Live to 100 Winter 2019

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c e l e b r i t y

a n g e l s

Live to 100

with Dr Hilary Jones


Fertili ty


To Sleep Better





Live A Longer, Fitter Life!



With TV Favourite


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Choose a specialist centre of excellence for your hip or knee replacement The Horder Centre is an independent hospital in Crowborough, East Sussex, specialising in orthopaedic surgery and musculoskeletal services, including physiotherapy. Performing over 2000 knee and hip replacements a year, we deliver exceptional outcomes for our patients and our centre has been designed to provide a therapeutic environment to enhance recovery and wellbeing. Rated ‘outstanding’ by the Care Quality Commission, we excel at patient care and our standards of service are reflected in our patient feedback.

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14/10/2019 17:51



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11/10/2019 12:52


Health in Your Hands Why learning more about the crucial issues around health and wellbeing will help us all to live longer, happier and more productive lives



elcome to the latest issue of Live to 100. As always we have a packed issue for you, one which will help you to understand some of the most important health issues of today. And it’s more important than ever that we do get to grips with them, because we’re all being faced with a lot of misinformation and propaganda which can be thoroughly misleading. There are major issues facing our health services which I’m sure you will have read about—the crisis in care provision for the elderly, the increase in diabetes, the dangers of winter illnesses such as influenza, and so on—and there are lots of myths surrounding these subjects. We’ll be busting a lot of those myths in this issue. But there are also great things going on in healthcare which I’m sure you will want to know about—research into treatment for cancers, promising advances in technology and the wonderful potential of genetic and regenerative medicine to address

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disorders which are currently untreatable, such as Alzheimer’s. As you read about these in this issue, I’m sure you will agree that there’s lots to look forward to in the future of healthcare. It’s always important to remember that in many ways our health is in our own hands, and the way we approach our lifestyle, taking care of diet, getting plenty of exercise and making sure we have regular checkups, are important steps on the road to a long and healthy life. Just as important is that we think of our mental wellbeing, learn to enjoy our lives and take a positive outlook—that way we should all have a long life and a happy one. •


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10 INTERVIEW Britain’s favourite TV Doctor Hilary Jones talks to Chris Jenkins about the most common health conditions affecting us all, how we should take responsibility for our wellbeing and what needs to be done to improve the physical and mental health of the nation

Fitness and Nutrition 14 PROBLEM SLEEPING

If you can’t sleep, your waking performance is bound to suffer—we suggest the top tips for making sure that you get all the healthy rest you need

18 SLEEP THERAPY Stress can be a big disruptor of sleep, but what if there are other causes? Hopefully you won’t nod off before reading our guide to medical problems and solutions

23 SEAWEED STORIES You can eat it, wash your hair with it, even put it on your skin—who would have though that humble seaweed would hae so many health and nutrition benefits to offer?

25 HEMP AND CBD The incredible rise of hemp and CBD oil as a panacea for all sorts of ills comes under our microscope. What’s the scientific basis for it, and are the claims justified?


No part of your body works harder than your heart, but it won’t have a fighting


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14 chance if you don’t look after your diet and fitness. If your heart seems to be older than you are, read on


How breakthroughs in robotics, artifical intelligence, virtual reality and nonengineering could lead to the health treatments of the future


Diet fad, or the key to natural health? We examine the trend for ‘clean eating’ explain what it is and how it can be taken too far

36 CLINICAL APPROACHES TO WEIGHT LOSS When dieting and exercise aren’t doing the trick, what clinical solutions are there to the problems of obesity?



It’s a taboo subject for some, but talk of shortages of HRT treatment has brought focus onto the important issue of managing the menopause


Thinking of ditching your glasses for contacts? We tell all about lenses


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Contents Contents


pregnant for a first or subsequent time. Our Ultimate Guide to Fertility looks at the causes, therapies and range of available treatments for the complete range of fertility worries


54 Your Health Care 44 RETINAL DISORDERS

The light-sensitive layer at the back of the eye is delicate and susceptible to all sorts of disorders—how can we care for it and help to protect our precious sight?


What breakthroughs in medical science could be made through better understanding of how our DNA works, and what are researchers finding out about when genes go wrong?


These nasty accretions can cause all sorts of health problems if we let them build up. We look at how dentists are trying to educate their patients about the horrors of biofilms



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TO FERTILITY Many couples battle with fertility problems and face years struggling to get

Uterine Tract Infections can be persistent and distressing, and are increasingly failing to respond to antibiotic treatment. So what can we do to prevent them and what's the current state of medical thinking?


Studying rare diseases can teach us a lot about how the human body works, so pioneering research is making strides by looking at disorders that affect only a very few


HEALTH CHECKS Whatever your age, condition and state of health, it’s important to keep up with regular medical checks. We tick off the most essential screenings for all ages, and suggest some you might not have thought of…


Vaccinations are in the news, with shortage scares, ‘flu campaigns and the rollout of HPV vaccination to boys – and a battle against worrying anti-vax propaganda on the internet. But why is it so important for us all to keep up with our jabs?


Recovering from cancer can be a long and difficult road. We look at some of the ways education and support can make the process easier

71 VACUUM ASSISTED BIOPSY Biopsies can be a worry, but now there’s a procedure which can make the process faster, more efficient, and more effective


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THERAPY How innovative cancer therapies using advanced imaging techniques are promising a revolution in treatment and recovery


Look after your teeth and they’ll look after you, they say—so what are the best ways to make sure your pearly whites stay that way throughout your life?

82 SLEEP APNOEA It’s not just a matter of keeping your partner awake with your snoring, sleep apnoea is a worrying condition which left unaddressed can have serious health consequences


DENTAL IMPLANTS Got a gap to fill? Dental implants can address many problems with our teeth in a more permanent and reliable way than the alternatives. But just what is involved in getting implants?


A ‘heart flutter’ might not sound serious, but atrial fibrillation is not minor matter. Our explanation of the causes and possible treatments should help stop your pulse pounding

92 RESEARCHING BREAST CANCER How innovative research into genetics and genomics is opening up new approaches and better understanding of the best treatments for breast cancer


Winter sniffles are no fun, particularly if you are already not in the best of health —but there are many myths surrounding ‘flu and the best ways to fight it

100 CHRONIC AND ACUTE WOUNDS How doctors and nurses deal with wounds that just won’t heal


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Causes and treatments for a distressing condition likely to affect wheelchair users, the bed-bound and post-operative patients



The charms of this small country might hide the fact that it is also an increasingly popular destination for a range of medical treatments using the latest procedures and technologies


This bone condition can affect anyone, but is most prevalent in older age groups. Lifestyle changes can help avoid it, but otherwise what are the treatment options?


We all find that getting about can become harder as we get older. Fortunately there are plenty of mechanical aids and therapies to restore easier movement



What are the implications for our sight of the increase in diabetes? We look at the dangers to our vision, how they can be treated and why we should all look out for our optical health

121 DIABETIC AWARENESS Diabetes is on the rise due to a lack of education on the subject and an understanding of the implications of an unhealthy lifestyle. Now campaigners are striking back


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celebrity PUBLISHER & CEO Kevin Harrington EDITOR Chris Jenkins SUB EDITOR Elika Roohi

Dementia care in the UK is a contentious issue—why has a problem arisen, what can we all do to improve understanding, and what sort of help can we rely on when the time arises?


Stem cell research promises a range of treatments addressing previously untreatable conditions—so how does it work, and how are researchers facing up to the ethical questions involved?





FILL AND SCULPT Are dermal fillers for you? They're a 'lunchtime lift' that might be a better bet than cosmetic surgery


PUCKER UP There's a hot new way to add volume, definition and colour to your lips—will you go for Lip Blushing?


ERASING STRETCHMARKS Post-pregnancy or weight change, stretchmarks can be a pain—so what can you do about them?


Stroke can be debilitating, and getting back to full health afterwards can be a long battle. Now there are some innovative treatments aimed at making it easier to cope with the aftermath

WINTER SKIN CARE As cold weather sets in you have to throw out all your ideas about summer skin care routines


PUMP UP THE VOLUME What can you do with thinning hair? Don't pull it out—read our suggestions for care and treatment


NATURAL SKIN We bust some of the myths about skincare and explain how the natural way might be the best course

145 SKIN OVER 60

Skin changes as it gets older, and so should your skin care regime. We explain how to keep smooth and supple over 60

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EDITORIAL ASSISTANT Robyn White PRODUCTION DIRECTOR Joanna Harrington PRODUCTION COORDINATOR Severine Eidem OFFICE COORDINATOR Adam Linard-Stevens PUBLISHED BY Celebrity Angels © 2019 all rights reserved

Live to 100 with Dr Hilary Jones Celebrity Angels Suite 2, 143 Caledonian Road, London, N1 0SL Tel: 020 7871 1000 Fax: 020 7022 1694 For sales enquiries call: 020 7871 1000 All material in Live to 100 with Dr Hilary Jones 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. Disclaimer: Live to 100 with Dr Hilary Jones has been produced as a family health guide. It does not constitute professional medical advice. In no way does this publication take away your responsibility to seek professional medical advice should you have concerns regarding your health. Please visit your GP should you require professional medical advice.

Images: Shutterstock



DESIGN Jason Craig


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Getting in Touch With

Your Health Britain’s favourite TV Doctor, Dr Hilary Jones, talks to Chris Jenkins about health concerns we should all share, what the health services can do for us, and what we should do for our own health


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normal weight is vital in this regard. We should also keep in mind any family history of heart disease and pay particular attention to having our cholesterol and blood pressure levels screened and to consider taking statins and low-dose aspirin if appropriate. Q. What’s the importance of sleep to health and well-being? What can we do to improve our sleeping patterns? HJ. Adequate restorative sleep is vital to our health and well-being. During sleep our brain makes sense of everything that it is taken in during the previous day and processes it. Without it our concentration and cognition deteriorate. Sleep deprivation has been used as a method of torture. To improve our sleep patterns the most important thing of all is to establish a regular sleep routine otherwise known as sleep hygiene so that we go to bed at

Images: Shutterstock; ITV's This Morning

Q. With cardiac health becoming a concern for many people, what are the best ways to make sure that our ‘heart age’ doesn’t exceed our actual age? HJ. Our heart is a fist-sized organ which beats around 70 times per minute or 4,200 times per hour. That is 100,800 beats per day or 37 million per year. It really pays to look after our heart because if it stops for more than two to three minutes, we are effectively brain-dead. The best ways to do this is to exercise the muscle of our heart just like we do any other muscle in our body. Regular aerobic exercise can achieve this whether it is brisk walking cycling rowing swimming or ball games— anything in other words that makes our heart rate increase. We also need to look after our coronary arteries which supply our heart muscle with oxygen. A healthy balanced diet, not smoking, avoiding stress and maintaining a

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Interview Interview

roughly the same time in the evening and wake up at roughly the same time each morning. Establishing regular cues for this pattern is important and we should aim for around seven to eight hours uninterrupted sleep each night. This means a sleep environment which is dark and quiet, and at a comfortable temperature. Avoid any caffeine or alcohol in the hours before bed, don’t eat too late and make sure your bedroom is a technology free zone.

weight naturally medical intervention may be appropriate to prevent pre-diabetes, diabetes, coronary heart disease, arthritis, hypertension and other problems which could curtail life. Q. Is a little indulgence really that bad for us? Can luxuries like wine and chocolate actually do us some good? HJ. Life is for living. That means having some fun and enjoying occasional treats, but not to the detriment of your health. The real problem is that too many people are indulging all the time. There will always be temptations and there is plenty of availability. Fast food, sweets and cakes are ubiquitous and cheap, but some

Adequate restorative sleep is vital to our health and well-being... without it our concentration and cognition deteriorate

Q. At what point should we decide that diet and exercise aren’t enough to shift excess weight, and start looking at medical intervention? HJ. The real problem for most overweight people is that they never realise what a necessary level of diet and exercise is actually required for weight loss. The human body is extremely efficient when it comes to energy conservation and stubbornly hangs onto its fat stores. It is an evolutionary device which still protects us from any possible famine. It means that only frequent and regular moderately vigorous exercise will burn off sufficient calories and that only a diet that is difficult to stick to is required. This entails huge self-discipline and will mostly only work if monitored and supported with specialist outside help. When a person’s body mass index indicates that they are becoming morbidly obese and developing medical conditions secondary to their obesity, and when every attempt has been made to lose

degree of self-discipline is important. This means exercising regularly and eating a healthy well-balanced diet most of the time and only enjoying those indulgences such as alcohol and confectionary as occasional rewards. Q. Are we becoming averse to certain medical treatments such as vaccinations? Why is it important to keep up with them? HJ. A hundred years ago, a quarter of all children died before their fifth birthday due to infectious diseases which are now fully preventable. Imagine the outcry and private and public distress if this was still the case today! Vaccination programs have revolutionised all that, and children dying from infection at all is rare in the developed world. Unfortunately, because of the amazing success of vaccination people have become complacent and have forgotten the damage that these diseases can wreak. But these illnesses are still out there. Measles alone killed 90,000 people last year globally.

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Q. Why is oral health declining in the UK, and why is that worrying? What should we do to reverse the trend? HJ. There is no doubt that oral health has decreased in the UK and one reason is because of constant cuts in funding for NHS dental treatment. For many people regular check-ups and treatment is proving too expensive and our diets, so high in sugar, are contributing massively to dental decay and gum disease the commonest condition of all. Today the commonest reason for hospital admission for young children is dental extraction which is an awful indictment for something which is completely preventable. We need more resources and subsidies, less sugar in our diets and better education on dental hygiene.

A hundred years ago, a quarter of all children died before their fifth birthday due to infectious diseases which are now fully preventable

Mini-epidemics have returned to parts of Europe and the USA as a result of falling vaccination rates and lowered herd immunity. Ignorant anti-vaxxers propagate all kinds of misinformation and fake news and would probably be the first people to be queueing up and banging on the doctor’s surgery door if a major epidemic threatened their own children.

awareness of the signs and symptoms, earlier diagnosis, more widespread screening and more personalised treatments. We also now have a better understanding of family history and genetic predisposition, which is increasing the chances of preventing the development of breast cancer in those most at risk. Q. With fertility problems worrying many young couples, are resources being directed properly? Is it a misuse of medical technology to promote pregnancies in older mothers?

12 | Live to 100 with Dr Hilary Jones

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Images: Shutterstock; ITV's This Morning

Q. How are new treatments for breast cancer likely to change outcomes for patients? Are there any particularly promising approaches? HJ. New treatments for breast cancer are being developed all the time. We have always relied on surgery, chemotherapy, hormone treatment and radiotherapy, but increasingly new treatments which identify the type and staging of breast cancer can target cancer cells more specifically and are achieving better results and outcomes. This is the result of increased

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HJ. One in six of couples have problems conceiving, but there remains a postcode lottery for investigation and treatments, with different health authorities imposing different criteria for treatment and offering different numbers of cycles of treatment. For many this seems unfair. Also, some criteria seem reasonable yet others such as those relating to age can be controversial. In the UK we are protected from the excessive ambition of certain fertility specialists, who seem to recognise no boundaries for age or gender selection, by the HFEA who oversee fertility treatment in this country with an exemplary ethical and moral code of conduct. Few people can really believe that achieving pregnancy for selfish reasons in a mother who will be 70 or 80 by the time the child reaches the age of 10 and the father perhaps five years deceased is a good idea. Q. What are the most promising fields in medical technology, and what benefits can we hope to gain from them? HJ. Robotic surgery is capable of achieving much better results with more accurate interventions with less blood loss and shorter hospital stays than ever before. Technology also promises more personalised and effective medical treatments based on genetics and tissue typing. More sophisticated technology is attaining more accurate and earlier diagnosis in the fields of cancer and coronary heart disease and should lead to earlier interventions and better outcomes. At the same time the identification of specific biomarkers will hopefully demonstrate cancers earlier than ever before perhaps even before symptoms of common disorders reveal themselves to the patient. We are already seeing better results with fewer side-effects from the latest centres which are offering more accurately targeted proton beam therapy for brain and prostate cancer.

with the dignity and respect they deserve. Addressing social isolation and loneliness is particularly important as it is a scandal that so many people over the age of 70 may only see a human face once a week or less. There is a huge amount that can be done in this area which will reduce the burden of depression, dementia, suicide and physical comorbidities which social isolation promotes.

Q. With the increase in demand for dementia care and other services, are we paying enough attention to the medical needs of the ageing population? HJ. The social and medical care of our ageing population is one of the greatest healthcare challenges our nation faces. Currently 800,000 people are living with dementia in the UK a figure estimated to rapidly increase within the next few years. We need to recognise the needs of our elderly folk and treat them

Q. In what areas would you like to see changes that might improve the health of the nation in the future? HJ. I’d like to see improvements in mental health, health education for children in schools, and people taking more personal responsibility for their health. Recently we have seen a long overdue increase in public interest in mental health. There has been such a stigma linked to this in the past but now people are much more willing to talk about the

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Today the commonest reason for hospital admission for young children is dental extraction

problems they face and their feelings generally. Campaigns have had high-profile supporters such as Princes Harry and William and they have helped considerably with their charity work. Enlightened employers are now doing much more to support their workforce in many areas. The government also seems more willing to recognise the scale of the problem especially in young people who increasingly do not seem to have the coping skills necessary to deal with adversity. However there remains much still to achieve. I have always believed passionately in educating young children about how their bodies work, how disease can be prevented and establishing good habits about diet and exercise from a young age. They are always curious to learn, excel at practical lessons in CPR, and perhaps we would help diminish the problem of drug abuse or unplanned pregnancies later on in their lives if we gave them the wherewithal to avoid such difficulties. Finally, people need to take more personal responsibility for the health. Only we ourselves can control what and how much food we put on a plate and how often we eat and snack. Only we ourselves can control our alcohol consumption and our levels of exercise. We must also be aware of and nurture our mental health. Healthcare professionals are always there to pick up the pieces when things get out of control, but the best plan is surely to avoid having to use their expertise in the first place. • Live to 100 with Dr Hilary Jones | 13

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FITNESS & Nutrition

21Top Tips

For Refreshing Sleep

Having trouble getting your ‘forty winks’? We uncover the experts’ top 21 tips for an undisturbed night of sleep


he average adult should be enjoying approximately eight hours of sleep a night, but increasingly, stress, overuse of electronic devices and poor lifestyle habits mean that insomnia, the inability to sleep well, is becoming a familiar experience for many of us. Inadequate sleep can lead to poor concentration, irritability, fatigue and low moods during the day–but there are plenty of ways to achieve better sleeping that you can explore yourself, rather than turning to medical treatment. These are some of the methods recommended by sleep experts to ensure you’re getting the refreshing sleep you need to kick-start your day.

14 | Live to 100 with Dr Hilary Jones

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1Ban the blue

Dr Hilary Jones says; "Technology is a massive problem now, and one of the main causes of insomnia". Blue light wavelengths emitted by devices such as mobile phones and tablets trigger alertness and increase attention. Though valuable during the day, this causes immense difficulty when settling down to sleep, as the blue light suppresses the body’s production of melatonin, the sleep hormone. So try to limit your use of digital devices in the hours before bedtime.

2Blackout curtains

Even natural light can influence your sleep patterns by interacting with the body’s natural sleep/waking cycle, known as your circadian rhythm. Blackout curtains can block out evening sunlight and light

from bright streetlights, thereby setting the ideal, dark environment needed for restful sleep.

3Befriend your bed

Bumpy mattresses and unsupportive pillows can disrupt your sleep patterns by keeping you tossing and turning throughout the night. If your find your sleep poor, consider investing in a new, more supportive mattress (you should have one every eight years), hypoallergenic or temperature controlling pillows, or a shoulder pillow to support your head and neck.

4Loud silence

Silence is not always the way to restful sleep and not all noise is disruptive.

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FITNESS & Nutrition

FITNESS & Nutrition

5Keep it clean

7Midnight wanders


8Stay cool

Working a nine-to-five or juggling parenthood can make it difficult to keep track of the last time you cleaned your sheets. Sleep medicine specialist at John Hopkins University, Dr Rachel Salas strongly advocates washing bedsheets at least every two weeks, and findings by a National Sleep Foundation appear to support this, with the smell of clean sheets being one of the top things people liked about their bedrooms.

Natural light Once it’s time to

rise, open your curtains and let in the natural light; this alerts the body into an awakened state, and helps to regulate your circadian rhythms.

A quick trip to the loo, popping downstairs for water or checking that everything is switched off is completely normal, yet every time you turn on your lights to do so, the light disrupts your body’s production of melatonin, the sleep hormone. So if you do get up in the night, instead of switching on the lights, use a torch and keep it pointed downwards so the light is facing away from you.

Treating yourself to a warm bath can promote healthy sleep through the subsequent cooling, which deceives your body into believing that it is now night time.

9Good exercise

Jogging, cycling, swimming, or even brisk walking—in fact any aerobic exercise, can promote healthy sleep by increasing the level of adenosine in the body. The neurotransmitter adenosine encourages sleep by interacting with our circadian rhythms or sleep/wake cycle.

Images: Shutterstock

10Dodge stimulants

Insomnia triggered by anxiety or stress can be alleviated by listening to calming music. Behavioural sleep medicine specialist Lisa Medalie recommends listening to ‘white noise’, a gentle hiss containing a mix of frequencies, particularly useful for individuals with tinnitus who struggle to sleep. You can download a white noise app, purchase a white noise machine or find compilations of white noise music online.

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Energy drinks, tea, coffee and cigarettes are all stimulants, containing either caffeine or nicotine. You may feel dependent on your morning coffee or evening energy drink, but addiction can disrupt sleep patterns. The NHS supports Nicotine Replacement Therapy (NRT), but if you find yourself craving caffeine, opt for green tea which contains less caffeine than black tea and coffee.

11The herbal way

The soothing alternative to caffeine-rich drinks is a herbal tea, such as chamomile, which contains the antioxidant, apigenin. This binds to certain brain receptors to create a calming effect and reduce anxiety. For something to chew on, Wicked Gummy Co’s Peaceful Zzzzz are registered with The Vegan Society and contain only natural fruit flavourings. Live to 100 with Dr Hilary Jones | 15

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FITNESS & Nutrition

The gummies contain Passiflora, 5-HTP and valerian root to increase serotonin levels, fight depression, anxiety and sleep disorders, and bring natural, blissful sleep and an energised tomorrow.

12Don’t fill up

Over eating before you go to bed can increase your blood sugar levels and keep you awake during the night. Restrict your last meal to two to three hours before bed-time to ensure healthy digestion and stable blood sugar levels.

13Ditch the drink

Unlike coffee, energy drinks and cigarettes, alcohol is a depressant and so theoretically could help you nod off quicker—but in fact it blocks the rapid eye movement (REM) phase of sleep, so alcohol can leave you dazed and unable to focus in the morning.

14Stay cherry

A study by the School of Life Sciences department at Northumbria University served 20 volunteers either a 30ml serving of tart cherry juice or a placebo twice a day for a weeks. Results suggested that the cherry juice generated improvements in sleep patterns, via an increase in melatonin levels.

calm 15Keep and yoga on

The NHS recommends gentle yoga prior to climbing into bed to ensure improved sleep. The benefits extend to all demographics from pregnant women to the elderly, and different positions explore helpful breathing techniques.

16Sex it up

If you’re inclined to use your bed as a snack-bar, workplace or Netflix bingeing station, it can impact on your sleep patterns. Try to restrict your bedroom activities to sex and sleeping, to help establish a routine which signals to your brain that bedtime is sleep time.

16 | Live to 100 with Dr Hilary Jones

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17Magic magnesium

The shift to a diet full of carbohydrates and refined sugar has made magnesium deficiency more common. Magnesium is essential in maintaining a healthy sleep cycle as it regulates the body’s production of melatonin and the neurotransmitter gamma-aminobutyric acid (GABA) which counters the effects of glutamate, the brain’s main excitatory neurotransmitter. Increase your magnesium levels with supplements or magnesium rich foods, such as spinach, almonds, dark chocolate and pumpkin seeds.


To-do list

For insomnia induced by stress or anxiety, writing down a to-do list before you go to bed can be beneficial. Jot down on a pad or sticky note what you need to do the following day to stay on top of things, and place the list nearby. Creating a to-do list allows you to both feel and become more organised.

19Suit up

Signalling to your brain it’s time for bed is core to establishing healthy sleep patterns, hence the importance of ‘suiting up.’ Don’t drift off

without taking off your work clothes and slipping into pyjamas. Wearing clothes specifically for bedtime signals to your brain that it's time for sleep.

20Sleep massages

Alongside improving circulation, massage can relieve signs of stress, pain and tension by relaxing the muscles. The sensations of massage can help achieve a drowsy state, as well as relieving the symptoms of anxiety or stress-related insomnia.

21Smells like sleep

Environmental cues for sleep are not solely visual, so aromatherapy can be integrated into your routine as a sleep signal. A blend of essential oils rather than one can generate an improvement in sleep quality. Popular choices include chamomile, lavender, vanilla and valerian root. Adopt aromatherapy into your sleep routine by adding the essential oil into a diffuser, mixing into your bath or diluting essential oils with a carrier oil and applying it to your body. Follow all our advice and you’ll soon be sleeping better, feeling better, and even looking better! •

15/10/2019 14:35 020 8347 8734

Want to live to 100? Sleep is your superpower. Good sleep keeps us young. It powers our immune system, cleans toxins from our brain, and is essential for the body’s repair. If we don’t get enough we can’t benefit fully from healthy food or exercise. Sleep poorly and our risk of serious illness and obesity increase.

“I spent thousands on insomnia supplements and therapies. Nothing cured it. I now sleep 8-10 hours a night. What a gift!! Worth every penny !!!” Christy

The Zeez Sleep Pebble uses brainwave patterns to prompt good sleep all night long. No noise, no vibration, no app. Just the gentle power of science. We have tested the Zeez Sleep Pebble for 6 years. It is available now to people of any age who want to sleep well and stay young.

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01/10/2019 12:00

FITNESS & Nutrition

Sleep Disorders

and Medical Solutions

Sleep disorders such as apnoea, insomnia and Restless Leg Syndrome prevent millions from enjoying a restful night. Live to 100 uncovers their causes and medical solutions.


he NHS is facing increasing demands for sleep disorder tests—the number performed has doubled from 69,919 in 2007/8, to 147,610 in 2017. Clearly, our sleeping problems are getting worse. The main method for checking sleep disorders is polysomnography, which involves observing sleep patterns and recording signals from electrodes which are placed onto various parts of the body. These tests can incorporate other techniques such as electroencephalography (EEG) to monitor brain waves, electromyography (EMG) to examine muscle tone and electrocardiography (ECG) to check the heart, alongside recordings of breathing movements. Particularly worrying is NHS data published in 2018 showing a rising number of children diagnosed with sleep disorders, up from 6,520 in 2012/13 to 9,420 cases in 2018. Sleep consultant at

18 | Live to 100 with Dr Hilary Jones

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The Sleep Sanctuary, Rachel Taylor labels sleep issues ‘the hidden public health crisis.’

Insomnia Insomnia refers to sleeplessness generally, yet there are there are three different types of insomnia: transient, acute and chronic. Both transient and acute insomnia are short term, though while transient insomnia will only last for no longer than a week, acute insomnia can span several weeks and can be caused by extended periods of stress. Chronic insomnia has far more complex and varying reasons ranging from chronic stress to physical disorders such as sleep apnoea. The majority of sleep disorder tests are used to diagnose sleep apnoea. The term derives from the Greek word ‘apnea’ meaning ‘without breath’. There are three categories of apnoea: obstructive, mixed and central. The most diagnosed type of

apnoea is obstructive, otherwise referred to as OSA. In all types of sleep apnoea, breathing is disrupted during sleeping by relaxation of the throat muscles, causing the throat to narrow and block the airways. The interrupted breathing caused by OSA deprives the brain of oxygen, leading to the brain being compelled into wakefulness to allow normal breathing.

BREATHING FREELY Several studies have tied the occurrence of sleep apnoea to a higher risk of developing Type 2 diabetes, due to the effect of interrupted sleep on metabolism, so it causes more of a risk to health than simply being tired. Discussing the dangers of a sleep apnoea episode, Dr Phyllis Zee, a sleep apnoea expert at Northwestern University explains, “There’s little air exchange for 10 seconds or more at a time… oxygen goes down and the body’s

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FITNESS & Nutrition

Spot the Symptoms of OSA • Breathing that is interrupted by gasping or snorting • Loud snoring and breathing • Night Sweats • Urge to urinate during the night

fight or flight response is activated. Blood pressure spikes, your heart rate fluctuates, and the brain wakes you up partially to start your breathing again. This creates stress.” Each episode therefore increases your risk of experiencing a stroke, which is why apnoea must never be left untreated. In some cases, occurrence of OSA can be reduced by lifestyle changes, such as quitting smoking, limiting alcohol intake and stopping the use of sedatives. More severe cases of OSA necessitate extra attention and can be treated using surgical treatments such as tonsillectomy, where enlarged tonsils are removed to prevent the blockage of airways during sleep; adenoidectomy, which involves removing adenoids, if they are found to be enlarged and restricting the airways; tracheostomy, where an artificial insertion is created in the trachea or windpipe that is held open by a tracheostomy tube; or finally bariatric surgery or weight loss surgery, which treats OSA by combatting one of its biggest causes, obesity.

nose and mouth. The mild air pressure prevents the airways from collapsing when inhaling during sleep and reduces snoring, promising a better bedtime for you and anyone else in the house. Uses of a CPAP device to treat severe OSA can have potential, mild side effects from pressurised air entering the stomach, such as abdominal pain, headaches and bloating. An alternative which should avoid these side-effects is the Mandibular Advancement Device (MAD), similar in appearance to the gumshields used in competitive sports. The MAD prevents the collapse of airways by changing the jaw and tongue position,

pushing outwards to increase airflow. It is advised you have a MAD created for you by a dentist, to match the alignment and shape of your teeth, rather than purchasing a device online.

Can’t Stop Moving Restless Leg Syndrome (RLS) is a neurological disorder which creates an uncontrollable feeling of discomfort in the legs and arms. In most cases, there is no obvious cause, and the NHS refers to this as idiopathic or primary restless leg syndrome. The condition has similarities to Periodic Limb Movement Disorder, but this appears to have different causes. Some neurologists believe the neurotransmitter dopamine could play a role in primary restless leg syndrome, as it is involved in governing muscle movements. But RLS can also be brought about by iron deficiency or kidney failure, when it is known as secondary RLS. Pregnancy has been shown to increase the likelihood of experiencing RLS—up to one in five pregnant women will experience RLS in the last trimester. Lifestyle changes can help ease the symptoms. These include frequent exercise, stopping smoking and avoiding stimulants

OSA TECH There are technologies which can be used to treat OSA short of surgery. A pressurised device designed for the airways known as a Continuous Positive Airway Pressure device (CPAP) works by providing a continuous supply of compressed air via a pump and typically comes with a mask to cover both the

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FITNESS & Nutrition in the evening such as caffeine and alcohol. Applying hot or cold compresses to leg muscles and practicing gentle yoga is equally effective in relaxing the muscles and reducing symptoms of RLS.

RISKS AND RESULTS In cases of primary restless leg syndrome where low levels of dopamine are responsible, dopamine agonists may be suggested. The NHS recommends ropinirole, pramipexol and the rotigotine skin patch to balance dopamine (though these do have potential side effects such as nausea, dizziness and, in extreme cases, impulse control disorder (ICD), though these subside once the medication has been stopped. Codeine-based painkillers can be used to treat symptoms of RLS, and severe and extremely painful cases of RLS can be treated with migraine drug gabapentin, or epilepsy treatment pregabalin. All sleep disorders are associated with a higher risk of cardiovascular disease, but this risk is greater in individuals with RLS, as rapid leg movement can increase both blood pressure and heart rate. You can cut your risk by maintaining a healthy diet, getting regular exercise and quitting smoking. Cognitive Behavioural Therapy (CBT) for treating insomnia looks at relaxation training, sleep restriction and stimulus control. Relaxation training encourages muscles in different parts of the body to relax and calm the body; breathing exercises, specific meditation techniques and guided imagery can all help the body to transition into a state of relaxation. Similarly, stimulus control works by conditioning the brain to associate the bedroom with sleep. Stimulus control will restrict all non-sleep related activities from the bed, and ensure you’re only getting into bed when you’re actually sleepy to eradicate unhealthy sleeping habits. In conjunction with stimulus control, sleep restriction can be used to remove poor sleeping habits by introducing subtle behavioural changes.

20 | Live to 100 with Dr Hilary Jones

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SWEET SPOT FOR SATISFYING SLEEP The peak times when our body feels the most sleepy are at 2 a.m. and 2 p.m., so don’t blame yourself for wanting to nod off

hemp plant, interacts with the body’s endocannabinoid system, governing physiological and cognitive processes, and helps your circadian rhythm (the body’s natural cycle of adjustment to light and temperature between day and night) correct for the change in temperature in summer.

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Dr. Kulreet Chaudhary reports

A relatively low-tech way to reduce stress and encourage relaxation is the pillow speaker - this plays ambient music from a smartphone app, which you hear through bone conduction rather than air conduction, so it shouldn't disturb your sleeping partner. Researched as a way to relax autistic children, this sort of design was found to be helpful in inducing sleep in adults during studies in American universities. It's a passive system - it doesn't in any way monitor or react to your sleep state - but it's thought to regulate stress by activating the vagus nerve, which conveys sensory information from the organs to the central nervous system. So if you're suffering from lack of sleep, you don't have to take it lying down— there are plenty of bedtime therapies to help you get your Z's. •

the most productive sleep time for improved energy levels and a happier day ahead is between 10 p.m.-2 a.m. These can include keeping a regular bedtime, stopping excessive napping or getting out of bed a specific time after waking up.

The Holistic Way A poll conducted by found that temperatures above 18.3 degrees Celcius cause sleeplessness for 52 percent of Brits. CBD (cannabidiol) oil or capsules have been suggested as an effective form of self-treatment for summer sleeplessness. The theory is that CBD, a natural ingredient derived from the

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FITNESS & Nutrition


I Need Some Body!

It’s not just good for your hair and skin—seaweed is good to eat too. We look at the marvellous properites of this neglected marine resource


he term ‘seaweed’ implies something that’s an unwanted nuisance, but in fact the huge range of marine plants from microscopic phytoplankton to massive kelps can be of all sorts of benefit, from providing a source of nutrition to promising medical and cosmetic advances. Seaweed is popular in cuisines all over the world, particularly from China, Japan and Korea (though ‘Chinese Crispy Seaweed’ is actually fried cabbage). In Wales, the seaweed known as slake is boiled then fried to make ‘laverbread’. Nutritionally, seaweed contains Iodine and Tyrosine, which supports Thyroid function. Kelp is the type of seaweed that contains the best sources of iodine. Seaweed also contains powerful and protective anti-oxidants, a large amount of fibre and can potentially reduce risk of heart disease due to how it lowers blood cholesterol levels. Sprinkling dried seaweed on foods can be a simple way to increase vitamin and mineral intake.

SKIN As a natural source of amino acids, vitamins and minerals, seaweed can have anti-ageing benefits for the skin. These amino acids can help skin look ‘plumped up’ and more youthful. Seaweed can also contain natural moisturisers and vitamin E, which prevents dry and flaky skin.

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Seaweed can also help acne and sensitive skin problems. This is because the Omega-3 fatty acids, zinc and magnesium found in different types of seaweed can create a protective barrier on our skin which can help protect it being subject to harsh weather, overly dry environments, and other types of damage. The anti-inflammatories in seaweed can help acne heal more quickly.


A medical study by PubMed Central showed that participants given a dosage of fucoxanthin, a substance found in brown seaweed, had improved blood sugar levels compared to those who received none, suggesting that medication derived from seaweed could help to prevent diabetes.

Seaweed can also be great for your hair health. Its Omega-3 fatty acids provide hair follicles with the right amount of nutrients to stimulate hair growth, and to strengthen hair. Omega-3 can also improve the blood circulation in your scalp, preventing damage and providing a healthy starting point for your hair to grow. Some people who suffer from dry and damaged hair also experience hair loss, and there is a reason why they find seaweed infused hair products the most beneficial—seaweed contains vitamin A and C, which hugely helps sebum production. The production of sebum, an oily substance which keeps the hair and skin moisturised, can naturally condition your hair and keep it looking full and healthy. It’s even been suggested that low cancer rates in Japan could be partly due to seaweed in the diet—so who know what other benefits could be derived from this marine marvel? • LIVE TO 100 WITH DR HILARY JONES | 23

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FITNESS & Nutrition

Natural Health



n recent years, CBD (cannabidiol) and hemp oil products have increased massively in popularity, both claiming many health benefits and safe, natural ways to enhance our wellbeing. The idea around the oils is that they provide us with the beneficial and medicinal properties of cannabis, without any element of intoxication—though they are extracted from cannabis-like plants, they don’t contain any THC (tetrahydrocannabinol), the ingredient that makes cannabis psychoactive, or in other words, the element that gets you high. But, considering how popular it is becoming, and the many health benefits they claim, do we know enough about these supplements? There’s little medical research to back their claims, and the two are often confused, or marketed with vague claims an no medical evidence, while actually there are big differences that consumers need to be aware of.

HEMP OIL Hemp oil is often classed as a ‘superfood’. It doesn’t claim to target mental wellbeing or physical pain, and has no CBD or THC, but has large amounts of anti-oxidants and the beneficial fatty acids Omega 3 and 6. It’s used mainly to improve acne and oily skin, as well as working as a moisturiser and skin softener.

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CBD and hemp oil are being promoted for all sorts of health benefits—but what’s the difference, and how do they work?

The main difference is that CBD oil is made from the whole plant, whereas hemp oil uses just the seeds. Subsequently, they are used for very different applications.

CBD OIL The cannabidiol in CBD oil is claimed to work with the body’s endocannabinoid system, part of the nervous system. It’s said to have anti-inflammatory properties, and so is often marketed as a way to relax and relieve stress, as well as reliving a myriad of stress-related symptoms, while still being fully in control of your senses. CBD oil is claimed to have benefits in conditions as diverse as anxiety and depression, skin complaints such as acne and eczema, anorexia, insomnia, chronic pain, drug withdrawal, epilepsy, arthritis, joint pain and glaucoma. It’s claimed that CBD acts on the brain receptors for serotonin, increasing the general sense of wellbeing, and it anti-inflammatory properties address joint pain. Epilepsy UK reports some promising results with an

unlicensed CBD product called Epidiolex, though this should not be confused with the THC-based products which are now available in very limited cases or rare forms of epilepsy. A study by the University of Vienna of 300 patients undergoing post-cancer chemotherapy indicated that CBD could reduce the side-effects of nausea and vomiting. So, while the jury may still be out on the benefits of CBD and hemp oil, your individual experience may well work to bring a better understanding of the value of these natural products. •


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YOUR Wellbeing

Listen to Your Heart

Unless you have a diagnosed heart problem, you probably have no idea what condition your ticker is in—but the majority of us are walking around with a heart which is effectively older than we are


n fact, 80 percent of us are at risk of conditions such as heart attack or stroke, and a heart attack happens every three minutes in the UK. Fortunately, there is plenty we can do to listen to our hearts and improve their condition. Since the 1980s, when measures such as the Framingham Risk Score were used to calculate a patient’s risk of suffering from a heart condition, there have been relatively simple ways to work out our

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risk factor. Currently accepted systems include QRISK3, developed by ClinRisk Ltd using data from the NHS, and JBS3, a heart risk app available through iTunes and Google Play, which is ideal for practitioners wanting to demonstrate the benefits of interventions to reduce the risk of heart disease. The easiest system for most of us to use is the NHS’s own Heart Age tool (on, which asks 16 simple questions such as your age, height,

weight, sex, ethnic group and smoking history, and quickly calculates the ‘age’ of your heart compared to your actual age.

Preventable deaths Shockingly, Public Health England’s finding following analysis of results from its own Heart Age test was that one in 10 men aged 50 has a heart age of 60. PHE says that 7,400 people in the UK die from heart disease or stroke every month, and people under 75 account

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YOUR Wellbeing for a quarter of these deaths, most of which can be prevented. The issue affects women nearly as much as men; more than 900,000 women in the UK are living with heart disease and it kills nearly three times more women than breast cancer. So, what can we do to improve our heart health and lower our heart age? Some factors, such as age and gender, we can do nothing about—nor can we change having a family history of cardiovascular disease. There are also some hidden factors that don’t cause any visible symptoms but can increase risk, such as high blood pressure, cholesterol levels or blood glucose (diabetes). For this reason, the online heart age test is more accurate if you know your blood pressure and cholesterol levels. But some factors contributing to a raised heart age are very much under our control—the main ones are smoking, alcohol, diet and exercise. The good news is that it is never too late to do something about all of these.

Images: Shutterstock

Checking in Your first step should be to get a health check—every 40- to 74-yearold in England is entitled to a health check every five years at a GP surgery, pharmacy or, in some areas, in local libraries or mobile units in shopping centres. Over-75s can have an annual check-up. Under-40s are generally at low risk but should see their GP if a close family member has had a heart attack or stroke at a young age (under 55 for a male relative, under 65 for a female). You can buy a DIY cholesterol-testing kit, and measure your blood pressure at home with an inexpensive monitor, but it is essential to have a discussion with a health professional, too. If your heart age turns out to be higher than your real age, try to balance it out with these basic steps.

Smoking damages the lining of the arteries, leading to fatty build-up. Quitting can be hard—every year, nearly half of all smokers in the UK try to stop, but only two to three percent succeed. Your best move is to accept all the help you can get, from psychological support to nicotine-replacement therapy and prescribed drugs to reduce cravings. Just one year after giving up smoking, your heart-attack risk will be halved.

120/80, and it’s considered to be high if consistently measuring above 140/90. A basic battery-operated blood pressure meter costs about £20 and takes only a few minutes to check your blood pressure using a pressurised sleeve placed around the forearm. In many cases, blood pressure can be regulated by making lifestyle changes such as maintaining a healthy weight, lowering salt and alcohol intake, managing stress and keeping active.

Reduce your blood pressure

Exercise more

Blood pressure is a measure of the pressure in the heart when it pumps blood around the body, over the reduced pressure when the heart is resting. Your blood pressure will inevitably rise as you get older, fatter and less active, drink more alcohol and eat more salt, but there may be no visible symptoms, even though high blood pressure can cause long-term tissue and organ damage. Even slim, active people can have high blood pressure and can benefit from medication. The ideal blood pressure measurement lies between 90/60 and

It takes only two-and-a-half hours a week of moderate physical activity to lower your risk of cardiovascular disease by a third. Any activity is better than none, and even a brisk walk is valuable, but to really make a difference, exercise needs to warm you up and increase your breathing and heart rate. You don’t have to join a gym and become an exercise fanatic—try something free and simple like joining a local park running group. A recent study concluded that going from no exercise to recommended

Stop smoking At least a third of all cardio-vascular disease is attributable to smoking.

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YOUR Wellbeing

Dr Hilary JoNes Says you should be able to hit these exercise targets:


In your 20s

➤ Run five kilometres in 30 minutes

In your 30s

➤ Deadlift more than 50 per cent of your bodyweight activity levels over six years in middle age may reduce the risk of heart failure by 23 percent.

Balance your cholesterol Cholesterol, a fatty substance found in meat and dairy products and made in the liver, comes in two types; low-density lipoprotein (LDL), ‘bad cholesterol’ which can clog up your arteries; and high-density lipoprotein (HDL), ‘good cholesterol’ which is protective. Your total cholesterol levels should be under 5mmol/l, and LDL under 3mmol/l. A home cholesterol testing kit can be bought for around £25, but for really accurate interpretation of the results you may need to go for a full medical check-up. If your overall levels are high you will be given advice on improving your diet and getting more exercise and may be offered medication such as statins. 28 | Live to 100 with Dr Hilary Jones

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Try to cut down on fried food, pastries, processed meat products such as sausages, cream and cheese, all of which contain saturated fats.

Manage your weight Being overweight makes your heart work harder and reducing weight can lower blood pressure and reduce bad cholesterol. Your waist measurement is a good rough guide to appropriate weight; women’s waists should be below 80cm (32 inches) and men should aim for a waist measurement of less than 94cm (37 inches). For people from a South Asian background, who are at higher risk, this is 80cm (32 inches) for women and 90cm (35 inches) for men. So, some causes of heart disease we can do nothing about, but others are entirely under our control—pay attention to your heart health and your whole body will thank you for it. •

In your 40s ➤ Touch your toes comfortably, keeping your legs straight

In your 50s ➤ Run at a moderate pace for 60 seconds without stopping

In your 60s ➤ Put one arm over your shoulder and the other behind your back so your fingers can touch

In your 70s ➤ Rise from a chair without using your hands and repeat twelve times in 30 seconds

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YOUR Wellbeing

How Technology is

Re-Booting Health

Revolutions in treatment mean that your health could soon be in the hands of robots and other advanced technologies

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YOUR Wellbeing


echnology has become such a large part of our everyday lives that it’s not surprising it is leading to revolutions in medical practice. Particularly on the cellular level, where it can be used against cancer and genetic conditions, technology is being used to make amazing strides in research, treatment and surgery. Technology suggests new approaches to removing cancerous cells, repairing brain damage and substituting for chemotherapy which could revolutionise many forms of treatment.

in a wide range of cancer surgery procedures,” Dr Takats said. “It provides a result almost instantly, allowing surgeons to carry out procedures with a level of accuracy that hasn’t been possible before. We believe it has the potential to reduce tumour recurrence rates and enable more patients to survive.” The iKnife has the potential to track down and remove more cancer cells than conventional surgery, improving outcomes and reducing the need for further surgery. It could be in wider operation in a couple of years.


Magnetic robot

The intelligent knife, or ‘iKnife’, may be a game changer for cancer surgery. Described as the knife that can ‘smell’ tumours, it has previously been used to treat brain and breast cancers, and has recently been assessed by researchers at Imperial College in tests for its safety and accuracy in detecting womb cancer. The iKnife uses electrosurgery, which applies an electrical current to rapidly heat tissue, cutting through it while minimising blood loss. In doing so, it vaporises the tissue, creating smoke that is normally sucked away by extraction systems. Researchers realised that this smoke, if analysed by a mass spectrometer, could identify the types of tissue being cut. The inventor of the iKnife, Dr Zoltan Takats of Imperial College London, realised that this smoke would be a rich source of biological information. To create the iKnife, he connected an electrosurgical knife to a mass spectrometer. In tests the iKnife correctly identified 91 samples from cancer patients. If it is found to be successful in the detection of womb cancer, then this could be a game-changer, because this type of cancer is often so hard to detect, and the iKnife can safely seek out and remove the cancerous cells. “These results provide compelling evidence that the iKnife can be applied

Blood clots in stroke patients, which can cause brain damage and aneurysms, could be sought out and destroyed by a magnetically-steered robot worm. Capable of gliding through narrow pathways and blood vessels without getting stuck, the robot worm (shown

below right) could replace the current form of treatment, which involves a thin wire being inserted into a vessel in the leg or groin, then being directed into the brain by hand. The potential damage caused by this technique would be avoided by the worm robot, which is able to move throughout the body without friction and can be controlled remotely by using magnetic fields. Scientists at Massachusetts Institute of Technology say the robot, made of nickel-titanium alloy and coated in hydrogel, could prevent brain damage in stroke victims. They are moving towards tests on live subjects.

The Royal College of Surgeons 2018 report on The Future of Surgery predicted four main areas of advance:


Robotics and nanotechnology used for minimally invasive surgery


Virtual Reality and Augmented Reality used to guide surgeons


Artificial Intelligence and ‘big data’ research results used to predict disease


3D bioprinting of tissues and organs, neural implants and bionics

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YOUR Wellbeing

Proton beam

Images: Shutterstock

Proton beam therapy, a form of external radiotherapy, could potentially replace X-ray therapy for cancer in a few years. Proton beams deliver as much energy but with less side radiation than X-rays, making it particularly suitable for treating child patients while reducing the chance of later side-effects. Researchers at Rutherford Health, who are developing the treatment, believe that around 10 percent of patients that are being treated with radical radiotherapy would see more benefits from proton beam therapy.

Robot surgeons Though we’re probably decades away from seeing full-blown robot surgeons, surgical assistance from robot arms is already a reality in systems like Mako, in

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use at the private Princess Grace Hospital in joint replacement procedures. The accuracy of placement enabled by the Mako Robotic Arm (shown left) can help world class surgeons perform complex hip and knee surgeries where patients feel less pain, have quicker recovery, gain better motion and function, and over time have fewer revisions than standard hip and knee replacement surgeries. Patients undergo a Computer Tomography (CT) scan of their joint, which produces a 3D virtual model of their unique anatomy. Uploaded into the Mako system, the scan guides the robotic arm within a pre-defined area, enabling the surgeon to remove only the diseased bone whilst preserving healthy bone areas and tissue. • Live to 100 with Dr Hilary Jones | 31

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YOUR Wellbeing

Eating Clean Does It Mean What You Think It Means?

So-called 'clean eating’ is no longer just a diet, it’s a lifestyle movement. So where did the idea come from, and is it for all of us?


he ‘clean eating’ movement is presented as a movement away from modern food trends—away from highly processed snacks, factory style farming, untrustworthy food chains and the perceived threat of genetic modification. Clean eating emphasises foods that are “whole” and “unprocessed”—it means cooking at home and finding good ingredients. But do some practitioners, including Hollywood celebrities and Instagram influencers, take the whole concept to extremes? Has the pendulum swung too far in the other direction?

DIET OR MOVEMENT? At its core, clean eating has an undeniable appeal which can’t be dismissed. All dieticians agree that we should be eating more vegetables, less refined sugar and less meat. And it’s undeniable that some of the processes used in growing, processing and packaging our food can be harmful. But nutritionists, seeing a spike in disordered eating connected to clean eating and wellness trends, are speaking out, saying that the phrase 32 | LIVE TO 100 WITH DR HILARY JONES

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DID YOU KNOW Sales of courgettes the UK soared 20 percent from 2014 to 2015, fuelled by the popularity of the spiraliser. “clean eating” has now taken on a new, misguided meaning. And the trend’s popularity can be dangerous, since aswith most wellness trends is is not based on rigorous scientific research. “The implication is that if you’re not ‘eating clean’, what you eat otherwise is dirty, lazy or unhygienic, and that’s simply not true,” says clinical nutritionist Jaclyn London. “It’s morphed from a sense of awareness about food into a diet-driven caste system. Not only does the phrase establish a hierarchical model for eating well, it’s yet another medium for foodshaming.” Jordan Younger, an early proponent of clean eating on her Blonde Vegan blog, discovered this the hard way. She built up a sizeable following for her extremely strict gluten-free, sugar-free, oil-free, grain-free, legume-free, plant-based raw vegan diet, but eventually she experienced

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YOUR Wellbeing health problems including hair, skin and menstrual issues, and recognised that she was suffering from orthorexia, an obsession with consuming only foods that are pure and perfect.

WHAT TO EAT? Younger started widening the repertoire of foods she consumed, starting with fish. Today, perfectly healthy, she blogs under the name The Balanced Blonde. She no longer hashtags her posts #eatclean. But as Jordan Younger found when she moved away from strict clean eating, fierce adherents of the movement can make it difficult to advance any argument against the trend. She received irate messages from followers including death threats and lost followers by the thousands. Her experience is indicative of some attitudes towards 'clean eating' held today. No longer a decision to strive for simpler meals, it has instead become a way of life. Clean eating cookbooks are too often not just vegetarian cookbooks, but a promise of a 'new you'.

Eat food, not too much, mostly plants.

Michael Pollan

Images: Shutterstock

MOSTLY PLANTS For those who feel a bit overwhelmed by all the contradictory food rules out there, it’s always helpful to remember the words of Michael Pollan, author of several books about nutrition: “Eat food, not too much, mostly plants.” Jaclyn London echoes this advice, saying we should just be eating more plants, more often—not obsessing about whether they are organic farmers’ market greens, or merely from the corner grocer.

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"My top tip for warding off illness? A healthy diet! Dr Hilary Jones

Everything else, you can eat in moderation—even sweets. London calls this “transparent eating”. “You know what I love about candy? It may not be ideologically aligned with #cleaneating, but it accurately represents itself as an indulgence. No one bought a candy bar thinking it was anything other than a treat!” London says. “'Transparent’ is a word I wish would take off, because it means being what it claims to be. Is your candy bar a candy bar, or is it a candy bar pretending to be an energy bar?! If it’s the latter, put it back and go for the real thing.”

SOMETHING SWEET If the idea of a nutritionist suggesting we eat refined sugar in moderation sounds shocking, take a closer look at some of the white sugar alternatives on offer. For instance, coconut sugar, which costs four times as much as the regular stuff, is metabolised by the body in just the same way as refined sugar, and the same goes for agave syrup. In the end, ‘clean eating’ is just a diet—a very popular diet, amounting to a lifestyle movement—but a diet nonetheless. And as with all diets, conventional wisdom still stands: most of us will benefit more from making small but sustainable lifestyle changes, rather than taking up an overly restrictive and perhaps ultimately unsustainable set of commandments. • LIVE TO 100 WITH DR HILARY JONES | 33

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Every Diet Needs


We should all be aware of the benefits of eating a healthy diet – but how can we make sure we are getting enough protein in our daily nutrition?

Luigi Gratton, M.P.H Vice President, Product Training – Herbalife Nutrition Trained at Mount Sinai Medical School of New York University with a postdoctoral fellowship in clinical nutrition from David Geffen School of Medicine at the University of California Los Angeles, Luigi Gratton M.P.H. has worked in family medicine and on human nutrition. As Vice President of Product Training at Herbalife Nutrition, Gratton is responsible for ensuring Herbalife Nutrition Independent Distributors have a thorough understanding of Herbalife Nutrition products, ingredients and benefits.

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ltra-processed foods can be high in sugar, fat and salt, and lacking in fibre, vitamins and minerals. Consuming ultra-processed foods is associated with obesity 1. Many of us are aware of the benefits of a healthier diet and have adjusted our diet to suit, but whatever our dietary lifestyle – vegetarian, vegan, flexitarian or embracing animal-based sources – we all need certain ‘macronutrients’ which are the essential building blocks of the human body 2 . Two of these are carbohydrates (consisting of sugar and starch) and fats (e.g. from fish oil or vegetables). But the third compound and perhaps the most essential is protein. When not well-planned, some plant-based diets can come up short on this vital ingredient. So what is protein, why do we need it, and how can we ensure we get enough of it? We asked Herbalife Nutrition's M.P.H. Vice President of Product Training Luigi Gratton to explain. “A lot of people don’t know what protein is” says Gratton. “Protein is one of the essential building blocks in the human body. Protein structurally gives the body form and function – it’s what makes your muscles strong, it’s what helps give strength & stability to your bones and tissues. But it also has a lot of functions in the cells. It actually makes up the components of cellular membranes, so it’s important from head to toe. “All humans need protein in certain amounts, so there are international recommendations or minimums as to the amounts we should eat. A healthy woman of 62.5 kg needs to eat 50 g protein per day while a healthy man of 75 kg needs to eat around 60g per day (based on a protein need 0.8 g/kg bodyweight per day) 3 “Herbalife Nutrition recommends a little more than the international minimum. We recommend consuming up to 30% of the calories from protein4. Which is 150 g for a man consuming 2000 kcal per day and 105 g for a woman consuming 1400kcal per day.” So what are the best sources of protein? “You can get it from meat, fish or chicken, but no matter what the source, that protein should

Advertorial have all the essential amino acids, the essential building blocks our body can’t produce for itself. Generally, animal sources have complete proteins - they have all the essential amino acids. But a lot of people are moving into "plant based" diets – trying vegetarian or vegan diets or even a flexitarian diet which is "plant based" protein intake mid-morning and mid-afternoon as a key part of a healthy meal or after exercise, with the occasional inclusion of meat. But when you’re eating a "plant based " diet, then how do you get protein?” Fortunately, there are vegetable sources with a broad range of amino acids, such as soy beans, seitan (which derives from wheat), flaxseed, rice, peas, beans or chickpeas. The important thing, as Gratton explains, is to blend your sources of protein together – “So if you’re okay eating meat and chicken, that’s wonderful - but if you’re on a vegetarian or vegan diet, look for those rich sources of protein and make sure you’re getting the full complement every day.” “The other important consideration is that when we think about developing countries or people around the world who are starving, protein deficiency is one of the causes of underweight children 5. So, as we look towards the future in terms of sustainability, a healthy planet, a healthy population, we want to make sure we can feed a growing planet with healthy sources of protein. And that’s why it’s not just about eating meat and dairy, but why plant-based sources are going to become very important.” Without sufficient protein, the body starts to rob other tissues to keep feeding and maintaining other vital organs, with possibly serious effects. “And it’s a myth that as we get older we need less protein” says Gratton – “In fact, it becomes more important because as the metabolism slows down with age, it becomes more important to take in protein - the amount typically recommended is 1 to 1.2 g protein per kg of body weight per day . So, if you were 100 kg you would need to eat 100-120g of protein per day 6as you age to make sure you’re getting sufficient protein for your body’s needs.”

1 (da Costa Louzada et al., 2018; Moubarac, Batal, Louzada, Steele, & Monteiro, 2017; Poti, Braga, & Qin, 2017) 2 (The Nutrition Society, 2009) 3 (WHO, 2007) 4 (USDA, 2015) 5 (McGuire, 2015)

Low in sugar and with an amazing flavour, Herbalife Nutrition Tri Blend Select is 100% vegan and, contains naturally sourced ingredients while providing vitamin C and seven key minerals - perfect for those who seek natural and highperformance nutrition. Tri Blend Select can increase plant-based protein intake mid-morning and mid-afternoon as a key part of a healthy meal or after exercise.

Now there’s an easy way to get all the essential amino acids you need in the form of a vegan protein shake, Herbalife Nutrition Tri Blend Select.

Five Facts About Tri Blend Select

■ It’s called Tri Blend Select

because it contains a unique blend of three plant proteins - quinoa, pea and flaxseed

■ It has all the essential amino acids that the human body needs in the right amounts – so it’s a complete protein source

■ Tri Blend Select is low in

sugar, high in protein and fibre with vitamin C as well as seven key minerals

■ Tri Blend Select contains

naturally-sourced, vegan and wholefood ingredients

■ You can use it as an

ingredient to make all of your favourite recipes; you can add it to shakes, smoothies or breakfast bowls*, bake it into a cookie recipe**, and use it as a simple way to manage your protein intake through all of your favourite drinks and dishes.

✱Herbalife Nutrition Tri Blend Select banana flavour is available in the UK now. * Only when prepared as instructed on the product label does our product deliver the full nutrition benefits described on that label. ** Please remember that if a Herbalife Nutrition product is used in a heated recipe, some vitamin levels in the finished product may decline in comparison to label values.

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27/09/2019 16:43

YOUR Wellbeing

Weight Loss: The Clinical Approach When dieting isn’t enough, it may be time for clinical intervention—but what are the options?


t’s no secret that being seriously overweight can have a negative impact on your quality of life. Obesity can lead to further physical and mental health issues, such as diabetes, coronary heart disease and increased risk of stroke. Many people are able to lose weight by making simple changes to their diet, maintaining careful calorie control, or by getting more exercise. But once somebody’s BMI (body mass index) reaches 30 or higher they are considered obese, and the need to lose weight becomes urgent.

Preventable Obesity isn’t just a number on your bathroom scales—it’s regarded as a chronic condition requiring treatment. Often, diet and exercise alone don’t to the trick, or the subject isn’t able to maintain them, so a clinical approach to weight loss may be needed. Clinical approaches to weight loss refer to methods of helping a person lose 36 | Live to 100 with Dr Hilary Jones

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weight through medical procedures under the guidance of a clinician. There are a variety of different methods, ranging from weight loss medications to surgery. In 2018, a study by Warwick Medical School showed that 3.6 million people in the UK were eligible for weight loss surgery—however only 6,627 actually went ahead with it. Possibly it’s still felt that obesity is in some ways a taboo subject, or that the condition is preventable and so it should be the responsibility of the individual, rather than becoming a burden on the NHS. Nevertheless weight loss surgery, also called bariatric or metabolic surgery, is regarded as a wide investment of resources as it can improve many expensive obesity-related conditions, such as type 2 diabetes or high blood pressure.

Drugs Weight loss pills can be an option before surgery is considered, but they must be

used along with lifestyle changes (such as changing your diet). Many so-called ‘fat-burning’ pills have not been properly tested and so should be approached with caution. The NHS regards only one pill, Orlistat, to be proven safe and effective in clinical trials in the UK. Orlistat is a prescription-only drug and comes in 120mg doses. It works by blocking certain chemicals in the gut which digest fat, so that nearly a third of the fat in blocked by the drug. The undigested fat is then passed straight into the stools. It is important to remember that while the drug helps to avoid gaining weight, it does not

15/10/2019 16:17

YOUR Wellbeing


Bariatric surgery—the options SURGERY

Surgery is used to treat severe obesity, usually with people who have a BMI of 40 or more. People who have a BMI of around 35 and also have a condition such as type 2 diabetes and high blood pressure are automatically eligible for surgery. There are several different types of procedure, including:


A gastric band creates a smaller pouch in the stomach which takes in less food. This works to make the patient feel full without eating as much. The band can be tightened and loosened once it is put into place – it usually takes a while for people it find the right tightness for them.


A gastric bypass uses staples to create a small pouch at the top of the stomach and then connects the small intestine, missing out the rest of the stomach. This works to not just take in less food, but also absorb fewer calories.


This is a temporary procedure, where a soft balloon is put into the stomach. The balloon makes somebody feel full without eating as much and is usually removed after a maximum of six months.


Images: Shutterstock

necessarily help you lose weight. Other weight loss pills available in the UK include Xenical, which is essentially a branded version of the same drug and of the same dosage. The only weight loss pill which is available over the counter in the UK is Alli, which is also a version of Orlistat, although it is a lower dosage (60mg instead of 120mg). People taking weight loss pills should bear in mind that they can create side effects, such as wind, needing to go to the toilet urgently and headaches. These side effects are less likely to occur, however, if you stick to a low-fat diet.•

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Alternatively, in more severe cases, clinicians will decide to remove around 80 percent of the stomach, which is called a sleeve gastrectomy. As always, the best advice for losing weight is to download the NHS 12-week weight loss plan, which has been downloaded more than 3 million times, to start your weight loss journey. The plan is designed to help you lose weight safely—and keep it off.

ventable cause... Obesity is the second biggest pre ... of cancer in the UK. However, according to the World Health Organisation, in 2018 62 percent of adults in the UK were overweight, with a BMI over 25, and 28 percent were clinically obese with a BMI over 30.


15/10/2019 14:54

YOUR Wellbeing


Menopause E Menopause is a sign of healthy ageing and needn’t be an ordeal. Live to 100 explores the most common symptoms and explains why you shouldn’t let them dictate the way you live

38 | Live to 100 with Dr Hilary Jones

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ven though menopause is a natural part of healthy ageing, the frustrating lack of information about it can make this normal experience feel daunting. But armed with the proper knowledge, menopause—like everything else in life— is manageable. Usually occurring between the ages of 45 and 55, menopause is the time in a woman’s life when her ovaries lose their reproductive function. Symptoms of menopause may appear

for months or years before your periods stop, and can occur for around four years. A change in the flow of periods is the first indicator of menopause, followed by changes in frequency, and eventually complete cessation. The other common symptoms of menopause are insomnia, reduced libido, vaginal dryness, headaches, mood fluctuations, anxiety, and hot flashes— brief episodes of feeling intense heat in the face, neck and across the body. Menopause can increase risk of osteoporosis (brittle bones) and can can cause stiffness and pain in the joints, reoccurring urinary tract infections (UTIs) and heart palpitations. But there are plenty of options to help you take control of these symptoms and prevent them from interfering with your everyday life. Hormone replacement therapy (HRT) is one of the top options.

15/10/2019 14:58

YOUR Wellbeing

GLANDS DON’T TAKE BREAKS There are many myths surrounding menopause, the most common being that the body stops producing hormones after menopause. This just isn’t the case— your adrenal glands don’t take breaks, and while the production of oestrogen and progesterone falls, they do not stop altogether.

HORMONE REPLACEMENT THERAPY HRT works by delivering oestrogen into the bloodstream via skin patches or tablets, to counteract the loss of oestrogen caused by menopause. There are two main types of HRT—oestrogen-only, combined oestrogen and progesterone. Oestrogen-only HRT cannot be used by women who still have their womb, as it can expose them to a higher risk of developing womb cancer, so combined HRT is the preferred option in most cases. HRT can provide major relief from night sweats and hot flashes, addressing insomnia and making the whole process of menopause more manageable. Of course, you need to discuss the options with your GP—some factors such as high blood pressure, liver disease or a history of ovarian cancer, breast cancer, womb cancer or blood clots may make combined HRT unsuitable.

Images: Shutterstock

ONE BY ONE An alternative approach is to treat the symptoms of menopause individually. Healthline recommends using antidandruff shampoos with ketoconazole 2 percent and zinc pyrithione 1 percent for signs of hair loss, while for symptoms of hair growth across the body, eflornithine hydrochloride in

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the form of a topical cream can be used. Similarly, the NHS advocates oestrogen treatment placed directly into the vagina as a cream or vaginal ring to combat vaginal discomfort and dryness. To eradicate insomnia and the overall discomfort triggered by hot flashes and night sweats, the NHS also advises specific antidepressants and clonidine, a medication traditionally used to treat high blood pressure. Other measures you can take to reduce hot flushes and night sweats include cool showers, dressing in lighter clothing, minimising stress, exercising more and avoiding potential triggers such as caffeine, smoking and alcohol. Lack of libido can be treated with testosterone supplements—yes, the hormone is mainly associated with the male sex drive, but studies show it to be effective in treating menopause symptoms and is less likely than HRT to increase the risk of breast cancer. Potential side effects to be wary of are unwanted hair growth and acne.

INDEPENDENT WOMAN Alongside your physical health, menopause can impact mental health, with common symptoms including mood swings, depression and anxiety. You can exercise control over these symptoms and maintain your cognitive wellbeing via simple self-help measures. These include getting more sleep, exercising and performing relaxing activities such as yoga or tai chi, which can help with joint pains. To maintain healthy bones, getting enough vitamin D is paramount, and you can get your boost by going for leisurely strolls in the sunshine. If it’s a typical UK summer, you may have to opt for vitamin D supplement capsules instead! At the same time, Cognitive Behavioural Therapy (CBT) can ease the impact of menopause on mental health, by improving low moods and reducing anxiety. CBT involves discussing with a therapist your behavioural and thought patterns, and introducing new, helpful thought patterns. You can discuss this option further with your GP or sign up to online CBT courses. •

EARLY MENOPAUSE Early menopause, occurring before the age of 40, can have many causes ranging from the genetic to high Body Mass Index, smoking, vegetarian diet, lack of sunlight, thyroid problems and epilepsy. Early menopause can’t usually be reversed, but the symptoms can be treated with HRT.


15/10/2019 14:59


If you are, then there is almost a 50% chance your child will be as well. 1

What is short-sightedness? ‘Short-sightedness’ is a common term for myopia – a common eye condition which causes distant objects to be blurry and out of focus, while close objects can be viewed more clearly. Myopia is a common eye condition in both adults and children. Currently myopia affects around 80 million children around the world,2 a figure that is set to rise sharply by 2050.3 The average onset age of myopia is also getting progressively younger; in 1983 it was eleven-years-old, whereas in 2000 it was eight-years-old.4

Genetics The risk of myopia in children increases when parents are myopic.1

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22 %

chance of developing myopia when neither parent is myopic.


chance of developing myopia when one parent is myopic.


chance of developing myopia - when both parents are myopic.

29/07/2019 15:28

Typical Eye

Clear vision Light focuses on the retina (the light-sensitive lining inside the eye) for clear vision.


Controlling myopia in children is important. As children’s eyes grow and their myopia increases so does their dependency on glasses. This can reduce the child’s ability to participate actively in sports and other activities.

Myopic Eye

Blurred vision If the eye grows too long, light is focused in front of the retina making distance vision blurry.

Light is focused here

Increasing myopia can also lead to eye health problems in the future. For example, you are 16 times more at risk of retinal detachment if you have a high myopic prescription of -6.00DS. 5

Introducing MiSight® 1 day – the first soft contact lens with a proven ability to slow the progression of myopia.


MiSight® 1 day is a daily disposable contact lens suitable for myopic children as young as eight-years-old. The lens is designed using ActivControl® technology which allows children to see clearly while slowing their myopia progression and eyeball growth. Wearing MiSight® 1 day contact lenses is shown to reduce myopia progression

in children by 59% on average, reducing their reliance on vision correction.6†

wearing their MiSight® 1 day contact lenses over wearing their spectacles.

MiSight® 1 day lenses are child-friendly.

90% of children could handle MiSight® 1 day lenses on their own.‡

Over a three-year clinical study MiSight® 1 day contact lenses in children aged 8–15 years.6

100% of parents said their children were happy with the experience of wearing contact lenses, including comfort, vision, ease of use and freedom from spectacles.

90% of children said they preferred

Find your nearest MiSight® 1 day stockist at

Available at select independent opticians and nationwide at Boots Opticians. 1. Mew-May Wu M, Edwards MH. The Effect of Having Myopic Parents: An Analysis of Myopia in Three Generations. Optometry and Vision Science. 1999 Jun 1;76(6):387–92 2. Siatkowski RM, Cotter SA, et al. Two-year Multicenter, Randomized, Double-masked, Placebo-controlled, Parallel Safety and Efficacy Study of 2% Pirenzepine Ophthalmic Gel in Children with Myopia. J AAPOS 2008; 12:332-339. 3. Holden BA, Fricke TR, Wilson DA et al. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmology. 2016; 123:1036-42. 4. Wolffsohn JS, Calossi A, Cho P, et al. Global Trends in Myopia Management Attitudes and Strategies in Clinical Practice. Cont Lens Anterior Eye. 2016; 39:106–16. 5: Flitcroft. The complex interactions of retinal, optical and environmental factors in myopia aetiology. Prog Retin Eye Res. 2012;31:622-60. 6. Chamberlain P, Back A, Lazon P, et al. 3 year effectiveness of a dual-focus 1 day soft contact lens for myopia control. Presented at the 40th British Contact Lens Association Clinical Conference and Exhibition; 10 June 2017; Liverpool, United Kingdom. *Compared with a single-vision, one-day lens over a three-year period. † MiSight® 1 day contact lenses may not slow the rate of myopia progression in all children and will not cure myopia. ‡ As reported by parents.

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16/10/2019 11:37

YOUR Wellbeing

Clearer Vision Are you thinking of looking into contact lenses? We consider the pros and cons and compare the different types


yeglasses can be a fun accessory, and now come in such attractive designer styles that they’re a long way from the embarrassing specs of yesteryear. We love them—but we don’t love it when our glasses get fogged up after coming in from the cold, rain obscures our vision, we have to clean the grease off them or they fly off our faces on the bus. So, whether you’re someone who wears glasses constantly or only once in a while, and you want the experience of coping without glasses, you might consider contact lenses. But what type to try—soft, hard, daily, weekly, extended wear, disposable...? We’ve put together a simple guide so next time your eye-test is due, you know what to discuss with your optometrist.

HARD LENSES Old-fashioned acrylic hard lenses are now obsolete, and have been replaced by Rigid Gas-Permeable lenses. If you want the sharpest vision possible, RGP lenses are the best choice. Because they have a hard, polished 42 | LIVE TO 100 WITH DR HILARY JONES

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surface, they typically have better optical qualities than soft contact lenses. Hard lenses might be a good choice if you’ve tried soft contact lenses and have been unsatisfied with the results or if you have dry eyes. Rigid gas-permeable contact lenses are more durable than soft contact lenses. They’re also more breathable, allowing more oxygen to the cornea. These contact lenses must be removed for cleaning and disinfection at night, but

SOLUTION It’s important to take out your rigid lenses every night and put them in contact lens solution. You should always use new contact solution— reusing the same solution for a few days is a big no-no. In fact, if you’re not wearing contacts for a few days, it’s recommended that you change the solution every day. Using new solution makes it less likely that bacteria will grow on your lenses.

some can be worn for a week or even up to 30 days. It might take a few days or up to a few weeks to adjust to wearing rigid gaspermeable contact lenses. However, if your prescription doesn’t change and you take care of your lenses, you can use the same pair for up to two to three years. Hard lenses can also help improve vision overtime, as they shape the eye. However, for this to happen, they require consistent wear to maintain the adaptation of the eye.

SOFT CONTACT LENSES Soft contact lenses are the most commonly prescribed type, as they are generally more comfortable to wear than hard lenses. Soft lenses can be used to correct various vision problems, including:

• Nearsightedness (myopia) • Farsightedness (hyperopia) • Blurred vision (astigmatism) • Age-related loss of close-up vision (presbyopia)

15/10/2019 14:59

YOUR Wellbeing

Allergy tips If you wear contact lenses and suffer from summer allergies, consider switching to daily instead of twoweek or monthly contact lenses. This can help reduce allergy contaminants in your eyes. Keep your re-wetting drops handy, and ask your optometrist for advice on coping with allergy symptoms.

Soft contact lenses come in various types, including:

Images: Shutterstock

Daily wear lenses: One-day lenses are rmoved and disposed of at the end of each day. Other options include two-week, monthly and, for some prescriptions, quarterly disposable lenses. Typically, you remove these lenses each night for cleaning and disinfecting. Overnight (extended) wear:

Some soft contact lenses can be worn for up to 30 days continuously, including while you sleep. However, without care this type of lens wear can cause

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complications, such as the build-up of debris under the lens, corneal problems or serious eye infections.

SPECIALISED CONTACT LENSES Depending on your vision needs, you may require something other than the typical hard or soft lens. There are several kinds of specialised lenses. Talk to your doctor about if any of these are right for you:

Hybrid contact lenses: Hybrid contact lenses have a rigid gas permeable centre surrounded by a soft outer ring. They can correct near-sightedness, far-sightedness, astigmatism and age-related loss of close-up vision, as well as an irregular corneal curvature (keratoconus). They also might be more comfortable to wear than traditional gas permeable lenses.

Multifocal contact lenses: These lenses are available in various materials and can correct nearsightedness, far-sightedness and presbyopia at the same time.

Tinted contact lenses: Contact lenses can be tinted for cosmetic or therapeutic purposes. Tinting

can enhance colour perception and compensate for colour-blindness.

Scleral contact lenses: These rigid gas-permeable lenses are larger than most, extending to the white outer layer of the eyeball (sclera). They can help correct vision if you have an irregular or distorted cornea.

Orthokeratology: These special rigid gas-permeable lenses are worn while you sleep to temporarily change the curve of your cornea. This creates clear vision while you’re awake.

Contact lens coatings: This treatment makes the surface of the lens slippery and more resistant to bacteria sticking to it. The coating can be applied to soft and rigid gas-permeable contact lenses. •

ACANTHAMOEBA Never wash your contact lenses in tap water. Acanthamoeba is an amoeba found in tap water that thrives on contact lenses, and from there can infect your eye.


15/10/2019 15:58

YOUR Healthcare

Keeping a Watch

on Eye Health The eye is a finely focussed instrument, but what happens when one of its parts stops working? We look closer at the nature of retinal disorders

Vision 101 The eye is said to be the window to the soul, but the scientific fact is that it’s a complicated structure with many interacting components, including the retina, cornea, lens, and optic nerve. The cornea (the transparent covering of the front of the eye) and lens work by focusing light onto the retina. The image is 44 | Live to 100 with Dr Hilary Jones

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upside-down due to the way the lens works. The central area of the retina, the macula, absorbs light and translates it into nerve signals. The optic nerve carried these signals to the brain, where they are interpreted into right-side-up images. Despite this chain of complex tasks, all of this happens almost instantaneously. In fact, a 2014 study by ophthalmologists at MIT discovered that the brain can process and interpret images presented to the eyes in as little as 13 milliseconds. Retinal problem tend to develop with age and are a leading cause of blindness in the developed world. Common retinal disorders include age-related macular degeneration, diabetic retinopathy, floaters, retinal tears and retinal detachment. Age-related macular degeneration is a common condition of the retina that causes central sight loss. The symptoms involve

blurry central vision, warped straight lines or difficulty focusing on fine details. Blind spots can develop as the condition worsens. Fortunately, there are treatments, such as an antioxidant supplement that slows the progression of the disorder.

DIABETES Diabetic retinopathy is a complication of diabetes that occurs when small blood vessels stop feeding the retina properly. In the early stages, the blood vessels may leak fluid causing blurry vision. And as the disease advances, you may notice floaters, blind spots or cloudiness of vision. If you have diabetes or are at risk, it’s very important to have an eye exam with pupil dilation annually. Advanced diabetic retinopathy can be corrected with laser photocoagulation surgery. Floaters are tiny spots or specks that

Images: Shutterstock


espite its immense importance of sight in our daily lives, it’s easy to forget that the retina, the fine sheet of nerve tissue at the back of the eye that reacts to light, is very delicate and subject to disorders. Usually we only think about the retina when our sight shows signs of deterioration. So what can go wrong with the retina, and what do we need to do to keep it in peak operating condition for as long as possible?

16/10/2019 11:11

Healthcare YOURYOUR Healthcare float across the field of vision. Most people notice them in well-lit rooms or outdoors on a bright day. While floaters are often normal, they can sometimes be indications of eye problems such as retinal detachment, especially if they are accompanied by light flashes. If you notice a sudden change in the type or number of floaters, make an appointment with your optician. Retinal tears occur when the clear, gel-like substance in the centre of your eye shrinks and tugs on the retina with enough traction to cause a break in the tissue. It’s often accompanied by symptoms such as floaters and flashing lights.

DETACHMENT Retinal detachment occurs when the inner and outer layers of the retina become separated. Without a retina, the eye cannot communicate with the brain, making vision impossible and causing blindness. Symptoms of retinal detachment include a sudden appearance of spots or flashes of light; vision that appears wavy, as if you were under water; and a dark shadow anywhere in your field of vision. Laser surgery can often reattach the retina and bring back all or part of your eyesight.

PHAGOCYTOSIS Dr Karl Matter at Moorfields Eye Charity is working on a stem cell-based approach to curing retinal disorders by stimulating phagocytosis, the process which clears cell debris which has accumulated on the retina

It’s important to pay attention to any changes in your vision and find care quickly when you notice them. Seek immediate medical attention if you suddenly notice floaters, flashes or reduced vision. These are warning signs of potentially serious retinal disease. In addition to regular eye exams, making several simple healthy lifestyle changes will also help preserve your eyesight. • Make sure to eat well, filling your diet with nutrients like omega-3 fatty acids, lutein, zinc and vitamins C and E—these can be found in dark leafy greens, oily fish, nonmeat protein sources, citrus fruits, oysters and pork. • Quitting smoking will also preserve your vision; smokers are at particular risk of macular degeneration and cataracts. • Wear sunglasses that block UV and UVB rays, not just in summer but on sunny days throughout the year. • Look away from the computer screen where possible. With four-fifths of the information our brains receive coming from the eyes, it hardly need saying that protecting our sight should be high on our lists of health care issues throughout our lives. •

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16/10/2019 11:11

Optos Case Study

A Chance Meeting A grandfather-of-four could have become blind in one eye if it wasn’t for a chance meeting with an old friend in his local supermarket.


avid Williams was picking up groceries one Sunday afternoon when he bumped into optician Tracey Crane, owner of Taylor Biddle Opticians in Compton, Wolverhampton. The 61-year-old explained to Tracey that he had been experiencing flashing lights and floaters in his left eye for the past month. He had been to his local optician for a check-up but was told they could not find anything wrong. David explained to Tracey that the floaters were gradually getting worse and, instinctively, she knew something was not quite right. Tracey asked David to come into her practice the following day for a full eye examination to get to the bottom of his symptoms. “When Tracey asked me to come into the practice, I didn’t think it was going to be anything serious,” said David. “Apart from wearing glasses to read, I’ve never had any problems with my eyesight. When I started seeing the flashing lights and floaters, I went straight to my high-street optician, but

they didn’t pick up on anything, so I wasn’t too worried.” But Tracey believed it could be something serious that David was experiencing. “I thought David’s symptoms could be the early sign of possible retinal detachment”, she explained. “This is a serious condition where the retina at the back of the eye tears away from the layer of blood vessels that provides it with essential nutrients and oxygen. The main symptom of this happening is flashers and floaters in your vision.” But the symptoms are often easily missed by opticians that use basic tests. “Because the signs of some retinal detachments can only be found in the outer area of the retina, known as the periphery, David’s local optician could have missed it if they were using standard imaging methods that can’t see that part of eye,” Tracey continued. “ At our practice we offer patients ultra-widefield imaging on an Optos Daytona device. The Daytona can capture a digital image of up to 200°, or 85 percent, of the retina including the periphery, known as an optomap®. I knew

“Having this imaging done has literally saved my sight.”

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our Optos Daytona would be able to immediately test my initial thinking and get to the bottom of his symptoms.” David visited Tracey’s practice the next day and within minutes of being examined on the Daytona, Tracey could see from his optomap that there was a tear in his retina. She immediately referred him to the local eye hospital in Wolverhampton and within 24 hours he had undergone emergency laser surgery to correct the tear. Left untreated, David’s retina could have completely detached, meaning he would have lost full vision in his left eye. “Once we finished the imaging, I was able to show David his optomap and the tear in his retina immediately. The ultra-widefield technology in the Daytona device meant we were able to spot the problem before it was too late and managed to save the sight in his left eye,” said Tracey. David was relieved. “To hear my retina was peeling off and that it could detach completely at any moment was very scary,” he said, “but thanks to Tracey and optomap I was treated quickly, and my eyesight has completely returned to normal. If I hadn’t bumped into Tracey at the local shops, I dread to think what would have happened. I’m a bricklayer by trade, so not only would I have lost my sight, but also my job.” At the hospital, David’s doctors told him just how fortunate his chance encounter with Tracey had been. “Having this imaging done has literally saved my sight,” he said, “Everyone needs to take care of their eyes, and visiting an optician regularly that offers this service is the best way to do this. It’s worth it just to be reassured everything is fine.” David now regularly gets his eyes examined with the Optos Daytona device and has fully recovered from the surgery carried out to fix his retina. Tracey said that it’s not just retinal detachments that optomap can

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be used for. “Using an optomap image means we can identify the early signs of a range of diseases and conditions, including diabetes and even cancer. As optometrists, using this technology gives us the reassurance that we’re giving patients a comprehensive examination. For our patients, it gives them peace of mind that we’re spotting anything before it becomes an issue. “Thankfully, when I bumped into David that day in the supermarket, he had been experiencing symptoms so I knew something was wrong. But I sometimes have patients with no symptoms who think their eyesight is perfectly fine, and it turns out there is something to be concerned about.” “We use this technology to spot problems early, so that they can be treated early. I hope by hearing David’s story other people can see how important it is to have your eyes checked regularly and comprehensively.” Optos, based in Dunfermline, Scotland was founded 27 years ago by Douglas Anderson. Douglas developed the ground-breaking optomap retinal imaging system after his five-year-old son lost sight in one eye because his retinal detachment was missed during a routine eye examination. Thousands of independent optometrists across the UK offer optomap as part of their eyecare services. To find one local to you, just visit:

16/10/2019 11:13

YOUR Healthcare

Doctoring Our DNA


any of the most debilitating and deadly diseases are caused not by infection by bacteria or viruses, but by our own genes. If we could only rewrite those genes, there would be wonderful potential for treating all kinds of conditions. Though the challenges are enormous, the last couple of years have seen tremendous breakthroughs. Each cell in our body contains a nucleus, into which are packed chromosomes consisting of strands of DNA (Deoxyribonucleic Acid). The sequence of molecules in the DNA comprises the gene, the unit of heredity. DNA contains the instructions to create proteins which build into new cells, and by unravelling and duplicating itself, the double helix of DNA can pass on genetic information through reproduction.

DISORDERS If this genetic information is incorrect or damaged, the result can be genetic disorders such as Down syndrome, muscular dystrophy, haemophilia, sickle cell disease, cystic fibrosis, Crohn’s disease and many others—in fact around 6,000 genetic disorders are recognised. These disorders can be caused by three types of genetic damage; to a single gene (sickle cell anaemia is an example); to a whole chromosome (for instance Down syndrome) or a complex 48 | Live to 100 with Dr Hilary Jones

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disorder where there is mutation to two or more genes. Since the structure of DNA was identified by Watson and Crick in 1953, scientists have been working to analyse the human ‘genome’, the complete genetic code, and to tackle the possibility of correcting mistakes. Scientists keep track of genes by giving them unique names—for example, a gene on chromosome seven that has been associated with cystic fibrosis is called the Cystic Fibrosis Transmembrane Conductance Regulator, or CFTR. But identifying errant genes and correcting them are two quite different things. How can we hope to make adjustments to such impossibly small molecules?

It is estimated that one in 25 children is affected by a genetic disorder and therefore 30,000 babies and children are newly diagnosed in the UK each year. Source:

THERAPY In ‘gene therapy’, researchers typically do this using a virus to carry the corrected genetic cargo into the patient’s cells, because that’s what viruses evolved to do with their own genetic material. Researchers are testing several approaches to gene therapy, including: • Replacing a mutated gene that causes disease with a healthy copy of the gene. • Inactivating, or ‘knocking out,’ a mutated gene that is functioning improperly. • Introducing a new gene into the body to help fight a disease.

Gene therapy was first tested on humans in 1990 and can be performed inside or outside the body. When only certain populations of cells need to be ‘fixed’, doctors may inject the virus carrying the gene directly into the part of the body that has defective cells—for example part of the brain when treating Parkinson’s disease. This approach is also being used to treat eye diseases and haemophilia. In out-of-the-body gene therapy, researchers take blood or bone marrow from a patient and separate out immature cells, then add an edited gene to those cells and inject them into the bloodstream of the patient; the cells travel to the bone marrow, mature and multiply rapidly, eventually replacing all of the defective cells. This would be used for instance in cases of sickle-cell anaemia and immune deficiency. Gene therapy has its difficulties, as the viral hosts can cause side-effects, so at the moment It is being tested only for diseases that have no other cures. But researchers are working on ways to eliminate the side effects and consider the technique to be extremely promising.

RESEARCH From 2020, all seriously ill children in England with an unexplained disorder will be eligible for genome analysis, following a project at Addenbrooke's Hospital and Cambridge University which found that one in four children in intensive care had a genetic disorder. Researchers were able to give a diagnosis within two to three weeks, which sometimes led to a change in treatment or spared children further invasive tests. So far, about 350 babies and children in intensive care at Addenbrooke's Hospital have had their genome, made up of billions of letters of DNA code, analysed as part of the Next Generation Children research project. Meanwhile Great Ormond Street

Images: Shutterstock

Gene therapy may be the key to curing many debilitating or deadly disorders. How are researchers tackling this complex yet promising technique?

15/10/2019 15:02

YOUR Healthcare

Hospital (GOSH) and the Institute of Child Health (ICH) continue to lead the world in gene therapy, and together are responsible for more innovative gene therapy trials than any other centre worldwide. Seven of these trials have focused on primary immunodeficiencies. Under the leadership of worldleading scientists Professors Adrian Thrasher and Bobby Gaspar, the gene therapy team have made extraordinary progress, particularly in pioneering new

treatments for children born with weak or completely absent immune systems. Despite their early success, the team know that more needs to be done. Over the next five to 10 years, Professors Thrasher and Gaspar aim to refine and develop their gene therapy techniques so that they can be used to help children with a wider range of life-threatening and life-limiting genetic diseases. These include some metabolic disorders and certain blood diseases.



In humans, each cell normally contains 23 pairs of chromosomes, for a total of 46. Twenty-two of these pairs, called autosomes, look the same in both males and females. The 23rd pair, the sex chromosomes, differ between males and females. Females have two copies of the X chromosome, while males have one X and one Y chromosome.

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Professor Gaspar says “We want to be able to deliver gene therapy for a whole wide range of conditions, not just the ones we started off with. Of course we want to build on that as well, but we want to treat far more diseases. "We want to treat larger numbers of patients and not just patients at Great Ormond Street Hospital. We want to take this and make it a medicine that can be used in patients worldwide.” And Professor Thrasher adds: “With support, I believe that a decade further on, gene therapy will be able to improve the

DID YOU KNOW? A new technique called Gene Silencing, using drugs such as patisiran to knock out faulty RNA messenger molecules, has recently been approved by the NHS for the treatment of the potentially fatal hereditary nerve disease amyloidosis. Gene Silencing could potentially be used to treat Parkinson's and Alzheimer's too. life and health of many children with life-threatening diseases, where other treatment methods are either ineffective or non-existent. It’s a very exciting time to be working in this field.” • LIVE TO 100 WITH DR HILARY JONES | 49

16/10/2019 11:17

YOUR Healthcare

Why Your Biofilm

is a Tough Subject

The layer of microorganisms coating your teeth is an example of ‘biofilm’, in this case one that leads to plaque buildup. So how should we tackle the slimy menace?

a ‘discloser’ treatment which shows up the biofilm by colouring it, making it easier to guide the dentist’s cleaning procedures, and to educate the patient in a self-treatment program. Improvements in clinical cleaning procedures mean that polishing treatments which actually cause damage to the enamel of the teeth and leave ‘hiding places’ for biofilm can be replaced with safer and more effective air-based polishing systems. But a lot of responsibility for good oral health remains with the patient, and there are many ways oral hygiene problems are treatable. Firstly, it is always essential to visit your dentist as soon as you notice signs of bleeding gums or soreness.


type of ‘biofilm’, dental plaque is a build-up of bacteria that forms on the surface of your teeth. The majority of plaque can be removed with regular brushing and flossing, however if this isn’t maintained plaque can build up to the point where it has serious consequences. If there is a lot of plaque on your teeth, the biofilm uses the sugars in your food to produce acids that eat away at your tooth enamel. Plaque that is not removed can then harden into tartar, which makes it more difficult to brush and floss, causing it to

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collect on your gum line. This is what ultimately causes swollen and bleeding gums. This is called gingivitis, which is the early stages of gum disease. If the gingivitis goes untreated, it will lead to more severe gum disease, causing tooth loss and decay. Most adults in the UK actually have gum disease to some degree, and it can be caused by a number of factors, but poor oral hygiene is the most common.

Treatment Treatment of biofilm is partly a matter of education, and many dentists will now use

Many cases of gum disease that are still in early stages of gingivitis, can be treated by just maintain proper standards of oral hygiene. This means brushing at least twice a day, flossing and using mouthwash. However, more severe cases of gum disease may need special treatment provided by the dentist. A ‘scale and polish’, for instance, is a method of deep cleaning your teeth, that works to get rid of the tartar that a toothbrush alone will not be able to remove. Depending on how much tartar has built up in your gum line, you may need more than one scale and polish. In other cases of gum disease, root planing may be required. This is a deep clean underneath the gums, getting rid of the bacteria that has accumulated in the roots. Many people require an anaesthetic before the procedure and can expect discomfort for around 48 hours afterwards.

Images: Shutterstock

Who’s at risk?

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YOUR Healthcare

Prevention ■ Regular dental check-ups should keep plaque build-up in check, but lifestyle changes are also helpful.

■ Keep your sugar intake to a minimum so that plaque has a smaller chance of accumulating on the surface of your teeth.

■ Stopping smoking will have a huge benefit to your overall wellness, as well as improving your oral health.

■ Don’t just brush your teeth, floss and use mouthwash as well

In very severe gum disease cases, the decaying teeth may need to be removed or gum surgery may be necessary. Factors contributing to gum disease are: Smoking: a huge factor in gum disease because the chemicals inhaled from cigarettes interferes with your ability to repair damaged tissues. Nicotine is toxic to your fibroblast cells, which are essential to the repairing of tissues, and the less they work, the more rapid progression of gum disease. Age: gum disease is most common in adults over 35. Diabetes: Diabetes means that a person’s blood sugar levels become too high, thus causing more damage to the teeth and increasing the risk of gum disease. Pregnancy: hormonal changes during pregnancy can actually make a woman’s gums more vulnerable to plaque build-up. Weak immune system: People who

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have a weakened immune system are more susceptible to gum disease because their bodies to not work to repair ailments as quickly as others do. This includes people who are undergoing chemotherapy, and those with HIV or AIDS. •

■ Use an electric toothbrush to remove the line


of plaque along your gums in parts of the mouth that a handheld brush can’t reach—then you’ll need fewer trips to the dentist

BIOFILMS Biofilms can cause a variety of health problems, ranging from a common earache to a specific bacterial infection found in people living with the genetic disease cystic fibrosis. LIVE TO 100 WITH DR HILARY JONES | 51

15/10/2019 15:05

Transforming smiles with pain-free care


owadays, we rarely see a celebrity picture in a magazine or on social media without their ‘perfect smile’ as the centrepiece. It’s no wonder therefore that the demand for straight, white teeth has grown in popularity – with almost twothirds of Brits considering cosmetic dentistry like tooth whitening and orthodontics. While the dental profession welcomes the increase in patients through the door, they are at pains to stress that there is far more to a nice smile than what it looks like, and that starts with good oral health. After all, there’s no point in having cosmetic dentistry to achieve the perfect smile if your teeth then fall out due to neglect! Despite this truth, a recent study showed that over a third of people in the UK said they had never visited a hygienist and prioritised beauty treatments over maintaining their smile. Perhaps testament to this, according to the Oral Health Foundation, one-third of British adults have tooth decay and two-thirds have visible plaque. Tooth loss, pain, bad breath, difficulty eating and swallowing, as well as a nose-dive in self-esteem, are what one might expect if conditions such as tooth decay and gum disease are not prevented and then left untreated. And it doesn’t stop at the mouth. Did you know that gum disease can be linked to other diseases in the body, such as diabetes, heart attack, stroke, and dementia, as well as pregnancy complications? That’s not all – the list goes on… Yet it’s simple to achieve and maintain good oral health. All you need to do is make good food and drink choices, brush twice a day with a fluoridated toothpaste for two minutes (which removes 60% of the bacteria in your mouth), clean between your teeth every day and visit the dentist and hygienist at regular intervals to ensure your entire mouth stays clean and healthy all year round.

So, why aren’t more people visiting their hygienist?

A big part of the problem is dental anxiety – caused in no small part by a very understandable fear of pain, worry that an injection might be needed, and the thought of that dreaded drill.

New technology =incredible results

The great news is that NEW Guided Biofilm Therapy (GBT) has transformed the patient experience, by exchanging old-school ‘scale and polish’ methods for a revolutionary system that offers a lifetime of painfree and fear-free oral healthcare for all ages. This Swiss innovation uses airflow technology to remove all bacteria (biofilm) in your mouth that contribute to tooth decay and gum disease,

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while reducing your time in the hygienist’s chair from 20 to just 7 minutes. These procedures are so gentle they can be used on natural teeth, restorations, orthodontic braces, implants, the tongue and gums. Scientifically backed and minimally invasive while being maximally preventive, GBT removes all stains resulting from coffee, tea, wine and tobacco use. It is also highly beneficially before tooth whitening, to achieve even better results. Added to all that, patients in the UK are now able to have greater control of their oral health since legislation was passed to allow appointments to be booked directly with hygienists, rather than needing to be referred by a dentist.

How GBT will work for you

The first step involves the dental hygienist checking your mouth to identify any dental decay or gum disease. This allows the hygienist to assess your treatment needs. Next, teeth are ‘disclosed’ using a dye that makes biofilm visible. You are then shown any problem areas, which will help to personalise your oral hygiene routine. The colour will also guide the biofilm removal. Colour removed = bacteria removed. You need to do your bit between appointments too, so you will also be

08/10/2019 10:17

Advertisement Feature

shown how to maximise your at-home oral hygiene with a personalised routine to emphasise prevention. This may include brushing technique and how to clean effectively between your teeth. Then we come to the main event – the clean. Depending on your needs, a combination of up to three cleaning systems are used to gently remove biofilm, staining and light deposits. These procedures are so gentle they can be used on natural teeth, restorations, orthodontic braces, implants, the tongue and gums. We’re nearly there. A final inspection ensures all biofilm and deposits have been removed and checks one last time for any decay. Teeth are then protected with a fluoride seal. Last but my no means least, based on your oral hygiene and a risk assessment, your next appointment will be scheduled. This is usually between 3 to 6 months. To experience the wonder of EMS’ GBT, first ask your own dental hygienist or dentist if they can offer this to you or email to find out where else you can access this professional service. For more information visit : where Anna Middleton, founder of London Hygienist , explains more about the GBT process.

GBT will leave you feeling and looking good. What more could you ask for? EMS.indd 2

08/10/2019 10:19

YOUR Healthcare

Fertility Your Ultimate Guide

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irst of all, if you’re struggling to conceive, remember that you’re not alone. When it comes to falling pregnant naturally, the odds are not always in your favour. One in six couples has difficulty conceiving. Fertility is a highly personal issue, and different families face different challenges. But there are helpful steps you can take when you’re ready to conceive, and medical interventions which can help if you can’t.

Some background If you are having trouble conceiving, first believe us when we tell you that you are not alone, and second, be ready to talk about the problem, because there are lots of ways you can get help. Getting pregnant at the drop of a hat is not as common as our sex-education classes might have led us to believe. In fact, recent research suggests that a 25-year-old has only an 18 percent chance of falling pregnant in the first three months of trying. For a 40-year-old

Images: Shutterstock

Getting pregnant sounds simple in theory, but conceiving is not always straightforward. Fortunately medical science has stepped in to help the process. Read on for our ultimate guide to fertility

16/10/2019 11:52

YOUR Healthcare woman, this number decreases to seven percent. A couple is not diagnosed as having fertility issues until they have been trying to conceive for over a year with no success; yet, a year can feel like a long time. Once pregnant, staying that way is more of a lottery than many mothers may realise—as many as 50 percent of all pregnancies end in miscarriage, most often before a woman misses a period or knows she’s pregnant.

KNOW YOUR OVULATION There’s a difference between having sex and having sex to try to conceive. Yes, the two go hand-in-hand and sometimes you manage to conceive without even trying (whoops!). But if you are one of the more than half of women for whom it takes six months or more to conceive, then timing will play a big part in your journey. This is where tracking your ovulation comes in. Ovulation occurs when a mature egg is released from one of your ovaries and pushed down the fallopian tube in order to become fertilised. When, as occurs more often than not, the egg is not fertilised, it gets shed during menstruation, along with the lining of the uterus that built up to accommodate a potential foetus.

WE HAVE TO STRESS THIS It’s stressful to hear someone tell you to stop stressing—but in this case, it can make or break your fertility. Stress can affect your relationship with your partner and cause a loss of sex drive. In severe cases, stress may also affect ovulation and sperm production.

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84 percent of couples will conceive naturally within a year if they have regular unprotected sex Source: NHS

It’s an oversimplication that women ovulate on the 14th day of their cycle, based on the myth that all women have 28-day cycles. Yes, some women do have very regular, four-week cycles. But it’s also quite normal for cycle length to vary from 21 to 40 days—even just for one woman! And while ovulation falls in the middle of the cycle, it does not reliably fall smack dab between the first day and the last.

BASAL BODY TEMPERATURE To gain an accurate idea of when you’re ovulating, get in the habit of taking your basal body temperature (BBT), which is the lowest body temperature attained during rest. For best results, take it as soon as you wake up every morning with a thermometer that measures out to two decimal places. Tracking these temperatures will give you an accurate idea of when you’re ovulating, as you will see a sustained increase of 0.2 degrees Celsius on those days. Your BBT can also tell you when you’re pregnant, sometimes even before a pregnancy test. Eighteen consecutive days of elevated temperatures are an indication of pregnancy.

FERTILITY AWARENESS METHOD Some couples use basal body temperature as a natural birth control method. Doctors don’t recommend this, as it has a one-in-four failure rate. Sperm can live in a woman’s body for up to six days, so if you are having sex before ovulation, it’s possible that a pregnancy may still occur even if you avoid the ovulation days.

Get your body ready Preparing your body for pregnancy is a process in itselft. If you’re overwhelmed with where to begin, this simple checklist should help:

Diet: Do your best to give up on unhealthy food, including processed foods, sugars and starches. Try introducing more produce and lean meats into your diet. Birth control: This one may seem obvious... but stop taking birth control when you know you want to start trying for a baby. It can take several cycles for your body to adjust back to normal once stopping the pill or other hormonal methods. If you are using an IUD, schedule an appointment with your doctor to have it removed. Medication: If you are on any medication, you and your doctor will need to discuss whether or not you should continue taking it for the time being. Supplements: Many women are familiar with the idea of taking a prenatal vitamin with folic acid once pregnant, but taking it in advance while trying to conceive has many benefits as well Drinking and smoking: If you drink or smoke, now is the time to quit, to make sure your body is as healthy as possible as you prepare for baby. And for the record, the items on this list largely apply to your male partner as well—diet, exercise and abstaining from smoking and drinking will have a positive effect on his fertility.


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CAN I TAKE ANYTHING? One reason the subject of infertility can be scary is that the leap between trying to make a baby the old-fashioned way and the world of in-vitro fertilisation is a huge one. However, somewhere between these

TWO TYPES OF INFERTILITY PRIMARY INFERTILITY: where someone who’s never conceived a child in the past has difficulty conceiving SECONDARY INFERTILITY: Where someone has had one or more pregnancies in the past, but is having difficulty conceiving again

two are medications that may help, and your doctor will be able to determine what is right for you. Clomiphene citrate, metformin, bromocriptine and recombinant FSH injections such as Gonal F or Puregone can all be used to help with ovulation problems. There are also over-the-counter remedies such as Elevit, Cod Liver Oil and vitamins that may have a positive effect. Herbal supplements that have been suggested to help when trying to conceive include Red Raspberry Leaf, Nettle Leaf, Dandelion, Alfalfa, Red Clover and Maca.

INTRAUTERINE INSEMINATION (IUI) IUI is a fertility treatment that involves directly inserting sperm into a woman’s womb. This treatment is more commonly used by single women seeking to have a baby on their own, as well as female couples; however, it is sometimes used by heterosexual couples.

Images: Shutterstock

If you’ve been trying to conceive without result for twelve months, it’s time to make an appointment with your doctor. They will be able to help you understand what may be happening and possible next steps. Your doctor will perform a routine exam, making sure that everything is fine with your reproductive system. Conditions such as Polycystic Ovarian Syndrome (PCOS), endometriosis, fibroids or even a cyst on your ovaries can cause complications with fertility. An exam will be able to detect any of these issues, and your doctor will be able to guide you with regard to what to do next. It’s also time for your partner to visit the doctor for a male fertility test. While infertility issues tend to be considered a female problem, falling sperm count causes problems just as often. A male fertility test will assess your partner’s sperm, checking to see if the sperm concentration is above or below 20

million sperm cells per millilitre of ejaculation fluid.


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15/10/2019 15:06

YOUR Healthcare When undergoing IUI or IVF, multiple birth, i.e. twins or triplets, is an increased possibility

IUI separates the better-quality sperm from the sluggish, non-moving or abnormally shaped and then injects them directly into the womb. IUI is less invasive and less expensive than IVF, but it has a lower success rate and often necessitates trying more than once. The waiting list can be very long, but the NHS covers IUI if: • You’re unable to have vaginal sex

FOLIC FRENZY One of the easiest and best things women trying to get pregnant can do is to take a daily supplement of folic acid. The NHS recommends taking 400 micrograms of folic acid every day before you get pregnant and through the end of your first trimester.

• You or your partner need specific help to conceive, for example, if one partner has HIV and it’s not safe to have unprotected sex • You’re in a same-sex relationship and haven’t got pregnant after up to six cycles of IUI using donor sperm from a licensed fertility unit

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IN VITRO FERTILISATION (IVF) If you have been trying to get pregnant for two years, it could be time to consider IVF. Discuss it with your doctor to see what’s right for you. During IVF, an egg is removed from the woman’s ovaries and fertilised with

sperm in a laboratory. The fertilised egg, or embryo, is then returned to the woman’s womb to grow and develop. IVF can be done with your own eggs and your partner’s sperm, or with eggs and sperm from donors. IVF is the most expensive but also the most effective fertility treatment. It can also be disruptive, requiring patients to inject themselves with hormones that add another layer to an already stressful and emotional process. LIVE TO 100 WITH DR HILARY JONES | 57

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YOUR Healthcare

The six main stages of IVF are: ■■ Suppressing your

natural cycle: The menstrual cycle is suppressed with medication

Not alone Fertility problems affect one in six couples in the UK and can be caused by a multitude of conditions. The most common causes fall into two categories: ovulation failure and sperm disorders— these can occur from hormonal disorders, physical disorders or disorders of the reproductive system, among other things.

However, in 25 percent of couples, fertility problems can’t be explained. So, if you are having trouble, remember that there are countless other couples who are going through the same thing. Find a support group; keep the line of communication open with your partner who is probably feeling just as alone and frustrated; and stay positive. While making a baby is a natural thing, it doesn’t always happen naturally. •

■■ Boosting your egg supply:

Medication is used to encourage the ovaries to produce more eggs than usual

■■ Monitoring your progress and

maturing your eggs: An ultrasound scan is carried out to check the development of the eggs, and medication is used to help them mature

■■ Collecting the eggs:

A needle is inserted into the ovaries, via the vagina, to remove the eggs

■■ Fertilising the eggs:

The eggs are mixed with the sperm for a few days to allow them to be fertilised

■■ Transferring the embryo(s):

The success rate of IVF depends on the age of the woman undergoing treatment, as well as the cause of the infertility (if it’s known). Younger women are more likely to have a successful pregnancy. IVF isn’t usually recommended for women over the age of 42 because the chances of a successful pregnancy are thought to be too low. IVF doesn’t always result in pregnancy, and it can be both physically and emotionally demanding. You should be offered counselling to help you through the process.

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% ▶ NHS figures for successful IVF treatment between 2014 and 2016 using the woman's own eggs and partner's sperm were:




for women under 35

for women from 35-37

for women from 38-39




for women from 40-42

for women from 43-44

for women over 44

Images: Shutterstock

1 or 2 fertilised eggs (embryos) are placed into the womb

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Vita Green Eur.indd 1

16/08/2019 17:44

YOUR Healthcare

When UTIs

Just Won't Clear


ver half of women will get a urinary tract infection (UTI) at some point in their life. This common problem has a common solution: a short course of antibiotics should clear it up. However, the generous use of these antibiotics has created strains of antibiotic-resistant UTI bacteria, causing a growing and worrying trend—recurrent UTIs that can’t be treated.

WHAT IS A UTI? A UTI is an infection that occurs in the urinary system. While the most common infections involve the lower urinary tract (bladder and urethra), they can occur in the kidneys and uterus as well. UTIs are caused by the bacteria E. coli rising from the perianal region into the urinary tract. Because of their shorter urethra, women are at greater risk for contracting UTIs, although infections do occur in men. UTIs usually present the following symptoms:


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Uncomfortable urinary

• Needing to pee suddenly or

tract infections (UTIs)

• Pain or a burning sensation

are all too common, and unfortunately, our habit of popping antibiotics to clear them up isn’t doing us any good

WATCH OUT UTIs are common in postmenopausal women older than 60, but they can be difficult to spot in patients with dementia. If you notice changed in behaviour such as increased aggression, agitation or anger in a loved one with dementia, it could be caused by a UTI.

more often than usual

• • • •

when peeing Smelly or cloudy pee Blood in pee Pain in lower tummy Feeling tired and unwell

Visit a GP if you’ve been suffering any of the above symptoms for more than a few days. Some UTIs may clear up on their own or with the use of over-thecounter cranberry supplements, which contain proanthocyanidins (drinking cranberry juice doesn’t provide enough PACs and loading up on sugar often does more harm than good). Typically a short course of antibiotics is needed to treat the infection.

ANTIBIOTIC-RESISTANT Nanell Mann, aged 82, began getting UTIs almost 50 years ago, following a hysterectomy after the birth of her sixth

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Cysticlean ■ Recurrent urinary tract infections can result in damage


Images: Shutterstock

To prevent UTIs, the NHS suggests wiping from front to back when using the toilet, trying to fully empty your bladder when peeing, staying hydrated, taking showers rather than baths, wearing loose cotton underwear and peeing after sex. It also suggests avoiding perfumed bubble bath, soap or talcum powder; holding your pee; wearing tight, synthetic underwear; wearing tight jeans or trousers; and using condoms or diaphragms with spermicidal lube.

NO SILVER BULLET If antibiotics won’t cure UTIs, patients are out of luck—there isn’t a ‘Plan B’ for UTIs that won’t go away on their own, or with natural remedies.

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We’re definitely in need of new treatments Urogynecologist

child. She would take antibiotics and get better, then get sick again and take a different type of antibiotic, over and over for decades, until the list of treatments that worked against her infections dwindled. Her UTIs were so resistant to antibiotics that nothing worked anymore. It’s an extreme case, but this is the ‘canary in the coal mine’ for a worrying trend of more UTIs becoming resistant to antibiotics. Without them, doctors aren’t sure how to treat what were once easilycured infections. “They kind of give up on you because they don’t know what to do,” Mann said.

Felicia Lane

“I always feel bad,” said microbiologist Matt Mulvey, “Because I feel very unable to help.” Mulvey, while unable to present a silver-bullet solution to long-suffering patients, has made some advances in the field of UTI research. Researchers debate whether the bacteria that cause recurring UTIs come from the bladder or the gut. But through studying Mann’s case, Mulvey discovered that her bacteria were hiding in the gut, opening the door for new treatment options such as faecal transplants. Mulvey suspects that the particular strain of E. coli, ST131, that Mann has is evolved enough to enter a dormant state to hide from antibiotics—only to wake up after the course finishes to cause yet another UTI. So they’re trying faecal transplants that target the gut microbiome. While it does seem to work temporarily, the effects wear off after around six months. •

to the bladder wall, encouraging toxins to attach to the wall of the bladder, where they can proliferate and cause further misery for sufferers who can have three or more infections a year.

■ Cranberries contain a group of scientifically documented very specific antioxidants called proanthocyanidins (PACs) and the amount present can vary wildly in each cranberry product and juice.

■ PACs have the ability to block the ‘receptors’ existing on the bladder wall improving the bladder’s ability to flush away those toxins. A higher concentration of PACs has been proven in clinical research to have a greater effect than lower concentrations.

■ Cysticlean contains 240mg PAC’s derived from the North American Cranberries and has one of the highest levels of PACs available.

■ A million women in Europe have benefited from natural Cysticlean 240mg PAC®, drug-free support from experts in the maintenance of the urinary system.


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YOUR Healthcare

How Rare Diseases Can Improve Public Health

Around 3.5 million people in the UK live with a rare disease. But these chronic, lifethreatening and isolating conditions can encourage medical research


t can seem contradictory to talk about the large number of patients suffering from rare diseases—but when you realise that over 7,000 rare diseases have been identified, and that a rare disease is defined as a condition that affects fewer than 1 in 2,000 people, it becomes clear that rare diseases are a common problem. While the causes, symptoms and response to different rare diseases are hugely diverse, most patients share common experiences, such as being overlooked by medical professionals, research programs and the general


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public. Patients of rare diseases can find it hard to get the support they need, spending months or even years with misdiagnoses, and finding it hard to find help and information.

DID YOU KNOW? Studies of rare diseases are fundamental to modern medicine, as around 80 percent have a genetic basis, and understanding them helps us understand human biology.

While patients of common chronic illnesses are no strangers to pain and suffering, they at least have access to information, different treatment options, support groups and even charity organisations. Armed with many unanswered questions, patients of rare diseases can find their health deteriorating, struggling to keep jobs and feeling increasingly isolated. This grim reality often leads rare disease sufferers and their family to take matters into their own hands—in fact, rare diseases are at the forefront of patient engagement in medical research

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YOUR Healthcare and drug development, and this can be an overwhelmingly positive aspect of rare diseases.

BETTER UNDERSTANDING One such example of rare diseases furthering medical research can be found in the case of the rare genetic illness, Familial Hypercholesterolemia (FH). In FH patients, the system that monitors and breaks down ‘bad’ cholesterol is damaged, meaning that less is removed from the blood. Normally, the breakdown of cholesterol also tells the body to slow its natural cholesterol production. However, FH patients don’t break down the bad cholesterol, so it keeps being produced, clogs the blood vessels and can increase the risk of a heart attack. By studying FH, scientists gained a better understanding of how cholesterol is managed in the body. This led to the discovery of statins—drugs that slow the body’s natural cholesterol production and increase the removal of bad cholesterol from the blood. While this can help FH patients, it has also helped millions of people who have high cholesterol and are at risk of heart disease. FH is an example of a “fundamental disease”—what happens when a rare disease acts as a gateway to understanding, or even treating, much common conditions. For pharmaceutical companies, rare diseases linked to common conditions can often act as a gateway into a larger market, and this can bring much-needed investment into rare disease research.

Images: Shutterstock

CHALLENGES OF RARE SCIENCE Despite this silver lining, research of rare conditions is still a long and challenging road—both for doctors and patients— caused by a lack of research, knowledge, and treatments. Why is rare disease science so hard?

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Patients are rare

To research a condition you need to find patients. These are few and far between for any rare condition, and until a disease is well understood, securing an accurate diagnosis is also challenging.


Knowledge is limited

With little pre-existing knowledge and few disease models, it is hard to identify potential treatments.


Multiple symptoms treated by different specialists

Rare diseases in the scientists' sights ■ Alkaptonuria A rare genetic disease also called Black Bone Disease. It is a model for osteoarthritis, a disease affecting millions of people.

■ Congenital Leptin Deficiency

Doctors often specialise in a certain body system, but many rare diseases affect multiple systems. When different symptoms are treated by different doctors no one has the full picture and key connections will be missed.

This ultra-rare genetic disease is characterised by severe earlyonset obesity and marked overeating. The study of this disease is leading to the discovery of new obesity genes.


■ Congenital Generalised Lipodystrophy (CGL)


Funding is harder to secure if the condition is not a research priority for governments, industry, funding bodies, or charities.



Developing a treatment for a rare disease can be less expensive than for a more common illness, but the costs are still high. With a limited number of patients to treat the pharmaceutical industry can view the development of rare disease drugs as financially nonviable. You can find information and support from the charity Rare Disease UK (www. , which works with health departments across the UK to implement the UK Strategy for Rare Diseases to ensure that patients and families living with rare conditions have equitable access to high quality services, treatment and support. Rare Disease UK is a campaign run by Genetic Alliance UK, the national charity of over 200 patient organisations, supporting all those affected by genetic conditions. •

This rare genetic disorder is characterised by near complete absence of body fat, high levels of fats in the bloodstream and insulin resistance. Studying this extreme form of insulin resistance is helping to understand type 2 diabetes.

■ Hunter Syndrome Children with Hunter syndrome often appear healthy at birth. The signs and symptoms of the condition become apparent as glycosaminoglycans (GAGs) start to build up in the cells and organ systems of the body. Symptoms vary from case to case, but can include a decline in speech, learning and cognitive abilities and an effect on life expectancy. Many symptoms of Hunter syndrome cannot be reversed once they have progressed to a certain point, so early diagnosis is essential, so that disease management can begin as soon as possible.


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YOUR Healthcare


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Approximately one in four adults worldwide have high blood pressure. It is projected to affect more than 1.5 billion people around the world by 2025.


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Nurse, the Screens! We all worry about our health as we get older, but routine checks and screenings can provide reassurance and help catch any worrying conditions at an early stage. So, what are the essential checks for the older subject?


he NHS offers a health check every five years to everyone aged between 40 and 74, looking particularly for signs of stroke risk, diabetes, dementia and heart and kidney disease. The British Heart Foundation estimates that seven million UK citizens have undiagnosed high blood pressure, increasing the risk of heart disease or a stroke.

DETECTION There are national screening programmes for early detection of cervical, breast and bowel cancer, and aortic aneurysms, as well as checks on ovaries and breasts for women, and testes and prostate for men. Indeed you could go in for a ‘whole body scan’, though some clinicians don’t encourage the idea, suggesting that it could trigger a cascade of surgical investigations of minor abnormalities resulting in little overall improvement in health levels—so ultimately universal whole body scans might do more harm than good. Dr Margaret McCartney, a GP who presented a BBC radio documentary on screening, says: “If a screening test is cost-effective, the NHS is doing it. We don’t have evidence for additional tests at the moment.” So, what are the most effective and worthwhile tests available on the NHS?

Abdominal aortic aneurysm (AAA) screening AAA screening checks for a bulge or swelling in the aorta, the heart’s largest artery. An abdominal aortic aneurysm won’t often have symptoms, but if it enlarges and bursts it could cause life-threatening bleeds

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inside the stomach. Aortic aneurysms are more common in men, so they are offered screening at the age of 65. Ultrasound tests take only a few minutes, are painless and give immediate results.

Cervical screening

High blood pressure can weaken the heart and damage arterial walls. Testing with a pressure cuff can be done by a practice nurse, is quick and painless and gives immediate results. You may also be offered a kidney function blood test.

About 3,000 cases of cervical cancer are diagnosed each year in the UK, but since the screening programme was introduced in the 1980s, the number of cervical cancer cases has decreased by about seven percent each year. All women aged 25-64 are eligible for a free cervical screening test every 3-5 years. A cervical examination using a speculum can be uncomfortable but doesn’t take long. Test results and if necessary an invitation for further examination are usually received within two weeks.

Bowel cancer screening

Cholesterol tests

Bowel cancer is the fourth most common cancer in the UK and the sooner it is detected, the easier it is to treat and the better your chance of surviving it. Bowel cancer screening is indicative rather than conclusive but can detect potential problems. It’s done using a Faecal Occult Blood Test (FOBt) card which is used at home then sent to a lab for analysis. Screening is offered every two years to all men and women aged 60 to 74. A colonoscopy will be required for full diagnosis.

High levels of the fatty substance cholesterol in the blood can cause no symptoms but can increase the risk of a heart attack or stroke. Cholesterol testing involves a simple blood test. Treatment includes changes to lifestyle such as diet and exercise, and if necessary, your GP may prescribe cholesterol-lowering medicines such as statins.

Blood pressure screening

Breast screening There has been recent discussion about mass breast screening picking up on asymptomatic cancers which would not require treatment, but it’s largely accepted that regular breast screening is beneficial. From the age of 47 (older in some areas) to 71 all women should be invited for an X-ray mammogram every three years. The procedure can be uncomfortable but takes only a short time. Results are returned in about two weeks, followed by an invitation to an assessment clinic if necessary.

The NHS Health Check This is the big one! The NHS Health Check is a free check-up of your overall health and can suggest whether you are at risk of common health problems such as heart disease, diabetes, kidney disease and stroke. It takes 20-30 minutes and involves a range of checks including height, weight, blood pressure, blood tests and a questionnaire about lifestyle and family history. If you’re over 65, you will also be told the signs and symptoms of dementia to look out for. You should be invited for a free NHS Health Check every five years if you’re between 40 and 74. If you haven’t had an NHS Health Check in the last five years, ask your GP for an appointment now. • LIVE TO 100 WITH DR HILARY JONES | 65

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The Jab for the Job


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YOUR Healthcare With recent headlines about shortages of vaccinations in mind, why is it more important than ever for us to keep up with our jabs?


ecent scares about shortages of ‘flu vaccinations, while at the same time the free jabs are being rolled out to a wider public, emphasise the importance of keeping your jabs up to date. At the same time politicians have been talking about the ‘anti-vax’ propaganda pervading the internet. So why are vaccinations so crucial to public health?

FROM ‘FLU TO FLYING Influenza The influenza vaccine is available to anyone on the NHS every year, and special groups can get it free. This includes the elderly, pregnant women, people with underlying health conditions (such as long-term heart disease), and people with weakened immune systems. It also may be recommended to people who work in people facing health roles or social care workers, as well as children in primary school (who may take it as a nasal spray). You might feel a little down after having a ‘flu jab, but this doesn’t mean you have ‘flu; the vaccination does not contain living ‘flu virus. Your immune system, though, may react to the jab to give you some shortlived, minor ‘flu-like symptoms.

Travel Not all foreign travel requires vaccinations, but check the NHS website or countries which do have recommended of mandatory vaccinations. Parts of Africa for example require you to have proof of being immunised against yellow fever. The most common travel vaccinations are for Hepatis A, Diphtheria and sometimes, Hep B. Some types of travel may require a rabies vaccination, and protection against cholera.

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DID YOU KNOW? … that if you are not immunised against measles, you can catch it by just going into a room up to twohours after an infected person has left it?

MMR After the UK lost its measles-free status due to reduced rates of MMR (Measles, Mumps and Rubella) vaccinations, health authorities are urging every parent to get their child vaccinated (in fact there is talk of making it compulsory). The MMR vaccine is widely available on the NHS and is usually given in two doses over a period of time.

Pneumococcal Pneumonia can affect anyone; however certain groups are more at risk of serious consequences of the disease therefore are given it free on the NHS. This includes babies, adults aged over 65, and people with long term conditions. The vaccination is given in three doses for babies whereas older people only need it once. This vaccine is part of the childhood vaccination programme.

Meningitis The MMR vaccine can often protect against meningitis, as measles, mumps and rubella can sometimes cause complications that may lead to the disease. However, in recent years the Meningitis B vaccine has been adapted, which protects against meningococcal group B bacteria, which is a common cause of the disease, especially amongst children.

HPV The HPV vaccine is mainly known for protecting against cervical cancer, however also has a huge effect on preventing mouth and throat cancers and some cancers of the

anal and genital areas. It used to be routinely offered in schools to girls in the UK aged 12 and 13, however since 2018, it is also being offered to boys of the same age.

PRIVATE VS NHS With the current media panic about NHS shortage of vaccinations, you may want to enquire with a private clinic where there are less likely to be shortages. Travel vaccinations for example, are vital yet sometimes inaccessible to the NHS, particularly if you need an immunisation for a disease such as Japanese Encephalitis, which only affects Asian countries, and is therefore less common. Private clinics can also often offer shorter waiting times, particularly useful for any last minute vaccinations, such as meningitis, which needs to be done before the start of a school or university term. Additionally, the HPV vaccine is always offered in schools in Year 8, but some may prefer a more private setting, without the wait. Private clinics will usually have a nurse or doctor specialising in travel vaccinations, and may be in a better position to spend time discussing with you the vaccinations you may need.

EASIER AND TIME EFFICIENT If you are a new parent looking to get your child vaccinated for MMR or pneumonia, it NHS surgeries may require you to come for several appointments. Private clinics are more likely to allow you to get your child vaccinated in one appointment, which ultimately saves time and prevents your child from having to go through multiple injections. The same can apply to adults , where it may be preferable to get a course of vaccines done in one sitting, in order to save time off work. Whichever you choose, make sure you get all the regular and special vaccinations you need, for the sake of your own health and that of others. • LIVE TO 100 WITH DR HILARY JONES | 67

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YOUR Healthcare

Coming Back

from Cancer


ore than one in three of us will get cancer, and for many of us it will be the toughest fight we will ever face. Feelings of isolation and loneliness that so many people experience can make it even harder, and those feelings don’t always go away even when you are in recovery. But there are support services and charities to help at every stage of cancer treatment, from diagnosis through recovery and beyond. Cancer affects many areas of life, not just your physical health. Organisations such as Macmillan Cancer Support emphasise that medical treatment is just part of the journey—there are emotional, practical and financial concerns that affect every cancer patient in different ways. So how do support organisations work to help patients through treatment and into recovery?

RECOVERY After a cancer diagnosis, your GP or practice nurse should be able to organise a Cancer Care Review. This aims to improve your quality of life during and after treatment for cancer and should lead to a plan usually referred to as a Recovery Package. Part of the Recovery Package is a Holistic Needs Assessment (HNA), where 68 | LIVE TO 100 WITH DR HILARY JONES

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you discuss with your healthcare team a plan for your care, which you should receive as a written summary. This summary is also sent to your GP, so you both know what has happened and what to expect after treatment. The assessment usually has three parts: first, you answer a simple set of questions or checklist about all areas of your life, to see whether there are any concerns you may have. The questions may be answered on paper or electronically and usually take under ten minutes to complete. The care plan you agree on may include things like giving you information leaflets or contact details for organisations that could help with your concerns. At the end of your treatment, your healthcare team should create a Treatment Summary, which will also tell you what to expect now that your treatment has finished. The summary should include details about:

• The cancer treatment you have had • Any further tests or investigations you might need • Side effects or potential signs and symptoms you should be aware of • Emergency treatment notes • Contact details for your healthcare team

Knowing what might happen next can help you readjust to life after your main treatment is over, and your treatment summary may be useful when, for instance, you want to apply for travel insurance. You may be invited to a Health and Wellbeing event, where you and other people affected by cancer can find out more about healthy living and getting local support, which usually lasts a few hours and includes a variety of workshops, stalls and talks. The events can be a really good opportunity to learn about support in your local area, and who to contact for help in the future, if

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Surviving cancer can be about more than medical treatment—full recovery requires emotional and practical support too. We look at some of the helpers on the way to cancer recovery

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Don’t MISS the bus A dedicated mobile team of highlyqualified Macmillan Cancer Support professionals travel across the UK on a fleet of six big green Mobile Information and Support Services (MISS) buses: Basil, Bertie, Beryl, Betty, Bronwen and Dougie. The buses park up at lots of public places, from markets to outside shopping centres and libraries. Everyone is welcome to use the service. Whether you have a cancer diagnosis, have a friend or relative affected by cancer, or are worried about cancer in any way at all, there are lots of ways that Macmillan can support you—medically, financially, emotionally and practically. The team also mans Macmillan information stands indoors in public places like shopping centres, hospitals, libraries and exhibitions, and visit places of worship, community groups and workplaces, even shows and festivals. Wherever the mobile service is, a team of trained radiographers, dietitians and financial experts are there to talk to you in confidence, for as long as you need, to open up all the Macmillan services on offer, or you can pick up leaflets to take away with you.

■ The mobile team can help you with: ■ Screening and what signs and symptoms to look out for ■ Different cancers, their treatments and side effects ■ How cancer affects your life, for example finances or employment ■ Talking about your cancer, or talking to someone with cancer ■ Being there for someone with cancer, or the support available locally ■ Survivorship and recurrence

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YOUR Healthcare you need to. Health and Wellbeing events are also good sources of information on:

• Claiming benefits and other financial support • Getting back to work or education • Eating well and leading a healthy lifestyle • Possible long-term consequences of treatment • Emotional effects of cancer and its treatment may have, and where to seek help • Awareness of signs and symptoms of cancer returning • Local services and opportunities such as support groups

Self-management can include: • Learning more about your

condition and how it affects your life • Eating well and keeping active • Keeping in contact with your healthcare team • Aware of possible side effects of treatment • Planning ahead and setting goals for the future Whether or not you have regular follow-up appointments such as scans or blood tests, you will still be able to contact your healthcare team directly if you need help.

FOLLOW-UPS There are three main types of followup care available, depending on how confident you feel about managing your own health: 70 | LIVE TO 100 WITH DR HILARY JONES

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• Supported self-management, where you are given information to help you self-manage, though you can still contact your healthcare team if you need to. • Shared care, where you continue having scheduled face-to-face, phone or email contact with your healthcare team. • Active management, where you need more support or different care than supported self-management and shared care can provide. Free training courses such as Macmillan Cancer Support’s HOPE (Helping to Overcome Problems Effectively) can help you with ways to manage the impact of living with and beyond cancer. Macmillan also has online courses available and has local centres (you can find your nearest one at Many people affected by cancer want to make positive changes to their lives, such as giving up smoking, becoming more physically active, eating a well-

balanced diet and limiting alcohol intake, and information on these is available from your GP, hospital team. Your pharmacy and community or leisure centre can also help you. Equally important is emotional support, as it is natural to worry about whether your cancer may come back. Your healthcare team can help you with these worries and suggest coping strategies, as well as providing practical advice on subjects such as work, relationships and finances. Macmillan Cancer Support has a free helpline on 0808 808 00 00, open seven days a week from 8am to 8pm. Citizens Advice provides advice on a variety of issues including financial, legal, housing and employment issues. Find details for your local office in the phone book or on one of the following websites: for England, Wales and Northern Ireland, www.citizensadvice.; for Scotland, •

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You should at any time be able to talk to your GP about any concerns you have, any requirements for further information, support available in your area, work and benefits, prescriptions and getting more active. Your healthcare team will also support you into self-management, in other words taking a more active role in your own healthcare.

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YOUR Healthcare

It’s never pleasant to undergo a biopsy, but modern medical technology can make the experience easier to handle. We look at some of the techniques available to ease the process


hen faced with the possibility of a condition such as breast cancer, physical examination and imaging techniques such as mammogram and MRI can be a strong indicator of the diagnosis. But the only way to be certain is to take a tissue sample from the suspicious area and have it examined microscopically by a pathologist. The requirement to have a biopsy procedure to remove a tissue sample can be worrying, but fortunately the procedure itself can often be quick and minimally invasive. Your clinician will usually choose the least invasive type depending on your condition— in other words, the type of biopsy which requires the smallest incision and leaves the least amount of scarring. Biopsy needn’t involve any surgery—it can often be done by inserting a fine needle through the skin. In some cases, though, minor surgery will be necessary, with the skin being cut through to remove some or

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Facing Up to

Biopsy all of the suspicious tissue. So, what do the different kinds of biopsy involve?

FINE NEEDLE ASPIRATION BIOPSY Fine needle aspiration (FNA) is the least invasive method of biopsy and usually leaves no scar. Local anaesthesia is usually given, and a thin needle with a hollow centre used to remove a sample of cells from the suspicious area. In some cases, an ultrasound image will be used to guide the doctor, or in investigations of possible breast cancer, mammogram images taken from different angles to form a sterotactic image.

CORE NEEDLE BIOPSY Core needle biopsy is conducted in a similar way to FNA, with the subject lying down and using local anaesthesia, but with a larger hollow needle used to take to several cylinder-shaped samples of tissue. Again, the procedure does not normally

leave a scar and ultrasound or stereo imaging can be used for guidance. As needle biopsies remove only a small tissue sample, they do carry the risk of giving false negative results, so your doctor may discuss with you a surgical biopsy as a follow-up to, or instead of, a needle biopsy.

INCISIONAL BIOPSY If a needle biopsy is inconclusive, your doctor may recommend an incisional biopsy, which is more like a surgical procedure, though again under local anaesthesia. Incisional biopsy again uses mammography, ultrasound or a needle to locate the suspicious tissue, then the skin is cut with a scalpel to expose and remove the tissue. This procedure may leave a scar and require some recovery time.

EXCISIONAL BIOPSY The most involved form of biopsy, excisional biopsy is surgery to remove the entire area of suspicious tissue, as well as a small rim LIVE TO 100 WITH DR HILARY JONES | 71

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YOUR Healthcare of normal tissue around it referred to as a margin. Again, using local anaesthesia, mammography or ultrasound and possibly needle wire localisation, excisional biopsy has the advantage of removing all of the suspicious tissue, but will leave a scar and require more time to recover.


BIOPSY POINTERS • Avoid using deodorant on the day of the biopsy. Chemicals in deodorant can cause interference in X-ray images. • Advise the radiologist if you are allergic to local anaesthetic or skin antiseptic. • Wear a two-piece outfit as you will need to remove the clothing on your upper body. • Follow aftercare advice on dressings and pain relief. • Avoid strenuous activity for 24 hours following the procedure to help the skin heal. • Contact your hospital if you experience any pain or infection after the biopsy.

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Vacuum-assisted biopsy is a newer technique using a special probe to remove a larger sample of tissue, but without the multiple insertions required by core needle biopsy. For vacuum-assisted breast biopsy, the subject lies on an examination table with special round openings for the breasts, local anaesthetic is applied, and the probe is guided to the suspicious site by ultrasound or mammography. A vacuum draws tissue into the probe, and a cutting device removes a tissue sample and transfers it into a collection compartment.

The surgeon or radiologist can rotate the probe to take another sample from the suspicious lesion several times so the entire area for investigation is sampled. In some cases, a small metal clip can be placed into the biopsy site to mark the location, in case future examination is needed. The clip causes no pain, is harmless and can be removed when any further surgery is required. According to medical guidelines, about 90 percent of biopsies should be needle biopsies, the least invasive type; but research shows that in cases of breast cancer, about 70 percent of biopsies are surgical. This means that many women who don’t have cancer are having unnecessary surgery, and that women who are diagnosed with breast cancer often have to have a second operation to remove the cancer. So, it’s important before undergoing any biopsy procedure to discuss the options and likely outcomes fully with your doctor. •


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Vacuum assisted biopsy, an alternative to breast surgery

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YOUR Healthcare

s y a W w e N ncer a C t a k o to Lo


he problem with cancer treatment can be that ‘the cure is worse than the disease’—in other words, necessary though they are, chemotherapy or surgery can have sideeffects which make the patient feel worse, or which impact negatively on their lives. But new thinking about interventional oncology, alternative to or complementary to traditional cancer treatment, is showing a way towards less disruptive treatment. Traditionally, there have been three cancer treatment disciplines: surgical,


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medical and clinical. Surgical oncology involves removal of solid tumour deposits, either through an open wound or through several smaller cuts using ‘keyhole’ surgery. Medical oncology involves the administration of chemotherapy and biological agents. Lastly clinical or radiation oncology manages the use of radiotherapy and other forms of ionizing radiation for the treatment of cancer. But over the last ten or so years, a fourth

oncology discipline has developed— Interventional Oncology (IO). In Interventional Oncology, real-time imaging is used to guide therapy. This may be for direct tumour treatment, for relief of symptoms, or for placement of tubes into vessels that allow delivery of other treatments (such as chemotherapy). Imaging may also be used to obtain small samples of tumour tissue (biopsy). Radiologists (X-ray and MRI), anaesthetists and surgeons can all use interventional oncology techniques, so the discipline

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Innovative cancer therapies using advanced imaging techniques promise a revolution in treatment and recovery

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YOUR Healthcare

ABLATION Interventional oncology involves applying real-time imaging techniques to guide less invasive treatment methods, the two primary types being tumour ablation and embolization. In tumour ablation, commonly applied to liver, kidney, bone and lung tumours, a needle-like device directs thermal energy to the tissue area to be treated. The type of energy required depends on the size and location of the tumour. A number of different energy systems are in use, including Radio Frequency (RF), microwave (MW), laser and high intensity focused ultrasound (HIFU). In each case the aim is to heat the tissue to a temperature of 60 degrees to induce acute cellular necrosis— in other words, the death of the tumour cells. Alternatively, the process of cryoablation causes cellular necrosis by cooling affected tissue to temperatures of lower than -40 degrees. Then there is the process of electroporation, which adopts a non-thermal approach to treating tumours by using high voltage, low energy direct current pulses to damage and destroy tumour cells. For treating a single tumour or a section of a large tumour, high intensity focused ultrasound (HIFU) can also be used to destroy cancer cells. All forms of tumour ablation can be used in conditions where the cancer has spread, such as lung or liver metastases. In contrast to surgery, the treated tumour is afterwards left for the body to heal naturally, mirroring the way a body heals itself following an injury by replacing dead cells with new ones.

of a tumour is cut off to starve it of oxygen and nutrients before therapy is applied to the tumour itself to prevent it from damaging the rest of the body. In a typical embolization procedure, a catheter is inserted into the blood vessel in the left wrist or inside the groin, then moved up to the liver. An X-ray visible dye is injected to pinpoint the location of the blood vessel supplying blood to the tumour, and embolisation particles injected to block off the tumour’s blood supply. Painkillers can be administered to minimise discomfort during the procedure, and any bleeding from the catheterisation point can be stopped by applying pressure.

MAXIMUM EFFECT Embolisation techniques can be used in conjunction with chemotherapy, referred to as trans-arterial chemoembolisation (TACE). TACE combines embolisation with high doses of chemotherapy, releasing the

treatment directly into cancer cells. This is a possibility when surgery is not practical, though to benefit from chemoembolisation, the cancer must not have spread into lymph nodes or across other sections of the. Repeated courses of treatment may be necessary to successfully treat the tumour. For some, the treatment method can open up surgery as an option, by shrinking the tumour; for others, chemoembolisation will afford more control over their cancer, as they wait for a liver transplant.

HAVE NO FIOR A charity, the Foundation for Interventional Oncology Research (FIOR), is dedicated to furthering research and dissemination of Interventional Oncology techniques. FIOR supports physicians undertaking new imageguided interventions as well as research projects to make a difference to those with cancer. FIOR is part of the University College Hospital Charity, •

Increasingly new treatments ... are achieving better results and outcomes

is offering the benefits of less intrusive treatment to a wide range of patients. The approach taken with these techniques depends on the size and location of the tumour, and whether it has spread to other organs or lymph nodes.

Dr Hilary Jones

EMBOLIZATION Another form of less invasive cancer therapy is known as vascular oncology. This attacks the blood supplies of tumours through the process of embolisation, so the blood supply

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16/10/2019 11:21

Interventional Oncology

Targeted Cancer Treatments Leading clinical and interventional radiologists from LION Oncology discuss the latest in targeted cancer treatments you might not know about, but should. LION Oncology is a group of Interventional Radiologists who specialise in targeted cancer treatments and other procedures that target tumours in the liver, lung and kidneys specifically. The group consists of five highly trained and specialised Interventional Radio-logists. All of them working together and super-specialising in procedures that target lesions and organs through X-rays and combining them in some treatments with chemotherapy and radiotherapy to effectively target cancer.

What is interventional oncology and how does it differ from conventional oncology? Rather than treating the whole body, interventional radiology is a specialty where a doctor trained in medical imaging uses X-rays and scans to guide treatment to a specific organ in the body, through the use of catheters (fine tubes). They direct it to the liver, lungs, or kidneys or even cut off blood supply (embolise) to a tumour. While there are more than a dozen types of procedures that the team get involved in, the most common procedures target the liver.

The four most common targeted liver treatments:

How do the treatments fit in with the other treatments like Chemotherapy, Radiotherapy that Oncologists often recommend and talk about? Targeted treatments are usually considered where there is a defined tumour that cannot be cut out by surgically removing it or effectively treated by other methods such as Chemotherapy, Radiotherapy or Immunotherapy. In the past years the LION team they have found that targeted treatments are increasingly effectively when used earlier in the patient’s treatment plan, as well in combination or in-between other whole body treatments. In many cases the targeted treatments have eliminated tumours completely or shrunk them so that surgery has become an option.

What are some of the benefits of targeted treatments?

One of the benefits of the targeted treatment is that the hospital stays are quite short compared to surgery and other oncology treatments usually either day case or a night’s stay in hospital. Because they don’t treat the entire body, patients are reporting fewer side effects and a very quick return to their normal activities following treatment. A grateful patient recently wrote to us to say:

LION-1 with URL.indd 1

1 2

TACE (transarterial chemo-embolisation)

This is a method of sending high dose chemotherapy into the liver via the arteries.

SIRT (selective internal radiation therapy)

This procedure delivers a high dose of radioactive particles called SIR-Spheres® Y-90 resin microspheres1 into liver tumours, in a similar way to TACE.


Chemosaturation (Percutaneous Hepatic Perfusion)


Tumour Ablation

This is a new technique aimed at delivering very high doses of chemotherapy into the liver while on a liver bypass machine (similar to a heart bypass machine). ‘Ablation’ refers to the process of minimally invasive tumour destruction. Unlike surgery, the treated tumour is left in place for the body to deal with naturally. In the same way that the body is able to form a scar after an injury, so too is it able to remove dead tissue after treatment.

01/10/2019 10:41


What other treatments do the LION Interventional Radiologists get involved in?

All treatments that the LION team can offer can be found on or by calling 0207 9083756. You can also email us at: and our team will guide you through your available options.

For SIRT treatments the technology is provided by SIRTEX


What are SIR-Spheres® Y-90 resin microspheres and how are they used?

SIR-Spheres Y-90 resin microspheres are used to deliver targeted internal radiation therapy directly to liver tumours via the hepatic artery. This therapy is called Selective Internal Radiation Therapy (SIRT) and is performed using minimally invasive surgical techniques by an interventional radiologist.

Where SIR-Spheres Y-90 resin microspheres are used, the available clinical evidence suggests SIR-Spheres

Y-90 resin microspheres may approximately double the rate of tumour shrinkage and tumour remission. The evidence also suggests it may be capable of improving the life expectancy of patients.

About Sirtex - An emerging global leader in cancer treatment

Thank you for helping sort out my naughty liver again last week. J and I were so happy to be able to attend our friend’s wedding approximately 36 hours after the operation!

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Sirtex Medical is a global healthcare business with offices in the U.S., Australia, Germany and Singapore, working to improve outcomes in people with cancer. Our current lead product is a targeted radiation therapy for liver cancer called SIR-Spheres Y-90 resin microspheres. Over 100,000 doses of SIR-Spheres Y-90 resin microspheres have been supplied to treat liver cancer patients at over 1,230 medical centres in over 40 countries. For more information, visit For Chemosaturation treatments the technology is provided by DELCATH Systems UK Limited & MEDAC PHARMA

Delcath Systems, Inc. is a specialty pharmaceutical and medical device company focused on oncology. Our proprietary product - Melphalan Hydrochloride for Injection for use with the Delcath Hepatic Delivery System (Melphalan/HDS) - is designed to administer high dose chemotherapy to the liver, while controlling the systemic exposure to those agents. The Company’s principal focus is on the treatment of primary and metastatic liver cancers. Chemosat is the trade name of the Melphalan/HDS system in Europe.

01/10/2019 10:42

YOUR Healthcare

Saying No To

Enamel Cruelty How regular brushing and dental check-ups will help you maintain a sparkling smile and overall health ELECTRIC TOOTHBRUSHES The bristles of electric toothbrushes vibrate or rotate to help you remove plaque build-up from your teeth and gums. The vibration allows for more micro-movements every time you move your toothbrush. This method controls plaque and gingivitis more than manual toothbrushes do—studies show that after three months of use, plaque was reduced by 21 percent and gingivitis by 11 percent. Electric toothbrushes can also be easier to use for people with issues that affect mobility, such as carpal tunnel

BRUSHING BASICS By far the best thing you can do for your teeth is to brush them twice a day (or more) after meals. However, brushing is most effective is people use the correct 78 | LIVE TO 100 WITH DR HILARY JONES

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technique. When brushing your teeth, use small circular motions, taking care to brush the front, back and top of every tooth. This process takes between two and three minutes. Make sure you avoid sawing, back-and-forth motions. Brushing too hard or using a hardbristled toothbrush can damage tooth enamel and your gums, which can lead to tooth sensitivity, permanent damage to the protective enamel of your teeth and gum erosion. It's best if you use a toothbrush that has soft bristles and change it roughly every three months. While you can certainly achieve good brushing from a manual toothbrush, an electric toothbrush has many benefits that can greatly improve the quality of your brushing.

Fluoride According to the NHS, around 5.8 million people in England receive fluoridated water, which means fluoride has been added to the water supply to bring the amount to 1mg per 1L of water—the level found to reduce tooth decay. Fluoridated water schemes are currently in place in the West Midlands, the North East, the East Midlands, Eastern England, the North West, and Yorkshire and Humber. If you’re curious about whether your water is fluoridated, check the website of your local water supplier.

Images: Shutterstock


esearch shows that there is an association between oral health and overall health, and experts consider oral health problems to be a global health burden. So, what are the best practices for keeping your teeth and gums healthy? We’re taught from childhood that brushing twice a day and regular visits to the dentist are important—but what else do you need to know about your teeth and how they relate to your overall health?

15/10/2019 15:20

YOUR Healthcare

Techy teeth Some electric toothbrushes include built-in timers, helping you make sure that you are brushing your teeth long enough to sufficiently remove plaque from your teeth and gums. syndrome, arthritis and developmental disabilities.

Flossing Flossing once a day is imperative for oral health. It can remove plaque and bacteria from between the teeth where a toothbrush is unable to reach and so can help to prevent bad breath. The best way to floss, according to most dental health professionals, is to gently push the floss all the way down to the gumline before hugging the side of the tooth with up-and-down motions. It is important to avoid snapping the floss up and down between your teeth, which will cause pain and not remove plaque so effectively.

See a dentist If you have generally good oral health and aren’t experiencing any pain or problems, the NHS recommends

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scheduling a check-up with your dentist once every 12 to 24 months. After examining your teeth, your dentist will speak to you about what’s best—the time to your next check-up could be as short as three months! During a routine examination, a hygienist will clean your teeth and remove plaque and hardened tartar. The dentist will check for visual signs of cavities, gum disease, mouth cancer and other oral health issues. They may sometimes also use dental X-rays to check for cavities.

Dental health in London But clearly, this advice isn't being widely followed. A recent report shows that by the age of five, over a quarter of children in London are suffering from tooth decay. Owing to the state of the dental health of London’s children, Mayor Sadiq Khan and

the London Assembly Health Committee have proposed some recommendations to promote good oral health for kids. Some of the recommendations include: • Making all schools in London

sugar-free by 2022 • Supervised brushing in schools • Ensuring that every child in

London sees a dentist by age one • Appointing a specialist in

children’s dental health to the Child Obesity Task Force About the initiative, Dr Onkar Sahota, Chair of the London Assembly Health Committee, said, “Schools are the centre of a child’s education and a commitment to sugar-freedom would be revolutionary. Every child in London could have a sugar-free start in life—the health benefits would be enormous.” • Live to 100 with Dr Hilary Jones | 79

15/10/2019 15:21

Whiter, healthier For your TEETH, for your HEART, for your WHOLE BODY – your oral health is important.

Many serious illnesses are associated with poor oral health:

HEART DISEASE STROKE DIABETES Gum diseases like gingivitis and periodontitis occur when harmful bacteria build up in your mouth, leading to the deterioration of bone and tissue surrounding your teeth. Clinical studies suggest that periodontal disease may permit bacteria to enter and spread throughout the body, potentially putting your heart’s health at risk. An effective daily oral care routine can keep your mouth healthy and may contribute to better overall health.

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16/10/2019 11:24

teeth for life The Philips Sonicare DiamondClean electric toothbrush provides a gentle, yet effective clean. ✔ Whiter teeth from day 1 ✔ Unrivaled sonic technology - a sonic sweeping motion

with up to 62,000 brush head movements per minute creates gentle microbubbles for a superior brushing results

✔ Tough on plaque, gentle on gums - the sonic motion gently drives fluid between teeth, even in hard to reach areas including along the gum line, while the brush gently strokes and effectively removes plaque.

✔ Extra deep cleaning - the combination of the motion of the brush head with the three-minute brushing time ensures an exceptional deep clean all over.

✔ Five brushing modes - Sonicare’s most versatile brush yet has five bespoke brush modes.

Learn more about Philips Sonicare


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07/10/2019 12:10

YOUR Healthcare

Wake Up to the Dangers

of Sleep Apnoea Despite being a common condition, obstructive sleep apnoea (OSA) can have potentially serious consequences. But what causes it, and what are the possible solutions?

Snore A Lot? Your bed buddy may be first person to spot potential signs of OSA, for example loud snoring, though snoring itself is not always a symptom of obstructive sleep apnoea. Other symptoms of OSA include loud breathing during sleep, night time sweats, high blood pressure and a reduced sex drive. According to Jonathan Jun from the John Hopkins Center of Sleep, OSA can profoundly impact your ability to perform day-to-day tasks, “We’re talking about car accidents in the daytime, lost productivity at work, mood swings, waking up feeling groggy and falling asleep in class.” 82 | Live to 100 with Dr Hilary Jones

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Who’s at Risk? The NHS says that OSA is more common in the over-40s, menopausal women where hormonal changes lead the throat to relax more, and men with a collar size of over 17 inches. Genetics can be equally influential, though environmental factors such as drinking, smoking and using medications with a sedative effect are far more likely to increase your chances of developing OSA. If these measure don’t work, see your doctor, who may recommend one of two devices. A dental appliance known as an MAS or mandibular advancement splint can improve the symptoms of OSA by gently keeping the lower jaw forward to allow airways to remain open. A good MAS will be made to measure and fitted by a dentist.

For help and advice on all aspects of sleep apnoea, contact the Sleep Apnoea Trust at The adanced option is CPAP, the Continuous Positive Airway Pressure device, an air pump attached to a breathing mask. Modern CPAP machines have overcome some of the side effects of earlier designs such as nasal dryness and sore throat by incorporating humidifiers. •

Side Effect So what can you do about it? Lifestyle changes are the first resort; stop smoking, lose weight, and avoid alcohol. Sleeping on your side rather than your back can help in mild cases.

Images: Shutterstock


bstructive sleep apnoea (OSA) refers to periods of interrupted breathing during sleep, which occur as a result of the upper airway muscles relaxing and restricting the airways. In standard apnoea the airways are blocked for 10 seconds or more; in hypopnoea the airways are constantly partly obstructed with a lower airflow. There is a fundamental difference between the causes of OSA, which can range from obesity to hereditary issues, and the less common Central Sleep Apnoea. This develops as a result of the brain failing to send signals to breathing muscles during sleep, thereby greatly diminishing airflow.

15/10/2019 15:21








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You may not know that it’s your dentist who can help. Find your nearest dental practice offering snoring treatment at S4S.indd 1

24/09/2019 14:21

“There’s not one photograph I have with my grandchildren where I’m actually smiling.” Terry Evo Patient

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497 Full Jaw Corrections in 2018 alone

Trust score 9.5 I 265 reviews

Before coming to Evo, Terry and Julieanna were both incredibly conscious of going out in public, eating out at restaurants with their friends and what really upset them was the fact they had no photographs with their grandkids where they were actually smiling. Due to being so phobic of going to the dentist and by not addressing the fact they had advanced gum disease (periodontitis) their oral health declined. Julieanna came to Evo thinking she needed both jaws treated, after further assessment our Clinicians explained she only needed her upper jaw treated, whereas Terry required upper and lower jaw correction. When we first met them, Julieanna told us she used to consciously cover her mouth anytime she would talk or laugh. Now she tells us, “you laugh and joke more than you did before!” They are both so ecstatic, they can’t stop smiling. When we caught up with them at their six month sign off, Terry told us “we play a lot of boules and you can hear her cackling down the other side of the boules green now, laughing with people!”

Tooth loss and gum disease affect millions of people worldwide in every age group. Having no teeth at all is a widespread handicap, with 6% of adults being edentulous (no natural teeth). (NHS Oral health & function survey). For most people in this situation, their only options are dentures or full jaw dental implants. Wearing dentures can be a source of great embarrassment and discomfort, and although dentures can replicate the look of natural teeth, they cannot replicate the function of natural teeth. Evo fully understand the impact that tooth loss can have on a person’s physical, social and emotional well-being. The EvoSolution™ is the solution for thousands of people who have to live with removable false teeth or have been told by a dental professional that tooth loss in one or both jaws is inevitable. Evo aim to change lives by providing a complete functional rehabilitation of an entire jaw or jaws with fixed teeth on dental implants. If you think you may be suitable for the EvoSolution™, contact Evo to book your FREE Clinical Assessment today.

Evo Locations Biggleswade Canterbury Edinburgh Liverpool London Prestatyn Wincanton York Terry and Julieanna at their 6 month sign off with Evo Clinician Ellen and Evo Nurse Laura

4/5 visits can take place in one of our Evo Local Access Partner Clinics, however your smile in a day treatment takes place in our Liverpool or London Supercentre.

*Finance available to UK residents aged over 21, subject to status. Terms and conditions apply. Evodental Limited is an Appointed Representative of Chrysalis Finance Limited which is authorised by the Financial Conduct Authority to carry out the regulated activity of credit broking. Finance example for the above one jaw treatment , £2,000 deposit, plus 120 payments of £99.00 at 5.9% APR. Total paid £13,888.00, including administration fee £21, total interest paid £2,859.00.

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15/10/2019 13:07

YOUR Healthcare

SOUND BITES: All About Dental Implants

Ordinary bridges and dentures aren’t always comfortable or even a possible option for some dental patients. In those cases, implants may be the solution

WHAT ARE DENTAL IMPLANTS? Implants are a long-term solution for replacing missing teeth. Made up of a titanium screw attached to a false tooth, implants are surgically placed directly into your jawbone where they provide an artificial replacement for the missing tooth. Although there are “part set” dentures which replace one or a few missing teeth, dentures are often used as a solution for replacing most or all teeth. In situations where a denture might not work—such as in a younger patient who had a tooth knocked out in an accident, in an older patient whose mouth has shrunk too much to accommodate dentures, or for someone who would prefer not to deal with something removable—implants can provide more flexibility. Dental implants are also a more 86 | LIVE TO 100 WITH DR HILARY JONES

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permanent option than dentures. As long as you care for your implant properly and practice good oral hygiene, they can last as long as natural teeth. Dentures, in comparison, tend to last for around five to 10 years, and as dentures are made to fit your mouth exactly, they can become less comfortable over time as your mouth changes shape.

A single tooth implant can cost anywhere between £700 and £3,000. Dental implants are quite an investment, both in terms of time and money, with each one costing several hundred pounds, and done properly they take a long time to do, involving a series of procedures over a period of three to six months. Your dentist will help you decide what implant option is best, and then take measurements to order the correct size.

TEETH TYPES Endosteal implants are the most commonly used and are attached directly to the bone in your jaw, recreating the natural root of the tooth. Zygomatic implants are used when the patient needs upper jaw implants but does not have enough bone in their jaw—the implants are instead connected to the zygomatic bone, or cheekbone. This is a complex and uncommon procedure.

The third type of implant is subperiosteal, where the implant sits on top of the bone but underneath the gum. Dental implant surgery is relatively uncomplicated and is usually done under local anaesthetic. The recovery process is similar to that of having wisdom teeth removed—patients should eat a soft diet for a few days and be careful when brushing the affected area. The implants themselves will take between two and six months to bond with the bone, after which the false tooth, typically a crown or bridge, fit on top.

ATTRACTIVE Implants are usually only available privately, and they are certainly an expensive option. A single tooth implant can cost anywhere between £700 and £3,000. They are sometimes available on the NHS for patients who can’t wear dentures or whose face and teeth have been damaged, such as people who have had mouth cancer or an accident that’s knocked a tooth out. Although the initial cost of implants can be more expensive than other options, don’t forget that implants are a long-term solution and the benefits are likely to last a lot longer Getting an implant isn’t always the right option, even if it seems like an attractive solution. Whether you’re a good candidate for implants depends on many factors, including which teeth are missing as well as the condition of your remaining teeth and gums. There are several other options

Images: Shutterstock


lobally, about 30 percent of people over age 65 have no natural teeth – or as the specialists say, they are ‘edentulate’. No matter how good your oral hygiene routine, ageing catches up to all of us eventually—and when it comes for your mouth, it’s good to know your options. Dentures have been, and remain, the go-to option when it comes to losing teeth in old age; but removable artificial teeth come with their own care and comfort problems. However, advances in modern medicine and technology mean there are now more solutions, and one of the most popular is dental implants.

15/10/2019 15:22

YOUR Healthcare when it comes to replacing missing teeth, such as full or partial dentures and bridges. And for any of them, it’s imperative to speak with a dentist before making a decision. Implants aren’t suitable for anyone under 18, as the underlying bones are still growing. However, in general, dental implants are suitable for most adults who are in good health and have healthy gums. Your dentist may not recommend implants if you are a smoker, have had radiotherapy to your jaw area, have diabetes or suffer from gum disease. Tell your dentist about any medical problems you have, and they’ll let you know if implants are for you. •

130,000 dental implants are performed in the UK every year.

Implant facts ■ Titanium is 5x stronger than bone ■ Dental implant surgery has a success rate of 98% ■ Dental implants preserve the bone structure of the jaw

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Live to 100 with Dr Hilary Jones | 87

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MILLION PEOPLE in the UK are currently AFFECTED BY AF and it is estimated to at LEAST DOUBLE OVER THE NEXT 50 YEARS as the population ages.1,3



• Atrial Fibrillation increases the risk of stroke by 5 times.2 • The NHS have made stroke care a clinical priority as it is the fourth single leading cause of death in the UK and the single largest cause of complex disability.4 en-UK/find-a-center.html

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• Stroke presents a major public health challenge, with a high case of fatality and the cost of stroke to the NHS is £25.6 bn a year.6 • That in patients with Atrial Fibrillation not caused by heart valve problems, 90 % of left atrium blood clots originate in the Left Atrial Appendage (LAA)?7

1. NHS: (accessed 21 Aug 2019). 2. Stroke Association: stroke_v4_web.pdf (accessed 21 Aug 2019). 3. European Society of Cardiology: Guidelines for the management of atrial fibrillation. 2014. 4. Stroke Association: State of the Nation. 2016. 5. NHS: (accessed 21 Aug 2019). 6. Stroke Association: Current, future and avoidable costs of stoke in the UK. (accessed 21 Aug 2019). 7. National Center for Biotechnology Information: (accessed 21 Aug 2019).

08/10/2019 09:55

WHAT IS ATRIAL FIBRILLATION (AF)? A common heart condition, a type of irregular heartbeat, occurring when the atria (the upper chambers of the heart) do not contract properly resulting in the heart not pumping blood as efficiently as usual.5

Left Atrium Left Atrial Appendage Right Atrium Right Ventricle


4 3

Left Ventricle

1 AF causes blood to stagnate in the LAA.


The stagnant blood becomes an ideal

2 environment for a thrombus or blood clot to form.

1 2


The blood clot dislodges from the LAA and travels through the arterial system.


The embolism lodges itself in the blood vessels of the brain, restricting blood flow and causing a stroke.

WHAT ARE THE BENEFITS OF WATCHMAN LAAC THERAPY? • A safe and effective therapy that reduces the risk of stroke in people with atrial fibrillation not caused by a heart valve problem. • A one-time minimally invasive procedure, that does not require open heart surgery permanently closing off the left atrial appendage. Patients commonly stay in the hospital overnight and leave the next day.

BLOOD THINNER THERAPY Effective reduction of cardioembolic stroke risk vs bleeding complication risks in some patients.

LEFT ATRIAL APPENDAGE CLOSURE THERAPY Effective reduction of cardioembolic stroke and bleeding risks in patients unable or unwilling to take blood thinners. en-UK/find-a-center.html All cited trademarks are the property of their respective owners. CAUTION: The law restricts these devices to sale by or on the order of a physician. Indications, contraindications, warnings and instructions for use can be found in the product labeling supplied with each device. Information for use only in countries with applicable health authority product registrations. Information contained herein for distribution outside the USA, France and Japan only. SH-693101-AA © 2019 Boston Scientific Corporation or its affiliates. All rights reserved.

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08/10/2019 09:57

In Association with Boston Scientific

When Your Heart Misses a Beat Around 1.2 million people in the UK have atrial fibrillation, a type of irregular heartbeat that increases your risk of stroke. Here’s what you need to know


few months after her son was born, professional ice skater Karen Christensen started noticing that her heart would race without warning, making her feel lightheaded and weak. At first, she thought it was a fluke, perhaps related to eating too quickly or even her recent pregnancy. However, her light-headedness started lasting longer, and Christensen decided to visit a doctor. That’s when she found out she had atrial fibrillation, sometimes called AF or AFib. AF is among the most common heart rhythm irregularities. If you have AF, you are five times more likely to have a stroke; however, diagnosing and treating AF significantly lowers your risk. Christensen was lucky–she discovered her AF in her 30s, almost 20 years ago. Today, she’s an ice-skating instructor, as well as an activist for awareness of AF.

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“I know it can be scary. But you really need to address the symptoms early because of the risk of stroke,” Christensen said. “Once you get it checked out and treated, you can live a full, happy life.”

EXPLAINING AF AF occurs when the usually rhythmic contractions of the heart muscle’s upper chambers (the atria) are replaced by an ineffectual quiver that does not completely move blood out of the heart chamber. This causes the blood to pool and become sluggish and can result in the formation of blood clots. If a clot leaves the heart and travels to the brain, it can cause a stroke by blocking the flow of blood through cerebral arteries. Some people with AF can go through life with no symptoms, but others may experience a range of synptoms including

a fluttering feeling in the area of the chest above the heart, chest pain, lightheadedness or fainting, shortness of breath and fatigue. AF is diagnosed by an electrocardiogram (ECG), a device that records the heart’s electrical activity. Other tests are often

Foods rich in Vitamin K are recommended to fight AF. Start eating: ■ ■ ■ ■ ■ ■ ■ ■

Green leafy vegetables Brussel sprouts Broccoli Cauliflower Cabbage Fish Liver Eggs

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In Association with Boston Scientific

There are four

types of AF:


Paroxysmal AF comes and goes. Your heart goes back to its normal rhythm without any treatment, usually within 48 hours. Persistent AF is where you have AF episodes that last more than seven days and it’s unlikely that they’ll stop on their own. You’ll need treatment to restore your normal heart rate. Permanent AF is there all the time. You might be diagnosed with permanent AF if you’ve had it for more than one year.

2 performed to rule out contributing causes, such as high blood pressure, an overactive thyroid gland, heart failure, faulty heart valves, lung disease and stimulant or alcohol abuse.

TREATMENT Doctor-prescribed treatments for AF can range from advice on lifestyle changes such as cuttin down on sodium and fat intake, to medication, to shock therapy or surgery. You may be offered medication to slow your heartbeat and to thin the blood, preventing clots. You might need to try several types of medication, in consultation with your doctor, before you find the right one for you. Other treatments focus on getting the heart to beat more regularly. This can include medication, or cardioversion, which uses a brief electric shock to restore a normal heart rhythm.

Other treatments for AF include surgical catheter ablation, where radio frequency energy is used to remove the area of the heart causing abnormal rhythm. Another promising technique is a medical procedure to insert a Left Atrial Appendage Closure device (LAAC). Dr John P Foran, Consultant Cardiologist (Cardiac Electrophysiology and Coronary Intervention) at Royal Brompton Hospital, London, says: “As a one-off key-hole procedure, LAAC effectively reduces the global risk of stroke in people with atrial fibrillation not caused by a heart valve problem. As a permanent implant, LAAC devices like Boston Scientific’s WATCHMAN FLX™ avoid the bleeding risks associated with the long-term use of blood thinners. This makes it an important option for people with a history or risk of serious bleeding on blood thinners.” •



Long-standing persistent AF is when

you have had continuous atrial fibrillation for a year or longer. ■ As well as these four types, a small number of people may be diagnosed with “lone AF”. This is when doctors cannot find what is causing your AF, or you don’t have any risk factors for it.

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15/10/2019 15:25

YOUR Healthcare

How Research

is Beating Breast Cancer

92 | Live to 100 with Dr Hilary Jones

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reast cancer is the most common cancer in the UK—roughly one in eight women are diagnosed with it in their lifetime. The earlier it's detected the more successful treatment is likely to be, and the better the chance of recovery. Screenings for breast cancer are imperative to catch the disease and save lives. The X-ray test (called a mammogram) can spot cancers when they’re too small to see or feel.

Now the charity Against Breast Cancer (ABC) has launched ABC Discover, a new project to provide a basis for precision medicine in breast cancer. By applying the latest analytical technologies to clinical samples taken from breast cancer patients, ABC Discover hopes to improve rates of early detection and improve our understanding of the impact of diet and lifestyle on breast cancer recurrence and secondary spread. Representing a five-year, £1,200,000

Images: Shutterstock

One in eight women in the UK will develop breast cancer in their lifetime. We look at some key research projects promising improvements in treatment

15/10/2019 15:25

YOUR Healthcare commitment, ABC Discover will be based at the University of Southampton and brings the charity’s long-term research spending commitments to over £4,000,000 for the first time in its history. Working in close collaboration with the advanced research infrastructure Against Breast Cancer already has in place at the University of Southampton, ABC Discover will be led by Dr Paul Skipp who together with his team plans to perform deep ‘molecular phenotyping’ of the clinical samples. The research promises to have a major impact on the discovery of 'biomarkers', which are required for the development of new tools to identify risk and early detection of Stage IV breast cancer.

BIOMARKERS Dr Paul Skipp said “ABC Discover will enable more effective and personalised treatments meaning a better outcome for breast cancer patients. By using molecular signatures with clinical and lifestyle data, we will be able to better tailor existing treatments, paving the way for the development of new therapeutics and diagnostics”. By identifying risk biomarkers and factors such as diet and lifestyle which are associated with recurrence, ABC Discover hopes to revolutionize treatment intervention to improve patient outcome. Advancing the effectiveness of predicting risk, diagnosing and monitoring responses and understanding cancer behaviour in response to diet and lifestyle, ABC Discover aims to provide the basis for precision medicine in breast cancer. Bernadette Jones, Chief Executive of Against Breast Cancer said: “We need to better understand breast cancer and want to pave the way toward enabling more personalised and effective healthcare treatment and diagnosis. "ABC Discover will advance our understanding of why some breast cancers become metastatic and the impact diet and lifestyle has on patient progression and outcome. With the number of people

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living with breast cancer predicted to grow dramatically over the coming years the need to improve rates of earlier detection has never been greater.” Meanwhile a relatively new science, genomics, promises improvements in the understanding of the human genetic code and the treatment of breast cancer. Genomics (a term coined in 1986) looks at the way groups of genes are expressed, particularly significant in breast cancer biology. One exciting area of research is what genomics can tell us about the way in which cancer cells are likely to respond to chemotherapy, and therefore whether this is the best way to treat a particular patient. Dr Caroline Archer, a Consultant Medical Oncologist specialising in breast cancer based at Portsmouth Hospitals NHS Trust, has been working with genetic testing specialist Genomic Health on a trial aimed at defining the benefits of chemotherapy.

US National Cancer Institute and set a new standard of care in the UK and beyond.” TAILORx was built around a test for the likelihood of cancer recurrence known as Oncotype DX, developed by leading Californian genetic research company Genomic Health.



Dr. Archer said: “TAILORx, or Trial Assigning IndividuaLised Options for Treatment (Rx), is aimed at defining the benefits of chemotherapy. It was one of the world’s largest breast cancer clinical studies, involving 10,273 women. The research was an independent study sponsored by the

Dr Archer said: "With greater understanding of the molecular biology of cancers and the use of genomics with tests such as Oncotype DX, we can better refine our treatments for those who will benefit most, achieving a personalised medicine approach to an individual’s cancer journey.” •

Men can get breast cancer too—it’s rare, with around 400 men (compared to around 55,000 women) diagnosed each year in the UK, but risk factor increases with age, high oestrogen levels, and close familial connection to female breast cancer sufferers.


15/10/2019 16:06

Providing personalised medicine for UK cancer patients.

Genomic Health improves the quality of cancer care by developing cutting-edge diagnostic tests. Customer Support UK: Tel: 020 3031 8087

Please visit our websites:

Genomic Health, Oncotype IQ, Genomic Intelligence Platform and Making cancer care smarter are trademarks or registered trademarks of Genomic Health, Inc. Š 2019 Genomic Health, Inc. All rights reserved. GHI11729_0719_EN_UK

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01/10/2019 11:36

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The Key to Breast Cancer? A relatively new science, genomics, promises improvements in the understanding of the human genetic code and the treatment of breast cancer. We asked a leading consultant to explain


r Caroline Archer is a Consultant Medical Oncologist specialising in breast cancer, based at Portsmouth Hospitals NHS Trust. We asked her to explain the promising new field of genomics, the role of genetic research specialist Genomic Health’s Oncotype DX test for breast cancer, and the application of its clinical study TAILORx. GENOMICS Dr. Archer said: “Genomics looks at how groups of genes are expressed, particularly significant in breast cancer biology. One exciting area of research is what genomics tells us about how cancer cells are likely to respond to chemotherapy, and so whether this is the best way to treat a particular patient. TAILORx is one of the world’s largest breast cancer clinical studies, involving 10,273 women. The research was an independent study sponsored by the US National Cancer Institute and sets a new standard of care in the UK and beyond.”

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“The NHS currently offers the Oncotype DX test to around 26,000 women each year, and there is increasing data for the role of the Oncotype DX test in another 6,500 women affected by early stage breast cancer, potentially sparing more women the toxic effects of chemotherapy.”

“The trial’s primary objective was to define the benefit of chemotherapy, if any, for woman with early breast cancer with a Recurrence Score result of 11-25 as defined using Genomic Health’s Oncotype DX test.” “The ground-breaking study was conducted in six countries using the Oncotype DX test with followup for over nine years. The results indicated no additional benefit from chemotherapy for these patients with an Oncotype DX Breast Recurrence Score result of 11-25, which comprised the majority of patients in the study.”

Defining Chemotherapy Benefit Dr Archer added: “TAILORx has established the benefit of the Oncotype DX test in patients with no nodal involvement, and now we are eagerly awaiting the results of similar studies in patients where nodes are involved potentially extending its utility and role.” Genomic Health now delivers over 500 Oncotype DX test results per day to more than 90 countries through a centralised clinical laboratory, serving the company’s overall vision, which is to revolutionise the treatment of cancer throughout the patient journey.

02/10/2019 12:10

YOUR Healthcare

Fighting 'Flu

and Keeping Fit There may be no cure for the common cold, but there is something we can do to ward off the more serious condition, influenza


oth influenza, otherwise known as the 'flu, and the common cold are contracted through viruses spread by moisture droplets in the air, or by contact with contaminated surfaces. But the similarities end there. Symptoms of the common cold affect the respiratory tract and usually include an itchy throat and a runny nose, whereas symptoms of the flu can affect other areas of the body and can lead to complications, as can pneumonia which is even more serious. Dr Rob Hicks from the Randolph Surgery in London explains the quickest way of distinguishing between the two is the ‘tenpound note’ test. "If you are able to pick up a note off the floor without any difficulty or

pain, you more likely to be experiencing a common cold than the flu." Flu epidemics tend to peak during the winter, though it’s a myth that they’re caused by us being cold. The two main flu viruses are influenza A and influenza B. Influenza A can be found in humans and many animals such as chickens, pigs and ducks, while influenza B is exclusive to humans. Type A is far more likely to mutate to a new antibioticresistant form (which is why you need a new vaccination each year). A famous example of an influenza A pandemic was the swine flu outbreak in 2009 to 2010. Contrastingly, influenza B is behind smaller outbreaks and predominately affects young children.

SPOTTING THE SYMPTOMS Flu is highly contagious and symptoms can appear extremely quickly. Symptoms include a sudden fever, a runny nose, a cough, a sore throat, muscle pain, joint pain, irritability, headaches, insomnia, a loss of appetite and dehydration. You can recover more quickly by getting plenty of rest, staying hydrated and taking ibuprofen to treat pains. Certain groups are far more likely to experience complications following flu, for example those above the age of 65, individuals working in the health sector and pregnant women.



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Images: Shutterstock

Dr Hilary Jones highlights the importance of at-risk individuals seeking treatment. “Brits need to stop playing Russian roulette with flu—it is an extremely serious illness and, as such needs to be taken extremely seriously. "Going to work while still ill may seem like the noble thing to do but all it does is delay your recovery and infect those around you. "And parents should think seriously about getting their children vaccinated—it is easy for kids to pass on flu to their grandparents, who are particularly vulnerable to the disease.”

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YOUR Healthcare Jabbed Better Children (who are regarded as 'super spreaders') may be administered a live quadrivalent 'flu vaccine in the form of a nasal spray, free through their schools; for adults a quadrivalent injected vaccine is used, or for older patients a trivalent injected vaccine mixed with adjuvants to boost the immune system and the overall effectiveness of the vaccine. If you are pregnant, you are strongly advised to have an injectable form of the vaccine, due to the higher risks involved. The NHS reports that receiving a flu vaccine will decrease your likelihood of developing

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flu-related complications like pneumonia, cut your risk of facing a miscarriage or giving birth to a premature baby and post birth, for a short duration, a flu vaccine can even aid with defending the baby’s immune system against flu. Expecting mothers can have a flu vaccination at any point in their pregnancy, and you too, fathers-to-be! You should qualify for a free 'flu jab if you suffer from asthma, emphysema, chronic obstructive pulmonary disease (COPD), chronic forms of heart, kidney, or liver disease, neurological conditions, obesity, diabetes, a weakened immune system, or if you have spleen related problems. Frontline health and social care workers and primary carers, due to their more frequent exposure to pathogens, are also entitled to a free NHS 'flu vaccine.

Can’t Catch This Pathogens spread by the 'flu virus can remain on hands and surfaces for up to 24 hours, so to prevent the spread of 'flu, good hygiene is paramount. Make sure you sneeze into a tissue, not on the poor person on the train next to you. Wash your hands frequently—you don’t have to invest in antibacterial soap or expensive, lavender-smelling hand gels, as regular soap can be just as efficient at fighting the 'flu. •

Needling Out the Myths The ‘anti-vax’ movement spreading inaccurate information about vaccination has led to a resurgence in measles, mumps and pertussis (whooping cough). Talk to your doctor about the importance of vaccinations, which save nearly three million lives worldwide per year.

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YOUR Healthcare

Healing With Feeling I

f a wound has not healed in more than eight weeks, and does not show any progress in doing so, it is considered a chronic wound. This is as opposed to an acute wound, which is classed as an injury that heals well within a certain amount of time. Chronic wounds include, but are not limited to, diabetic foot ulcers, venous leg ulcers, and pressure ulcers. They are a challenge to wound care professionals around the world, and consume a great deal of healthcare resources. Some common features shared by each of these wounds include prolonged

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or excessive inflammation, persistent infections, formation of drug-resistant microbial biofilms, and the inability of skin to heal. Chronic wounds are a common problem for people with certain conditions, and in many cases apart from the discomfort they cause, there’s the emotional and psychological effects of the chronic wound to consider. Many people with complex chronic wounds find that psychological support is just as important as physical support, because quality of life can suffer as the ability to perform simple tasks can be hindered.

Bedridden patients are particularly at risk of suffering from a chronic wound, as long periods of immobility can result in poor circulation. Bedridden patients may also experience pressure ulcers, a type of chronic wound which is sometimes known as a bedsore. They occur as a result of long term pressure being applied to certain areas of the body.

REPAIRS While injuries are an unavoidable part of life, our body always works to repair the damage. However, for people with diabetes, what initially starts off as an acute wound can carry great risks and can result in serious health complications. People with diabetes have high blood glucose levels, which often causes

Images: Shutterstock

To remedy chronic wounds, it’s important to understand what causes them and why they are a treatment challenge

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YOUR Healthcare stiffness of the arteries. This can also cause narrowing of blood vessels and diabetic neuropathy (nerve damage caused by diabetes). The effects of these body changes carries an increased risk of wounds and complications in healing. Even when acute wound does not develop into an infection, slow healing has effects on a personal quality of life. Wounds that take time to heal can make walking and exercise painful and sometimes nearly impossible. Foot ulcers have proven to be a very common chronic wound in people with diabetes. Reports have found that 1 in 4 people who suffer with diabetes have also suffered with a foot ulcer. If foot ulcers go untreated or take too long to heal, infection can take over, to the point where amputation is necessary.

IMMUNITY What you eat can determine your body’s ability to generate new tissue, an essential element in wound healing. When the body is injured, the immune system works to repair the damage with new tissue and prevents bacteria multiplying in the wound and causing infection. In cases of people with poor nutrition, chronic wounds tend to develop because the immune system is compromised. Conversely, obesity can also be an underlying factor in chronic wounds.

Often, chronic wounds stall in the inflammation phase of healing, due to a range of causes including cellular senescence (cells which are too old to divide), recurrent infection, melanoma (cancer of pigment cells), or other factors.

IT’S ABOUT TIME Drs Robert G. Frykberg and Jaminelli Banks write in the paper Challenges in the Treatment of Chronic Wounds that a holistic approach to treatment is needed, involving nutrition, surgical assessment, and infection control, summarised in the acronym TIME • Tissue assessment and management • Infection and Inflammation management • Moisture imbalance management • Edge of wound observation and management

TREATMENTS There are a number of advanced clinical treatments available for chronic wound care, such as electrical stimulation, topical oxygen therapy, low-frequency ultrasound, placental tissue treatments and skin transplants – but before resorting to any of these, conventional wound care using medical dressings can often present a solution. There are many possibilities, including standard and super absorbent gauzes, foam, silicon and polyurethane dressings, zinc oxide dressing and ointments, hydrogels (absorbent polymers), alginates (carbohydrates derived from clinical bacterial sources), and even honey dressings (using medical grade honey, which has antimicrobial and anti-inflammatory properties). The fight against chronic wounds can be a long one, but with proper medical advice and attention, it's one which it is possible to win.

Wounds heal in four stages:

1 2

Hemostasis – constriction of the blood vessels and blood clotting

Healing – blood platelets secrete

growth factors, phagocytes remove bacteria, and growth factors start repair work


Formation – new tissue and blood

vessels form and inflammation subsides over a period of about a week


Collagen replacement – tissue

in the closed wound is remodelled into bundles in a process which can take 1-2 years or longer

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by Professor Richard White and Alexandra Bishop.


e turn our attention to wounds in the older population and consider why some wounds are slow to heal, or do not heal at all. In either circumstance it must never be regarded as “just one of those things” but instead be reason for further medical investigations and careful scrutiny of treatments and lifestyle. We no longer accept that wounds need ever be slow to heal, or impossible to heal without just cause. First however, we need to take a quick look at the problem of wounds in our NHS. It has been calculated that wounds cost our health system well over £5 billion a year. This is about 4% of the total spend on health! In the older segment of our population, leg and foot ulcers, and pressure ulcers (formerly known as bed sores) are expensive to manage - as well as being a major quality of life issue for both patients and

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their families. Surgical wounds in patients discharged from hospital can also be problem healers in the community situation. Far too many wounds do not heal, why might that be and, what can be done about it? Firstly, we at DDRC Wound Care take the view that few, if any, wounds are ‘unhealable’. Most can, with the correct management, heal up. However, in many cases this does not happen. To understand this we must look at the factors which lead to wounds being slow to heal, or even non-healing.

“...we must look at the factors which lead to wounds being slow to heal, or even non-healing.” The term “chronic wounds” has long been applied to leg and foot ulcers and to pressure ulcers. Indeed some innocuous trauma wounds become chronic. This means that they do not heal in

the typical way and rate that we understand wounds to heal. Chronic wounds are unremitting, never-ending, recurrent and as such take up valuable resources including dressings and nurse time. This need not be the case; it is important that patients and their families do not despair when wounds don’t heal, help is at hand.

“ is important that patients and their families do not despair when wounds don’t heal, help is at hand.” A chronic wound is at risk of infection until it is fully healed. It may well leak or ooze and become smelly. Pain is frequently a major factor causing loss of sleep and great distress. The accepted approach that experienced doctors and nurses take to avoid this happening is clear and should be made available to all patients.

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to us may be privately, and we are currently working on a referral pathway for GPs. We aim to prepare detailed care plans such that patients may then be managed by their local doctors and nurses with our guidance. We are based on the Plymouth Science Park close by Derriford Hospital, Plymouth.

From left to right - Joanne Small, Tissue Viability Nurse; Alexandra Bishop, Tissue Viability Nurse Specialist; Del Waller, Tissue Viability Nurse Specialist.

Firstly, a thorough assessment must be conducted, preferably by a wound care nurse specialist or Tissue Viability nurse. This will take up to an hour. It will involve a detailed medical, lifestyle and dietary history and an examination of the wound. It is only by this approach that the next stage, the care plan, can be deduced. Assessment is not a one-off event but rather a regular occurrence, conducted to monitor progress or to revise the care plan if healing does not happen as expected.

“The care plan is an essential component of every patient’s management.” The care plan is an essential component of every patient’s management. It will outline in detail exactly how the wound and related medical issues, such as pain or infection, must be managed such that if the patient is cared for in their own home, all nurse or doctor visits will focus

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on the care plan. This way the constant changing of dressing types can be avoided. Similarly, if healing does not progress as anticipated, the patient can be re-assessed and the care plan revised to take account of changing circumstances. In our experience, we frequently see patients who have non-healing leg ulcers and find that bandaging has been inconsistently applied, dressings changed without due cause, vital diagnostic tests not done or misinterpreted and social and nutritional intake has not been considered.

In our hands these deficiencies can be quickly remedied and the patient treated in a fashion which will optimise healing, otherwise we will arrange referral to the appropriate medical, surgical or other specialty for detailed investigations. No patient deserves to be left with a wound which is not healing!

DDRC Wound Care is pleased to work co-operatively with Advancis Medical as both a research and clinical partner. By doing so we are able to access quality wound care products as well as to have advanced experience with new developments in the management of wounds. “At Advancis Medical, we are passionate about working with patients and clinicians to develop the best wound care solutions. We do not accept that some wounds simply will not heal and by working with proven care providers like DDRC Wound Care, it is our mission to provide products that can help every wound to heal.” Victoria Smallwood, Marketing Manager. No patient deserves to be left with a wound which is not healing, and there is no justifiable excuse for doing so.

research and clinical partner to

A brief note on DDRC Wound Care: we are a part of a medical charity, DDRC Healthcare, providing expert wound assessments and care. Referrals

02/10/2019 12:02


Rotational Chair Bed

Restoring Mobility, Dignity and Independence The Rota-Pro速 will help restore mobility and independence to people who are weight bearing and able to walk, but struggle with moving from a lying to a sitting position in order to get into and out of bed independently. The Rota-Pro速 promotes improved quality of life within the home environment and reduces the cost of care packages at home for most customers. Let the Rota-Pro速 do the work and help you get back to sleeping soundly in a bed, without the worry of independently getting up in the morning or throughout the night.

Quote LIVE100 for a Free UK Demo Today and a 5% Discount! T: 01905 774695 E: @ApexMedicalUK

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YOUR Healthcare

Stop the Pressure Pressure sores are a common side-effect of prolonged bedcare, but what can be done to avoid or treat them?


ressure sores, also known as pressure ulcers or bedsores, are a type of chronic wound which usually occur when there is prolonged pressure on the skin. They most often occur in wheelchair users or patients confined to bed for prolonged periods, and are most prevalent in the over-70s, where skin is likely to be fragile and prone to damage. Obesity and blood circulation problems can also contribute to the development of pressure sores, the first symptoms of which pain or itchiness in an affected area, skin becoming discoloured and slow healing wounds or blisters.

removal) or surgery may be performed to remove damaged tissue, but of course prevention is better than cure, and there have been some promising developments in medical care equipment specially designed to help those who are at risk of developing pressure sores. Special mattresses, for example, provide pressure relief for bedbound patients. Many of them use a combination of air cells and specialist foams to form a surface capable of pressure reduction. These mattresses can be very effective in reducing the risk of pressure sores in post-operative or long-term care patients. For people on bedrest, tilting beds are especially helpful. These provide pressure relief to patients by turning the user side to side automatically, thus preventing the risk of pressure sores and enabling the patient to move if they are unable.


While there is no certain way of preventing pressure sores developing, there are some basic principles to observe which can reduce the risk—for example, regularly changing your lying down or sitting position if you are confined to a bed or wheelchair. You can also regularly check your skin to make sure you spot pressure sores developing early on, and you should eat a healthy, balanced diet so that your body gets the right amount of vitamins and minerals to maintain good skin health. Stopping smoking can also greatly improve your blood circulation, which strengthens your skin and your body’s ability to heal wounds. •


CARE AND TREATMENTS Special dressings are available to treat pressure sores, such as alginate dressings made from seaweed and a combination of sodium and calcium, which significantly speed up the healing process. Others contain a special gel which keeps the surrounding skin healthy and dry to ensure the growth of new skin cells. In very severe cases, debridement (tissue

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Pressure sores are more likely to develop in patients suffering from condition which affect blood supply such as diabetes, peripheral arterial disease, kidney failure, heart failure, multiple sclerosis (MS) and Parkinson’s disease.


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Belgium’s reputation for fine food and beautiful buildings is matched by its appeal as a destination for affordable, high-quality medical treatment


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Medical training in Belgium is extensive, with some specialisms such as cosmetic surgery requiring 12 years of study


elgium, known for its medieval towns, Renaissance architecture, and as the site of the European Union headquarters, is an affordable and historic tourist destination nestled between Germany and France. While the small country, population around 10m, might not often feature on the bucket list of thrill seekers, the picturesque canals of Bruges, the belfries, castles and carnivals are anything but boring—and for lovers of decadent chocolate and Trappist beers, there’s no better place to visit. Belgium has enjoyed a growing reputation for being historic yet hip, and the cheap transportation from London

EFFICIENT Belgium boasts impeccable clinical standards and specialises in treatments that can have a seriously positive effect on our quality of life. In fact the nation topped the World Markets Research Centre health survey in 2002, which declared Belgians the healthiest people in the world. A huge downside to the UK health system is the long waiting time experienced in not just emergency facilities, but also routine appointments at the doctor’s surgery. Belgium offers a huge reduction in waiting times due to flexibility built into its healthcare service. Costs are considerably lower than in the UK and US too, often by a factor of 40 to 50 percent, and standards are of the

Images: Shutterstock

Medical Tourism in

including the option of Eurostar makes it accessible and an increasingly popular weekend trip for friends looking to feed their souls with ales, mussels and French fries (which the Belgians proudly boast they actually invented). What is perhaps little known about Belgium is that it’s also rapidly becoming an emerging medical tourism destination from the UK. The Dutch have been medical tourists to Belgium since the 1970’s, and now it seems the enthusiasm has spread to Britain.

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MEDICAL Tourism highest, with an extremely low secondary infection rate of just 0.5 percent. Belgian residents are brought up as bi-lingual, and many Flemish- and Frenchspeaking people will speak at least three languages, one of them always being English. Medical training usually uses English language text books, and many Belgian doctors study in the UK or US. Medical training in Belgium is extensive, with some specialisms such as cosmetic surgery requiring 12 years of study.

ORTHOPAEDICS Many medical tourists choose Belgium for their excellence in orthopaedic treatment of hips and knees. In the UK, although orthopaedic treatment is normally free on the NHS, waiting times can sometimes be as much as 18 weeks if the case is considered ‘nonurgent’. This is because of high demand, meaning that the NHS has to put a system in place to assess who are the urgent cases and who are not. Additionally, some patients who need knee replacement surgery don’t get referred, as they don’t match the criteria. This can result in a seriously damaged quality of life, negatively impacting physical wellbeing as well as mental health, as the pain can be crippling and debilitating, often stopping them from

KLINIEK waiting times are minimised by a flexible healthcare system

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TESTING, TESTING Belgium has a five-year period for the testing and release of new drugs and treatments, half the time taken by most other European countries, so the latest medicines and treatments can often be found in Belgium before they are available in the rest of the world.

82 years the average life expectancy at birth in Belgium, two years above the OECD average. Source: OECD Better Life Index

doing everyday chores and activities. However, in a private practice ‘kliniek’ in Belgium, there are rarely waiting times for such procedures, and Belgium has particular expertise in the area of orthopaedic treatment, including access to medical technologies such as the Mako hip and knee replacement surgery robot. Belgium is one if the cheapest countries where patients can seek this type of surgery. The robot works with a scan of the

patient’s anatomy, help the surgeon to remove only the unwanted tissue and spare good tissue, resulting in minimal pain and surgical trauma, and improved recovery times.

HEART SURGERY The UZ Brussel (Brussels University Hospital) is one of Belgium’s premier Centres of Excellence in healthcare, biomedical research and medical education—its Centre of Reproductive Medicine has pioneered techniques including Intracytoplasmic Sperm Injection, its Oncology Centre offers high-end medical services including an innovative tumour vaccination programme, and its Diabetes Centre Brussels has built up solid and worldwide renowned expertise in insulin treatment systems. Belgium also specialises in heart surgery, with some of the best practising heart surgeons. In 2017, a Belgian surgeon delivered the first ever heart surgery that involved replacing a heart valve using simple keyhole surgery. The groundbreaking technique went on to set an example for surgeons all over the world. From the Belfry of Mons to the Town Hall of Leuven, and the Cathedral of Tournai to the Castle of Gravensteen, Belgium has lots to see and is small enough that tourists can get to any point within a few hours; so whether you visit just for fun or as part of a medical trip, there’s plenty to see and do, and you’ll return home feeling all the better for it. •


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Top-class orthopaedic treatment AZ Delta, Belgium AZ Delta is a highly specialised hospital in Roeselare, Belgium. The hospital owns the Joint Commission International (JCI) golden qualitylabel. Over 4000 people work at AZ Delta, of whom approximately 385 are doctors. The department of orthopaedics is specialised in i.a. knee, hip, and shoulder surgery. On the campus Brugsesteenweg the orthopaedic department has 7 operating rooms incl. robot-assisted surgery (Mako, Stryker), nursing departments, medical imaging (MRI, EOS, CT), outpatient clinic and rehabilitation facilities.

Customised treatment By adopting a high-quality and multidisciplinary approach Orthopedie Roeselare has evolved to become a leading orthopaedic service, able to offer all orthopaedic subspecialities. Each patient is guaranteed an exact diagnosis and customised treatment plan.

Highly refined operations The surgeons have extensive experience and the operations are highly refined due to superspecialisation. Continuous training linked to a busy practice ensures state-of-theart treatment. The use of validated standard procedures in the operating theatre reduces risks. Rehabilitation and aftercare takes place in association with your general practitioner, rehabilitation physician and physiotherapist.

Excellent care Head of department dr. Stijn Muermans: “Our aim is to provide excellent care each and every day. Our ambition is to continue to be pioneering in Flanders, Belgium and Europe by constantly striving for these values and increasingly focusing on quality.�

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All-in package for patients abroad Our Patient Care Manager organises an all-inclusive package tailored to each individual patient. Note that surgery can be performed within 6 weeks (no waiting times). Upon your arrival in Belgium, everything is well prepared and organized. The Patient Care Manager will help you through each step that has to be taken. Before your arrival in Belgium: Q&A, phonecalls and mailing with patient and family Video-call between surgeon and patient Medical file screening All paperwork During your stay in Belgium: All transfers and appointments in the hospital and hotel Accompaniment on day of surgery Daily local support Once back home: Aftercare with Q&A Additional follow-up-service Further information? e t +3251236417

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Advantages of knee replacement with robot AZ Delta has switched to a high-quality surgical robot (Mako) for knee replacement surgery since April 2018. The Mako helps the surgeon to determine the optimal position of the prosthesis to fit each individual patient. After this calculation, the Mako helps to carry out this plan by implanting the prosthesis with the utmost precision.

Optimal position of the prosthesis Dr Philip Winnock de Grave says: “The Mako robot provides the surgeon with extra information about the individual patient’s specific anatomy and biomechanics. This means the optimal position of the prosthesis can be established in advance, for each patient individually.”

Highly precise bone cuts Dr. Thomas Luyckx continues: “As soon as the optimal position of the prosthesis has been established, the robot helps to put the plan into practice with the robotic arm, by making highly

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precise bone cuts up to 0.5 mm and 0.5° of accuracy. Another advantage of the robot is that a maximum of tissue is spared during the sawing process. It means surgical trauma is reduced which promotes a smooth and quick recovery. The risk of complications is minimised as a result.”

Pioneering service Due to its qualitative and multidisciplinary approach, the Orthopaedic department in Roeselare is a pioneering service. The introduction of this smart robot in the operating theatre is the result of a very conscious decision made by the hospital. This robotic surgery will be provided by all the knee specialists at the Brugsesteenweg campus of the AZ Delta in Roeselare, Belgium.

“Surgery with the Mako robot reduces surgical trauma which promotes a smooth and quick recovery.”

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The World’s First Non-Drug Device For Preventing Osteoporosis Marodyne LiV is the world’s first medical device certified to: ✔ Prevent osteoporosis / osteopenia ✔ Improve blood circulation and lymphatic flow ✔ Increase muscle mass and strength in the legs ✔ Improve postural stability, balance and co-ordination ◆ FREE from side-effects ◆ FREE from contra-indications ◆ SIMPLE to use at home without supervision ◆ 100% Natural

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Live Well for

Strong Bones

Osteoporosis affects three million people in the UK every year, with around half a million suffering from breaks or fractures due to the condition


steoporosis, a condition where your bones become weakened and fragile, is caused by a number of factors, but is less common in the young. Bones are at their strongest in early adult life (until the late twenties) and begin to weaken at around 35 years old. While osteoporosis can affect anyone, it tends to occur in women more than in men—seemingly because when a woman goes through menopause, the levels of oestrogen, a hormone which contributes to bone health, drop significantly. For that reason osteoporosis can also affect people with hormonal disorders. Other causes could include having a family history, long-term use of steroid tablets, heavy drinking or smoking, and long periods of inactivity, such as being on long term bed-rest.

Treatments Though osteoporosis causes more than 300,000 fractures a year in the UK, it is treatable, with several options available to reduce its effects, including a long course of bisphosphonate tablets or injections to slow the rate that bone is broken down in the body, selective oestrogen receptor modulators (SERMs) to take the place of oestrogen in maintaining bone density, and parathyroid hormone to regulate the amount of calcium in bone. Unsurprisingly, calcium and vitamin D supplements are also useful, as calcium is the main mineral found in bone. There is also research suggesting that

Low Intensity Vibration (LIV) machines can stimulate osteoblast (bone-building) cells by delivering high-frequency vibrations to the skeleton.

Prevention Lifestyle changes to reduce the risk of osteoporosis include regular exercise, which can benefit both bones and muscles., and attention to the calcium content in the diet, a recommended 700mg of calcium a day. A healthy varied diet should deliver enough calcium without the need for supplements—foods high in calcium include leafy green vegetables, dried fruit, tofu and yoghurt. •


Images: Shutterstock

While there aren’t typically symptoms in the early stages of the disease, there are signs that occur when bones weaken. These include:

• Back Pain • Collapsed Vertebra • Loss of height over time • A stooped posture • Regular bone breakages It may be advisable to talk to your doctor about osteoporosis if you went through an early menopause, or know that either of your parents had hip fractures.

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World’s first nondrug option to prevent osteoporosis launches in the UK


he fight to prevent osteoporosis has now stepped up a gear with the launch of Marodyne LiV - the world’s first clinically-approved, non-invasive, non-drug option for osteoporosis prevention. Set to change the way consumers and medics deal with the bone-thinning disease, Marodyne LiV (Low-intensity Vibration) therapy is certified as a safe and effective tool to help people with osteopenia and osteoporosis, encouraging bone growth, building muscle mass and strength and stimulating blood circulation and lymphatic flow. A number of clinical studies have shown that LiV can assist in the prevention of osteoporosis in post-menopausal women and promote bone and muscle growth in younger osteoporotic women. Marodyne LiV is safe and easy to use: you simply stand on it for 10 minutes a day to allow the low intensity vibrations to stimulate your body’s cells to reform bone and

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muscle tissue. When you step onto the platform, its ‘smart’ technology automatically adjusts to your weight, mass and movement to produce low acceleration, high frequency vibrations that send signals to re-activate the bone building cells in the body. Marodyne LiV can be safely used alongside all prescription drugs currently available to treat osteoporosis. “The Royal Osteoporosis Society is encouraged to see the results so far from the Marodyne LiV research and its potential as a safe and effective tool for the prevention of osteoporosis,” says Henry Mace, Head of Clinical Partnerships, Royal Osteoporosis Society. “We look forward to working with Marodyne LiV and will be watching with great interest to

see the difference it makes to people living with the condition.” Marodyne LiV works by delivering a precise and targeted low-magnitude mechanical signal at a frequency of exactly 30 Hz per second to the person standing on the device. The frequency is calibrated to stimulate and regulate critical stem-cell processes that are key to regenerating tissues within the body, including bone. Just a faint buzzing sensation is felt as you stand on the device. Health guru Diana Moran, 80, likens the

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sensation to the purring of a cat. An early adopter of Marodyne LiV, Diana uses it at home to help her manage her osteopenia – the midpoint between having healthy bones and having osteoporosis. With over 10 years’ expertise speaking on this health topic, Diana likes the fact that the device offers a non-drug, non-invasive option to treat the symptoms of osteopenia and osteoporosis. “Unlike some osteoporosis drugs, there are no side effects with Marodyne LiV and no need to take a ‘drug holiday’,” says Diana. “I love the way it stimulates the body’s cells in a wholly natural way. Even better, it does more than just help build bone: it also helps improve muscle strength, reduce knee, hip and back pain and helps improve your balance, reducing your risk of falling,” she explains. “I find it’s a really positive way to boost my health, energise me and set me up for the day.”

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Great opportunity to buy in our summer sale at fantastic prices We are a British-based company supplying made-to-measure adjustable chairs and beds, all manufactured in the UK. All our chairs are made to measure with optional lateral back support and massager. The beds come with 2000-pocket sprung mattresses with four inches of wool and silk. If you suffer from conditions such as arthritis, osteoporosis or diabetes, not only will you benefit from the excellent support you will also qualify for zero-rated VAT on any purchase. And if you buy one of our bespoke chairs you can either have one free or get 50% off any additional purchase.

Mrs Willis of Derbyshire says, “I am so delighted with my purchase. I didn’t think I could get a chair that is so comfortable for someone of my size. My head and neck are fully supported as are my legs and ankles. The massager is a wonderful addition and the quality of the furniture is first class.”

For a FREE no-obligation demonstration or for any queries please call us on the number below • 0800 533 5099 New Life Mobility.indd 1

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Keep Moving Longer We all find that getting about becomes harder as we get older. Fortunately there are plenty of mechanical aids to easier movement


veryone ages—you, your parents, one day your children too. And the gaining of more years, wisdom and experience can mean losing the mobility you once had. This is so-called “age-related functional decline”, and it’s perfectly natural—but we don’t have to put up with it making life harder. Age-related functional decline can occur slowly, with gradually reducing flexibility, or suddenly as a result of illness, infection or catastrophic event. It can affect physical abilities, but also mental capacity.

WHY IS THIS HAPPENING? Functional decline occurs because as our cells age, their ability to divide and create replacements as they die is reduced, and so all our organs and systems lose capacity. Age-related functional decline affects everyone differently. However, the most common types of issues that arise are decline in vision, hearing problems, trouble with balance, memory loss, other brain related issues and weakened bones. Regular visits to a doctor and quickly addressing any of these issues is crucial to overall functional maintenance.

Common types of age-related functional decline ■■ Vision problems such as macular degeneration, trouble reading, cataracts, and glaucoma ■■ Hearing problems like loss of hearing and tinnitus ■■ Balance problems ■■ Memory and brain problems, including changes in mental fitness or dementia ■■ Weakness in bones like osteopenia and osteoporosis

Specialist furniture products such as adjustable beds or recliner chairs specifically made for customers with functional decline can make your life at home much more comfortable.

LIFESTYLE Before you get to the point of installing complex technology, though, bear in mind that certain changes can help keep us healthier for longer. Our cells naturally go through changes as we age, but lifestyle can have an effect on their overall health and ability to function. This advice will likely sound familiar, but it’s golden: eat a healthy diet, get plenty of exercise, manage stress, stay mentally active and keep on top of your general health so you keep as mobile as possible for longer. •

Images: Shutterstock

HELP AT HOME If you or a loved one has reached this stage of life, the good news is that modern technology and appliances makes many things easier. These home fixes range from the simple (like putting an anti-slip mat in the bath) to the more complex (installing a stairlift, wheelchair lift or elevator).

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Keeping an Eye

on Diabetes D 116 | LIVE TO 100 WITH DR HILARY JONES

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iabetes is becomingly increasingly common in the UK, with an estimate of around four million people suffering from the condition, 90 percent of whom have Type 2 (caused by insulin resistance). So why is it so important for anyone who has or suspects they may have diabetes to have their sight checked? This is because they are at risk of diabetic retinopathy, which occurs when high blood sugar levels get to the point of damaging the back of the eye (the retina).

Images: Shutterstock

Did you know that diabetes can affect your sight? In fact diabetic retinopathy is the most common cause of blindness among adults aged up to 74 today. But what can we do to prevent it?

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OVER 60 HOW IT HAPPENS The light-receiving retinal layer at the back of the eye needs a constant supply of blood which it receives through a network of tiny blood vessels. The high blood sugar level caused by diabetes effects the retina in three stages: Bulges appear in the blood vessels which cause them to bleed slightly, although this doesn’t usually affect the vision. More damage is caused to the blood vessels, causing more bleeding. The scar tissue and new blood vessels are weak and end up bleeding more easily. This damage can spread to the retina and cause loss of vision.


• Gradually worsening vision Sudden vision loss • Shapes floating in your vision • Blurred or patchy vision • Eye pain, swelling or redness

FAST FACT The NHS estimates that unless there is a change in lifestyle habits, by 2025 around five million people in the UK will have diabetes

Everyone who has diabetes is at risk, of diabetic retinopathy, and should get their eyes screened once a year. People who suffer from Type 2 diabetes can usually keep the risk low by working hard to keep their blood pressure levels under control. People may be at a higher risk if:

• They have had diabetes for a long time • They have a constant high level of blood glucose • They have a high cholesterol level • They are pregnant

Images: Shutterstock

SYMPTOMS Diabetic retinopathy doesn’t usually show in the very early stages, which is why it is very important to get regular eye screenings, as this is often the only way to see whether it is developing and put treatment in place to prevent further damage. However, if you are diabetic, there are certainly symptoms to look out for to make sure you get treated as soon as possible. Such as:

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whether there is any evidence of diabetic retinopathy. Although a simple procedure, this testing procedure can make a huge difference to the number of people who go blind in the UK. In 2017, the NHS founds that the proportion of diabetics who go blind had halved since a new retinopathy screening programme started in 2007.

HOW TO REDUCE THE RISK There are several measures that people can take to reduce their risk of diabetic retinopathy. The main one is to keep diabetes symptoms under control, by checking blood sugar and blood pressure levels at home and throughout the day. It’s also important to manage high cholesterol levels by getting regular blood tests carried out by your GP. Health professionals say that diabetics who maintain a healthy lifestyle are not nearly as likely to get diabetic retinopathy. This includes eating a healthy and balanced diet, as well as exercising regularly. It is also important to stop smoking and to not exceed the recommended alcohol limits.


WHAT IS A DIABETIC EYE SCREENING? The eye screening procedure consists of having photos of the retina taken using an ophthalmic imaging system. First, the patient is given eye-drops to make the pupils bigger (dilate them)—this can cause the eyes to sting and water for some hours. The flash from the photographic equipment can also be uncomfortable for a moment. After the examination, patients should not drive, as their eyesight will be affected for some hours. On the NHS, results will take a couple of weeks to come through, and will be sent to the patient and their GP. The photographic image will show a trained ophthalmologist

Treatment is usually only offered when the condition has reached an advanced level and taking these precautions will no longer help. If the retinopathy gets to this advanced stage, laser treatment is often used to treat the growth of new blood vessels developing at the back of the eye. This can also stabilise some cases of maculopathy, which is damage to the macula (centre of the retina. Eye injections can also be used to treat retinopathy that is starting to threaten the sight. When the condition becomes too advanced for laser treatment or injections, then surgery is a last resort, to remove blood or scar tissue from the eye, but with increasing awareness of the condition, hopefully fewer people will get to that stage. • LIVE TO 100 WITH DR HILARY JONES | 117

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Seeing into

the Future

In the UK, people with diabetes aged 12 and over are entitled to a free eye health check. Farhan Zaidi, consultant ophthalmologist and clinical lead for South West London’s diabetic eye screening programme, reveals how missing this appointment could seriously risk a person’s eyesight.

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oing blind might not be something you associate with diabetes, but according to Diabetes UK, every year 1,700 people experience their vision being seriously affected as a result of the condition. Diabetic retinopathy is a disease of the retina, which is caused by high blood sugar levels damaging the back of the eye (retina) and if left untreated can result in impairment or loss of vision. Perhaps the most frightening thing about retinopathy is that it can cause no symptoms until the condition is quite advanced. Regular eye screening is vital for discovering and treating any eye problems as early as possible. However, Public Health England reports that over 420,000 people a year are missing out on this important free eye examination. One of the reasons people don’t attend the eye screening is because they regularly visit the opticians. The truth is you need to do both. At the eye screening examination, the clinicians are specifically looking for any diabetic changes to the back of the eye. The earlier these are discovered and treated, the better the chances of reducing and preventing permanent damage to a person’s sight. The diabetic screening test is a straightforward procedure. Eye drops are put into the eyes to dilate the pupils to give a clear view of the retina. A digital camera is used to photograph the back of the eyes and retina. The images are then sent to be reviewed and if no issues are spotted a date is made for another routine appointment in the near future. However, if the results reveal signs of retinopathy or the development of other eye issues, patients undergo closer monitoring, or a referral will be given to a hospital eye clinic for tests and possible treatment.

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It’s a painless check that ensures diabetes doesn’t rob a person of their sight. To help reduce the risk of developing long-term eye problems associated with diabetes, it’s vital to:

● Attend eye screening appointments ● Control your blood glucose as much as possible ● Visit your doctor regularly to check your blood pressure ● Ask for advice if you notice a problem with your sight

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Tune in to Type 2 It’s estimated that there are almost one million undiagnosed people living with Type 2 diabetes in the UK. Why are the symptoms so easy to miss?


ype 2 diabetes is a common condition in which the body can’t control the amount of glucose in the blood. It can have serious complications, such as deteriorating eyesight, gum disease, nerve damage and circulation problems with the extremities (hands and most often feet). Despite the risk of these serious issues, it is estimated that Type 2 diabetes goes undiagnosed in as many one in four cases, according to What are the risk factors, the symptoms and why are they so easy to miss? Live to 100 investigates.

Images: Shutterstock

Risk factors One in 10 people over 40 in the UK now has Type 2 diabetes, a number that has risen stratospherically over the last several decades. Nutritionists and researchers point to growing obesity rates as the main driver of this dramatic increase. Today three in every five adults in England are overweight or obese; 20 years ago, it was one in two. While not every case of Type 2 diabetes is caused by excessive weight, it is the single greatest risk factor for developing the condition. Other risk factors include age, family history and ethnicity. People of African-Caribbean, Black-African or South Asian descent are two to four times more likely to develop Type 2 diabetes than those of Caucasian descent. Many cases of Type 2 diabetes could be prevented by healthy eating, being more active and losing weight. With 12.3 million people in UK at risk of developing Type 2 diabetes, taking these measures becomes essential. If you’re over 40 or fall into any of the risk categories, it’s recommended that you take a diabetes risk assessment test online, or get a free NHS Health Check.

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If you experience any of these symptoms, see a doctor for a blood test:

■■ Peeing more than usual, particularly at night

■■ Feeling thirsty all the time ■■ Feeling very tired ■■ Losing weight without trying to ■■ Itching around your genitals, or repeatedly getting thrush

■■ Cuts or wounds taking longer to heal

■■ Blurred vision “The signs of Type 2 diabetes are often not obvious, that’s why spotting them early can be life-changing,” said Chief Executive Chris Askew.

Complications Left unchecked, Type 2 diabetes can cause complications such as sight loss, nerve damage, kidney failure and even limb amputation. Chris Askew adds: “Early diagnosis means that fewer people will experience diabetes-related complications… because they could seek support to manage their condition effectively as soon as possible.” Find out about the NHS Diabetes Prevention Programme at •

No is D vembe Awa iabete r rene s M o ww nth! ss w.d org iabete .uk s.

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Paving the way for a future without Alzheimer’s disease Every three seconds, somebody develops dementia, and without an effective treatment, 1 in 3 people born today will die with dementia, creating the biggest global socio-economic and health care crisis. Re:Cognition Health is trying to change that.


world-leading centre for international clinical trials for Alzheimer’s and dementia research, Re:Cognition Health is dedicated to finding new-generation medications to halt the progression of dementia and ultimately find a cure. Involvement in clinical trials enables individuals to receive the next generation of emerging medications, free of charge, before these medications are licensed for global use. Participants receive outstanding medical care and are monitored regularly throughout the study by a team of cognitive experts. All medical costs are covered by the pharmaceutical company, so the very best care and medical facilities are provided at no cost to the individual. Our expert team are working to improve the lives of millions of people affected directly or indirectly with cognitive disorders, the most prevalent of which is Alzheimer’s Disease. At our five UK centres located in London, Guildford, Plymouth, Birmingham and Essex and our US centre based in Washington DC, our award-winning team of brain and mind experts use the latest research, evidence, techniques and treatment plans to achieve the very best patient outcomes. Patients at Re:Cognition Health receive the most sophisticated diagnosis and best treatments available worldwide, free of charge, through international clinical trials. Our 4.9/5 Doctify rating and the recent accolade

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of Excellent Patient Experience 2019 is a reflection of the exceptional treatment and services delivered. “With the introduction of new biomarkers to detect evidence of Alzheimer’s disease at its earliest stage, there is reason for cautious optimism that new generation medications will delay progression of disease and also boost cognition. Just as research through clinical studies has improved our outlook for numerous diseases such as certain forms of cancer; the same action is being taken today for Alzheimer’s disease. With every study conducted we understand more about the disease and become closer to finding treatments, and ultimately a cure,” says Dr Emer MacSweeney, CEO and Consultant Neuroradiologist at ReCognition Health. Dr MacSweeney is passionate about making a difference to people with memory and related cognitive problems and has been recognised for her dedication with numerous awards, including EY Entrepreneur of the Year for Societal Impact, London & the South East 2019. Why clinical trials? Clinical trials are essential for the development of new medicines and without these studies, new medications cannot be developed. Hundreds of thousands of people participate in clinical studies every year, helping to treat symptoms and conditions, cure disease, save lives and contribute to vital research whilst advancing our knowledge.

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Potential benefits of joining a clinical trial: ✚ Volunteers have the opportunity to gain access to new

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Dealing With Dementia Dementia care can be daunting, but the right support and assistance makes this tough job a little bit easier


here are some 850,000 people with dementia in the UK, with numbers predicted to rise to over one million in 2025 and two million by 2050—and for every patient with dementia, it’s important to realise that behind them is a grieving family caring for their loved ones. While the care-giving journey can be rewarding, it’s certain that it can be an overwhelming challenge. Educating yourself about dementia and doing your best to maintain a positive but realistic attitude allows you an element of control as a care-giver. It can take the sting out of surprising challenges, while also improving the care you provide.

Images: Shutterstock

Understanding dementia The course dementia takes can vary widely from person to person, influenced by factors like age and type of disease, but it generally follows a three-stage pattern. When dementia is first noticed, it’s typically in the early stages, when it can be classed as mild dementia. In this stage, patients may have difficulty remembering words and names, learning and remembering new information, and planning and managing complicated 124 | Live to 100 with Dr Hilary Jones

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activities such as driving. They may also be experiencing sadness, anxiety, loss of interest in activities and other symptoms of major depression. In moderate dementia, judgement, physical function and sensory processing are typically affected. This can cause problems with personal hygiene, inappropriate language and wandering. As a patient moves from mild to moderate dementia, some home modifications are often needed. These may include removal of throw rugs, installation of locks and safety latches, the addition of a commode in the bedroom and the fitting of utility safety cutoffs such as SGN's free gas cooker locking valve ( The final stage is severe dementia, where the patient suffers from extensive

Worldwide, women with dementia outnumber men two to one. Researchers hypothesise this may be because women live statistically longer than men.

memory loss, limited or no mobility, and possibly physical difficulties in swallowing and bowel and bladder control. At this stage, there may be need for around-the-clock care.

Support for caregivers You may not think of yourself as a carer, particularly if the person with dementia is a partner, parent or close friend—it can be easy to diminish in your mind the actual amount of work you’re doing, since it’s for a loved one. But both you and the person with dementia will need support to cope with the symptoms and changes in behaviour. The first thing to do is make sure you’re registered as a carer with your GP. After that, you can get a carer’s assessment—a free assessment available to anyone over 18 that will recommend and connect you to services that will make your life easier. Carer’s Allowance, amounting to £64.60 a week, is the main state benefit for carers, and is available anyone who provides more than 35 hours a week. Other benefits include Carer’s Credit, where a National Insurance contribution is made for you to help make sure you don’t lose out on social security benefits

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because of gaps in your NI record. To understand the full range of benefits you may be entitled to, visit the NHS website.

Carers' assessments often suggest: • Someone to take over caring so

you can take a break.

• Gym memberships and exercise

classes to relieve stress.

• Help with taxi fares • Help with gardening and


• Putting you in touch with local

support groups.

• Advice about benefits for carers. • As a carer, you may be entitled to

state benefits to help with costs.

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Actively empathise Care starts with compassion and empathy. For example, people with dementia are prone to becoming confused about their whereabouts and even the time period in which they are living. Trying your best to meet your loved one with dementia in the now is healthy for both parties. Remember that patients with dementia can remember emotions even after they forget the event that caused those emotions. There are some hopes that treatments to detect and delay Alzheimer's will spring from current research. Dr Emer MacSweeney, CEO and Consultant Neuroradiologist at Re:Cognition says: “With the introduction of new biomarkers to detect evidence of Alzheimer’s disease

In the UK a new case of dementia is diagnosed every three minutes. at its earliest stage, there is reason for cautious optimism that new generation medications will delay progression of disease and also boost cognition. Just as research through clinical studies has improved our outlook for numerous diseases such as certain forms of cancer; the same action is being taken today for Alzheimer’s disease. With every study conducted we understand more about the disease and become closer to finding treatments, and ultimately a cure.” • Live to 100 with Dr Hilary Jones | 125

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Leading dementia charity The Alzheimer’s Society highlights ten ways in which research is contributing to better understanding and treatment of dementia.


Join Dementia Research (www.joindementiaresearch. helps people with dementia, their carers, or anyone interested in dementia research to be matched to studies taking place in their area. Over 25,000 people have signed up to Join Dementia Research so far.


Researchers have discovered that some antiinflammatory treatments for arthritis could be repurposed for dementia. The Alzheimer’s Society is now supporting the next stage of this research led by Dr Bernadette McGuinness.


The London Borough of Camden’s planning committee has approved UCL’s planning application to redevelop the former site of the Eastman Dental Hospital, paving the way for a new world-leading research centre for dementia and neurological disease research, expected to open in 2024.

4 Research by the Alzheimer’s Society has highlighted concerns that antidepressants and bladder medications may be linked to a higher risk of dementia.


The society’s GameChanger app encourages people without dementia to play ‘brain games’ on their smartphones as part of study alongside the University of Oxford to help researchers understand more about how brains change over time.

The charity has been supporting dementia research for 40 years, and despite the fact that no new dementia treatment drugs have been introduced for 15 years, the society continues to innovate in dementia research and support.


The society has programmes to tackle taboo subjects around dementia, including sex and intimacy and incontinence. Ten organisations – including Alzheimer’s Society, Age UK, Marie Curie and Parkinson’s UK – made recommendations to tackle the stigma of incontinence. 126 | Live to 100 with Dr Hilary Jones

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The society is partnering with other research organisations including the Global Brain Health Institute and Joint Programme— Neurodegenerative Diseases to support research across the globe.


Society researchers are focusing on understanding why women are more at risk of dementia than men. Jacqueline Mitchell, a Society funded researcher at King’s College says: “We are very aware of sex-based differences— we always make sure to use a balance of male and female to check response to drug treatments.”


Since 1999, Alzheimer’s Society has pioneered the active involvement of people affected by dementia through its awardwinning Research Network. Network volunteers are involved in deciding research and funding priorities, and monitoring and sharing results.


The Alzheimer’s Society Accelerator Programme offers a 12-month partnership to develop innovations, including bespoke business support and investment up to a value of £100,000, and an ‘innovation buddy’ to develop ideas during the partnership.

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Healing from

the Future Might we one day be able to grow organs, treat burns and cure diseases using stem cells? That’s the promise of regenerative therapy


Images: Shutterstock

tem cell research is playing an important role in medical advancement, and the science can already be used to treat some cancers and blood-related diseases, such as leukaemia, lymphoma, neuroblastoma and multiple myeloma. But what are stem cells and why is their use so promising? The most useful type of stem cell for research is the ‘Pluripotent’ stem cell, which can develop into any cell type in the body. This extraordinary flexibility means they have the potential to treat many currently incurable conditions such as Type 1 diabetes, blindness, Parkinson’s disease, heart disease and arthritis. Since the shift of emphasis from research on embryonic cells harvested from unused IVF embryos to pluripotent stem cells, ethical questions about stem cell research have diminished.

Maturity Opening the door for exciting possibilities in regenerative medicine, and treatments for conditions such as Alzheimer’s, stem

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cell research also gives scientists an increased understanding of how diseases occur. By watching stem cells mature into cells in bones, heart muscle, nerves and other organs and tissue, researches are gaining a better grasp on how diseases and conditions develop Stem cells also open new areas of study for testing drugs for safety and effectiveness before human testing. For instance, nerve cells could be generated to test a new drug for nerve disease, allowing scientists to refine the medication before it is ever brought to human trial.

What does the future hold? Research into regenerative medicine has yielded exciting breakthroughs so far, but the road from successful trial to application is a long one. Treatments using stem cells also tend to be very expensive, because they require special production facilities and highly skilled staff. With health budgets being squeezed everywhere, high costs are a serious issue

for hard-pressed health services. However, it seems certain that the next few years will see amazing breakthroughs in regenerative medicine. In the near future, we may be able to replace organ donation with organs grown from stem cells, treat burns with immediate skin replacement, replace damaged bones with ‘off-the-shelf’ tissue, restore vision with one operation or even cure diabetes. Regenerative medicine using stem cells may indeed be the path towards treating the formerly untreatable. •

Where To Find Stem Cells Found in tissues such as bone marrow and umbilical cords, stem cells are undifferentiated cells capable of becoming many types of differentiated cell, such as skin, muscle or nerve.

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Step Change One of the common after-effects of stroke can be mobility problems, but therapies like FES could counteract conditions such as 'foot drop'

Images: Shutterstock


lmost ten years ago, Eric was celebrating his wedding anniversary with his wife when suddenly, over dinner, his speech began to slur. Eric was suffering a stroke, and was rushed to hospital. He spent a week in a neurological care unit, before moving to a rehabilitation centre for physical and speech therapy, but still suffered some paralysis—he could no longer move his right leg. Eric and his wife tried many different therapies, searching for something that would help him recover some of his former physical independence, but today, ten years after his stroke, Eric is able to walk again, thanks mainly to a technique known as Functional Electrical Stimulation.

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Functional Electrical Stimulation (FES) is a treatment where small electrical charges are applied to a muscle that has become paralysed or weakened from damage in the brain or spinal cord.

Treating Foot Drop The technique was developed in the United States in the ‘60s, but wasn’t commonly used until the early ‘90s when a group in the UK developed devices to administer electrical charges for people with multiple sclerosis (MS). FES can be an effective treatment for anyone experiencing loss of movement from nerve or spinal cord injury, as well as neurological damage. This includes people who suffer from conditions including:

 Stroke

 Multiple

sclerosis cord conditions  Parkinson’s disease  Cerebral palsy  Head injury  Familial or hereditary spastic paraparesis  Other brain conditions  Spinal

Many forms of damage to the sciatic or lower leg nerves can lead to the walking disability known as ‘foot drop’. To treat this, a form of brace called an ankle foot orthosis (AFO) can be used, but these have some disadvantages including weight and difficulty in fitting into shoes. An FES device such as the Odstock Dropped Foot Stimulator (ODFS)® Pace

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IT’S ABOUT CONFIDENCE Striding out with the ODFS Pace ” ” ®

“ We performed the first ever trial of a dropped foot stimulator here at Salisbury District Hospital in the mid 90’s and were the first team to scientifically demonstrate that FES increased walking speed and reduced the effort of walking. This evidence was used by NICE to justify the use of FES in the NHS and enabled us to set up the first FES service in the UK. Since that time we have helped many 1000’s of people with stroke, MS, Parkinson’s and other neurological conditions and we think we have set the standard for FES care.

FES has enabled me to get my life back. I have done things and gone places I could only dream of a few years ago.

At the end of each FES clinic appointment we ask what difference FES makes. The most common response is ‘I have greater confidence when walking with FES’. Through our research we have tried to capture the effect of FES and have relied on things we can measure such as walking speed, energy expenditure, gait analysis and frequency of falls. All these improve with FES but measuring confidence is a challenge. In truth confidence is made up of a lot of factors. FES users can walk further so they know they will get where they want to go and be less tired when they get there. Falls are reduced by 72% so they feel safer. FES can be more comfortable than wearing a rigid splint and studies show FES can supply greater ankle stability. It can also give greater ground clearance than a splint, meaning you are less likely to trip. But the benefit does not stop when you turn the FES device off. Our research shows FES can have a training effect; improving walking without FES once it has been used for several months.” Prof Paul Taylor. Clinical Director of OML HOW DOES FES HELP DROP FOOT?  Functional Electrical Stimulation (FES) is a means of producing movement in weak or paralysed muscles  The ODFS® Pace sends FES signals to electrode pads placed over the nerves, inducing a muscle contraction that lifts the foot.  Stimulation is timed to your walking using a small footswitch placed in the shoe.

OML provide a range of FES services to assist walking, improve hand and arm function and reduce shoulder pain at clinics across the UK, funded both by the NHS and privately.

Please visit or telephone 01722 439 565 for more information Odstock Medical 2.indd 1

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FES ON THE NHS To access FES treatment on the NHS, patients must be referred by their GP, MS nurse or neurologist. Find out more from the National Clinical FES Centre at or its clinical supply service www. They may also self-refer to a private clinic to purchase an FES device directly. Cost can be around £4,500-£5000 for assessment, the device itself, supplies and support.

has several advantages. It's typically worn in a cuff below the knee, the location of the nerve that stimulates the muscle that would normally lift the front of your foot. The FES device detects when the foot is about to lift to be swung forward, and sends out electrical impulses to stimulate the nerve and lift the foot. The stimulation of the nerve will stop when the heel hits the ground. While it may take some time for your gait to adjust to using an FES, some modern FES devices designed to be worn with sandals, or with no shoes at all, making life as normal as possible.

Paul Taylor of the National Clinical FES Centre in Salisbury says "While the therapeutic effects of FES are of benefit to many FES users, the primary use of the ODFS® Pace is as an orthosis, providing practical and effective gait assistance. FES users can walk further, with less effort and greater safety and hence can participate more in everyday life." Taylor quotes one user saying "It changed my life. One minute I was struggling around with a walking stick and the next I could walk without it. It gave me confidence and I’m no longer dependent on other people—I can just go."

BENEFITS OF FES Treatment with FES produces a more normal walking pattern, enabling people to walk faster, further and with less effort. It can also help build confidence in walking and increase independence, as well as reducing the risk of falls. FES can also be used in rehabilitation, complementing physiotherapy techniques, to assist with movements in muscles that have become weak. This allows strength and range of movement to be developed. It may also help with reducing spasticity and sometimes in reducing swelling, depending on the cause. Minor side effects of FES are that as old habits that helped patients manage their paralysed or weakened muscles are no longer needed, relearning a comfortable gait may cause some soreness in the legs, hips and torso as different muscles are used to walk. Some patients also find that the electrical stimulation causes a tingling ‘pins and needles’ sensation, but ensuring that wires and pads are in the correct position will help minimise these feelings. •

FES is not suitable for lower body motor neuron conditions. This is where the nerve that runs from the spinal cord to the muscle is damaged, as with peripheral nerve lesions, polio, motor neuron disease and Guillain-Barre Syndrome. If you have questions about whether FES will work for you, speak with a professional.


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Our Guide To

Images: Shutterstock


or all of winter’s highlights (cosy fires, twinkling lights, ice skating outdoors and sipping warm beverages under a blanket to name just a few) it also comes with some less than pleasant side effects—specifically, months of dry, itchy skin. And even if you think you finally nailed your skincare routine this summer, figuring out which serums and scrubs will keep your face radiant under the sun, the onset of autumn’s wind and chill can bring back all those problems you thought you already solved. Unfortunately, bringing your skincare routine from summer to winter involves a little bit more than just slathering on more moisturiser. On a quest to find out how to best protect our skin this winter, we sourced tips from some experts on how to keep the body’s largest organ healthy and hydrated.

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Hydration from inside and out Our skin is the barrier that keeps water insider the body, so when it’s dry and cold outside, water evaporates off the surface faster and easier. That’s why your face looks like it’s glowing in July and not so much in January. To prevent dryness, Dr Angela Lamb, a dermatologist in New York City, suggests using a humidifier in the bedroom, explaining that humidifiers are a great way to add moisture back into your home, especially if you’re prone to blasting the heat. If you can manage it, adding one or two extra glasses of water into your daily routine can combat winter’s dry skin. “Adequate hydration is crucial for all aspects of health—skin health included,” said dermatologist Dr Dendy Engelman. Flawless | 135

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Flawless Be gentle The change in seasons is a good time to revisit what products you’re using. Skin during the summer months can withstand a certain number of harsh products, but during the winter, it's more delicate and requires gentle cleansers. Dermatologist Dr Samer Jaber suggests looking for cleansers marked ‘gentle’ or ‘for sensitive skin’. He also advises looking for something ‘fragrance-free’, as fragrance is a catchall term for any number of chemicals that contribute to the scent of a product, but can cause reactions and redness. If you’re dealing with breakouts, don’t automatically reach for the spot treatment or salicylic acid wipes—these treatments, while effective in treating acne, dry out the skin. If you’re already dealing with seasonal dryness, they will only exacerbate the problem. Before opting for any harsh treatments, try washing the area with water and a gentle cleanser and lightly exfoliating with a washcloth.

Of course, skin is not one-solution-cures-all and, as with all of these suggestions, your personal mileage may vary. It depends on your skin type. For example, Dr Marchbein suggests that if you experience raw or severely dry skin, it’s best to forgo an exfoliating product altogether, and instead use a microfibre washcloth to gently manually exfoliate the skin.

Moisturise It goes without saying that winter requires a serious moisturiser. But it’s essential that you get the right one for your skin type. It’s worth analysing your skin habits—is it flaky? Is it itchy? Red? Sore?—and then searching for a product will really work for you. Dr Marchbein advises looking for creams, rather than lotions, and eyeing the product list for ceramides and hyaluronic acid. Ceramides aid in the prevention of the skin’s barrier, which is easily broken down during the winter. Hyaluronic acid helps your skin retain moisture. If your skin is really dry, apply it morning and night.


Hot showers

It might seem counterintuitive to exfoliate dry skin, but dermatologists say this step is the key to a brighter complexion. The trick is not to over-exfoliate or use harsh exfoliators. Exfoliating helps the skin slough off dead cells, something that helps the moisturiser sink better into the skin. Dermatologist Dr Shari Marchbein suggests looking for a mild chemical exfoliator with a small concentration of glycolic or lactic acid and using it once, maybe twice a week.

Even though the cold, draughty rooms in the house in the winter can make you want to run a piping hot bath or shower, this is actually the last thing your skin needs. Hot water evaporates quickly, and the skin—if not immediately moisturised—can develop tiny cracks. This results in what feels like many tiny paper cuts or eczema, also called ‘winter’s itch’. If you do indulge in a hot shower or bath, keep your bathroom door closed, and after you dry off, make sure to moisturise. F

WHAT THE FILAGGRIN?! A recent study in the British Journal of Dermatology showed that the levels of breakdown products of filaggrin—a protein that helps maintain the skin’s barrier function—on the cheeks and hands changes between winter and summer.

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s cosmetic surgery becomes increasingly popular, a demand for quick, non-surgical procedures as part of the anti-ageing maket has been rising as well. According to Statista, by 2022 global anti-ageing market sales are set to reach a colossal $199.5 million—up from $89.7 million in 2017. It’s no surprise then that the popularity of dermal fillers—injections administered to plump skin and iron out wrinkles—is increasing. A dermal filler treatment can take as little as 30 minutes to complete, so it very much fits into the 'lunchtime lift' category. But what should you be thinking about before you go for the needle?

Safety first Registers of cosmetic practioners include: British Association of Aesthetic Plastic Surgeons (BAAPS) Joint Council for Cosmetic Practitioners ( JCCP) www.Save British Association of Cosmetic Nurses (BACN)

Images: Shutterstock

Temp to perm Dermal fillers address a very real problem—as our skin gets older, it loses elasticity, causing wrinkles around the eyes and mouth. Fillers will reverse this appearance, creating a smoother and less lined look. There are two types of dermal filler—temporary and permanent. Collagen type fillers will give an effect for three to four months; hyaluronic acid works for around four to six months; calcium hydroxylapatite about a year and a half; poly-L-lactic acid can remain effective for up to two years; and polymethylmethacrylate beads (PMMA) is a lifelongoption. But dermal fillers can't correct the other effect of loss of skin elasticity, which is a sagging jawline.

Side effects Before a dermal filler treatment, an anaesthetic cream might be used first to numb your skin. Injections are given around the area of your face being treated, which is then massaged. 138 | Flawless

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The procedure may feel a little uncomfortable, but should not be painful. The treatment usually takes between 20 and 30 minutes, depending on the area being treated. Afterwards, the affected area may be a bit red, sore and swollen. Any swelling or bruising should settle down in a few days. Your practitioner should advise you how to reduce side effects. This includes not wearing make-up immediately after the procedure and avoiding alcohol, coffee and the sun. As with most medical procedures, there are risks associated with the use of dermal fillers, ranging from rashes, swelling and bruising to infection and blocking of blood vessels with potentially serious consequences. For all those reasons its vital that if you are considering dermal fillers you go to a reputable practitioner. Check the person doing your dermal fillers is on a register to show they meet set standards in training, skill and insurance. F

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Pucker Up! 'Lip Blushing' is the New Trend

Images: Shutterstock


he latest social media trend, 'Lip Blushing' is a semipermanent make-up technique hotly tipped as a less extreme alternative to injected lip fillers. Essentially a cosmetic tattoo of the lips, Lip Blushing gives fuller colour and improves shape and definition. The technique uses a small mechanised needle that deposits pigment into the lips, building layers of colour. Less invasive than fillers and often using natural vegan pigments which age better than carbon-based tattoo ink, Lip Blushing avoids the ‘swollen lip look’ that comes with lip fillers if not done properly—but it's equally expensive, if not more so, coming in at between £500 and £1,500. The results can last for several years. F Advertisement

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15/10/2019 16:36


Stretching the Truth?

It’s normal to experience stretch marks after pregnancy, but they can cause a lack of confidence. So is there anything we can do to avoid or remove them?


tretch marks (scientifically known as striae) occur when there is rapid growth to the body, the skin stretches to keep up, and dermal collagen tears. The rapid growth can cause marks appearing in red, pink or purplish blue. They often fade over time, but can be very noticeable when they first occur, and can be hard to remove. They can occur to anyone at any stage of life, including childhood growth spurts, changes in body shape during puberty, rapid weight gain, and less common causes such as bodybuilding using steroids, and certain conditions such as Marfan Syndrome, a genetic disease that weakens your skin fibres and causes unusual growth. But of course the time when rapid growth occurs most noticeably is pregnancy, when stretch marks occur around the stomach as the baby develops and the skin stretches around the mother’s bump.

it less likely for stretch marks caused by downwards tearing to form. Used in conjunction with a positioning Day Gel and a moisturising Night Cream, the band is worn during the day, when it also provides comforting back support, and is taken off at night. The ‘belly band’ doesn’t claim 100 percent success in eliminating stretch marks, but it’s an innovative contribution to an important issue which is often neglected in the pregnancy journey. F

Images: Shutterstock

Prevention The best chance people have of preventing stretch marks is to maintain a healthy weight, and to use sun protection. There are many creams and lotions that claim to prevent stretch marks, which some people find beneficial— however they aren’t always effective. Creams using Vitamin E and hyaluronic acid or ferulic acid are popular, and retinoid creams can sometimes help if used on new stretch marks. Derived from vitamin A, retinoids such as tretinoin may improve the appearance of stretch marks less than a few months old. Tretinoin helps to rebuild collagen, making stretch marks look more like normal skin. However, retinoids should not be taken orally when pregnant, and it’s probably best to avoid using them topically too. Efforts to find more effective treatment continue—one suggestion for instance is a form-fitting fabric ‘belly band’ with supportive dermal inserts, which grips the skin and makes 140 | Flawless

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Zapping Stretch Marks Light, laser or microdermabrasion treatments for stretch marks work by removing a thin layer of skin—but these treatments are not available on the NHS.

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Thinning hair doesn’t usually cause baldness; however, it can make your hair look less full and have an impact on your confidence. Here are some tips for treating thinning locks


hinning hair can be caused by a variety of reasons. Often it is linked to stress, or a hormonal imbalance, as the female hormone oestrogen is essential for hair growth. Women also experience hair loss after they have had a baby for this same reason. Hair can also fall out due to iron deficiency. These are just a few examples, as hair thinning is a lot more common than people think. While it can be distressing to notice that your hair is falling out or thinning, there are always things you can do to at home to prevent it and promote hair growth.

Anti-thinning shampoo

Images: Shutterstock

Some shampoos are specially designed to help those with thinning hair. They usually contain vitamins and amino acids which help generate more hair over time by creating a healthy scalp. There are also shampoos which don’t necessarily help your hair grow, but volumize your hair, thus making it look thicker, which is helpful for people with naturally fine hair.

Multivitamins Healthy hair is often linked to your overall health. Hair thinning may be linked to malnourishment, therefore multivitamins can help boost your intake. The essential vitamins that contribute to a healthy head of hair are iron, folic acid and zinc.

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Hair band Around 8 million women in the UK experience hair loss or hair thinning.

Scalp Massage When you wash your hair, applying pressure with your fingers around your scalp can encourage blood flow, and therefore hair growth. This can also help to remove dead skin cells.

Loose hair Simple steps such as wearing your hair loose and avoiding tight buns or ponytails can ensure that less hair falls out.

Egg Mask While it may sound strange, many people swear by using egg whites on your hair. This is because egg have very high selenium, sulphur, zinc and protein content, which massively helps in promoting hair growth. Pour an egg white into a bowl with some olive oil and honey, and apply it to your hair, finally washing it off with a mild shampoo. F Flawless | 141

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Skincare You Could Eat Given our current preoccupation with health and wellness, it’s only to be expected that the next revolution would be natural beauty


he beauty world can be a dense and confusing place, where unproven claims abound, so we understand if you're considering switching to a more natural and organic skincare routine. But just because something is made in a laboratory, doesn’t mean it’s toxic—and just because something’s completely natural, doesn’t mean it’s not. Arsenic, for example, is natural, yet can be lethal in high doses. But before you give up and dump all your beauty products— natural and non—down the toilet in a frenzied confusion, here’s what you need to know.

Natural or not? The label “natural” doesn’t actually mean anything–there are no guidelines restricting the use of the word in advertising. Instead, look for “organic” as a descriptor of skincare products. It’s always important to read the ingredients label, and not just to rely on the promotional language on the front of the bottle. Even the names of natural ingredients can sometimes be unfamiliar, but if the phrase seems vaguely Latin that’s usually a good sign. “If an ingredient is natural, it’s typically written in Latin on the ingredient list,” says nutritionist Adina Grigore. Conversely, the super-long chemical names that you can’t pronounce may be the ones you want to avoid–think helianthus annuus (sunflower seed 142 | Flawless

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oil) versus ethylene oxide (which is a known carcinogen). As when transitioning to a healthy diet, you have to be patient when switching to natural beauty products. “You can’t eat salad one day and feel good tomorrow after eating burgers for 20 years,” says Adina Grigore. “Kale doesn’t work overnight.” The epidermis (the top layer of skin) takes about a month to renew, so typically that's how long it takes to see any results. F

Skingenius: A Natural Solution The SkinGenius 100% natural Foaming Face Wash, Leave on Purifying Gel and Soothing Moisturiser are designed to work together to help combat acne, acne rosacea, oily and spot-prone skin. These multi-award-winning products are packed with anti-bacterial ingredients that tackle the causes of acne and breakouts. Natural ingredients including Red Clover, Nettle, Calendula and Macadamia work together to actively reduce inflammation and redness while hydrating, calming, soothing and smoothing irritated skin. Rich in anti-oxidants to protect the skin, SkinGenius leaves the skin feeling more vibrant and youthful and helps to reduce scarring. Even better, the products prevent further problems by tackling the causes – not just the symptoms – of troublesome skin. The beauty of SkinGenius lies in its simplicity: three products for clearer skin. Simply CLEANSE, TREAT, HYDRATE, REPEAT. Prices start from £17.99 at

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Start with a cleanse The first step in any skin care routine following a long day of work is a deep cleanse, which gives your skin the opportunity to wind down and break free from the sweat, make-up and dirt that has accumulated in the day.


Images: Shutterstock


kincare, once considered an unglamorous private duty for women trying to hold off the signs of ageing, is suddenly cool—pop into any pharmacy, and you’ll find sheet masks, fancy acids and a dizzying number of serums, moisturizers and scrubs. If you’re looking for something a bit more high-tech than cleansers and moisturisers, beauty gadgets such as electric cleansing brushes, LED facemasks, light-therapy lamps and oxygen pressure injectors are also on trend. The sudden popularity of skincare has been attributed to the rise of wellness culture and ‘self-care’; the social pendulum swinging away from heavy makeup and towards celebrating a ‘natural radiance’; and, maybe most simply, celebrating the routines we have each day, our ‘me time’ in the morning and at night. While this may all seem like a new trend ruled by Instagram influencers, in fact skincare has a long historical background, and

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whatever age you are, there are products that can bring a little bit more glow and radiance to your life.

Picture Perfect Regardless of your skin type or current condition, your skin serves as an important barrier to environment pollutants and is responsible for excreting waste through perspiration, so it has to be treated with care if it is to function efficiently. So put your best skin forward with our guide to crafting the picture-perfect skincare regime. Skin has different needs at different stages throughout your life. For those over 60, your skin will be at its ‘mature’ stage—losing elasticity and showing signs of natural ageing. To reduce the appearance of fine lines, improve skin tone and rejuvenate the skin, look for products with collagen—a protein that helps keep skin supple, strong and firm. Flawless | 145

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Flawless Contains retinol Retinol, a Vitamin A compound, has been shown to help neutralise the free radicals found in skin cells that are responsible for causing our cells to break down. This breakdown is what causes wrinkles, age spots, rough skin and other signs of aging typical of someone in their 60s. Many products contain some retinol, but more potent retinols compounds require a prescription, so visit a dermatologist if you feel this is what you need.

Supplements Instead of applying care products directly to the skin, you may prefer to take supplements, nourishing your skin from the inside out. Collagen can be purchased in both a powdered form and a capsule form in the nutritional supplements section of most health food stores. Other skin-healthy anti-aging ingredients that can be found in supplement form include Vitamin A, Vitamin C, rose hips and green tea. Celebrity dermatologist Dr. Dendy Engelman recommends starting any skin care routine with a deep cleanse incorporating two steps. Start by applying micellar water on a cotton pad or a gentle make-up remover to remove the day’s grime and create a blank canvas for your regime. Once the surface is cleared, an oil-based cleanser with warm water is advised to target the less obvious sebum and pore-blocking bacteria.

while hyaluronic acid is meant to alleviate dry skin, reducing the appearance of fine lines and wrinkles and speeding up the process of wound healing.

Moisturising Miracles The last, yet vital step in your routine is moisturising—according to Dr Engelman, the skin rebalances itself during sleep and can become dehydrated in the process. A combination of both a serum and a night cream can support and further hydrate your skin, leaving skin dewy and refreshed in the morning. F

MEDICAL MATTERS "Adhesive dressings or stoma pouch removal can often be difficult and unpleasant. Peeleasy range helps by gently and painlessly removing such appliances with no sting and no wastage—especially important for sensitive and fragile skin areas."

Almighty Serums Skin serums—lightweight moisturisers claimed to penetrate the skin and deliver active ingredients such as hyaluronic acid and Vitamin C—are the preferred treatment of many makeup artists. The type of serum you choose will depend entirely on the specific skin dilemma you’re hoping to treat, whether this be fine lines, dark patches, wrinkles or drooping skin. Before skimming through Amazon looking for five-star products reviews, check that the products you plan to purchase are free from alcohol, mineral oils, parabens and fragrance to prevent any possible irritation to your skin. For a glowing complexion, look for serums including vitamin C, as this can aid with fighting free radical damage and balancing your skin’s complexion. Alternatively, serums including active ingredients such as aloe vera, calendula and salicylic acid are useful for targeting inflamed areas and soothing the skin,

146 | Flawless

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8 out of 10 women will get stretch marks in pregnancy. Secret Saviours can change all that. 82% of women using this simple 3-step system, consisting of a Day Gel, Bump Band and Night Cream come out of pregnancy stretch mark free. Secret Saviours Bump Bands have been created with clever textile technology which equalises pressure caused by stretching skin and prevents stretch marks forming downwards. To find out more go to

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14/10/2019 18:05