Personal Health - Q3 2021 by Mediaplanet UK&IE

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Why CBD oils are not all the same What are CBD products, how are they made and are they all the same? An Irish grower and producer explains the differences.

C Mark Canavan CEO and Co-founder, Greenheart CBD

annabidiol (CBD) oil or hemp oil all come from the hemp plant. The hemp plant is extremely versatile and useful in a number of sectors including textiles and personal health. The plant naturally contains more than 100 cannabinoids, notably cannabidiol (CBD), but despite this, not all oils are the same. Mark Canavan, co-founder of Greenheart CBD explains: “Most oils on the market are produced using chemical extraction or made up from concentrates, but at Greenheart we keep our product fully natural and extract in a natural process known as cold pressed extraction.” How the process works The company uses a ‘seed to shelf’ production process that starts in the fields of Wicklow and provides full traceability to the end consumer. “We grow hemp under licence, using strains permitted in the EU and scan the fields daily using AI-enhanced drones, which relay details about the health and stage of growth, this allows us to identify any problems and harvest crops at the optimum time,” says Canavan. The company plans to introduce larger drones that allow for soil testing, weeding and the spray application of organic fertiliser or plant nutritional products and have partnered with Zenadrone. Greenheart has also partnered with UNIPHAR, Ireland’s largest pharmacy distributor allowing Greenheart products to be readily available in pharmacies nationwide.

A new cryptocurrency Canavan shares, “We are a very forward-thinking company and due to the evolution that is occurring in the financial sector, we decided to get involved in the crypto currency space and create a decentralised platform for farmers looking to get into hemp production and improve their quality of life through our new currency ‘CBD’. “We embarked on this project in 2019 and got our token launched on Pancake Swap in May 2021. We have ambitious plans to grow the community and value of our currency by implementing the various targets we have set on our roadmap.” Liam Robertson, chief executive of Alphabit Fund says, “Greenheart CBD has committed itself to making a difference in today’s world with a unique and original approach to helping farmers climb from the poverty trap.”

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You can find out more on greenheartcbd.ie and greenheartcbd.io Greenheart CBD is an award-winning company winning a place in the Sunday Independents ‘30 under 30’ in 2019 and winning a Business All-Star Award for the company in 2020 as well the AIBF ‘Partnership of the Year’ and ‘Funding Round of the Year’ award for 2021.

Knowing the symptoms and risk factors for type 2 diabetes is important as non-diagnosis can seriously affect your quality of life. ~Sinéad Powell, Senior Dietitian, Regional Development Officer, Diabetes Ireland

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Help your doctor help you, keep a migraine diary Migraine is a complex neurological disorder which is underrated by many. It is the most common primary headache disorder presenting to doctors and the more chronic forms can be very disabling.

here are approximately one million migraine sufferers in Ireland, some having a couple of migraine attacks every decade and others experiencing multiple attacks each week. The peak migraine prevalence for women is between ages 15-49. The lifetime prevalence is 42% in females.1 From a monetary perspective, it directly costs the Irish economy at least €252 million per year.2 Migraine is therefore a cause of significant societal burden, both medically and financially. Unfortunately, it is often misdiagnosed, underdiagnosed and undertreated.” says Dr Martin Ruttledge, Consultant Neurologist at Beaumont Hospital. This is not just in Ireland, but it is a worldwide problem. Dr Ruttledge, Dr Mary Kearney and Ms Esther Tomkins co-authored The ICGP Migraine Quick Reference Guide (QRG) in 2019, a “teaching manual” developed to help primary care doctors and other community Health Care Professionals (HCP) to better understand migraine, and to facilitate better diagnosis and management in primary care.

frequency of attacks and medication taken. The diary should also document associated symptoms, duration and severity of each attack, together with possible trigger factors such as female hormone fluctuations, weather or skipping meals. The authors suggest that when a patient visits their GP with recurring headaches, they should be advised to keep a detailed headache diary. This usually provides very useful clinical information and can help confirm the diagnosis. Dr Ruttledge concludes: “It’s all about just sitting and talking to the patients, taking their medical history and explaining the condition in straightforward language.” However, it takes time and investment to develop Headache Specialists. More training for doctors and specialist headache nurses is a must for Ireland going forward. References 1. Frederick IO, Qiu C, Enquobahrie DA, Aurora SK, Peterlin BL, Gelaye B, et al. Lifetime prevalence and correlates of migraine among women in a pacific northwest pregnancy cohort study. Headache 2014 Apr; 54(4):675-685. 2. Steiner TJ, Stovner LJ, Vos T, Jensen R, Katsarava Z. Migraine is first cause of disability in under 50s: will health politicians now take notice? J Headache Pain 2018 Feb 21; 19(1):17-018-0846-2.

Keeping a diary of symptoms Some patients can experience relatively few migraine attacks throughout their life, while the average patient can experience one to two attacks per month. In addition, approximately 10% of all patients suffer weekly attacks. The authors of the above ICGP document recommend that patients should keep a headache diary, documenting

Dr. Martin Rutledge Consultant Neurologist, Beaumont Hospital

HOW TO MANAGE PRESSURE

It’s a hangover Isn’t it just a headache?

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MISCONCEPTIONS Don’t be so dramatic

Just take a tablet

• Set realistic expectations • Find your coping mechanism • Know your limitations • Don’t be too hard on yourself • Structure your day

KEEP A DIARY

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Managing my migraine in the workplace Louise O’Sullivan Migraine Patient, Co. Cork

Most people see migraine as a headache which will go away once you take some painkillers. Unfortunately, that couldn’t be further from the truth. Migraine is a neurological condition.

anaging a condition like migraine that has multiple symptoms which can last days at a time while working can be difficult. The workplace can be a stressful environment which migraineurs really have to mind themselves in. I have been very lucky that my employer has always been supportive and understanding of just how unpredictable a condition like migraine can be. Unfortunately, that is not always the case for migraine sufferers.

AT H E

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Don’t call your headache a migraine if it’s not!

Sadly, the ‘Hollywood’ version of men today as strong, silent warriors who sneer at death and laugh at pain, has veered men away from seeking medical help when needed. Hazel Breen Communications and Information Officer, Migraine Association of Ireland

The stress of migraine Migraineurs will often try to hide the condition out of fear that employers will lack understanding or worse, out of fear that they may lose their job if their absence becomes too frequent. That brings about so much stress because it branches out to worry about financial obligations. The Migraine Association of Ireland has always been a great source of support for me. They provide resources and guidance in all aspects of managing the condition.

No Technology in Bed OR Get Blue Blockers

painkillers are not the solution

I have good friends at work who are aware of my migraine and can often spot when I might be having one if I disappear suddenly.

More than just a headache For me, I have to go to the bathroom immediately, take my medication and wait for the aura to pass. I have often had to get a colleague to come down to the bathroom just to bring me some water or if I have been gone a while to check on me. I have good friends at work who are aware of my migraine and can often spot when I might be having one if I disappear suddenly. That support is imperative to managing migraine at work.

• Start a discussion with your boss and colleagues • Keep hydrated • Prioritise tasks • Get plenty of fresh air • Watch your posture

Men and migraine:

his issue is not limited to Irish men but is an issue worldwide. Surely fighting your own demons and battles is one of the bravest things you can do?

Migraine misconceptions The misconception that migraine is a female only condition can cause men to avoid seeking medical support. Many dismiss this debilitating and complex neurological condition as just a headache. This often leads to men selfmedicating with over-the-counter medications. In turn, this can lead to developing medication overuse headache, which is a huge problem among Irish men today. “Men are just as concerned and interested in their health as women are. However, the statistics do not give that impression” says Hazel Breen, Communications and Information Officer, MAI.

The misconception that migraine is a female only condition can cause men to avoid seeking medical support. An Irish Health Survey published in 2019 states that when it comes to the range of visits to health professionals, females are more likely to visit than men. Of the females reported, 85% said that they visited a GP in the 12 months prior to the survey, compared to 68% of men. Moreover, 63% of females visited a dentist compared to 52% of men. Regarding general visits to GPs, older people report visiting more than younger people; 94% of 75 years and over, compared to 67% of those ages 15-24 years.

TRIGGERS1,3 WEATHER

LIGHTING

MOVEMENT

SMELLS

STRESS

MENSTRUATION

TRACK USINGE MOBIL APP

TIPS2,3 GOOD QUALITY STAY REGULAR SLEEP HYDRATED PATTERN

HAVE A MIGRAINE BUDDY LONG GAPS BETWEEN MEALS

NOISE LEVEL

COMPUTER SCREENS

GOOD DIET

EXERCISE/ YOGA

REDUCE PHONE BRIGHTNESS

References: 1. www.speakyourmigraine.ie/about/triggers/ last accessed 01/09/21 2. www.speakyourmigraine.ie/tips/ last accessed 01/09/21 3. Data on file

Further information available at www.migraine.ie & www.speakyourmigraine.ie IE150990 | August 2021

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How technology helps a rowing champion stay fit

Type 1 diabetes: what you should be aware of Type 1 diabetes is one of the most prevalent chronic illnesses in children and adolescents, but can occur at any age.

f all people living with diabetes in Ireland, 10% have to continuously take insulin just to survive. They also have to be educated to self-manage diabetes to prevent diabetes-related complications and live long and healthy lives. Living with type 1 diabetes The majority of people with diabetes in Ireland use insulin pens and take at least 3-4 injections a day – only a few use insulin pumps. To deliver insulin safely, diabetes management requires frequent blood glucose checks. One of the ways living with diabetes has improved, and the burden of all these daily tasks has been reduced, has been the advances in technology. Continuous or Flash glucose monitoring allows the checking of glucose levels and patterns continuously by connecting a reader or a mobile phone to a sensor attached to one’s body. If well controlled, diabetes does not have to be a barrier to living a normal, active and healthy life. Be aware the sooner it’s recognised, the better. Think diabetes? Think TEST – Thirst increased, Energy reduced, Sudden weight change and Toilet trips increased. To learn more, visit our website www.diabetes.ie

Dr Kate Gajewska Clinical Manager for Advocacy and Research, Diabetes Ireland

Flash glucose monitoring is helping rowing champion Aoife to maintain her fitness while living with type 1 diabetes.

t 20 years old, Irish rowing champion Aoife Willis was diagnosed with type 1 diabetes. “At first I rebelled,” says Aoife. “I thought, ‘This is not going to stop me rowing’.” She returned to training that night and within a year she had won at the Irish National Rowing Championships. Now, she says: “I looked as though I managed my diabetes well. I had learnt lots about the condition, but I didn’t realise that I lacked detailed knowledge of how it affected me. You can’t fight it. You have to work with it and it’s a steep learning curve.” When she restarted running in January 2020, she found she could not manage her glucose levels properly. “I was using a finger-prick system of monitoring, but it wasn’t working well for me. I’d wake up in the night because I didn’t know how to keep my levels up,” says Aoife, from Limerick City. Technology as a teacher A friend told her about a technology that continually increases her understanding of her diabetes. “My Flash glucose monitoring system consists of a sensor attached to the back of my upper arm, coupled with a phone app. I can ‘flash’ scan the sensor with my phone – even through clothes - to pick up my readings and get an eight-hour insight into my glucose movements,” says Aoife. “A short walk used to mean taking my glucose

monitor, insulin, glucose tablets, insulin pen and needles. Now a swipe with my phone shows what my glucose will do in that time, so I just carry my phone and glucose tablets.” Better monitoring means she is now running halfmarathons. “I can keep up with the children I coach at the rowing club, so it’s made a big difference to me – and them,” she says.

You have to learn how it affects you, and this technology helps. Better control “It’s made an invisible condition visible. People ask about the system and it shows diabetes is not all blood, needles and fasting.” She advises others living with type 1 diabetes: “You have to learn how it affects you, and this technology helps.”

Aoife Williams Athlete living with diabetes, FreeStyle Libre Ambassador WRITTEN BY Linda Whitney

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Images are for illustrative purposes only. Not actual patient or data. 1. 60-minute warm-up required when applying the sensor. 2. Sensor is water resistant in up to 1 metre (3 feet) of water for a maximum of 30 minutes. Do not immerse longer than 30 minutes. Not to be used above 10,000 feet. 3. Finger pricks are required if glucose readings do not match symptoms or expectations. © 2021 Abbott. FreeStyle, Libre, and related brand marks are marks of Abbott. ADC-45738 v1.0 09/21.

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Technology provides pregnancy reassurance for those living with type 1 diabetes Pregnancy can bring extra concerns for women with type 1 diabetes, but technology is helping deliver more peace of mind.

I get monthly checks from the maternity hospital’s diabetes team and the app means I can share my glucose levels with them beforehand.

M Mairéad Parker Teacher living with diabetes, FreeStyle Libre Ambassador WRITTEN BY Linda Whitney

y Flash glucose monitoring system was the best Christmas present ever,” says Dublin primary school teacher Mairéad Parker. “It’s given me extra peace of mind, especially now I’m pregnant.” Mairéad was diagnosed with type 1 diabetes aged four. “I’m the only one in my family with the condition, so it was a big learning curve, especially for my mum. She monitored my glucose levels and gave me carefully measured doses of insulin twice daily. Meals had to be at set times and food carefully monitored.” Mairéad took extra snacks and glucose drinks to school. “It was a small county school, and I was in a class of 10. The teachers helped but everyone knew and there was so little education about diabetes that stereotypes and myths abounded.” Then five years ago she got a Flash glucose monitoring system as a Christmas gift. “There’s a sensor on the back of my upper arm which I ‘flash’ with my phone and an app records my glucose levels,” she says. “If I’ve had a walk or eaten something different, or I am not feeling well, I type that into my phone and see how my levels are affected.” Pregnancy concerns Before getting pregnant, Mairead was initially concerned about how her diabetes could affect her and the baby.

“My diabetes and diabetic retinopathy teams gave me guidance and said I was in a good position to proceed. Now I am pregnant I get monthly checks from the maternity hospital’s diabetes team and the app means I can share my glucose levels with them beforehand from home.” Get advice Mairéad advises other women who are living with type 1 diabetes and who are considering pregnancy: “It’s natural to be worried, but don’t let fear stand in your way. Speak to your diabetes teams and join online patient support groups. I found everyone very willing to help. “The Flash glucose monitoring system means I have better control of my glucose levels, which is comforting because controlled levels help to support your baby’s development.”

Find out more at freestylediabetes.ie

Glucose monitoring that works with you FreeStyle Libre sensors let you monitor your glucose without finger pricks.3

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Understanding the impact of the gut brain connection

immunological factors. When these are released from the gut, they send signals to the brain. To describe bacteria which affects the brain and mood, the team coined the term psychobiotic.

We all know that we can feel tension and anxiety in the “pit of our stomach” but also happiness and excitement. Now there is the science out there to prove it too.

he gut microbiome is made up of trillions of live microbes living in the human intestine. It contains at least 150 times more genes than the human genome. It is a complex ecosystem with amazing diversity. It consists of bacteria, viruses, fungi and yeasts. They live symbiotically with us, metabolising foods, processing vitamins, and supporting our immune system. The gut-brain axis The gut-brain axis is a two way communication system between the brain and the enteric nervous system (ENS). The ENS is an integrated circuit of 100 million neurons embedded in the lining of your gastrointestinal tract. It coordinates the digestive process devoid of input

from the brain, earning it the name of the “second brain”. How the microbiome interacts with the ENS and the brain was proposed in the landmark study by Nobuyuki Sudo and colleagues. They discovered that germ-free mice, which are born without any bacteria, had an impaired stress response. Sudo then gave the germ free mice healthy gut microbes and showed that the mice developed a normal stress response. The experiment demonstrated how gut bacteria can affect behaviour. Further research on the mechanism was proposed by John Cryan and Ted Dinan at University College Cork. They demonstrated a combination of ways the axis communicates including hormones, microbial metabolites, neurotransmitters and

Ways to balance your microbiome Eat fibre rich foods: Short-chain fatty acids (SCFA) are produced from microbial fermentation of fibre and appear to have an anti-inflammatory affect and are a source of energy for your colon cells. Eating fibre-rich foods, such as fruit and vegetables promotes their formation. Good news, wine and chocolate are good for you, in moderation: Dark chocolate i.e. 70% cocoa, red wine, coffee and tea all contain polyphenol which our microbiome metabolise into bioactive metabolites. These can help to control bodyweight by inhibiting appetite and improving lipid metabolism. Eat fermented foods: A new study from researchers at Stanford School of Medicine demonstrated that eating foods such as yogurt, kefir, fermented vegetables and kombucha tea led to an increase in overall microbial diversity. Therapies such as cognitivebehavioural therapy (CBT) involve relaxation techniques and cognitive restructuring, teaching people to challenge negative thoughts and manage stress better.

Dr Cara Dunne Gastroenterology Consultant, St James’s Hospital and @CHI IrSPEN Director

Patients are silently suffering from opioid constipation Constipation from pain-relieving opioid use is common, yet more must be done to encourage patients to discuss this common, painful condition.

Dr David Moore Consultant Pain Specialist & Anaesthetist Beaumont Hospital & Bon Secours Hospital Dublin WRITTEN BY

Sean Duke

he ordinary, or functional constipation that most of us are familiar with is usually the result of poor intake of fibre in the diet, dehydration, physical inactivity and aging.1 These factors can all result in the gut contracting more slowly than it would normally do. Ordinary constipation is said to occur when people are passing less than three stools per week.1 These stools are firm, lumpy and hard to pass. Opioid-induced constipation When opioids are taken for pain, they impact on pain receptors in the spine, but also on other receptors in the body, including in the gut. Opioid-induced constipation results when opioid receptors in the gut are activated. That results in abnormal motions in the gut and the disruption of normal, involuntary, peristaltic motions there.2 This means that waste is not processed along the gut as it should be, but instead, is being passed back and forth. These effects continue for as long as a patient is taking opioids 3 and can lead to severe bloating, a painful bowel, flatulence, inability to pass stools, diarrhoea, nausea, vomiting and lethargy.4 All of which can have impact on your quality of life. Treatment options In the first instance, a doctor may prescribe a common laxative to determine whether the cause of constipation is the use of opioids. If the laxative doesn’t work, the doctor may then prescribe a Peripherally Acting μ-Opioid Receptor Antagonist (PAMORA). The PAMORAs are a novel class of drugs designed to displace the opioid from receptors in the gut, allowing the normal gut function to resume.5

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At the same time, the PAMORAs do not displace the opioid from the pain receptors, and so do not interfere with patient pain relief.6 Talking to patients about opioid constipation Constipation is common among those prescribed opioids for pain relief,6 but many patients may be too embarrassed to discuss these symptoms. Similarly, doctors who are running busy pain clinics may not do enough to encourage patients to discuss their constipation difficulties. There is a danger that patients may be unwilling to talk about their constipation for fear their pain-relieving medication will be stopped. It is important that doctors and nurses, and other pain specialists ask people who are taking opioids whether they suffer from constipation. Doctors need find ways of letting patients know that it is okay to discuss this important issue which can affect every aspect of their quality of life from work, to sleep, to mood levels and sex life.7 References 1. Relief from Constipation. National Clinical Programme for Palliative Care, HSE. Available at: https:// www.mater.ie/services/palliative-care/relief-constipation.pdf Last accessed: September 2021 2. Brock C et al. Opioid-induced bowel dysfunction: pathophysiology and management. Drugs. 2012 Oct 1;72(14):1847-65. 10.2165/11634970-000000000-00000. 3. Treatment of Opioid-Induced Constipation: The Hard Facts. Available at: https://www.drugs.com/slideshow/treatment-of-opioid-induced-constipation-the-hard-facts-1283 Last accessed: September 2021 4. Drewes AM et al. Definition, diagnosis and treatment strategies for opioid-induced bowel dysfunction-Recommendations of the Nordic Working Group. Scand J Pain. 2016 Apr;11:111-122. 10.1016/j.sjpain.2015.12.005. 5. Pergolizzi JV Jr et al. The Use of Peripheral -Opioid Receptor Antagonists (PAMORA) in the Management of Opioid-Induced Constipation: An Update on Their Efficacy and Safety. Drug Des Devel Ther. 2020;14:1009-1025. 10.2147/DDDT.S221278 6. Kalso E et al. Opioids in chronic non-cancer pain: systematic review of efficacy and safety. Pain. 2004 Dec;112(3):372-380. 10.1016/j.pain.2004.09.019. 7. Bell T et al. Opioid-induced constipation negatively impacts pain management, productivity, and health-related quality of life: findings from the National Health and Wellness Survey. J Opioid Manag. 2009 May-Jun;5(3):137-44. 10.5055/jom.2009.0014.

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This article was commissioned and funded by Kyowa Kirin September 2021 KKI/GB/MOV/0036

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Preventing type 2 diabetes: early recognition, healthy diet and activity One in three families in Ireland are affected by diabetes. There are about 225,000 people living with type 2 and about 25,000 living with type 1 diabetes in Ireland. It’s important to know the differences between them, causes and treatments.

D Sinéad Powell Senior Dietitian, Regional Development Officer, Diabetes Ireland

iabetes is a condition where there is too much glucose in the blood because of a lack of insulin or insulin is not working properly. Diabetes prevalence is on the increase, especially for type 2 diabetes as this is largely linked to unhealthy lifestyle behaviours frequently associated with being overweight and/or inactivity. Type 1 diabetes on the other hand is not linked to lifestyle and is classed as an autoimmune condition. It cannot be prevented and has to be treated with insulin (everyday injections or insulin pump). Diabetes risk factors Information on the prevalence of diabetes in Ireland is based on estimates from different regional and national studies. Nevertheless, the risk of raised blood glucose is 5.5% in those aged over 50 and this increases to 13.4% in those aged over 80 years. Knowing the symptoms and risk factors for type 2 diabetes is important as non-diagnosis can seriously affect your quality of life. Undiagnosed or poorly managed diabetes can damage your heart, eyes, nerves and kidneys leading to serious health problems. However, if managed well, you can live a long and healthy life. Early recognition, good understanding and making positive lifestyle changes can help to prevent any potential complications.

When to see a doctor? If you see any of these symptoms: • Blurred vision • Tiredness • Thirst • Frequent trips to the bathroom (urination) especially at night • Weight loss or gain • Frequent infections • Numbness, pain or tingling in feet You are more at risk of getting type 2 diabetes if you: • Are over 45 years of age • Have a family history of diabetes • Had diabetes during a pregnancy (gestational diabetes)  • Are overweight • Are inactive • Have high blood pressure/cholesterol • The more risk factors or symptoms that you have the more likely you are to develop diabetes or pre-diabetes. Managing your diabetes If you have been diagnosed with type 2 diabetes, treatment involves managing glucose levels to keep these as close to normal levels as possible so between 4-8mmols/L. It can be effectively managed through education, support and adoption of healthy lifestyles (diet, exercise), combined with medication as required. Evidence exists that type 2 diabetes can be prevented, and that remission of type 2 diabetes may be possible for some people.

Revolutionising new microscopic treatments for glaucoma It is estimated that around a quarter of a million people in Ireland are currently diagnosed with glaucoma. It is a serious, progressive eye disease, which left untreated, can lead to blindness.

G Mr Graeme Rogers Consultant Ophthalmic Surgeon and Glaucoma Specialist at Dublin Ophthalmic, Beacon Hospital, Dublin

laucoma is a serious, progressive group of eye diseases, which left untreated, can lead to blindness. It can be difficult to detect without an eye test most types of glaucoma have no symptoms. Glaucoma is sometimes caused by an increase in pressure in the fluid in the eye when the fluid cannot drain adequately. Lifelong glaucoma management Damage to the optic nerve is permanent and irreversible, so it is very important to lower the fluid pressure in the eye. Once diagnosed, the most common treatment is

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prescription eye drops, which will help to either reduce the fluid production or increase the drainage of fluid from the eye. These eye drops need to be applied up to three times a day, every day for the rest of your life, so perseverance can become challenging, limiting the efficacy of the treatment. Innovations in medical implants An international study has shown 72% of patients who were treated with iStent inject® no longer need to take glaucoma medication after 12 months.1 The device comprises of microscopic 0.36mm stents which

are implanted into the eye. When in place, they aren’t visible to the human eye. The stents work by helping to restore the eye’s natural fluid outflow, thus reducing ocular pressure.2 The surgery is elegant and can be carried out at the same time as cataract surgery, or during a separate procedure, usually under local anaesthetic by an ophthalmologist. iStent inject®has an excellent safety profile and is performed by eye surgeons while you are awake. There are a significant number of studies that show its efficacy and safety. Trabecular micro-bypass surgery, namely iStent implantation, can be a good alternative treatment.

Visit our website diabetes.ie to assess your risk of type 2 diabetes. Diabetes Ireland have lots of supports available for people diagnosed with type 2 diabetes diabeteseducation.ie

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References 1. Voskanyan L, Garcia-Felijoo J, Belda J, Fea A, Junemann A, Baudouin C. Prospective, unmasked evaluation of the iStent inject® system for open-angle glaucoma: Synergy trial. Adv Ther. 2014;31:189-201 2. Neuhann TH. Trabecular micro-bypass stent implantation during small-incision cataract surgery for open angle glaucoma or ocular hypertension: Long-term results. J.Cataract Refract Surg. 2015; 41: 2664-2671

Today the original iStent® and iStent inject® have been implanted in over 700,000 eyes around the world, with more and more patients who have glaucoma benefit from the procedure every day. For more details, visit glaukos.com/en-uk

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Understanding the risk factors of atrial fibrillation Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting one in four people over 50 years old. With AF the heart rate becomes completely irregular.

A Dr Angie Brown Consultant Cardiologist and Medical Director, Irish Heart Foundation

lthough some people complain of palpitations, dizziness, breathlessness or chest tightness, 70% of AF is asymptomatic or ‘silent’. This means the actual true prevalence in the community is unknown and probably underestimated. Data collected from pacemakers, loop recorders and Holter monitors show that even short episodes of AF (less than one hour) convey an increased risk of stroke. The difficulty in diagnosing such cases can be improved by screening with regular pulse checks, more prolonged monitoring, or loop recorder insertion. Risk factors for atrial fibrillation The risk of developing atrial fibrillation increases with age. Prevalence is also increasing due to better survival post myocardial infarction (MI), congenital and valvular heart disease, and increasing hypertension and obesity. Other recognised risks are viral infections, pneumonia, heart failure, lung disease, diabetes, sleep apnoea, thyroid disease and lifestyle factors such as excess alcohol, coffee and cigarettes. Overweight populations have a higher AF incidence and progression of AF compared with normal weight counterparts. Obese patients with atrial fibrillation who lose at least 10% of their body weight are six times more likely to achieve long-term freedom from AF compared to those who don’t lose weight.

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Obese patients with atrial fibrillation who lose at least 10% of their body weight are six times more likely to achieve long-term freedom from AF compared to those who don’t lose weight. Finding the right treatment Treatment includes ensuring there are no potentially reversible causes such as thyroid disease and excess alcohol. Good blood pressure control and weight loss in obese patients reduces the risk of recurrent AF. In some studies, statin therapy appears to reduce AF and in other studies beta-blocker use in heart failure also reduces the risk of AF. AF significantly increases the risk of stroke so prevention of stroke with anticoagulants (blood thinners), if appropriate, is crucial. In some patients we would consider restoration of sinus rhythm with medication, ablation or cardioversion. In others it’s important to ensure adequate rate control with a variety of medications. The treatment options will vary depending on patient factors and symptoms.

The Irish Heart Foundation is committed to reducing avoidable death and disability so increasing the awareness and the understanding of the potential causes of AF, improved detection and prevention of this common arrhythmia is important. More information about AF and how to check your pulse can be found on our website www.irishheart.ie

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Does your school have access to an AED? All schools, universities and educational establishments must have access to an automated external defibrillator (AED). They are vital tools that can mean the difference between life and death.

T Trudie Lobban MBE Founder and Trustee, Arrhythmia Alliance

he on-field collapse of Christian Eriksen during a EURO 2020 match showed why defibrillators are so important; without prompt use of a defibrillator, he would not be alive today. Eriksen collapsed because he had a sudden cardiac arrest (SCA). A SCA is not a heart attack — it is when the heart stops because of a dangerous arrhythmia (irregular heart rhythm disorder) whereas a heart attack is when blockages in the heart restrict blood flow. With a SCA, the only way to restart the heart is to “shock” it back into a healthy rhythm with a defibrillator. CPR is not enough While CPR is important, it is not enough. CPR alone increases survival by 9% but CPR plus an AED increases survival from SCA by more than 50%. Additionally, AEDs require no training — you just follow the verbal instructions from the machine. An AED will only deliver a shock if one is needed; it will not shock someone whose heart is in a healthy rhythm therefore, you cannot harm anyone by using it. However, you can potentially save a life. We believe AEDs should be as commonplace as smoke alarms — at present — there is no legal requirement for them. Many governments are “looking to change” regulations so that all schools will have access to an AED, but action is needed now. We should not have to wait for anyone else to die because they did not have access to an AED.

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An AED will only deliver a shock if one is needed; it will not shock someone whose heart is in a healthy rhythm therefore, you cannot harm anyone by using it. However, you can potentially save a life.

Getting defibrillators into schools To kick start the Autumn term, Arrythmia Alliance is relaunching its Defibs in Schools campaign. We are calling for all schools, universities and educational establishments to have access to an AED. We want these AEDs to be available to the whole community 24/7. SCAs do not just occur during school hours; they can occur at any time, to anyone of any age. Defibrillators in schools must be accessible to all — they will not save lives if they are locked away in a cupboard. SCAs can occur to anyone, anywhere, at any time and of any age. Everyone should know what to do if one occurs. Do not let the ones you love be the ones you lose.

For more information, see: bit.ly/Defibs InSchools

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Men are being urged to reboot Heart valve disease is rising their lives rapidly due to the ageing population

A new lifestyle campaign has been launched to encourage men in Ireland to review their lifestyles and make important changes to improve their heart health.

Heart valve disease is a serious cardiovascular condition which can be fatal if left untreated, but it has received little attention compared to other heart conditions.

ne in four men in Ireland die from heart disease and stroke. Men are nearly three times more likely than women to die young from these issues – but the good news is that 80% of those deaths are preventable through healthy lifestyles. The older you get, the higher your risk – and so it is important that men, particularly those in their 40s and 50s, take stock of and reboot their lifestyles by identifying what simple changes they can make now to benefit their heart health into the future.

CSO data shows that 999 men died of a heart attack in 2020, compared to 642 women. Reviewing your lifestyle A new survey has found that more than one in four men do not consider the health of their heart a priority, despite the fact that men are at an increased risk of dying early from heart disease and stroke compared to women. The Irish Heart Foundation has launched a new campaign which aims to encourage men in Ireland to review their lifestyles and make important changes to improve their heart health. The campaign is supported by Rugby Players Ireland and the Irish Heart Foundation was delighted to get the help of a number of former Ireland internationals – Tommy Bowe, Malcolm O’Kelly, Peter Stringer and Paul Wallace to launch the campaign.

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In the past five years, two of the players’ friends and former teammates, Anthony ‘Axel’ Foley and Gary Halpin, passed away suddenly due to heart issues at the ages of just 42 and 55. Taking control of your health The former players have come together with the Irish Heart Foundation to encourage men of all backgrounds and fitness levels to take control of their health and ‘Reboot their Lives’ this September. CSO data shows that 999 men died of a heart attack in 2020, compared to 642 women. In the same year, in the 45 to 54 age group, 217 men died of heart disease and stroke compared to only 75 women. The campaign calls on men to sign up on the Irish Heart Foundation website where they can access heart health information, assess their lifestyle through a quiz and download a helpful booklet with lots of tips to Reboot. The campaign is being supported by the HSE as part of their delivery on Healthy Ireland, the national framework to support health and wellbeing in Ireland.

Men all over Ireland can sign up to Reboot their Lives and find lots of helpful tips and information at www.irishheart.ie

Janis Morrissey Director, Health Promotion, Information and Training, Irish Heart Foundation

Neil Johnson Chief Executive, Croí, the Heart & Stroke Charity and Executive Director, Global Heart Hub

eart valve disease, which is largely a condition of ageing, can be a serious cardiovascular condition. It could be fatal if left untreated. As the population is ageing, heart valve disease is on the rise with the number of people affected (one in eight over the age of 75) expected to double by 2040 and triple by 2060. Tackling barriers in care The COVID-19 pandemic has compromised care for many people with heart valve disease, adding to existing barriers in early diagnosis and timely care. Unlike with some other cardiovascular conditions, there are effective treatment options for heart valve disease that can halt disease progression, improve quality of life and reduce mortality. In an effort to raise awareness and improve outcomes for people living with heart valve disease, Croí is leading ‘Heart Valve Disease Awareness Week’ in Ireland and recently contributed to an EU report, Heart Valve Disease: Working Together to Create a Better Patient Journey, to help raise stakeholder awareness of heart valve disease across Europe. As we are living longer, heart valve disease is increasingly an issue that we may need to face, particularly as we progress to the ‘third age’ (65 years and older). Heart valve disease has been described as the next cardiac epidemic. Sometimes we dismiss symptoms like breathlessness, feeling easily fatigued or not being able to do things as easily as we used to, as just getting older. However, the symptoms of heart valve disease can be masked by the natural signs of ageing. Recognising signs and symptoms Too often, heart valve problems go unnoticed and undiagnosed as we don’t realise that there may be something more going on. I would encourage everyone over the age of 65 to ask their doctor, at least once a year, to listen to their heart with a stethoscope. Unfortunately, we know from research that most people over 65 years in Ireland are not having regular stethoscope checks when they attend their GP. To detect heart valve disease, this needs to change. Early detection and timely treatment are potentially not only lifesaving but also the key to healthier, active ageing and a longer life. Early detection and diagnosis require both patient and doctor to be proactive, in recognising symptoms and pursuing timely treatment. New innovations in treatment are adding quality to many people in their golden years.

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Moments you keep in your heart

Having type 2 diabetes increases your risk of cardiovascular disease (stroke and heart attack)1 Talk to your diabetes team about the diabetes medications that will lower your risk of cardiovascular disease Questions to ask your diabetes team: How is type 2 diabetes related to my heart? If I am taking medicine to treat high blood pressure or cholesterol, am I still at risk?

For further information about diabetes visit DiabetesWhatsNext.ie scan the QR code using your smartphone

Can my diabetes medicine help to reduce the risk for cardiovascular disease?

Reference 1: Wong et al. Atherosclerotic cardiovascular disease and heart failure in type 2 diabetes mellitus – mechanisms, management, and clinical considerations. Clinical Update: cardiovascular disease in diabetes mellitus, Circulation. 2016;133:2459–2502. Changing Diabetes® and the Apis bull logo are registered trademarks owned by Novo Nordisk A/S. Date of preparation: September 2021. IE21DI00235

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Novo Nordisk Limited First Floor, Block A, The Crescent Building Northwood Business Park, Santry Dublin 9, D09 X8W3, Ireland Tel: 01 8629 700 Fax: 01 8629 725 Lo call: 1 850 665665 infoireland@novonordisk.com www.novonordisk.ie

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Help is at hand for those living with COPD As one of the groups most vulnerable to serious illness from COVID-19, the pandemic has been an anxious and challenging time for people with COPD.

C Dr Aidan O’Brien, President, Irish Thoracic Society

OPD (chronic obstructive pulmonary disease) is a common, treatable lung condition. It is a chronic disease, so it will never go away, but there are many things that people can do to manage it, in order to enjoy the best possible quality of life. COPD is an umbrella term for emphysema and bronchitis and is mainly due to exposure to harmful particles or gases that are inhaled, causing abnormalities to the airways and within the lungs. COPD in Ireland COPD remains a serious problem for people in Ireland and for our health system. The HSE’s NHQRS Annual Report 2020 estimates that 380,000 people are living with the disease yet only 110,000 are diagnosed. It states that at least 1,500 patients die each year of COPD and over 15,000 patients are admitted to hospital with it. The OECD reported that Ireland has the highest hospitalisation rate for COPD in 2017, the latest year for which international data is available. Causes of COPD Smoking is the most common cause of COPD but prolonged exposure to air pollution, such as environmental toxins, fumes and dust, is also a risk factor. This means that the disease is largely preventable by never smoking and/or avoiding long term exposure to harmful fumes, dust or gases. However, some people with an existing illness such as chronic asthma may be more prone to developing COPD, while others may be pre-disposed to it due to a hereditary lung condition known as Alpha-1 antitrypsin deficiency.

Persistent symptoms such as a cough, phlegm and difficulty in breathing can be an indication of COPD. People over the age of 35 who have these symptoms, who are or have been smokers or who have a family history of the disease, should ask their GP for a COPD health check.

Persistent symptoms such as a cough, phlegm and difficulty in breathing can be an indication of COPD. Help is at hand Those living with COPD often experience social isolation, lack of mobility, reduced independence, frequent hospital admissions and mental health issues. People with COPD were identified as one of the groups most at risk of serious illness if they catch COVID-19 – this means the last 18 months have been a particularly anxious and challenging time for many. Greater awareness of signs and symptoms of COPD and increased access to supports in the community for detecting and managing the condition are critically important.

COPD Support Ireland offers peer support, information, group exercise and SingStrong programmes tailored to people with COPD. Access to diagnostic and other healthcare supports are available through GP or Community Healthcare teams. www.copd.ie COPD Adviceline: 1800 832146

What science can do Next generation therapeutics Advancements in biotechnology have expanded our toolkit of drug modalities. This provides an opportunity to design therapeutics for disease mechanisms previously considered difficult, if not impossible, to target and enables our scientists to pioneer new approaches to drug discovery.

Veeva ID: IE-3030 Date of Preparation: September 2021.

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More than 18 million deaths occur annually from CVD, many of them in low- to middle-income countries.

Improving cardiovascular health through digital care From wearable devices to voice-activated medical assistants, the digital sphere is teeming with breakthroughs that can make a difference for the world’s growing incidence of noncommunicable diseases (NCDs).

I Fausto Pinto President, World Heart Federation (WHF), Professor of Cardiology and Head of the Cardiovascular Department, University Hospital de Santa Maria/ CHULN in Portugal and Dean of the Faculty of Medicine at the University of Lisbon

f, as the saying goes, “our health is our wealth,” then we must invest in digital healthcare for everyone to tackle the world’s leading killer, cardiovascular disease (CVD). More than 18 million deaths occur annually from CVD, many of them in low- to middle-income countries. Digital healthcare is not a salve for all health woes, but it can widen or narrow the existing gap in accessible and affordable healthcare.

If a positive outcome of the pandemic exists, it could be the wider uptake of digital tools as an additional aid in healthcare. Being ‘well-connected’ ‘Well-connected’ in the usual sense may imply special treatment or favours; in our digital world, it is all about equity. Indeed, increasingly, to be well is affected by our ability to be connected via some technological means, encompassing tools from a basic landline to hand-held heart monitoring devices. Wearable devices include smartwatches and more sophisticated tools that read the wearer’s data via embedded microchips and sensors. Other examples include hand-held or chest-applied electrocardiogram (ECG) devices attached to smartphones that can record heart rhythm and help diagnose irregular heartbeat when it involves,

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for instance, atrial fibrillation, which can have serious consequences, such as stroke. In some cases, they can even take images from the heart using ultrasound technology. Smartphone cameras can be used to monitor blood pressure and connecting pharmacies on a common mobile platform has aided their participation in patient management. In 2019, the wearables market grew by 89% before seeing a decrease in 2020. A chance for damage control It is estimated that in least developed countries (LDCs), 17% of the rural population has no mobile coverage, with only a 2G network covering 19% of the rural population. The road to an even playing field must entail investment, infrastructure, education and privacy protocols. Weaving digital literacy into education efforts will increase comfort levels for patients and health workers who might not be used to technology as a health resource. If a positive outcome of the pandemic exists, it could be the wider uptake of digital tools as an additional aid in healthcare. The biggest winner could be within reach: that all means, digital or traditional, are accessible to the most vulnerable and in need. Our future is an opportunity to do damage control, to correct past mistakes of unequal access to affordable care and save many a beating heart.

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COPD is an umbrella term for emphysema and bronchitis and is mainly due to exposure to harmful particles or gases that are inhaled, causing abnormalities to the airways and within the lungs. ~Dr Aidan O’Brien, President, Irish Thoracic Society

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