Dear Doctor 2013 by kat.mccann

WELLBEING

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WOMEN’S HEALTH

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MEN’S HEALTH

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COMMON CONDITIONS

DEAR DOCTOR WITH DR CHRIS STEELE

DearDoctor CELEBRITY ANGELS

with Dr Chris Steele

In A s s o c ia ti o n w it h

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Lift Your Mood e

Natural Way

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Top Tips to deal with Disability

EAT WELL, LOSE WEIGHT

AUTUMN 2013

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GUEST EDITOR

Dr Chris Steele

THE ONE-STOP HEALTH MAGAZINE FOR YOU AND YOUR FAMILY

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contents

Contents 10. Dr Chris Steele interview The dedicated doctor reveals his most memorable career experiences, and tells us what drives him to keep going after so many years in the profession Common & Serious Conditions

14. Fight cold and flu

Protect yourself against colds and flu this winter with Dear Doctor’s top tips

16. Skin talk

From acne and eczema, to psoriasis and impetigo, we spotlight some of the UK’s most common conditions to get under your skin

20. The sinister suntan

Skin cancer is now the most common type of cancer among the Caucasian population

22. Diabetes: Are you at risk?

Detect the early signs of diabetes with Dear Doctor

26. BREAST CANCER: YOUR HEALTH IN YOUR HANDS

Diagnosis of breast cancer is on the rise, highlighting the importance of prevention

help you kick the habit for good

31. COELIAC DISEASE:

44. Bright eyes

Follow these tips to make sure your bones remain strong

46. Glad to hear it!

64. DON’T GET STRESSED, GET EVEN

Dr Chris is one of Britain’s most recognised coeliacs, but what else do we know about going gluten-free?

34. DEPRESSION: MORE THAN JUST FEELING LOW

How to distinguish between depression and feeling low Health & Fitness

36. Tell it to your heart

Take these simple steps towards a healthier heart

42. Ten benefits of stopping smoking Our list of tangible advantages will

Keep your eyes healthy with our selfhelp tips One in six people in the UK are believed to suffer from some degree of hearing loss. What should you do if you think you may be one of them?

51. Hair loss

Don’t fret about excessive hair loss. Dear Doctor gives you the facts

56. Eat well, lose weight, FEEL GREAT

Shed those unwanted extra pounds with a healthier diet and lifestyle

61. BUILD HEALTHY BONES

Body & Soul Get on top of stress before it gets on top of you

68. GET HEALTHY, BE HAPPY

A healthy mind and body make for a happy life. Holistic expert and therapist Gemma Clare shares her top tips on how to feel good

71. SUPPLEMENT YOUR HEALTH

Invest in your mental and physical wellness with these top moodenhancers, vitamins and supplements

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CONTENTS

PUBLISHER & CEO Kevin Harrington

remain diagnosed for many years. We take a look at this silent killer What You Should Know

102. WHAT SCREENING DO YOU NEED?

116 74. A HEALTHY RETIREMENT

Ensure your retirement is a healthy, happy one with these top tips Mothers & Babies

76. IVF: THE VERY LATEST

ADMINISTRATORS Linda Young, Jessica Samuels

Clinical research is at the forefront of the fightback against life-threatening and chronic diseases. Dear Doctor investigates

110. A MOBILE HOME

112. MOBILE MAKERS

87. DOES MY BABY NEED THESE TREATMENTS?

Dear Doctor investigates the vitamin K injection, antibiotic eye drops and the hepatitis B vaccine Parenting

89. RAISING A BRAINY BABY

The best ways to enhance your baby’s mind, from nutrition to activities

92. ADHD

ADHD is more than just ‘bad behaviour’. Symptoms include excessive inattentiveness, hyperactivity and impulsiveness that can be hard to handle Men’s Health

96. PROSTATE CANCER

Prostate cancer is the most common cancer in men in the UK, yet it can

DESIGNER Juliana Martinhago

105. LET’S GET CLINICAL

79. WHAT TO EXPECT WHEN YOU’RE EXPECTING

Your baby’s first six months

SENIOR DESIGNER Reneta Bozhinovska

PRODUCTION DIRECTOR Joanna Harrington

Living with a disability shouldn’t stop you from enjoying your home the way you want

85. UNDERSTANDING MILESTONES

FEATURE WRITER Kathryn McCann

Screening is essential to determine if there’s a need for further tests or treatment

Dear Doctor went in search of some of the latest treatments available

Dr Louise Howarth and Professor James Walker reveal what is happening throughout your pregnancy

EDITOR Annabel Ross

Reclaim your independence with the best home products on the market

116. GET OUT AND GO!

Don’t let your disability defeat your love for the great outdoors

118. MAGNETIC THERAPY

Do you suffer from chronic pain? Instead of reaching for the medicine cabinet, why not opt for an alternative treatment?

120. CLINICAL NEGLIGENCE A simple guide to legal action

123. GOING PRIVATE

Choosing private healthcare can supplement what is available on the NHS, and give you more choice and flexibility

126. A NEAT ENDING

Dear Doctor considers the emotional benefits and practical realities of prepaid funerals

127. PRIORITISE YOUR HEALTH

Ensure that you’re in optimum health with these top products and services

PRODUCTION COORDINATOR Helen Shaw

CONTRIBUTORS Dr Chris Steele, Eleanor Tucker, Jagoda Wachowska, Glenda McCauley, Emma Tonkin WITH THANKS TO Dr Chris Steele PUBLISHED BY Celebrity Angels 2013. © All rights reserved COVER IMAGE © RexFeatures

Dear Doctor with Dr Chris Steele Celebrity Angels Linton House 39-51 Highgate Road London, NW5 1RT Tel: 020 7871 1000 Fax: 020 7870 2010 For sales enquiries call: 020 7871 1000 All material in Dear Doctor with Dr Chris Steele magazine is wholly copyright and reproduction without the written permission of the publisher is strictly forbidden. The views expressed in this publication are entirely those of the authors and do not necessarily represent those of Celebrity Angels. The information in this publication is carefully researched and produced in good faith, however, neither the publisher nor the editors accept responsibility for any errors. The Celebrity Angels Series is published in the UK under licence by Damson Media Limited. Damson Media Limited is registered in England and Wales under registration no. 07869300. Disclaimer: Dear Doctor with Dr Chris Steele has been produced as a family health guide. It does not constitute professional medical advice. In no way does this publication take away your responsibility to seek professional medical advice should you have concerns regarding your health. Please visit your GP should you require professional medical advice.

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COMMON AND SERIOUS CONDITIONS | skin cancer

The

SinisterSuntan Many consider a healthy glow to be a fashionable accessor y – but could end up counting the cost. Skin cancer is now the most common type of cancer among the Caucasian population.

Did you know?

Basal cell ca rcinoma (B CC) is the most common fo rm of skin cancer, accounting for 75% of cases.

here are three common types of skin cancer, divided into melanomas and non-melanomas. The good news is that the most common types are non-melanomas, which are relatively easy to treat, slow growing and rarely spread to other parts of the body, posing only a small threat to life. However, malignant melanoma does pose a risk and is the most serious form of skin cancer. It is aggressive, fast growing and difficult to treat if not detected early enough.

Symptoms

Of the non-melanoma skin cancers, basal cell carcinoma (BCC) is the most common type, accounting for 75% of skin cancer cases. The majority of BCC’s are very slow growing and it is unlikely they will spread to other parts of the body. If treated at an early stage, they can be completely cured. They affect a type of cell within the top layer of skin (epidermis) and often start as a small, painless red spot or nodule, with a smooth surface and a waxy or pearl-like border. They may be itchy and bleed occasionally, developing into an ulcer that doesn’t heal. Often they are mistaken for another condition, namely a chronic rash such as ringworm or dry skin. Some can become more aggressive, and if not treated can spread into the deeper layers of the skin and even to the bones, making treatment difficult. BCC’s usually occur in middle or later life, and can recur in the same area of skin after treatment.

Melanomas have irregular edges and are usually more than one colour or shade.

One in five skin cancers (20%) in the UK take the form of squamous cell carcinoma (SCC), which is the second most common form of the disease. Usually SCC is slow growing

and prone to spread to other parts of the body if left untreated for a long time. The main symptom is an area of thickened, reddish brown scaly skin that develops into a painless, hard lump with an irregular edge. The lump forms a recurring ulcer, which doesn’t heal. Most people with SCC can be completely cured with straightforward treatment. Unlike these more common types of non-melanoma skin cancer, the symptoms of malignant melanoma begin with a change in the common mole and can spread much more rapidly through the layers of skin. Less

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SKIN CANCER | COMMON AND SERIOUS CONDITIONS

common than BCC and SCC, it affects around 11,000 people in the UK and tends to be much more resistant to treatment. If not caught early enough, or treated successfully, it can easily spread to the liver, lungs or brain. The main symptom is a noticeable change within an existing mole, or a quick growing, irregular dark-coloured spot which appears on previously normal skin. The mole will need to be checked by a medical professional straight

S p o t c h e c k:

If skin is burned or blistered the risk of developing skin cancer increases.

Spot the difference between a melanoma and a normal mole by using this handy ABCDE checklist:

PREVENTION & TREATMENT

Asymmetry – Melanomas will have irregular edges, and the two sides won’t match. However normal moles will be symmetrical (both halves look the same). Border – Melanomas are more likely to have an irregular border with jagged edges. Ordinary moles will have a welldeﬁned, regular border. Colour – Melanomas are usually more than one colour or shade. They may be brown mixed with black, red, pink, white or even a bluish tint. Normal moles will be a uniform shade of brown. Diameter (width) – Melanomas tend

to be more than 7mm in diameter. Normal moles are normally no bigger than the blunt end of a pencil (about 6mm across).

Evolving – The mole will change in size, shape and colour.

away if it starts to exhibit symptoms such as bleeding, itching, crusting, reddening and irregular edges. Unlike non-melanoma skin cancers, malignant melanoma can appear anywhere on the body, including under or along part of the nail.

IMAGES © 123RF

CAUSES

The number one cause of skin cancer is over-exposure to harmful UV rays either from the sun or from overuse of sunbeds. Although a suntan is seen to

BEWARE You could be more at risk if you have:

Fair skin that burns easily Lots of moles and unusual moles A family history of melanoma A weakened immune system provide the wearer with a rather healthy glow, it is actually a sign of damaged skin. It is thought that harmful UV rays can disrupt the normal cell-making process, causing damage that leads to cancerous changes. The nonmelanoma skin cancers BCC and SCC tend to be caused by prolonged sunlight exposure over many years, whereas the main cause of malignant melanoma is exposure to short periods of intense sunlight, which cause sunburn and blistering.

The best way to prevent skin cancer is simple: Avoid getting too much sun. A bit of sun is good for us; it provides our body with vitamin D – essential for healthy bones and teeth. However when our skin is burned or blistered, it is damaged and we become at risk of developing skin cancer. In order to avoid harsh sunlight it is best to stick to the shade between 11am and 3pm, cover up your head and body, apply a high-factor sunscreen regularly (minimum SPF15), and avoid sunbeds. Treatment for skin cancer will depend on how far the cancer has spread. Non-melanoma skin cancers can be treated by an operation, removing the affected area. If the cancer covers a larger area, radiotherapy or chemotherapy may also be used to kill off all remaining cancer cells. As these cancers tend to be slow growing, cure rates are high and deaths uncommon. On the other hand, because malignant melanoma is such an aggressive cancer, those affected will need to be looked after by a team of specialists. Again, treatment for the cancer will depend on how far it has spread. The melanoma will be removed and further operations may be needed if cancer cells remain. In order to ensure the cancer has not spread deeper, nearby lymph glands may need to be removed and examined. If a melanoma has already spread, further surgery or laser treatment may be advised. Chemotherapy and radiotherapy are sometimes used too.

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COMMON AND SERIOUS CONDITIONS | BREAST CANCER

Breast cancer: Your health in your hands

Breast cancer is the world’s most common cancer. The good news is that fewer people are dying from it, however diagnosis is still on the rise, highlighting the impor tance of prevention.

reast cancer is a disease that indiscriminately chooses its victims – young and old, men and women, small breasts, medium breasts and larger breasts; they are all potentially at risk. In fact, one in eight women in the UK will develop breast cancer during their lifetime, and every year 400 men are also diagnosed with the disease.

PREVENTION IS BETTER THAN CURE

All this goes towards highlighting the significance of prevention methods in the battle against cancer. “Checking your own breasts regularly is of vital importance because early diagnosis gives the best chance of successful treatment”, says Professor Gareth Evans, Consultant in Cancer Genetics at The Christie Clinic. It is estimated that 5 - 10% of breast cancers are inherited. The decision of Angelina Jolie to undergo a preventative double mastectomy this year (due to the fact the actress carries the ‘faulty’ gene BRCA1), has done much to raise the profile of breast cancer’s genetic risk. This particular gene elevates the risk of contracting breast cancer to around 87%. About one in twenty breast

cancers are linked to faulty genes BRCA1 and BRCA2, with tests and counselling commonly offered to people whose close family members have had the disease, to see whether they carry either of these genes. The biggest asset in the push for prevention, alongside self-checking, is breast screening. Currently all women aged between 47 – 73 years of age are invited for breast screening every three years as part of the NHS Breast Screening Programme. Screening has become a vital part of breast cancer prevention, diagnosis and cure as a result of early detection and treatment. “A recent review of the National Breast Screening Programme assessed that it saves around 1300 lives annually,” says Gareth. “NICE has called for more frequent screening for those at increased familial risk. MRI screening in women who carry mutations in BRCA1 and BRCA2 has been shown to be extremely effective when performed annually for women aged 30 - 49 years”.

RISK FACTORS

The biggest asset in the push for prevention, alongside self-checking, is breast screening. Currently all women aged between 47 - 73 years of age are invited for breast screening every three years as part of the NHS Breast Screening Programme.

Meanwhile a number of the known risk factors do not depend on genetics. According to Gareth: “The increase in breast cancer diagnosis is almost

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BREAST CANCER | COMMON AND SERIOUS CONDITIONS

Did you know

It’s though t that aro und 550,000 p eople are alive in the UK despite b e ing diagnosed with brea st cancer. DEAR DOCTOR WITH CHRIS STEELE 27

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COMMON AND SERIOUS CONDITIONS | Breast cancer certainly related to changes in diet and reproductive patterns associated with Western lifestyles.” Adult weight gain is a big risk factor which can potentially double postmenopausal breast cancer risk. Other big factors include: getting older, being female, being childless or having children later in life, starting your periods early or having your menopause late (e.g. after 55), not breast feeding when you have had children, and possibly taking hormone replacement therapy (HRT) for several years.

H e a lt h T i p Adult we ig

potentia ht gain lly postmen doubles op breast ca ausal ncer risk.

The first symptom of breast cancer most women notice is a lump or an area of thickened tissue in the breast. Other symptoms may include: A change in the size or shape of one or both breasts Discharge from either of your nipples (which may be streaked with blood) A lump or swelling in either of your armpits Dimpling on the skin of your breasts A rash (similar to eczema) on or around your nipple A change in the appearance of your nipple, i.e. it becomes inverted Pains in either of your breasts or armpits not related to your period

KEEP YOURSELF HEALTHY Your breast health is in your hands: Check yourself for lumps, maintain a healthy weight and exercise regime and attend your breast screening appointments. Consider genetic counselling if close family members have had breast cancer.

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If you notice any of the above symptoms, it is important that you get them checked by your GP as soon as possible. Earlier detection means earlier treatment and a better chance of survival.

Treatment

Treatment options for breast cancer are now very varied. The type or combination will depend on how the cancer was diagnosed and the stage it is at. There are also various types of preventative treatments for those who have the faulty genes BRCA1 and BRCA2. The first type of treatment for breast cancer is usually surgery. Options include a lumpectomy (removal of the tumor); a mastectomy (where the whole breast is removed) or lymph node removal if there is a chance the cancer has spread. Surgery is usually followed by chemotherapy or radiotherapy, hormone blocking treatments (i.e. oestrogen blockers like Tamoxifen), or certain biological treatments. The treatment will ultimately depend on the type of breast cancer. If the cancer is discovered after it has spread to other parts of the body (metastasis) the type of treatment provided may be different. Secondary cancer (advanced or metastatic) is not curable and

treatment aims to achieve remission (i.e. shrinking the cancer or making it disappear). “People at risk of developing cancer have other options, too,” adds Gareth. “Removal of the ovaries (oophorectomy), which produce eggs and hormones, has been shown to be effective at cutting the risk of developing the disease. However this is not a good option for women who want to have children later.” There are also drugs that can be taken to prevent cancer developing. This approach is called chemoprevention and relies on aromatase inhibitors (AIs) to block either the production or the action of the hormone oestogen, which breast cancer needs to develop. Each case is individual and unique, and will be treated as such by a team of experts called a multidisciplinary team (MDT). An MDT usually consists of an oncologist (a radiotherapy and chemotherapy specialist), a radiologist, a pathologist, a radiographer, a reconstructive surgeon and a specialist nurse. Many improvements have been made in the field of breast cancer management and treatment, however ultimately the end result will depend on early diagnosis and treatment, both of which are vital for beating the cancer successfully.

IMAGES © 123RF

Symptoms

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common and serious conditions | Gastric problems

Did you kn

ow?

Gluten c a found in n also be such as li non-foods p stamps a stick, postage nd some kinds of medic ation.

What is coeliac disease?

Coeliac Disease Dr Chris is one of Britainâ&#x20AC;&#x2122;s most recognised coeliacs, but what else do we know about going gluten-free?

Coeliac disease is a common digestive condition where a person experiences an adverse reaction to gluten, found in wheat, barley and rye. It is not regarded as an allergy or intolerance, but rather as an autoimmune disease. Coeliacâ&#x20AC;&#x2122;s suffer from an abnormal immune reaction to gliadin, one of the substances that make up gluten, when it enters their digestive system. The body releases antibodies, which cause the surface of the intestine to become inflamed, reducing its ability to absorb nutrients and digest food properly. The reason why the immune system in coeliac sufferers works this way is not entirely known, however experts believe that an increased risk comes from a mixture of family history and environmental factors. Wheat, barley and rye are found in a wide range of foods, including pasta, cakes, breakfast cereals, breads (most types), sauces (certain types) and ready meals (some types). Beer is also off-limits, as most beers are made from barley. Although, naturally, oats are gluten free, it is possible they may be contaminated by contact with other gluten containing grains in the growing, milling and production process. Additionally, some coeliac sufferers are allergic to the protein avenin, found in oats. Coeliac UK estimate that about 5% of coeliacs may be intolerant to avenin as well as gluten. However the good news is that for the remaining 95% of coeliacs, oats are safe to eat, with safety increasing over the last decade. A number of brands are currently working towards ensuring gluten-free oats are kept pure and free from contamination during manufacture. dear doctor with Chris Steele 31

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common and serious conditions | Gastric problems

Dr Chris says: “I suffer from coeliac disease and I’ve tested all of the glutenfree ranges available. I do have my favourites, but I believe you should test them all and decide what works best for you. Don’t forget that you can also get gluten-free ranges on prescription.”

What are the symptoms?

How is it diagnosed?

There are three steps to the diagnosis of coeliac disease and it is essential to maintain a normal diet containing gluten throughout the process: 1. Discuss symptoms with your GP. 2. Your GP may do a blood test, identifying any antibodies released during the body’s abnormal immune reaction to gluten. 3. Your GP will refer you to a

The only way of treating coeliac disease is by adhering to an exclusion diet.

gastroenterologist, a gut specialist doctor, for a procedure called an endoscopy, which involves a biopsy to detect the typical changes in the lining of the gut associated with coeliac disease, including inflammation.

How is it treated?

Unfortunately, the only way of treating coeliac disease is by adhering to an exclusion diet, cutting out all foods that contain gluten. When first diagnosed with coeliac disease, you will be referred to a dietician, who can provide guidance on a balanced diet without the protein. Cutting out gluten completely is extremely important, continuing to eat it will cause symptoms to return and can result

in long-term damage being caused to your health. Even a small amount of gluten consumed regularly could put you at greater risk of developing diseases such as osteoporosis and cancer in later life. Although it may all seem rather overwhelming at first, luckily there are plenty of diet staples that do not contain any gluten. These include: most dairy products, such as cheese, butter and milk; fruit and vegetables; meat and fish (unless breaded or marinated); potatoes and rice. After cutting the gluten from your diet, it can take up to two years for the digestive system to completely heal; however symptoms should improve within a matter of weeks.

images © 123RF

The symptoms of coeliac disease can range from extreme to mild, depending on the person. In mild cases there may be no noticeable symptoms and this can go unnoticed until the problem is detected when testing for another condition. However, the most commonly recognised symptoms include indigestion, bloating, abdominal pain, anaemia (loss of breath and tiredness caused by a lack of iron in the blood), changes in bowel habit (diarrhoea or constipation), loss of appetite, weight loss (but not in all cases), tingling and numbness in hands and feet (peripheral neuropathy), vomiting (more common in children), and alopecia (more common in adults). In more severe cases of coeliac disease symptoms can also include muscle spasms, and swelling of the hands, feet, arms and legs as a result of a build-up of fluid. Extreme diarrhoea can often occur suddenly at any time, including during the night, resulting in bowel incontinence (loss of bowel control).

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COMMON AND SERIOUS CONDITIONS | Depression

n o i s s e r p e D More than feeling low We all experience intense sadness from time to time. This could be a result of grief over the loss of a loved one, a par ticularly difficult breakup or a stressful work environment. However depression is different. WHAT IS DEPRESSION? According to NHS choices, “depression is more than simply feeling sad or fed up for a few days”. Symptoms range from lasting feelings of hopelessness and tearfulness, to a loss of interest in the things you used to enjoy. Many people with depression also have symptoms of anxiety, and feel guiltridden, irritable and intolerant of others, often without any explanation. Contrary to popular belief, depression also has physical symptoms, which include moving or speaking more slowly than usual, a change in appetite or weight (usually weight loss), constipation, unexplained aches and pains, a lack of energy or lack of interest in sex, changes to the menstrual cycle and disturbed sleep.

HOW IS it TREATED? If you suffer from these symptoms every day for more than two weeks, you should seek advice from your GP. Some of us still do not recognise that depression is a real illness, however it is not something you can simply ‘snap out of’ or dismiss. It needs

Depression is not something you can simply ‘snap out of’ or dismiss.

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COMMON AND SERIOUS CONDITIONS | DEPRESSION

Did ysyomuptoknmoswof? The re both depression a al and psychologic l. physica

specific treatment, and the type of treatment will depend on its severity. If you suspect that you may be suffering from depression, a chat with your GP will not only help you to diagnose the condition, but also establish what sort of depression you are suffering from and what treatment is best for you. There are no physical tests for depression specifically; it is most likely that your GP will carry out a physical check of your general health first, to make sure that there are no underlying medical problems such as an underactive thyroid ( a symtom of which is depression). Once other possible causes are ruled out, your doctor will ask you a lot of questions about how you feel mentally and physically to try and determine if you have depression and how severe it may be. It is extremely important that you are as honest as possible with your doctor, as the sooner you seek treatment, the sooner you will start to feel better. Once your GP has made a diagnosis, the next step will be formulating a treatment plan based on whether the depression is mild, moderate or severe.

IMAGES © ISTOCKPHOTO

HOW TO COPE WITH MILD DEPRESSION If diagnosed with mild depression, the good news is that your depression may go away by itself. The best treatment is to incorporate exercise into your daily routine –a proven aid in the battle against depression. Also, talking through your feelings with trusted confidents such as family, close friends or a local self-help group is also incredibly beneficial. This will help to

assure you that you are not alone, and there is plenty of support available out there. You doctor will keep a close eye on you during this period, and will monitor your progress in order to determine whether your condition has improved or whether you need further treatment. MODERATE DEPRESSION If after a few more weeks you find you still have mild depression, which is not improving, or becomes progressively worse, your GP may recommend a type of psychotherapy or ‘talking therapy’. The most common type is cognitive behavioural therapy (CBT), which teaches you how to overcome negative thoughts and challenge hopeless feelings. You could also undergo counselling or interpersonal therapy (IPT), which focuses on your relationships and the way you communicate with others. SEVERE DEPRESSION In instances of severe depression, your GP will prescribe medication in the form of antidepressants. Your doctor may also recommend a

combination of both antidepressants and therapy, depending on the severity of your depression. A combination of CBT, IPT or counselling together with an antidepressant, usually works better than just one of these treatments. A team of mental heath specialists including psychiatrists, psychologists, and specialist nurses will be on hand to monitor your progress and provide intensive specialist talking treatments.

R e m e m b e r!

Depression can range in severity from mild to severe.

Mild depression has some impact on your daily life. Moderate depression has a signiﬁcant impact on your daily life. Severe depression makes it almost impossible to get through daily life – a few people with severe depression may also have psychotic symptoms.

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Hair loss | health & fitness

HairLoss We all lose our hair – on average between fifty to a hundred strands a day are lost when we brush it or simply change our hairstyle. Excessive hair loss is different, it’s a medical condition and can affect both men and women.

air loss is normal and natural. This is our hair working through its growth cycle, and another one will soon replace it. However excessive hair loss is a medical condition, affecting both men and women, and can be extremely difficult to come to terms with. “40% of all women and 50% of all men will experience some form of hair loss in their lives,” says Chris Keeble, C.E.O of Pharma Medico. “There are many reasons for hair loss including genetics, hormonal changes, diet, stress, pregnancy and childbirth, health issues, reactions to certain medication and over-styling hair techniques.” Using harmful chemicals on hair, such as those found in certain dyes, also contributes towards hair loss. Natural products are much kinder to the hair. If you dye your hair regularly, it is much safer to use hair colour products containing natural ingredients to help keep hair as healthy as possible.

PATTERN BALDNESS AFFECTS BOTH SEXES

Both male-and-female-pattern baldness is due to genetics, inherited from either the mother or father’s side of the family. According to NHS choices, the condition manifests itself in different ways: “Male-pattern baldness begins with a receding hairline, followed by thinning of the hair on the crown and temples. Whereas femalepattern baldness can start as early as the late teens and the earlier it starts, the more severe the hair loss tends to be. The hair usually only thins on the top of the head and the first signs are a wider parting or a smaller ponytail.” Treating male pattern baldness is usually not necessary as it is a natural part of aging and poses no risk to your health. However baldness can be a distressing experience, for both sexes, and those who suffer from it may choose to take the topical medication minoxidil to treat it. Minoxidil works by prolonging the growth phase of

Male-pattern baldness begins with a receding hairline, followed by thinning of the hair on the crown and temples.

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health & fitness | Hair loss

Alopecia - what is it?

Alopecia is the general medical term for hair loss, and the most common types are called alopecia areata and scarring alopecia. Alopecia areata manifests itself as patches of baldness usually affecting teenagers and young adults, with six out of ten sufferers developing their first bald patch before they are 20 years old. The most likely cause of this type of hair loss is an underlying problem with the immune system. Like male-and-female-pattern baldness, it could be hereditary. The good news is that although it may be very emotionally upsetting, in many cases the hair grows back after about a year. The most popular treatment for this type of alopecia is a course of steroid injections, although it is also possible to use a steroid cream, gel or ointment. Hair growth can also be encouraged by a treatment such as immunotherapy, which involves stimulating hair growth through an intentional allergic reaction. Scarring alopecia, on the other hand, is hair loss that results from another condition such as discoid lupus (chronic inflammation and scarring) or lichen planus (an itchy skin rash). With this type of alopecia the hair follicle is completely destroyed, and the hair will not grow back. The most common causes of other types of hair loss include cancer treatment (chemotherapy), other types of medication and stress. These types of hair loss are temporary and should improve when medical treatment is finished, or on its own accord after some time has passed.

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will of all men and 50% rm fo e m e so experienc in s s lo of hair . their lives

If you are finding hair loss difficult to deal with, talk to your GP, who can best advise you on how to get help.

Emotional issues

There are various treatments for the physical symptoms of hair loss – minoxidil, steroid injections, immunotherapy and hair transplants to name a few. However in many cases the emotional symptoms of hair loss also need to be addressed. Sufferers of the condition may feel that in losing their hair, they have also lost an important or defining part of their identity, and this can be extremely distressing and difficult to deal with. “Hair loss and hair thinning, especially in women, can be extremely traumatic. Hair is a great part of who you are,” says Chris. “ It impacts on your femininity and sexuality, your confidence and self-esteem.” If this mind-set is left untreated, these feelings could ultimately manifest

as conditions of stress, anxiety or even depression. A recent study revealed that 46% of women suffering from hair loss did not know where to turn for help. If you are finding hair loss difficult to deal with, it is best to speak to your GP first, who can best advise you. They may suggest counselling, where you can discuss your fears and feelings with a trained therapist. You may also benefit from joining a support group, and spending time talking to others who are suffering from the same condition. A number of charities, such as Alopecia UK, have support groups and online forums where you can talk to others who are experiencing hair loss. For more information and support, visit www.alopeciaonline.org.uk

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hair, and is very effective, however for noticeable results you will have to wait for up to three or four months.

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18/10/2013 11:19

health & fitness | Weight control

Eatwell Loseweight Feelgreat Sometimes it really is as simple as it sounds – if you eat a balanced diet and get regular exercise you’ll be well on your way to a healthier lifestyle that’ll help you to shed those unwanted extra pounds.

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Weight control | health & fitness

hen it comes to weight loss, we’re often bombarded with so much information and advice that it’s easy for us to become overwhelmed before we’ve even started. Keep it simple. If you want to lose weight, all you need to do is encourage your body to burn more calories than it consumes. The best way to do this is to eat a healthy balanced diet and exercise regularly. If you improve your health, that will automatically lead to weight loss,” says Vivienne LoganReid, Director of Prodimed UK. “Don’t just think about cutting calories, think about what you are eating.” So what are you waiting for? Use these tips to help you to kick-start a change in your daily routine.

Check your BMI

Working out your Body Mass Index (BMI) will give you a good indicator of whether you’re a healthy weight for your height. To calculate, all you need to do is divide your weight (in kilograms) by your height (in metres) and then divide the answer by your height again to get your result. A healthy BMI score ranges between 18.5 and 25, while 25-30 is classed as overweight, and a score of over 30 is classed as very overweight. Being overweight can increase your risk of developing heart disease, joint problems, dementia, type 2 diabetes, fatty liver disease, sleep apnoea and many other conditions.

Body Mass Index Healthy: 18.5-25 Overweight: 25-30 Very Overweight: 30+

Drink plenty of water: Sometimes it’s difficult to tell whether you’re hungry or just thirsty. Many people confuse the two, so next time you feel peckish, help yourself to a cold glass

of water and see if that settles your craving before consuming unnecessary extra calories. Try herbal teas and sugar free cordials for a bit of added oomph. Always eat breakfast: How many times have we heard the words: “Breakfast is the most important meal of the day”? Skipping meals will inevitably leave you feeling hungry and more tempted to snack. Use breakfast

as an opportunity to get all-important fibre into your diet to promote good digestion throughout the day and, thanks to its bulky nature, it will help to keep you feeling full for longer. Make time for a healthy morning meal, like high-fibre cereal with skimmed milk and berries. Exercise daily: You need to burn calories by expending energy so find time to exercise regularly. Several dear doctor with Chris Steele 57

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HEALTH & FITNESS | WEIGHT CONTROL

30-minute bursts of anything from a brisk walk, to cycling, jogging, swimming or even dancing will get the cogs turning and kick-start weight loss. Keep a food diary: Make an effort to jot down what you eat day-to-day. You might be surprised at naughty habits you find and it’s a good way of keeping track of your calorie intake. Be honest though – you’ll only be cheating yourself if you’re not!

WHAT GOES INTO A BALANCED DIET?

Base your meals around fruit, vegetables and starchy carbohydrates: Overall, aim for 33 percent fruit and vegetables, 33 percent carbohydrates (rice, pasta, potatoes, bread, etc) 11 percent protein (meat, eggs and beans) 11 percent fat or sugar and 11 percent dairy (milk, cheese, yoghurt). Eat at least five portions of fruit and veg a day: They’re low in calories, packed with fibre and vitamins and help you stay feeling fuller for longer. “Always aim for a colourful plate at mealtimes,” advises Vivienne LoganReid. “A non-colourful plate often means high calories and a lack of nutrients that are essential to keeping you happy and healthy.” Eat at least two portions of oily fish a week. Learn to love mackerel, herring, sardines or tuna for their rich omega-3 content, which can protect you from heart disease and may also reduce the risk of you developing dementia and inflammatory illnesses such as rheumatoid arthritis. Cut down on salt: Too much salt can

To p fo od s t h a t h e lp fi g ht fa t:

Peppermint – Well known for its healing digestive properties, this helpful herb is at its best when brewed in hot water as a healthy alternative to tea or coffee.

Grapefruit

– One of the best fatﬁghting foods around, this ‘super fruit’ is high in ﬁbre and low in calories. It’s also a ‘negative calorie’ food, which means that the body uses more calories to digest it than it takes from the fruit itself.

Bananas

– Packed full of ﬁbre, bananas are a great way to help you stay fuller for longer as they release energy slowly. They also contain high levels of potassium, a well-known mood booster.

Salmon – Meat-based protein breaks down slower than that from veggies or grains. Lean meats or ﬁsh, such as salmon, will settle your stomach and help you to avoid late night snacking! Lentils

– Full of ﬁbre and a good source of iron, which means they’re a great way of boosting your metabolism. Perfect as an alternative to rice and pasta; try adding them to a warming winter stew for a lowcost midweek supper.

lead to high blood pressure, which puts you at higher risk of stroke and heart attack. Aim to eat less than 6g a day. Know your fats: Avoid trans fats found in processed foods such as cakes, biscuits and some ready meals. Keep saturated fat below a third of your daily intake (including eggs, dairy and meat) and switch to unsaturated fats including polyunsaturated fats found in sunflower, soya and corn and monounsaturated fats found in olive oil and rapeseed oil. Avoid eating too much sugar: It’s high in calories and rots your teeth! Be careful to spot high sugar content often hidden in the most unlikely of foods. For example, eating a salad is a healthy lunch option, but make sure the dressing isn’t loaded with sugar; if in doubt try making your own! Another culprit is dried fruit - in drying, it shrinks down causing the nutrient, calorie and sugar content to become concentrated. So be aware that a handful of raisins or banana chips could have a sugar content that doubles its fresh counterpart. Drink alcohol in moderation: That means just one alcoholic drink per day for women, and no more than two for men. The lowest in calorie choices include wine, beer, or liquor without mixers.

IMAGES © 123RF

Watch your calorie intake: Depending on how active you are, the body needs a certain amount of calories per day to keep going. The average man needs 2,500 calories a day (10,500 kilojoules), while the average woman requires around 2,000 calories (8,400 kilojoules). If you consume more calories than your body uses then, quite simply, you will gain weight.

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boby & soul | STRESS

Don’t get stressed, get even The demands of modern day life can be a balancing act - juggling career, relationship and money woes often leaves many us feeling stressed and unable to cope. But it only takes a few simple strategies to get a grip on stress, before it gets a grip on you.

tress is not a sign of weakness; it is a signal that we are under too much mental or emotional pressure. It affects how you feel, think, react to certain situations, and how your body works. Common signs of stress include sleeping problems, sweating, loss of appetite and difficulty concentrating. The psychological symptoms of stress can manifest as feelings of anxiousness, irritability or low self-esteem. You may have racing thoughts, worry constantly or go over things in your head. Day-to-day life may become more difficult as you find yourself acting unreasonably around others, drinking too much alcohol or losing your temper much quicker than before.

Triggers you may want to keep a note of include: The date, time and place of a stressful episode What you were doing Who you were with How you felt emotionally and physically Your reaction

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A result of our body’s natural response to a perceived threat, stress is not always a negative thing. It releases hormones, the ‘fight or flight’ response we need when coping with difficult or potentially dangerous situations. 64 dear doctor with Chris Steele

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STRESS | BOBY & SOUL

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However stress does become bad for our health when it is constant, and can cause serious illness if not addressed. The best way to tackle stress is to recognise the symptoms, and what triggers them, as early as possible. This will help you to manage stress more effectively, preventing you from adopting unhealthy coping methods such as smoking and drinking. Spotting the early signs will also help prevent the condition from getting progressively worse and causing serious health complications such as high-blood pressure or depression.

To p te n st re ss bu st ers There’s no ‘one solution fits all’ approach to cure stress. However there are some steps you can take to reduce the symptoms. Alexander Barani, of JASÖN® natural products shares his top tips for reducing stress:

Music – If you’re feeling overwhelmed by a stressful situation, try taking a break and listening to relaxing classical music. Playing calm music has a positive effect on the brain and can also lower blood pressure, and reduce cortisol, a hormone linked to stress. Friends

– Take a break to call a friend and talk about your problems. Good relationships with friends and loved ones are important to any healthy lifestyle, and there’s no time that this is more evident than when you’re under a lot of stress.

Perspective

– Try putting the problem into perspective by calmly talking yourself through it. Ask yourself why you’re feeling stressed out, work out what needs to be done to complete the task at hand and, most importantly, reassure yourself that everything will be OK.

IMAGES © 123RF

Laughter – Laughter releases endorphins that improve mood and decrease levels of the stress-causing hormones cortisol and adrenaline. Laughing tricks your nervous system into making you feel happy – try it! Herbal Tea – Sip green tea. It has less than half the caffeine of coffee and contains healthy antioxidants, as well as theanine, an amino acid that has a calming and soothing effect on the nervous system.

Diet – Stress levels and a balanced diet are closely related. Try to avoid the vending machine and plan ahead, keeping dried fruit and nuts at hand to snack on. Oily ﬁsh with high levels of omega-3 fatty acids have been shown to reduce the symptoms of stress.

Mindfulness – The concept of ‘mindfulness’ plays a large part in meditative and somatic approaches to mental health. From yoga and tai chi to meditation and pilates, these systems of mindfulness incorporate physical and mental exercises that help to prevent stress and promote calm. Try joining a class or buying a book on the subject.

Breathing

Exercise

– The advice ‘take a deep breath’ may seem like a cliché, but it holds true when it comes to stress.

For further information on JĀSÖN® natural care products visit www.jasonnaturalcare.co.uk <http:// www.jasonnaturalcare.co.uk> or call 0845 072 5825

For an easy 3 to 5 minute exercise, sit up in your chair with your feet ﬂat on the ﬂoor and hands on top of your knees. Breathe in and out slowly and deeply, concentrating on your lungs as they expand fully in your chest. Deep breathing oxygenates your blood, helps centre your body, and clears your mind.

– A short walk around the ofﬁce or simply standing up to stretch during a break at work can offer immediate relief in a stressful situation. Getting your blood circulating releases endorphins that can help to improve your mood almost instantaneously.

Sleep – Don’t underestimate the importance of a good night’s sleep. Remember to turn all electrical appliances off in the bedroom at least an hour before you get into bed to allow your brain to go into ‘sleep mode’. Sleep is one of the most effective stress busters and a lack of it is one of the key causes of stress. DEAR DOCTOR WITH CHRIS STEELE 65

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VITAMINS AND SUPPLEMENTS | HEALTH & FITNESS

Supplement

Your Health!

They say your health is your wealth, so why not invest in your mental and physical wellness with these top mood-enhancers, vitamins and supplements.

Malki Dead Sea Bath Salts

Malki’s Dead Sea Aromatherapy Bath Salts with Frankincense have therapeutic minerals along with aromatherapy oils and rose petals to help you to feel your stress just ﬂoat away. Also works to soothe tense muscles and rejuvenate your skin. £6.85, boots.com

Energising Tea

Keep your spirits and energy up the natural way with a special blend of rare single estate green tea with vitamin-rich bay leaves, invigorating ginger, pepper and cardamom, digestive cinnamon and revitalising catkins. Energising tea can also wean you off caffeine, help maintain healthy bones and also act as a natural painkiller. £15, consciousfood.co.uk

Stress Remedy Plug-In Diffuser

Stress Remedy is a de-stressing, calming and uplifting plug-in diffuser that can be used at home, in the bedroom to help you sleep, or at work. Contains a natural blend of Valerian and other calming essential oils (Vetivert, Basil Sweet and Sage). £20, hollandandbarrett.com

Mood Food ‘Bounce Balm’ Ginseng & Guarana

Used for thousands of years, Ginseng can be used to reduce stress, enhance vitality and boost your immunity. Combined with Guarana, known to speciﬁcally help people with insomnia, the capsules can ease fatigue and lift your mood. £12.99, hollandandbarrett.com

This exquisitely fragrant aromatherapy balm has been expertly blended with a range of mood-enhancing essential oils to lift your spirits, balance your emotions and soothe every day stresses and strains. Apply to the pulse points as required. £10, bfaromatherapy.com

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health & fitness | Vitamins and supplements

Mune Immune Support

Mune Immune Support is flavoured spring water, which is made from 100% natural ingredients known to support immune defence. Free from gluten, wheat, lactose, caffeine, added sugar, artificial sweeteners and preservatives, choose from two delicious flavours: Mune Original and Mune Revive. Each 330ml serving provides 50% RDA (recommended daily allowance) of vitamins B3, B5, B6, B9, B12, C, D3 and zinc – known to contribute to the normal function of the immune system and the reduction of tiredness and fatigue. £1.79 for 330ml, munehealth.co.uk

Optibac Probiotics

Walnuts

For daily wellbeing, this extra strength probiotic contains 20 billion live microorganisms per capsule, with some extremely well researched and documented strains – including Lactobacillus acidophilus NCFM. Supports your digestion, immunity and energy. Suitable for vegans. £22.49, optibacprobiotics.co.uk

Battling the winter blues or suffering from an afternoon slump in the office, walnuts are the ideal snack to get you through the day. Providing a source of zinc, iron and potassium, they are great for providing energy and keeping your vitamin and mineral levels at the recommended amount. £2.75 for 200g, hollandandbarrett.co.uk

Revive Active

Revive Active is a revolutionary health food supplement that includes 26 full and active ingredients. Its many benefits include increased energy, a boost to your immune system, an increase in your cardiovascular performance and anti-aging properties. It is delivered in one simple convenient sachet. £59.95 for a box of 30, reviveactive.com *Introductory offer of 15% off online purchase with promotional code CS15

Belle+ Rosehip syrup

Rosehip extracts may help modulate certain aspects of the immune system, act as anti-inflammatorys and even prevent kidney stones. Belle+ have created three nutritional rosehip syrups specially formulated to help maintain women’s health. Choose from vitamin D, iron or Omega 3. £5.75, phytacol.com

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BODY & SOUL | HEALTHY RETIREMENT

A Healthy

Retirement Finishing work and entering retirement is not an ending, but a new beginning. With work a distant memory, you have the freedom to simply enjoy life as you choose. Ensure your retirement is a healthy, happy one with these top tips.

Volunteer Non-profit organisations are always on the lookout for volunteers to contribute to keep their charity or organisation ticking over, from working in a charity shop to cleaning beaches. If you still want to keep active and stimulated through a form of employment, then perhaps this could be for you. Visit www.volunteering. org.uk for more on which volunteer work will appeal to you most.

Senior fitness classes

Gardening

Not only is gardening a brilliant way to lose unwanted calories, it is also a relaxing hobby that can be enjoyed outside in the fresh air. As well as plants and flowers, growing your own herbs and vegetables is a satisfying way to fill your time and (re)discover your green fingers.

Travel

If you’ve not had the privilege of travelling the world then now is the perfect opportunity. Visit new places and experience different cultures. An exploration of countries can keep you physically and mentally active. Plus, a lot of travel companies offer packages for seniors, which can ensure you get the most out of the experience for an affordable price. Or you could organise the trip yourself as the research and planning will provide stimulation and fulfilment. Elder Treks is a fantastic website to use for organising exotic adventures because they cater especially for travellers aged 50+. With concentrated tours in every continent, there will be something there for everyone. Call the UK hotline on 0808 234 1714 or visit www.eldertreks.com for further details.

A new hobby

Now is the perfect time to immerse yourself in a new hobby you’ve always wanted to take up. Whether it’s a physical exercise, like salsa or ballroom dancing, learning a language or taking up a new skill, many libraries and community colleges (who often host such activities) offer discounts for seniors. As a bonus, simply travelling to and from the classes will help you to get active in itself, while the classes will allow you to meet like-minded individuals. At some colleges, such as Ealing, Hammersmith & West London College, courses are free if you are a senior citizen, with a £20 enrolment fee. To find out more, call 0800 980 2175.

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Plenty of gyms and health centres around the country offer tailored fitness classes for seniors. The most popular courses are yoga, Tai Chi and water aerobics. You may be surprised to find out that even your local library may host fitness classes or excursions, including walks. The average price is usually less than £10 for a senior gym membership. At GlaxoSmithKline sports and social clubs seniors aged 65 and over pay just £9 for club membership. Contact 0800 221 441 for more details.

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PARENTING | ADHD

ADHD

Recognising problems, understandin treatments g

ADHD is more than just ‘bad behaviour’. Symptoms include excessive inattentiveness, hyperactivity and impulsiveness that can be hard to handle.

ttention deficit hyperactivity disorder or ‘ADHD’ as it’s more commonly known, is a condition affecting between 2 -5% of school aged children and young people, yet still remains shrouded in mystery.

DIAGNOSIS

Risk factors or contributing factors include learning difficulties and sleep disorders, however diagnosing the condition can be difficult. There is no simple test to determine the existence of ADHD, and since young children are often very active and easily distracted, the condition can exist, undiagnosed, into adulthood. “The key to diagnosis is identifying that the child is showing enough significant differences from their peers,” says Val Harpin, Consultant Paediatrician, NHS. “The difficulty is the jigsaw of putting the pieces together. Specialists have to consider factors such as genetics, social circumstances and birth information, putting this together with the actual symptoms displayed. It is a complex process, but where it is done properly, a diagnosis can become clear.”

ADHD mainly inattentive ADHD mainly hyperactive-impulse ADHD combined

span, making careless mistakes, being forgetful or losing things, unable to concentrate or stick at tasks deemed to be tedious or time consuming, being unable to listen to or carry out instructions, constantly changing activity or task, having difficulty organising tasks or struggling to settle.

Factors that are considered as ‘inattentive’ include: a short attention

Factors considered to be ‘hyperactive’ or ‘impulsive’ include

TYPES OF ADHD

ADHD is a condition that can be separated into three distinct subtypes, depending on symptoms. These are:

being unable to sit still, constantly fidgeting, excessive physical movement and talking, acting without thinking, interrupting conversations or having little or no sense of danger.

CAUSES

The exact cause of ADHD is believed to be a mixture of hereditary and environmental factors. It is recognised that a child is four or five times more likely to suffer from the condition if the

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vaccinations | mothers & babies

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There is osis. Boys are m . gir ls iagn ADHD d diagnosed than d, ly n lo o se u comm be becau usually ld u o c is Th ur is gir ls e behavio disr uptiv ble in males and a e c ly ti more no to have the main f tend e type o inattentiv ition. d the con parents are also diagnosed. “ADHD is a very genetic condition,” says Val. “ It’s not a straightforward genetic condition such as eye colour, but it does run in families and there are many genes involved. It is these genes which give an individual vulnerability.” Environmental risk factors for ADHD range from smoking, drug and alcohol abuse during pregnancy, to excessive exposure to television and being born prematurely. Neglect in the child’s environment can also be important, as exemplified in extreme cases by some children in Romanian orphanages.

Treatment

Unfortunately, there is no cure for ADHD, however careful monitoring and management of symptoms ensure that those with the condition can continue

to lead a normal day-to-day life. The most common treatments are medications such as methylphenidate, dexamfetamine and atomoxetine. These do not provide a cure, however they do reduce a child’s difficulties by providing relief from the symptoms. They help sufferers to calm down, manage their emotions more easily, become less aggressive and hyperactive, and improve their performance in school. Although ADHD can be difficult to diagnose, early treatment is imperative. Children with the condition may have problems socialising with others in school and find it hard to fit in, difficulties which can continue and become worse over time, potentially acting as a catalyst for further mental problems including stress, anxiety and depression. Another popular treatment, effective if provided alongside medication, is therapy. Therapies including psychotherapy and cognitive behavioural therapy (CBT) have proved useful in treating additional problems to ADHD, such as anxiety. Although not supported by

medical evidence, those with the condition may find that a healthy diet, supplements and regular exercise could improve their symptoms. Some foods such as sugar and caffeine are likely to aggravate hyperactivity, whereas intolerance to wheat or dairy products could enhance symptoms. Finally, family support is a crucial factor in successful treatment. According to Val: “It is important that the family and the child are given as much opportunity to learn about the condition and understand it. GPs and teachers should be the first port of call for a family to discuss any concerns and it is important for the professionals to have an open mind, really listen and try to understand just how difficult it is for the family and the child. Then the family should be given access to specialist services and if it is ADHD get the support they need.” dear doctor with Chris Steele 93

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men’s health | prostate cancer

ProstateCancer

Prostate cancer is the most common cancer in men in the UK, yet it can remain undiagnosed for many years. Dear Doctor reveals the secrets behind this silent killer.

symptoms may include painful urination or the need to pass urine more often. “If you are experiencing any possible symptoms of prostate cancer, you should make an appointment to see your GP or a urologist as soon as possible,” advises Mr Vijay Ramani, Consultant Urological Surgeon at The Christie Clinic. “These symptoms could be caused by many other conditions that are not cancer-related, but it is still important to get them checked.”

What are the risk factors?

Remember! Prostate cancer in a first degree relative (a father or brother) significantly increases a man’s risk of developing the disease himself (120-150%).

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MEN’S HEALTH | PROSTATE CANCER

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very year over 40,000 new cases of prostate cancer are diagnosed in the UK, yet there is still so much we do not know about this disease. In its early stages, many men find they do not experience symptoms, and often the first signs of the disease only become apparent when the prostate is large enough to affect the urethra – the tube carrying urine from the bladder to the penis. As a result some common symptoms may include painful urination or the need to pass urine more often. “If you are experiencing any possible symptoms of prostate cancer, you should make an appointment to see your GP or a urologist as soon as possible,” advises Mr Vijay Ramani, Consultant Urological Surgeon at The Christie Clinic. “These symptoms could be caused by many other conditions that are not cancer-related, but it is still important to get them checked.”

PREVENTION AND DIAGNOSIS

“The public focus should be on raising awareness of the possible symptoms so that men present themselves for diagnosis at an earlier stage, when treatment tends to be more effective,” insists Vijay. The most commonly used tests for prostate cancer are a combination of blood tests, a physical examination of the prostate (a digital rectal examination or DRE) and a biopsy. The blood test, known as a prostatespecific-antigen (PSA) test, measures the level of PSA and may help detect early prostate cancer. Unfortunately, unlike breast cancer, men are not routinely offered screening, as results can be unreliable. However Vijay believes that “men who are in good health and have a more than ten to fifteen year life expectancy should have the choice to be tested after appropriate counselling.” You can request to be tested for prostate

Sy m p t o m s Symptoms of prostate cancer may include:

Needing to pass urine more often, particularly at night Finding it more difﬁcult to pass urine or slow ﬂow Blood in the urine (although this symptom is unusual) Painful urination

The risk of prostate cancer increases with age, with most cases developing in men aged 50 or older. It has been shown that prostate cancer in a firstdegree relative (a father or brother) can significantly increase a man’s risk of developing the disease himself (120150%). It is also linked to breast cancer, with evidence that a man is 19¬-24% more likely to develop prostate cancer if his mother had breast cancer, and if the genes BRCA1 and BRCA2 are present. Several other genetic variants appear to increase likelihood, and research is ongoing into identifying more. However most cases of prostate cancer occur by chance.

WHAT ARE THE RISK FACTORS?

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clinical trials | what you should know Each trial is unique; some will need people with a specific disease or condition, while others enrol healthy people to test new approaches to prevention and diagnosis.

LetsGetClinical Clinical research is at the forefront of the fightback against life-threatening and chronic diseases. Dear Doctor investigates.

clinical trial or medical research study is a carefully designed and supervised test of new medicines and treatment options. Study participants, who must meet the eligibility criteria, volunteer to undergo these tests in a hospital, clinic or doctor’s office. Each trial is unique; some will

require people who have a specific disease or condition, while others enrol healthy people to test new approaches in prevention, diagnosis and screening methods. “We need clinical trials to find out whether a new treatment works better than the treatments already in use, and to work out what its side effects are,” says Dr Arkenau, Medical Director at Sarah

Cannon Research Institute. “Scientists must answer these questions before a drug can be licensed and given to large numbers of patients.” On the other hand, it could be that the medicine is already being used by doctors, but is being tested for its effectiveness in dealing with a new disease, or as a possible new dose or combination. dear doctor with Chris Steele 105

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what you should know | clinical trials

The type of clinical trial patients undergo will depend on which ‘phase’ it comes under. There are four different phases in total, ranging from the earliest stage in testing to the last stage: Phase I – Preceded by extensive laboratory research, these are the earliest trials in the life of a new drug or treatment and are carried out to establish the safe dose range, the side effects, how the body copes with the drug and if the treatment shrinks the cancer. Phase II – Not all treatments in phase I trials make it to phase II. These aim to find out if the new treatment works well enough to test in a larger phase three trial, more about the side effects, how to manage them and the best dose to use. Phase III – These trials compare new treatments with the best treatment currently available. They may compare a completely new treatment with the standard treatment. Phase IV – Phase four trials are done after a drug has been shown to work and has been granted a licence. These trials focus on the long term risks and benefits, how well the drug works when its used more widely than in clinical trials and more about side effects and safety.

Protections and regulations

Each clinical trial will follow strict scientific standards; in order to protect patients against possible risk and to ensure the study results are as reliable as possible. Existing protections include strict rules set by the Medicines and Healthcare products Regulatory Agency (MHRA), an executive agency of the department of health. Every participant is closely monitored with medical tests and examinations before, during and after treatment or medicine is administered. An ethics committee (EC) made up of healthcare professionals and non-medical

Clinical trials are often the first stage in the battle against life-threatening, chronic and incurable diseases.

members will ensure the trial is ethical and the highest standards of safety are maintained. Other safeguards are also in place. “In the NHS, some hospital trusts won’t let their doctors use new drugs before they are approved by NICE (The National Institute for Health and Clinical Excellence)”, says Dr Arkenau. “NICE looks at the evidence on how well the drug works, and how safe it is, as well as its cost effectiveness. Sometimes, this can take a long time, although NICE have introduced a ‘fast track’ process to evaluate drugs more quickly.”

A personal approach

Clinical trials are often the first stage in the battle against life-threatening, chronic and incurable diseases such as cancer. There are differing schools of thought when it comes to which approach is the best one, however those at the Sarah Cannon Research Institute believe that personalised medicine is the best way forward for drug development in regard to cancer. “No two cancers are identical; the

Each clinical trial will follow strict scientific standards; protecting patients against possible risk genetic characteristics of a cancer vary from one patient to the next.” Explains Dr Arkenau. “So, even patients with the same type of cancer will respond differently to the same treatment – if they have a different genetic makeup. We’ve always believed this is the way forward.” The latest developments in personalised medicine include fewer invasive procedures when extracting tissue for testing, and quicker analysis of complex data in relation to drug characteristics. In the meantime, clinical trials will continue to push forward with further developments and breakthroughs.

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Types of trial

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WHAT YOU SHOULD KNOW | A MOBILE HOME

AMobileHome Living with a disability shouldn’t stop you from enjoying your home the way you want. Dear Doctor investigates the help available.

our home is a place where you ought to feel relaxed and at your most comfortable - free to move around and do as you please. Those coping with a disability may feel restricted and increasingly dependent, frustrated and upset by difficulties faced from previously straightforward tasks. However, this needn’t be the case. There is plenty of support and help available out there to ensure you can create a much more mobile home.

ADAPTING

The first stage towards domestic bliss will be an assessment by a professional, usually an occupational therapist, from a hospital or sent by social services. Occupational therapists work with people of all ages to assist them in overcoming the difficulties of living with disability caused by aging, accident, physical

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There is plenty of support and help available out there to ensure you can create a much more mobile home

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To p T ip s Fo r M o b ilit y For those with limited mobility or poor vision, a portable or permanent ramp should be installed at the front door. Ramps should have handrails, a non-slip surface, and unexposed edges. In the home, the focus should be on the ability to move freely from room to room and from downstairs to upstairs. Ramps can be used where necessary, with mini-ramps in doorways. Hallways should be kept clutter-free. Fit handrails around the home, at a height that suits. An occupational therapist should be able to help with this. Ideally everything the individual needs should be on the ground ﬂoor, however if there are stairs, consider adding a stairlift or handrails depending on the severity of the disability.

Doorways should be wide

enough to accommodate two people at a time, providing enough space for a wheelchair, or for someone to provide assistance. If the individual suffers from dementia, it is best to avoid doors that are self-shutting or lockable on the outside; they can become confused and distressed if the door shuts and they are locked in.

or psychological illness. This begins in the home, and can range from small jobs such as grab rails or half steps, which encourage a feeling of independence, to extensive changes such as separate wheelchair access. There are plenty of options for adapting your home. In the kitchen, for example, you can install a halogen hob, fit pullout worktops and foldaway

Grab rails or half steps encourage a feeling of independence.

ironing boards, and buy easy-to-use handles for cupboards and drawers. Appliances such as the washing machine and dishwasher can be positioned within easy reach, and worktops can be lowered to 10cm below the elbow. In the bathroom, you can put down non-slip flooring, install grab-rails for the shower and bath, and purchase adaptors to raise the height of the toilet. It is also worth considering an electric shower or thermostat, so water can be easily monitored and fixed at a safe temperature. For split-level houses, stairlifts are a great option.

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A mobile home | life starts at 60

“Installing a stairlift provides the user with freedom and independence, says Lea Dobby, Managing Director, Otolift Stairlifts LTD. “Many of our customers have had to resort to sleeping downstairs and using commodes as they can’t access bathrooms and bedrooms. A stairlift installation can become the difference between being re-housed into a bungalow to being able to stay in your own home.” It’s easy to feel overwhelmed, but social services, your local council and the environmental health department are all on hand to provide the assistance and support you might need; they have the facilities and the budgets to help as, depending on your disability, adaptations needed in the home can be extensive and very costly. The more work that needs done, the longer it may take to have it approved and carried out. For major changes, it is important to get all the help you can ¬– usually in the shape of a disabled facilities grant or a low cost loan from one of the providers mentioned above.

Did you

know?

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Funding

A disabled facilities grant can be up to £25,000 per home for those necessary improvements, but is usually means tested. For those who can afford the cost, it is still worth bearing in mind that some work to increase mobility, such as installing a lift between floors or increasing wheelchair access by adding a ramp, can be done at a VAT rate of zero. This will save 17.5% on the overall cost, which can be quite a significant saving on an extensive overhaul to mobilise your home. The cost will also depend on whether you are planning a house move within the next few years, or whether you have no plans to move at all. If you can see yourself staying put for the foreseeable future, it is worth investing in the best quality materials to transform your home, such as wheelchair ramps made of concrete, for example. On the other hand, if you are thinking of moving home, a material such as wood is a cheaper, less permanent option. dear doctor with Chris Steele 111

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WHAT YOU SHOULD KNOW | A MOBILE HOME

MobileMakers Reclaim your independence with the best home products on the market. Grab bars

Lightweight Transit Wheelchair

Grab bars by Mira Showers ensure safety when showering and facilitate independent living. Made from premium stainless steel, the grab bars, which are available in three different sizes, also come with quality grade stainless steel fixings to ensure durability. mirashowers.co.uk

The Lightweight Transit Wheelchair has been designed with maneuverability and quality in mind. Constructed to an excellent standard, it is packed with a host of useful features; including cable brakes, a built-in lap belt, and swing away footrests. betterlifehealthcare.com

The Otolift ONE The Otolift ONE stairlift is designed for narrow and steep stairs. This stairlift can be placed along the inner curve of your staircase, while the stairs remain safe to use. Perfect for narrow, steep staircases, you can even keep your banister. A high quality finish whilst remaining sturdy and reliable, this is functionality in its most elegant form. otolift.com

The Advance ATL Flex Endorsed by the Royal National Institute for the Blind, due to its usability and safety features. These include tactile raised areas, a large colour contrasted rotary lever with a large loop, a large on/off button, backlit buttons and an audible click on the temperature lever. A phased shutdown flushes hot water from the tank, making it safe for the next user.

Dycem non-slip mats Dycem non-slip Mats are the ideal kitchen companion, enabling independent cooking and dining. Effectively gripping items in place and holding them up to a 45-degree angle to prevent any possible spillages. Circular mats are available in 14cm or 19cm diameter, or rectangular at 18cm x 25cm, 25cm x 35cm or 38cm x 45cm. dycem-ns.com

mirashowers.co.uk

Bellavita Ultra Light Bath Lift The Bellavita is an ultra modern bath lift, lightweight at only 9.3 kg and available at 6cm seat height, it is designed for the users ultimate comfort and safety. It has built in safety controls and a lightweight, fully waterproof floating hand control. Easy to install and dismantle for storage and transportation purposes. betterlifehealthcare.com

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18/10/2013 12:13

what you should know | mobile outdoors

Personal Independence Payment The government has started to replace Disability Living Allowance (DLA) for eligible people aged 16 to 64 with Personal Independence Payment (PIP) from 8 April 2013. PIP helps towards some of the extra costs arising from a long term ill-health condition or disability and is based on how a person’s condition affects them in their day-to-day life, rather than the condition they have. It is neither meanstested, nor subject to tax and is payable to people both in and out of work. The weekly rate paid under PIP will be no different to that paid under DLA, and is made up of two components, a daily living component and a mobility component.

Get out and go!

Don’t let your disability defeat your love for the great outdoors.

uffering from a condition such as arthritis, back or spinal troubles, leg, knee, hip problems or a poor heart shouldn’t impede on your ability to go out and about unaided. There are plenty of options available, whatever your needs and budget, from Wheelchair Accessible Vehicles (WAVs) to scooters and powered wheelchairs. These give disabled people back their freedom – whether it’s getting to work, meeting up with friends, enjoying a day trip or going shopping – so they are able to enjoy the independence most of us take for granted.

A new car

The most popular option is often a new car, with specific adaptations to help with mobility. The adaptations will depend on the type of disability, but some of the most popular include automatic transmission, hand controls, pedal modifications and steering wheel balls. Many cars can also be fitted with a lift for scooters and powered wheelchairs. Infa Red Hand Controls – This enables the driver to operate a vehicle’s secondary functions at the touch of a button. Secondary functions include indicators and hazard lights,

horn, windscreen wipers and washers, headlights and fog lights. Quick release pedal guard – These stop accidental use of the brake or accelerator pedals and prevent feet or prosthetic limbs from becoming trapped underneath. Push pull hand controls – These are specially designed for people who are unable to operate the foot pedals in automatic vehicles. To operate, you simply pull the handle towards you to accelerate, release the handle to decelerate, and break by pushing the handle away.

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WHAT YOU SHOULD KNOW | MOBILE OUTDOORS

Did you k

now?

Some adaptatiof the most p o o automans for car s in pular clude tic tran smis han modiﬁcd controls, pe sion, dal ations wheel and steering balls.

Steering aids – A tetra driving aid enables the user to turn the steering wheel by using their wrist, while a steering wheel ball enables safe onehanded steering.

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THE MOTABILITY SCHEME Purchasing a new car or adding adaptations to an old vehicle is a costly process, as is the choice to buy either a scooter or powered wheelchair. Although these are essential items for increased mobility, many may be put off by the price. However fortunately there are affordable options to suit almost any budget. One of these options is the Motability Scheme, which has helped millions of people with a diverse range of disabilities to lease a new car, scooter or powered wheelchair, using their Government funded mobility allowance.

HOW IT WORKS

The Motability scheme works with 33 leading car manufacturers, who help to provide the choice of 2,000 makes and models. Customers can order their car through any one of 4,500 Motability dealer partners across the UK. The process is entirely online, minimising paperwork. Trained Motability specialists in dealerships look after customers’ needs, supplying the car and offering after-sales support. Your Disability Allowance (DLA) is yours to spend as you please, and whether you purchase a more expensive model is entirely up to you. Motability currently offers around 450 cars that cost no more than the weekly disability allowance, and almost 200 of these cost less than the allowance, giving customers money back to spend as they wish.

If a product costs more than the customer’s weekly allowance, they can top it up with an upfront payment, known as an Advance Payment. This represents the difference between the amount their allowance covers over the three-year agreement period and the overall lease cost of the car they choose. New WAVs are leased through Motability on a standard fiveyear agreement. The cost of the lease includes insurance, road tax, servicing, tyres and breakdown cover. For customers who would otherwise be unable to afford the type of vehicle they need for their disability, Motability may be able to offer financial help towards an Advance Payment. Most scooters and powered wheelchairs cost less to lease per week than the mobility allowance, so the remainder of the allowance continues to be paid direct to the customer. The cost of a Motability scooter or powered wheelchair includes insurance, breakdown cover, maintenance, servicing, tyre or battery replacements.

G o w ri n g s M o 5 0 y e a rs o bf ilwit y c e le b ra t e s a c c e s s ib le v ehhe e lc h a ir ic le s . As the original convertor of wheelchair passenger vehicles, with 50 years history, Gowrings Mobility thoroughly understand the needs of the wheelchair passenger. The conversions available from Gowrings Mobility including the Vauxhall Zaﬁra, Fiat Doblo and Citroen Berlingo offer discreet, stylish, comfortable and reliable mobility vehicles. Whatever your needs Gowrings Mobility personal mobility advisors will ensure you select the optimum vehicle.

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18/10/2013 12:21

WHAT YOU SHOULD KNOW | Magnetic therapy

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Magnetic Therapy t is widely accepted that conventional painkilling drugs like paracetamol and ibuprofen have many weaknesses. Although used to treat a wide range of ailments, they still only manage to block pain, unable to treat its cause. Painkillers are only effective for a short period of time, usually lasting between 4-12 hours; depending on the type of painkiller, where they interrupt the pain pathway and the strength of the drug.

Magnets Vs pain

These particular shortcomings, not to mention a fear of dependency on drugs as a cure, has led many to seek out other, more alternative forms of therapy to help relieve chronic pain and inflammation. One such option lies in magnetic therapy, where magnets are placed directly over a major artery such as the radial artery (the wrist pulse point) or the carotid artery (the pulse point in the neck). It is believed

that when therapeutic magnets are placed on the skin, the magnetic field penetrates through it, into the surrounding tissues and blood stream. The iron in the blood is attracted to the magnetic field, promoting increased movement within the blood stream and, as a result, blood flow is improved. When the bodyâ&#x20AC;&#x2122;s blood flow, and thus oxygen level, is increased, nutrients and hormones are distributed to organs and tissues in the body much more effectively and quickly. A fresh, rich supply of oxygen and nutrients work to deeply nourish, while hormones, including endorphins (the bodyâ&#x20AC;&#x2122;s natural pain killer) are absorbed. This leads not only to a reduction in pain, but also a faster healing process.

Targeting the cause

Unlike conventional painkillers, magnets work on the cause of the hurt by targeting inflammation and swelling

that causes pressure on the nerves and sends constant pain signals to the brain. The magnetic field penetrates through the skin and deep into the tissues and blood stream. This begins the process of eliminating the excess fluid from within the cell, reducing swelling, preventing further cell damage and kick-starting the healing process. Magnets are usually worn as bracelets or necklaces, but can also be used as knee or back support. It is possible to wear more than one magnet at once; with the most important element being its location. The location of the magnet is of paramount importance to healing and pain relief. In order to maximise the success of magnetic therapy, the magnet must be placed over a major artery to allow for a much larger perfusion of blood flow. If not, the increase in blood flow will remain localised to the area where the magnets are placed, limiting their effectiveness.

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Do you suffer from chronic pain? Instead of reaching for the medicine cabinet, why not opt for an alternative treatment?

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18/10/2013 14:14

WHAT YOU SHOULD KNOW | CLINICAL NEGLIGENCE

Clinical Negligence

A simpl to legal e guide action

Your doctor has a legal duty of care to you as a patient. If they breach this legal duty, you could have a case for clinical negligence. practices or improve standards, it can not discipline a health professional, nor make them apologise. Anthony Wilson, Senior Lawyer, Your Legal Friend, says: “Any patient who seeks medical treatment and puts their complete trust in healthcare professionals should be protected by the law. However you need to demonstrate that not only was there negligence in the first place, but also that any health problems or negative impact on the patient’s life that occurs later were definitely caused by that negligence. Without the help of a specialist legal team the chances of success are much reduced.”

A BURDEN TO PROVE Negligence is the breach of a legal duty of care that is owed to one person by another, and results in damage being caused to that person. Negligence exists in many forms, however clinical (or medical) negligence is expressly concerned with practicing doctors and other health professionals. A successful clinical negligence claim can result in compensation or damages for those affected, however the burden to prove negligence is on the claimant (i.e. the patient) who must effectively prove the following elements: The doctor or other healthcare professional owed a duty to take care of the claimant without causing undue injury; There was a breach of that duty to take care; That breach of duty has caused harm to the claimant; and Damage or other losses have resulted from that harm The outcome of the case will depend on whether it is more likely than not

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A BURDEN TO PROVE

that the defendant (i.e. the medical professional) was, in actual fact, negligent. Clinical negligence can be in relation to surgery, medication, diagnosis, a delay in treatment, psychiatric care, psychotherapy, counselling, dentistry and childbirth (including damage to the unborn child). It can also include instances of medical omission, i.e. withholding treatment from a patient or inadequately explaining the risks/side effects of a proposed treatment. The result for a claimant that wins a successful negligence claim is solely monetary. The court cannot force a hospital to change its working

A good way of maximising your chances of success in a clinical negligence challenge is to use a solicitor who is a member of The Law Society Clinical Negligence Accreditation Scheme. According to The Law Society: “Members will have shown that they have and will maintain a high level of knowledge, skills, experience and practice in the area of clinical negligence.” A full list of members can be found on The Law Society’s website at www.lawsociety.org.uk Taking legal action may seem daunting in the short term, but in the long term it can be extremely beneficial. It can help prevent the same mistakes from happening again and, if successful, support you financially while you’re unable to work.

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health insurance | what you should know

GoingPrivate Choosing private healthcare can supplement what is available on the NHS and give you more choice and flexibility. full à la carte menu, you can use your insurance to request this benefit.

beware before you buy When purchasing health insurance, it is tempting to assume that this umbrella term covers all present and future healthcare concerns. However, be aware that health insurance will usually NOT cover private treatment for the following:

Did you know?

Private health insura nce has many benefits including flexibility, choice, privacy and speciali sed one-to-one care.

What is private health insurance? If you are a UK resident, you will be entitled to free healthcare from the NHS. However if you decide you would rather be treated privately, health insurance can help pay all – or some – of these costs.

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Choice and control Health insurance can give you more choice and control over the level of care you get, and how and when it is provided. Depending on the policy you buy, the costs of most in-patient treatments (tests and surgery) and out-patient treatments (specialists and consultants) will be covered by private medical insurance. You can ask your GP for a specialist referral, use your cover to pay for a scan if it is delayed or refused by

the NHS, reduce the waiting time for treatment and (in theory) have access to a selection of top hospitals to choose from, with experienced specialist consultants and high quality surgeons. Private health insurance allows for overall flexibility, you can schedule appointments around your life and receive one-to-one care that is first rate. It also covers you for drugs and certain treatments that you can’t get on the NHS, such as specialist surgery for sports-related injuries and quicker access to physiotherapy (however it’s important to ensure this is definitely included in your policy before you buy). Perhaps it is simply the case that you would rather use private hospitals and treatment, where possible. For example, if you feel you would be more comfortable in a private room with an en-suite, TV, Wifi, phone and

Chronic illnesses, including HIV/ AIDS-related illnesses, diabetes, epilepsy, hypertension and related illnesses. Pregnancy and childbirth costs Organ transplant Pre-existing medical conditions Cosmetic surgery for aesthetic improvements Injuries caused by dangerous sports or arising from war or conflict

is the price right? The price of private healthcare is perhaps the most important factor to consider before buying insurance. It’s an expensive option, and with free healthcare available through the NHS, it’s not essential. Whatever you decide, it is likely to depend upon your own personal financial circumstances. You can also choose to pay for individual treatments or private consultations instead of regular premiums. If you run your own business, or live abroad, you may want to consider business or international health insurance. Business health insurance enables employees to get quick treatment and thus enjoy a more rapid return to full health. International health insurance is ideal for expats and those residing in countries requiring health insurance as part of a visa. dear doctor with Chris Steele 123

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Did you

know?

A pre paid f unera can re lm li of the eve your lo eans you ved emo burde tional and ones n of p ﬁ lannin nancial g your funera l.

A neat ending: Prepaid Funerals

With an increasing number of people opting for prepaid funerals, Dear Doctor considers both the emotional and practical benefits.

A prepaid funeral plan allows you to protect your friends and family from the emotional and financial burden of arranging your funeral at an already difficult time. You make all your own decisions, paying for your funeral based on today’s prices. This means you can sit back and relax in the knowledge that everything’s been covered, and you and your loved ones will not be affected by rising costs.

WHAT DOES IT INVOLVE?

When the time comes, your prepaid funeral plan will be transferred to a funeral home of your choice. Prepaid funerals are growing in popularity and the number is increasing yearon-year. According to the Funeral Planning Authority, there were 120,731 Funeral Plan sales in 2012, compared to 112,714 in 2011. The process is not specific to the UK, and is in fact much more common in other countries in Europe, such as France, Germany, Belgium and the Netherlands.

Prepaid funeral providers, such as the Co-operative Funeralcare, offer a choice of set or tailor-made funeral plans. “Set funeral plans cover all of the essential services for a burial or cremation, or tailor-made plans allow the client to arrange their funeral services in as much detail as they wish,” says Helen Chandler, Head of Product and Services at The Co-operative Funeralcare. “Clients can also choose to personalise their funeral by expressing their funeral requests to us. This allows the client to record their wishes about their funeral. These will be safely stored and later dispensed to the person arranging the funeral when the time comes.”

The Co-operative Funeralcare is the UK’s leading Funeral Director and has been arranging funerals and taking care of families for more than 70 years.

B e n e f it s o f a p f u n e ra l in c lu dreepa id : Personalisation – You make all the

key arrangements and decisions, creating a funeral that’s both unique and personal. These touches reflect your individuality and provide comfort for your family. For example, choose a unique musician for the service, specific readings, catering, flowers and gravestone engravings.

Reassurance – Avoid the inevitable pressure placed on loved ones, and relieve them of stressful decisionmaking, by specifying the exact funeral arrangements you want. Financial guarantee – On average, funeral costs have doubled over the last decade. Get any ﬁnancial worries out of the way by covering your funeral costs yourself and protecting your family from future prices and rising inﬂation.

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WHAT IS A PREPAID FUNERAL?

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