Dr Matthew Nye Halcyon Medical Three highs high

Dr Matthew Nye Halcyon Medical

� Three ‘highs’ – high blood pressure, high cholesterol and high blood sugar � NHS cancer screening programmes � What should one do when visiting a GP or hospital appointment

� Is a level consistently at or above 140/90 � 16 millions people in UK � 30% of women and 32% in men � Major risk factor for stroke, heart attack, heart failure and kidney failure � 3 x to develop heart disease and stroke � 2 x likely to die from it than normal people � 62, 000 unnecessary deaths � Most patients have no symptoms � 1/3 patients do not know they have HBP

� Most patients need to take 2 or more medications to control to target level � More than 90% patients on medication not controlled to target level � Every 10 mm. Hg rise will increase risk to 20% � 12% GP appts are for HBP

� Three measurements each time in three different occasions � If still suspect, 24 hr ambulatory BP or home monitoring � If under 45 yrs of age – need to exclude other causes for the high blood pressures � Need to have full blood tests, ECG, urine testing as well as physical examination including back of the eyes

� BP measurements � Blood tests and urine test � ECG � Medication review – all drugs will have some side effects

� Too much of fatty substance in your blood � Mainly caused by eating fatty food, not exercise enough, being overweight, smoking and drinking alcohol but also runs in families � You can lower your cholesterol by eating healthy, getting more exercise. Some people might need to take medicine � Too much cholesterol can block your blood vessels. It makes you more likely to have heart problems or a stroke

� Your GP will calculate the QRISK – risk for stroke and heart attack in 10 yrs to decide whether you should have medication � That will include BMI, diabetes screen, BP etc � In general you will start with a low fat diet for at least 3 months and repeat blood test � It is important to have the low fat diet even when put on medication

� Common side effects ( 1 in 10 patients) � - nose bleed, sore throat, runny or block nose � - headache � - nausea, constipation/diarrhoea, flatulence & indigestion � -muscle pain � - increase chance for diabetes with raised blood sugar ( but may be the disease rather due to drug)

� 1 ������- in 100 actually sick loss of appetite or weight gain insomnia peripheral neuropathy dizziness hepatitis, pancreatitis

� 1 in 1000 � Visual disturbance � Bruising � Jaundice

� CK level if raised more than 5 x – might need to stop � Rhabdomyolysis – increase risk in: � - over 70 � - liver problem � - high alcohol intake � - FH � It is rare 1. 5 in 100, 000

� Drugs such as antibiotics and antifungals � Drugs for heart rhythm � Grapefruits increases risk for side effects � Should not drink more than 14 units alcohol a week � Best to take Simvastation in the evening � Atorvastation not that much difference

� Better to measure Hg. A 1 c � Prediabetic or borderline diabetic � All patients should be on low carbohydrate diet � If borderline patient will be referred to education programme to change lifestyle and diet � Aim to prevent development of diabetes � Need to check yearly then if high despites diet then will put on Metformin

� Best to take it with meals to reduce side effects � Common side effects: � - feeling and being sick � - diarrhoea and stomach ache � - going off your food, metallic taste

� Bowel cancer � Breast cancer � Cervical cancer

� To check for bowel cancer or abnormalities that could lead to bowel cancer � Testing for blood in stools and /or internal examination with a scope � In England between 60 – 74 yrs old � Using FIT test ( faecal immunochemical test) � If that is positive, then an internal examination � For patient over 74, can request FIT test every 2 yrs by contacting 0800 707 6060

� 1 in 8 women in UK are diagnosed with breast cancer during their life time � If it is detected early, treatment is more successful � Mammography uses an X ray test to detect cancers to small to see or feel � Age 50 to 71 registered with a GP will be contacted every 3 yrs � A trial to have one extra test between 47 and 49 as well as one between 71 and 73

� You can still have screening when you are 71 or over by contacting local screening office at Birmingham Treatment Centre on 0121 507 4967 or GP � If you have a family history of breast cancer, talk to GP as you might need to have screening at earlier age with MRI scan or more frequently

� 5 main cancers in women reproductive organs � Cervical, ovarian, uterine, vaginal and vulvar � HPV is the main cause of cervical cancer � Cervical cancer mainly affects sexually active women between 30 to 45 � Early stage usually with no symptoms � But it can be vaginal bleeding during or after sex, in between periods or new bleeding after been through menopause

� Between 25 and 64 � Between 25 and 49, every 3 yrs � Between 50 and 65, every 5 yrs � HPV 16 and 18 � HPV vaccine is offered to girls between 12 to 13 since 2008

� If you do not speak English, do book interpreter or take friend � Bring ID with full name, DOB and address � Bring all the medications in original boxes and bottle � If you do not know how to check in on machine, just go to reception with a piece of paper written on the date and time of your appointment to see Dr, nurse or blood test or pharmacist, counseller etc

� Modern health care: � - you will be see by other health professionals � - you can have a telephone or video consultation � - however you can insist on face to face consultation � Every patient on medication will need to see a health professional for review

� Thank � Any you questions ?