Asian Health 2017

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GUJARAT SAMACHAR TM

TM

Health Care Winter edition

Diabetes: A crisis - Diabetes UK The Heart of South Asians - Dr. Amitava Banerjee, SAHF Child Health - Prof Monica Lakhanpaul, SAHF Community pharmacy under threat - Ian Strachan, Chairman, National Pharmacy Association Ifertility, needless stigma - Dr Geetha Venkat, Director, Harley street Fertility Clinic Quality life despite dementia - Neem Tree Care Centre Care for the elderly - Harnoop Atkar, CEO, Oakland Primecare

Supported by

National Pharmacy Association

2017 January

Diabetes UK - DUK.qxp_A4 Temp 14/12/2016 10:40 Page 1

COMMUNITY CHAMPIONS Do you want to...

Receive training and develop new skills?

Raise awareness and help prevent diabetes?

Engage and connect with your community?

BECOME A COMMUNITY CHAMPION email communitychampions@diabetes.org.uk call 0800 138 1639 or apply at forms.diabetes.org.uk/community-champion-application www.diabetes.org.uk www.facebook.com/DiabetesUK @DiabetesUK A charity registered in England and Wales (215199) and in Scotland (SC039136). Š Diabetes UK 2016 1021

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Health Matters - In Safe Hands

A healthy nation, it has been said, is a wealthy nation. To a very large extent the UK is a testimony to that.

In the 45 years of the ABPL group, both Asian Voice and Gujarat Samachar have laid special emphasis on health matters in order to help our readers understand better preventable chronic conditions such as obesity, diabetes, lung cancer, heart disease, etc.

It is medically proven that the Asian community is at a higher risk of developing conditions such as diabetes and heart disease when compared with people of European ancestry. Some may argue that we are genetically predisposed. While that has not been scientifically proven, what is true is that a healthy lifestyle is a sure panacea, to a large extent, to avoid potentially life threatening conditions.

As a diabetic for the last 37 years, thanks to a healthy diet, regular exercise, medication and regular visits to my GP I have no extreme manifestations of diabetes and I enjoy an active and cheerful life.

I firmly believe that it is our individual responsibility to cultivate a healthy personal environment. We no more require our GPs to warn us about unhealthy choices such as tobacco use, poor diet, sedentary lifestyle, misuse of alcohol and drugs, etc. There is abundant information available at the click of a button.

Our NHS

Even the harshest critic of our health services will admit that the NHS is at the heart of the nation's well-being and is in myriad ways responsible for the excellent health the average UK citizen enjoys. We are fortunate that our lawmakers in their wisdom, have enshrined in the NHS constitution access to comprehensive and free care without any discrimination and disparity. The NHS has come a long way since the days of its founder Nye Bevan, the Labour Party politician, who was the Minister for Health in the postwar Attlee government from 1945 to 1951, and I would like to quote former Prime Minister Gordon Brown:

“The astonishing fact is that Bevan’s vision has stood both the test of time and the test of change unimaginable in his day. At the centre of his vision was a National Health Service, and sixty years on his NHS – by surviving, growing and adapting to technological and demographic change – remains at the centre of the life of our nation as a uniquely British creation, and still a uniquely powerful engine of social justice.”

That in a nutshell sums up the NHS today. The taxes that we pay and the national insurance contribution that we make, I believe, are well spent on primary care, secondary care and social care in spite of several criticisms and challenges.

Community Pharmacy

Over the years community pharmacy too has been playing an important role in delivering key services, and to an extent taking the burden off our GPs. I would like to stress from firsthand experience that the services our local pharmacists offer are second to none. I am delighted that the National Pharmacy Association is supporting this edition of the Healthcare magazine.

UK charities

I would also like to mention here the selfless services that UK charities, of which there are several, provide, and the complementary role they play alongside our health services. Many of them work silently, tirelessly and with an unflagging pursuit of excellence. In order to make their voices heard we launched the Asian Voice Charity Awards in 2016. I would like to make a special mention of Diabetes UK which for several years has been proactively educating the Asian community about diabetes.

Care Homes

What is also heartening to note is the number of excellent care homes in the UK. This sector too has kept up with the challenges and technological advancements in healthcare provision. It is a fact that there is an increasing population of ageing first generation Asians in the UK and the proliferation of care homes can only bode well for the community. In recent years many care homes have come to offer facilities tailor-made to Asian culinary, cultural and spiritual needs as explained by Rupane Shah of Neem Tree Care Homes in this magazine. Unfortunately there is still a stigma within the Asian community about placing the elderly in care homes but I am confident that in due course that attitude will change.

Looking forward

We are at that time of the year when most of us make resolutions for our lives ahead. Some we break and others we follow through. But one resolution that would be well worth making and keeping is to look after our health. As Gautama Buddha said, 'To keep the body in good health is a duty... otherwise we shall not be able to keep our mind strong and clear.'

Seasons greetings to all our readers and all the very best during the coming year.

CB Patel Publisher / Editor Asian Voice & Gujarat Samachar Asian Voice & Gujarat Samachar - 2017

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Health - Overview

Dr Kiran Patel

Chair of Trustees, South Asian Health Foundation Consultant Cardiologist & Medical Director

Welcome to this Health Supplement. It is a pleasure to introduce many important topics relating to our health and wellbeing on behalf of the South Asian Health Foundation (SAHF) and ABPL Group. Why is it important to be aware of these issues one might ask? The answer is simple. Individually we have a vested interest either avoiding many of the conditions discussed in these articles, or in knowing more about them so that we might help ourselves, our friends or our family members.

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The South Asian population, which encompasses those of Indian, Pakistani, Sri Lankan and Bangladeshi origin, is prone to experience certain conditions. Diabetes is the most well known condition, where south Asians are several times more likely than white European individuals to be afflicted by the condition. Many of us will also know of young individuals struck down by premature heart attacks or strokes too. Then there are disabling conditions such as arthritis and the mental health conditions such as dementia and depression. All these conditions manifest in the south Asian population as in other ethnic groups. After all, human beings are more similar than they are different. However, inequalities in health and health outcomes persist for south Asians in the UK and internationally and pose to us several challenges.

Firstly, we must address deprivation, one of the most important determinants of adverse health status and poor health outcomes.

Although the solutions to deprivation are not wholly within the gift of the individual to resolve, our last 2 generations have seen significant social mobility and prosperity from which our mental and physical health benefit today. How do we lift those remaining impoverished out of the spiralling trap of low wealth and poor health?

Secondly, stigma surrounding illness serves to disable communities and societies. I see our communities now freely able to raise awareness and discuss conditions such as diabetes and heart disease and in the past decade SAHF has made great progress in helping communities to tackle these conditions. It is now time to create the same openness to discuss culturally taboo subjects such as mental health conditions, suicide, domestic violence and cancer. Unless we do, that, victims will suffer in silence and remain vulnerable.

Thirdly, we must strive towards health preservation rather than resting assured that the health service will manage our illness should it arise.

There is a saying that prevention is better than cure. That prevention starts even before birth. A healthy pregnancy delivers a healthy child. A healthy childhood delivers a healthy adolescent and a healthy adolescence delivers a healthy adult. Maintaining mental and physical health in adulthood and old age then ultimately adds life to years, enabling us to die youthful and able, at an old age.

So it is with great pleasure that I encourage you to read the articles in this supplement and play your part either individually or within your community, to addressing the challenges we face and continue our journey to even better health and well being.

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Asian Voice & Gujarat Samachar - 2017

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Please support your local pharmacies they are under threat!

Ian Strachan

Chairman National Pharmacy Association (NPA)

Local pharmacies have been around for generations, helping people from the beginning of life to end of life and providing a wide range of health services, in easy reach of where people live, work and shop.

Pharmacies serve people in all communities – including the most deprived neighbourhoods. The same cannot be said of all parts of the health service.

Many pharmacies, like my own, are family owned, family run businesses, which are heavily focused on NHS services. These independent pharmacies are a local lifeline and essential to the health of the nation. They tend to be very responsive to local need, and community focused.

The average community pharmacy gets 137 visits per day for health related reasons. In recent years, pharmacy has expanded its role, and now supplies a wide range of NHS services, from medicines advice services to minor ailments schemes (in which pharmacists can treat coughs & colds and other common ailments with prescription only medicines), NHS stop smoking counselling, Health Checks and flu vaccinations.

Pharmacies also typically provide a range of added value services beyond those funded by the NHS. For example, many pharmacies will deliver medicines to housebound patients and provide compliance aids, to help vulnerable elderly people to take their medicines properly.

Yet this uniquely accessible health care resource is under threat from NHS cuts and related Government policies.

The Department of Health has said that it wants to make substantial cuts in the next two years and hasn’t ruled out more cuts to follow. Unfortunately, this is bound to have an impact on patient services. Pharmacies will try to keep the full range of services going, for as long as possible in the light of the cuts. However, the path the NHS has started down will inevitably lead to reduced access to care and put

extra pressure on GPs and hospitals. Many pharmacies will be forced to reduce opening hours, restrict services, or ask people to pay for services that are currently free of charge, such as home delivery to house bound patients.

The Government is overlooking the potential for local pharmacies to do more for patients and the NHS and putting at risk a part of the health system that holds the key to solving many of its problems. Pharmacies could actually save the NHS money if we are given a greater role in urgent care and managing medicines waste.

Health Secretary Jeremy Hunt appears to view medicines as just another commodity which can be delivered through mail order pharmacies. Actually, local pharmacies are more than just a distribution point for medicines; and medicines are not just ordinary items of commerce like tins of baked beans. Pharmacies are a valuable health and social care asset at the heart of communities; and medicines are vital to the wellbeing of millions of people, with the power to harm as well as heal. People want to see health care professionals face to face; the supply of medicines through the internet is in no way equivalent to the wide range of services you can get at local pharmacies. Seven in 10 people regard face to face advice from a pharmacist or other member of the pharmacy team as very important to them. The importance of the provision of face to face advice increases significantly amongst certain groups of pharmacy users – mothers, carers and older people.

The National Pharmacy Association is passionate about keeping pharmacies in communities and the ‘community’ in community pharmacy. We want to engage with officials on implementation of a programme for change and improvement which builds on the strengths of our sector rather than seeks to dismantle it. By working together, we can make the pharmacy sector and the health system overall more efficient, whilst ensuring that no patient is left behind.

As patients and customers of pharmacies, I urge you to make the most of your local independent pharmacy. That’s one of the best ways you can help ensure that your local pharmacy will be there to serve the generations to come.

Or you can lobby your MP – please go to www.supportyourlocalpharmacy.org for more information.

Asian Voice & Gujarat Samachar - 2017

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Krishna Sarda

Diabetes - A crisis

Engaging Communities Manager of Diabetes UK

There is a crisis in diabetes in the UK, both in the numbers of people living with diabetes, and supporting those with the condition to make sure they manage it well.

This is a crisis for everyone – but South Asians are two to four times more likely to develop Type 2 diabetes than the White population. We at Diabetes UK are working hard to find out the reasons why, and help people cut their risk and manage the condition if they have it.

So why are South Asians at higher risk? The short answer is that we don’t know for certain, but there looks to be a mixture of genetic and environmental reasons. We have funded £4.7 million into research on how diabetes affects Asian, Black and Minority ethnic peoples into all aspects of the causes and effects of diabetes.

While we fund research to find solutions for the future, we also work to improve prevention and management of Type 2 diabetes for South Asians today.

This is closely informed by working with people living with diabetes, many of whom volunteer in our Community Champions programme to raise awareness of diabetes risk and management in their communities. We have also built networks on diabetes and diversity to help experts share their knowledge and to find out what diabetes specialists think. And the same messages from all these groups come through time and again, and have helped inform how we tackle Type 2 diabetes.

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Asian Voice & Gujarat Samachar - 2017

Food is a major and complex issue. This is a broad field but it includes tackling the higher intake of sugary and starchy foods, and the use of highly saturated fats like ghee.

Exercise is something that most people struggle with, as lots of us now live more sedentary lifestyles with more driving and less exercise. But levels are particularly low for South Asians, and even more so for women.

There is also a lot of variance in how South Asians engage with healthcare professionals. While older people tend to adhere to their diabetes medication, for example, younger people do not.

Language barriers can be a barrier to engagement, meaning that health messages are often missed or misunderstood. One in five people in the South Asian communities have poor, or no, English.

And there are also cultural beliefs that we have to consider afresh with every different community we work with. There are people for whom ‘feeding up’ your family is a sign of wealth and success, and pushing food on to friends is a measure of hospitality – and not taking diabetes as a serious threat is a problem across the board.

Having mapped out many of the causes for higher prevalence of Type 2 diabetes, we are now building programmes to tackle them head on.

Our flagship Community Champions programme is the key starting point. They are our ambassadors at a local level, and signpost people to healthcare services, bridge the gap between communities and healthcare settings and create community hubs through faith and community centres.

We are on target to have 1,000 Community Champions recruited and trained by 2016, and we have new projects coming up in 2017. Brent is a good example of a location where the Community Champions are having a real impact: in the one-year programme in 2015, 36 Community Champions were involved in 65 community events, reaching 75,000 people and engaging with 6,500 people from target communities.

There is no ‘one size fits all’ solution to diabetes, and diversity in the UK is increasingly complex. This leaves us with specific challenges in tailoring our engagement efforts to take into account the needs of diverse audiences – but from our frontline Champions work to our networks of expertise, we have the right programmes in place to make sure that we reach everyone affected by diabetes.

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Complications

what can you do to cut your risk?

Natasha Marsland

Senior Clinical Advisor at Diabetes UK

Complications are a scary topic for people living with diabetes to consider as a possible part of their future. Failure to recognise the condition can be life-threatening; failure to take it seriously, once diagnosed, can have equally serious consequences. Stroke.

Amputations. Early death.

If you or a loved one is living with diabetes, we know how intimidating the condition and its complications can sound. But there are things that you can do to help cut the risk.

Take an education course

A serious, life-threatening, life-limiting condition requires an urgent response, and it is vitally important to your future health and wellbeing that you attend an approved diabetes course. The more you know diabetes, the more you can fight diabetes.

We hear from people who lived with diabetes for years who go on a course and learn something new – for some, what they learn can be life changing. Ask your healthcare professional what is available in your area.

Get the right tests and checks

Getting the right checks to see how your condition is progressing is also vital, and getting the best care is a good way of stopping any complications as early as possible. If you are living with diabetes, make sure you have checked our 15 Healthcare Essentials to see that you are getting all the tests and checks you need – they cover everything from medical checks like your blood pressure, to getting your flu vaccination and going on an education course. To find out more go to www.diabetes.org.uk/15-essentials.

Change up your lifestyle, including your diet

Living a healthy lifestyle can also help to reduce your risk of developing complications. Whatever form of diabetes you

have, eating a healthy diet, moving more and maintaining a healthy weight will make a huge difference to reducing the risk of developing complications, as will taking the medication you have been prescribed and stopping smoking.

Indeed, making changes to your diet can help with your general condition management: watching your portion sizes, keeping an eye on how much saturated fat, salt and sugar is in your food and drink, eating ‘traditional’ dishes which use low glycaemic index foods such as basmati rice, pulses and lentils such as chick peas, chana dal and black gram. Cutting back on ‘westernised processed food’ and Indian sweets and deep fried snacks and getting your 5 a day of fruit and vegetables will all help.

Move more

Whether you are a busy parent, sat behind a desk all day or in your retirement years, upping your level of physical activity – regardless of how small an increase – can make a real and positive difference to your health. You don’t have to sign up for a marathon just yet – a 30 minute brisk walk every day is a manageable way to get moving. Speak with your GP before undertaking any major new activity programme.

On their own, walking more, switching to healthier foods and getting your health checks are small changes. But these little changes add up to a healthier lifestyle that go a long way to cutting your risk of developing complications.

To find out more about diabetes and how to manage it, call our Helpline on 0345 123 2399, Monday to Friday, 9am– 7pm. If you would like to speak with us in a language other than English, just call the Helpline number and tell us your name, telephone number and the language you wish to speak in. We will then arrange for an interpreter to call you back within a few minutes.

What complications does diabetes cause?

l South Asian people are at much higher risk of developing cardiovascular problems, and people with diabetes have about twice the risk of developing a range of cardiovascular diseases such as stroke and heart attacks compared with those without diabetes. l There are now 20 diabetes-related amputations in England every day, an all-time high, even though we know that four out of five of those amputations could have been prevented l People with diabetes are also more likely to experience damage to their eyes, kidney disease, depression, sexual dysfunction or develop dementia.

Asian Voice & Gujarat Samachar - 2017

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Community Champions make change from the ground up

Rohit Patel, a financial consultant from Mill Hill, has been living with Type 2 diabetes since his diagnosis in 2003. He’s now one of Diabetes UK Community Champions, helping to spread the word about how serious diabetes can be in the Gujarati community in north London.

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ut knowing how to manage his diabetes didn’t happen from day one of his diagnosis.

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“At first I just understood my diabetes superficially,” says Rohit. “It wasn’t a scary thing. I just thought, everyone in my family has it so I have it too.”

Rohit isn’t alone – many people don’t take diabetes seriously once they receive their diagnosis. This can be because the condition is now so prevalent that people don’t always realise its significance, or because Type 2 diabetes can develop much more slowly than Type 1 diabetes, taking years to take its toll.

However, without careful management, Type 2 diabetes does cause very serious complications.

When he was first diagnosed, Rohit was able to manage his condition through diet alone. After a few years he was put on to medication to help keep his condition under control. Even with medication, Rohit found it difficult to maintain control because of lifestyle issues.

Change came when he attended a one-day training course on diabetes through the Wembley (Brent) Lions Club, where he is a volunteer.

“The course really drilled down into the condition and made more sense,” he says. “It brought home how serious diabetes can be. You become more aware of what you’re eating – I don’t eat crisps, snacks and biscuits as that was one of the things that came up from the training. And the training also showed the importance of exercise – now I religiously do 45 minutes of cross training in the morning.”

The training was a turning point for Rohit’s own health, but it also led to him training up as a Diabetes UK Community Champion, attending two days on how Type 2 diabetes develops, how people can reduce their risk of developing it, and how to manage the condition well if you do have it.

There are now 1000 trained volunteers who are tackling diabetes in their own communities, and Rohit has taken part in Diabetes UK roadshows, events and manned stalls at festivals and Melas to get the word out about what people can do to improve their health.

It’s a prime opportunity to advise people living with the condition and their relatives on the importance of managing it well, and guiding those without diabetes to the Diabetes UK website to help them find out their risk.

Asian Voice & Gujarat Samachar - 2017

Rohit Patel

And there are lot of ideas around about food, health and diabetes that the Community Champions have to tackle every time they go out.

“With the Gujarati community, food is the biggest part,” says Rohit. “Our food is very rich and there are a lot of misconceptions around things that are good for you. They might have been considered good for you once but they aren’t now – someone might say that ghee is pure, for example, which it might be, but it is pure fat.”

“Our forefathers worked the fields ate a lot of ghee and sweet stuff, but they were doing hard physical labour and they were burning it off, but we can’t continue with the same tradition because we aren’t doing the same. Walking for only ten minutes isn’t enough; people need to do more exercise relative to how much they eat.”

Changing habits isn’t easy, but Rohit’s story shows that providing the right information can make a real difference to people’s health. Alongside the 1,000 other Community Champions – and with more being trained in the coming years – the programme is helping make sure that everyone understands what diabetes is and why we all need to take it seriously.

To find out more about training as a Diabetes UK Community Champion, email CommunityChampions @diabetes.org.uk or freephone 0800 138 1639.

Janssen is delighted to be working in partnership with Diabetes UK to deliver their Community Champions programme from 2016 to 2018. As part of the wider Johnson & Johnson family, Janssen has a proud heritage of addressing health inequalities, and is committed to improving outcomes for people living with Type 2 diabetes.

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Cook up a storm with the flavour toolbox

Try these tips to make your favourite foods healthier, without losing the great flavours of your traditional meals…

l Roast and toast spices – cumin (jeera), cardamom seeds (elaichi), cloves, black peppercorns, cinnamon sticks and onion seeds (kalonji) still release their flavour and aroma when toasted without oil. l Marinate chicken, fish, lamb, and mutton in chopped chillies, ginger, garlic and lemon juice and then simply grill or roast in the oven. Add yogurt, paprika and tomato purée if you like it tandoori or tikka style. l Making samosas? Try filo pastry instead. Use two or three sheets per samosa and spread milk or beaten egg between the sheets to stop them going dry. Then bake your samosas instead of frying them. Just brush with a little oil beforehand. l Grill masala fish. Use your usual spices and add a drizzle of olive, sunflower or rapeseed oil or a few sprays of spray oil. While that’s grilling, you could dry roast your spices for the masala. l Grill or toast poppadoms on a tawa. l Chutneys and pickles can be made with lemon juice and fruits to help you cut down on oil and sugar. Fresh kachumber made from onions, green chillies, cucumber, tomato and lemon juice or vinegar adds a refreshing touch to rice dishes. l Do you need to add jaggery (gur) to savoury dishes? It is cane sugar so if you really must, just add a small chunk. l Use 0% fat or low-fat Greek yogurt in korma, instead of cream or coconut milk. Stir it in at the end of cooking and take care not to boil to prevent it separating. The yogurt adds flavour and a creamy texture.

You can download or order the South Asian Enjoy Food guide from shop.diabetes.org.uk/go/enjoy-food.

catching up with the housework and getting dinner done to get into bed by 7pm to be up for work.”

She had tried signing up at a local gym and spent lots of money on exercise equipment, but couldn’t find something she would regularly take part in. In the end, Urmila realised she didn’t need to spend a lot of cash – and instead goes for a 30-minute walk with her husband after dinner. “At first I took my husband and it was difficult – we would be talking and getting out of breath, and I knew I had to get better.

But it’s got easier now. “l finally found what l like and it is free, relaxing, helps keep my lungs stronger as l walk and to talk to my husband and not realising the distance walked. My HbA1c [a measure of your long term control which indicates your blood glucose levels for the previous 2 to 3 months] is under much better control and the hospital are happy.”

Check in with your GP before starting any major new activity.

Urmila’s is one of 100 useful tips around every part of life and diabetes taken from ‘100 things I wish I’d known about living with diabetes’. Download a copy from www.diabetes.org.uk/100things.

How can I move more?

We all know that being active is good for your health – it can help you manage your diabetes if you have it, or reduce your risk of developing Type 2 diabetes if you don’t. But it isn’t always easy to fit it into your week, as Urmila, 50, from Slough, found when she couldn’t fit it around her work schedule.

She says: “I would often be told about exercise but medical staff often didn’t understand that I would be doing shift work so I would get up at 3.30am and come home at 2pm.

“The last thing on my mind was exercise – it was Asian Voice & Gujarat Samachar - 2017

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Dr Venkat, Director of Harley Street Fertility Clinic discusses the stigma attached to Asian couples struggling with IVF

Infertility is a condition that is still widely stigmatised within Asian communities, yet despite being a cultural taboo, it is estimated that 2 out of 14 Asian couples experience infertility issues.

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he problem is so extreme that over a third of couples on waiting lists for donor eggs are Asian, all of who are hoping for matching eggs that currently don’t exist. Dr Geetha Venkat, Director of Harley Street Fertility Clinic believes that many Asian couples are largely ignorant of their ‘fertility time-bomb.’Cultural issues and concerns are, in some instances, prevent them for seeking medical help and advice.

It is a little known fact that the fertility of an Asian woman declines earlier than in Caucasian women – at 32 years compared to 35 years. Potential causes of why Asian women’s fertility may decline earlier may be gynaecological or other medical disorders that impair fertility, such as polycystic ovarian syndrome, endometriosis and Systemic lupus that can affect nearly half of Asian women worldwide.

Additionally, like their Caucasian counterparts, many Asian women are delaying starting a family for educational and career reasons.

Dr Venkat comments, “Seeing a specialist later and trying for a longer period of time without assistance may have a huge psychological shock on a woman if she is told that she cannot produce eggs anymore. Out of desperation to seek donor eggs, many couples travel abroad to countries such as India every year, often to practices that are unregulated. This can have devastating results and leave people vulnerable to scams.” So we advise couples to seek help earlier.

The same issues that confront women are present for men as there is also a certain stigma attached to male infertility. The stigma of male infertility is often the reasoning behind why so many men wait for months, or even years to seek help when there is an issue with fertility. Misguided thoughts about not being “masculine” can unfortunately sneak in, and men can find that they are unable to voice their worry with family and friends.

Dr Venkat comments; “Many Asian men still find it embarrassing to talk about sperm problems, inhibiting them from seeking medical advice and help. They often feel ashamed and embarrassed and find it difficult to talk to a doctor. I want to help raise awareness of the issue of infertility amongst both Asian men and women – accepting that you might have a problem is the first step in helping to solve it. There are so many options now available to help couples who are struggling to conceive and fulfil their dream of having a family.”

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Asian Voice & Gujarat Samachar - 2017

Geetha Venkat

If the struggle of conceiving is still apparent after a year of trying, Dr Venkat recommends visiting a fertility expert who will be able to investigate your situation and help you get to the bottom of what might be wrong. Harley Street Fertility Clinic is supported by a 22-strong team of specialist consultants in the fields of fertility, gynaecology, obstetrics and urology and offers a comprehensive range of treatments covering all aspects of fertility including gynaecology, endoscopic surgery, urology, assisted conception and male infertility management. The clinic boasts some of the best results in London.

For further information, please visit: www.hsfc.org.uk or call 020 7436 6838.

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12-13-NPA Leyla Hannbeck.qxp_A4 Temp 12/01/2017 14:28 Page 12

Community Pharmacy At the heart of healthcare Where can you obtain high quality healthcare advice without booking an appointment?

Where can you get your winter flu vaccination? Where can you get support to stop smoking?

our local community pharmacy offers a variety of healthcare services alongside the traditional role of dispensing prescriptions. Leyla Hannbeck, Chief Pharmacist at the National Pharmacy Association, explains what your pharmacy can offer.

Pharmacists are arguably the most accessible healthcare professionals; an individual can walk into a pharmacy, with no appointment or booking, and get expert advice on their medication, common ailments, management of any long-term conditions and practical help on keeping healthy.

To qualify and work as a pharmacist now takes four years of university education for a masters degree followed by successful completion of one year’s pre-registration training. In addition, pharmacists must keep their knowledge up to date throughout their career by undertaking continuing professional development. Majority of registered pharmacists work in a community setting to provide frontline care for patients; they are required to offer advice and make decisions that can have a significant bearing on people’s health and well being.

There are approximately 11,700 pharmacies in England and every day 1.6 million people visit a pharmacy in England. 99% of the population in England live within 20 minutes travel time of a community pharmacy. Many are open for extended hours including weekends, often when other healthcare professionals may not be available. In addition, most pharmacies have a private consultation area to freely discuss confidential or sensitive issues without being overheard by other members of the public.

medicines are supplied to the patient with appropriate information and advice, including how to use and side effects. l Providing advice on minor illnesses: pharmacies can give information on how to manage minor ailments, recommend nonprescription medicines and offer selfcare measures. l Promoting Leyla Hannbeck healthy lifestyles: pharmacies can provide patients with healthy living advice, either opportunistically to patients presenting with prescriptions for long-term conditions or by contributing to wider health campaigns. l Disposing unwanted medication: pharmacies can safely dispose of certain waste medicines from homes. l Signposting to other health or social care providers: pharmacies can offer details of other organisations to patients who require further support which cannot be provided by the pharmacy.

A number of pharmacies can offer NHS “Advanced Services”- these services are provided by accredited pharmacists who have undergone additional training. The services utilise the private consultation room and offers an area where the patient and pharmacist can sit down.

Community pharmacies offer a combination of NHS and private services in addition to the traditional role of dispensing prescriptions. In recent years, pharmacies have diversified the nature of work undertaken to cater for the health needs of the local community. There has been a steady growth in the type of services offered both locally and nationally, as NHS commissioners recognise the vast benefits that pharmacies can offer to the public.

All pharmacies offer “Essential Services” as part of their NHS pharmacy contract. Some of these services include: l Dispensing prescriptions: pharmacies ensure

l Medicines Use Review (MUR): pharmacists can undertake medication reviews with patients which covers their understanding of their medicines, potential side effects and information about their health condition. l New Medicine Service (NMS): pharmacists can support patients who have been newly prescribed a medication for asthma, chronic obstructive pulmonary disease, hypertension, type 2 diabetes, anticoagulant or antiplatelet therapy. l Flu Vaccination Service: pharmacists can administer the seasonal flu vaccination to patients in at-risk groups.

Y

What services do community pharmacies offer?

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The Advanced Services provided by most pharmacies include:

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Some community pharmacies are contracted by the NHS to provide locally commissioned services, depending on the health needs of the local area. The pharmacy can be commissioned from the local NHS England team, Local Authority or Clinical Commissioning Groups. Examples of services that can be offered include: l Anticoagulant monitoring l Blood pressure monitoring l Chlamydia screening and treatment l Cholesterol monitoring l Minor Ailments Service l Needle and syringe exchange programme l Smoking cessation l Weight management service

Community pharmacies predominantly offer NHS services, however increasing numbers also offer many private services. A pharmacy can supply or administer certain prescription-only medicines directly to patients for an identified clinical condition under a written direction that is pre-authorised by a doctor. This is beneficial for patients as they may be able to get different treatments or vaccinations for specified health conditions at their local pharmacy without needing to make an appointment with their doctor.

Examples of private services offered by pharmacies include: l Cervical cancer vaccinations l Erectile dysfunction l Hair loss l Malaria prophylaxis l Meningitis B vaccinations l Period delay l Travel vaccinations l Weight loss

How can community pharmacies ease the burden on the NHS?

Pharmacies are expanding their usual remit of practice and are developing more clinical-based services which could help ease the burden on the NHS. The government has an aim to make £22bn of efficiencies within the NHS by 202021 to deal with rising demand. Pharmacists can alleviate the pressure off other healthcare providers by stepping in to undertake services which can be carried out with ease in a community pharmacy setting.

Many common ailments can be treated in pharmacies, for example sore throats, cough and colds, aches and pains, eye problems, upset stomach, diarrhoea or constipation. GP and A&E visits could potentially be diverted to pharmacies; this would provide patients with faster treatment and reduce unnecessary waiting times for other healthcare providers.

Between a third and half of all medicines prescribed for long-term conditions are not taken as recommended.

Pharmacists can review a regular patient’s use of their medication under the Medicines Use Review service. This

can help identify and address issues individuals have with their medicines in an open comfortable setting. The primary aim of the review is to improve medicines adherence, which is a term used to describe if the patient’s medicine usage matches the agreed recommendations from the prescriber.

This can potentially help clinical outcomes, cost effectiveness and reduce medicines wastage. It could also reduce patient visits to GPs, tests, investigations and hospital admissions.

When a new medication is prescribed for a patient, it can potentially be a daunting time for them. They may have been newly diagnosed with a health condition and prescribed a new medication. The first time a patient gets a new medicine dispensed for a certain long-term health condition, for example asthma or hypertension, the pharmacist can undertake a New Medicine Service. This helps support the individual throughout the first month of their treatment. The service would involve contacting the patient either via telephone or in person to discuss how they are getting along with their new medication, any adverse effects and if any support with their condition is required. By addressing issues early in the patient’s journey, patient adherence may be improved leading to better health outcomes.

What is the future of pharmacy?

The government has recently announced reforms on how community pharmacy is funded. It is important to recognise the good work that thousands of pharmacy staff currently do and will continue to do in the future regardless of any potential changes.

Multiple pilots into potential future pharmacy services have been undertaken by the NHS. One new pilot scheme, entitled the “NHS Urgent Medicines Supply Advanced Service”, is being commissioned and introduced in England. Patients contacting NHS 111 to request urgently needed medication will be referred to a pharmacy providing the service for an assessment and be given a supply if appropriate. A benefit of the service is that it can reduce demand on the rest of the urgent care pathway preventing unnecessary visits to GP’s or A&E departments by patients who may have run out of their medication.

We are living longer than ever before and we have an ageing population. The annual cost for healthcare is greater for older people, which poses significant challenges to the NHS. Increasing numbers of pharmacists are visiting care homes to undertake medication reviews, ensure medicines are safely administered and provide training to staff.

Community pharmacy is rapidly changing – at this crucial time, pharmacists and other healthcare professionals must work together to ensure patients receive the best possible care tailored to each individual.

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Neem Tree Care Centre

Leading a Quality life with Dementia

About Dementia

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Though the elderly are fortunate to be living longer, with age often comes illness, and dementia is one of the most common conditions. The Alzheimer’s society says ‘The word dementia describes a set of symptoms that may include memory loss and difficulties with thinking, problemsolving or language. Dementia is caused when the brain is damaged by diseases, such as Alzheimer's disease or a series of strokes. Dementia is progressive, which means the symptoms will gradually get worse.’

They go further and say ‘Diagnosing dementia is often difficult, particularly in the early stages. The GP is the first person to consult. The GP may then refer the person being diagnosed to a specialist such as a consultant.

Assessments can include conversations with the person being diagnosed and those close to them, a physical examination, memory tests and/or brain scans.

Becoming forgetful does not necessarily mean that you have dementia. Many of us notice that our memory becomes less reliable as we get older. It can also be a symptom of stress or depression. In rare cases, dementialike symptoms can be caused by vitamin deficiencies or a brain tumour.

Even if the diagnosis is dementia, there is a lot that can be done after diagnosis to support someone to live well with the condition.’

Dementia is increasing across all demographics.

Different cultures have different perceptions of mental illnesses – including dementia. Sadly, in the UK, people from the Asian community are more likely to approach their GPs for physical than mental health symptoms.

According to the Alzheimer’s Society, in 2011, there Asian Voice & Gujarat Samachar - 2017

were 25,000 people with dementia from black, Asian and minority ethnic groups in England and Wales. This number is expected to double to 50,000 by 2026 and rise to over 172,000 by 2051. This is a nearly a seven-fold increase in 40 years, compared to just over a two-fold increase in the numbers of people with dementia across the whole UK population in the same time period.

Can older patients stay at home?

Rupane Patel, a director at Neem Tree Care Centre, says “In Asian tradition, parents look after children who, in turn, look after parents: elderly relatives being cared for inside the family is something that Asians take great pride in. There are, however, several situations in which no matter how much a family wants to care for their parents or grandparents, their medical needs cannot be met at home.’

Furthermore, modern reality is that the Asian extended family dynamics have changed, children may have moved away from the family home or all family members work – there is therefore no one who can look after parents or grandparents at home. Gradually and reluctantly, some British Asian children are realising they can no longer care for their parents. But the decision to have someone else care for them is not one taken lightly.”

Can a patient with dementia get better?

The Alzheimer’s Society states, “There are no drug treatments that can cure Alzheimer's disease or any other common type of dementia. However, medicines have been developed that can temporarily alleviate symptoms, or slow

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down their progression, in some people. Drug treatment for Alzheimer's disease is important, but the benefits are small, and drugs should only be one part of a person's overall care. Non-drug treatments, activities and support are just as important in helping someone to live well with the disease.”

Family Carers

Family members caring for loved ones also need support.

Says Rupane, “Looking after someone with dementia can be stressful. In a family setting all the carers need frequent breaks. At Neem Tree we take away that stress from the family, we offer short respite stays so the family can go on a holiday or just take a well needed break.”

Facilities and Care at Neem Tree Care Centre Environment

Neem Tree Care Centre is situated across three floors and surrounded by a secure sensory garden. The ground and first floors offer nursing care and the top floor is a specialist Asian dementia wing. All of the en-suite bedrooms are fully equipped, however residents are encouraged to bring their own belongings so as to create that 'Home from Home' feel.

The purpose built building has been thoughtfully designed to create a therapeutic dementia care environment. This should enable residents to recognise their surroundings, take part in everyday activities and take control of their own environment. Some of the design features implemented to help achieve the above objectives are specifically designed lighting levels and visual cues to aid orientation. There are comfortable lounges, dining rooms, a prayer room, cinema room and hairdressing salon.

At Neem Tree you can see signs all around the home and that makes it easy for people to orient themselves.

There are colour coded seats and rails in the en-suites because sometimes residents suffering from dementia can’t decipher colour. So to encourage independence the contrast helps. All the flooring and furnishings have been kept fairly neutral because busy wall panels can confuse residents even more. Everything is kept homely, simple and conducive to somebody suffering from dementia.

Care

The care home provides trained and skilled staff who have the experience needed to deal with Dementia. At Neem Tree they believe, quality care can only be provided if their staff understand the residents’ needs well. They are trained to take each day as it comes and provide individualised care, rather than ‘one size’ fits all type care.

At Neem Tree Care when a resident comes into the home, a detailed care plan is prepared that is unique to that individual. Carers learn from resident's families what their loved ones like and dislike and what their routine at home was like before they came into care. The day is structured by offering choice and respecting their preferences.

Staff

Staff are multi-lingual with most staff working on the Asian units fluent in Gujarati, Punjabi or Hindi.

“We are acutely aware of the sensitivities of the Asian culture and religious beliefs and our style of care reflects this,” says Meera Shah, director of Neem Tree Care Centre.

“Our staff are specifically recruited with the correct language skills so they are able to communicate fully with our Asian residents and are aware of specific needs.

Meals

The way food is prepared and served is also a significant part of what Neem Tree offers Asian residents.

It’s menus cater for different Asian ethnic groups, with a choice of dishes at every mealtime. All meals are freshly prepared by the home’s expert cooks in modern kitchens.

Neem Tree’s cooks provide popular regional Asian cuisines including Gujarati, Punjabi and south Indian. It also caters for residents who are strict vegetarians – it has a separate, fully vegetarian kitchen to ensure that all ingredients, appliances and utensils are kept apart. Cultural preferences are observed and respected.

Diets that require certain foods to be omitted, and ingredients to be sourced and prepared in a specific way, are strictly adhered to. Residents may also wish, for example, to fast or eat certain foods on particular days. The home does its best to enable this so long as it is not detrimental to residents’ health.

Activities

The level of activity provision in a care home is probably a lot higher than people would have in their own homes. Hobbies and pastimes in the Asian community differ from other communities. We offer activities that are drawn from Asian culture.

“Our aim is to always provide a full and varied activities programme, which is planned in consultation with the wishes of the residents. Special arrangements are made for birthdays and other celebrations, such as satsangs (reading, reflecting on and discussion of scriptures) in our prayer room or garden parties in our beautifully maintained sensory garden.”

Neem Tree’s prayer room is open to all religions and is intended as a place for quiet contemplation. At times it can also be a social place to hold small group prayers. The home's dedicated activities co-ordinator ensures that all faiths are recognised in term of events within the home, as well as with external visits to, for example, local temples and churches.

At home it may become quite difficult for one person in the family to cope with the challenges that come from caring for someone suffering from dementia for 24 hours every day every week. Neem Tree in Greenford, West London provides state of the art facilities in beautiful and peaceful surroundings.

Neem Tree has proved that a quality life can still be led by someone suffering from dementia and that family members can rest assured that their loved ones are being cared for in an environment that is ‘home from home’.

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Showcasing UK Pharmacy in the Arab World

Dr Mahendra G Patel hD FRPharmS FHEA

Fellow of National Institute for Health and Care Excellence Principal Enterprise Fellow of Pharmacy University of Huddersfield Board Member of the Royal Pharmaceutical Society

I was delighted to be an invited guest representing the UK pharmacy profession and the RPS, as well as the University of Huddersfield at The Lebanese Order of Pharmacists (OPL) and its 24th Annual Congress "Advancing Pharmacist's Role: Together We Make A Difference," November 2016 Beirut.

It was fascinating to see how the OPL functioned in terms of its commitment and endeavor to deliver a high standard of professional practice throughout Lebanon, and at the same time uphold governmental driven legislative practice against clear difficulties and challenges.

Within the OPL and its committee, there is a clear passion and obvious determination to deliver pharmacy practice safely, effectively, and legally throughout the country. Furthermore, their main aim is to share and promote good pharmacy practice to the rest of the Arab countries (who had attended in large numbers): Egypt, Jordan, Morocco, Syria, Iraq, Qatar to name but a few. They were all well represented by their respective presidents and chairs of their professional and governing bodies, alongside senior pharmacists both from the clinical and academic sectors and community. In total there were more than 1500 attendees largely speaking English, Arabic and French.

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Asian Voice & Gujarat Samachar - 2017

Dr. Patel (left), Minister Segaan Kazi (centre) and Dr. Georges Sili, President of the Lebanese Order of Pharmacists

Interestingly but worryingly, there is a large disconnect and disparity between adhering to legislation and maintaining professional practice in Lebanon – in my view a clear signal for fatalities. This was surprising and somewhat difficult for me to comprehend fully, especially being a perceptive guest of a pharmacy audience who on the whole appeared distinctly keen and enthusiastic about their profession. However, I soon learnt that this perceived interest was possibly explained by the large number of credits that pharmacists could attain through their attendance at the various continuing professional education lectures and workshops made available at the Congress.

The Lebanese pharmacy profession requires a minimum of 15 credits as part of a mandatory requirement for pharmacists’ continuous professional development.

Pharmacy is practiced with little regard to legislation across all sectors and not just in community. In Lebanon there is no national health service (or at least how we see ours) and hence payment is required for all medicinal and

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pharmaceutical supply from the pharmacy. The OPL strive to support and equip their members as best as possible but feel they lack the resources and experience to drive forward a truly high standard of consistent and credible professional practice throughout the country. Alarmingly, some pharmacists are even providing vaccinations without any regulated or formal accredited training – and for many years. Equally, antibiotics are freely available through the government appointed community dispensaries as part of everyday normal practice. In fact, everything apart from scheduled drugs can be obtained from these dispensaries – dispensaries which are not regulated. These dispensaries invariably operate without pharmacists and actually supply medication to patients! Storage requirements for vaccines in the community setting are not always adhered to also.

Within the hospital sector, one pharmacist could be singularly looking after a ward of up to 100 beds alongside other less qualified staff. There is no over-the counter listing for medicines as such.

It is along this dichotomy of challenges that the OPL are constantly striving towards reviewing and changing legislation made by the government in the best interest of the patient and healthcare provision.

I was honoured to present two talks to the Arab audience of more than 1500 pharmacists in the presence of the Minister of Health and the Prime Minister’s team of representatives. One of these showcased how the Royal Pharmaceutical Society (RPS) endeavors to reach out to its members in the UK to support its workforce in order to competently, effectively, and safely deal with the challenges of the extensive demands of the NHS. The other was promoting the new models of care and new roles of pharmacists where there is clear evidence of improved health benefits. Both talks emphasised the importance of practising legally at all times.

In light of this fantastic experience and the huge concerns openly aired in the UK with respect to our own healthcare system – the world reputed NHS, and our highly respected pharmacy profession, it was extremely rewarding and uplifting to find that that the President of the OPL and its senior committee members are now actively looking towards the Royal Pharmaceutical Society to provide appropriate advice and support. This is with a view to helping the pharmacists of Lebanon in terms of using a trusted system of accreditation and professional recognition such as that offered by the RPS through its Faculty and Foundation programmes. The OPL are driven to producing a pharmacy workforce that is suitably equipped, competent in their delivery, and confident that the service they provide

Key issues centred around improving patient care within the middle Eastern sub-continent by sharing and advocating the high class innovative practice of pharmacy now seen in the UK such as:

1. Incorporating pharmacists more fully into the delivery of urgent and emergency care to deal with people whose conditions could be treated elsewhere e.g. those for minor ailments and requests for emergency supplies of medicines but who use A&E services as a first and alternative source of healthcare Also by providing a national common (minor) ailment service through community pharmacy to reduce the unnecessary burden on GP waiting lists and doctor’s time.

2. For primary care patients, pharmacists can work more closely with the wider multidisciplinary team e.g. in diabetes with the local diabetes teams and refer patients to various secondary care services including cardiology, dermatology, weight management services, smoking cessation services.

3. Pharmacists working in GP surgeries are now providing extra help to manage long-term conditions more effectively by offering specific advice and where necessary carry out medicines reviews for those with multiple medications. Also for those at higher risk of developing diabetes and cardiovascular disease they can help provide better access to the necessary health checks.

4. Accessing full read and write patient health records for all pharmacists involved in a patient's care with the patient's consent – working towards the ideal of one single patient health record where all essential information is stored for a better and more effective integrated care across health and social care.

5. Pharmacists having overall responsibility for medicines and their use in care homes. Our professional body is now strongly leaning strongly towards having one pharmacist working alongside one general practitioner in each care home. Also to tackle the complex issues around polypharmacy and supporting medicines optimisation – the final goal is to improve patient safety by ensuring the delivery of coordinated and consistently high standards of care.

6. Managing long term conditions to provide direct patient care for example in arthritis, diabetes, cardiovascular disease, asthma with pharmacists – opportunity for pharmacists to train and make further use of their clinical skills by becoming prescribers.

is always one of highest safety and efficiency.

It is not surprising that since this visit both Jordan and Morocco are now looking towards showcasing our profession and the RPS at their annual conferences. There is clear potential for collaboration.

I have always been proud of my profession up to now, but this Lebanese relationship has made me doubly proud and even more appreciative of my own profession and the RPS – even away from home where English is not the first language. I would never swap my profession and would always fly the flag for the RPS and the NHS wherever I travel.

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Professor Monica Lakhanpaul Professor of Integrated Community Child Health, Programme Director, Children, Young People and Maternal Health UCL Partners.

UCL Great Ormond Street Institute of Child Health

Child Health

Healthy children lead to healthy adults. Any society which aspires to being successful needs to make sure that they invest in the early years of a child’s life, if not before. This article will talk about the issues around feeding practices for 6 months to 2 year old infants in the South Asian community with the aim of influencing the attention that needs to be taken if we are to prevent dental caries, diabetes, heart disease and obesity in adults.

up a disproportionate number of people with diabetes in the UK (Figure 2). Similar findings are seen in the risk of developing cardiovascular disease where South Asians with type 2 diabetes are 3 times more likely to develop cardiovascular disease. This is worsened by the fact that survival rates in these individuals are significantly worse compared to their European counterparts.

We believe these outcomes are linked to the infant feeding practices of South Asians with consequences that follow through during life.

Figure 2: Estimates of diabetes prevalence by ethnicity for England in 2010.

Error bars indicates the level of variability/uncertainty [6]

Background

When trying to improve health and wellbeing, working in partnership with the community and understanding social, cultural and religious beliefs that drive practices and developing solutions with families themselves is more likely to be successful than solutions led by health professionals only. This works for three main reasons. Firstly, having strong social connections and networks strengthens good health – after all, we all feel better having confided in a family member or shared moments with our friends. Secondly, collaborating together with the community in mind makes sure that any inequalities are addressed and tackled because there is power in unity. Thirdly, in collaboration, local assets and community resources can be used and if they were in use before, they can be used more effectively.

Figure 3: Spatial distribution of the dental caries (12-years-old) in the world according to quartiles Infant Feeding

Health Statistics amongst South Asians

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Despite the guidance provided by NHS healthcare professionals to everyone, a number of differences in ill health related to nutrition have arisen between South Asians and other ethnic groups in the United Kingdom. For example, obesity levels are amongst the highest in Bangladeshi children aged 4 – 5 years and 10 – 11 years of age. Dental caries are also extremely common in South Asia (Figure 3).

In addition, South Asians are 2 – 4 times more likely to develop Type 2 diabetes. In 2015, of the approximately 3.5 million people diagnosed with all types of diabetes in the UK, South Asian people comprised 11.2% yet only make up 4.9% of the total population. South Asians therefore make Asian Voice & Gujarat Samachar - 2017

Figure 4 below shows the relationship between breast, formula, complementary (weaning) and responsive feeding (baby-led).

Figure 4: Infant Feeding Practices

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After 6 months, the World Health Organization (WHO) advises that complementary feeding should be started with babies weaned onto more substantial foods. These should fulfil four main criteria: l l l

Timely: solid foods given in addition to breast milk at 6 months.

Adequate: the amount, frequency, consistency and variety of solid foods cover the nutritional needs of a child during breastfeeding.

Safe: measures are taken to minimize the risk of contamination with pathogens.

in India & Bangladesh that we’re intending to use in Tower Hamlets to tackle issues such as; 1) how food is prepared, 2) if parents can easily buy healthy foods which they can prepare, 3) where do parents get their information and advice from, and 4) how we can ensure families receive the best advice.

Figure 7: Women’s groups Figure 5: NEON UK Study Flow Diagram

A novel approach utilised in India and Bangladesh is the use of women’s groups; women meeting, discussing and arriving at their own solutions for improving infant feeding practices in their communities (Figure 3 and 4).

It is these innovative approaches that are blazing the trail

Figure 6: Women’s groups

Conclusion

Infant feeding practices amongst South Asians need to be addressed and improved. It is important that we work together in partnership with communities in the UK so that both infant feeding and the damaging effects of inequality and marginalisation are addressed.

The sooner we tackle the issue; the sooner we ensure both the short and long term health of South Asians in the UK and abroad from infancy to adulthood.

“The research [was funded / supported by] the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care North Thames at Barts Health NHS Trust. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.”

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The heart of South Asians

Dr Amitava Banerjee

Senior Clinical Lecturer in Clinical Data Science and Honorary Consultant Cardiologist, University College London, Trustee, South Asian Health Foundation

People of South Asian origin represent one of the world’s largest ethnic groups, with India’s population alone exceeding one billion. It is well-documented that South Asians are at particular risk of heart disease. In this article, I will review some of what we know and what can be done to improve cardiovascular health in the South Asian community.

Defining the problem

For at least 50 years, we have known that South Asians in the UK have higher rates of mortality from coronary heart disease than any other ethnic group.

Four explanations have been offered. First, the risk factors for heart disease (such as high cholesterol, diabetes, hypertension and obesity) are more common in this community. Second, South Asians may be more susceptible to these risk factors. Third, specific risk factors may be at play, such as insulin resistance, which underlies the high rates of diabetes in South Asians, or use of ghee. Finally, there may be fewer competing causes of death in middle-aged South Asians, such as comparatively lower rates of cancer.

In 2012, two experts from the South Asian Health Foundation(SAHF), Dr Justin Zaman and Professor Raj Bhopal, answered three key questions with the most up-to-date evidence:

1. Is the high rate of coronary mortality in South Asians a result of high rates of new cases or more severe cases with higher rates of mortality?

Contrary to earlier studies in the 1980s and 1990s, it appears that South Asians do not have more severe heart disease and may actually even have a better prognosis than white populations of coronary disease. However, the rates of incidence (“new cases”) are higher and therefore effective strategies will involve prevention of the risk factors underlying these new cases.

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1. Why are there ethnic differences, and are they the result of biology, healthcare or social circumstances?

First, there is currently no strong evidence of biological differences between South Asians and other ethnic groups to explain differences in rates of heart disease. There is no single specific gene identified which causes heart disease.

Second, there is no contemporary evidence to suggest that there are ethnic inequalities in access to or provision of cardiovascular healthcare services in the UK. Third, and most importantly, South Asians are themselves diverse, representing different behaviours, lifestyles and socioeconomic circumstances. The implication is that heart disease is caused by lifestyle factors wherever you live, irrespective of your ethnicity.

1. Is the cardiovascular health future for South Asians (and especially the UK-born second generation) any brighter than in their parents?

Despite several decades of large-scale efforts to raise awareness, there is little evidence to show improvements in physical activity, lifestyle change and health education in South Asian communities. The direct consequence is that the sons and daughters of the original South Asian

immigrants to the UK have not yet tackled the high cardiovascular risk which plagued their parents.

Practical solutions

The good news is that both at the individual and the community level, South Asians can take back control of their heart health.

Tobacco is bad news for the arteries and risk of heart disease, whether one smokes, snuffs or chews tobacco, and so needs to be stopped.

South Asians have a predisposition for diabetes with up

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to 25% of us affected. If you have symptoms of thirst, need to urinate either at night or very frequently, or if you think you are at risk, your Doctor can easily test for diabetes.

Tablets called statins are recommended if diet alone is insufficient to lower cholesterol levels. Excessive cholesterol builds up in the arteries and if it accumulates in arteries supplying blood to the heart, these arteries can block, leading to a heart attack (muscle death due to inadequate blood supply).

In a previous article in Asian Voice, the Chair of SAHF, Dr Kiran Patel, has defined a heart healthy diet:

1. Go for a Mediterranean-style diet, with lots of vegetables and fruits along with fish and small amounts of lean meat.

2. Include some wholegrain foods in your daily diet, for example, wholegrain cereals, granary bread, wholemeal Atta, brown rice.

3. Watch out for trans-fats in processed foods which can also raise your cholesterol levels e.g. hard margarine, pastry, cakes and biscuits, 4. Cut down on salt.

5. If you drink keep your alcohol intake within sensible limits.

6. Make the change to reduced-fat dairy products, e.g. semi-skimmed milk, low fat yoghurt and paneer from semi skimmed milk.

7. Use pure cooking oil, mono or polyunsaturated, rapeseed or olive oil (Pommace), sunflower or corn oil instead of ghee or butter.

8. Help not harm: Take only fruit, not sweetmeats to the temple.

Blood pressure should be controlled and can be reduced by adhering to a low salt diet and by following the other lifestyle measures, including increased physical activity.

The recommended physical activity level is 30 minutes of moderate activity, five times weekly. For South Asians, this is a particular area that needs improvement and gym membership does not have to be involved.

Instead, we need to organise our lives so that being active and healthy become easier.

A family history of heart disease or stroke should make you ask your Doctor to assess your risk of heart disease. If you already have heart disease, you must ensure you have access to all available treatments, ranging from medication to different forms of surgery.

People who do not ask for help have the worst prognosis.

It is crucial to keep taking medications as long as they are prescribed by your doctor, as they cannot reduce your risk of heart disease if you are not taking them.

Real change will only come at the population level.

SAHF is a UK charity which holds seminars and meetings in communities around the UK (the SACHE programme), discussing heart disease and led by healthcare professionals. Should you wish your community to benefit from one or several of these meetings, please contact us at Raj.Gill@sahf.org.uk.

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Elderly care homes -

time for change in Asian perception

Harnoop Atkar CEO, Oakland Primary Care

It is widely recognised that the elderly population in the UK is growing at a phenomenal rate. As one of the largest ethnic minorities in the country, people of Asian origin are no exception. That means those requiring elderly care in the Asian community is increasing at a rapid rate. However, aside from GP support, other types of specialised services offering care for the elderly are not regularly sought after by Asians.

This is due to a number of reasons but the most common is the deep-rooted family bond which has traditionally meant that care is provided within the home by the family. For most, sadly, due to the stigma associated with it, the very last option is to place their loved ones in a care home.

However, what if care homes did not have this negative connotation? Wouldn’t it be wonderful if care homes were places that would significantly improve the quality of lives of our elderly, and also the lives of the family care givers themselves? Perhaps that time is already here.

There are a number of care homes across the country that are not only delivering a high standard of care but have also created environments that are welcoming, warm and luxurious with amenities such as cinemas, fine-dining rooms, café/bistro areas and well-appointed rooms.

Respite care is normally provided by these homes. Respite care is a concept that is not widely understood but it simply means ‘short stay’. It allows individuals to stay at a care home for as little as one week. This may be because your elderly family member has recently had surgery and still requires care in an environment which can deliver it more effectively than at home. Or because the regular family care givers are away on holiday. This is a great way to introduce a care home environment for a short period, and can be the beginning of breaking barriers to how care is perceived in the Asian community.

Of course, other than perception of external care, there are other strong reasons preventing Asians from exploring care outside of the family environment. These include: language barriers, lack of appropriate food choices, lack of cultural sensitivity and the list goes on. However, issues faced by the elderly, such as dementia and loneliness are becoming increasingly prevalent in the Asian community and it is important that as a community we recognise that certain care requirements are best supported by care and 22

Asian Voice & Gujarat Samachar - 2017

Harnoop Atkar

clinical professionals rather than solely by family. Therefore it is important that we as a community start highlighting our requirements to care home providers so that these needs can be met.

This is especially so as times change and community attitudes towards care are being transformed. We are increasingly seeing Asian children moving away from home due to their own young family or work commitments, leaving parents without the traditional care support structure. And lack of information on how to get care can leave our elderly in a vulnerable situation.

There are organisations that have developed information geared towards Asian families, such as Alzheimer’s Society, which has been particularly effective.

However, more needs to be done in order to get information about the various forms of care which might be specific to the Asian community. Places of worship and community centres are key sources of information and can be instrumental in providing this so that people can be guided to various organisations across the care spectrum.

If you are in need of information on elderly care provision within a care home environment, I encourage you to find a quality care home in your area and speak to them about your family's care needs. They have an abundance of information and will be keen to help you.

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Child Health

Darshna Morzaria Little Darling Childcare

Fruit instead of Sweets

When we celebrate a birthday or wedding with our families, our minds turn to food – especially sweet food. Yet we all know that fruit is better for us, but a study by BBC’s Newsround found that 44% of the children surveyed don’t eat any. Not a single grape. This statistic is rather concerning given the invaluable role fruit plays in a child’s health, as not only does it provide them with lots of vitamins and nutrients, it also helps boost their precious little digestive and immune systems.

A 2008 Canadian study published in the Journal of School Health also uncovered a link between high consumption of fruit and better performance at school.

and mould their eating habits from an early age, and leading by example is a fantastic way to do this. The simplest method would be to make sure your child sees you eating fruit, but even better would be to sit and enjoy the fruit with them. This latter option means the act of eating fruit can become a joint, pleasurable experience rather than a (perceived) punishment that is being forced on only them.

My second suggestion is to make the lead-up to eating fruit a series of experiences you can enjoy together. For example: • Take your child fruit picking (choose something like strawberries because of their delicious smell and bright colour) • Turn food shopping with your child into an interactive experience by exploring the different shapes, colours, smells and textures of fruits • Prepare fruit together, allowing your child to do the washing of it so they have a ‘hands-on’ role in the experience • Get creative with presentation, encouraging your child to experiment with displaying different coloured and shaped fruits • Make eating fruit fun, perhaps by getting your child a ‘magic’ bowl that makes the fruit taste extra yummy, for example.

More information available in, ‘The Big Yummy Treasure Chest’.

Available at www.LittleDarling.co.uk/books or from online retailers.

Darshna Morzaria is an Ofsted registered childminder, author and member of PACEY. Contact her for advice on your childcare related issues. www.LittleDarling.co.uk or 07932 623 852.

So how much fruit should we be giving our little cherubs? Well, this is where things get a little hazy. Reports suggest that it is actually variety rather than amount that is key when it comes to fruit consumption. To provide a benchmark is therefore tricky; especially as children’s needs vary depending on their age/appetite/activity level.

I can, however, offer you three suggestions to help encourage your child to incorporate different fruits into their diet (accepting that you may break their heart when telling them that Fruit Shoots don’t count).

My first suggestion makes use of the fact that little ones are like sponges, soaking up everything we do. The downside to this, of course, is the dreaded moment we hear them repeat a profanity that slipped out when we didn’t realise they were stood behind us. The upside, however, is that we can try Asian Voice & Gujarat Samachar - 2017

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24-25-Osteoporosis.qxp_A4 Temp 12/01/2017 14:18 Page 24

Sarah Leyland

What is Osteoporosis

Osteoporosis Nurse Consultant at the National Osteoporosis Society

Osteoporosis is a condition in which bones lose their strength and are more likely to break, usually following a minor bump or fall. Broken bones are also referred to as ‘fractures’ (the words mean the same thing).

Fractures that occur because of reduced bone strength are described as ‘fragility fractures’ and many of these will be caused by osteoporosis.

One in two women and one in five men over the age of 50 experience fractures, mostly as a result of low bone strength. Although fragility fractures caused by osteoporosis can happen in various parts of the body, the wrists, hips and spine are the most commonly affected sites. Osteoporosis is also a term used to describe low bone density as measured on a bone density (DXA) scan.

This means your bones may have lost strength.

and in younger women and children is complex and generally a referral to a hospital specialist is recommended.

Your Bones Your bones have several functions. They give your body its overall structure and provide support and protection for your internal organs. They store calcium and other minerals and work with your muscles to allow your body to move.

They also contain bone marrow, which is where your blood cells are produced.

Although from the outside your bones look like simple, solid structures, they actually have a clever design that allows your skeleton to be strong without being heavy. Each bone is made up of two types of bone tissue: l a thick outer shell called ‘cortical’ bone l a strong mesh or scaffolding (like a honeycomb) inside the shell called ‘trabecular’ bone.

Both types of bone tissue are fed by a nerve and blood supply while fat and bone marrow (for blood cell production) fill the spaces. Some bones, such as the ends of the long bones in your arms and legs, and your spinal bones, have a high proportion of trabecular bone.

Who is affected by osteoporosis?

Women and osteoporosis Women are more susceptible to osteoporosis because bone loss becomes more rapid for several years after the menopause, when sex hormone levels decrease. In addition, women tend to have smaller bones than men and in general live longer, with loss of bone tissue continuing for longer, making fragility fractures more likely.

Men and osteoporosis Osteoporosis is not a condition that just affects women, although this is a common misconception. If you are a man, you might be thinking osteoporosis can’t affect you as it’s a ‘women’s problem’, but, in fact, one in five men break a bone after the age of 50 years because of low bone strength.

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Younger men and women and osteoporosis Younger men and women (before the menopause) can also, but more unusually, have osteoporosis and fractures.

Usually an underlying condition or reason is identified but sometimes no cause is found. The medical word for this is ’idiopathic’. If you are a healthy younger person who is frequently breaking bones, this can be particularly distressing. Diagnosing and treating osteoporosis in men Asian Voice & Gujarat Samachar - 2017

Bone tissue is made up of protein hardened by calcium salts and other minerals to make it strong.

Bone tissue is alive and constantly changes through life to make sure it remains as healthy as possible. Throughout each bone, older, worn-out bone tissue is broken down by specialist cells called osteoclasts and rebuilt by bonebuilding cells called osteoblasts. This process of renewal is called bone remodelling. In younger adults, up until about the age of 35 years, there is usually a balance between the amount of bone that is removed and the amount of bone that is laid down; repair and renewal are usually in balance and the total amount of bone tissue thus stays the same.

In childhood, osteoblasts work faster, enabling the skeleton to increase in size, density and strength.

During this period of rapid bone growth it takes the skeleton just two years to completely renew itself. In adults,

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this process takes seven to ten years. Bones stop growing in length between the ages of 16 and 18 years but the total amount of bone tissue you have (the thickness of the cortical shell and the trabecular bone inside) continues to increase slowly until your late twenties.

Bones & Osteoporosis

After the age of about 35 years, the difference between the amount of bone that is removed and the amount of bone that is laid down starts to get slightly out of balance as part of the ageing process. As a result, the total amount of bone tissue starts to decrease.

This is often described as ‘bone loss’ or ‘bone thinning’. It doesn’t mean your bones look any different from the outside.

However, inside, the cortical ‘shell’ thins and the struts that make up the inner structure become thinner and sometimes break down. This results in the holes in the honeycomb structure becoming larger – hence the description ‘osteoporosis’, literally meaning ‘porous bone’. This change in the quality of your bones is much more likely and more significant as you move into later life, which explains why bones become more fragile and fractures become more common in old age.

There are many other factors that can upset this balance of ‘bone remodelling’ and lead to osteoporosis, and these are described in our Are you at risk page.

Consequences of Osteoporosis

late seventies or eighties, although you may be younger.

This type of hip fracture typically occurs as the result of a fall. Like any fracture, a broken hip is painful and has an immediate impact on day-to-day living. Most people who break a hip are admitted to hospital and require an operation. If you are fit and well before your hip breaks, you should be able to look forward to independent living with appropriate physiotherapy and help from social services if you need it. As you get older, you may also be coping with other medical conditions, and making an uncomplicated recovery from an operation to mend your hip and getting back to your own home may be less easy. This is why it’s so important to try to do everything possible to prevent a hip fracture happening in the first place.

Spinal Fractures Fractures due to osteoporosis of the bones in the spine (vertebrae) usually occur in the lumbar (lower) or thoracic (middle) areas of the spine. They are often referred to as spinal or vertebral fractures. Bones become squashed or compressed because of their reduced strength. Sometimes they are referred to as ‘crush’, ‘collapsed’ or ‘wedge’ fractures, depending on which part of the vertebra is affected. ‘Compression fracture’ is a good way of describing these fractures. Back pain is the most frequent symptom of a spinal fracture; however, the degree of pain varies in different people, with many having no symptoms at all. Why this is so is not clear. In most people, spinal fractures heal over a period of 6–12 weeks and back pain if present tends to decrease during this time. However pain may persist for a longer period, particularly if you have had more than one fracture.

For more information about osteoporosis and keeping bones healthy visit the National Osteoporosis Society at www.nos.org.uk or call our Helpline on 0808 800 0035. The Charity provides information leaflets about osteoporosis in Bengali, Hindi, Gujarati and Urdu at www.nos.org.uk/publications

Although sufficient force (e.g., when moving at speed or falling from a height) will cause anyone to break a bone, if you have osteoporosis, broken bones are more likely to occur after even a simple fall.

If you are told you have ‘established’ osteoporosis, this means you are someone who has been diagnosed with osteoporosis on a scan and you also have fractures caused by osteoporosis. Bones affected by osteoporosis are not in themselves painful but the broken Bone density scanning bones that may result can cause pain and other problems.

Broken wrists A broken wrist can be the first indication that you have osteoporosis. Wrist fractures in women often occur soon after the menopause and typically occur following a fall, as people commonly put out an arm in an attempt to break their fall.

Broken hips The most common site for a hip to break is across the top of the thigh bone (fractured neck of femur). If you have broken your hip as a result of osteoporosis, you are most likely to be in your

A bone density scan, using a densitometry X-ray (DXA), measures how much ‘bone mineral’ is in the area being measured – usually, one hip and the lower part of your spine Asian Voice & Gujarat Samachar - 2017

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Macular Conditions

Cathy Yelf Chief Executive, Macular Society

Age-related macular degeneration (AMD) is a condition of the macula, a tiny area of the retina at the back of the eye.

Your macula is only about the size of the grain of rice, that’s about four millimetres across. It is responsible for nearly all our good, clear vision, so all the vision that we have in focus straight ahead of us. The fine detail of what we see and a lot of our colour vision is all the responsibility of the macula.

Types of Macular Conditions

There are two types of AMD, known usually as dry and wet.

Dry macular degeneration is a condition that comes on very slowly. It may be very many months or maybe even years before people lose their central vision. There's no treatment for dry AMD. Over time, people will lose their central vision. They will just have gaps in their vision. They will be unable to drive.

Getting out and about is often difficult and people lose their confidence as they can’t see.

The other form of macular degeneration is called wet. It is called wet because it's characterized by the growth of abnormal leaky blood vessels at the back of the eye. The leakage scars the macula and can cause a very sudden and dramatic loss of central vision. Wet AMD is much more aggressive, and fast-acting than dry AMD. If it is left untreated, sight could be lost within 2 or 3 months.

There are several drugs, which are now used to try to slow the progress of wet AMD. However, they only slow down the progress and cannot cure the condition.

There are many other types of macular conditions, which don’t necessarily affect older people, such as juvenile macular dystrophies and diabetic macular oedema.

Symptoms

If your macula becomes damaged, as it does in agerelated macular degeneration, then to begin with you would have some sort of blurred vision, or perhaps some distorted vision. Gradually, the photo receptors in the macula die and you lose all your central vision.

That means people with advance macular degeneration cannot drive read or recognise faces. It can be a very isolating disease and although you don't go completely blind it can be devastating for those affected.

AMD is the most common cause of sight loss in the UK, affecting more than 600,000 people, that figure is expected to more than double by 2050 to 1.3million – equivalent to 400 new cases every day. It is an urgent public health issue.

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Asian Voice & Gujarat Samachar - 2017

l l l

Macular degeneration affects different people in different ways. You may not notice any change in your vision during the early stages, especially if you have AMD in only one eye.

However, as macular cells deteriorate, your ability to see clearly will change: l Straight lines such as door frames and lampposts may appear distorted or bent l Vision may become blurry or develop gaps l Objects in front of you may change shape, size, colour or seem to move or disappear l Dark spots, such as a smudge on glasses, could appear in the centre of your vision l Colours can fade You may find bright light glaring and uncomfortable You may find it difficult to adapt from dark to light environments Words might disappear when you are reading

Risk factors

A lot of risk factors for AMD are quite similar to some of the risk factors with things such as heart disease and stroke, for example: high blood pressure, obesity, poor diet, smoking, lack of exercise, all those things that are bad for your general health are also very bad for your eyes.

If you smoke, you're 3 to 4 times more likely to develop macular disease. If you smoke and you have certain

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The Macular Society sponsored research by Dr Dominic ffytche of the Institute of Psychiatry in London into non-drug treatments for visual hallucinations. Dr ffytche recommends using eye movements to lessen hallucination impact and length. Eye movements activate visual parts of the brain in people with macular disease even if they have little remaining vision. These movements may stop certain types of hallucinations, particularly the grids, checkerboards, lattices and colours.

The Macular Society

genetic characteristics, then your risk goes up enormously.

You could be 20 or more times more likely to get macular disease if you have those certain genes and you smoke.

Smoking is incredibly bad for your eyes.

There's also some evidence that people who have a poor diet, low in antioxidants may be more be at risk with macular degeneration.

Visual hallucinations

Some people with sight loss experience visual hallucinations, known as Charles Bonnet Syndrome. Many worry unnecessarily that there is something wrong with their mind. It is important to understand that the hallucinations are a natural experience and not a sign of mental illness.

Up to half of all people with macular degeneration are thought to experience visual hallucinations at some time.

They are more likely to occur if both eyes are affected by sight loss. Charles Bonnet hallucinations can be simple unformed flashes of light, colours or shapes. However, many people see geometrical grids and lattices. Some people also report seeing landscaped gardens or vistas, animals, people, or other vivid images.

The Macular Society is the national charity for anyone affected by central vision loss. We have more than 22,000 members and, as the biggest membership group in the sight loss sector, we are the voice of people with macular conditions. We provide information and support to improve the lives of people with macular disease and to ensure no one has to face it alone.

We have around 300 peer support groups across the UK and beyond, all run by volunteers. Our groups offer practical and emotional support to people with macular disease from people with macular disease. They can help people to further understand their condition as well as come to terms with their sight loss. Members of our groups share information about treatment and tips about how to make every day living that bit easier.

Other services include a specialist helpline, as well as a free telephone counselling service.

Campaigning

The Macular Society campaigns for better care and funds medical research so that one day we will find a cure for macular disease.

Research into macular disease is very under-funded.

The Macular Society has launched a landmark report - Agerelated macular degeneration: collaborating to find a cure – which exposes the shocking lack of investment in AMD. Our report highlights the fact that of the £22.7m spent on eye disease medical research in 2014, just £6m was spent on AMD. It sets out the case for more funds to be allocated to scientific research to find better treatments and, ultimately, a cure for AMD. The report has been backed by many leading figures, including more than 60 of the UK’s top eye experts.

This is an urgent public health issue. Unless strong action is taken right away we will be facing an epidemic in the decades to come. AMD is almost as prevalent as dementia and represents a huge cost, care and societal burden, yet it does not receive a level of research funding proportionate to its impact.

Alongside the devastating personal consequences of sight loss, AMD costs the UK £1.6bn annually. The drug costs alone are now more than £200 million a year and the number of people with AMD is expected to double by 2050.

Our report hopes to bring together researchers in a unified approach to AMD research, with the aim of securing a new funding model to support it.

To find out more about the work of the Macular Society visit www.macularsociety.org Asian Voice & Gujarat Samachar - 2017

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Dr. Mahendra G Patel PhD FRPharms FHEA

Mouth Cancer

Fellow of National Institute for Health and Care Excellence Director Mouth Cancer Foundation

As one of the country’s leading head and neck cancer charities, the Mouth Cancer Foundation, looks at the possible reason for the escalating statistics and illustrates how dental professionals and the general public may be able to do their part in tackling the problem.

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should also be checking themselves.

The Mouth Cancer Foundation has developed a quick and easy mouth cancer check which anyone can do at home, at any time on a regular basis. The charity recommends that a self-check is done once a month after teeth have been cleaned and by everyone over the age of 16 years.

The Bite Back at Mouth Cancer campaign is the Mouth Cancer Foundation’s latest life-saving initiative, encouraging members of the public to carry out selfexamination on their own mouth, head and neck area at least once a month. This simple check can be done in a matter of minutes by everyone in the comfort of their own home and will help save lives.

For many, the community pharmacist is often the first port of call for common and minor ailments. Pharmacists are easily accessible and can play a key role in the early identification of the potential signs and symptoms of mouth cancer. What at first may appear to be a simple mouth ulcer could be something more sinister if it lingers and exists beyond 3 weeks for example. The pharmacist is ideally positioned to effectively signpost patients with anything that may appear unusual around the mouth or head and neck area to their dentist or GP for further investigation.

Oral cancer was once a disease that affected the elderly, mostly male, smokers and drinkers. In the 1990s, the ratio of male to female victims was 5:1. 87% of all oral cancer cases were over 40. Today the disease is killing more women; the ratio is now 2:1 and affecting younger people.

Around 60,000 people in the UK will be diagnosed with In the very early stages mouth cancer over the next A brief screen for oral cancer includes this eight-step examination of the inside of the mouth mouth cancers are almost decade. In the UK, over 7,700 people were diagnosed with invisible making it easy to ignore. They are often painless Mouth Cancer in 2011 according Cancer Research UK. so it is important to be aware of the general signs and 50% of these patients presently die from oral cancer symptoms of mouth cancer as follows: within 5 years of being diagnosed despite treatment.

However with early detection, referral and intervention, l Sores, ulcers or white or red patches anywhere in the survival rates can increase to closer to 90%. mouth that do not heal within 3 weeks.

Not getting mouth cancer is better and risky life-style habits should be avoided. Tobacco use, is still considered l Lumps or swellings anywhere in the mouth, jaw or neck the main cause of mouth cancer. According to the World that persists for more than 3 weeks.

Health Organisation, up to half of current smokers will die of a tobacco-related illness – including mouth cancer. In l Difficulty in swallowing, chewing or moving the jaw or Asian communities, the traditional use of chewing betel tongue. quid (often with tobacco) is an additional risk factor especially among some Bangladeshi communities. l Numbness of the tongue or other area of the mouth.

Drinking to excess can increase the risk of mouth cancer by four times. Those who smoke and drink are up to 30 l A feeling that something is caught in the throat. times more likely to develop mouth cancer. The above habits are often associated with a poor diet which is linked l Chronic sore throat or hoarseness that persists more to a third of all cancer cases. than 6 weeks.

An increasing number of cases are now caused by the Human Papilloma Virus (HPV), which is transmitted through l An unexplained loosening of teeth with no dental cause. oral sex. Experts say, this could overtake tobacco and alcohol as the main risk factor within the coming decade.

Link: visit http://mouthcancerfoundation.org/getTo win the war against mouth cancers the general public involved/bite-back-mouth-cancer Asian Voice & Gujarat Samachar - 2017

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Prostrate Cancer

Prostate cancer is cancer that starts in the prostate gland, which is a walnut sized gland at the base of the bladder in men.

body or to the bones. It can also spread to other organs.

Symptoms of advanced cancer

Symptoms

Early prost0te cancer often has no symptoms at all.

If you do have symptoms they can be similar to those of other prostate conditions.

The symptoms include:

Passing urine more often You might find you need to empty your bladder more than normal during the day.

Getting up in the night You may be getting up a few times in the night to empty your bladder.

Difficulty passing urine It might be harder to empty your bladder than normal. This is called urinary hesitancy.

It might be difficult to start emptying your bladder or the flow might be weaker.

You might be straining to pass urine. Or it might stop and start when you do go.

Urgency You might often have a sudden strong urge to empty your bladder. And you may need to rush to the toilet.

Leaking urine You might find that you leak a little after passing urine.

Blood in urine or semen You may have blood in your urine or semen. This is rare.

Erection problems You might find it difficult to get an erection. This is uncommon.

What else can cause these symptoms As men get older their prostate gland enlarges. It is not normally due to cancer. It is a condition called benign prostatic hyperplasia (BPH). BPH doesn’t usually develop into cancer. But an enlarged prostate might sometimes contain areas of cancer cells.

BPH and prostate cancer have very similar symptoms, caused by the prostate gland pressing on the urethra. The urethra is the tube that empties out urine from the bladder.

About advanced prostate cancer Find out about advanced prostate cancer and how it might affect you.

Advanced prostate cancer means the cancer has spread from the prostate to other parts of the body. It is sometimes called metastatic prostate cancer. It most commonly spreads to lymph nodes in other parts of the

Find out about possible symptoms of advanced prostate cancer and when to see your doctor.

Advanced prostate cancer means that a cancer that began in the prostate gland has spread to another part of the body. If your cancer has spread you might: l feel very tired (fatigue) l feel generally unwell l have weight loss for no known reason These symptoms can also be caused by other medical conditions so might not be a sign that the cancer has spread.

Where cancer can spread The most common place for prostate cancer to spread to is the bones. It can also spread to the lymph nodes, liver and lungs and other soft tissues of the body.

A large tumour in the prostate gland can spread into or press on areas around the prostate, such as the back passage or urethra. The urethra is the tube which carries urine from the bladder to the outside of the body.

Symptoms You might have specific symptoms depending on where the cancer has spread to.

When to see your GP See your doctor if you notice a change that isn't normal for you or if you have any of the possible signs and symptoms of cancer.

Even if you're worrying about what the symptom might be, you shouldn't delay seeing them. Your worry is unlikely to go away if you don't make an appointment. It might not be cancer. But if it is, the earlier it is picked up the more likely it is that it can be treated successfully. You won't be wasting your doctor's time.

Asian Voice & Gujarat Samachar - 2017

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Try not to be embarrassed. What you tell your GP is confidential. Doctors are used to discussing intimate problems and will try to put you at ease.

Tell your GP if you are concerned about prostate cancer because friends or family members have the condition.

They can talk to you about the pros and cons of having a PSA blood test.

l l l

Ask the GP to explain anything you don’t understand.

Ask the GP to write things down for you if you think this might help.

Find out before your appointment if family members have had prostate or breast cancer.

Referral to a specialist Your GP should arrange for you to see a specialist (urologist) within 2 weeks if you have symptoms that could be due to prostate cancer, including a raised PSA level.

A urologist is a doctor who specialises in treating disorders of the urinary tract, including the bladder, kidney and prostate.

Getting the most out of your GP appointment It can be difficult to remember everything you want to say and ask when you see the doctor. These tips will help you get the most out of your appointment. l l l l

Tips Write down your symptoms including when they started, when they happen and how often you have them.

Write down if anything makes them worse or better.

Tell your GP if you are worried about cancer in particular.

Bring a friend or relative along for support - they could also ask questions and help you remember what the GP says.

Web content: Cancer Research UK www.cancerresearchuk.org 15th December 2016

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