The Lovell Health Guide by Men's Health Forum

THE LOVELL HEALTH GUIDE Building better health and wellbeing at work

HAYNES Haynes Publishing Group is the world’s market leader in the producing and selling of car and motorcycle repair manuals. Every vehicle manual is based on our experience of the vehicle being stripped down and rebuilt in our workshops. This approach, reflecting care and attention to detail, is an important part of all our publications. We publish many other DIY titles and books about motor sport, vehicles and transport in general. Haynes Publishing, Sparkford, Yeovil, Somerset BA22 7JJ, England

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MEN’S HEALTH FORUM The Men’s Health Forum’s man manuals contain easy-to-read information on a wide range of health subjects. Founded in 1994, the MHF is the independent voice for the health and wellbeing of men and boys in England and Wales. Our goal is the best possible physical and mental health and wellbeing for all men and boys. The Lovell Health Guide © Men’s Health Forum All rights reserved. You must not reproduce or transmit any part of this booklet in any form or in any way without written permission from the Men’s Health Forum. This includes photocopying or scanning it. Printed in the UK. ISBN: 978-0-85761-039-3 Men’s Health Forum, 32-36 Loman Street, London SE1 0EH Registered charity number 1087375 Company limited by guarantee number 4142349 – England

020 7922 7908 www.menshealthforum.org.uk A full list of references is available at: menshealthforum.org.uk/MMreferences The MHF encourages your feedback at: menshealthforum.org.uk/MMfeedback

CONTENTS Introduction 4 Be Good To Your Heart 6 You Are What You Eat 8 How To Get Active 11 Beat Stress, Feel Better 14 Erection Problems 17 How To Get Enough Sleep 18 What About Booze? 21 How To Quit Smoking 23 How Dangerous Is The Sun? 25 Women’s Cancers 26 Other FAQs 30 Under The Weather? 32 Who Can Help? 35 Published: June 2018 • Revision dates as per the source publications: The Man Manual, Woman and Beat Stress, Feel Better, published by the Men’s Health Forum • Edited by Jim Pollard • Cartoons by John Byrne Advisory Board chaired by Dr John Chisholm. Image credits: p35 The authors and the publisher have taken care to make sure that the advice given in this edition is correct at the time of publication. We advise you to read and understand the instructions and information included with all medicines and to carefully consider whether a treatment is worth taking. The authors and the publisher have no legal responsibility for the

results of treatments, misuse or overuse of the remedies in this book or their level of success in individual cases. The author and the publisher do not intend this book to be used instead of advice from a medical practitioner, which you should always get for any symptom or illness.

MEN’S HEALTH MADE EASY

INTRODUCTION Research shows that being in work is generally good for people’s health and wellbeing, and case studies indicate that helping employees to improve or manage their health can result in increased attendance and performance. Lovell aim to create a sustainable workforce where the positive links between work and health are recognised by all, and where everyone aspires to a healthy and fulfilling lifestyle. This mini-manual doesn’t pretend to cover everything when it comes to perfect health, but it can make a difference along with common sense and better use of available health services. It’s a no-nonsense guide to making informed choices about your health. “We know that work is good for people. It provides economic stability as well as being a valuable source of social interaction both for the individual and the community within which they work. Fit, healthy staff deliver profitable businesses which in turn allow the UK to

remain one of the most prosperous and best places to work and live.” Professor Dame Carol Black, UK National Director for Health and Work (2006–2011).

SMALL CHANGES – BIG DIFFERENCES Take the big killers: cancer, heart disease and lung diseases (or chronic obstructive pulmonary disease - COPD). Most of us will run into at least one of these at some time but there’s a lot you can do to delay them, avoid them and even live with them. Today, a record 2.5 million people are living with cancer in the UK. As many people now survive the disease as die from it. But Cancer Research UK also reckons that in the last five years a further 600,000 or more cases of cancer could have been avoided with the sort of changes we’re talking about in this booklet. It’s similar with heart disease. Deaths from heart attacks halved in the decade to 2012. But it’s still men who are dying prematurely. Three-quarters of those who die from heart disease under 75 are men.

FAST ACTION – QUICK RECOVERY So how do you increase your survival chances? Simple: catch it early. That means that if you are worried about anything, get it checked. If you’re offered screening or check-ups, go for it. Reading this booklet and making a few little changes can seriously My complex improve your odds. There is more diabetes is the on all these topics on our website: direct result of menshealthforum.org.uk not going to the GP.

DO THE MATHS: DO YOU DO THESE? > NOT SMOKE

> DRINK FEWER THAN 14 UNITS OF ALCOHOL A WEEK

> EAT 5 FRUIT & VEG A DAY > TAKE AT LEAST HALF AN HOUR EXERCISE A DAY Research shows that doing all four adds about 14 years to your life. That’s time to see your grandchild grow up (or three World Cups!)

HOW TO BE GOOD TO YOUR HEART KNOW YOUR HISTORY You can get a good idea of the hand youâ&#x20AC;&#x2122;ve been dealt by knowing your history. Many health problems run in families: heart disease, cancer, strokes, depression, mental health challenges. Find out if your parents, grandparents, aunts and uncles have had any of these illnesses, especially if they died young. Make sure your GP knows your family health history.

TUNE YOUR ENGINE Tune your engine by using the right fuels. The heart needs: >> fresh air >> a balanced diet >> a healthy weight >> regular exercise and >> a relaxed attitude. Heart disease is caused when the arteries that pump your blood get damaged with gunk called plaque. This makes the arteries harden and narrow. The main causes are: >> smoking

The health check was simple - less than twenty minutes.

>> high blood pressure >> high cholesterol >> diabetes >> lack of exercise >> being overweight >> family history.

This booklet will help you with all these. For more on the heart-friendly diet, see page 8. For more on exercise and weight, see page 11.

GET A CHECK-UP Meanwhile, get your blood pressure and cholesterol levels checked. If youâ&#x20AC;&#x2122;re over 40, ask your GP practice for a free NHS Health Check which will estimate your risk of getting heart disease. Hereâ&#x20AC;&#x2122;s a little incentive for men to look after your heart: everything that is good for your heart is good for your penis. Clear, unblocked arteries mean firm, durable erections. For more on erection problems (an early warning sign for heart disease), see page 17.

YOU ARE WHAT YOU EAT Eating better comes with a lot of advantages. It can help you: >> keep a healthy weight >> avoid high blood pressure, high cholesterol, heart disease, stroke, diabetes and some cancers >> exercise better >> work better >> concentrate better >> feel better >> have better sex. It may even save you money.

CURBING CRAVINGS Eat more slowly so you (and your body) both notice what you’re actually eating. This way, you’re less likely to eat more than you need and more likely to choose a balanced diet. Go for a walk (even a short one) after your meal - it reduces the rise in blood sugar and fat levels. If you crave something sweet, distract yourself. Exercise will do this best - a walk or run - as it will also burn off the effects of stress and curb the cravings - but anything that keeps you absorbed will help. If you can’t get away, drink water or herbal tea. Are you really hungry? Often we think we want a snack but we’re just thirsty.

EAT WELL TOP TIPS Looking for simple pointers to healthier eating? >> Always have a good

breakfast to start the day right. >> Eat mindfully. Sit down and chew each mouthful thoroughly and slowly. >> Don’t eat while distracted by TV, phone surfing or reading. >> Choose healthy snacks between meals such as fresh fruit and unsalted nuts.

Plate smart. You’ll get a better idea of what you’re eating if you fill your

plate just once: half with salad or vegetables, one quarter with protein foods (eg lean meat, fish, eggs, beans) and one quarter with starchy carbohydrates (eg brown rice, wholewheat pasta, quinoa, baked potato, noodles).

Water is usually the best rehydration fluid when exercising. >> Go easy on alcohol – it’s particularly fattening. >> Smart food substitutions make healthy eating easy and painless. >> Keep a food diary - write down everything you eat and drink from the >>

moment you wake until you go to bed. Accounting for everything that passes your lips helps you make healthier choices and reduce random snacking.

Read labels. Food nutrition labels help you make healthier choices such as cutting back on salt, sugar and calories.

>> If you choose lower-fat, lower-calorie or lower-sugar versions of foods you eat regularly such as mayonnaise, salad dressings, yoghurt or milk, check labels carefully. Whatever is taken out is usually replaced with something else so low-sugar may be high-fat and low-fat may be high-sugar. >>

Enjoy all the foods you like but in moderation. If they are full of fat or sugar, simply eat less of them and/or find some healthier options that taste just as good.

THE GREAT PLATE Regular meals help balance swings in your blood sugar levels and reduce swings in mood (grumpiness) and tiredness. Start with a decent breakfast then for main meals fill: >> HALF your plate with salad or vegetables, >> one QUARTER with protein (eg lean meat, fish, eggs, beans) and >> one QUARTER with starchy carbs (eg brown rice, wholewheat pasta, quinoa, baked potato, noodles). Aim for your 5 fruit and veg portions a day (only one can be juice) and make sure you get some dairy (milk, cheese, yoghurt) to keep calcium levels up and bones strong. Watch out when life changes. When you leave home, move house or job, end or begin relationships, it’s easy to forget about what you’re eating. I really enjoy cooking now that I know what I’m doing.

There’s more on this topic in the Men’s Health Forum’s man manual Eat. Drink. Don’t Diet.

BRING ON A SUBSTITUTE Think about smart substitutions. Fish instead of red meat. Grilling instead of frying. Wholegrain instead of white bread, pasta or rice. Semi-skimmed for full fat.

HOW TO GET ACTIVE Don’t underestimate it. If exercise were a drug, we’d all want to take it. Exercise boosts physical and mental wellbeing and helps you live longer. Scientists now reckon being inactive is even more of a health risk than being overweight. People who do regular physical activity have a 35% lower risk of heart disease and stroke and a 50% lower risk of diabetes and of bowel cancer. Regular exercisers also have a far lower risk of osteoarthritis and hip fracture. Best of all, exercise feels good. It boosts feel-good chemicals that raise self-esteem and helps sleep and concentration.

I feel great after exercise. It’s a natural high.

Regular exercisers have a 30% lower risk of depression and of dementia.

WHAT DOES ‘REGULAR PHYSICAL ACTIVITY’ MEAN? To get the full benefit, the NHS reckons you need 150 minutes a week of moderate-intensity aerobic exercise. This means exercise that makes you slightly breathless - fast walking, cycling, jogging, mowing the lawn, swimming, playing sport. The statistics on page 17 about the benefits of exercise are based on these sorts of exercise levels. And, if your exercise goal is to lose weight, you probably need to do more than this. But - and it’s a very big but - anything is better than nothing. Try walking. Walking reduces the risk of heart disease by a third. The further and faster you walk the better but even walking just 5-6 miles a week at a very slow pace (2 miles per hour) will help reduce risk. Little and often is fine. Get a pedometer to count your steps. If you want a target, aim for 10,000 steps a day. Stretching and strengthening muscle is also important. Again, this doesn’t have to be vigorous. Yoga is fine.

NEED TO LOSE WEIGHT? Being overweight increases your risk of heart disease, stroke, diabetes and some types of cancer. Next year in England and Wales alone around 50,000 deaths will be down to excess weight. So get the tape measure out. >> men have a HIGHER risk of health problems if your waist size is more than 94cm (37 inches) and an EVEN HIGHER risk if it is more than 102cm (40 inches) >> women have a HIGHER risk of health problems if your waist size is more than 80cm (31.5 inches) and an EVEN HIGHER risk if it is more than 88 cm (34.5 inches).

I HAVEN’T GOT TIME. Build exercise into your everyday life: >> Get off the bus/train/tram a stop or two early >> Park the car and walk >> Cycle instead >> Use the stairs >> Exercise in your lunch-break >> Exercise at home or in the park - you don’t need to go to a gym >> Play more with your kids >> Get into housework and gardening >> Walk and talk (on the phone or with colleagues). Can work help? Some employers have a gym or offer gym membership or cycle-to-work schemes. Combine exercise with your social life by joining a gym, club or team. Increasingly, there are sports opportunities for people of all ages and abilities. But make sure you’re fit enough to avoid injury.

I HAVEN’T EXERCISED FOR YEARS. Take it easy. Often new exercisers find that their heart and lungs rise to the challenge quicker than the skeleton and muscles. Result: they get injured (and give up). When you start over, the only thing you really need to focus on is not getting injured. Warm up properly, build up slowly and don’t do more today than you will be able to do tomorrow. So start with a nice walk.

How do I fit exercise in with work? I jog home from the office.

BEAT STRESS, FEEL BETTER What’s going on between your ears is probably the biggest single factor in your staying healthy. If you feel good, you’re more likely to notice both when you’re ill and to do something about it. Keep an eye on the main causes of stress: work (or lack of it), relationships, money, bereavement, drink and drugs. Too much stress can: >> damage your immune system and heart >> increase your risk of serious health problems >> reduce life-expectancy >> damage your sex-life. Get to know what triggers stress and low mood for you. You can beat stress by: >> eating better - see page 8 >> sleeping better - see page 18 >> exercising - see page 11 >> having fun - singing, dancing and laughing are all proven to boost mood >> not becoming isolated - you don’t have to talk about what’s stressing you but connecting with other people in even a small way will make you feel better >> doing something different - volunteer, learn something new, do something creative >> finding some time for things you enjoy >> having sex - cuddles help even if you don’t fancy the full works >> reading the Men’s Health Forum’s man manual Beat Stress, Feel Better.

DASHBOARD WARNING LIGHTS If you spot any of these, ask yourself if they could be early warning signs of stress overload. If they are, do something. The sooner you act, the easier it will be to deal with and the less damage it will cause. >> Eating more or less than normal >> Mood swings and anger >> Low self-esteem >> Feeling tense or anxious >> Not sleeping properly (or wanting to sleep all the time) >> Poor memory or forgetfulness >> Excessive drinking and/or drug use >> Feeling really tired and lacking in energy >> Withdrawing from family and friends >> Behaving out of character >> Finding it hard to concentrate and struggling at work >> Losing interest in things you usually enjoy >> Having unusual experiences, like seeing or hearing things that others don’t. There may be physical signs too like headaches, irritable bowel syndrome or aches and pains. Try to live in the moment. If you’re playing with the kids, play with the kids. Turn off the phone. Don’t think about work or whatever’s on your mind. If the warning lights continue to flash, see your GP. Some of these warning lights might have physical causes and, if they don’t, there are still many treatments available (and they needn’t involve drugs.) But don’t ignore the warning lights. Men and women who commit suicide are not so different from those who don’t. Mostly the only difference is treatment and support. So take care of yourself.

ARE YOU GETTING ANGRY? Men are generally more explosive in their anger than women, and often express it in more violent ways - violent language, violence against others or themselves, criminal violence or even suicide. Occasional anger is normal. The best short-term response if you feel you’re losing control is to remove yourself from the situation (see ‘How to take a time-out’). If you get angry often, easily or quickly and it is causing stress for you and others, you need to find a way to stop before it leads to something you will regret. Treatment can include CBT, psychotherapy and anger management courses. (More about these later.) NHS Choices offers a free guide to anger self help.

HOW TO TAKE A TIME-OUT When you see your warning signs: >> Remove yourself from the immediate source of stress if you can (you could say ‘I’m going to the bathroom’) >> Give yourself a simple manual or mental task to ‘distract’ your mind >> Change scenery – somewhere peaceful such as a library, church or garden >> Take a walk >> Turn off social media, especially mobile phones and email >> Breathe deeply from the waist rather than the chest to relax the body (search YouTube for ‘diaphragmatic breathing’).

I CAN’T GET AN ERECTION Erectile dysfunction (ED) affects most men at some time (about 1 in 10 at any given moment). Often the cause is physical: >> diabetes >> blocked arteries (see page 6 on the heart) >> drinking too much >> drug side-effects >> spinal cord injury >> prostate or other surgery in this area. Sometimes the cause is psychological: >> relationship problems or sexual boredom >> tiredness, stress, depression or anxiety >> sexual identity problem. If you can’t get an erection with your partner but can when masturbating or during the night, there’s a good chance your ED has psychological causes. There are many treatments available. See your GP. They treat ED everyday. Saw my GP. Don’t buy drugs privately. Life-threatening problems like heart Got my sex life disease and diabetes can cause ED and you need to rule these back. It was out. What’s more, drugs sold online are often not what they that simple. claim to be and can be dangerous fakes (see page 34).

MY ERECTION WON’T GO DOWN If an erection lasts more than four hours, it could be a condition called priapism. See a doctor right away. Untreated priapism can be dangerous leading to, for example, permanent erection problems.

HOW TO GET ENOUGH SLEEP One in three Britons sometimes has trouble sleeping. And women suffer more than men. A snoring partner. Wakeful children. Worries about work. The end result? A bad nightâ&#x20AC;&#x2122;s sleep. Most of us have to deal with an occasional broken or restless night that leaves us feeling grumpy and tired the next day. But regularly sleeping badly could have serious consequences for your health. Of course, the reverse is also true. Sleeping well can help you live a long and healthy life. DID YOU KNOW? Blue light from smart phones, tablets and e-readers can slow or prevent the production of the sleep hormone melatonin.

HOW MUCH SLEEP? Everyone is different. It mainly depends on your age, but also your lifestyle. Most adults need around eight hours sleep each night. Some people can get by with much less. If you are awake and alert throughout the day, you’re probably getting enough. If you wake up feeling tired and grumpy, and/or feel sleepy during the day, you’re probably not. If you’re having trouble sleeping, you’ve probably developed some bad bedroom habits.

TEN SIMPLE SLEEP TACTICS 1. Set your alarm clock Get in the habit of going to bed and getting up at roughly the same time every day. Don’t sleep in after a bad night – it will make it harder to get to sleep the following night. 2. Cut down on caffeine Caffeine – found in tea, coffee and some fizzy drinks – is a stimulant that stays in your body for hours and can keep you awake. So avoid anything with caffeine in for six hours before bedtime. 3. Go for a walk Moderate, regular exercise such as swimming or walking, can help relieve tension and make it easier to sleep. The best time to exercise is late afternoon or early evening. Later than this may disturb your sleep. This doesn’t mean you can’t have sex, though! 4. Avoid alcohol in the evening It may help you fall asleep, but you will almost certainly wake in the night because alcohol affects the quality of sleep and acts as a diuretic (so you’ll need to get up to go to the loo). 5. Eat earlier – but don’t go to bed hungry Have your evening meal earlier rather than later but don’t go to bed hungry – if necessary, have a light snack.

6. Get the temperature right Turn down the heating thermostat or open your bedroom window. If it’s too hot – or too cold – you won’t sleep well. Researchers say a temperature between 60F and 67F (16C to 19C) is optimal for sleeping. 7. Switch off early Don’t check emails, watch TV or message friends right up until bedtime. If you want to read in bed, pick up a paperback not an e-reader or tablet. 8. Block out the world Make your bedroom as quiet and dark as possible. Try using an eye mask or ear plugs. 9. Unburden yourself Deal with worries or a heavy workload by making a ‘to do’ list and tell yourself you’ll deal with things tomorrow. 10. Wind down to bedtime Have a warm (not hot) bath, listen to quiet music or do some relaxation exercises. If none of this helps, and lack of sleep is affecting your daily life, see your GP Your doctor can check that your sleeplessness is not due to a physical illness, any medicines you’re taking, or emotional problems. He or she may refer you for CBT – cognitive behaviour therapy – rather than prescribing sleeping tablets as these don’t work for long and are addictive. CBT is a talking treatment that helps you examine the thoughts that affect your feelings and behaviour and teaches skills to deal with problems.

OVER THE COUNTER SLEEP REMEDIES Always check with your GP or a pharmacist before using sleeping remedies. They often contain an antihistamine that will make you sleepy but may leave you still feeling drowsy the next day. Herbal medicines usually contain Valerian. Research isn’t clear on the benefits and there may be side effects such as headaches.

WHAT ABOUT THE BOOZE? Too much alcohol damages nearly every organ in the body. It can cause heart disease, nerve damage, liver disease, depression, erectile dysfunction, cancer and digestive problems. If youâ&#x20AC;&#x2122;re worried that youâ&#x20AC;&#x2122;re becoming too keen on the drink, ask yourself the questions on page 24.

HOW TO CUT DOWN ON YOUR DRINKING If you want to cut down on your drinking, here are some trusted ways to do it: >> Drink water - both during the day and to cut appetite before eating and drinking >> Stop drinking for a week or a month >> Avoid drinking on at least two nights a week. Increase it to three then four and so on

I feel better and more alert since I cut down the booze.

>> Download the NHS Drinks Tracker app and/or write down each day how much you drink — seeing it in black and white helps >> If there is a situation in which you always have a drink — for example, after work — try to cut it out >> When out for the evening, don’t drink more than one drink an hour. Set yourself a maximum and stick to it >> Make your first drink a soft one >> Reduce the strength of what you’re drinking >> Don’t get into rounds >> Say “No” every so often. Try a few of these ideas. If you can’t do them then you need to stop drinking. If you can’t stop drinking, you need to get advice. The NHS advises men to not regularly drink more than 3-4 units a day and not to binge drink. (A pint of 5.2% lager is 3 units.) Don’t forget, Lovell’s operate a random drug and alcohol testing regime at all our projects and premises.

HOW MUCH ARE YOU DRINKING? Large glass of wine (175ml) 15% alcohol

3 units

120-170 calories

Small glass of wine (125ml) 12%

1.5 units

85-120 calories

Bottle of wine (750ml) 12%

9 units

510-720 calories

Pint of beer 5%

3 units

180 calories

Pint of beer 3.5%

2 units

160-170 calories

Single measure of spirits (25ml) 40%

1 unit

60-75 calories

SMALL CHANGE BIG DIFFERENCE Most of us want to make little changes which will make our lives more fun. For example, most smokers want to quit.

HOW DO I QUIT SMOKING?

We all know ciggies are bad for our health. Less well known is how quickly you start to feel better after quitting. Here are some tips to help: >> set the day in advance (when doing something new can be a good time such as going on holiday or starting a new job) >> get rid of all your smoking stuff at home, work, in the car etc >> team up with a friend or two to quit together >> try to avoid smokers >> try to avoid places or circumstances in which you usually smoke >> list all your reasons for quitting >> when you get a craving, talk to someone, go for a walk, drink water or nibble on a healthy snack (carrots are good), get a change of scene or do something that will keep you busy >> take it a day at a time and mark your progress

I saved ÂŁ1500 in six months. It paid for a great holiday.

>> put the money you save to one side and watch it grow >> don’t be tempted to have ‘just one’ - it doesn’t work >> check out the NHS Stop Smoking Service. They have products that can help you quit. Download their app.

ARE E-CIGARETTES OK? If you used to smoke and now vape, e-cigarettes may be a step in the right direction. But watch out: the step between smoking and not smoking is smaller when you vape so it’s easier to slip back into the tobacco habit or fall into it for the first time. Research continues on the effects of vaping. E-cigarettes are regulated as medicines.

AM I ADDICTED? You can have too much of a good thing. Think you might be addicted to drink, drugs, gambling, computer games, porn or something else? Even work or exercise. Ask yourself these questions: >> Do you think about X while doing something else and look forward to it? >> Do you feel you need more X each time to get the same enjoyment? >> Have you made efforts to cut back on X? >> Do you do X for longer than intended? >> Have you put X before more important things like relationships or work? >> Have you lied to others about your involvement with X? >> Do you use X as a way of escaping from problems or of relieving, for example, feelings of guilt, anxiety or depression? If the answer to any of these is yes, you need to stop doing X. If you can’t stop, you need to talk to someone. It’s that simple. You’re not alone - at least two million people in the UK are fighting an addiction. There’s no shame. Some men are tall. Some get colds. Some get addicted. The problems really begin if you can’t admit the truth to yourself. Talk to a mate, family member, your GP or an organisation working with people with the same challenge as you.

I got very very badly sunburnt in just half an hour.

HOW DANGEROUS IS THE SUN? It can be very dangerous. The number of people in hospital for skin cancer is increasing. What’s more, men are more likely to die from the disease than women. The main cause of skin cancer is the sun. If you have fair skin, light-coloured eyes or more moles, you’re at higher risk. Don’t avoid the sun. Being outside is good for you. But cover up. Wear a shirt rating. and hat. Choose sunscreen that is at least SPF 15+ and has a Keep an eye on your moles. You’re looking for changes to the ABCDE: A – asymmetry (both halves should look the same) B – border irregularity (it should be round) C – colour change (it should be tan - not red, black or white) D – diameter (it should be below 4mm) E – elevated (raised) or enlarged. Also watch for itchiness or bleeding. Any concerns, see your GP.

****

WOMEN AND CANCER No one likes to think about cancer, but there’s no getting away from it – half of us in the UK will develop cancer at some point in our lives. It’s not all bad news. Cancer may be more common – but more people are surviving cancer than ever before. Take breast cancer for example: survival rates have doubled in the UK in the last 40 years. Cancer Research UK say that more than four out of 10 cases of cancer can be prevented by making the kind of lifestyle changes this booklet suggests. But women also need to be vigilant – and not only for signs of the cancers that we associate with being female. Lung cancer is still the biggest ladykiller, followed by breast cancer. Third comes bowel cancer, responsible for one in 10 of all female cancer deaths. That sounds scary. But the sooner cancer is diagnosed, the easier it is to treat – and the more likely treatment will be successful. So accept invitations for ‘smear’ tests and mammograms to screen for

cervical and breast cancer even if you think everything is fine (and don’t panic if you are recalled – in many cases, there will be nothing to worry about.) But also get to know your body and what’s normal for you. Keep an eye out for any unusual, persistent changes and if you notice a change, talk it over with your practice nurse or doctor.

THE PILL AND CANCER Taking the pill increases the risk of breast and cervical cancer – but the combined contraceptive pill lowers the risk of ovarian and womb cancer, and may also lower the risk of bowel cancer. Experts agree that any increase in risk is likely to be small and starts to drop as soon as you come off the pill. After 10 years the risk is the same as if you had never taken it.

BREAST CANCER: SEVEN SIGNS TO WATCH FOR Breast cancer is easily the most common cancer in women – but the good news is that more women are surviving breast cancer than ever before. The key is to catch it early. Be breast aware. Watch out for: 1. A lump or thickening in an area of the breast 2. A change in the size or shape of your breast 3. Dimpling of the skin like orange peel 4. A change in the shape of a nipple 5. Discharge from one or both nipples 6. Redness or a rash on the skin and/or around the nipple 7. A swelling or lump in your armpit These signs don’t necessarily mean cancer – most lumps are harmless. But if you notice any change from what is normal for you, see your GP as soon as possible. DID YOU KNOW? Having 1 drink a day could increase the risk of breast cancer by 5%. And the risk increases the more a woman drinks.

ANTIPERSPIRANTS AND BREAST CANCER

Parabens are chemicals used in deodorants and antiperspirants, as well as many other cosmetic products. Parabens have been found in breast tissue removed following breast cancer but researchers haven’t found any convincing evidence that parabens cause breast cancer. Sometimes women are advised not to use deodorants containing aluminium salts before going for breast screening. This isn’t because the salts are dangerous, but because they can affect the results of screening tests and make breast cancers harder to detect.

CERVICAL CANCER Women of all ages can develop cancer in the cervix – the neck of the womb – but it’s the most common cancer in women under 35. Most cases are linked to the human papillomavirus (HPV) which can be spread during sexual activity, so using a condom can reduce your risk of infection. There are now vaccines to prevent HPV infection but they don’t protect against all types of the virus and it will be some time before the vaccination programme will reduce the number of cervical cancer cases. That’s why it is important to go for cervical screening – commonly known as having a ‘smear’ test. (You need to be registered with a GP to be invited for screening.) If you are too young – or too old – to be called for screening, watch out for: > any unusual bleeding from the vagina, particularly after sex or after the menopause > persistent vaginal discharge that is blood-stained or smells unpleasant These can be early signs of cervical cancer. Even if you’ve had a normal screening result or been vaccinated against HPV, it’s important to let your doctor know if you develop any of these signs so they can be checked out straight away. DID YOU KNOW? The best time to have a ‘smear’ test is in the middle of your menstrual cycle because the health professional is likely to get the best possible sample of cells at this time.

WOMB CANCER Womb cancer is almost always curable if caught at an early stage. The early symptoms are: > vaginal bleeding after the menopause > bleeding that is unusually heavy or happens between periods > vaginal discharge, from pink and watery to dark and foul smelling These can also be symptoms of much more common conditions than womb cancer but if you have any of them, it’s important to see your doctor to find out.

Don’t die of embarrassment. Doctors have seen it all before.

OVARIAN CANCER When ovarian cancer is diagnosed at an early stage, the outcome is usually good. If you know the key signs to look out for, you can seek advice as soon as possible. These are: > persistent pelvic and abdominal pain > increased abdominal size/persistent bloating > difficulty eating and feeling full quickly If you regularly have any of these symptoms – and they are not normal for you – see your GP, particularly if you are over 50 or have a strong family history of breast or ovarian cancer.

WOMEN’S CANCER ORGANISATIONS >> Breast Cancer Care (Helpline 0808 800 6000) www.breastcancercare.org.uk >> Cancer Research UK www.cancerresearchuk.org >> The Eve Appeal www.eveappeal.org.uk >> Macmillan Cancer (Free Helpline 0808 808 00 00) www.macmillan.org.uk

HOW TO BEAT BOWEL CANCER Bowel cancer is one of the most common types of cancer in the UK. There are 40,000 new cases every year. Nine in ten cases are in people over 60. You’re also at increased risk if you have a family history of the disease, smoke, drink, have a diet high in fat and low in fibre, are overweight and don’t exercise. Look out for: >> Bleeding from your back passage and/or blood in your stools >> A change in bowel habit lasting for 3 weeks or more especially to looser or runny stools >> Unexplained weight loss >> Extreme tiredness for no reason >> A pain or lump in your stomach area. If you’re aged 60-74, there is a screening programme for bowel cancer. Ask your GP about it.

I HAVE TROUBLE PEEING For men, all of these could be the sign of a prostate problem: >> a weak flow when peeing >> a flow which stops and starts >> having to wait before you start to go

>> having to pee more often than previously >> a sudden urgent need to pee >> peeing more often at night.

It is normal for the prostate to grow as we get older. Because the prostate is right next to the bladder, this growth can push on the bladder and cause peeing problems. See your GP to check that it is not prostate cancer and for advice on the various treatments. Incontinence may also be a sign of prostate growth but there are other causes too. See your GP.

HOW DO I PROTECT MY BACK? In the UK, 15 million working days were lost to back pain in 2013. It is the main cause of long-term sickness absence. The key thing is to keep active. Immobility weakens muscles and range of movement. Think about your back when staying in the same position for some time or lifting. Lift with a straight back and with the load close to your waist. Distribute weight evenly and know your limits. Exercise will both prevent and reduce back pain. If you’re overweight, lose some. Over-the-counter painkillers can help in the short term but if back pain persists, see your GP. The NHS Choices website has an online back-pain guide.

I USE TECHNOLOGY ALL THE TIME. ANY WORRIES? Staying in the same position for too long, especially unnatural positions like on the train or on the couch, may affect your back. The screen may affect your eyes. Look away, take screen breaks and get up regularly to move around. At your desk, note how you’re sitting, the computer screen position, your chair height, the position of your mouse and keyboard and the rest of your desk equipment. Adjust your position so your eyes are level with the screen, arms are comfortable and supported and the chair supports your back. If you’re using a laptop for a long period, use a separate keyboard and mouse and a laptop stand. (Remember too that using a laptop actually on your lap can damage sperm and fertility.) We know some people feel they are sensitive to the electromagnetism from these devices so there may be effects on health we don’t yet know about.

UNDER THE WEATHER? WHAT SHOULD I DO WHEN I’M ILL? For coughs, colds and other minor problems, try your high-street pharmacist. For illness or personalised advice, the local general practice is the first point of contact. Make sure you’re registered with one. It’s very easy to do. Choose one that is easy to get to from home or work. Check opening hours, the appointment system and what you can do online or by phone. General practices also provide information, vaccinations, clinics, healthchecks, blood tests and some simple operations.

WHAT ABOUT OUT OF HOURS? If you need information out of hours call 111. Or your GP’s out-of-hours service. In an emergency, call 999 or go to the Accident and Emergency Department (A&E).

WHAT’S AN EMERGENCY? Call 999 or go to A&E if the patient is: >> unconscious > in a very confused state >> having fits that are not stopping

> having breathing difficulties

>> having persistent, severe chest pain >> bleeding severely and you cannot stop it. You are wasting your time and everybody else’s if you go to A&E and it is not an emergency.

The A&E staff were great. The four-hour wait wasn’t.

WHAT OTHER SERVICES ARE THERE? Minor Injuries Units are an alternative to A&E for less serious injuries like sprains, breaks, minor burns and bites. They’re quicker and easier for non-emergency injuries. There are also some Walk-In Centres which are open out of hours providing minor ailment and some minor injury services without an appointment. Sexual health clinics offer free confidential advice, testing and treatment for sexually-transmitted infections. There are also many other NHS services for, for example, stopping smoking, mental health problems and social care. You can find services near you on the Men’s Health Forum or NHS Choices websites. Another very useful source for help with minor health problems and advice on treatment and local services is your pharmacist. There’s one on most high streets. Just walk in. Many have a private area to talk if need be.

MY GP IS TOO BUSY The NHS is stretched. You will get the best out of it if you make things as easy as you can for your GP (or any other health professional you see). Turn up in good time. Note the questions you want answered. Answer their questions honestly. Get to the point - don’t save what’s really on your mind until you’re about to leave. Make sure you understand what’s going on with any treatment or drugs prescribed before you leave.

WHAT ABOUT THE INTERNET? Choose sites that display the NHS England Information Standard ‘Health and care information you can trust’ logo. (You can see the logo on page 2.) Be sceptical of social media and commercial sites without this. On overseas sites, the HONcode is a sign of quality. Sites like the Men’s Health Forum’s and NHS Choices provide lots of useful health information. But information is all it is. You need a doctor to diagnose.

WHAT ABOUT GETTING DRUGS ONLINE? If you have a prescription from a GP, many GPs and pharmacists can deal with these online.

I paid £130 for a product that didn’t work.

If you don’t have a prescription, get one. Don’t self-diagnose and buy drugs online. Many sites offering drugs without prescription are illegal. The drugs they sell may be useless or dangerous fakes. Fake drugs have been known to include pesticides, brick dust, paint and floorwax. Plus your credit card details may be stolen. Perhaps even more importantly, you won’t get a diagnosis of your problem. Not being able to get an erection won’t kill you. But heart disease or diabetes (of which erection problems are a sign) can.

SHOULD I GET MY SIGHT TESTED? See an optometrist if you are having difficulty focusing close-up or seeing long distance or have pain, headaches, blurred vision or see halos around lights. As we age, some deterioration in sight is normal. The basic eye test is cheaper than you think and is free in many cases or if ‘clinically necessary’. If you already wear glasses or contacts, you should go for an eye test at least every couple of years. People over 40 and people from black or minority ethnic groups may need tests more frequently. (People from African-Caribbean backgrounds are at greater risk of glaucoma and diabetes and people from south Asian backgrounds at greater risk of diabetes.) If you use screens as a significant part of your normal work, your employer should pay for a proper eye test and any glasses you might need for screen work. Always protect your eyes when working by using the right mask, shield or goggles.

WHO CAN HELP? Men’s Health Forum www.menshealthforum.org.uk Health information from the Men’s Health Forum Lovell www.lovell.co.uk

Domestic Violence – Men Men’s Advice Line (for victims) 9-5 Mon-Fri 0808 801 0327 www.mensadviceline.org.uk Respect (for perpetrators) 9-5 Mon-Fri 0808 802 4040 www.respectphoneline.org.uk

NHS Choices Online ‘front door’ to NHS www.nhs.uk www.nhs.uk/lifecheck www.nhs.uk/change4life apps.nhs.uk Call 111 (24 hour) for nonemergency medical advice. http://tinyurl.com/oohNHS for more on NHS out of hours.

Domestic Violence – Women Refuge www.refuge.org.uk Women’s Aid www.womensaid.org.uk National Domestic Violence Helpline 0808 2000 247

Alcohol Drinkaware www.drinkaware.co.uk Alcoholic Anonymous 0800 9177 650 www.alcoholics-anonymous.co.uk

Organ Donor Register www.organdonation.nhs.uk

British Dental Health Foundation www.dentalhealth.org

Sexual Health www.fpa.org.uk www.loversguide.com

Eye health www.rnib.org.uk/eye-health Macmillan Cancer Free helpline 0808 808 00 00 www.macmillan.org.uk (There are other cancer organisations on p29.) PHOTO CREDITS: Thanks to Lovell and flaticon.com (for the house icon made by Freepik) plus Toby Otter, Craig Cloutier, bareknuckleyellow, Quinn Dombrowski, Reg Natarajan,

Health and Safety at work www.hse.gov.uk

Mental Wellbeing www.mentalhealth.org.uk www.time-to-change.org.uk

Smoking 0800 022 4332 www.smokefree.nhs.uk Drink and drugs Frank 0300 123 6600 www.talktofrank.com

Jim Larrison, D Sharon Pruit, Len Rizzi, Julian Mason, chinesechef, Elliot Brown and Train Photos who were all kind enough to make their images available through the Creative Commons. (If this is not

Prostate Cancer 0800 0748383 www.prostatecanceruk.org Diabetes UK 9-6 Mon-Fri 0345 123 2399 www.diabetes.org.uk British Heart Foundation Heart helpline: 0300 330 3311 www.bhf.org.uk Back Care 0208 977 5474 www.backcare.org.uk Stroke Association Helpline 0303 303 3100 www.stroke.org.uk Gay, bisexual and transgender www.gmfa.org.uk HIV Awareness, support & advice: 0808 802 1221 www.tht.org.uk FEELING DESPERATE? Samaritans 116 123 Emotional support 24/7 www.samaritans.org Calm 0800 58 58 58 www.thecalmzone.net

the case, please contact us.) Full credits, links and licences via the source manual at: menshealthforum.org.uk/ MMreferences

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