Published on Discovery Channel health, 28 March 2003

Everyone has a mole or two. But what are they, where do they come from and can they be dangerous? We take a look.

Moles – known medically as naevi – are darkened patches of skin, which are nearly always brown in colour and usually found above the waist on sun-exposed parts of the body.

They come in a variety of shapes and sizes – large, small, raised, flat, and hairy or smooth. The only consistent thing about moles is that everyone has them – most people average between 10 and 40 on their body – and they are nearly always harmless.

Rise above, then fade away

Moles are actually made up of clusters of the skin cells that give you a tan – melanocytes. These cells exist everywhere in your skin and produce a pigment which causes the skin to darken when exposed to the sun.

It’s not known exactly why, but occasionally a large number of these melanocytes group together, producing a dark patch of skin on the body. As the body is exposed to sun over the years, they tend to grow, becoming larger in diameter or raised above the surface of the skin.

While some people are born with a few moles (congenital naevi), most appear while the body is developing. After the age of 20, new moles are uncommon. They also have a lifespan – albeit a long one. Over time, moles may flatten again, fade and become flesh coloured or simply disappear.

Some people are predisposed to moles – mostly fair-skinned people – and people who have them are more likely to have children with moles. Apart from that, exposure to sun is the most common cause of new ones appearing.

Down, down, deeper and down

But while moles are mostly harmless, they are a major cause for concern with regard to skin cancer. Consultant dermatologist at St Mary’s Hospital in London, Dr Sarah Wakelin, says moles are a risk factor, and melanoma – skin cancer that can spread to other parts of the body – is continuing to increase in the UK.

She explains that the melanocytes that make up moles are usually found on the bottom layer of the epidermis of the skin. With age, they may fall deeper into the skin and hence appear to vanish from the outside. However when some moles divide and grow they may spread up and down layers of the skin as well as grow abnormally. “The deeper down into the skin they go, the more likely it is that they have spread.” And once in the blood stream, as with any cancer, the major organs are at risk of infection.

Dr Wakelin explains how a cancerous mole is diagnosed, “It’s difficult to choose one sign. The most important question is whether it has changed recently? Any rapid change – darkening, becoming raised – is an indication, especially when it happens to just one mole but not to the others.”

It’s less of a worry when a person’s moles all change in the same way, she explains, because such general changes can be caused by events such as pregnancy.

As for spotting a cancerous mole, there is the “ABCD” basic guide. A is for asymmetry – is the mole the same on one side as it is on the other? The more symmetrical, the safer the mole. B is for border – does it have a smooth (fine) or ragged border (risky)? C is for colour. Is the mole a consistent colour throughout (good thing) or has it recently changed colour (bad thing). And D is for diameter. Any mole more than 6mm in diameter is suspicious.

I am a mole and I live in a hole

However, Dr Wakelin says these are only indicators, and not proof. If a doctor or dermatologist is concerned, the likelihood is that they will cut the mole out and have a look at it under a microscope.

Since they are quite small, the whole mole, plus a little extra outside it, is usually cut out down to the fat layer. This can mean an incision of as much as 1cm if it is on the back, or a very tiny slice if it’s on the eyelid. The hole is then stitched shut and left to heal, with usually with just a thin white scar remaining.

One patient, 29-year-old analyst Mark Fletcher from London, had a mole removed from his face as a precautionary measure. “It took about 15 minutes after the anaesthetic was injected and I had about five stitches,” he says. The resulting scar is about 6mm long and 1mm wide. Fortunately, it is not that visible “except when in shadowy light”.

Lab tests on the mole revealed it was not cancerous. But there is a grey area, explains Dr Wakelin. “There are some moles that we call dysplastic, that are abnormal but not cancerous. If they are very dysplastic, it is best to have them removed. But it is difficult to tell.”

Beware of sunscreens

Fortunately, awareness of skin cancer in general means many cases are caught sooner. However, worryingly, the incidence of skin cancer in the UK continues to rise and, according to the latest figures, the death rate from skin cancer has now surpassed that of Australia.

Since sunlight is the most important environmental factor in the risk of melanoma, this may seem incredible in a country as sun-free as Britain. Ironically, it is the sunscreens designed to protect us that are thought to be aggravating the problem.

“Sunscreens help reduce UV exposure, but melanoma may not come from that,” Ms Wakelin explains. “It may simply be the amount of exposure to sunlight that causes more damage.”

Sunscreens also give people a false sense of security, she says. “If you don’t have burning to warn you, people may be over-exposing their skin.” People also tend to put too little on too infrequently – possibly due to the high-cost of such creams.

Instead, the official advice from doctors to help reduce the chances of skin cancer is to spend less time sunbathing, cover up the body with clothing and use strong sunscreens on the parts of the body that are exposed. Apart from that, keep a regular eye on your moles, and if you see any sudden changes in them, visit a doctor to be on the safe side.

Further information:

• British Association of Dermatologists
• Dermatology.co.uk

Published on Discovery Channel health, 28 February 2003

Each year, more than a million people in the UK sustain some form of head injury. The majority recover while some have severe long-term problems. But experts warn that those in between are being neglected.

Any problems, however, are not always immediately obvious because 90 per cent of people make a good physical recovery. Once they are up and about, friends, relatives, loved ones and, sadly, medical and social services can often assume the problem is dealt with.

But the truth is quite often different. The brain is a delicate and complex organ, and any damage can result in significant “invisible” problems. These include personality changes, slowness, poor memory, irritability, bad temper, tiredness, rapid mood changes, tension, anxiety, threats of violence and depression.

While anyone who has had to look after someone recovering from a moderate brain injury will tell you these emotional and cognitive problems are par for the course, it has been an uphill struggle to persuade government and the health service of the need for continued support and rehabilitative help.

Gaps in the system

One of the main organisations offering support is the brain injury association Headway. The charity began in 1979 when it became apparent that people recovering from brain injuries had no support once they left hospital.

There has been progress – a House of Commons Health Select Committee report and an NHS National Service Framework specifically on the issue – but today Headway still represents the main source of help and advice about brain injuries.

“It’s getting better – slowly,” says Headway spokesman Graham Nickson, “although it’s almost a postcode lottery when it comes to help. We still need better social and medical care and more resources attached to it. Social services certainly need to be more aware.”

The level and kind of support varies from person to person but often they just need to know that what is happening is normal. “Social support is very important,” says Graham. “People need to know they are not alone and that help is out there.”

The ideal scenario is a “pathway of care”, he says, so people (including those looking after the patient) aren’t cut off as soon as they return home. This could vary from helping people return to work to checking on them at home, or enlisting them for courses to deal with amnesia or memory loss.

This flexible approach is strongly supported by Dr Lynne Turner-Stokes, director of the North-West Thames Regional Rehabilitation Unit at Northwick Park Hospital, Middlesex. She uses the analogy of a child’s slinky toy to explain the best way to help.

There are different stages of progress on the staircase to recovery, she says. These begin with acute care of the injury itself, through to intensive rehab at the hospital using day-care services, community outreach and home assistance, and finally to drop-in centres.

Dr Turner-Stokes says excellent communication and flow of information from one stage to another is vital to enable the individual to move down the staircase seamlessly. “If one or more of the steps is missing, the analogy still holds – the thing tumbles down the rest of the way and ends up in a tangled mess on the floor,” she says.

Risky business

It is this mess that most concerns Headway; particularly the effect that a lack of support can have on young people. The charity says brain injury is the most common cause of death and disability in young people in the UK. Young men are more at risk since they tend to undertake dangerous activities and are more likely to be involved in violent assaults.

Figures show that road traffic accidents account for 40-50 per cent of all traumatic brain injuries, accidents at home and work for 20-30 per cent, sports-related accidents between 10-15 per cent and violent assault 10 per cent.

But regardless of the cause, brain injuries can lead to significant problems not only in the following years but also for the rest of people’s lives. “Many injuries are sustained by people between 16 and 24 years old,” says Graham. “And this a crucial time in people’s development when they are forming their first vital relationships.”

Problems such as losing the capacity for planning, concentrating or problem solving, or trouble with communication and, perhaps most disquieting, emotional and behavioural difficulties, can all isolate the individual. Socially inappropriate and impulsive behaviour or bursts of anger or anxiety can lose someone their friends and break up relationships, Graham explains, and this can cause life-long emotional damage.

Relationship breaker

It’s not just young adults that are affected. A brain injury can force a complete restructure of a relationship, as one half of the couple becomes a different person overnight. Many relationships don’t survive the abrupt change.

One woman who sought help from Headway explained her situation. “We had been married for seven years and had two small children when Frank had his accident. He was in a coma for a week. I remember being elated when they said he was going to live and felt that he would be back to normal in a few weeks. I was wrong.”

Frank was no longer full of ideas and jokes but had become far more lethargic. “Frank has little enthusiasm, is slower, has lost his sense of fun, gets very irritable, and is often preoccupied by his problems,” she explains.

And this has impinged, not only on everyday events, but also on the relationship itself. “I miss his friendship, intimacy, partnership and the sexual relationship that we had. I still love Frank, but in a different way, almost like an elder sister. Life is much harder now because, not only do I have to look after the two children, but I have to keep an eye on Frank.”

Brain injuries can cause stressful and exhausting difficulties for years afterwards but aside from prevention – for example, forcing children to wear bicycle helmets – the most effective way of dealing with the problem is to introduce a support structure.

Gradually, the importance of this structure is being realised across the country, and it will become increasingly necessary as medical advances enable more people to survive from brain injuries that just a decade ago would have killed them.

Further information:

• Headway
• Department of Health’s National Service Framework for brain injuries [dead link]
• Select Committee report into brain injury rehabilitation [dead link]

Published on Discovery Channel health, 21 February 2003

There’s nothing more luxurious than relaxing in a hot spa or sauna after a hard day’s work. But as well as making you more relaxed, can these therapies actually boost your well-being?

The history of hydrotherapy

Water has been used for thousands of years to improve health and is now being rediscovered by doctors, sports players and stressed office workers as a terrific means of recuperation.

Healing with water, or hydrotherapy, has been around since records began. There’s evidence that people built water installations as early as 2400 BC. The Egyptians and Assyrians used mineral waters for their health. Most famously, the Romans were huge fans of water therapy, ranging from hot and cold water to steam rooms, but it was equally popular with the Japanese, Chinese and Greeks.

The decline of the Roman Empire saw the West turn its back on hydrotherapy. The Church branded any association with the use of the elements, like water or fire, pagan, and hence its use rapidly petered out.

Not that it died out completely. The German government, for example, remained so convinced of the recuperative effects of spas that until recently all its citizens were entitled to four weeks every three years at the famous spa town of Baden-Baden, all on the state. When the government decided to cut its expenditure on spas to balance the books, Germans were up in arms over what many saw as their birthright.

Feelings may not run so high in the UK, but spas and saunas are nevertheless becoming big business, now found in many hotels and several dedicated facilities around the country.

A new Bath spa

Dr John Harcup, medical advisor to the British Spas Federation, says Britain’s most famous spa town – Bath – will soon benefit from a brand new dedicated spa complex, which should be open in two or three months. Crucially, however, he says that about 20 per cent of the complex will be for specifically medical use.

“Spa treatments are getting more medically orientated,” he says. “There’s lots of research into things like arthritis and sports treatment.” He is hoping Bath rugby club will take advantage of the facilities. “It’s much easier to exercise in water, and so after injuries or operations or strokes it is very effective for rehabilitation.”

Water not only supports the body but is also excellent at distributing, applying and removing heat. “People have used water for 2,000 years but post-war they didn’t think they needed things like water. What they have forgotten is that it has very little side effects,” explains Dr Harcup.

Sarah Cox, chartered physiotherapist and member of a special interest group for hydrotherapy, agrees entirely. “There are many conditions that can be treated in a pool but not in a gym,” she says. “People with broken legs or knees for example. They can’t walk normally but they can exercise in the water.”

Pain relief is also a great advantage, according to Sarah, who says terminally ill patients often contact the group in order to gain some relief.

As well as aiding injuries, aching or stiff muscles and joint problems such as arthritis, the New England Journal of Medicine claimed in 1999 that soaking in a warm spa can help type 2 diabetes. The condition mainly affects older people; especially those who are overweight.

Dr Philip Hooper of the McKee Medical Centre in Colorado found that, over three weeks, patients who spent 30 minutes a day in a hot tub had an average drop in blood sugar levels of 13 per cent. In some cases, this meant they did not need to take their insulin injections.

Exercise while soaking

The significant drop was put down to a spa’s ability to act in a similar way to exercise. The heat of the water draws a lot of blood into the skin, which causes a drop in blood pressure. This drop then causes the heart to pump faster in order to maintain blood pressure.

It is this change that is behind many of the water therapy’s positive effects but also why people with high blood pressure, pregnant women and children should be wary of spas and saunas.

Only last week, doctors warned people with kidney problems and high blood pressure to avoid jacuzzis after a 36-year-old German man with cysts on his kidney suffered internal bleeding after using one.

Jacuzzis, named after Roy Jacuzzi who invented the artificial water-jet spa in 1970, are unusual in that a fast jet of air is fired into the tub. The man – who also had high blood pressure and took medication to thin his blood – was particularly susceptible to the blast.

Ask the Finns

Extensive research shows that saunas do have a physiological effect. Experts have carried out large numbers of medical experiments on the Finns who are famous for their love of them. Aside from facts and figures on cardiac output, studies have shown saunas to induce hormonal changes.

The Finnish Sauna Society says a sauna is a pleasant, relaxing and refreshing experience beneficial to both body and mind. It cleanses the skin, removes aches and pains, and helps people sleep more soundly. The society adds that a sauna has many physiological short-term effects, but no permanent effects on health.

Dr Harcup assures us that a bath in dense water, perhaps including creams or algae or peat, is so soothing that the intense feeling of relaxation lasts for hours or even days afterwards. Don’t expect miracles from your spa, but you might be surprised at just how many benefits a bit of water therapy can provide.

Further information:

• British Spas Federation
• Finnish Sauna Society

Published on Discovery Channel health, 21 February 2003

Laser surgery is sold as a modern, simple cure for sight problems. But Health Which? recently warned that some providers of the service are being less than honest about the procedure’s risks. What’s the story?

The magazine’s two most disturbing conclusions were that patients are often misled about the risks of the procedure, and that under-qualified surgeons carry out the operation.

But how risky is laser eye surgery, and how successful is it? Are surgeons offering this costly operation – prices range from £750 to £2,000 per eye – really misleading patients? And if so, what is being done about it?

Operation low-down

To understand the risks, it’s first necessary to understand the procedure. The type of operation that is heavily advertised, and which an estimated 100,000 people in the UK have done each year, is called LASIK, standing for Laser-Assisted In-Situ Keratomileusis.

In LASIK, a laser is used to reshape the cornea – the clear covering on the front of the eye. A flap is cut in the cornea using a special machine and the surgeon folds the flap back. A laser reshapes the tissue behind it by burning off parts, much like creating a sculpture by chipping away at the stone. This new shape should bend the light so images are sharper on the back of the eye, improving the person’s vision.

Once this is done, the cornea flap is put down, the patient is given a short rest and the operation is complete. The whole thing takes 20 minutes and the effects are usually immediate. The great advantage of LASIK over other types of eye surgery, say practitioners, is that it is relatively pain-free, giving it mass appeal and pushing a tricky procedure on an extremely sensitive part of the body into the realms of cosmetic surgery.

What’s the problem?

The problem is that while LASIK – particularly in the hands of a highly experienced eye surgeon – is extremely safe, it remains a surgical operation and so there is always the risk of complications.

Reported problems have included seeing halos on objects, haziness, glare, poor night vision and double vision.

But Dr Gerald Panting, the communications and policy director for the Medical Protection Society (MPS), says part of the trouble with laser surgery is inflated expectations, poor-quality information and misleading advertising.

As the insurance provider for doctors, the MPS is dismayed at the number of claims being brought and won against ophthalmologists carrying out LASIK. In response, it has raised the premium for these doctors and drawn up a list of guidelines that will be released in about a month, which it expects surgeons to sign up to and follow.

“This is an area of practice in which there is a large amount of advertising direct to the public,” says Dr Panting. “And as such, expectation is very high and therefore often not met – it is the same with most forms of cosmetic procedure.”

The MPS guidelines will advise on patient selection, informed consent (giving patients all the relevant information) and follow-up care. “We want to make sure no hopes are unduly raised,” he explains.

Getting a clearer picture

The most essential element for anyone thinking of undergoing LASIK is to choose the best surgeon available and ask all the right questions. Experienced surgeons are significantly better than those new to LASIK.

Two surgeons documented their cases and the first found a complication rate of 4.5 per cent for the first 200 eyes operated on, slumping to 0.87 per cent for the following 4,800 cases. The second recorded a 6 per cent complication rate for the first 100 eyes, 2.3 per cent for the next 600 and just 0.3 per cent for the next 300.

But Health Which? found that some clinics hire people with limited skills and revealed that the Royal College of Ophthalmologists had even heard of keen GPs being allowed to carry out the procedure.

Mr Dan Reinstein, one of the people drawing up the MPS guidelines and also a specialist refractive eye surgeon and medical director of the London Vision Clinic, takes it one step further. He says there is a marked difference between “expert” and “experienced” surgeons.

An expert, he says, is one who has both training and experience. If someone untrained is operating on their 1,000th eye and comes across a problem they haven’t seen before, it is equivalent to someone operating on their first eye. His clinic’s website contains a lengthy guide on what to ask a surgeon. “Any surgeon should be able to answer the questions,” he says.

Mr Reinstein is keen to make people realise that eye surgery is not something to enter into lightly. “We are dealing with one of the five senses and possibly the most critical one,” he says. “But this surgery has been trivialised far too much; it’s been made to look like a lunchtime massage, but it’s not – it’s a medical procedure.”

So what’s the solution?

Put simply, patients should be aware that laser eye surgery is not without risks. It is generally accepted that there is a problem in 1 per cent of operations. The worst of these problems can mean lengthy and dangerous follow-up surgery, and deterioration in sight.

There are “minor” complications in around 5 per cent of cases. This is the risk element you need to consider, and the risk will be different for every individual due to the make-up of their eyes. But many people say laser eye surgery has made a significant difference to them. You may still need glasses later in life as the eye stiffens, but you might not have to wear them for 20 years.

If you’re willing to take this risk (and with new technology, that risk is reducing every year), your best bet is to do the necessary research and visit the best surgeon you can find.

Further information:

• Lasik Eyes (patient-led site)
• London Vision Clinic
• Medical Protection Society
• Royal College of Ophthalmologists

Published on Discovery Channel health, 7 February 2003

A recent study concluded that the majority of us consume double the recommended amount of salt. But is this important? Do we need to cut down on salt – and if so, how do we do it?

The survey by the Food Commission compared the amount of salt in four different types of processed food – white bread, crisps, baked beans and canned tomato soup – with levels in the same products in 1978. It was disappointed to find that, despite food industry claims to have reduced the amount of salt in products, levels had changed very little – and had even increased in some products.

Furthermore, a closer look at foods aimed at children revealed that many of them – including Burger King kids’ meals, Dairylea Lunchables and Teletubbies canned pasta – actually included more than the child’s recommended maximum salt intake in just one serving. In many cases, they were saltier than seawater.

Why this is important

So what’s the problem with high salt levels? Although salt is an essential part of our diet – it helps our bodies function properly by aiding our nerves and maintaining our muscles – too much can lead to osteoporosis, asthma and cancer of the stomach.

It also increases blood pressure and high blood pressure is behind 170,000 deaths every year in England alone, contributing to strokes and heart attacks. A reduction in salt intake would save an estimated 30,000 lives a year, say experts.

The government’s minimum salt level recommendation for an adult is 1.4 grams a day, although we should be aiming for 4g a day. It puts a maximum recommended level at 6g a day.

The problem is that 90 per cent of us consume over 6g a day and many eat double or even triple that.

The reason behind the rise is an increasing reliance on processed food (which has a far higher salt content) and a move away from fresh produce in our everyday lives. Estimates vary, but between 65 and 80 per cent of our daily salt intake now comes from processed foods.

The problem is even more worrying in children. The government body that reviews salt in our diet, the Scientific Advisory Committee on Nutrition (SACN), has given a target daily intake of under 1g for babies, 2g for children up to six, and 5g for those aged between 7 and 14.

However, if a child’s portion of baked beans contains 2.5g and a Burger King kids’ meal 3.3g, it becomes clear that children are consuming dangerous levels of salt every day. The furring of the arteries that is behind heart attacks and strokes starts in childhood, doctors have revealed – leaving a ticking time bomb in many kids.

What are we doing about it?

The government is trying to reduce our salt intake. SACN is meeting this month to discuss the responses it had from its investigation last year into salt and health. In the report, it warns repeatedly of high salt intake, especially with regard to children.

A spokeswoman from the Food Standards Agency (FSA) says it is in discussion with the food industry to reduce the salt it includes in products. But, she explains, no one can force manufacturers to change their methods. “At the moment there is no legal recourse. It’s all consumer choice – we aren’t going to prescribe the amount of salt you can put in a product. But we are in discussions to find reasonable ways to reduce the salt level in many foods,” she says.

The food manufacturers themselves defend their salt levels. The Food and Drink Federation (FDF) says the claims that there has been no reduction in salt are “out of date, out of touch and based on self-selecting surveys”.

It points to a government report in November 2001, which said bread manufacturers had reduced the amount of salt in their products. The Snack, Nut and Crisp Manufacturers’ Association says that salt levels in crisps have fallen 25 per cent over 10 years.

“We use salt for various reasons,” explains an FDF spokeswoman. “For taste, for flavouring, food safety – it gives the product a longer shelf life. And it also contributes to the texture and quality of the food.”

The chef’s view

However you choose to look at it, though, many processed foods contain too much salt for healthy consumption. Salt masks what would otherwise be very bland food. It is also something that the palate gets used to, as it stimulates the taste buds.

Experts say, however, that after three or four weeks of eating a low-salt diet, your taste buds increase in sensitivity, enabling your palate to appreciate subtler flavours.

Luke Finn, the head chef at Finns’ seafood restaurant in Newquay harbour, Cornwall, agrees. “Processed food is not as good as fresh produce simply because it isn’t fresh. You add a pinch of seasoning to steak or fish and it brings out the flavour, it’s a flavour enhancer. But if you add too much, it’s horrible.”

“Of course, different salts do different things,” he adds. “Sea salt and rock salt have a nicer flavour but table salt is ground right down and is much stronger because of it.”

The solution

So, how do you cut down on your salt levels if most of it comes from processed food? Well, clearly the answer is to cut down on ready-made foods and eat more fresh produce.

But if you buy food packaged as “low-salt”, manufacturers will supply more of it to retain their market.

Alternatively, cut down on salt in your meals and replace it with herbs and spices, or lemon juice or vinegar. Or why not add onions, garlic, ginger or chillies? Anything that adds more flavour to the dish itself will reduce the need for salt to stimulate the taste buds and make the meal enjoyable.

Further information:

• SACN
• Food Standards Agency
• Food and Drink Federation

Published on Discovery Channel health, 31 January 2003

You want to get fit but the idea of running on a treadmill or ploughing into an opponent doesn’t really appeal. So why not take up cricket?

Cricket may not be famed for its lithe, fit practitioners, as this joke makes clear:

Two men were discussing the importance of fitness in the game of cricket. Said one, “When I’m at the crease, my body is highly tuned and as taut as a bowstring. The bowler comes up, bowls, and my brain snaps out a command to my body to get quickly behind the line, raise the bat and execute a perfect stroke.”
The other man asks: “Then what happens?”
The first one replies: “My body says: ‘Who, me?’”

But the sport is actually an ideal way of building up your fitness, even if you are chronically unfit, say advocates. For example, as a fielder in an unusual position, you won’t be required to rush about all the time, but every now and again will need to chase after a ball and throw it back to the wicket. Then you will have time to recover while still remaining a vital part of the game.

When in bat, you have to concentrate and then if you strike the ball successfully run the length of the wicket for a run. Maybe back again for two. Then you have time to recover while the bowler starts his run-up again.

Best of both worlds

But while this may sound frivolous, it can be a real step to improved fitness. Because you are playing a competitive sport, you will want to improve your game and for each step in improvement, there is a corresponding increase in fitness. At national and top club level, cricketers are supremely fit.

Mark Hodgson of the England and Wales Cricket Board says the enduring appeal of cricket is that it’s a unique mixture of an individual and team sport. “It is a team sport, but it is also one batsman facing one bowler.”

As for fitness considerations, he says, “If you’re a fast bowler and you are constantly running up and down the wicket – on a hot day you need quite a high level of fitness. Equally, a batsman may be batting for two, three hours if they do well and that can be really knackering. To do that well, you have to be fit, but equally you don’t need a high level of fitness just to play.”

A social sport

To achieve optimum fitness, cricketers tend to incorporate jogging with sprint training. They also do body-weight exercises, such as press-ups, and free weights. The emphasis is on building up strength rather than muscle, particularly in the arms and shoulders. Abdominal strengthening exercises are also very important because one side of body tends to be over-used in cricket.

One advantage of cricket, apart from the fact that you are getting fit without noticing, is that the game is very social. “There are 9,000 clubs across the UK. If you go along to your local club, the team will most likely be very welcoming,” says Mr Hodgson.

Indeed, in many towns and villages the cricket club is a social epicentre on Saturdays and Sundays, with local residents turning out to support the team or just have a chat or a picnic.

Let’s hear it for the ladies

And don’t think that cricket is just for the men. While women’s cricket in the UK has still to reach the same level as it has in other countries, particularly Australia, there are new women’s clubs opening every year and the number playing has jumped 20 per cent in the past five years.

One woman who knows all about women’s cricket is Sally Bailey, fitness advisor to the Australian women’s team. “The game of cricket is particularly taxing – both physically and mentally,” she says.

“Achieving and maintaining an acceptable level of physical fitness is a vital ingredient towards being a balanced and consistent cricket player.”

And conversely, playing cricket will make you a fitter person. Being fit will help you run faster between wickets, jump higher to catch the ball, hit the ball harder and faster, and enable you to make quicker, more agile responses, she explains.

Go get involved

It is the nature of the game that makes fitness an intrinsic aspect. Games are long and require constant concentration, players are on their feet all day, and will have to make short sprints accelerating and decelerating extremely quickly.

When you are fielding, you test every part of your body as you perform crossover throws, hip throws and diving. Add to this the need to have a high level of mental alertness and you have an all-over body and mind workout.

So next time you find yourself running on a rotating piece of rubber in a sweaty gym, or, more likely, sitting on the couch pondering how to get fit, why not contact your local cricket club and see if they need more players? You can find a full list and contact numbers on the England and Wales Cricket Board’s website.

Further information:

• England and Wales Cricket Board

Published on Discovery Channel health, 24 January 2003

The Equal Opportunities Commission (EOC) has just released a report that suggests men want to spend more time with their children than ever before. But are employers and the government standing in their way?

Men now take on about a third of all the childcare, according to the report, revealing an entirely different world to the traditional image of the husband dozing in front of the TV while his wife puts the kids to bed.

However, our culture of long working hours is preventing many dads from becoming more involved in their children’s lives, even though they want to be, the report argues.

Chained to the office desk

Nearly 40 per cent of fathers work more than 48 hours a week and 12 per cent work 60 hours or more, meaning the burden of childcare continues to fall mostly on the mother.

“Many dads are spending far more time with their family than their own fathers did, but it is difficult for them to do more while they work such long hours,” says EOC Chair Julie Mellor. “The knock-on effect is that women often have little choice about how they balance work and family.”

Also, because women tend to earn less, a couple will often decide that the woman should spend less time at work. This, argues the report, is reinforcing the old belief that childcare is a woman’s job without recognising the fact that many dads wish to be more involved.

Vive la revolution

That view is strongly reiterated by the co-founder of campaign group Fathers Direct, Jack O’Sullivan. “Research shows that there is social revolution going on, but it is quite clear that men are having difficulties. They want to spend more time with their children but are also working long hours so they are being squeezed,” he says.

“It’s no good pretending that women do all the child raising any more – men are out there doing it, they’re not sitting in the pub.”

Working practices

Jack says many fathers become frustrated that they can’t spend more time with their kids. So what’s the solution? Julie Mellor says employers can help by promoting family-friendly working practices to all employees, and making sure they are paying women fairly.

“This is in employers’ interests and the interests of the economy as a whole, as it can boost morale and productivity,” she says.

But why would companies want to change? The EOC says family-friendly practices can encourage good staff relations plus improved motivation, commitment, retention and turnover. In fact, eight out of ten employers questioned agreed, but more than half still failed to offer schemes that could help new dads.

A step in the right direction

But it’s not only employers that are falling behind the times. The government is too, despite recent efforts. The law is due to change on 6 April – after that date, fathers will be entitled to two weeks’ paternity leave within eight weeks of a child’s birth at £100 per week.

A further four weeks unpaid leave can be taken in the first year of the child’s life. And employers will be obliged to consider requests for more flexible working for those with kids under six.

But while Jack O’Sullivan welcomes this as a “good start”, he says it’s nowhere near enough. “We have a social revolution running way ahead of policy,” he says.

“I think the government is beginning to understand, but we need more leadership from those in the higher echelons to help recognise the reality of life today.”

Legal wranglings

A prime example, he explains, is that under the new law, the four weeks of unpaid leave must be taken in week blocks. “If we really supported getting women back to work, then when she is ready why could she not go to back one day a week and the father take that day off to look after the kids?” As he explains, “women would much rather hand a baby over to the father than a child minder.”

It’s hard to argue against giving men more chance to be involved with their child’s development. You need only look at all the pictures of male celebrities pushing their kids along in prams – an unthinkable image only a few years ago – to see that society has changed.

Man about the house

One man who has benefited from a more flexible work life is Lester Haines from Manningtree in Essex. Lester works for an IT website, and when his baby daughter was born 14 months ago, he was commuting to London every day.

“The problem was that I’d often arrive at home after the baby had gone to bed,” he says. “I got very little time to spend with her.”

A few months later though, Lester was delighted when his company let him start working from home. “I was given the opportunity so I took it,” he says. “Now I get to see the kid every day, which is definitely better. Every parent should consider working from home a bit more.”

Men are taking a more active role in childcare and employers that appreciate this will be more attractive to a new dad. However ambitious they are, given a choice, most fathers would have no trouble deciding between their job and spending more time with their child.

Further information:

• Equal Opportunities Commission
• Fathers Direct

Published on Discovery Channel Health, 29 November 2002

Figures suggest that addiction causes 150,000 deaths in the UK each year, and researchers believe we may soon be able to pinpoint the genes responsible. But is it really all in our DNA or do we make a conscious choice to become an addict?

Ever since the 1600s when King James I recorded that the worst smokers were also the worst drinkers and that some people therefore had addictive personalities, scientists and doctors have tried to discover the cause of this kind of behaviour and find ways of preventing it from happening.

Genetic engineering

This dream of an addict-less society has recently been reborn. In the last two years, dozens of studies claim to have discovered genes for various addictions. Nicotine genes, alcohol genes, opiate genes, addictive-behaviour gene mutations, thrill-seeking genes – all of them documented in medical journals and widely reported as the breakthrough we’ve been waiting for.

But while the idea of addiction as a disease appears to make sense and suggests the possibility of a medical cure, are we not discounting the notion of free will and self-control? Can a child really be born a self-destructive addict?

Complex interactions

No, it cannot, says Dr Neil Wright, a psychiatrist from the Queen’s Medical Centre in Nottingham. “It is nonsense that a gene can dictate addiction,” he says. “Why would we carry a gene for alcoholism at all? Genes carry basic building blocks, not complex social interaction.”

Dr Wright concedes that genes do have some influence on behaviour and therefore certain people may be more likely to become addicts. However, he argues that such interaction is so complicated that the idea of modifying just one gene and overriding years of habit and experience is nothing but fantasy.

The author behind one study that pointed to an addiction gene, Dr David Collier of the London University Institute of Psychiatry, says addiction is caused by a combination of genetics and environment.

“There is evidence that genes influence addiction,” he says. “Very few people say they have no effect but similarly no one says it is purely genetic. It’s a mixture between the two.”

A medical condition?

Dr Collier’s study suggested that genes which encourage thrill-seeking and make people open to new experiences could cause addiction. He also concluded some genes might affect the intensity of a drug experience in different people. Combine the two and you have someone heavily drawn to a drug that may have addictive properties.

This is why some experts believe addiction is an illness – something someone gets, cannot help, and has to be treated for. Alcoholics Anonymous strongly believes that alcoholism is a disease. The support group encourages people who drink too much to realise they have a problem that has to be tackled head on.

Doctors too tend to believe that addiction – especially drug addiction – is beyond a person’s control. Why else would addicts continue down a path that gradually ruins their life and which they themselves often say they wish to end?

A different approach

So what’s the answer? Despite centuries of research, there is still not one undisputed cause of addiction and no proven method for tackling the problem. The closer we appear to get to understanding it, the more elusive it becomes.

Dr Wright takes a strong behaviourist approach and believes the problem is that various myths about addiction are self-perpetuating or encouraged by people with a self-interest.

It is both easy and convenient for addicts, doctors and rehab clinics to believe that an external force causes addiction, Dr Wright argues. Addicts are protected from blame, doctors can treat it in the traditional aloof fashion and rehab clinics get to sell a neat package that you can buy to conquer the problem.

Pure pleasure seeker

The reality, he argues, is that addiction is simply the result of constant decisions made in favour of a particular activity, whether that be drinking, smoking, injecting or even working or shopping, “because fundamentally we are pleasure-seeking and irrational beings”.

He says the solution is to widen a person’s social experience and bring them into contact with people who do not follow the same patterns.

So is this the future of tackling addiction and is the idea of an addiction gene dead in the water? It’s unlikely. For now, it seems we are no closer to knowing what turns people into addicts as we are to knowing what makes some people happy and others sad.

Further information:

• Alcoholics Anonymous
• Action on Addiction

Published on Discovery Channel Health, 13 September 2002

An estimated 50,000 people in the UK, 90 per cent of them women, are suffering from a complicated and disabling disease called lupus. The problem is that many of them don’t yet know they have it.

Joint pain, fatigue, skin rashes, confusion, headaches, flu-like symptoms and chest pains can all be symptoms of systemic lupus erythematosus (SLE) to give it its full title. Unfortunately, they can also be symptoms of hundreds of other problems.

Doctors and researchers at the cutting edge are still trying to understand lupus and a range of new drugs are being developed to help those already suffering from the disease.

Although there is no actual cure, it is vital that people are diagnosed as early as possible so they can be quickly treated. The charity Lupus UK has therefore designated October Lupus Awareness Month.

Self-destruction

Lupus is an autoimmune disease. The body’s immune system goes into overdrive and produces too many antibodies, making the body attack itself. This causes joints, muscles and other organs to swell up.

It also causes frequent skin rashes, often on the face, which give rise to its rather unpleasant name. The rash was thought to resemble a wolf bite, so the disease was named after the Latin name for wolf – lupus.

Untreated, lupus can be fatal because it can attack the major organs. But with increasing knowledge of the disease and careful monitoring, most sufferers can expect to live a normal lifespan in greatly improved conditions.

The disease is genetic, nearly always affects women and is usually sparked by a sudden increase in hormones – such as puberty, pregnancy and the menopause. Strong medication, sunlight and heavy stress can also trigger the illness.

One of the world’s leading authorities on lupus, Professor David Isenberg from University College London, explains why tackling the disease is so difficult.

His clinic sees an average of 30 lupus patients a week. “The first patient might be Caucasian with a history of a photosensitive rash, arthritis, mouth ulcers,” he says. “The second could be Afro-Caribbean with aggressive lupus nephritis, kidney failure, a previous history of pericarditis. The third may be Asian with severe pleuritis, a previous history of a psychotic illness and arthralgia.” He says each of these patients meets the criteria for lupus.

“We are dealing, in reality, with a group of related syndromes, and certainly not a homogeneous disease entity. This fact is often not appreciated by basic scientists who, in my experience, far too often think of SLE as a single and simple disease entity.”

Sick and tired

Prof Isenberg also makes the startling observation that most patients are less troubled by the worst aspects of the disease, which include scarring on the face, kidney failure or even death, and far more bothered by the constant tiredness that comes with lupus.

This is backed up by Joanne Forshaw, who launched the popular Lupus website www.uklupus.co.uk after she was diagnosed more than six years ago, aged just 20.

“At first I just didn’t go out, I was too tired, it was too much,” she says. “Even now I’m still not like a normal 27-year-old – I don’t go out clubbing or stay out late, I’m too tired by then.”

Joanne’s life is significantly better since she was diagnosed, but like many sufferers, there was a long delay between her getting the disease and being treated.

“The first thing I had was a giant pain in the knees,” she explains. “I went to my GP and he told me it was just a virus. But it didn’t go away, so I had a blood test and went to a rheumatologist. There, I had some more blood tests and then three or four months later, he said I had lupus – although he didn’t explain it to me.”

That wasn’t the end of it though. “For the next year, he kept changing his mind. He said the blood tests would show it and then they wouldn’t. Finally I went into hospital for hydrotherapy but they took me off my medication and the pain suddenly returned.”

Support network

The pain was so bad that Joanne was on crutches and had to be medically retired from work. Eventually she got involved in a local lupus group who told her about a doctor in Manchester who specialised in the condition.

“I went to him and he said straight away that I had lupus. It’s been so much better since then. Now, I run my own business. I still get pain and fatigue and don’t know day-to-day if I will wake up in pain but I have learnt to adjust and come to terms with it.”

Joanne started her site to help other people with the condition and because she “was sat at home all day, exhausted, with nothing to do”. She says she is holding out for new drugs or a possible cure.

She may see her wish come true. There have been major advances in treating lupus in the last decade and Prof Isenberg says there will be further significant changes over the next 10 to15 years.

He hopes new drugs, new treatments and improved assessment will all help make sufferers’ lives that much easier.

Further information:

• Joanne Forshaw’s site
• Lupus UK

Published on Discovery Channel Health, 30 August 2002

For many people a bad back is part of life. A staggering 80 per cent of us will have at least one day of extreme back pain in our lives and half of all adults in the UK get it badly every year.

But just because it’s common, it doesn’t mean it’s any less miserable. Everyday tasks can become a struggle and the constant nagging makes you tetchy at best and heavily depressed at worst. No wonder then the condition is one of the main causes of days off work.

Back pain is also extremely costly. An estimated 11 million working days are lost each year, worth £5 billion. There are 1 million people in the UK officially disabled with the condition, costing £140 million in GPs time, at least £500 million in NHS bills and £250 million spent on private healthcare.

Exercising your back

The problem is that despite our increasing knowledge about the causes of bad backs, more people than ever are suffering, and at younger ages. Why? Because of our sedentary modern lifestyle. From bed to car to computer desk to car to sofa, we’re hardly exercising our backs at all.

Exercise, you see, is key. Nia Taylor, deputy chief executive of charity BackCare, is keen to press the point home. “The more fit or active you are, the less likely you are to suffer,” she says. And that also means exercising when you have a bad back.

Ms Taylor says, contrary to popular belief, spending a few days in bed if you have back pain is the worst thing to do. Chartered physiotherapist Jenny Wigram agrees, “We hope GPs have got the message that people with back pain have got to keep active – within limitations.” But, according to BackCare, a quarter of people with back pain are still advised to rest by their GPs.

Prevention

The best way of dealing with back pain is, of course, to try to avoid it in the first place. Chiropractor Tim Hutchful from the British Chiropractic Association says most people have missed the point when they complain that “the simplest thing” put their back out. “A back problem is a culmination of different factors, accrued over time,” he explains.

So rather than wait until they get a searing pain, people need to look at their posture, how they sit and how much exercise they give their back, especially if they have a job that includes repetitious tasks.

New laws will soon force employers to supply health and safety information, but many businesses still don’t fully understand back pain. Ms Taylor says, “Employers have to be more prepared to be flexible, for example have someone come in for a few hours a day after being off for back pain and then gradually increase that up to a normal day.”

Schooling can be bad for your health

Jenny Wigram and Bristol osteopath Ed Gilbert are particularly concerned about the number of children they are seeing. “We are barely stemming the flow,” Mr Gilbert says. “Back care should be made a part of the core curriculum.”

Both cite the same causes – “one-size-fits-none” school furniture, overloading thanks to removal of pupil’s desks or lockers, and the tendency to carry bags on one shoulder.

Ms Wigram says that tackling the issues when young is essential if far greater problems are to be avoided later in life. “Once you have had acute back pain, it is far more likely to occur again.” And if you’re 15 when that happens, you’ve got plenty of time for recurrences.

Keep on moving

So what should you do if you have a bad back? The answer is universal but perhaps best summed up by Tim Hutchful. “People with pain should ‘rest actively’. I know that sounds like a politician’s phrase but it means potter about, don’t sit too long, don’t stand too long.” By moving about and dealing with the pain, people also tend to focus on it less.

As for exercise, stay active, but stop if you get any pain. Jenny Wigram stresses that every person and every back problem is different. “It is important to get the right exercise, so I give every patient a set of custom exercises,” she says.

Most importantly, if you have a recurring pain, go and see someone – your GP, an osteopath, chiropractor or physiotherapist. Back problems are rarely so serious that they will need surgery, but a professional will soon pick up any warning signs. An expert will also be able to help you deal with the pain and change your lifestyle to reduce the chances of it happening again.

Painkillers or anti-inflammatory drugs may help but, if you don’t tackle the cause, the pain will be back. Tim Hutchful gives the following analogy – “Pain is the fire alarm telling you something may be wrong. It may be a false alarm, maybe not. A painkiller will turn off that alarm. Anti-inflammatories will tackle the fire. But a chiropractor, for example, will remove the kerosene.”

Further information:

• BackCare
• British Chiropractic Association