Healthcheck Media Bulletin

IN THIS ISSUE:

The importance of vitamin D

Put your best foot forward

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Helping your skin survive this winter

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WITH WINTER FAST APPROACHING, THERE ARE A NUMBER OF steps we can take to ensure we look and feel our best during these dark, cold and dreary months ahead. In fact, there are many aspects of our personal health that we naturally have front of mind during summer, but we don’t tend to focus on at other times, and others that the festive season – as you would expect - draws attention to. In this edition of Healthcheck, we take a detailed look at winter health, and the services and expertise The London Clinic can offer to help keep you in top condition. You will find advice on how to look after your liver and your feet during the festive period, how to avoid injuries when undertaking winter sports such as skiing, and how to ensure you maintain vitamin D levels in times of limited sunlight. We also discuss with Dr Conal Perrett, consultant dermatologist, the importance of looking after your skin during the cold spell, as well as being vigilant about checking your moles all year-round.

Christmas drinking – be reasonable... Dr Peter Fairclough, Consultant Gastroenterologist and Professor Simon Taylor-Robinson, Consultant look after your liver and gastrointestinal tract, and

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Hepatologist at The London Clinic discuss how to what steps can be taken to limit damage to these vital organs. How much alcohol is it safe to drink? The best advice is for people to routinely keep to the limits recommended by the Department of Health: 21 units for men and 14 units for women per week.

unit of alcohol, and could even be equivalent to 3! Roughly speaking, a 100ml glass of wine is about 1 unit and a half a pint of lager is 1.5 units. The unit calculator on www. drinkaware.co.uk will help you calculate how much you drink.

drink and drive, run risks with operating machinery or pastimes such as skiing or cycling. Alcohol and dangerous sports definitely don’t mix.

So how much is ‘a unit’? One unit is 10 ml of pure alcohol - the amount of alcohol the average adult can process within an hour. People often don’t realise that a regular glass of wine may be much more than 1

We all recognise that people will drink a bit more at celebratory times and this shouldn’t do longterm harm, provided they don’t frequently drink above the limits, and they take great care not to

What harm does alcohol do? Excessive drinking can lead to a wide variety of serious health problems including fatty liver disease, alcoholic hepatitis (severe liver inflammation), cirrhosis of the

liver, pancreatitis (inflammation of the pancreas, which may lead to diabetes), high blood pressure and heart muscle damage (which may lead to heart failure and strokes). Long-term alcohol misuse can also cause irreversible brain damage, including to the areas of the brain that process thought and memory. Long-term drinking damages the liver. As with any other part of the Continued over>

Healthcheck Continued from front page> body that is injured, such as a cut to the skin, the body tries to repair the damage by forming a scar. The same process happens in the alcohol-damaged liver, causing the scarring of the liver, known as cirrhosis. Indeed, the 5-year survival of a person diagnosed with cirrhosis is less than 50%. What can be done? The better news is that there are new technologies that can quickly and relatively painlessly assess the state of the liver. If your liver is found to be in suboptimal health we can now suggest ways to encourage the liver to regenerate itself, so early detection of problems and a change of lifestyle can often prevent serious and irreversible problems like cirrhosis. Old wives’ tales It is popularly believed that mixing alcohol with other beverages can reduce the harm it does. Although the rate of alcohol absorption into the blood stream from the gut depends on the individual and on the mixer, it’s the amount of alcohol that you consume that counts. It’s also believed that drinking slowly – avoiding ‘getting paralytic’ – is safer; again it is the amount of alcohol you take in that counts. More alcohol, more damage. Some also believe that because someone they know has been drinking heavily for years and seems fine, anyone can do the same. This just isn’t true. Some people do seem to suffer less damage than others, but can you be sure you’re one of them? Take it easy It is important to take it easy with alcohol and to avoid drinking and driving, but very occasionally modest overindulgence is unlikely to cause much harm to your liver… just make sure it doesn’t become a habit!

The importance of vitamin D during the winter months

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of the UK population suffer some form of

UVB rays convert cholesterol to vitamin D

vitamin D deficiency

One of the unappreciated effects of reduced daylight hours during the winter months is the impact on vitamin D levels following reduced exposure to sunlight, and the negative result this can have on our health. Vitamin D is important for general good health, growth, strong bones, muscle function and immune response. Professor Michael Besser, Consultant Endocrinologist at The London Clinic, states “Vitamin D is of the utmost importance to your body, but deficiency is a very common – and little appreciated - problem in the UK. Current evidence suggests that about half of the population has insufficient levels, and the long-term impact to health is potentially debilitating. Whilst this is a particular issue during the winter, vitamin D deficiency is in fact a year-round epidemic that needs addressing.” The great majority of our vitamin D is made in the skin with the help of sunlight, where UVB rays convert cholesterol into vitamin D, with the remaining amount obtained via a healthy diet. Exposure to sunlight can be reduced under cloud cover, and also in the shade, and the UVB rays are completely blocked by glass. Whilst challenges to gaining direct exposure are especially significant during the dark and dreary winter months, there are also challenges throughout the summer period with the increased use of sunblock. If exposure to the ‘sunshine vitamin’ is limited, deficiency can occur, and this can eventually lead to osteomalacia – a disease that causes the bones to become weak and painful. Other associated conditions include muscle weakness, an

increased risk of diabetes, heart disease and certain cancers. Professor Besser adds “Recent evidence indicates that we simply cannot gain adequate amounts of vitamin D from our food, and we actually require much higher levels from sun exposure than we ever thought before, particularly in order to maintain bone mass. There are year-round obstacles to consider and, whilst every healthcare professional would advocate the use of sunblock to counteract the risk of skin cancer due to excessive levels of sun exposure, somehow we must also ensure that we obtain adequate levels of vitamin D from sunlight to maintain general good health.” Dr William Marshall, Clinical Director of Pathology and Consultant Clinical Biochemist at The London Clinic, comments “Vitamin D levels are easy to measure, and this is an essential step to reliably detect sub-optimal levels. These sub-optimal blood levels of vitamin D are very common, especially during the winter. Some people are more at risk of deficiency, in particular pregnant women, breastfed babies and people with black or Asian skin types. Ask your doctor about vitamin D3 supplements to keep bones strong. And it is also important also to do weightbearing exercise to maintain muscle mass and help strengthen bones.”

Put Your Best Foot Forward As the cold months set in, there are number of activities you should be aware of that can potentially damage your feet leading to a number of longer terms issues. Sajjad Afzal, Podiatrist at The London Clinic, provides advice on a range of steps that you can take to reduce these risks and ensure tip top foot health. The obvious winter sport that thousands partake in each year is skiing. A lot of focus is given to safety and precautions in general, but little of this is given to your feet. Your feet and ankles are particularly important in skiing, as they act as shock absorbers and brakes, as well as helping you to steer and accelerate when whizzing down the slopes, and so must be as protected as possible. Mr Afzal says “As well as causing new issues, skiing can exacerbate pre-existing foot conditions such as bunions. It is important to take precautions when on the slopes to minimise the risk to your feet. Ensure you invest time in choosing the right boots that fit properly, wear one pair of socks that are designed for skiing, take plenty of plasters and blister cream, and wear clothes that are fully waterproof to ensure your feet remain warm and dry.” Once the New Year comes around, runners with intentions of taking part in the London

Ski Boots Skiing can exacerbate pre-existing foot conditions such as bunions Ankles act as shock absorbers

Running Shoes The number one cause of injuries whilst training is improper shoes. Intensive training can lead to heel pain

High Heels Permanent problems a result of wearing 'killer heels Hammer toes, bunions and damage to leg tendons

Marathon among others strenuous races tend to begin their training. Intensive training for runners can inevitably lead to issues with the feet, including blisters, heel pain, excessive sweating leading to irritable feet, athlete’s foot and other infections. These however, are

not necessarily inevitable for those who take good care of their feet in preparation for and during the training period. Mr Afzal comments “The most important decision you can make is proper running shoes for the biomechanics of your feet – the way your foot moves. The number one cause of injuries whilst training is improper shoes. Your shoes need to fit properly – a specialised shop can help you with this, and never train in shoes that are worn out. Warm up slowly and ensure you take regular breaks if you experience any foot pain.” Finally, ladies it is important to pay some attention to your feet when wearing high heels for longer periods. Experts are increasingly concerned about the long-term implications of this. Permanent problems a result of wearing ‘killer heels’ range from hammer toes and bunions to irreversible damage to leg tendons. Many of the problems – which can occur simultaneously – are caused by the increased pressure high heels put on the ball of the foot; the higher the heel, the greater the pressure. Mr Afzal says “To minimise the risks of high heels, choose a slightly wider heel as this will spread the load more evenly. Wear soft insoles to reduce the impact on your knees – and make sure your shoes are well fitting so your foot remains in place and doesn’t slide forward, putting even more pressure on the toes.”

Bend zee knees Whilst the number of injuries sustained on the slopes has declined over recent years, there remains no room for a blasé attitude, particularly when it comes to the potential for knee injuries, which are in fact becoming increasingly common. Mr Rob Pollock, Consultant Orthopaedic Surgeon at The London Clinic, provides some tips on how to avoid knee injury on the slopes this winter:

• Do not jump unless you know where and how to land. When you do jump, land on both skis and keep your knees flexed • During a fall, try to keep your knees flexed until you have stopped sliding, and don’t try to get up until you have stopped sliding • Be vigilant at all times - avoid altogether high risk behaviour, routinely correct poor skiing technique, and recognise and respond quickly and effectively to potentially dangerous situations

• Before you embark on your winter holiday on the slopes, consider undertaking a training regime of exercises such as cycling or rowing to strengthen your leg muscles, making you less susceptible to injury • Snowboarders need to ensure that their bindings are well fitted and adjusted to prevent knee sprains

AND DON’T FORGET YOUR EYES…. It’s well known that during the summer months, it is important to protect your eyes from the harmful UVA and UVB rays produced by the sun. However, we tend not to put so much focus on this during the winter months, despite the sun being just as harmful. This becomes especially significant when

considering winter sports, which tend to be undertaken in an environment which gives lots of glare, for example skiing. It is important to consider the health of the delicate and vulnerable skin on the eyelids, but also to consider the health of the actual eyes. In order to protect your eyes during winter sports, it is important to ensure the correct protective eye wear. Mr Hugo Henderson, Consultant Ophthalmologist at The London Clinic says “Choose protective goggles that fit all around your eyes and block out as much of the harmful rays as possible, and ensure they meet current European standards. Try to cover as much of your eyes and the surrounding area as possible.”

Healthcheck Helping your skin survive the winter We all think of looking after our skin during the warm summer months when our clothes are shed, but it’s also important to consider being kind to our skin during the colder winter months, paying attention to the usual chapped and dry effects the climate has on us, but also being aware of existing and new blemishes. DR CONAL PERRETT, NEW CONSULTANT DERMATOLOGIST AND DERMATOLOGICAL SURGEON AT THE LONDON CLINIC, tells us about his background and expertise, and discusses the importance of looking after your skin, particularly during the winter period, and key steps you can take to ensure best skin health.

SKIN CARE CHECK LIST • P rotect your skin from the sun damage all year round • E xposure to UV rays at altitiude is greater than at ground level • Check moles and skin blemishes regularly. If you spot any changes, contact a consultant dermatologist

Tell us a bit about your background and expertise in dermatology? Having qualified from the University of Bristol I undertook post-graduate training in Oxford and London. In 2002 I was awarded a Cancer Research UK Clinical Research Fellowship to study skin cancer in organ transplant recipients at the Cancer Research UK London Research Institute and Barts and The London. I was awarded a PhD by the University of London in 2008 and subsequently undertook specialist dermatology training and also a fellowship in dermatological surgery. My current NHS appointment is at University College Hospital London and my special interests include skin cancer, dermatological surgery, photodynamic therapy and skin problems in organ transplant recipients. Why is it important to look after your skin during the winter as well as the summer? It is really important to look after your skin all year-round. However, in winter the skin tends to lose its essential oils and can become dry. To combat dryness it is important to apply a good moisturiser frequently.

Are there particular risks to our skin posed by winter sports? Sun protection is not only important on the beach in the summer months. Many winter sports enthusiasts are unaware of the damaging effects of the sun on the skin. There is a misconception that skin cancers cannot be caused by winter sun. This is very inaccurate and means people are putting themselves at unnecessary risk. UV exposure when you are up a mountain at altitude is greater than at ground level, so skiers are prone to sun damage – which can ultimately lead to skin cancer. On this basis it is crucial to employ adequate sun protection measures such as wearing a SPF 50+ sun cream. Why is it so important to check your moles all year around? Changes can occur in your skin at any time of year and so you must be aware of your own skin blemishes and be alert to any changes. How do we check our moles/what are we looking for? Ensure you are familiar with your skin, and know what your normal blemishes look like. You should regularly check your moles for any changes in size, shape, colour, texture. If any of these changes are noticed or if any of your moles become inflamed, itchy, ulcerated or bleed, ask your GP for a referral to a consultant dermatologist – these are the only professionals who are fully trained to identify and diagnose problems. What services do you offer at The London Clinic? We offer a full range of dermatological services at The London Clinic. These include mole checks, diagnosis and treatment of skin cancers, removal of benign skin lumps and bumps, dermatological surgery (including Mohs micrographic surgery- precise removal of skin cancers) and photodynamic therapy (PDT) and laser treatment for sun damaged skin.

The London Clinic – welcome to the world of inspired care thelondonclinic.co.uk • One of the UK’s leading independent hospitals • Located on Harley Street in the heart of London’s medical community • Long-standing international reputation attracting leading consultants • Highly complex procedures in addition to routine surgery and medicine • 24 hour consultant-led Intensive Care Unit Healthcheck is compiled by The London Clinic Press Office team. To contact us please call 020 8786 3860 or email: pressoffice@thelondonclinic.co.uk