from technological advancements.

What is it?

Arthroplasty involves replacing the bone of a damaged knee. A patient undergoing knee replacement surgery will be administered general

anesthetic before the surgeon begins to remove the worn ends of the bone in the knee. The bone is then replaced with a metal or plastic implant known as a prosthesis, which will be measured to fit before the procedure. There are two main types of knee replacement surgery: total knee replacement (TKR), where both sides

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of the joint are replaced; and partial knee replacement (PKR), where only one side of the knee is replaced during a smaller operation. TKR is an invasive procedure that comes with both risks and benefits; serious consideration— and thorough research—is advised before undergoing the operation. Recovery time varies from patient to patient. When ready to leave the hospital, patients are usually given crutches and a course of physiotherapy to strengthen the knee.

When is it necessary?

Knee replacement is necessary when the joint has been damaged to the extent that movement or everyday activity is seriously impaired. The surgery is offered as a last resort if other methods such as steroids and physiotherapy have been unsuccessful. Patients most in need of knee replacement surgery are those who suffer from osteoarthritis. Other common causes for knee damage include rheumatoid arthritis, gout, haemophilia, knee injury and avascular necrosis.

Former methods

One previous technique for knee replacement surgery involved the positioning of a rod along the femur; depending on where the rod sat was where the first incision would be made. This was a risky practice: the rod would often displace the bone marrow and interrupt the veins in the femur. As the femoral bone is bowed rather than straight, this method was also found to be quite inaccurate.

IMAGES © Shutterstock


Advancements in technique and equipment have created options that are more effective yet less invasive for arthroplasty patients. Experienced practitioners are beginning to offer the option of creating 3D models of the knee prior to the surgery using CT scan data to fit the specifics of the patient. A custom-made implant is then designed from these models. This is intended to reduce the chance of an ill-fitting joint and the need for further surgery.

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In April this year, experts at Duke University in North Carolina had a breakthrough whilst testing 3D-printing techniques to assist with knee replacement surgery. They found that they could create printable synthetic cartilage that could be perfectly shaped to fit a knee joint. Human knees have a thin fibrous cartilage between the surfaces of the joints called menisci—this cushions connected joints when we walk or move. The scientists at the North Carolina university have been the first to create a new hydrogel-based cartilage, which matches that of the body in strength and elasticity, whilst also being 3D-printable and stable. Not only does this new technology fit perfectly, but it also supports the growth of new cells to encourage healing around the site of injury. The cartilage was made printable by mixing two types of hydrogel together with a special kind of clay—an innovative idea that had not yet been tried before. This research was published in the

journal of ACS Biomaterials Science and Engineering. Dr Benjamin Wiley, associate professor of chemistry at Duke University, commented: ‘We’ve made it very easy now for anyone to print something that is pretty close in its mechanical properties to cartilage, in a relatively simple and inexpensive process.’


Alternative surgeries to knee replacement include osteotomy—an open operation whereby the surgeon cuts the shinbone and realigns it so that weight is distributed away from the damaged part of the knee—and mosaicplasty. Mosaicplasty is a keyhole operation that involves transferring plugs of hard cartilage and bone from another part of the knee to repair the damage. If you are suffering from knee joint discomfort, consult your doctor for advice on the best course of action. • dear doctor with dr Chris Steele 113

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Should You Choose

Laser Therapy? REMEMBER Patients should be cautious when opting for laser therapy treatment. Lack of regulation means that as long as a therapy laser is able to prove safety, it can be sold. Therefore, results may vary depending on the therapy laser used

Laser therapy is becoming increasingly popular as more people suffering with acute and chronic pain seek less invasive methods of treatment


aser therapy is thought to be an effective treatment in reducing pain and promoting wound healing by using red and near infrared light to stimulate and accelerate tissue regeneration. Lasers are tuned to specific wavelengths in order to target molecules in the body’s cells. These laser beams allow manual therapists, doctors and surgeons to concentrate on small areas of the body that require medical attention with no risk to the normal surrounding tissues. Patients who opt for laser therapy may experience less pain, swelling and scarring than would normally occur when the body’s tissues heal post-surgery without a therapeutic laser. 114 DEAR DOCTOR WITH DR CHRIS STEELE

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According to Dr. Stephen Barabas, director of K-Laser UK, ‘“Therapy Laser” targets molecules in the cells to enhance and photo-biostimulate tissue regeneration via specific wavelengths directed at chromophores (colourpigments present in molecules) in the body’s cell molecules’. Biochemical change occurs when the light from a red or infrared therapy laser is absorbed by the chromophores. ‘This has the effect of “healing” damaged tissues, reducing the inflammatory response and improving blood flow and oxygenation to and from the affected area, accelerating metabolism and reducing scarring,’ Stephen says. According to Dr. Barabas, laser therapy has been proven to be effective on neuropathic conditions such as fibromyalgia and polymyalgia providing considerable pain relief to sufferers. It accelerates healing in wounds, such as bedsores and diabetic ulcers, that require enhanced blood flow and metabolism to stimulate an active healing environment.

Reduced fibrous tissue formation. Laser therapy can help to reduce the formation of scar tissue following damage from cuts, burns and surgery. Reduced pain. Laser therapy is reported to have an analgesic affect; this works by decreasing nerve sensitivity and releasing endorphins—the body’s natural pain reliever, in addition to reducing swelling and tissue inflammation. Faster wound healing. Laser therapy works to stimulate collagen production, blood flow and oxygenation to damaged tissues. Anti-inflammation. Laser light therapy can cause a process called vasodilation, which dilates blood vessels and enhances microcirculation. It also activates the lymphatic drainage system, which reduces swelling caused by inflammation or bruising. Diabetes. This treatment may be used in healing chronic non-healing wounds in diabetic patients and simultaneously reducing diabetic neuropathic pain. Osteoarthritis. When laser therapy is applied over the course of several weeks, it may reduce chronic pain caused by conditions such as osteoarthritis, dramatically improving quality of life for sufferers. • >>This article was written with the help of K-Laser UK.

IMAGES © Cour tesy of K-Laser UK


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A New Revolution in Managing


Knee Arthritis and Cartilage Injuries

nee replacements are a common procedure and their success has revolutionised the management of knee arthritis in recent years. Despite this, one in five people are still not happy following knee replacement surgery and this is either due to some ongoing pain, stiffness, lack of expected function or a combination of these. Some of the reasons for this 20 percent dissatisfaction rate can be attributed to: Sizing of the implants. During surgery, the knee is sized and an implant size is then chosen. But with routine knee replacement designs, there are only a set number of sizes and the best fit decision with the available implant is made. Due to this, there is sometimes a subtle variation in sizes which can sometimes lead to an overhanging of the components. This can cause soft tissue irritation and impingement leading to some ongoing pain following surgery. Positioning of the implants. Adequate positioning of implants at the time of knee replacement surgery is vital to avoid any rotational mal-alignment which can lead to anterior knee pain and patella (knee cap) tracking problems. This is routinely done manually at the time of surgery, but again—subtle variations in mal-positioning can lead to problems following surgery.


Patient-specific total and partial knee replacements address these issues by designing implants which are specific to you. The implants themselves and implant positioning surgical blocks are manufactured based on your anatomy to improve sizing and positioning of your knee replacement. This helps to improve the dissatisfaction rate that may be contributed by these issues. This is 116 DEAR DOCTOR WITH DR CHRIS STEELE

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achieved by having a CT scan of your knee. The images are used as a template and with 3D-printing technology, your implants are manufactured—usually taking four to six weeks. Other advantages of patient-specific knee replacements reported are: • Better subjective satisfaction rates • Shorter in-hospital stay • Quicker recovery following surgery


Localised cartilage knee injury sometimes cannot be treated successfully with arthroscopic (keyhole) surgery. It may also not be treated successfully if you have had a previously failed arthroscopic surgery procedure that caused pain and loss of function. There are only a few options available in this scenario apart from waiting for a partial or total knee replacement procedure. This may not be an ideal solution for a localised cartilage lesion.

Patient-specific knee resurfacing procedures address this and use an MRI scan of your knee to create a patient-specific implant that is sized and anatomically matched to your cartilage defect. This is used through a minimally invasive technique to successfully seal off the cartilage defect. Advantages of this are: • Minimally invasive procedure • Short hospital stay • Knee joint preservation option that delays the need for partial or total joint replacements • Improves pain and function by directly addressing the cartilage defect. •

27/09/2017 10:16

Stop Living with Knee pain…..

…get moving again ! Comprehensive Knee Care Service  Cutting edge evidence based management options for your knee  Innovative treatment plans to get you back on your feet  Early access clinic appointments available throughout the NorthWest  One Stop Knee Clinics to streamline your care “Just to say a big thank you for doing such a good job on the surgery to my knee. You have done wonders with my knee as I don’t feel such severe pain that I did have before the surgery.”

SERVICES OFFERED: » » » » » » » » » »

Patient specific knee replacements for knee arthritis Patient specific knee resurfacing implants for cartilage injuries Partial knee replacements Knee ligament reconstruction Cartilage Reconstruction and Regeneration Acute knee injury clinics Management of early arthritis PRP and viscosupplementation injections Stem cell therapy Joint preservation surgery

MR. FAHAD G. ATTAR E: T: 0161 393 3996

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“I was most impressed with the excellent treatment I received, both during and later after surgery…” “I take this opportunity in thanking you most sincerely for your help, dedication, excellent surgery and pleasant bedside manner… you are a true gentleman and a credit to the medical profession.”

In Association with

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Complement Genomics Ltd.indd 1

30/08/2017 14:33


In Our Blood

While uncomfor table for many, DNA testing can give individuals priceless insight into their genetic code

Did you know? Genetic counselling services are available for individuals who wish to receive support, information and advice about genetic conditions. Sessions may involve learning about a health condition that runs in your family, a closer look at your medical history and understanding your DNA tests


lood tests are carried out for a variety of reasons. For a clearer insight into genetics and overall health, people are choosing to undergo DNA testing to diagnose a specific condition, work out the chances of developing a particular disease or determine whether they are carriers of a genetic mutation that could be inherited by offspring. Depending on the condition being tested for, these DNA samples will be examined in a laboratory. So, what are the pros and cons?

IMAGES © Shutterstock


When dealing with health, preventing illness is always better than finding a cure—DNA tests are making prevention efforts easier. Genetic testing allows the identification of potentially harmful genes, allowing for forward planning and a sense of

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relief from medical uncertainty. In one of the most high-profile cases of this, actress and humanitarian Angelina Jolie opted to have a mastectomy and hysterectomy after discovering that she had a mutation in cancer-suppressing genes BRCA1 and BRCA2. The mutation effectively caused a hereditary breast-ovarian cancer syndrome. It is undeniable that DNA testing can provide unparalleled knowledge on our health and how to preserve it for as long as possible, though it’s up to us to decide what to do with this information. Support groups and sessions are available to help with this.


One of the greatest limitations of this type of DNA testing is that, in some cases, it may induce a false sense of security in patients. It is

important to keep in mind that just because—for example—you receive a positive result for a ‘harmful’ gene, this will not necessarily mean you will develop the disease. More crucially, a negative result for a ‘harmful’ gene does not guarantee you won’t be affected by that disorder in your lifetime. In either scenario, talking with your doctor or specialist about your results is an important step in the process of safeguarding your health.


For individuals at risk of having a child with a serious genetic condition, pre-implantation genetic diagnosis (PGD) is a viable option. This involves using IVF. The resulting embryos are tested for mutation and two unaffected embryos are then transferred into the uterus. • DEAR DOCTOR WITH DR CHRIS STEELE 119

26/09/2017 09:49


Coping with

Alzheimer’s Alzheimer’s is a disease that requires careful management and support—find out how carers and patients can control it


lzheimer’s disease is the most common form of dementia, affecting approximately 850,000 people in the UK today. It is a neurodegenerative condition that usually starts slowly and progressively worsens over time. The precise causes of Alzheimer’s are still unknown; ongoing research is being carried out by charities and privately funded organisations on the topic. A paper by Ballard C. et al. in 2011 proposed that 70 percent of the risk factors are tied to genetics. While this hypothesis has merit, only further research and studies will be able to confirm it. 120 DEAR DOCTOR WITH DR CHRIS STEELE

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Alzheimer’s sufferers experience atrophy, or shrinking of different parts of the brain including the hippocampus. This process negatively affects brain structure and function in these areas. Another similarity among Alzheimer’s patients is the presence of amyloid plaques (abnormal protein deposits in the brain) along with imbalances of a chemical called acetylcholine. There are currently no treatments that can stop or reverse the disease’s progression, however, there are some measures that can be taken to alleviate its symptoms.

SIGNS AND SYMPTOMS Early symptoms of Alzheimer’s are often confused with natural signs of ageing such as forgetfulness, confusion, obsessive and repetitive behaviours and hesitation to make decisions. Behavioural changes— such as agitation and anxiety—are also characteristic of the disese. As Alzheimer’s advances, some symptoms may worsen and new ones may appear. Other symptoms can involve mood swings and depression along

with disturbed sleep, delusions, hallucinations and trouble with performing spacial tasks. Sometimes, individuals with Alzheimer’s may become violent or suffer significant problems with speech. If this is the case, the individual will likely need a higher degree of care to help them cope. In extreme cases, patients will need full-time care to aid them in performing daily tasks and keep them safe. Depending on the severity of the condition, this responsibility and level of attention can put strain on family members who do not have the resources or medical skills to look after their relatives. Some families may decide to employ a qualified carer or may request the sufferer stay in a care facility.

MANAGING ALZHEIMER’S: FAMILY AND FRIENDS While it can be upsetting to see a loved one suffer from a serious illness, your positivity will be hugely beneficial to their wellbeing. Follow Dear Doctor ’s tips on managing

26/09/2017 09:48


Alzheimer’s from the perspective of family and friends: Offer your support sensitively—try not to criticise what they do out of anger or confusion. This is one of the best ways to help. You can employ memory aids around the house—this is especially helpful for those in the early stages of Alzheimer’s. Try to label things clearly and leave reminders for your dependent. Maintain their healthy diet. It is still extremely important to uphold their nutrition; try to encourage balanced meals and different forms of exercise. Try to involve them in their food preparation; this will alleviate any anxiety come mealtime. Suggest creative activities. This has a soothing effect and can pose as a good distraction. Try to remove distractions and background noise when communicating or socialising—this may help their focus. Give them plenty of time. Patience, in all manners of the word, is vital. They may take longer periods of time finding their words or understanding situations; your positive attitude can improve their feeling of security. •

Managing Alzheimer’s: sufferers

IMAGES © Shutterstock

Being the sufferer of a degenerative disease can be lonely and frightening at times. It can also be hard to know how to get treatment and how to communicate with those around you. Try the following: Your condition may cause you to withdraw and shy away from social situations. If you fear being in large groups, arrange visits with one or two close companions instead.

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A number of medications are available that temporarily improve some symptoms and slow the condition’s progression. These include donepezil, galantamine and rivastigmine (known as AChE inhibitors)—they are prescribed for early to mid-stage sufferers. Consider seeing a therapist. Therapists can identify elements of your everyday life that are difficult or problematic and work with you to

devise strategies to manage them. Try assistive technology. These are devices that can help you maintain independence. They may come in the form of an alarm system or a way of tracking your movements. Keep a diary of your activities. This will help if you feel lost or confused. Create a weekly timetable to give yourself a structure. Label cupboards and objects to make sure your surroundings stay familiar.


26/09/2017 09:48


✔ Cosmetic Surgery

✔ Bed Sores

✔ Dental

✔ Brachial Plexus Injuries

✔ Failure To Diagnose

✔ Cerebral Palsy

✔ Gynaecology And Fertility Claims

✔ Claims Against GPs

✔ Late Diagnosis And Misdiagnosis Of Cancer ✔ Maternal Injury Caused By Childbirth ✔ Orthopaedic ✔ Shoulder Dystocia

✔ Infection

For more information please visit or call the office on one of the numbers below: WINCHESTER 01962 844333

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CHANDLER’S FORD 023 8022 1344

POOLE 01202 466669

BOURNEMOUTH 01202 315005

LONDON 020 7816 5983

21/07/2017 09:56



Things You Need to Know about Clinical Negligence

Dear Doctor clarifies the complexities of clinical negligence with five key facts that ever ybody should know

Who can take legal action?

If you have suffered an injury as a result of a treatment, this is commonly referred to as a medical accident. The difference between this and clinical negligence is that the latter involves care that would not have met medically acceptable standards; therefore meaning that the injury was preventable. This could involve claiming for: • Psychological damage • Loss of earnings • Having to pay for ongoing treatment • The cost of adapting your home • Being unable to carry out activities or hobbies like you once did • Extra care or equipment Certain circumstances may even allow you to take legal action for somebody else if they don’t have the capacity to claim themselves or have died due to negligence.

change or dictate how the medical practitioner works—nor will it necessarily lead to them being disciplined.

What are the time constraints?

There is a time limit to making complaints, therefore they should be made as soon as negligence has been identified. Legal claims should normally be made no more than three years after the date of the event. There are circumstances where the window for complaint can be extended—for instance, if it was difficult to complain earlier due to ongoing trauma.

Are there other options?

Compensation schemes are in place for specific injuries and losses. These

provide a quick route to compensation without having to attend court. Particular circumstances have their own scheme available. For example, those who have suffered medical problems as a result of a routine vaccination are able to claim via the Vaccine Damage Payment Unit. Visit for more details on similar schemes. •

Did you know? NHS trusts paid out more than £1.4bn in damages for medical negligence in 2015-2016 according to the NHS Litigation Authority

How can you proceed?

IMAGES © Shutterstock

You can explore two avenues, either using the NHS complaints procedure or by pursuing your own legal action independently. It may be advisable to use the NHS claims procedure to gain a more thorough understanding of what has happened. If you do decide on legal action, it is vital that you promptly gain expert advice on the matter.

What is the result?

It’s important to understand that making a medical negligence claim is solely about the right to compensation. The court cannot make the healthcare professionals involved apologise. Likewise, the decision taken by the court will not be able to

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26/09/2017 09:51

The simplest no-fuss cremation plan you can buy. Perfect for people who don’t like funerals.

Times have changed - and funerals are changing too. Today’s families want a more personal experience. That’s why thousands have embraced the new level of freedom offered by a Pure Cremation. Find out more about our no-fuss, no-frills cremation. Order your FREE info pack today:

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04/09/2017 10:37


Funeral Planning simple steps to buying a funeral plan


CONSIDER HOW YOUR FAMILY WOULD COPE Your funeral can also be paid from your estate. If this is possible, or if your family has the money to cover it, a basic plan—or no plan at all—could be your best option. USE A COMPARISON SITE Much like insurance, using comparison sites when shopping around for your funeral plan may help you get the best deal. KNOW THE COST BREAKDOWN As funeral plans differ from provider to provider, check every cost for a clear breakdown of what is covered. PAY IT QUICK Again, much like various types of insurance, paying in installments over a long period of time will inevitably end up costing you more. According to Which?, 12 monthly payments might cost the same, but paying over 60 months may add around 20 percent to the overall cost. STUDY THE FINE PRINT Many items, such as funeral plots and headstones, may be excluded from your funeral plan. In some cases, costs may also be capped. Make sure you are fully aware of these limitations before you commit to a purchase.

2 With funeral costs rising year-on-year, pre-planning your own can give you—and your family—financial peace of mind


IMAGES © Shutterstock

hether you’re worried about being able to afford your funeral or don’t want to leave your family with a sizeable financial burden, funeral planning is becoming a popular choice among the elderly. Funeral plans can be bought from a provider or from a funeral director. Individuals will have the choice of either paying a lump sum (one-off payments are usually between £3,000 to £5,000) or in monthly installments over one to 10 years.

WHAT’S INCLUDED IN A FUNERAL PLAN? Different plans will include different elements—though costs not traditionally met by a funeral director, such as the cost of flowers, may not be covered.

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Providers may cover viewings of the deceased, a limousine procession and a church service. It’s important to keep in mind that some costs may not be fully taken care of—check the details of your plan and make sure you know what you are buying before you make a final decision. For example, some providers may guarantee the price of cremation but will only pay a contribution towards burial costs. In order to safeguard the money that you pay into your plan, your chosen provider may opt to place it in a trust fund or invest it in an insurance policy that will cash out when you pass away. There are different types of protection when it comes to the money you spend on your funeral plan; these can range from credit card protection, Funeral Planning Authority (FPA) and the Consumer Credit Act 1974. •





27/09/2017 09:57


End Your Timeshare Agreements Today CALL Timeshare Relief TODAY 01386 765355 / 765395 Email:


imeshare Relief is an established UK business based in Evesham, Worcestershire, working with timeshare owners to help them dispose of their timeshare contracts. We have been timeshare consumer champions, the people’s champion, for many years now and freed our first timeshare owners from their contract as far back as 2009. Our directors and award-winning management team who will be handling your file have over 100 years collective experience in international Timeshare contracts. Are you fed up with trying to book your timeshare week/points and always being told it is not available, only to find it elsewhere on various travel sites far cheaper than your actual annual maintenance? Have you been forced into fractional ownership and feel disappointed with the product you have been left with? Are you worried about burdening your family with never-ending and increasing management fees, particularly now as more and more owners leave, which results in the small percentage of remaining owners to bear the weight of 100 percent of the costs? If you could get the money you spent on your Timeshare back today, would you? If you answered YES to any of the above then, subject to certain criteria, we may now even be able to claim your money back. Alternatively, if your timeshare has now just become an ongoing financial burden and you simply need a legal exit from your contract (or you just want some friendly, honest advice on your ownership) then we are here and more than happy to help. Timeshare Relief specialises in extracting consumers from their timeshare contracts and financial obligations once and for all. Our expert advisors are on hand to help you through the process. We know how to deal within the industry to make sure you are permanently released from your financial obligations with no strings attached. With many of the resorts and self-proclaimed disposal companies all interlinked in some way (with the sole objective of keeping you locked into a financial obligation with them for one scheme or another), we can assure you that we will provide an unbiased, 100 percent bona fide service to our clients and will never ask you to purchase any points, timeshare/holiday clubs, fractional ownership, travel vouchers or any other schemes that are currently trapping the trusting timeshare owner into further financial loss and misery.

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Here is just a small sample of comments made by our happy customers and many, many more can be found on our website at ‘Thanks to your actions this has now ended and we are very grateful to you for your prompt and very efficient handling of the whole transaction, it has been a great relief to us.’—Mr & Mrs Edwards, 76, Retired. ‘Thank you so much for your help in making it possible for us to terminate a timeshare we had unwittingly agreed to.’ —Mr & Mrs Mansell, Warwick. ‘First class service from the offset. We have no hesitation in recommending their services.’—Mr & Mrs Campbell, 69, retired. We have recently gotten back £7,800.00 for Mrs Hill, 75, retired— ‘Thank you very much for all your hard work, much appreciated.’ Mrs Rhule, 59, Safe Guarding Officer 15-year finance agreement for the original purchase was also cancelled totalling £17,500.00. ‘The experience was speedy and painless. We were saved a lot of money given the long term implications of the timeshare, thank you so much—you are truly professional.’ ‘Thank you for all your help and I confirm that I would be happy to discuss your services, and our satisfactory conclusion, with any of your future prospective clients.’—Mr & Mrs Bigland, retired. ‘I have no hesitation in recommending Timeshare Relief to anyone who wants to get out of a timeshare contract.’—Mr Sexton, 69, retired

Take the first steps to freedom—if not now, when? CALL 01386 765355 / 765395 NOW to speak to Rebecca Warren and quote ‘DRCHRIS’ to claim your 10 percent discount today. Please also email us on or today. Or if you prefer us to call you, then please visit our website and send us your details via our Contact Us page and one of our team will call you back within the same working day. Rebecca Warren and her team are available via telephone, Skype or private consultation at our office in Evesham for those of you who cannot travel or feel more comfortable seeing us in the comfort of your own home we can arrange a no obligation home consultation.

21/09/2017 14:37

CALL TODAY on 01386 765355 / 765395 Email:

Do you want to end your timeshare agreement and the financial responsibilities attached to it today? Are you tired of trying to book your timeshare week just to be told it is not available? Have you been forced into fractional ownership or some other scheme you didn’t want to buy, and feel disappointed with the product you have been left with? Are you worried about burdening your family with never-ending and increasing management fees? Before making a decision on whether or not our service is right for you, we invite you to contact our previous clients, all of which have used our professional service to dispose of their timeshares including Mrs Hill, 75, retired, who recently got back £7,800.00—‘Thank you very much for all your hard work, much appreciated.’ Mrs Rhule’s 15-year finance agreement for the original purchase was also cancelled, totalling £17,500.00. ‘The experience was speedy and painless. We were saved a lot of money given the long-term implications of the timeshare, thank you so much—you are truly professional.’—Mrs Rhule & Mr Llewellyn, Surrey ‘Thank you for all your help and I confirm that I would be happy to discuss your services, and our satisfactory conclusion, with any of your future prospective clients.’—Mr & Mrs Bigland, Essex ‘I have no hesitation in recommending Timeshare Relief to anyone who wants to get out of a timeshare contract.’—Mr Sexton

Call Timeshare Relief on 01386 765355 / 765395 or email NOW to speak to Rebecca Warren and quote “DRCHRIS” to claim your 10% discount today and visit to use our free maintenance fee calculator and see the real cost to you and your family. Timeshare Releif Ad.Rev2.indd 1

21/09/2017 14:37

Choosing a

Private Doctor


ne of the many benefits of deciding to go private with your medical care is the freedom to choose your doctor. But before you begin your search, there are various things to consider.


It is important to establish a budget early on in the process. Unless you have private medical insurance, the cost of private medical care is likely to be substantial depending on your treatment. You should ask your chosen doctor about what you will be charged for in advance of treatment. Charges vary from provider to provider, but prepare to be invoiced by your surgeon, an anaesthetist and the hospital in which your treatment will take place.

Finding your doctor

It is important to choose a doctor that you are 100 percent comfortable with. Take the time to speak directly with the selection of doctors and surgeons that you have chosen and ask the following questions: • What qualifications do you hold? • Can you provide a detailed profile of your experience? • What papers on your area of expertise have you published in medical journals? • How many operations of the specific type I require do you perform yearly? • Can I speak to previous patients about their experience with you?

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IMAGES © Shutterstock

Whether you need knee surgery or heart surgery, make sure you do your research and opt for the right doctor for you. •

27/09/2017 09:56


Mr. Fahad G. Attar

Consultant Orthopaedic Surgeon Specialising in hip and knee replacements and knee reconstruction surgery


r Fahad G. Attar currently works in the north west of the UK and is a consultant orthopaedic surgeon specialising in hip and knee replacement surgery and knee reconstruction surgery. After finishing his orthopaedic training here in the UK, he completed his specialist fellowship training and gained experience in joint replacement surgery and knee reconstruction surgery from world renowned centres; Nuffield Orthopaedic Centre in Oxford, Holland Orthopaedic Centre, Sunnybrook hospital in Toronto, Canada and at Wrightington hospital in the UK. His expertise is in managing knee arthritis and performing patient-specific partial and total knee replacement procedures. His expertise is also in managing complex knee cartilage problems and performing knee resurfacing procedures with patient-specific implants. His other areas of experience and expertise include: • Managing knee ligament injuries • Meniscal repair and meniscal replacement surgery • Managing anterior knee pain and patella instability • Knee joint preservation surgery His areas of interest include managing young adult arthritis and sports-related knee injuries. Fahad is well published and has been involved in ongoing clinical and lab-based

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KEY INFO Mr. Fahad G. Attar FRCS(Tr&Orth), MRCSEd Consultant Orthopaedic Surgeon Specialising in hip and knee replacements and knee reconstruction surgery Specific area of interest: patient specific knee replacement surgery, patient specific knee resurfacing procedures, managing young adult arthritis and cartilage injuries Services offered: comprehensive management of knee arthritis and sports related knee injuries & one-stop knee clinic

Contact details

Mr. Fahad G. Attar email: tel. no.: 0161 393 3996

research right through his training and fellowship years and this has culminated in numerous publications and presentations in both national and international meetings where he has been an invited speaker. He constantly strives to improve patient care by measuring and monitoring outcomes and uses innovative evidencebased treatment options in managing complex knee issues and also strives hard to improve patient satisfaction. His philosophy of streamlining and improving patient care has led to the development of his one-stop knee clinic service.

One-Stop Knee Clinic

• Easily accessible locations across the north west • Initial consultation • Investigations required such as X-rays, ultrasound, MRI scans done at same appointment • Follow-up appointment to discuss results and diagnosis following the investigations • Physiotherapy review if required • Certain treatment modalities initiated on the same day if your knee condition warrants it (e.g.: steroid injections, PRP injections and shockwave therapy)

The clinic provides: • Review of all knee conditions including acute injuries

All this is done between two and two and a half hours on the same day. This avoids multiple hospital visits over the span of two to three weeks, avoiding delay in knowing the diagnosis and starting treatment. It provides an improved and enhanced patient experience. •

The clinic comprehensively addresses knee problems: from providing diagnosis and performing investigations to providing treatment as outlined below.

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27/09/2017 10:29

Dear Vet with

Peter Wright & Julian Norton

EXOTIC ANIMALS All you need to know

s u o i r o l g , d o o F fo od !


train your pet with our easy how-to guide

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IMAGES © Exclusive Press and Publicity, Shutterstock


27/09/2017 09:42


Peter Wright & Julian Norton Stars of Channel 5’s The Yorkshire Vet share everything you need to know about looking after your pet

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27/09/2017 11:02


Paws for Thought The stars of Channel 5’s The Yorkshire Vet, Peter Wright and Julian Nor ton, give us the inside scoop on pet health

JN: It is important to do plenty of research, too. Some animals start small but end up very big. I had a client recently who bought a ‘micro’ pig. It lived in her sitting room, but soon it became clear that the pig wasn’t so ‘micro’ after all.

Q. How would you advise a first-time pet owner on navigating the over-saturated pet food market? PW: Dogs and cats are predominantly carnivores so it is important that the food—whether wet or dry—has a reasonable proportion of added animal protein combined with a balanced energy level in the form of fats and carbohydrates. JN: An enormous amount of research goes into producing dog and cat food that is perfectly balanced, and for this reason, proprietary foods from reputable companies are the best option. For rabbits and guinea pigs, pelleted—rather than muesli-type—foods are the best. 132 DEAR VET WITH PETER WRIGHT & JULIAN NORTON

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Q. The topic surrounding feeding a dog a diet of raw meat has proved to be a controversial one—from your perspective, is this diet safe? JN: The feeding of raw meat to dogs is very controversial. Many dog owners advocate the feeding of this type of food, as they consider it to be a more natural diet. However, there is much evidence to suggest that raw diets are not properly balanced. PW: I personally cannot recommend feeding a raw diet to a dog for several reasons. It is not a balanced diet. Even more of a concern is the fact that raw meats can contain Salmonella, E. coli or campylobacter which may cause food poisoning in your dog.

Q. Do you think that owners can ‘over-

love’ their pets (in the sense of overfeeding and being too over-protective) and contribute to preventable conditions such as obesity? PW: We all lead busy lives and sometimes over-compensate with food and treats to ease our guilt in the fact that we have insufficient time to devote to our pets. A combination of excessive food intake and lack of exercise in some cases can result in obesity and development of vices such as destructive behaviour. All this can be prevented by

IMAGES © Exclusive Press and Publicity, Shutterstock

Q. What are the key things that wouldbe pet owners should consider before deciding on buying/adopting an animal? PW: The first issue that a potential pet owner needs to consider is the time needed to spend with their prospective pet. For instance, some dogs require greater amounts of exercise than others dependent on breed and age.

26/09/2017 16:36


Most dog owners do have their pets vaccinated, but it would be nice if it were 100% —Julian Norton

adequate pet/human interaction and food/exercise balance.

earlier this year killed three dogs who had not been vaccinated.

JN: The vast majority of pet owners love their animals in a way that is hugely positive for both owner and pet. It is a wonderful, symbiotic relationship. Occasionally—and usually unwittingly— this can become too much. I have seen situations where the husband has been banished to the sofa because the dog will not allow him into the bedroom.

Q. What common but preventable conditions and complaints do you often deal with in the surgery? PW: Top of the list is obesity. This is much easier to prevent by regularly weighing your pet and adjusting feed accordingly.

Q. What are the biggest myths

surrounding pet health? PW: Common myths surrounding pet health include if a dog has a wet nose it must be healthy and if a cat is purring, it must be happy. Cats will purr in other emotional states e.g. anxiety. JN: I suppose the biggest myth surrounding pet health concerns vaccination. We still regularly see outbreaks of parvovirus. An outbreak

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JN: We frequently see the nasty condition of pyometra which is a serious infection within the uterus, usually of a bitch, but sometimes in a female cat too. This is a life-threatening condition and is completely preventable by having a female dog or cat spayed.

Q. What behaviours should we look out for that indicate a problem with our pet’s emotional or physical health? PW: If pets are emotionally upset, this may manifest in different ways. Some pets will become withdrawn, others require human comfort and closeness

and may exhibit repetitive behaviour such as circling and destructive behaviour such as chewing furniture. Physical health issues are much easier to spot such as inappetence, changes in drinking habits, shivering, lethargy, depression and reluctance to go for a walk. JN: Cats, in particular, can be very sensitive to emotional stress, for example if a member of the family leaves or a new baby arrives.

Q. What have been the strangest encounters that you have experienced in your TV show, The Yorkshire Vet? PW: One unusual encounter was the lady who rang me to ask if I castrated ferrets. I asked when she would like to book the ferret in for his operation and she said, ‘no you don’t understand, we need 13 ferrets castrating!’. That morning we set up a ferret castrating production line. JN: One thing that made me laugh out loud, in the early days of the programme,


26/09/2017 16:36

Interview was when I was coming out of the local butcher’s one Saturday morning. A hooded youth, who looked about 16 years old, was lurking outside. He came over to talk to me, in the typically monosyllabic way of a teenage boy. ‘Can I have a selfie?’ he blurted out. ‘Of course,’ I replied, and the photo was duly snapped. ‘Love your show,’ he muttered before skulking off, hood swiftly pulled back into place.

Q. How does the legacy of James Herriot still live on in the Skeldale Surgery and, indeed, your personal practice? PW: I feel very privileged to have worked for the world famous vet and author, James Herriot. [He] was a very humble and gentle man who always made time for every patient and their owners and afforded as much care and compassion

to a baby bird falling out of a nest as he would to a prize race horse. I have spent my working life trying to ensure that his legacy lives on at Skeldale Veterinary Centre. JN: His books and their portrayal on the television inspired me, and my generation of vets, to enter the profession. Those days of a traditional, mixed practice— where cows, sheep, dogs, pigs, tortoises, cats, hamsters, ferrets and chickens were all treated with equal enthusiasm—still live on at our clinic.

JN: Series five of The Yorkshire Vet is out in the autumn and it promises to be another good one! We have some more great stories covering, quite literally, all creatures great and small. Episode one includes two amazing cases, the likes of which I have never seen before! •  The new series of The Yorkshire Vet starts this autumn on Channel 5, Tuesdays at 8pm.  A Yorkshire Vet Through the Seasons by Julian Norton is out now, £14.99 hardback, Michael O’Mara Books.

Q. Finally, what can our readers expect from the new series of The Yorkshire Vet? PW: The next series of The Yorkshire Vet will, of course, visit old clients and their veterinary problems. We will also introduce new clients and their animals, some of which will take us out of our comfort zone!

Avoid unbalanced diets, eg. vegetarian diets which are now available for dogs—these are unacceptable —Peter Wright 134 DEAR VET WITH PETER WRIGHT & JULIAN NORTON

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26/09/2017 16:37

Your perfect dog sitter DogBuddy means you’ll never be stuck without a dog sitter again. Giving you, and your four-legged friend, the freedom to enjoy life.


here’s no doubt about it, owning a dog is a huge commitment. But now it doesn't have to mean giving up on the things you enjoy! Whether it’s taking the trip of a lifetime or making time for date night, life can get busy, and it’s not always possible to be around to give your dog the attention they need to stay happy and healthy. Enter DogBuddy, a handy service that connects dog owners with vetted and reliable dog sitters in their area. Solving a real problem The story of DogBuddy’s creation is an all-too-familiar tale to anyone who has ever owned a dog. The company was founded in 2013 by entrepreneur Richard Setterwall after he struggled to find a sitter for his own dog. Friends and family were unavailable, and he didn’t want to leave his dog in a kennel due to the stress it would cause. Realising that there are hundreds of willing dog sitters out there, Setterwall came up with a simple and efficient way of connecting dog owners and dog sitters.

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Reviewed by other dog owners The service is easy to use and available online or as an app. Simply enter your postcode and the dates you need help, and you’ll be shown a list of available sitters in your area, along with their ratings and reviews from other dog owners. Read potential sitters’ profiles, along with seeing photos of their home, so you can ensure you are making the right choice for your pooch. DogBuddy also recommends a meet and greet before your booking to make sure everyone gets along. While your dog is with them, your sitter can send photos and track their walks, so you know your dog is having fun. Sitters have access to a special 24/7 vet line, so if they suspect your dog is feeling under the weather, they can get advice straightaway. Profiles checked What’s more, sitters have to complete an assessment and create a profile that is then manually checked by DogBuddy. In fact, only 10% of applicants are approved, which ensures every sitter is of the highest quality.

A handy service that connects dog owners with vetted and reliable dog sitters in their area.

The company has since grown into a community of more than half a million dog lovers, offering dog boarding, doggy daycare, and walking across seven countries (UK, Spain, Italy, France, Germany, Sweden and Norway) and over 200 cities. For more information visit

26/09/2017 09:34

Nutrition & Wellbeing

Common & Serious

Conditions in Pets From diabetes to rabies, being aware of symptoms and problems in your pet’s health can help early diagnosis and promote wellbeing


ust like humans, pets are susceptible to a number of health complications. While some complaints—like arthritis and kidney disease—are more common in older pets, diabetes and dental diseases can strike at any age. Regular visits to the vet and a religious vaccination regime can both help you keep your pet in top shape, but being informed about animal disease management is key. Read on for a comprehensive guide to the most common and serious conditions in pets and how to treat them.



A chronic disease usually linked to the natural ageing process, diabetes can also affect younger pets for a multitude of reasons—both hereditary and nutritionrelated. While diabetes can be managed with a vet-approved diet and tailored

exercise plan, some pets may need regular insulin shots to cope.

Kidney disease

An illness most common in older cats, kidney disease can be diagnosed by undergoing regular blood tests at the vet. While cats with the condition can be kept healthy for several years, dogs typically deteriorate more quickly. Some symptoms include vomiting, weight loss, excessive thirst and bloody urine. Manage the condition with a low salt and low protein diet—neutering or spaying is highly recommended under these circumstances.


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Dental disease

Both dogs and cats can develop dental problems like tartar, gum disease and cavities. It’s important to monitor your pet’s dental health and invest in regular professional dental cleaning—poor oral hygiene can also lead to heart and kidney conditions. Brush your pet’s teeth from a young age so they understand that it’s a normal part of their grooming routine. IMAGES © Shutterstock

Obesity is as big of an issue in the animal world as it is for humans. Obese pets are more prone to other chronic conditions such as heart disease, arthritis and diabetes. The risk of an early death also rises with excess weight. While obesity may be caused by a slow metabolism, over-feeding is usually the main culprit. Give your pet the recommended amount of sustenance; avoid giving them unhealthy treats or fatty human foods. Consult with your vet to find out how to manage the condition—a combination of diet and exercise will be needed.


Arthritis can be diagnosed through a routine exam or X-ray. The condition, which is extremely common in older animals, may make your pet’s

26/09/2017 16:38

Nutrition & Wellbeing

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movements slow and painful. There is no cure for arthritis, but the condition may be managed with acupuncture and joint supplements to keep your pet as mobile as possible for as long as possible.

Flea & tick diseases

These tiny insects can carry harmful bacteria that can cause serious illnesses—like typhus and tapeworm—in both pets and their owners. In order to prevent these, use a topical flea and tick preventative, wash and inspect your pet regularly and be wary of when they spend any amount of time outdoors. While some animals will only experience itching, others may develop allergic dermatitis.


Even though this disease is completely preventable with a vaccine, it is highly contagious and dangerous—it kills more dogs than any other infectious disease. This virus—which is spread through body secretions—affects brain cells, skin, mucus membranes and the gastrointestinal tract. As puppies are at most risk, vaccination is highly recommended. Some early symptoms include fever, watery discharge from the eyes and nose, depression, loss of appetite, dry cough, vomiting and diarrhoea. The condition cannot be cured but your vet may prescribe a course of antibiotics, intravenous fluids or other types of medication to manage it.


In dogs, rabies is a disease that affects the brain and spinal cord. It is mostly spread through bites from

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other infected animals. A particularly serious illness, rabies can also affect humans—vaccination is absolutely crucial, especially if your pet is used to wandering around outdoors. Some symptoms include restlessness, insecurity, apprehension, insensitivity to pain, self-mutilation, sensitivity to light and snapping at imaginary objects.


Also known as ‘parvo’, this condition is one of the most contagious diseases affecting dogs. Spread mainly through faeces that contain the virus, this illness can be extremely dangerous to puppies. Although animals may not show any symptoms, parvo’s main warning signs include diarrhoea, vomiting, dehydration, dark or bloody faeces and a high temperature. The only way to properly diagnose the condition is through a complete examination and blood test in a vet’s surgery. In some severe cases, hospitalisation may be required, though the disease can be treated with antibiotics, steroids and antiemetics. •


26/09/2017 16:38

Win prizes!

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31/01/2017 15:00

Nutrition & Wellbeing

8 Reasons to Sterilise Your Pet Discover the numerous benefits of having your pet neutered or spayed— from relieving the overpopulation crisis to improving overall wellbeing


eutering and spaying are surgical sterilisation processes for animals, although modern veterinary practice uses the term ‘de-sexing’. Neutering refers to an operation performed on male animals where the testicles are removed. Spaying is a slightly more complex procedure for female animals; this involves the removal of the womb and ovaries. We highlight the key reasons behind the decision to neuter or spay an animal. Improves behavioural issues. A number of behavioural problems are resolved through sterilisation. Animals will demonstrate suppressed aggression, reduced anxiety and less frequent urinary marking. This is especially true for male dogs and ferrets, who can experience drastic temperament changes. Alleviates symptoms during heat. Females can suffer discomfort during heat periods; this can be vastly alleviated through spaying.

IMAGES © Shutterstock

Reduces overpopulation. The quantity of homeless animals is growing rapidly in the UK. Reducing birth rates would help animal shelters cope with the looming overpopulation crisis. Aiding shelters will decrease the amount of animals having to be euthanised because they cannot be rehomed quickly enough. Decreases risk of illness. Specific strains of cancer (like mammary cancer and testicular cancer) and uterine infections are far less likely once an animal has been neutered or spayed. Male ferrets are known to show

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signs of alopecia and anaemia, both of which are improved with neutering. Avoids birth defects. Related offspring do not usually take note of family relationships, therefore it is not unusual for brothers and sisters to mate. This can cause deformities and birth defects in the next generation. Stamps out theft. Sterilisation procedures can reduce the risk of animals being stolen for breeding purposes—currently a growing problem in the UK.

Quick recovery. Recovery from both procedures tends to be quite speedy. Pets will usually be back to normal after a couple of weeks of wearing a cone or inflatable e-collar. Vet fees can add up. With the introduction of the Animal Welfare Act in 2006, owners have a responsibility to meet their pet’s needs. This will include worming, vaccinating and treating all offspring for fleas. If owners do not have the budget to pay for these treatments, they should consider the sterilisation of their pet. •


26/09/2017 16:39

Inspired Pet Nutrition Ltd.indd 1

22/09/2017 10:33

Nutrition & Wellbeing

HealthyHappy Diet Pet Provide your furry companion with the best possible care; try our nutritional tips for a healthy and happy pet

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27/09/2017 09:38

Nutrition & Wellbeing


or hundreds of years, pets have steadily become the cornerstone of many family structures— particularly cats and dogs. We have allowed these furry critters into our homes and into our hearts. When it comes to diet, pets require a similar framework to humans in order to stay healthy. Providing them with a nutritional regime will vastly benefit their strength and growth. Cats and dogs require food that is appropriate for their age, size and breed. Meals should consistently include a mixture of proteins, fats, carbohydrates, vitamins, minerals and water. In relation to the main food groups, cats and dogs will have differing requirements; read on for a full breakdown.


Protein is the core of all animal nutrition—both cats and dogs rely on it. Cats are obligate carnivores, which means they are adapted to a diet of eating flesh from other animals. Consequently, they require a high-protein diet and cannot be vegetarian. Protein supplies essential amino acids, helping pets to manufacture antibodies, enzymes and restore tissues. It is recommended that dogs consume slightly less protein than cats—around 18 percent should contribute to their daily allowance. Pets can obtain protein from meat, fish, eggs and some vegetables.

Treat your pet

Treats should make up no more than 10 percent of your pet’s daily calories. While it can be tempting to give your cat or dog table scraps, try to avoid doing this. The seasonings and salt content of human meals are usually inappropriate and can upset your pet’s stomach. If you want to reward your furry companion with something special, why not make your own treats? Try our nutritious homemade liver snaps—for happy cats and dogs: Liver snaps

makes up a large percentage of a pet’s recommended daily diet. The majority of fat is obtained through meat, which contains important fatty acids such as omega 3 and omega 6. Fat provides all creatures with much-needed insulation and delivers a shiny coat. If fat levels are restricted in dogs, they can develop dry skin or a weak immune system. When buying pet food, check the label to make sure the fats included are being sourced from animal fat or oils from plants.


The feline diet should naturally be a low carbohydrate diet; cats don’t

• Select a high quality liver; preferably organic—beef liver usually works well. Start by sautéing the liver in a tiny bit of oil. • Cook through until there is no pink showing in the centre. Once cooked, allow the liver to cool and cut into thin slices (as thin as possible). • Spread out the slices on a non-stick baking tray and cook for two to three hours—or until dry and crispy.



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IMAGES © Shutterstock

Fat is extremely important in any pet’s nutritional regime and should be consumed in moderate proportions. It acts as a concentrated source of energy and aids in vitamin absorption and metabolic regulation. After protein, fat

27/09/2017 09:38

Nutrition & Wellbeing

produce the adequate enzymes to digest this food group properly. Their lack of salivary amylase means that breaking down starchy compounds like rice or grains is difficult—these should therefore be excluded from their diet or only provided in small doses. Dogs do not have as much difficulty digesting carbohydrates, but there are opposing views as to whether or not dogs actually need them. While the pet community is divided, most sources report that some levels are useful for delivering fibre to the body. However, carbohydrates shouldn’t be your canine’s main source of energy—this should come from protein and fat.

Vitamins and minerals

Vitamins assist with an array of vital bodily functions. Each vitamin has its own part to play in the upkeep of your pet’s vision, healing capabilities and nervous system. Vital compounds

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include vitamin A, B, B1, B12, D, E and K. A sufficient supply of minerals will also ensure your cat or dog develops strong teeth and bones. Important minerals include calcium, potassium, phosphorus, magnesium and sodium. Liver, kidney, vegetables, fruit and yeast are all good sources of nutrients.


Along with providing hydration, water also transports nutrients throughout the body and aids in digestion. Cats obtain most of their hydration through their food and naturally have a low drive for thirst. Dry food products are notoriously lacking in water—steer away from making these their primary source of sustenance. Cats reared solely on dry food have been known to develop urinary problems. As a rule of thumb, dogs should consume one ounce of water per pound of body weight per day. Always keep a bowl of clean water accessible to your pet at all times. •


27/09/2017 09:38

Penlan Farm Since 1993, Burns Pet Nutrition has built up a strong reputation as the go-to brand for those seeking a natural and holistic approach to pet food. The company prides itself on championing ethical values and is headed up by Veterinary Surgeon, John Burns who develops all the recipes. Mr Burns launched the business in response to common pet ailments (itchy skin, excessive moulting, tear staining etc) he was noticing time and time again at his veterinary practice. Believing diet to be the cause of most pet ailments, John recommended that his clients feed home cooked pet food to enable the body to function naturally avoid the build-up of toxic waste. At the time, no such pet food existed so John decided to create his own. Almost 25 years on, Burns is a thriving family business boasting 8 lines of specialist dry dog food and a varied treat selection. In 2009, the company decided to create a signature line of wet dog food that marked a return to the roots of John’s original recipe. Brown rice, high-quality animal proteins, minerals and

Locally Produced Food for Healthy and Happy Pooches vegetables make up the Penlan Farm formula which has won a string of awards including Your Dog Magazine’s Best Wet Food 2014/15. From field to dog bowl, Penlan Farm places strong emphasis on locally-produced food made in an ethical manner. Many of the free-range eggs and seasonal vegetables that go into the range come from the company’s own farm in West Wales. Production is local, too. Burns manufacture the entire Penlan Farm range at their own factory in Burry Port and last year won the Pet Industry Federation’s Manufacturer of the Year Award. Products are made using human grade ingredients including organic chicken. Penlan Farm is a fantastic option for time-strapped individuals who still want to do the best for their dog. There’s no cooking or fuss involved, just open the pouch and serve to be safe in the knowledge that you are feeding your dog a nutritious meal. Penlan Farm doesn’t compromise on quality and comes in 4 delicious varieties: free-range egg, chicken, fish or lamb with brown rice and vegetables. The range is available in both 150g and 400g pouches and is suitable for all dog breeds and ages.

To find out more about the Burns Penlan Farm range or any other Burns products, visit or call 0800 083 66 96

for free and impartial nutrition advice.

r a n g e

BURNS Real Food for Dogs

Developed by a Veterinary Surgeon

Fish, Vegetables & Brown Rice

Penlan Farm

Penlan Farm

Penlan Farm

Real Food for Dogs

Developed by a Veterinary Surgeon

Chicken, Vegetables & Brown Rice

r a n g e




Penlan Farm

r a n g e

r a n g e

Real Food for Dogs

Real Food for Dogs

Developed by a Veterinary Surgeon

Egg, Vegetables & Brown Rice

Developed by a Veterinary Surgeon

Lamb, Vegetables & Brown Rice

For more information contact our Nutrition Team on 0800 083 66 96 Burns Pet Nutrition.indd 1

26/09/2017 14:54

Nutrition & Wellbeing

Myths & Facts

Cooked bones can splinter. TRUE—feed your pet raw bones. Cooked bones can cause your pet harm. Choose ones of adequate size for your breed.

Cats and dogs can eat the same food. FALSE—dogs and cats have different dietary needs. Under no circumstance should either be fed food for the other species.

Cats need milk. FALSE—after weaning, cats do not require milk and tend to find it hard to digest. There are, however, specially formulated cat milks available for them as a treat.

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27/09/2017 11:59

Nutrition & Wellbeing

The raw food debate

 BENEFITS TO JAW AND TEETH. Commercial food products, especially wet ones, are very soft on the palate; they don’t often work the jaw muscles or clean teeth. Raw food options, on the other hand, do.

 TIME-CONSUMING PREPARATION. Although no cooking is necessary, planning, chopping and blitzing each meal can take time. For pet owners with busy lifestyles, this may disrupt schedules.

 NO ADDITIVES. This method gives you complete control over what goes into your pet’s meals, avoiding preservatives and additives completely.

 A MINEFIELD OF TOXIC FOODS. Less educated pet owners may not be aware of toxic foods to avoid when feeding their pet—certain foods can be extremely harmful.

 IMPROVED STOOL AND DIGESTION. Fresh food is associated with improved digestive health; this usually benefits stool structure and odour.  REDUCTION OF BAD HABITS. Many pet owners report that their pets chew their belongings. The nature of raw food is said to give pets a better outlet for their chewing tendencies.  RAW FOODS ARE BIO-APPROPRIATE. The ancestral background of cats and dogs involved the consumption of raw carcass meat and herbivorous stomach contents. Commercial pet food conglomerates have been known to use leftover human food wastage as a basis for their products, which is not always bio-appropriate.


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 COSTLY. Buying raw food ingredients is usually more costly than buying commercial pet food in bulk.  CONTAMINATION IS A POSSIBILITY. Some concerns revolve around the possibility of harmful bacteria from raw food—like salmonella—affecting a pet’s health. Such instances are unlikely, but choosing good quality produce is a must. Hygiene practices should be followed as stringently as they would be with human food preparation.

27/09/2017 09:38


30 years


Made with all natural ingredients

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21/09/2017 14:22

Nutrition & Wellbeing

Fitness Regimes for Pets Keep your pet fighting fit with our guidance on exercise and fitness—a healthy pet is a happy one


Each breed of dog has its distinct characteristics, tendencies and physical needs. It can be challenging to recognise which will be happy in your home. High-energy dogs High-energy breeds are always ready for action, they can easily be identified through their need to jump and play. Some of these dogs were originally bred for hunting, sporting and other pastimes such as herding sheep. Their intelligent nature demands that their owner constantly challenge them with games, puzzles and stimulating training exercises. Dogs of this kind should complete over two hours of exercise per day to keep them in peak shape. Swimming and brisk walks are the perfect way to help them hit this quota. 148 dear VET with PETER WRIGHT & JULIAN NORTON

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Specific breeds include Australian Shepherd, Border Collie, German Shepherd, Shetland Sheepdog Siberian Husky and Weimaraner. Medium-energy dogs This group of breeds usually embodies the best of both worlds; they can be mellow at times but also enjoy exerting themselves. Such canines are known for their fun and charismatic nature. Generally, they have a lot of energy to spend—although not as much as sporting breeds. They will need a significant amount of time outdoors to run and stretch their legs. Depending on the dog itself, the daily recommended amount of exercise will fall between 40 minutes and one hour and a half. Specific breeds include Border Terrier, Cavalier King Charles Spaniel and Golden Retriever. Low-energy dogs Dogs within this category need less exercise and are content with relaxing for long periods of the day. For most, their biological construction explains their incapacity for running or walking long distances. Brachycephalic dogs are a key example of this. Their breeding has provided them with short muzzles and noses, constricting their breathing and making strenuous exercise difficult. Despite their relaxed temperament, low-energy dogs still need a bit of movement—at least 20 minutes a day. Specific breeds include Basset Hound, Bulldog, Chihuahua, Pug and Shih Tzu.

IMAGES © Shutterstock


egardless of age, size or species, all animals need a degree of daily activity to keep fit and healthy. Before choosing a pet, be sure that their requirements are manageable in relation to your lifestyle. If you have a demanding job that involves long working hours, you may wish to consider a low maintenance pet. At-home workers or individuals with flexible schedules are usually suitable for more energetic or reliant breeds. We simplify the concept of exercise for household pets with some simple tips on regime and care.

27/09/2017 08:55

Nutrition & Wellbeing


Some cat owners may decide to raise their pet as an indoor cat, while others will choose to install a cat flap to allow them to come and go as they please. This decision will largely dictate how your cat exercises. Indoor cats Play is an important aspect in cat development, especially for indoor cats. Chasing a ball or playing with an interactive toy can keep them occupied and expend their energy. Take the time to engage with your cat and test them with training exercises. Indoor cats can sometimes become uninterested in their environment; get round this by building a space exclusively for them. Incorporate different levels and textures within the area with perches and cubbies for them to explore. Outdoor cats Cats are notoriously predatory creatures; most will happily roam their local area to hunt and catch small prey. This allows them to practice their climbing skills via trees and fences, keeping them fit and agile. Instinctive behaviour dictates that cats form their own territory, which is usually a personal neighbourhood. Felines from this group can split their day between outdoor explorations and time spent indoors with their owner.

Not getting enough? Small mammals

ll that sma en forget ft o le a p e o Pe , guin —rabbits rs— mammals d hamste n a s la il h c o. in h n pigs, c ulatio to ical stim s y h p e g ir in requ eir liv ve with th f soil Get creati e a tray o id v ro p t: n ra e m l e whee o arrange n exercis a , g in g in for dig to nestle for them soft area

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The consequences of pets not getting enough exercise can be detrimental to their health. Pets with restricted space can start to develop destructive tendencies as a result of boredom and anxiety. These can include: • Chewing/scratching furniture • Loud whining • Urinating inappropriately • Excessive barking In more extreme cases, animals can lash out or self-mutilate—this is often observed in birds and other animals that are kept in confined cages or without company. • dear VET with PETER WRIGHT & JULIAN NORTON 149

27/09/2017 08:55

Nutrition & Wellbeing

Keeping up


There is far more to pet hygiene than the occasional bath and regular trip to the vet. Read on for a list of grooming rituals you should be performing regularly


Top tip

ooking after your pet’s health is an important responsibility, but looking after their hygiene is just as vital. While animals may not need to wash as frequently as humans—and some take care of their own cleanliness—it is up to their owners to groom them and, therefore, look after their wellbeing.

Make sure groom to start wit h thes ing se early age so ssions at a e n yo u r p et used to the can get m

Bath time

Flea prevention

A good tick and flea prevention regimen can prevent the development of diseases like the bubonic plague and Bartonellosis—also known as the cat-scratch fever. Outfit your pet with tick repellent.


Whether they’re made of rubber or fabric, pet toys spend a lot of time being

chewed, thrown about and dragged around outdoors. It’s important to soak these objects in a half water-half vinegar solution (or a specialised pet-friendly product) for 30 minutes at least once a month. Using chemical soaps could harm your furry friend.


Pet beds are havens for fleas, ticks, dirt, germs and allergens. Purchase a bed with a removable—and washing machinesafe—fabric cover that can be easily removed and washed. A pet’s bed should be washed at least twice a month. If you


DV06.Pet Hygiene.indd 150

have a dog that sheds, vacuum the bed and its surrounding areas once a week.

Litter tray

A cat’s litter box should be cleaned every day, as it is a breeding ground for germs and intestinal parasites that can be picked up by humans—especially children. A daily clean will also limit the buildup of ammonia, which can irritate nasal membranes. After emptying the litter, clean the tray and any utensils used with mild dish soap, completely rinsing and drying. If you have multiple cats, it’s best to keep several litter trays scattered around the house.

IMAGES © Shutterstock

When your pet starts to smell, it’s a strong indicator that a bath is long overdue. Failing to give pets (especially dogs) a regular bath can result in odour problems as well as matting, shedding and dry skin or flaking. It may, in severe cases, also lead to a festering of fleas and ticks. When your pet comes in from a walk or outdoor playtime, instead of giving them a bath, clean their paws with baby wipes to protect them—and your home—from allergens, bacteria and parasites.

27/09/2017 08:58

Nutrition & Wellbeing

Oral health

An area that many pet owners neglect, dental hygiene is an essential part of an animal’s wellbeing. Dental issues, such as painful teeth or gums, may make your pet aggressive and restless. It is therefore important to schedule regular visits to the vet or—simply—start by brushing at home.


Collars should be cleaned once a month with pet-friendly soaps and shampoos. Food and water bowls—as well as any accessories your animal may own and use on a daily basis—should also be washed and sanitised with non-chemical products.

Pet food

Though pet food isn’t technically part of your pet’s physical hygiene, it can play a huge part in it. You wouldn’t eat food left out all day and night—so why should your pet? Have the same care in storing your animal’s food as you’d have for your own. Dry food can become contaminated with salmonella and cause severe illness in humans too. Store any dry food in airtight containers. Wet food should be refrigerated once opened. Incorrect storage will attract rodents and vermin.

The right types of cleaners

Many household soaps and cleaning liquids are actually poisonous to our pets. These include drain cleaners, limeremoval products, dishwasher detergent and oven and toilet cleaners. While it may be tempting to grab the first product on hand, it’s important to purchase petfriendly, organic cleaning products when it comes to your pet’s hygiene. These might be more expensive, but they will be infinitely safer for animals. •


to can lead hygiene t cases, e p re r o ra o P ction. In fe s in d n a to human illness translate o ls a y a this m

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27/09/2017 08:58

Nutrition & Wellbeing

Obedience Training

Grasping the Basics Obedience training can improve your relationship with your pet, stamp out bad habits and harmonise your shared living arrangements

Rewards & treats

In the early stages of training, you should try to gauge what motivates your dog. Some are partial to soft treats; others may like noisy toys to play with. Whatever retains your dog’s attention is what you should use during your lessons together. Having a pouch of small treats during training sessions is a must; these can be fed to them when they perform well. Positivity is key during training; you should promote an encouraging environment to make learning enjoyable for your dog.


Training is designed to teach your pet the correct way to behave. A common mistake with many pet owners is to bombard pets with negative feedback. In such circumstances they can become accustomed to it, resulting in reprimands being less poignant. Praise your dog as much as possible for good behaviour and only discipline them when necessary. Harmless behaviours may be ignored but potentially dangerous ones will need to be tackled immediately with a clear and sharp ‘no’. When they stop with the negative behaviour, be sure to reward them promptly. Your voice should be a sufficient rebuke; smacking or hitting your dog can have negative effects and promote further aggression or anxiety on their part.

Barking & whining

Barking and whining are both natural instincts for dogs, however, it is important to keep both under control. Your canine


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should understand when barking is acceptable, whilst also recognising when you want it to cease. Succinct and clear orders should be given: ‘stop barking’ or ‘stop’. These should be used as a command rather than a reprimand. Once they do stop they should be rewarded immediately with a treat—eventually, they should recognise the command for silence. Dogs whine when they are anxious, upset or scared. While it can be tempting to comfort your pet when they whine, this can sometimes be misconstrued as praise. It may even encourage your dog to repeat this behaviour for attention. Be sure to reward your dog as soon as whining stops, in time they will learn that whimpering is not the way to earn approval.

Put in what you want to get out

Your dog will mirror the energy and enthusiasm you put into your sessions with them. Schooling should be educational,

IMAGES © Shutterstock


raining your pet is very important; besides drawing boundaries and improving behaviour, it can vastly solidify your bond. Putting in the effort to teach your pet right from wrong can also be very rewarding. Dogs are the most common pets to receive training; they are notoriously intelligent—although some breeds are known to engage with instructions better than others.

27/09/2017 09:00

Nutrition & Wellbeing rewarding and challenging for both of you. Canines quickly pick up feelings of frustration; leave any stress at the door before you enter the ‘classroom’. Make sure to have fun during your time together.

Mix it up

Following the same routine can be boring for dogs and—much like humans—they can become lazy and disinterested. Offering the same commands or exercises during sessions will result in your canine being expectant of that routine. If you request that your dog sits before his meals, change it up with a practice of rollover or lay down instead. Try hiding treats in unexpected locations—the more challenging the task, the greater gratification they will experience upon completion.

Introduce obstacles

Once your pet has mastered a particular command, you can begin to introduce obstacles and distractions. They may have grasped the correct procedure but faced with everyday diversions, they may not be as obedient. Try making noise outside, playing with another dog or ringing the doorbell whilst tackling a task. Eventually, this technique will desensitise your dog to distractions and reinforce desired behaviours.

Consider classes

Dog training classes are widely available for those who wish to learn techniques from a professional. They come in a variety of stages, from puppy classes to those designed for troublesome breeds. These are a fantastic way to learn new skills and practice them at home with your furry companion. Classes are also a great way for your dog to socialise and make friends within a controlled environment. •

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27/09/2017 09:00

HAVE YOU TAKEN PET PARASITE ACTION? Cats and dogs are pretty special to their owners. We don’t just benefit from their non-judgemental love – there are health benefits too, such as improved cardiovascular health and stress reduction.1



Here’s an example of what they said…

• Ticks can carry Lyme disease, which can affect both dogs and humans.

The Pet Parasite Action campaign launched this summer and we asked 1,000 dog owners how they felt about their pet.

… the best thing about dog ownership is that it keeps you active and that dogs love you regardless of superficial things, such as how much you earn or how you look. As a result of all that love, the majority of the survey respondents admitted that their pet shared their bed and their sofa, sat on their lap and even gave kisses. Perhaps then, given all this close contact, it wasn’t too surprising that one in three had also found pet parasites on themselves or their children.2

Pet parasites can be dangerous to pets AND people.

• Both cats and dogs can play host to the roundworm Toxocara. The worm eggs passed out in the pet’s poo can infect people, potentially causing neurological disease or even sight loss, with children especially at risk. • Fleas bite and can cause itching in pets and people and can carry disease. If all of this is news to you, you are not alone! The survey found that pet owners didn’t always know what parasites should concern them most: 43% think dog lungworm is the parasite that poses the greatest risk to human health, when in fact, although it can be fatal to dogs, 2 it’s harmless to people. Just 28% knew that ticks are also a risk to human health due to the 2 diseases they can transmit. Only 7% think roundworm 2 could threaten human health.

2. Pet Buzz Survey of 1,056 dog owners Feb 2017

5. Overgaauw PA. et al. Veterinary and public health aspects of Toxocara spp. Veterinary Parasitology 2013, 398– 403

3. Abdullah et al. (2016) Parasites & Vectors 9: 391

6. Smith et al. Medical & Veterinary Entomology (2011) 25, 377–384

4. Wright et al. The prevalence of intestinal nematodes in cats and dogs from Lancashire, north-west England (2016). JSAP 57 (8), 393–395

7. Morgan et al. (2010) JSAP 51, 616–621


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8. Taylor et al. (2015) Parasitology 142 (9) 1190–1195

23/08/2017 15:35


Fleas are often very visible and most of us would rush to our vet to find out about flea control if we saw any on our pets. But not all pet parasites are quite so easily spotted.


• Ticks can be really tiny before feeding – the size of a seasame seed – making them hard to spot in your pet’s coat. Research shows that almost one in three dogs is infested with ticks.3 • Adult cats and dogs often show no sign of being infested with roundworm but they pass worm eggs into the environment. In fact, over one in four domestic cats that go outdoors has roundworm,4 as do up to a third of all dogs.5 • Even though lungworm can be fatal to dogs in the early stages of infestation pets often show no sign of being infected.

THE RISKS ARE INCREASING • Tick numbers are increasing and they are feeding all year round.6 • Cases of lungworm are increasing and spreading throughout the UK into previously unaffected areas.7,8 Despite the potential risks, over a third of people say they never think about the parasites their pet might be hosting when they hug them. Yet treating against pet parasites has never been easier, with a wide range of products available, including spot-on treatments and even oral chews. So keep hugging, because that’s good for everyone’s health – but let’s make sure we also act to help protect our families, furry or otherwise.


Or to find out more about pet parasites and carry out a risk check for your cat or dog visit

Brought to you by the manufacturers of

BROADLINE® is a registered trademark and NexGard Spectra™ is a trademark of Merial. For further information contact Merial Animal Health Ltd, CM19 5TG, UK. ©Merial Ltd 2017. All rights reserved.

Use medicines responsibly. Merial is now part of Boehringer Ingelheim.

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23/08/2017 15:35

Nutrition & Wellbeing

Protect Your Pets Against


Pets have a mind of their own—unfor tunately, this means their owners won’t always be able to control what they come into contact with


ating infected food or being exposed to other animals can give your pet a parasite. While some are just annoying, others can be deadly. Cats, dogs and rabbits are prime targets with parasites causing damage both externally—on the skin—and internally. While vets will be able to give an exact diagnosis, there are certain signs and symptoms you can look for to tell if your pet has a common parasite.

Common parasites

Fleas. These are probably the most common and well-known parasites. Fleas like to feed on warm-blooded animals and thrive in fur and feathers, meaning that most household pets are at risk. They can jump up to 50 times their body length and can feed off humans too. Flea bites are not only annoying and itchy; they can also lead to anaemia if not treated properly. Check if your pet has fleas by looking for flea dirt—a black/brown residue in the fur that when wiped with a wet cloth will turn red.

cause more obvious physical symptoms like vomiting or diarrhoea. Flystrike. Rabbits can be infected by a very serious parasitic infection called flystrike. This occurs when certain types of fly lay their eggs on your rabbit. These then hatch into maggots and eat the rabbit’s flesh. The flies that cause this condition are particularly drawn to wet or dirty fur. Check your rabbit daily for dirty fur and signs of infection and make sure their bedding is clean and dry. It is also important not to over-feed your rabbit so that they can continue to clean themselves properly.

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IMAGES © Shutterstock

Intestinal parasites. Fleas can act as intermediate hosts to intestinal parasites. They are also commonly picked up through ingestion. A tapeworm infection is usually contracted by spotting white segments that look like small grains of rice in your pet’s faeces, around its rear end or in its sleeping area. Other intestinal parasites may

27/09/2017 09:01

Nutrition & Wellbeing Earmites. There are several kinds of mites that like to live in animals’ ear canals to feed on the wax and oils found there. They most commonly affect ferrets, cats and dogs. While these mites may not present any symptoms, it is likely that your pet will be scratching their ears excessively and may leak black or brown wax from their ear canals. Mange. There are two kinds of mange: demodectic and sarcoptic. Both are caused by mites buried in the skin, but sarcoptic is the only type that can also spread to humans. Mange presents itself as various skin problems such as hair loss, scabbing and rashes. The condition is also prone to secondary bacterial infections that can be very uncomfortable for your pet. A vet will be able to perform a skin scraping test to check what kind of mange your pet has in order to treat it. •

Prevention is the best cure

While it is difficult to avoid parasites, there are measures you can take to stop them from spreading.  Don’t let your dog eat anything except its proper pet food—especially snails, rodents and soil.  Perform regular inspections of your pet’s fur and take note if they are itching excessively.

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 

Take your pet for annual health check-ups at the vet’s. Always clear your pet’s faeces using the correct bags or gloves, putting all waste in a designated bin. Inspect your pets for ticks daily and promptly remove any ticks you find.


27/09/2017 09:01

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25/09/2017 15:50

Nutrition & Wellbeing

The Basics of

Pet Insurance Over 56 percent of pet owners do not have insurance, leaving them with hefty bills after each visit to the vet. Discover our simple guide to pet insurance


ecent reports have confirmed that cases of pet obesity are on the rise in the UK. In fact, according to data collected by pet insurer Animal Friends, there has been a 900 percent increase in life-threatening pet conditions since 2011. Climbing occurrences of diabetes, asthma and heart disease have been chalked down to poor diet, lack of exercise and overfeeding. Combined with the high risk of common accidents, the need for pet insurance has never been greater.

Four main types of pet insurance

IMAGES © Shutterstock

Accident only. As the name implies, this type of insurance only covers you for accidents that your pet is involved in. This option usually involves a fixed sum per treatment, though this may depend on the provider. Per condition. These insurers cover for a set fee limit, however, there is no restriction on how long the treatment lasts. Cover will continue for as long as the owner renews the plan. Unfortunately, recurring illnesses do not tend to be covered by this sort of scheme. Time limited. This type of policy will pay for the treatment of your pet if they are sick or injured—but only for 12 months after

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their diagnosis. This is usually one of the cheapest types of cover. Most companies will impose a fixed payout; if treatment exceeds that amount, the owner will have to pay the remainder of the fees.

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Lifetime. This is the most comprehensive form of pet insurance. Usually providers will set a very high limit per year, although the policy will still need to be renewed. Lifetime plans often cover other services such as dental and burial expenses.

Benefits of pet insurance

Apart from providing cover for veterinary fees if your animal is sick or hurt, other benefits may include: • Reimbursement for the cost of your pet if it is lost, stolen or dies as a result of their illness.

• • • •

Cover for the cost of a reward to return your lost or stolen pet along with the cost of the advertisement of the incentive. The expense of care for your animal if you are taken ill yourself or hospitalised. The cost of your cancelled holiday can be returned if it is caused by your sick pet. Third part liability cover—for damages made to other people’s property. •


27/09/2017 09:02

Exotic Pets

Looking After

Exotic Pets

The environmental, behavioural and dietary needs of exotic pets can be challenging. Read Dear Vet’s handy guide before deciding to take one home


rom reptiles and tarantulas to Leopard Geckos and Bearded Dragons, the popularity of exotic pets has boomed over the last few years—it is now one of the fastest-growing sectors in the animal industry. Though exciting, the decision to adopt an exotic pet should be carefully considered; find out as much as possible about the animal’s needs and whether they would make a suitable pet for your home and family.

Frogs and other amphibians

Frogs have always been a popular choice among fans of exotic pets. Tree Frogs, for one, need to be kept in large terrariums as they are known to jump long distances. Moss makes for good flooring material and large bits of bark will give these small animals plenty of spaces to hide. Keep the temperature in their terrarium at 25C during the day and 20C during the night. As for food options, mealworms, crickets and earthworms are all suitable. Fire Salamanders, one of the most popular tailed amphibians for sale as pets, are exceptionally easy to care for and keep. They call for relatively large tanks with moss as flooring and logs for hiding. Keep their living spaces clean— they can be susceptible to fungus diseases. All types of salamanders are 160 DEAR VET WITH PETER WRIGHT & JULIAN NORTON

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27/09/2017 09:03

Exotic Pets

easy to feed; provide them with a mix of live foods and garden bugs.

that’s easy to clean. Much like pythons, these lizards will need a basking area (3842C) and a cooler area (22-26C) in order to live comfortably. Add accessories to the vivarium such as rocks and branches. Their diet consists of insects and vegetables. Note: this type of lizard sheds its skin in large pieces.

Pythons and other reptiles

Scorpions and other invertebrates

IMAGES © Shutterstock

While most Royal Pythons in the UK are bred in captivity, they will still exhibit some wild instincts—their needs will also be the same as they would be in the wild. Their vivariums should be made from solid material, easy to clean and secure. These should have a ‘basking zone’ where temperatures reach 32C as well as a ‘cool zone’ where temperatures range between 22-26C. These pythons should be kept at 60 percent humidity. For sustenance, they’ll need defrosted mice and rats. Note: these exotic animals can live for more than 20 years. Bearded Dragons, on the other hand, are the most popular pet lizards in the UK. A 120 x 60 x 60cm vivarium is the minimum size requirement for a fullgrown dragon’s ‘home’. It should be well ventilated and made from solid material

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The Emperor Scorpion, while impressive-looking, is a fairly inoffensive and easy animal to keep. A typically even-tempered critter, this scorpion’s sting is not likely to be more dangerous than a bee’s. A crucial requirement for any scorpion owner is a good tank and lid—these animals have a flair for escapology. House them in a tank with appropriately sized food containers, ventilated tops, bark chippings, moss and compost. They should be kept at around 25C, so some form of heating will be required. As for their diet, this type of scorpion is rarely picky. They will eat anything from locusts and crickets to any creepy crawlies you may find in your home. Feed them in the dark and leave them alone once you’ve given them their food.


27/09/2017 09:03

Exotic Pets


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Another easy invertebrate to keep is the Mexican Red Knee Tarantula. This critter, which is named after the distinctive colouring around its legs, doesn’t require a large home. Keep them at a temperature of 28C and at 75 percent humidity. Mealworms and crickets are all this animal will need for sustenance. Probably the easiest of all unusual pets is the Indian Stick Insect. Needing little more than a good-sized tank to live in, these creatures are comfortable at room temperature and eat a range of easily collected foods such as hawthorn, bramble and oak.


The first thing to think about when adopting any animal is whether their behaviour will fit in with your lifestyle. This is even more crucial when the pet in question is exotic. Will they be nocturnal or diurnal? Does the animal require company or does it enjoy and thrive in solitude? Their adoptive environment must allow them to live their life naturally—this includes burrowing, climbing or basking. Many exotics will require a carefully controlled living space; they may need specialised heating and lighting to maintain optimal health. Knowing how big they will grow is also important, as is finding out their

life expectancy, what they eat, how much and how often. Food for exotics may be more expensive and harder to find—before you choose your new exotic pet, make sure there is a specialised shop and vet near you for any supplies, treatments, emergencies and regular check-ups.


Caring for exotics can be timeconsuming and especially expensive as these animals have the same needs they would in the wild. According to the Animal Welfare Act, these needs must be met by law. In these situations, impulse buys may turn out to be extremely costly: some animals may grow too large, become aggressive, live for a very long time or require special paperwork to be legally sold or kept. Before purchase, it is also worth finding out the provenance of the animal and whether they would be harmful to the local environment. Unfortunately, some animals are still illicitly captured for the pet trade and are taken from the wild and often put through long and stressful periods of transportation. Ensure you don’t go back on your decision; some species are exceptionally hard to rehouse and others might even be illegal to release into the wild. •


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Keeping a parrot Perhaps one of the bestknown types of exotic birds, parrots can come in all shapes and sizes. Provide your pet with the largest cage possible, as their wild instincts will inevitably shine through from time to time. Invest in good perches and clean out the cage as often as possible—parrots are not known for their cleanliness

27/09/2017 12:43

Era Home Security.indd 1

07/08/2017 14:04

Our family are real-life heroes Pneumonia can affect any one of them. Don’t let them miss an opportunity to help protect themselves. Encourage your heroes to talk to their healthcare professional about pneumococcal pneumonia vaccination today.

Produced and funded by

Visit: for more information. PP-VAC-GBR-0465 September 2017

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22/09/2017 15:57

Profile for Magazine

Dear Doctor with Dr Chris Steele 2/17  

Celebrity Angels: Dear Doctor with Dr Chris Steele brings you health advise from ITV This Morning's resident doctor Dr Chris Steele. This is...

Dear Doctor with Dr Chris Steele 2/17  

Celebrity Angels: Dear Doctor with Dr Chris Steele brings you health advise from ITV This Morning's resident doctor Dr Chris Steele. This is...