Your Good Health Guide by Men's Health Forum

YOUR GOOD HEALTH GUIDE Health Made Easy For National Grid Staff

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 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. Your Good 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: 978-1-906121-97-6 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 Know Your Numbers Food and Drink > Alcohol > Eat Well Top Tips Physical Health > Exercise > Men’s Health > Women’s Health Mental Wellbeing Under The Weather National Grid Services Who Can Help?

4 6 10 11 13 13 18 20 25 31 34 35

Written and Edited by Jim Pollard • Cartoons by John Byrne • Based on the Man Manual and Woman published by the Men’s Health Forum • Thanks to the Forum’s advisory board chaired by Dr John Chisholm, Sharon Naylor for National Grid and all those who helped with the booklet • Photo credits p35 Published: November 2017 • Review dates as per source publications.

1 IN 5 MEN (AND 1 IN 8 WOMEN) DIE BEFORE THE AGE OF 65. 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 KNOW YOUR NUMBERS Physical and mental health are linked and one can impact the other both positively and negatively. This booklet explains how to keep both in top shape in 36 easy-to-read pages. Let’s start with the key numbers.

My complex diabetes is the direct result of not going to the GP.

Just like an MOT for our car we all need to keep an eye on our body to check it is working well or whether it is under strain. Knowing your basic health numbers will empower you to take control of your health. If you’re concerned about any of your numbers, see your GP.

DOES WAIST MEASUREMENT MATTER? Yes. 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:

>> find the bottom of your ribs and the top of your hips >> wrap a tape measure around your waist, midway between these points >> breathe out naturally before taking the measurement. Men with a waist more than 94cm (37 inches) have a HIGHER risk of poor health and a FAR HIGHER risk of damage with a waist more than 102cm (40 inches). Women with a waist more than 80cm (31.5 inches) have a HIGHER risk of poor health and a FAR HIGHER risk of damage with a waist more than 88cm (34.5 inches).

WHAT ABOUT BLOOD PRESSURE? Blood pressure (or BP as your GP might put it) is measured using two numbers. Numbers higher than 140/90 suggest high blood pressure, numbers below 90/60 are considered low blood pressure. Normal range is in between. High pressure puts a strain on your blood vessels, heart and other organs increasing the risk of heart problems and stroke. Pulse (heart rate) is different from BP. Most adults have a resting pulse (heart rate when not exercising) of 60-100 beats per minute. Generally a low pulse suggests increased fitness but if your rate is continuously over 120 or below 40, you should see your GP.

WHAT’S THIS ABOUT ‘BAD’ CHOLESTEROL? Cholesterol, a fatty substance in the blood, is vital for our health. Most of it is made in the liver but we do get some through our diet. Too much of the wrong type of cholesterol can increase your risk of heart problems or stroke. Ideally, total cholesterol levels should be below 5mmol/L and levels of LDL (the so called ‘bad’ type of cholesterol) below 3mmol/L. But your ideal level may be lower if you are at particular risk for any reason.

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!)

FOOD & DRINK Just like a car, our bodies need the correct fuel. Eating better comes with a lot of advantages. It can help you: >> keep a healthy weight

>> maintain healthy organs and body cells

>> avoid high blood pressure, high cholesterol, heart disease, stroke, diabetes and some cancers

>> maintain a healthy fertility and hormone balance

>> exercise better

>> maintain energy levels.

>> work better

It may even save you money.

>> concentrate better I really enjoy cooking now that I know what Iâ&#x20AC;&#x2122;m doing.

>> feel better >> have better sex

WHAT ARE THE BASICS? 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, baked potato, noodles). Or even an alternative like quinoa. Aim for your 5 fruit and veg portions a day (only one can be juice or smoothie) and make sure you get some dairy (milk, cheese, yoghurt) to keep calcium levels up and bones strong. A small amount of fat is essential to a healthy diet too (see page 8). 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. There’s more on this topic in the Men’s Health Forum’s Eat. Drink. Don’t Diet.

HOW DO I CURB CRAVINGS? Cravings and constant hunger can be a sign that you may not be eating enough protein or lacking other vitamins and minerals. 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.

ARE THERE REALLY ‘GOOD’ AND ‘BAD’ FATS? The only really bad fats are trans-fats – fats artificially processed with water to make them spreadable. They are linked with health problems such as heart disease so manufacturers have begun to remove most of them from processed foods and spreads. But they’re not actually illegal so avoid products that list partially-hydrogenated fat or oil on the label. Some saturated (animal) fats are converted into cholesterol in the body. For this reason they were considered ‘bad’. However, they are often present with good nutrients that minimise these effects (for example, egg yolks are also rich in lecithin and vitamins). Monounsaturated fats (found, for example, in olive oil, nuts and avocados) and omega-3 fats (found, for example, in oily fish, rapeseed oil and walnuts) are called ‘good’ fats as they have beneficial effects on cholesterol balance in the body. Remember though that all fats are concentrated sources of energy (9 calories per gram) so go easy. A little bit of everything does you good (except trans-fats). Use rapeseed, coconut or olive oil to cook with and extra virgin olive oil or nut oils for salad dressings. (It’s best not to cook with extra virgin olive oil as it smokes at lower temperatures and loses its benefits. Use plain olive oil.)

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.

SO HOW MUCH SUGAR? Most of us eat too much. Free sugar should be no more than 5% of your daily calories (but aim lower.) Free sugar is essentially the sugars you have some control over. It includes sugar in manufactured or processed food plus sugar or honey you add to food but excludes sugar found naturally in fruit, veg and dairy. So sugar in an apple doesn’t count but sugar in apple juice does (since juice is processed). Five percent is about 30g of free sugar a day (the equivalent of just seven sugar cubes) so check labels and go very easy on sugar you add yourself.

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 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. Ask your GP about bowel cancer screening. You should be invited automatically aged 60-74. If you’re over 74, it’s on request. There’s also a one-off test at the age of 55 being introduced in England.

COULD I HAVE AN EATING DISORDER? Doctors sometimes use the SCOFF questionnaire: Do you ever make yourself sick because you feel uncomfortably full? Do you worry you have lost control over how much you eat? Have you recently lost more than one stone (six kilograms) in a three-month period? Do you believe yourself to be fat when others say you are too thin? Would you say that food dominates your life? Answer “yes” to two or more of these and you may have an eating disorder.

WHAT ABOUT ALCOHOL? 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 you’re worried that you’re becoming too keen on the drink, ask yourself the questions on page 27. 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 >> 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 and women to not regularly drink more than 14 units a week and not to binge drink.

HOW MUCH ARE YOU DRINKING? 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

Single measure of spirits (25ml) 40%

1 unit

60-75 calories

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, baked potato, noodles). A little fat.

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.

HOW DO I QUIT SMOKING? We all know ciggies are bad for our health. (It is estimated that each cigarette takes 11 minutes off your life.) 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 >> 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.

I saved £1500 in six months. It paid for a great holiday.

ARE E-CIGARETTES BETTER? If you used to smoke and now vape, e-cigarettes may be a step in the right direction. But watch out: you’re still addicted to nicotine and 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 now a regulated product.

PHYSICAL HEALTH HOW IMPORTANT IS EXERCISE? Donâ&#x20AC;&#x2122;t underestimate it. If exercise were a drug, weâ&#x20AC;&#x2122;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. Regular exercisers have a 30% lower risk of depression and of dementia.

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

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 13 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 or use your smartphone 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. So is pilates (even rugby players do it).

I HAVEN’T GOT TIME. Build exercise into your everyday life: >> Get off the bus/train/tram one or two stops 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 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. 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.

DIGITAL DETOX If you’re worried about excessive reliance on your screens, try some of these: Stop texting while walking – enjoy the walk and avoid accidents. A screen is a screen – all the advice about computer screens applies to tablets and phones. ‘Tech neck’ (or neck strain from looking down at a screen over long periods) may be a bigger risk if you have a tinier screen. Regular breaks reduce the risks of eyestrain and muscular skeletal problems. Don’t take your tech to the toilet - for hygiene reasons if nothing else. Break before bed – avoid looking at screens for at least half an hour before bed. The blue light from TV, smart phones and laptop screens may affect melatonin, the hormone that helps us sleep. Your sleep will probably improve if you banish all screens from the bedroom. Laptop warning – men, remember that using a laptop long-term actually on your lap can damage sperm and fertility. Want more detox challenges? Try no phones at meal times or in bedrooms or in the bathroom. Or what about screen-free Sunday?

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’. It can also pick up eye diseases (like glaucoma and cataracts) and other health problems (like diabetes and high blood pressure). That’s why a test every two years is recommended. You may need one more often if you’re over 40 or are from an African-Caribbean background (at greater risk of glaucoma and diabetes) or south Asian background (greater risk of diabetes). National Grid Employees regularly working with Display Screen Equipment (DSE) can request an eye test. This should happen whenever working conditions change. Costs for the test (with your choice of optometrist) and basic frames or lenses are usually covered. Talk to your line manager to check. (Contractors are advised to contact their employment agency.) Always protect your eyes when working by using the right mask, shield or goggles.

WHAT ABOUT HEARING? Hearing also deteriorates with age - 40% of those over 50 have some hearing loss. Look after your ears by wearing ear protectors when necessary and keeping volume down when using headphones or headsets. Wax build-up can also affect hearing. Warmed olive oil (yes, the cooking type) can loosen wax, or try drops from your pharmacist. If they don’t help, see your practice nurse.

DO I HAVE TO GO TO THE DENTIST? Yes - at least once a year. It could prevent a lot of pain and expense later on. You can reduce the risk considerably by brushing twice a day for two minutes at a time with toothpaste. (The NHS suggests fluoride toothpaste.) Cleaning gets rid of the bacteria (plaque) that cause tooth decay and gum disease. Brush all surfaces including the gums gently with an up-and-down motion. Flossing or interdental brushes can help you clean between the teeth. Mouth cancer is more common in men than women. Watch out for white or red patches, ulcers or lumps that do not clear up after two weeks, especially if you smoke and drink.

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 >> 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 every day. Saw my GP. Got my sex life back. It was that simple.

Don’t buy drugs privately. Life-threatening problems like heart disease and diabetes can cause ED and you need to rule these out. What’s more, drugs sold online are often not what they claim to be and can be dangerous fakes (see page 33).

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.

I HAVE PAIN/A LUMP IN MY TESTICLES

Testicular cancer is rare. True, it is the most common cancer in younger men but this is because cancer is so rare in young people. But don’t let that keep you from the doc. Cancer in your testicles may be rare but the risk is real. So, if you notice a lump in your balls, see your GP immediately. Testicular cancer can be treated very successfully if caught early.

I HAVE TROUBLE PEEING 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. Usually the growth is not cancer but, all the same, prostate cancer is the most common type of cancer in men. Most cases occur in men over 50. See your GP to check that it is not prostate cancer and for advice on the various treatments. It can be treated and you’ll get your sleep back. Incontinence (peeing when you don’t want to) may also be a sign of prostate growth but there are other causes too. See your GP.

HAIR LOSS: THE RUGS DON’T WORK Male baldness affects most men sooner or later. Since it’s related to testosterone, the only real cure is castration before puberty. Not recommended. The rugs and the drugs are still not great, so better to just relax and remember some of the sexiest men on the planet are bald. If you’re seriously depressed by hair loss, it may be to do with something happening inside your head, not on it.

LET’S TALK ABOUT CANCER IN WOMEN 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.

CAN THE PILL CAUSE 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.

CAN ANTIPERSPIRANTS CAUSE 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.

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.

DO I NEED A SMEAR TEST? Yes. 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. 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.

WHAT ABOUT OVARIAN AND WOMB 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

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

Womb cancer is also 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 GP to find out.

HOW DO I AVOID THRUSH? Most women experience occasional bouts of thrush – itching, soreness and swelling of the vagina caused by a yeast infection – particularly during pregnancy or after a course of antibiotics. To lessen the risk of thrush: >> wash your vaginal area with water and avoid perfumed soaps, shower gels, vaginal deodorants, or douches >> avoid latex condoms, spermicidal creams or lubricants if they irritate your genital area.

WHAT ABOUT URINARY TRACT INFECTIONS? Half of women will have a urinary tract infection (UTI) at least once during their life. Lessen your risk by: >> emptying your bladder after sex >> wiping from front to back after going to the toilet >> drinking plenty of water >> avoiding constipation. UTIs usually get better on their own within 4-5 days. But see your GP the first time you have the symptoms or if you have a UTI more than 3 times in a year. You should also see a GP if you develop a high temperature, your symptoms suddenly get worse, you are pregnant or have diabetes.

I’VE LOST INTEREST IN SEX For both men and women, interest in sex (libido) is a complicated mix of emotions and hormones. Ups and downs with time and age are normal. But libido can also be reduced by: >> tiredness, stress, depression and/or relationship problems >> the side-effects of drink or drugs (including legal drugs such as anti-depressants and blood pressure medication) >> hormonal changes (particularly in women but also in men) >> medical conditions such as heart disease or diabetes. If prolonged loss of libido concerns you, see your GP.

TELL ME ABOUT THE MENOPAUSE The female menopause is caused when the ovaries stop producing as much of the hormone oestrogen and no longer release an egg each month. Periods sometimes stop suddenly but usually become less frequent over months or years and eventually stop: you are no longer able to get pregnant naturally. The menopause usually occurs between the ages of 45 and 55 (the UK average is 51). But 1% of women have it before the age of 40. This premature menopause may be caused by surgery to remove the ovaries, cancer treatment or an underlying medical condition but often the cause is unknown. Common symptoms of the menopause include: >> hot flushes >> night sweats >> vaginal dryness and discomfort during sex >> difficulty sleeping >> low mood or anxiety >> reduced sex drive (libido) >> problems with memory and concentration. Symptoms can begin months or years before your periods stop and continue for around four years after your last one (some women experience them for much longer). Talk to your GP if you have troubling menopausal symptoms or experience them before the age of 45. Your GP may well confirm you are menopausal based on your symptoms, but a blood test to measure your hormone levels can be carried out if you’re under 45. Treatments for troubling menopausal symptoms include: >> hormone replacement therapy (HRT) – tablets, skin patches, gels and implants that replace oestrogen >> vaginal oestrogen creams, lubricants or moisturisers for vaginal dryness >> cognitive behavioural therapy (CBT) to help with low mood and anxiety >> a healthy, balanced diet, regular exercise and maintaining a healthy weight. Your GP can refer you to a menopause specialist if symptoms don’t improve.

MENTAL WELLBEING 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 both to notice 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

Don’t forget National Grid’s Employee Assistance Programme - see page 34.

>> damage your sex-life. Get to know what triggers stress and low mood in you. You can beat stress by: >> eating better - see page 6 >> sleeping better

>> exercising - see page 13 >> 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 manual Beat Stress, Feel Better.

WHAT ARE THE STRESS WARNING SIGNS? If you spot any of these, ask yourself if they could be early warning signs of too much pressure or stress. 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 >> 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 >> Not sleeping properly (or wanting to sleep all the time) >> 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 signs. People who take their own lives are not so different from those who don’t. Mostly the only difference is treatment and support. So take care of yourself.

I FEEL DEPRESSED IN THE WINTER We all need daylight and the sun on our skins. Grey skies are gloomy. Being too hot or too cold will also affect your mood. Seasonal Affective Disorder (SAD) - or ‘winter depression’ - is linked to low exposure to sunlight. (The vitamin D we convert from sunlight is important for physical and mental health.) If you find yourself regularly despairing during darker days, talk to your GP. There is stuff available including special lightboxes. Visit sada.org.uk.

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 people 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.

WHAT WILL MAKE ME FEEL BETTER? All the ideas listed on pages 25 and 26 will help. If you feel you need something more, talk to your GP or ask your manager to refer you to National Grid’s Occupational Health Service. There is medication available and various talking therapies. From one-off counselling sessions to long-term, in-depth psychotherapy, each talking therapy uses a slightly different approach. Some are one-to-one with a therapist, others are done in groups. Some prefer the privacy of individual therapy; others find hearing from others with similar experiences useful. Your call. If you think that talking therapy might be useful for you, National Grid’s Employee Assistance Programme can help (see page 34). You can have up to six counselling sessions that are completely confidential. They will refer onto other therapies if they think you need it. If you prefer, talk to your GP. You may even be able to refer yourself under the NHS IAPT initiative (www.iapt.nhs.uk/services).

WHAT IS CBT? Cognitive Behavioural Therapy (CBT) works by enabling you to recognise the patterns of thoughts, feelings and behaviour that lead to difficulties in your life, and looking at ways of shifting these patterns through the way you think and what you do. It doesn’t focus on the past but on improving the present. Unlike some therapy, it may only take a few sessions to help you understand your stress - a bit longer (12 sessions) to help with depression. The website Living Life to the Full (llttf.com) offers a free introduction to CBT online.

SHOULD I TRY MINDFULNESS? If you feel like you’re always rushing around on autopilot, Mindfulness can teach you to recognise when your autopilot is dragging you into unhelpful thoughts and to return your attention to the moment, often using the breath as an ‘anchor’. Sounds weird? Possibly - but there’s a growing body of evidence for it. Anyone can do it and there are many apps, books and local groups around to help you. Mindfulness-based Cognitive Therapy combines meditation techniques with CBT. It offers a practical approach and again results can be pretty fast.

MENTAL HEALTH MEDICATION In 2012, the number of prescriptions in England for anti-depressants topped 50 million for the first time. But drugs (usually anti-depressants called SSRIs) are no longer the automatic choice for GPs when people go to them with mood or stress problems. Some people find them useful but it’s worth doing a bit of research first: >> What are the side-effects? >> How long before they should start working? (Most take 6-8 weeks.) >> How long are you likely to have to take them for? >> Are there alternatives to medication that might work better for you? >> How easy are they to come off? Their benefits in cases of severe depression are generally accepted but there is debate about how useful they are for mild to moderate cases. Depending on your symptoms, you may need medication to stabilise mood before talking therapies and some of the other ideas discussed in this booklet will begin to help. Discuss it with your GP. Your local pharmacist may also be useful.

I’M WORRIED ABOUT A COLLEAGUE Every year, one in four of us faces a mental health challenge. That’s odds of 3/1 so we all know someone affected. Watch out for changes in: >> appearance (tired, run down, niggling ill health) >> mood (irritable, emotional, angry) >> behaviour (withdrawn, not enjoying usual activities, drinking/eating more) or >> thinking patterns (thinking everything is terrible or relates to them personally – ‘they’ve got it in for me.’) If you think a mate is bottling something up, a simple way to make a difference is to do something together - car, computer, exercise, garden, walk, even housework. Get them to give you a hand. Feeling wanted makes us all feel better. You don’t have to talk but if you want to, doing something together makes it easier. Open up yourself - if you think he or she has work issues, perhaps talk about your work. (See the RUOK link on page 35 for more tips.) If you are concerned that a colleague may be suicidal, talk to the Employee Assistance Programme about their guidance for supporting employees with suicidal thoughts.

WHEN HOME ISN’T A SAFE PLACE It is estimated that domestic abuse will affect 1 in 4 women and 1 in 6 men in their lifetime. It’s not just about being physically hurt, it’s also about being emotionally hurt and controlled (including financial) and sexually abused. It covers threats, shoves and pushes, hair-pulling, constant criticism, stopping you from seeing family or friends – it’s any kind of controlling behaviour by a family member that frightens you or undermines your self esteem. If this is happening to you, remember you are not alone and it is not your fault. Whether you would simply like someone to talk to, or specific information about how to stay safe, check the list on page 35 to find organisations that offer advice and support.

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.

WHAT OTHER SERVICES ARE THERE?

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

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. (You may be responsible if, for example, drugs affect your driving.)

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.

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

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. 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.

A WORD ABOUT SHIFT WORK In some people, shift work (especially at night or with early morning starts) can disrupt your internal body clock causing tiredness and sleeping problems, affect appetite and digestion and increase use of sedatives or stimulants. It can impact on family life, fertility and increase the risk of heart, stomach and mental health problems, colds and flu. If you think shift work is damaging your health, speak to your line manager.

NATIONAL GRID

HEALTH & WELLBEING SERVICES AT NATIONAL GRID National Grid is committed to enabling our staff to better understand and support their health and wellbeing through our occupational health services, mental and physical wellbeing support programmes and engagement activities. National Grid’s Health and Wellbeing helpline:

0845 094 8107

(Option 1 –physiotherapy; option 2 – Employee Assistance Programme; Option 3 – manager’s support; Option 4 – occupational health) The Employee Assistance Programme (EAP) offers: >> 24/7 confidential support 365 days per year >> Information and advice on a wide range of issues >> Legal support and information >> Debt advice and information >> Signposting for individuals to other related services including local community-based support >> Immediate emotional telephone support >> Assessment and onward referral to short-term counselling (telephone or face-to-face) >> Support with career coaching, relationship problems either at home or at work. >> Help with drugs and alcohol dependency (or call direct: 0800 111 6387) >> Referral for CBT. You can also approach your line manager for advice and support on your team/team member management issues. Visit the EAP section of the Health & Wellbeing Pages of the infonet including a mindfulness webinar.

WHO CAN HELP? Men’s Health Forum www.menshealthforum.org.uk NHS Choices Online ‘front door’ to NHS www.nhs.uk www.nhs.uk/lifecheck www.nhs.uk/change4life apps.beta.nhs.uk Call 111 (24 hour) for nonemergency medical advice. http://tinyurl.com/oohNHS for more on NHS out of hours. Alcohol www.drinkaware.co.uk The NHS has a Drinks Tracker app. Alcohol Concern also have a units calculator. Alcoholic Anonymous 0845 769 7555 alcoholics-anonymous.co.uk Oral Health Foundation www. dentalhealth.org Eye health www.rnib.org.uk/eye-health Macmillan Cancer Free helpline 0808 808 00 00 www.macmillan.org.uk Breast Cancer Care Helpline 0808 800 6000 www.breastcancercare.org.uk

Domestic Violence www.refuge.org.uk www.womensaid.org.uk National Domestic Violence Helpline (run by Refuge and Women’s Aid) 0808 2000 247

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

Drink and drugs Frank 0300 123 6600 www.talktofrank.com Prostate Cancer 0800 0748383 www.prostatecanceruk.org Diabetes UK 9-7 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

Organ Donor Register www.organdonation.nhs.uk

Stroke Association Helpline 0303 303 3100 www.stroke.org.uk

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

Gay, bisexual and transgender www.gmfa.org.uk lgbt.foundation 0303 303 3100

Australian organisation RUOK also have interesting resources for talking about mental health: ruok.org.au/every-day-resources

HIV Awareness, support & advice: 0808 802 1221 www.tht.org.uk

Sexual Health www.fpa.org.uk www.loversguide.com For free condoms locally, try: http://tinyurl.com/NHScondom

FEELING DESPERATE? Samaritans 116 123 Emotional support 24/7 www.samaritans.org

Beating Bowel Cancer www.beatingbowelcancer.org

Smoking 0800 022 4332 www.smokefree.nhs.uk www.ash.org.uk

PHOTO CREDITS: Thanks to National Grid library and David McCairley plus Jim Larrison, Len Rizzi and chinesechef who were all

kind enough to make their images available through the Creative Commons. (If this is not the case, please contact us.)

Calm (for men) 0800 58 58 58 www.thecalmzone.net

Full credits, links and licences at: menshealthforum.org.uk/ MMreferences

THE GOOD HEALTH GUIDE One careful owner? With a little care, the high-performance machine that is the human body will run smoothly for a lifetime with just basic maintenance and minimal need for spare parts. This easy-to-read handbook will show you how to fine tune your engine, choose the right fuel and keep your mind on the road ahead. Weâ&#x20AC;&#x2122;ll explain the little changes that can make a big difference to the lives of both men and women: > know your numbers > food and drink > physical health > mental wellbeing Equipped with THE GOOD HEALTH GUIDE, you might just reach the finish line without your original exhaust pipe falling off. Excellent. So easy to read and so simple to understand.

WARNING: Reading this booklet could seriously improve your health. ISBN: 978-1-906121-97-6 www.menshealthforum.org.uk